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HomeMy WebLinkAboutTR-5870 Board Of Southold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. ISSUED TO . 5870 DATE:~eb. 25, 2004 RICHARD DIBLASI Aut11orÜ!utiott Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893: and Chapter 404 of the laws of the State of New York 1952: and the Southord Town Ordinance en- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the Resolution of The Board adopted at a meeting held on . Fe.!:>.. .25,.. 2004 , and in consideration of the sum of $ 200,()0 . paid by Richard DiBlasi of East Marion N. Y. and subject to the Terms and Conditions listed on the reverse lide hereof, W of Southol~ Town Trustees authorizes and permits the foUowing: etland PermIt to add a one-story room on the existing deck, 6'X 12', with the condition dryweIls and gutters are installed to contain the roof run-off; and as depicted on the plan prepared by Warren A. Sambach Sr. last dated March 10, 2004. aU in accordance with the detailed specifications as presented in 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 dah¡. ~~-:J~~~P- c!fr¡¡p,¡;~~~ Artie Foster (absent) T ruslees TERMS and CONDmONS The Permitœe Richard DiBlasi residin 360 Bayview Dr., East Marion guN. y~ as pan of the consideration for the i~"nœ of che Pemùt does understand and prescribe 10 the fol- lowing: 1. That the said Board of T~ and the Town 01 Southold _ relcoscd from any and aU damages, or daJms for damages, of AÚØ adsiog dúecdy or Iodùec:dy as a cesult of my opec' ation perfotmed pursuant 10 chis pem1Ït, md the said Pennittee will, u his or her own a:petIS<". delend any and all such suits· inidued bylbhd parde!, and the said Peœùuee .~_ fuU liability with respect thereto, to !he toolplete _....ucioo of the Ðoard of Trustees of the Town of Southold 2. That this Pemùt is wJid for . period of 24 mas. wbidi. is c:oasideftd to be the estimated time required to toolplete the wad< inwl..ed, but should circumstances wunot, ~ for an exœosion may be rœde to the Boud at a bier dace. 3. That this Petmit should be retained indefmitely, or as long IS the said Pemdttee wishes to maintain the 5ttUcture oc project involved, to provide evideoce to anyone conœmed chat anch· odzation was originally obtained. 4. That the work involved will be subject to the inspectioo and approval of the Boud or its agents, and DOn-œmplianœ with the ptovisions of the originating application, may be canse for revocation of this Permit by resolution of the said Board. S. That theee will be no unreasonable interference with navigation IS a cesult of tbe work herein aUthorized. 6. That thete shall be DO interference with the right of the public to pass and repass alOO8 the beach between high and low water macks. 7. That if future operations of the Town of Southold require the œmon1 and/or alteradoas In the location of the work herein aalbodzecl, or if, in the opinioo of the Board of TtuStees, the work shall cause unreasonable OOstnKtlOO to free aavigmoa, the said p..nn;ttet will be required, apoo due notice, to remove or alter chis work or project herein stated without er:peoses to the Town of Southold. 8. That the said Board will be notified by the Permittee Ot the toolpletlon of the work anch· orized. 9. That the Permittee will obtain all ocher pem1Ïts and COOSCIIts chu may be required sup- plemental ro this petmit which may be subject to revoke upoo fallure to obtain same. . . Albert J. Krupski, President James King, \Tice-President Artie Foster Ken Poliwoda Pegg}' A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 SOllthold, New York lI971-0959 Telephone i6311 765-1892 Faxi631> 765-1366 ,,. . .. ." .' .. ". ~ ..... .' ~ . BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD' CERTIFICATE OF COMPLIANCE Date Nov. 9, 2004 # 00 ¡8C THIS CERTIFIES that the 6,~'1-6t- 6-1'.0011. a.dcli;t{.oll At 360 Bitljv'¿ew VI1.., E,U;t Ma/tion Suffolk County Tax Map # 37-4-1 Conforms to the application for a Trnstees Permit heretofore filed in this office Dated 1/23/04 pursuant to which Trustees Permit # 5870 Dated 2/25/04 Was issued, and conforms to all of the requirements and conditions of the applicable provisions of law. The project for whicb this certificate is being issued is it 6~'1-6;t- 6./'.0011. a.ddi.:Uoll The certificate is issued to tUc.hiVtd ViBfuÛ owner of the aforesaid property. JihJ 1/ ~.ç,. Authorized Signature ------- Albert J. Krupski, President . James King, Vice· President Artie Foster Ken Poliwoda Peggy A. Dickerson . TO\.\'TI Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765·1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. Z)¡ ~(o..S; INSPECTION SCHEDULE Pre-construction, hay bale line 1 st day of construction v Yz constructed Project complete, compliance inspection. \ \\ -s l b-t 0 ~ J-. ~ Cwt.~~~· ~~ D'0~O' . . Telephone (6311 765-1892 Fax (631) 765-1366 Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971·0959 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD February 25, 2004 Mr. Warren A. Sambach Sr., PE P.O, Box 1033 7675 Cox Lane Cutchogue, NY 11935 RE: RICHARD DIBLASI 360 BAYVIEW DR., EAST MARION SCTM#37 -4-1 Dear Mr. Sambach: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, February 25, 2004 regarding the above matter: WHEREAS, Warren A. Sambach Sr., P.E. on behalf of RICHARD DIBLASI applied to the Southold Town Trustees for a permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated January 23, 2004 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 February 25, 2004, 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, -- 2 . . WHEREAS, the structure complies with the standards set forth in Chapter 97 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 approve the application of RICHARD DIBLASI to add a one-story room on the existing deck, 6'X 12', with the condition drywells and gutters are installed to contain the roof run-of, and as depicted on the plan prepared by Warren A. Sambach Sr. last dated March 10,2004. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $5.00 per inspection. (See attached schedule.) Fees: $5.00 Very truly yours, ~·f f} ~'f} Albert J. Krups'ki, Jr.. . President, Board of Trustees AJKllms - · . í7- # c}d£ I f--;c: )77 _ .XXL }î I::-~ n _ , ·3x kncd ~ c /--(Ye _ ¡/{ nC~· "777 Ë rrb¡lQ/7¡IL y - 1/9;;<1·c'? 77 D ¡ ;J/clSS., -7 . , C{¿ >1/'" .)~Ct'- } C) "0 /,d- -if ¡;:;- ï Ie' c._,¿: 7Yì C ')'1 !lrs " " c. J.:J. A--Tê <,:.-1- h L k{.y" C 71 ' ¡;~ 117 ¿~c h Lc ('(? hi- ____-J._ ( ) / 0Ú-r/FS,c.¿(¡.¡-¿' S1-CI"" / é- éL.,f.dcc¿ t-u t:n,.{¡,u-E i~il/K -J/,::-t;c/ ---' ~~F~B~: :4~ ~ Soulhold Town Board 01 Trustees . . K,¡,'--' Telephone (631) 765-1892 Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York I ¡ 971-0959 CONSERV A nON ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Monday, February 23, 2004, the following recommendation was made: Moved by William Cook, seconded by Don Wilder, it was RESOLVED to recommend to the South old Town Board of Trustees APPROVAL of the Wetland Permit application of RICHARD DIBLASI to add a one-story room on existing deck, 6'X 12'. Located: 360 Bayview Dr., East Marion. SCTM#37-4-1 Vote of Council: Ayes: All Motion Carried . . Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971·0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD -- Office Use Only jor - Minor ~E ~N~~ ~~ D ,L.,... Sout\1Old Town Board of 1ruste".:'5 Coastal Erosion Permit Application /'Wetland Permit Application ,- Ma Waiver/ AmendmztlCha,geS ~ceivedApplication: J ~3. ~ _Ar.:ceived Fee:$ ~OO 'fJ. _~rnpleted Application 3JQj _[ncornplete_____ _SEQRi\ Classification: Type I_Type ll__Unlisted_ Coordination:( date sent) ~C Referral sent.~ ...-uãte oflnspection: _Receipt ofCAC Repo :___ _Lead Agency Detennination:_ _ _Technical Revie\V:~/ ðublic Hearing Held:~ Resolution: RICHARD DI BLASI Name of Applicant W1t1!'1!'eJ!:Y~J(J(i!l:!O!¡>!l:K~X~XXxx~x h 360 BAYVJEW DRIYE Address ('x~ XX (!~~xx:~ítítxxx~x Rxjf~J{XX!!!: H~X EAST MARION, NY 11939 477-0977 ~XXK~~HX~xxMXxx**~ítX~K«~~tX~xxx~xx~~xx Suffolk County Tax Map Nwnber: 1000· -3. 7 4 I Southwest corner Bay View Drive & Dogwood Lane (provide LlLCO Pole #, distance to cross streets, and location) qoq~ fl Property Location: 360 Bayview Drive East Marion NY 11939 AGENT: Warren A. Sambach Sr. P.E. (If applicable) Address: P.O. Box 1033 7675 Cox Lane CutchoQue. NY 11g~~ Phone: fi, 1 _7,¿ _ 7¿¡Q 7 . Board . of Trustees Application l I GENERAL DATA Land Area (in square feet): 1390C + Area Zoning: R-40 ---- Previous use of property: One Family Residence with onE> c~r -Q"arage Same as above Intended use ofproperty:__ Prior permits/approvals for site improvements: Agency Building nep~rrmpnr Zoning Board Date Permit ~17676Z 12/9/88 #3852 --- _ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No---.X_ Yes If yes, provide explanation:_ Project Description (use attachments ifnecessary):¡\dd nnp <:tnry r""m-ûn existing ~ø~~ ~IOI' X '21011 · . Board of Trustees Application -1 I WETLANDrrRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: add a one story 6' 0" x 12' 0 " room on existing deck to be used as a den Area of wetlands on lot: none square feet Percent coverage oflot: % Closest distance between nearest existing structure and upland edge of wetlands: 60' + feet Closest distance between nearest proposed structure and upland edge of wetlands: 60' -'- 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: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: 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): None . Board of Trustees . Application 1 ! COASTAL EROSION APPLICATION DATA Purposes of proposed activity: add" onp ,,¡-ory F.'n" y 1'2'0" room on existing deck to be used for a den Are wetlands present within 100 feet of the proposed activity? X Yes No ---- Does the project involve excavation or filling? X No Yes [fYes, 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 £Tom implementation of the project as proposed. (Use attachments if necessary) None , 4-16-4 12i871- í~"t 12 I PROJECT 1.0. NUMaE.O . . 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSiVlENT FORM For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION (To be completed by Aoplicant or PrOject sponsor) I 2 PROJE,:-;- NAr.1E Build room on existin ,. APPUCANT ,SPONSOR Warren A. Sambach Sr. 3_ PROJECT LOCATION: Municipality Cùunt'l 4. PAEC:SE LOCATION (Street address and road IntersectIons. prominent lanomarKs. ~!c.. ùr Z'rovroe ,'nao! 360 Bay View East Marion Drive Southwest corner Bay View Drive & Dogwood Lane NY 11939 S. IS PROPOSED ACTION: o New Expansion 5. DESCRIBE PROJEC. BRIEFLY: o MOQlficatiomalteration Build 6'0· X 12'0· one story room on existing deck. '. AMOUNT OF l.JlND AF¡::¡:CTED: Initially N / A acres Ultimatelv ac'~s a. VIIL:... ,=!=ìOPIJSEiJ J.C-:-ION CCMPL Y 'NITH EXISTING ZONING OR CTHER EXISTING ~,'\/O USE ~E.s7HIC-:-¡CN5~ ~ 'fes [J No It ,'10, eJesC:¡be one/ly SEa g. '/JhAT IS ?RE3E~T L-\/'";ù ~J::~ IN '/ICINITY OF ~~OJECP OC M~s dEmtlal [j, ncLJs:na ~ C.JmmerC¡ôil. C!esc:lce: LOther U .-\grlcuJture ~ Parl<JForesUOoen space 10. DOES ..:.CTION INVOLVE A PSRMIT ...PPROVAL OR FUNDING. NOW OR ULTIMATELY .~MOM ANY OTHER GOVEHNME~TAL AGENCY ¡F::D RAL. STAíE e¡:¡ LOCAL)? CJcYes 0 No If yes, list agency(s) anCl permit/aoprovals New York State Department of Environmental Conservation/US Engineers c~rp. Buildin De artment d ~ 11. DOES ANY ASPECT OF THE Acnor~ HAVE A CURRENTLY VAUD PERMIT OR ., "PPROVAL? o Yes ex No If y~s. list agency name anCl permll/approval 12. AS A RE$UL7 :JF PROPOSEiJ ACTION WILL S(IST!NG PEAMITIAPP!=ìOVAL REQUIRE .\10QIFIC),tlCN? DYes I:XNO n. I CEi1Tlp· THAT 7HE INFORMATION PROVIOED ~eOVE IS TRUE 7"0 THE 3ES7 OF ,1,.1Y KNCWL~DGE ~ Warren A. Sambach Sr. P.E. ,.!"pplicanl/spcnsor ¡'lame: Dolle: Slqnature: t({ IVIÅÞA.. tl k~ k- ~ If the action is in the Co.::!sta ...\.rea, and 'Iou are a state agency. complete the Coastal Assessment Form before proceeding with this a~?essment OV!õR I ï ~ I I I ..:... CCE.:: ~C;'";C." ::.\l...=::'~ .:. " ~ 'of .S3ME:-lï . _. 7"ro.;::.E..3;,....CLJ : r ~ 1 , I .J :::~ c:r.-::j':?-~eC! :y ~ç;'2."!C" I ...."::=;:: ,; .:.¡:'.Î 3';. ;1 I~S. :~crCI('<ltg ::"1e ,'~"',~w :~'Jce~j ana 'J~~ ~r.<:! ='...:L_ .::.~¡: 'v. , ce~"U~ ,"c"" , I I ~n$Wer5 .7Ië;." ::E! 'ãnC::·.vrll:~rI. .r 'eO:;¡CII!I I :~;¡,;tic ::at:e~!ls. 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'Jeç!!ratfon or 'auna. ·Jsn. 5r:ellfisn or Nrlarife $;Jec:es. 5rgndicanl 'Mo!!ar~. ~( :nr~3!::!rled or ~ncançe~ea ~'::ec:es? ~C!';'¡n Jnar!'': I , - I A o:mmun..-(' wSimg ,..n, 0' ¡oalS 3S ottlc..,1V .oooteo. 0' a onange ¡n u,e 0' ¡nten,"y 0< u,e 01 'an: o~ o<n" naMaI 'e'ou".,7 tOI.,n _ I I :;.-owln. su:¡seauenl ::evelooment. :lr (elated aC:1VI[reS Iil<:elY ~o ,'Je ,naucea ,y 'ne :rccosea aC:lOn? Ë."!;,'Jrarn :rreilv. I I C":'. -< ... -..:;. I_:::nç :erm. 3õ!0(: o.er,":1. '::In"iulat:·le. Qr :liner erfec:,s ,101 rGe:1!1tleQ ,n C:·":;'s? ::."!;~Iarn :Jr1erly. ::r.-.~' moac:s i('\C:.Jc;nç ::-:ançes .n 'Jse 0' ~:t:-'er ouantlty -:;r :y¡:e or ~:1e~ç"fJ? :::"{~r';'Lr. ::;r:er:'{. j. S :'''-!E:-.E. ::A.S -¡...,-:::::::tE _:!":.=::..'~ .0 3E, :::;N':'<.GVE:--SY =!ë~,EJ 7'(J ?'JT:::~(í!,:.í... ;'~'J=q5ë ::,~ vIRCN,'II~~I,;'L .'.~P~C737 _':"es ·_.'¡o f ·~es. ~xc!au"l .)flellv :J"\Rï III-OEï'E~MINAT¡CN OF SiGNIFIC..).NCS (;0 :Je c:::>moletad ::,y ,ol.gency) !NS.RUC:-¡ONS~ Far ~3C:1 adverse ~!fec: Ident!fie~ '!ccve. determine wnetner It is substantial. large, :r.lCOt1õ.nI or.ornerWise ~içnific ;:.2.c:1 ~rfec: s,'ould :Je ,;,ssessed in connec:¡on 'Nun rts (al 3etting \L~. urvan or :ural); (t) .Jrooaollity of occ:J-""i!1g; (C dfJration' irre'ferszbllity: :et ,¡e-:>gra.cnrc 3C:Jce; anc (r) magnltuce. If necessary, aad. attacnments or reference suppon¡ng materials. j:1sure ~.xClana( cns c::nraln surtic:eot -Jela¡ to snow that all ~e!e"ant adverse rmpacts "a.ve been jdemifiC!d and aaeGlJatelY acc¡essec- JO''''J{ C:-Jecx. ~hls =Ox :f you "ave Identifiea ane 'Jr ;Tlore ::wtentla!/' larçe or SIgnificant ::.c'¡erse :rïìoac:s '.\lnic;-J ,',i"':"'~ ùC:::..Jr. :hen JrCC2ea ajrec~ y ~o :ne ,=UL:'" =AF ~nalor ;;reoare a positive" declararicn. C:-:eo:;:< :hlS ~ox :f you ,1ave 'Je!ermlneCl. JaSed 'In the information and analysis above and any Süc~or:;:-;ç ,:;:oc:.Jr.:enra,[!cn. :tlê.r :r.e ::¡rODosea ac~iO,1 WILL tJOT result In~n,! significant 3.CVerS2 en'II(·:::;nrr.enraJ irr.:ac:: "'NO Jrcvlce on ô¡:aco",ents 3S "ecessarv, 'he :e3S0ns succorting tills dete,mmâ¡ion: I r- ~ .,<0"'"'" ",.""",.,, ,,,,,,·"00 "m ·,,"00""'" '''''''r-- L ......".... 11 _<:..<J "'0.;""('/ .¡.;'" ".,m.. J[ ~,.,,:;')"\ I:H" _r¡".:~r " _........;¡ '..;"".:: : ,(1<: .)1 .(",oon\Jor" '.Jrr,c~r "I;"..¡L:r~ )/ ~..' cC""C'o!' ; 1°..:.:( 11 .,,-..10 ~';"""C" -'..,~ o ~ard of Trustees ApPlicati~ County of Suffolk State of New York RTf'HARO 01 RT.A~T BEING DOL Y SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRffiED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HISIHii 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 REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. //(,</ ,r; /1<.<> Signature SWORN TO BEFORE ME THIS qA DAY OF De c.. ,2o~1 ,..........,. ....."',"'.. O....·Ã···" ~ . - , ?o-: .~~ ~~:,~!:~~:~/':.- Sf.)j~ YANN "1\ _ ·lr,.~'.~I~::C!·I'CC927352 "i-"f':: .~t, -2 -,004 I.·..,¡:,'l.J+ c·"J6r,,"1øl'S Bed of Trustees APPlicatio4 .. AUTHORIZATION (where the applicant is not the owner) I, RT("'HARn niRT.a~T (print owner of property) residing at 3tiQ DAY "à~RI~E (ma~l~ng a ess East Marion NY 11939 do hereby authorize Warren A. Saambach Sr. (Agent) Consulting Engineer to apply for permit(s) from the southold Board of Town Trustees on my behalf. .a / /~ /)-,J /.. ({;" _' A, .... (Owner's signature) 8 . , I I I I C'l t ,,¡w'}ue fY 1193~ . ACCESS CONSENT FORM FOR ACCESS THROUGH PRIVATE PROPERTY Office use File #: Permit #: Only Print or Type: 1) 2) 3) 4) 5) Warren A. Sambach Sr. (Name of Applicant) P.E. 7F.7". {"n:v T :::I no PO (Address) ] n~ ~ , (Name & Address of Contractor Involved) 360 Bay View Drive, (Project Location) East Marion NY 11939. 1000- 37 - 4 (S.C.T.M. #) 1 Southwest corner Bay View Drive & Doqwood Lane, (Name of Road or Private Property Involved) East Marion, NY 11939 (Haml et) (Name & Address of Homeowners Association / Property Owner) 6) Build a one story room 6'0" x 12'0" on existing deeck (Brief Job Description) 7) 8) 9) As soon as Starting Date: pnQQihlP Completion Date: $11,750.00· ~9for9 5pptpmber 2004 Estimated Cost of Proposed Work: Insurance Coverage: A. The coverage required to be extended to the Property Owner: Bodily injury & Property Damage; $300,000/$500,000 Bodily Injury & $50,000 Property Damage. B. Insurance Company: C. Insurance Agent Name & Telephone # D. Policy # : E. State whether policy or certification is on file with the Trustees Office: (If no, Provide a copy 1ith Application) (yes/no) K1 ~WL 6l ~ .1L- (Signature of Applicant) (Date) ------------------------------------------------------------------ To be completed by the Property Owner: I/We the undersigned, fully understand the nature of the Proposed Work referenced above and have no objection to allowing the Applicant to cross My/Our Property to /'P the work. /. / /' /1"/,r¡, /- Þ-7'- /' _ (.'~ ,.// -; //,r /( /' "7 /~,~- i'_~ (Signature of the Property Owner or dul y aut hori zed represent at i ve) . . APPLICANTI AGENTIREPRESENT A TlVE TRANSACTIONAL DISCLOSURE FORM The To\VIl of Southold's Code of Ethics Drohibits conflicts of interest on the Dart of to\m officers and emplovees. The Dumose of this form is to provide information which can alert the to...-.11 of Dossible conflicts of interest and allow it to take whatever action IS necessary'to avoid same. YOUR NAME; SAMBACH, WARREN A. for RICHARD DiBLASI (Last name, first name, middle initial, unless you are applying in the name of someone else or other entity, such as a company. Use, indicate the other person's or company's name.) NAME OF APPLICATION; (Check all that apply.) Tax grievance Variance X Change of Zone Approval of plat Exemption from plat or official map Other (If"Other",nametheactivity.) 7'Erprt ~n pvrpnc:;nn f-n existing residence on deck. Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship \\.;th any officer or employee of rhe TO\\11 of Sourhold'." "Relationship" includes by blood, marriage, or business inrerest. "Business interesr" means a business, including a partnership, in which the town officer or employee has even a partial ovmership of (or employment by) a corporation in which the tOW11 officer or employee owns more than 5% of the shares. YES NO y If you answered "YES", complete the balance of this fonn and date and sign where indicated. Name of person employed by the TOYvTI of South old Title or position of that person Describe the relationship between yourself (the applicant/agent/representative) and the to\\.11 officer or employee. Either check the appropnate 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): _A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); _B) the legal or beneficial owner of any interest in a non-corporate 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 SUbmitte~~ay O~.,.,.- Signature , '4 ". L..( PrmtName ¡"arran A Samb:¡ch 200 ., - - -.-.-. - -- ~.- --'--~'- - -- - .Ji'-.. '" != , . ~ ----~-----~ - , I , , \ , I. . 1 i , , " ¡, ", '. , }~-¡ , , 11,' , I, I , J" .. ,. t-"'-," 1~:, ~~ , L-- I , " ¡----. " '" "'-, ., , , r 't~-· -. __. ____. ,____~ ~_ "'.'_'_'H ---. -. - -" _.~ '-'- , " '. -- I: , ·'~'-T'¡ f---¡--i -_._~- ---- -- '- ,i', ,i!] , ., , I I.. I , I , I I , , I I , I , 'I G..=.- 1 " , ,I ,..U' , " , ., - ,'oj I , t'] Ï Fì fj '- ~, ~ ~ t, -' FLOOR PLAN --.- ---- I' I . I I I if , ,',} I , . I I , , 1 ., , NORTH ELEV4T10t. ---_.----~ , ,I _u____ ___ __."_..~ _ _ _... , --_.----- i J .. \. j 2, 3. ~ , " 5. 8 , , , " " 9. .,. 1 " 10 ~ ~ , , . ~ , I l .1 , , ,..; ¡ " ." , SCALE: 112"= 1 "0" , I ~'./.\ ' : /:' ___._________m __ . --",- ¡r'-; .~ ~l ·t· -----,- +\ -(' -I <" .,' v y:. I'}. (:', t,,r" ,q'¡ ,II ,':; :;',1 V'" ,,-- ----- ._._ ~.__ .,,_._ ".1 I :..J CROSS SECTION , /~ l'f~·:. . . , , u:'':!G ¡[ 1-;'·1., i ,J ',- .. /-1 ~-' ~'"'.:I! ( t .;¡ J /,(' ~ [} y /" , . ,:-" .' -' i~1 '.)i , -,,' B{"/·,.,<j ,\ ~t I 1 , , j " . G . +.-"] ~. i j -'J¡1·,;1 ' I, " '.' ".' .'. ," j :~. '<" "" ;..,' II] ., , .' r , "-=> 'I I' ,J" ., ." I ¡ , ',1 ~ , ., j , , - _._~ - I 'J " .--" , , L _L LONGITUDINAL SECTION --- ------- --.- ----.-.. -.-. ---'-'--- -----'--.- -... -.. - ------.- ------.- .------. , , ! I , ! , 1:1! IIf! - II' 6, " I 7 . I- I 7. . , , I' <" .n ij .. , I ' ". I,~_ 1'1' :-4 ~:... ,'; r ( IL/¿', ... T , "'!",yJ -! '_, / .~'/,: ,(I.; .-- . ',' c co ~ ,~ . il - t..Ji .~, I 7/ '. ,. ~,O! : I .. . - :-1ò - ~, I L 1 Î >:.,' ,¡ 111/, I,_J', ._---.""-- , -. -~--.,,--.~..- .-.. -. ·"'"t I , _._.."_. _ _..~~."'M~,_~_ ~--._, --"-~_........ G F. n 1': R i\ L to visit ...-Ji- n T Jüb ~it~, R S ~~"i<1tin~; conf'truction c'1~c'{ 1\11 contractor~ aud where extension is to br' built. d "m['nr Douc.]a~ Fir Larch All [r<~r.linq lumber [¡h<:lll br: 'Ir~ 2 ",L ---, ~tructura] qraðe No. 2 or bp.tter. 1 I" . All nh~Dti~. l') L A.A ~.¡t ;nr1JT" .1 , D1n All ';ubfloorinq to b~ APA rat£d STURDI-I-FI,OOR, ~:~ilO:'U~~ All '"(~( ~<, r.r ""'lY' O'1r '~'1 b" ~~~ on ~Ollà t"Üc1,,;n:--:-:R .- 1, bloc!t:ing, " , 1//'" Vlir1~n-r-. ~]ue and nail ~11 Sh0<!tß. i ~h double, upri~~ntSt h~ar"~r~ ;,n...ll b¡~ ". r .'·}¡21l b:' FU1',Dort""'~ All 11 .a(1~r~. C' J _,,( 'JV" 9 I 0" AND OVER WITH WITH TRIPLE UPRIGH'l'S. All 7-2"xA" "r ,]S '-htP'n on t'l;::n- Doubl~ [raminç, around all openinqs. All [I ush "ood (~oonl'.ctionf; f'h<.J 11 1)" [,~~, t~'w'( -, i t ~ r;::. t"d r; ",1 v.-::.ni.; cd m,tdl connectorF. by "TECO" or ilpj)rov~('~ qrllaJ. N. ~: ~" --,.,~,-,;~ ,t1<-..11 b~~ ;~" ;Jer t!1:' NYS Iluilpiac- Cod~ as a rninimm. All 2"xl " stUè'f~ ~;hull r~'r~dVr I":-~OD ,\".i1' _~t <-:il1 ;r¡d . ¡ ~' . ~l~t~. hll' );tr·rior n~ilß shall be çalvanzrd. P]y~ood Rh~atinc to be nilil~d ':it~ RD ~ f" o/r ~7t0rior n~s~s ~nd fJD ~' 12"o/c int'2rm~diate. I A11 interior and exterior fiili~~es; f1i1!';'b.iW- to be: "'rovi(]'~è by contractor. rrovid~ smoke deteector ~s ~er cod~. r.l~ctrri(>?l "or1~ to rrm[orn '",0 1:;""" r-h"ttion.'~ El:~l:'tri(~ Cod,:" N~v York Sbùtr> EnerGY Code /tod ,),ny '~111ir;:;b]' [lWeI cr:;i'''. A11 ,_L11:(,"~- ',I, b" t., i:"n·~l jn~,\}Iat'--,¿ c..ldfi~;. · \ \ j c Z DE51r,N PA TER5 IPRE,ro'PTIVE DE5IG" GROUND WIND SEISMIC 5UBJECT TO DAMAGE fROM Wlnterr Ict'.nllld Flood ExpOlttI! SNOW DESIGN Welth/lrlng Frœt Ter!lIrt", DeGlg Oel19n UndCl'rlB~ hBlIrd~ ClleQ«i LO,f¡D SPEED CATEGORY line Temþ -lent - reUlred1 -4Slb!!ftJ 1:20 mþh B 5~ver~ ~'-O' mcderðte moderlle II" ''0 I~D B - I I · I " , , I ¡ · · , <I ~ I ,- - , ~ . , ) "I , e " ,,-- ~. - . :.¡: , w·j """1 '" <;"[1111'1).:'1-::;/;1--' :?, fl/.- _¡;...4CJ ':, . , .,., r ,. " I , c, f.. .- .< .. \ \ .\ \ ¡ 'I 1"--( \ , , LJ,·I/ ," ,. , ", ¡ ¡ '-.- ,'" .,' ,,-, ,-t_,":> \\ .. " 1'1 1 J" , I. \ , ~\ _t" -:;:tp. ,,' ,\",,11 _ !. ,·d,I" - '~¡'1' , ' . VI',!. , '\ "'~ ,. ~ ..' " '.' '^ , , <; " c ("l!, ( ". I" ,," ,,\ h ¡ '" ",,' .- , " . ., Co,'· /):..., , c, (, I· , - , , " , ',1 .". PLOT PLAN SCALE: 1 ":::40' [õ) IE ~ Ie I W Ie 1m lfll MAR 1 1 2004 l!lJ '" 1\ D.-r "J,' I' :~. \, SoutlJOld Town Board of Trtlstees I'-:,j)'/'.'I'- III I]C 1'./0 I' ., --.- --- iA ._L____ WARRE,N A. SAMBACH SR, Consulting Engineer & Planner PO. Bo ( 1033 7675 Co... Lan!'! CUTCHOGUE, NEW YORK 11935 --r¿ ¡:;-'v ~ ,_. .,~ , I '/·1, ,. .' II" "·1' ':'..'1 " iI· >' -\- .'>