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HomeMy WebLinkAboutTR-4994 Glenn Goldsmith, President ®F S10 Town Hall Annex A. Nicholas Krupski,Vice President ,`O� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski J Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 c4UfUTl,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 18, 2024 Robert Keller 11 Moffitt Boulevard Bay Shore, NY 11706 RE: 380 KNOLL CIRCLE, EAST MARION SCTM#: 1000-37-5-11 Dear Mr. Keller: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, July 17, 2024: RESOLVED, that the Southold Town Board of Trustees APPROVE the Administrative Amendment to Wetland Permit#4994, as issued May 26, 1999, to revise the size of the as-built deck to ±253 sq.ft; and as depicted on the site plan prepared by Ira Haspel, Architect, received on June 20, 2024, and stamped approved on July 17, 2024. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincere) Glenn Goldsmith, President Board of Trustees •J•i 'i.t. , r S 1. r�4 ti• i.• _ , •F •n'_ t (t' r.t 1 r; M1ti. •t: .t -,. ira, 'f •.f.• .. a :•S. I 't ter•: :r . .S• I r I >t' i , 1 1'r '` v i ''•'• t a ' 2. . 22 - J N 1 - - ---- -- -- o o r---- BATH j ,r•. • 2a_i- ; •-•--.+', 3' •e5,1' 7'-6�" ; 1 •`/W --J.. _ --- -_•. A '_T•r\\` , ./ EXIST. 2X6 WALL --- ---- �....� N �_- �`- `_..._- _�_.._....___..__.... I ;•y :NEW HANDRAIL As PER :.; NYS CODE' AS SELECTED EXIST. SHEATHING r.-_____-____- Gfb Z r-----__-__ + _ o RAF i Z` �-- i ..8,Y'OWNER, TYP.-', t T ---EXJST. -SIDING 1 ! i t 1 t i Ba_CO DOUR NEW 4x4 MAHOGANY ( I TC EN 'POST TYP. NEW 6x6 CCA POS�T1-----_ -___ BIIC • EXIST. w/ �'x2'xI' DP r C)OQR _ -�- ;1 " N•EW 5/4 x6" MAHOGANY LIVING Rs7OM P.C. FOOTINGS, TYP i jp DECK; TYP. tiNEW FLASHING L------------ 'r'Rr r'-1+r•,ss.-.r... '... •.a,a•L_ fir,::' . NExAr`'2x8 F3AND !�D -------------- 4. Z I c 00EXI T. F. 's , __-•_ G S rrNES+V SIMPSON' fIt , Tl'p.t NEW 2x8 ttA BAND W/ 1 EXISTING 2 '5 8" H.D: GALV. LAG 1 1 1 v F UNDATION W W• 1'0 C A � ) / _,, 0 ALL{ ) '7 CBOLTS 0 24 C.C. STAGGERED i - ° ; y�� y� •�•� .gyp @d'��7�A�V.•'�'W.L 1..�.. T,1.T• .. � t s '�' � .r +NEW SiMP50N . EGO , o 1 i A 4a: w :E XIST, �_ x 1 , EJ t - NEW S x �� ,. 4 x E 6 :t•... EXIST. P:C. FOUN AT)ON a� . E S D r U BASEMENT N MAHOGANY I '� • A T '. �L_ r WALL; TYP. At-.t N c, DECK , N tf1 x W X !£ C •=rya, 2 8 G f / r `tC .1'• ( 1- _- \ � I 'J'..Y#•. 'fir;. t :.,. •W_$'X5•CC, , POS' 'TYP: ,r , BASEMENT 1p' 6 K. y'', 'r.t v}.s.,. ,.f`; %, til s•'i i Ji yJ :S t' 'a r S r, .r:r-Y• :1 i 1` P.C. I 1ST. .0 SLAB , ;'. EX -; P=� E t t1 O T' I •'P , . TYP. JY COD E,E - I N :`. c 8 ccA =x z c x 1 z �. SIN r.• 1' 1 S•r '♦ iJ `f L c� N' N to .,a �-=.• ---� �s•.--*•-� 9r.r r T t ti i r r1 r r 14 M r t 1 "FOOTING.•r•. •'O` J P. 00 G• : ...X P.C. I i S 1 6' .0 '''C�' 6 0'C N ._ n.. N N J t -4' •'iY'• t i r' r � v ,•r .. 1 h�','r+¢4!;.+.,,/+• i. �y.a7 j, ,ti 1.'r•-. '...':4: ,-.�yV' ..::(p.2 S.:R.EBA#�':...- --,-,•.-••'..:.. -•' '- - 1: 1 , <.:} 22'-4 1 1.» s . >` .. 6 -1 1 - F . r� V , C A" JM T M. y. J YID r °'' 1�CAL,E:: 2 -1 � • ' , t , a. Y l.t WWI, 1 IDIDOPO � ry W .I� 4 E CAE .. 'r,• .. � .. ' SCALE: 1 4A_ ' _ .. FOUNDATIONN''PLAN ), SCALE: 1/4'=1:-0 4 �f: .�._...- - - --_ CAST IN PLACE CONCRETE ROUGH CARPENTRY 1. n ractor s}iall.'abtoin ail required o r ravais ermits 'certificates , .,.. .. �o t q PP , P of . 1. Provide cast-in- lace concrete includin formw rk and reinforcement, I. Ali wood to be 'in n with r i • ,: £a: ; } �,• . „ p g o . n as Contact t 'mason s to' be pressure trea#.ed 'CCA: r r fr i v r k.. •�i S' i al t f �v fr m' aen vn`o a c irjs`'ec ate o e . ere eel- o c o . ,...:. ccu n t o c. o o m e hframing ::xN •.r��<-, ' Yf P PP ,. A'.: 9 9 ,� IIi : . „ fete onsfruction shown an fhe`drawin s and. as`'s ecified herein. # tuber and dimerrsiona► lumber to .be Dau ia.� fir, with:a ;r •.required to comf; 9 P 2 A � '• -� ,r ' r3sb`iction. th reof. . J 1,r r 1 ! h A ! 1 if• i n r r r' i , ncr t f r •il miry rnum .of 0 PSI in x r i . . % , 2 Com with C 30 Sec seat o s fo St Structural o, Co e e o Bu dins 50 S e t erne' f her stress in bendin , i r' 'I.'.,, f i h i f�•it work. n' m •a�' -N.Y. •S • t Ida ,e !i I,:. 2 o tc to 8e:.doe r ::,:cb a t ° it o e .$u 'Cd ' a aca n Y t 9 y ' f r 3. All bolts, cl' n ' exce t os mods red he ein. clips, a d nails to b' hot dipped aivani2e Nail r aI: .. APP 9 . �' •Pe I . I I i eod.es .and 'Nbtiana 'Ere #rica. Code afes ` .ed lion, r 3. Pr Provide, transit-mi�c cancr.ete com I in with A5TM 'C94. Compressive stren the to N.Y. State Nailing schedule. . o P Y 9 P 9 g a d e '•.;����i' !�. fir.• - , 3. Cbntroctor`-to verif att: dirrlensions` rior :toy str[r,tin work. 'COntractor .to r. Y. P 9 be 3000 PSI at 28 days. ,r:,•, ,�G _•` t- I f fie ` riotif 'ArclaRect ir>�rriedr :te o an disc e aric ,s. Y � Y� Y• . P Provide •nf r f fi n h drawings, arid comply . . 4 P ov de rel o cement o f es shown o the d a s, o d c�ma, with ASTM 6'15; a 4. All materials e n iris r t hall' b in: tolfed i s rict 2 rrlate a s to be us, .dA a t p ojec s e. rode 40 unl e ' 9' , . ess .otherwis indicated. :.r r c n.f m'it.- With h' . ma. of r"r rec m r�+�ed s cif ti ns `for. in 11 n M41 TUBE PR T Ti• N F, o ort e actu e S. a e e a s y_ r� m p sta otio 5. Consolidate concrete in accordance* with ACI 309. G E O z; of their rboarct. Pr r h i n n free r honeycomb n f 6. ovide cone ete that s 'de se' and ee fromad other de ects. , :.. i. I h { rl' P . ,.maintain v r f r II• ire r e, ' on. s c. r i F as al o e ,n s n exterior walls. 5 Contractorshalco e age a ,a orlc s, b d , et .. os equ red 7. L>?av . slpb surfaces thot are free Pram trowel marks uniform in o earance• P g �T , PP b .•). k I i 2 Cai11 a o en n an fiat i x rwithr `' • . w 'on fi o.w r. .- s d 'o s n e to i,r Tr b la d b the' -owner. .. emco 'f�on color V v P 9 14 F/ J J .J •r� 1 it.h 'rf l n� I ra c x i i 8 in U'U when teste with :�•:�:-:'1•' w a ��U ace a e� toe n e not e ceed n 1 d a .:�. ,... t . t:.. r h 1 '1 f r :•i: ii' 1• 'r. directed). r1t a r i 1 n u` s s u re' e i 6 -The •co c or�:s a d r a +A a e•� o.• cud to t ax e.:.a s e d d.'t n u Y _ 9 9 I,,, ' r. o d 'con �� rie d::•-" 1 .n`s� �t e'co•� st c ion es a lac e a n a r' so t u t n s n. #o a:� e n 1 L A P � .; I for n �n i f. =t footings rn aim m O P r 'v Y`rr:::•`8 .Concrete o s abs 'and. oot s to be a u `o ..UO S corn essl e site. T r r f r 4 F r t h t ern r `i 5 es r f r s a t 28 t e s to be 'degrees c 5 'days n �e •J e a da e o u pour. , 9 9. days. Y i t 7 t`1 r r 1 •r• _ "in i m• n �C� shall 'i rnori•t o rn ze ;d. .. {; t acto s .s a •exe c see� "tad: e 't a o :ad'ace t' •, ,t , .i•40 or submit fans for otect n c nc ere. P n 1 ,r o ert e� A real dorrib ed duo4 ne co struct o a t be esto e� to . 9. i` r 1 I P r �h n min TM x -1 xl �i 9. lace w e es co fo to AS A 85 6 6 0 d a e� 6 5 d_ and ends m r' ':kt• T .1. THE FOLLOWING P'E PLANS ANDSPECIFIC'ATt I H •m the r on final :*ron'di'ti,Qia: - ONE 0 THE BEST OF I t. � 7' secure tied together.Y 9 /, i .`. a' u 'soil 1 YY.N 'I M D., N PROFESSIONAL 0 LE E F E B L E A D, M JUDGEMENT :..ARE 1:JL G A "�EE E II' i• . '.i _'f i lv � h: li � _�. fi l n' ,8. Each 'trn �l i sar' th e t t e to t' ese n�c de �sho a tze: ern�se s� � o -t a s a d P .. 1` Place concrete n undisturbed d soil vlrith 4 porous fill, or compacted d s .I , P P /1 COMPLIANCE' WITH TH N. . CONSERVATION VAT 4a E CO S, R tON CONSTRUCTION CODE, ca�irdirlcite tlleir work` ilfi .other trodes.. E, �r_v with 4 porous fill. Fii! excess cuts •with concrete_ Re rove foi+ei n matter •:,• ' •��`':' #' a' 9PREVENTIONr r i A'VO TH N.Y. . l�•F P, � N.Y.S. U 0 M FIRE ,RE &' J LDING COa �-) ..T:. 9 . If, `in the rse f cn :. \tion nditio ex'sts .:which •d'- a r.ee• -with that , : EI ' :F• . . . .. , , OI1 4 a st uc , .0 ivn ►�• � is g s t �and avoid segregation as much as possible. shall hc,v, •o minimum -of T . I TI N iF'• n R n h n` # T t 1 's an t1 I ti h i � EDI TION. , o d ca�f'e #tr s # e` co tr sat' to of e. •a c c,' ..,.• � ,� ,, s . d o e �'}i� ,- 00 0 ,(iaJ v .t to t. , 4 0 cover. ka t . a.. 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TAX No SCE DECEN ' •D MARCH 1, 1999 ADDED COMMENTS DE I7 JUN � O ry AREA d � '� (TO TE LINE TOM 1-110. • t L� y I , / •' V 1 •� � � of i i o• .. L v �� LN n0 (' 1, I I I I r o� • a"� F� •0 QT N \ \ �� I 1 i �I `k00 h C� nl j Cw7• ` 1 1 IN100 7o0.� o N• >� I I i 1 P V 4, b ff 4�v Y � Q•o er" I I / Y�c`^• °�v . ?' �r ''o CERTIFIED TO: FIRST AMERICAI �1,1. •' \�r'o�, OF NEW YOF , ROBERT KELLEF wExrD �W�i � y BARBARA KELLI I.INC.ON FEB.1, ID90 II �6 Aso G \ 'J A PRESTAPARED IFOR 1aT O DS %?"`X/ :: O �47. v �\�w FOR SU I i0 H USE • �k 1 TOLE ASSOCant cn — W (T1 CC) 'T � �' J \ Ca F r3 q �o RF . \s Joseph \� TO THIS SURVEY ALTERATION ORN ADDITION Land TO THIS SURVEY IS A VIOLATION OF SECTICH 7209 OF TIE NEW YORK STATE EDUCATION LAW. APPARE)tf LOW wAif71 MARK COPIES OF THIS SURVEY MAP NOT GEARINC AS PER SUFTTILK EfMIrtOtIMEI 9go THE LAND SURVEYOR'S INKED SEAL OR CONSULTING.INC. ON FEB•2, 19Y0 EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VAUD TRUE COPY. Title Surveys — Subdiviaior CERTIFICATIONS INDICATED HEREON SHALL RUN PHONE (516)727-2090 ONLY TO THE PERSON FOR WHOM T11E SURVEY IS PREPARED,AND ON HIS DEHALF TO THE TITLE COMPANY, GaVERNMENTAL AGENCY AND OFFICES LOWED AT THE EXISTENCE OF RIGHTS OF WAY LENDING INSTIIUTION LISTED HEREON,AND AND/OR EASEMENTS OF RECORD, IF TO THE ASSIGNEES OF THE LENDING INST1- One Union Squore ANY, NOT SHOWN ARE NOT GUARANTEED. TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. Aquebogue, New York 11931 Glenn Goldsmith,President Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 Eric Sepenoski o ,? P.O. Box 1179 Liz Gillooly y ��� Southold,NY 11971 Elizabeth Peeples ��iol ��"� Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: Completed in field by: C ���- ROBERT KELLER requests an Administrative Amendment to Wetland Permit#4994, as issued May 26, 1999, to revise the size of the as-built deck to ±253 sq.ft. Located: 380 Knoll Circle, East Marion. SCTM# 1000-37-5-11 Ty pof area to be impacted: v Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: Chapt. 275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: Present Were: G. Goldsmith N. Krupski E Sepenoski L. Gillooly E. Peeples 1 11 Moffitt Boulevard Bay Shore, NY 11706 (516) 639-9811 June 19, 2024 ® EC E E Board of Trustees JUN 2 0 20 44 TOWN OF SOUTHOLD Town Hall 53095 Route 25 Board of Trustees PO Box 1179 Southold, NY 11971 RE: 380 Knoll Circle, East Marion, NY 11939 To whom it may concern: I need to modify Permit #4994 to correct the size and shape modification making deck smaller approximately 253 square feet. Scope of new work I would like to perform would be to replace old wood decking and railing with new wood decking and railing. I give permission for the Trustees to come on my property for this application. Other information: Robert Keller Mailing Address: 11 Moffitt Boulevard, Bay Shore, NY 11706 Phone: (516) 639-9811 Very truly yours, Robert D. Keller RDK:sg (2� Enclosures �.,�e�7�. ,.��� •� ��- rl _y....n_ fit:... - �' '.. k. �i3; ga. v': +.' \ �k fl• :;�.F• . ,. '�`�' :4��. �r� �Y .:�/i. � fit•. ! - y,.�.� �\ -�`+'i' �! +.�r• AYE�� �/1�'. � � .r :-elL._ _ �.,_..� -.R •—:s+�jF , Board Of Southold Town, Trustees , ' SOUTHOLD, NEW YORK F `. PERMIT NO. 9 -9 L� DATE: Maur. 2.6, ..1.9..9.9 ROBE ........................................ ISSUED TO ............................RT...KELLER.................... ........... Y !y l `` �M • ' Pursuant to the provisions of Chapter 615 of the Laws of ; R + ! V.• . the State of New York, 1893; and Chapter 404 of the Laws of the .< State of New York 1952; and the Southold Town Ordinance en- " titled •"REC ULATING AND THE PLACING OF OBSTRUCTIONS �.. IN AND ON TOWN WATERS AND PUBLIC LANDS. and they REMOVAL OF SAND, GRAVEL-OR OTHER MATERIALS FROM h LANDS UNDER TOWN WATERS;`'. and in accordance with the Resolution of The Board adopted at a meeting held on ...MAY...24,-_.,1999 19..99...., and in consideration of the sum of $.....1.5.9.�.�.� ....... paid by E Suffolk..,Environ.. .ntal...Consultin.g....for...R O.B.ERT...KELLER ►� ...... N. Y. and subject to the . of ........Cutchogue............................................. .I - Terms and Conditions listed on the reverse side hereof, >i , mw of Southold Town Trustees authorizes and permits the following: Wetland Permit to construct a 490+s.f. deck with attached stair �! 1 x' �4j and to clean up the debris in the area and not re-vegetate. all in accordance with the detailed specifications as presented in c the originating application. ` IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. .t ......... ................ in rKS ................................. T tees 5 Town Hall Albert J.Krupski,President �� �✓� 53095 Main Road James King,Vice-President P.O.Box 1179 Henry Smith Southold,New York 11971 Artie Foster �® ® Telephone(516) 765-1892 Ken Poliwoda ��f®1 ®� Fax(516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 27 , 1999 Suffolk Environmental Consulting Inc . Bruce' Anderson _ P .O. Box' 2003" Bridgehampton NY 11932 Re: ROBERT KELLER SCTM #37-5-11 Dear Mr. Anderson, The following action was taken by the Board of Town Trustees during a Regular Meeting, held on May 26, 1999 , regarding the above matter: WHEREAS, ROBERT KELLER„ applied to the Southold Town Trustees for a permit -under the provisions of the Wetland Ordinance of the Town of Southold, application dated March 22 , 1998 and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations , and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on May 26 , 1999, at which time all interested persons were given an opportunity to be heard; and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standard set forth in Chapter 97-18 of the Southold Town Code, WHEREAS, the Board has determined that the project as -proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approves the application of ROBERT KELLER to construct a 480+ s . f . deck with attached stairs and to clean up the debris in the area and not re-vegetate. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency which may also have an application pending for the same or similar project. Permit' to construct and complete project will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. FEES: None Very truly yours, Albert J. rupski, Jr. President, Board of Trustees AJK/djh cc . 'DEC Dept. of State -AeE • Town Hall, 53095 Main Road 0 P.O. Box 1179 Telephone O Southold, New York 11971 (516) 765-1892 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Thursday, April 15, 1999 the following recommendation was made: Moved by Scott Hilary, seconded by Richard Smith, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Permit Application of-ROBERT:KEI;I,ER'375=11'.to construct a 480 s.f. deck with attached stairs and to recommend DISAPPROVAL of the application to re-vegetate 330 s.f of shoreline in native wetland shrubs. 380 Knoll Circle, East Marion The CAC recommends Disapproval of the re-vegetation because an adequate planting plan was needed stating what types of plants were going to be used and who would be responsible for planting them. Vote of Council: Ayes: All Motion Carried Suffolk Environmental Consulting, Inc. Newman Village,Main Street, P.O.Box 2003, Bridgehampton,New York 11932-2003 (516) 537-5160 Fax: (516) 537-5198 Bruce Anderson,M.S.,President March 18, 1999 Q Q Mr. Albert Krupski, President MAR 2 21999 Southold Board of Trustees P.O. Box 1179 Southold, NY 11971 Re: Robert Keller Situate: 3 80 Knoll Circle, East Marion SCTM# 1000-37-5-11 MAR 2 21999 --.. . Dear Mr. Kru ski OF SOII-fHnLf, ,' Enclosed herewith please find a complete application for the property referenced above. Contents include: Three copies of the Trustee Application for wetlands permit together with four copies of the survey prepared by Joseph A. Ingegno dated December 31, 1998, and a check made payable to the Town of Southold in the amount of$150.00. Kindly commence your processing of this application. Contact this office to let us know when subject application will be heard. incerely, .,W Bruce A. Anderson BAA:mis enc. cc: R. Keller 1.Agency 2 Dn/Precinct 1 3.ORI 4. prig Incident 5.Case No. ncide No. RP 4 J) E6 k-O' ,0ORT'.I NY El 1upp 05- S4/3.2 z I 7.ReportDay 8.Date 9.Report Time Occurred12.Time 10.0dy 1.Date Occu,r",icl 13.Day ].14.Datel 15.Time AV- 16.Incident T pe 17.Business Name 18.Weapon(s) ZA rw? Po L A.- Q 19.Incident Address(Street No.,Stree Name.Bldg No Apt.No.) 20.City,State zW El c C] T El v) 2 1.Location Code i��';0 s7a-5*,q,., 8. \1 3-0 c,�ar_ M^,� A.01 ATT 0 TENSE_, 23.No.of Victims C. 24. No.of Suspects D 3 n" i ' �LVict 7, he'�.,Pl'='Per's�onln Person Type:CO_C i!rn,, ` r 26.Victim also complainant C]Y C]N Reporpng k= tne E. TYPE/NO, NAME(LAST, IPPLE,TITLE), .'Pateof, STREET NO.,STREET NAME,BLDG:NO.,'APT.:NO,.CITY, STATE.'ZIP z Ti(ephone No. o La" co-1 F f ri-pi :3--)o ,/A_Po LL C e- E q 4-., o tjO , G. uj H. 'cES;GENCF. 1A 'M 27.Date of Birth 29.Age 029.Se 30.Race 3I.EthnicT[332-Handicap 33.Residence Status ❑Temp.Res.-Foreign Nat. x 0 H M [] F C1 White[I Black C] Other spanic❑ Unk. 0 e Resident (]Tourist[]Student Other Mo. I 1 0 U [I Indian[]Asian[] ❑Unk. 0 Non-Hispanic 0 Commuter C]Homeless❑Unk 1. J� I No H Military 4 XTY714. 35.Name(Last,First,Middle) 36.Alias/Nickname/Maiden Name(Last,First,Middle) 37.Apparent Condition Impaired Drugs [I Mental Dis .Unk K. 0 TA 3 ❑Impaired Alco 0 Inj/III[]App Norm M uJ 38.Address(Street No.,Street Name,Bldg.No.,Apt.No.,City,State,Zip) 39.Phone No. 40.Social Security No. C] Home L. FO C] Work 41.Date of Birth 42.Age 43.Sex 44.Race 45.Ethnic Occupation 1 ".1 in 47. 4A cue, MO 0 C1 M C1 F El White Black El other 0 Hispanic E] Unk. C] ft.ght J]Dark C]Unk. M. :3 Cr ❑ U [I Indian[j Asian E] Unk. C1 Non-Hispanic E]Medium Ej Other NQ 48.Height 49.Weight 50.Hair 51.Eyes 52.Glasses 53.Build 54.Employer/School 55.Address 11 C 0 Yes 0 Contacts E]Small C]Large N. C]No Ej Medium to 56.Scars/Marks[Tattoos(Describe) 57.Misc. 59.vjctimorl: ,'Property, y Propert ''Quantity! .,'Makedr I -Orug Tyl:ie Model Descriptionvllue� E2 Suspect No. Status,• Type Measure Serial No.; [3j cc 4 Uj 59.Vehicle 60.License Plate No Full El 61.State 62.Exp.Yr. 63.Plate Type ❑64.Value 0. Status 0 A V, Partial C] 5 LOU cc. 1: CL .-J 65.Veh.Yr. 66.Make 67 model 68. ye 69.VIN. 70.Color(s) F Towed By: 72.Vehicle Notes To: 8 73. 73 on -L q CA4-<-,Z `-4 a to F -OrH r3u L,0_ IK--R V: ❑ 0 a ij L i.4 iie- n-c-b 13-1� C AA n12 Z, 13 I oral ue' 74.Inquiries(Check all that apply) 75.NYSPIN Message No. 76.Complainant Signature > DMV 0 Want/Warrant 0 Scofflaw Crim.History [I Stolen Property ❑other F-: 77.Reporting Officer Signature(include Rank) 78 ID No 79.Supervisor's Signature(include Rank) 80.ID No. Z, %n T5. 84. Fag 81.Status E]Open C]CIOYed(If Closed,check x below) C]Unfounded 82.Status Date 83.Notified/TOT of ❑Vict.Refused to Coop. ❑Arrest C]Pros.Declined E]Warrant Advised CHI 0 Juv.-No Custody Arrest-juv. El Offender❑ Dead []Extrad.Declin []Unknown Pages DCJS-3205 (2/97) *FALSE STATEMENTS ARE PUNISHABLE AS CRIME-PURSUANT TO THE NEW YORK STATF PFNAI IAW MEMORANDUM To: Building, Planning an rustee epartments From: Zoning Appeals Department Date: December 15, 2000 Re: Attached Letter Re: Property of Robert &Barbara Keller The attached letter from Joan Egan was left with Ms. Cybulski for all Departments regarding a possible application pending, now or in the past. The Zoning Appeals Department does not have an application, in'the past or pending, for this project, and therefore are forwarding it on(to other Town Departments). Ms. Egan's letter mentions property of Robert and Barbara Keller at 380 Knoll Circle, (Spring Pond area), East Marion, and apparently Ms. Egan is of the position that plans are/were considered without her knowledge (as a neighbor). If you have an application pending or of record, you may want to review her letter and possibly reply. Thank you. cc: Town Clerk's Office `4J DEC 15 2000 ZBA Members _ ~ 0.1f "c I /z,, f� iI � 'J' r1a lir f➢: ' DEC' 1 5 2000 �cSO 1741PH was /9 ev�� Soo 11? t I 1( ! � f DEC 1 4 2000 H? BAY' IEW DRIVE NOTES: SURVEY OF 1 . ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM LOTS 25 & 26 EXISTING ELEVATIONS ARE SHOWN THUS:-5- MAP OF EXISTING CONTOUR LINES ARE SHOWN THUS: — — — — —s— — — — F.FL. - FIRST FLOOR GARDINER'�S+ BAY ESTATES G.FL. - GARAGE FLOOR SECTION TWO FILE No. 275 FILED SEPTEMBER 23, 1927 SITUATED AT EAST MARION TOWN OF ,. SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-37-05- 1 1 1ti SCALE 1 "=20' o DECEMBER 31 , 1998 i p - FEBRUARY 10. 1999 ADDED WETLANDS AS FLAGGED do LATH PROP. DECK CORNERS MARCH 1, 1999 ADDED COMMENTS PER SUFFOLK ENVIRONMENTAL CONSULTING, INC. 106 AREA = 11 ,574.20 sq. ft. (TO TIE LINE) 0.266 aC. 0 . O D ^ ,yam I I I iGib ' .. oc� , jo �,� �_� •° P `: o \ �. ;•. , D Z o ►ti m CA� Goy'\ I 1 ILAoQT •'• o�� �AILO � ` Y lLSJ o =al m� j MAR 2 2 1999 u ..�.�1 8 ,TT�� : :::: 11 I II 1 °° TOWN OF SOU T HOLD CERTIFIED TO: 4, FIRST AMERICAN TITLE INSURANCE COMPANY �`V�4'o`'�F"�. oOF NEW YORK —� a• ,� o C& ROBERT KELLER aPPAENT Low WATER MARK �)2 y�, BARBARA KELLER AS pER SUFFOLK ENVIRONMENTAL I�SacbpJ FEB.INC. ON 2, 1999 CONSULTING, PREPARED IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS AS ESTABLISHED QgQ BY THE L.IA.L.S. AND APPROVED AND ADOPTED N O .21 , o �00Y. \� \\3 e \ 0 v �� FOR SASSOCIATION.UCH USE THE NEW YORK STATE LAND W Ul � \ `Lp \ O AN° Z°o\ \\ ob -9 �' �p 1 D S, �Oc \ \ \yScZ 5• �. 5�pK A.IN, LK% O 0 $4 ^ ' yc 04 \ \ i \ \ Q O N N.Y.S. Lic. No. 49668 . 0,ON \ CPS \ ,►� Joseph A. Ingegno \11) TH ALTERATION ADDITION Land Surveyor � TOO THISIS SURVEY VEY IS A VIOLATION ION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. AppARENT LOW WATER WRK COPIES OF THIS SURVEY MAP NOT BEARING AS pER SUFFOLK ENVIRONMENTAL THE LAND SURVEYOR'S INKED SEAL OR CONSULTING, INC. ON FEB. 2, 1999 EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY.TO Surveys - Subdivisions - Site Plans - Construction Layout \ CERTIFICATIONS INDICATED HEREON SHALL RUN PHONE (516)727-2090 Fax (516)722-5093 ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND OFFICES LOCATED AT MAILING ADDRESS THE EXISTENCE OF RIGHTS OF WAY LENDING INSTITUTION LISTED HEREON, AND One Union Square P.O. Box 1931 AND/OR EASEMENTS OF RECORD, IF TO THE ASSIGNEES OF THE LENDING INSTIL q ANY, NOT SHOWN ARE NOT GUARANTEED. TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. Aquebogue, New York 11931 Riverhead, New York 11901 Albert J. Krupski, President Town Hall John Holzapfel,Vice President 53095 Main Road Jim King P. O. Box 1179 Martin H. Garrell Southold,New York 11971 Peter Wenczel Telephone(516) 765-1892 Fax(516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use only Coastal Erosion Permit Application Wetland Permit Application Grandfather Permit Application Waiver/Amendment/Changes 0 Received Application:4499199. ✓ i Received Fee: $ / Completed Application MAR 221999 Incomplete SEQRA Classificatio Type I Type II Unlisted Coordination: (date sent) ;11 '� I i/ CAC Referral Sent: 3 a q9' u - ,ZDate of Inspection: / Receipt of CAC Report: 0221999 Lead Agency Determination: Technical Review: "�� E Public Hearing Held: .1-/ g TOWN OF SOU"I `HO. Resolution: Name of Applicant Robert Keller Address 11 Moffitt Blvd Bay Shore NY 11706 Phone Number (516) 666-0200 Suffolk County Tax Map Number: 1000-37- 5 - 11 Property Location: 380 Knoll Circle East Marion,NY 225'+s/o BMiew Drive (provide LILCO Pole #, distance to cross streets, and location) AGENT: Suffolk Environmental Consulting, Inc. Address : P.O. Box 2003 Bridgehampton,NY 11932 Phone Number (516) 537-5160 Fax: #(516) 537-5198 1 Board of Trustees Application GENERAL DATA Land Area ( in square feet) 1,1,574 Area Zoning: R-40 Previous use of property: Residential Intended use of property: Residential Prior permits/approvals for site improvements : Agency Date X No prior permits/approvals for site improvements . Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description (use attachments if necessary) Applicant proposes to construct a 480+s f deck with attached stairs and to reve eg tate 330±s.f of shoreline in native wetlands shrubs. 2 Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations : Private residential. Area of wetlands on lot: 666 square feet Percent coverage of lot:- 11% existing 16%proposed o Closest distance between nearest existing structure and upland edge of wetlands : 0 feet Closest distance between nearest. proposed structure and upland edge of wetlands : 26.5 feet Does the project involve excavation or filling: X No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations : N/A Manner in which material will be removed or deposited: N/A Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate) : No impact to wetlands anticipated as proposed deck is to be installed over lawn area landward of an existing bulkhead. 3 Board of Trustees Application COASTAL EROSION APPLICATION DATA NIA Purpose of Proposed Activity: Are wetlands present within 75 feet of the proposed activity? No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from the implementation of the project as proposed. (Use attachments if necessary) 4 NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: Robert Keller S C TM# 10 0 0-3 7-5-11 YOU ARE HEREBY GIVEN NOTICE: 1 . That is the intention of the undersigned to request a Permit from the Board of Trustees to: Construct a 480+square foot deck with attached stairs and to revegetate a 330±square foot area of shoreline with native wetlands shrubs. 2 . That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows : 380 Knoll Circle-, East Marion New York 3 . That the project which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment. You may contact the Trustees Office at 765-1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: Bruce A. Anderson, Agent MAILING ADDRESS: Suffolk Environmental Consulting, Inc P.O. Box 2003 Bridgehampton NY 11932 PHONE # (516) 537-5160 Enc. : Copy of sketch or plan showing proposal for your convenience. 5 ATTACH CERTIFIED MAIL RECEIPTS-- Name: Address : Joan Eagan P.O. Box 777 Knoll Circle East Marion,NY 11939 Barton C. Johnson 29 Oslaleta Rd. P.O. Box 175, South Salem_NY 10590-0175 1 Z 043 435 998 gj`C!rV— US Postal Service ff- Receipt for Certified Mail No Insurance coverage Provided. Do not use for International Mail See reverse sent to ' 0 L J� Street&Number — 043 435 997 US Postal Service STATE OF NEW YORK Receipt for Certified Mail COUNTY OF NEW YORK No Insurance Coverage Provided. Do not use for International Mail See reverse Sentt Bruce A. Anderson, residingat Suffolk Environmental Consult O "� Street&Number Village,Main St. Brid e am ton NY being dully sworn de o aou that on the day of � 19 , depone� Post OHice,state,&ZIP 1DA y i = S-r- RR'D" N� «g3P copy of the Notice set for h in the Board of Tr postage $ Application, directed to each of the above name. addresses set opposite their respective names; 1 Certified Fee / addresses set opposite the names of said person, Special Delivery Fee address of said persons as shown on the current of the Town of Southold; that said Notices were Ln Rest,;dedDeliveryFee that sa. rn ReturnReceip(AQq og'y United States Post Office at , d F � � Whom,_D"ate�6�livere mailed to each of said persons by (c rtifi d) (] .a Rete ece. . to mail . a Dafe�a nMr�ea�s aamess 0 TaOTJW.A�-�gey&8 es�q(( 2 € pdstmark� Datr; e , �� Sworn to before me is / Cl) day qrf 9 - ----------- MARTH 10TARYPUB[C STATE AST OF NEW Notary Public � ilig COMMISSION SwIRES SEPTEMBER �t 2 6 Board of Trustees Application County of Suffolk ) State of New York ) Bruce A. Anderson BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT (S) , IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT (S) OR REPRESENTATIVE (S) , TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. &79igMature SWORN BEFORE ME THIS DAY OF ) -19_ V H DNA Notary Public � p!/B(� �•sHEE j%,V NO lsys 13 o WN �y SSEPTEM��R� Ulpk Q 0 MAR 2 2 1999 s 7 Board of Trustees Application AUTHORIZATION (where applicant is not the owner) I, Robert Keller residing at 11 Moffitt Blvd, Bayshore, do hereby authorize Suffolk Environmental Consulting, Inc. to apply for (Agent) permit (s) from the Southold Board of Trustees on my behalf. • I._ex . ss— :Ydriati re -' 8 PART ll--N'IInC?1h"Eili;;' ,- ESSN1ENT i -0 be CorncieteC ,-,y ,Agenc' i .. JCES ACT:CN -:i =-0 ^ �� -. cSHGLD 'rl t C=r, ?�Ei 7:i..-. it yes. =crainate :ne review ;rccess ana usa me =LL_ =A i_'!es NO ?- 'P11LL ACT!CN AECE:V E ZC-_P.CINATcD ?E7•1lEIN AS.RiOVICEG =CR UNL,STEC ACTiCNS:N 5 NYC.=Ft, ?AnT ,t i.j? if.;0, a neyat:ve _ec:ar_ may oe suoerseaec ay anctner;nvolvea agency. C. C ULO ACTICN R SUL-:N ANY ADVERSE ===cO S ASSGC:AT=:) N17H ^E r'OLL--'+'IING.,Answers may _e nenc•.,irmen. it ,egi lei ^ CL Existing air ouality, surraca or'grounowater auality or :uantity, noise levels, existing :ratfic patterns, solid :paste orccucnon or also_ pottteenttiai !!or erosion, drainage or!locoing proclems? E.-Main Srieily: Y v " _ e C1 Aesthetic, agricultural, arcnaeoicgical, hisiorjc, or other natural or cutiural .eseurcas: or cammunity or neignoornCad cn aractar? =Xclain 7 A) v '(egetation ar fauna, '!sn, snelifisn or wiielife scecies, significant nacitats,or *,nreatened or encangerea :cec:es? Exclain orlaily: C». A community's existing plans cr goals as officially aeooted,or a change in use or intensity of use of!and or other natural resources?Explain a: fV 0 CS, Growtn, suoseauent :evelooment.or retatea activities likely to --e inducea oy the afocosea action? Exolain onefiv. iC5. Long :arm, snort term, cumuiative,or other eifecs not identifiea in C.-CS? =xotain aneily. I � ..,. Ctner impacts iinc:ucing c^anges in use of either quantity -or type or energy)? =.:otatn rteily. I 7HE.=.E, --R :S _:Kc_' 70 BE. ,_CilTRGVE^SY ?.E:ATc7 TC ?CT=_NTIAL ACVE?SE =i4v[RCWAENTAL P4CTS? es %"lo !f Yes, exclain orietly PART III—OEi cRMINATION OF SIGNIFICANCE (To be conoleted by Agency) INSTRUCTIONS. =or each adverse effect identified above.determine whether it is substantial,large,important or ottterNise signific. =ac:t effect should be assessed in connection with its (a) setting (i.e. urban or rurai); (b)':probacility of occ,^, itrlg; Cc) duration: irreversibility; (e) geogracnic occee: and (f) magnitude- If necessary, add attachments or reference supporting materials. Ensure excianaticns contain sufficient detail to snow that all relevant adverse impacts have been identified and adequately addressec. Check ;his bCx if you have identified one or more Potentially large or significant adverse Imoac:s INhicn '.1.V _ v occur. Then proceed directly 'o the r- _A anclor prepare a positive declaration. i Check this box if you have determined, based on the information and analysis above and any supporting documentation. :hat the proposed action 'NIL! NOT result in-.:.-7rly significant adverse environmental impact AND provice cn attacnments as necassarV, the reasons supporting this determination: S v y 7 y z wi'Y r/e.�L N-ne ni _c.,u .agency ci(/(w/),eom.aie ..tiicer .n _sac.{ScnCi / :Mr of :L e: onsjoie Uincer �I 0 .griatute Or -(e5 nHO1e--inner�n :pia'Agency )f .'re7.lrer tlr ::IiSer+nt :(OT rBSOOn5101,.•JiiIC2r1 Cl- / ��te 14.16-4(9195)-Text 12 617.20 ,- . S E Q R PROJECT I.D.NUMBER Appendix C' State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT-FORM For UNLISTED ACTIONS Only PART 1-PROJECT INFORMATION' (To be com leted by Applicant or Project s p onsor 1. APPLICANT/SPONSOR 2. PROJECT.NAME Suffolk Environmental Consulting,Inc. KELLER 3. PROJECT LOCATION: Municipality Southold County Suffolk 4. PRECISE LOCATION (Street address and road intersections,prominent landmarks,etc.or provide map) 380 Knoll Circle,East Marion,New York . 5. IS PROPOSED ACTION: ® New ❑ Expansion ' ❑ Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: Construct a 484 square foot attached deck and plant 330±square feet wetlands vegetation within designated wetlands area. 7. AMOUNT OF LAND EFFECTED: Initially 0.018 acres ,Ultimately 0.018 acres. 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ® Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ®Residential ❑Industrial ❑Commercial ❑A"griculture ❑ParklForest/Open space ❑Other Describe: Single family dwellings. `10. DOES ACTION INVOLVE'A PERMIT APPROVAL,OR FUNDING,.NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENT AGENCY(FEDERAL,STATE OR LOCAL)? " ®Yes , ❑No If yes,list agency(s)and permit/approvals Southold Town Trustees Permit; Southold Town ZBA Zoning Relief. 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes ® No If yes,list agency(s)and permit/approvals 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑Yes ® No I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/spon ame:..Bruc . An so Suffolk Environmental Consulting,Inc. Date: 03/18/99 S' nature' ` If the action is in the Coastal Area, and you are a state agency,complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II-ENVIRONMENTAL ASSESSMENT To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.12? If yes,coordinate the review process and use the FULL EAF. ❑Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No, a negative declaration may be superseded by another involved agency. ❑Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED,WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality,surface or groundwater quality,noise levels,existing traffic patterns,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archeological,historical or other natural or cultural resources;-or community or neighborhood character? Explain briefly: C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitat,or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted,or change in use or intensity of use of land or natural resources? Explain briefly: C5. Growth,subsequent development,or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term,short term,cumulative,or other effects not identified.in C1-05? Explain briefly: C7. Other impacts(including changes in use of either quantity or type of energy)? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? ❑Yes []No D.. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes ❑No If yes,explain briefly PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important,or otherwise significant. Each effect should be assessed in connection with its(a)setting(i.e.urban or rural); (b)probability of occurring; (c)duration; (d)irreversibility; (e) geographic scope; and(f)magnitude. If necessary,add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed.If question D of Part II was checked yes, the determination and significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. - ❑ Check this box if you have determined,based on the information and analysis above and any supporting documentation,that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary,the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different From responsible officer) Date 2 O�QSVFF04COG Town Hall Albert J.Krupski,President ti� y 53095 Main Road James King,Vice-President o < P.O.Box 1179 Henry Smith y = Southold,New York 11971 Artie Foster O Ken Poliwoda y� �� Telephone(516) 765-18q2 Q! �a Fax(516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- In the Matter of the Application of _ -------------- COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING SUFFOLK ENVIRONMENTAL CONSULTING,PC amae kN%0e713ZJ residing at P.O.BOX 2003 being duly sworn, depose and say: That on the jg' day o li o; 199?- , I personally posted the property known as cuff by placing the Board 'of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for seven days prior to the date of the Q public hearing. (date of hearing noted thereon to be heldd1lQq"` on or Dated: 0gnatiqre)_ ' Sworn to before me this �(0 day of A4tj 1999 MARTHA L.SHEEHAN ci 2 LIC,STATE OF NEW YORK o ary Public N No.OISH6013878 COMMISSION EXPIRES SEPTEMBER 28,20 2_ �V� APPLICANT TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of the town officers and employees The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: Robert Keller Last name, first name, middle initial,unless you are.applying in the name-of someone else of other entity, such as a company. If so, indicate the other person's or-company's-name- NATURE OF APPLICATION: (Check all that apply.) Tax grievance Variance- X Change of zone Approval of plat Exemption-from-plat or official map Other X (If"Other,"name the activity.) Trustee Wetlands Permit Do you personally (or through your company, spouse, sibling, parent, or child)have a relationship-with any-officer-or-employee-of the-Town-ofSouthold? `Relationship" includes by blood, marriage, or business interest. `Business interest"means a business, including-a partnership, in which,the town officer or employee-has evenn-a partial ownership of(or employment by) a corporation in which the town officer or employee owns more than 5% of the-shares: YES NO X If you answered"YES," complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describer the-relationshipbetween..yourself(the applicant) and the town officer or employee. Either check to appropriate line A)-through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply):-- the owner of greater then 5% of the shares of the corporate stock of the applicant(when the applicant is a corporation); B)the-legat or beneficial owner of any interest in..a,noncorporate entity(when the applicant is not a-corporation); C) an officer, director, partner, or employee of the applicant; or D)the actual"applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of 199 r —igi}ature Print name Robert Keller !9'y i O 'A/�• �•M1/ A� C1' • i'/ `. % ' \' 'd' ' ,O� ^eOr r O ______ a BAYV1�� • ri ® ?. `�� 6 \\\``z —-AT— I I A 1d d �r� • r / t6 I• �` A t � � 7.7 yr ti BAYVIEN .�.°, ^A °'. / +r .� " °' •h,7,e m .? r , ' e r ~ LWO k • B� m� a '' � I vn 0 1 �' sciar� l ♦• •'+ to q Spr7� Pura lyu /.\ uf. IfU % 0 4 1.7 f ORIENT ARBOR '• a9 a � 6 t: SEE SM M 02 i5 IS P� i r I w •ts. sse.a•Im m ® tr — — se."m.er u. --sor— .»..a«er u.-- -- as wu an�nsr, 1 `—et Is K mt m 6 SECTION NO .ARE .R.rw"" T"E OLLO WO OCl7, NOTICE © COUNTY OF SUFFOLK SOUTHULD w..�.,o.. —�_ s,m"�.,anus,• f217 �,�, O m turrcr u. --r-- M,..o,mn Ir. --a-- ram sl.w ..n E WKEWILE.ILTEMIG{SLLEOS Real Property Tax Service Agency Y ,IW ,,,a„r,,,, __— --o-- 1 vwlox of Tic Counter Center r Riverhead,N Y 1�901 6 037 AerlM1i WOwrr lu Y1P 6 GlmmliEo if al0 2J = Ml At.or 1211 ten lb O.IM u> bu•ar.O.VtI to—.n-- YS1fl.iW tRlQlr'mm PEWGSmr K ilE A