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Home My WebLink AboutTR-5899 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0294C Date: February 1. 2008 THIS CERTIFIES that the construction of a single-family dwelling with gutters. leaders & drvwells. garage with gutters. leaders & drvwells. porches. patio. fencing and detached shed. At 50 Tuthill Road. Southold. New York Suffolk County Tax Map # 55-3-21 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 03/19/04 pursuant to which Trustees Permit # 5899 Dated 04/21/04. Was issued, and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the construction of a single-family dwelling with gutters. leaders & drvwells. garage with gutters. leaders & drvwells. porches. patio. fencing and detached shed The certificate is issued to JAMES DEMILT owner ofthe aforesaid property. rc;?~ Authorized Signature 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 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. INSPECTION SCHEDULE / Pre-construction, hay bale line 1st day of construction y" constructed ../ Projed romplete, rompl'""" l"peolloo.f3 ~ If ",5fl' ~ . . 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 (6311 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 18, 2004 Paul A. Caminiti, Esq. 53345 Main Rd. P.O. Box 846 Southold, NY 11971 RE: JAMES DEMIL T 50 TUTHILL RD., SOUTHOLD SCTM#55-3-21 Dear Mr. Caminiti: The following action was taken at the Southold Town Board of Trustees regular meeting held on Wednesday, August 18, 2004: RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a Transfer of Permit #5899 from John & Joan Weegar to James Demilt, with the revised survey prepared by Joseph Ingegno last dated July 15, 2004. If you have any questions, please contact our office at (631) 765-1892. Sincerely, ~~.;. 9- ~'(). Albert J. Krupski, Jr. President, Board of Trustees AJK:lms Board Of Southold Town Trustees SOUTH OLD, NEW YORK PERMIT NO. .5119' u. JOHN & JOAN WEEGAR ISSUED TO u.......u.....................·...················...·········........... .... DATE: ..~priI2~~.Z.004 .....-........................................ 1\ut~nrilntinu 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 Southold Town Ordinance en- titled f'RèéULATING AND THE l'LAClNG=OFOBSTRUCILONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS.F~M LANDS UNDER TOWN W A TERS{'. and in accordance with the Resolution of The Board adopted at a meeting held on u.Ap~~L~2J.,. . 2o..o..~.... and in consideration of the sum of $...PíQ..,.QP.. .u' paid by .. .........uu..!.().J:1:n.:..~..;r()"':n.:...~v~"g"'~ . ....._.............................................u...........·...... of ......u5..".':'t.J:>."lci...u.. ..... ... ..... N. Y. and subject to the Terms and Conditions listed on the reverse stde hereof, of Southold Town Trustees autho.rizes and ~rmits th~ fonowing: \,etlaná"Permlt to construct a slngle-famlly' dwellmg, garage. 1 porches,patio,fencing & detached 'shed, wHh the condition dryw & gutters are installed to éontain the roof run-off and haybales '. are placed down. ];)rio~ to contruction, and all .as.. depift:j 8" ·th surV'ey prepar~d "by Jps~ph _l"2."~no "I¡;,t dated Juné 0. 4 all in accordance with tlie detal\eã specifications as presenf In' . the originating appflCðtion. IN WITNESS WHEREOF. The said Board of Trustees here- by causes its Col")Ol"at~ ~al to be a~xed, and these ~esents to be subscribed by a IMlority of the saId Board as of this dat.e. . . TERMS and CONOmONS John & Joan. Wee gar ne Pcrmitttc ~ at 25.0 Tuthill Rd., Southold N. Y.. IS part of the coasideratioo lor the ...,.~ of che PCtmit does uødeøtaad And prescribe to the fot- Iowiøg: 1. That the said J30ud of Trustees and che Town of SouIhotd ate reI~.from any and aU damages, oc daIms foe damages, of suhs adsiøg. cIúcctIJ or inditecI1y .. . result of any opet- -4doa..petformed p.au,..tcto.ëlspaait, &ad .Jbe.JÚl&rm!~~.~. oc.taet ÐWI1~ defend allY and aU JUCh 1Ui1S'¡..ltI.1c<I by chhd.,anics, aod the said P. ....I'1ef! __ full JàbII/ty wid! reSpect cheœro., .'O -che"1Mlpl-teeulusioo of the 1Ioud. of Trustees of the Town of ~ 24: 2. ThaI this I'eIIiÙt Is ~d for .. ¡>tdod of _ ...tdd. Is ~ to be the e<fIm'led time·required to complete the wod<: Ia~l..ed, butihoald ~...... WUftIIt, ~ for an exœosioo .may be made to the Ðoud II . Wet iI4Ia:. . 5. ThaI this Pennie shou1d be RtaIaed iodefinltdy. or IS 1008 IS the said Permittee 'II'Isbes to . m.I....I.. the otruaure or project lavolved, to provide erideoœ to anyooe cooœro<d chat 1IIIh- ~tioo was originally obt.ained. .(. That che work Involved will be IlUbject to the Iospectioa aod apprant of the Boud or ia ageøcs. and _-comp1iallœ with the prcrrisioøs of the noIgI...flng app1iatioa. may be ause fot mocatioo of this Permit by resolutioo of the said Boud. 5. That IbeI:e will be no uareasooable Intedereoœ wid! a.av/gadoo IS . raa1t of the wodc baeIn ...ä.odreof, . , 6. That IbeI:e IbaU be 00 iaœrf_ wid! the tight of the pubIJc to pass aod RpUS üoaç the bead> Leaiœn bf8h and 1ft- water mub. . 7. Tb.at If fucure opendoos of the Town of Soathøld reqaI.œ die. ftIDOftI ØJdIoc a/œødoas In the 1Qro,q. of the wodc LercIø. _ck. J-t, or If, Ia the 0fIaI0a of. Boua of n-, the . WOIk.1ha11 cause _conohIe obsttacÞoa to free ø.aviguioo, the said p...m¡..... wU1 be ~ apondue IIOtIœ. to remove or a1ter chis wod<: or project herein IUIecI ,,!choat ~I to the T_ . of Soucho1d. . . . 8. That the aid Board will be DOCified by tbe I'etmItœe at the ~...w,Of the wodc IIIIh- orbed. 9. Tb.at the ·p.;.rml~ wU1 dJta1ø. aU ocher peaahs and .......-,;. 6It .....,. be teqaIred sa;; fI-"'" 10 chis permit ~ .....,.·be sabcct to moIœ apoa fåIaœ to obca1a-. - .. . . 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 SOUTH OLD April 21,2004 Mr. & Mrs. John Weegar 250 Tuthill Rd. South old ,NY 11971 RE: 50 TUTHILL RD., SOUTHOLD SCTM#55-3-21 Dear Mr. & Mrs. Weegar: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, April 21,2004 regarding the above matter: WHEREAS, JOHN & JOAN WEEGAR 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 March 19. 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 April 21, 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, WHEREAS, the structure complies with the standards set forth in Chapter 97 of the Southold Town Code, 2 . . 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 JOHN & JOAN WEEGAR to construct a single-family dwelling, garage, porches, patio, fencing and detached shed, with the condition drywells and gutters are installed to contain the roof run-off and hay bales are placed down prior to construction, and all as depicted on the survey prepared by Joseph A. Ingegno last dated June 1, 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 $50.00 per inspection. (See attached schedule.) Fees: None Very truly yours, b¿~,.ý- 9· ~.t}. Albert J. Krupski, Jr. President, Board of Trustees AJKllms . . Telephone (631)765-1892 Town Hall 53095 Route 25 P.O. Box 1179 Southold. New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Tuesday, April 13, 2004, the following recommendation was made: Moved by Don Wilder, seconded by Doris McGreevy, it was RESOLVED to recommend to the Southold Town Board ofTrustees APPROVAL WITH A CONDITION of the Wetland Permit application of JOHN & JOAN WEEGAR to construct a single-family dwelling, garage, porches, patio, fencing, detached shed and landscaped gardens. Located: 50 Tuthill Rd., Southold. SCTM#55-3-21 The CAC recommends Approval with the Condition of a 20' non-disturbance buffer. Vote of Council: Ayes: All Motion Carried · . New York State Department of Environmental Conservation Division of Environmental Permits, Region One Building 40 - SUNY, Stony Brook, New York 11790-2356 Phone: (631) 444-0365 FAX: (631) 444-0360 ~ ~ ~ Erin M. Crotty Commissioner Letter of Non-Jurisdiction - Freshwater Wetlands Act & Tidal Wetlands Act March 5, 2.004 ~ If; ~RIó! n \! í< ~ I Southold lOW" 80,((1 of TrD~\ee5 Joan A Weegar 25.0 Tuthill Road Southold, NY 11971 Re: 1-4738-03326/00001 Corner of Tuthill Road and Long Creek Drive SCTM # 1000-55-03-21 Dear Ms Weegar, Based on the information you have submitted, the New York State Department of Environmental Conservation has determined that: The parcel referenced above and show on the survey" Lot 5 - Map of Y ennecott Park" by Joseph A Ingegno, dated July 30, 2003 is not within NYSDEC Tidal Wetlands or Freshwater Wetlands jurisdiction. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 661) and Freshwater Wetland Regulations (6NYCRR Part 663) no permit is required. Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place within the Tidal or Freshwater jurisdictional boundaries, as indicated above, without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands or Freshwater Wetlands jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the wetland jurisdictional boundary and your project (i.e. a IS' to 20' wide construction area) or erecting a temporary fence, barrier, or hay bale berm. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals rrom other agencies. cc:Habitat BMHP verytru~s, ~vans ~~~E Regional Permit Administrator · . ~ (."O'(7Ý_ New York State Department of Environmental Conservation ~ Division of Environmental Permits, Region One ..... Building 40 - SUNY, Stony Brook, New York 11790-2366 -.. Phone; (6311444-0365 FAX: (6311444-0360 ~ Erin M. Crotty Commissioner Letter or Non..Jurisdietion - Freshwater Wetlands Act & Tidal Wetlands Act March 5, 2004 JoanA Wccgar 250 Tuthill Road _ Southold, NY 11971 Re: 1-4738-83316I00001 ---eomerofTatldltRøad1UldLoag Creek Drive - SCTM # 1006-55-03-11 -. - - - -- --- Dear MB Weegar, Based on the information you have submitted, the New York: State Department of Environmental Conservation has determined that: The paree1 refereueecl above IIDd show oa the sarvey" Lot 5 - Map ofYeDDecott Park" by Joseph A lDgegno, dated July 30, 1003 is not witIìin NYSDEC l1c1Ja1 Wetlaads or Freshwater WetlllDds jarisdidloa. l'herefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 661) and Freshwater Wetland RegulatiODB (6NYCRR Part 663) no permit is required. Please be advised, however, that no coostruction, sedimentation, or disturbance of any kind may take plaCe within the Tidal or Freshwater jurisdictional boundaries, as indicated above, without a pennit. It is your responsibility to ensure that all necessary precautiODB are taIœn to prevent any sedimentation oro1her alteration or disturbenccto the ground surface or vegetation within Tidal Wetlands or Freshwater Wetlands jurisdiction which mayresult fiomyour project. Such precautions may include maintaining adequate work area between the 'wetland jurisdictional boundmy and your project (i.e. a 15'to 20' wide construction area) or erecting a temporary fence, barrier, or hay bale berm. Please be further advised that this letter docs not relieve you of the responsibility of obtaining any necessary 1"',,,,;,,, or approvals fiom other agencies. cc:Habitat BMHP V~~ ~vans , ~ ~onaI Pennit Admin;Rator . . .- c"Of7Y_ New York State Department of Environmental Conservation ~ Division of Environmentel Permits, Region One .... Building 40 - SUNY, Stony BrOOk, New York 11790-2356 ~ Phone: (6311444-0365 FAX: (6311444-0360 ~ Erin M. Crotty Commissioner Letter of Non-Jnrisdiction - Freshwater Wetlands Act & Tidal Wetlands Act March 5, 2004 Joan A Wcegar 250 Tuthill Road _ Southold, NY 11971 Re: 1-4738-033Z6IOOOOl . - -eorner ofTatJdltRmnl1lDd Lolli Creek Drive . SCTM # l000-55-03-Z1 . - -- --- Dear Ms Weegar, Based on the information you have submitted, the New York State Department of Environmental Conservation has detennined that: The parcel ref~ above aad sllow 011 the lIIrVey .. Lot 5 - Map of YeJlDeeott Park" by Sosepb A IBgepo, dated Suly 30, Z003 is Dot witliia NYSDEC ndal Wetlaads or Freshwater Wetlaads jlllisdktioD, Therefore, in accordance with the CUIreI1t Tidal Wetlands Land Use Regulations (6NYCRR Part 661) and Fn:shwater Wetland Regulations (6NYCRR Part 663) no permit is required. Please be advised, however, that no construction, sedimentation, or disturbance of any kind may tala: place within the Tidal or Freshwater jwisdictionst boundaries, as indicated above, without a permit It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surfaceorvegetatioo within Tidal Wetlands or Freshwater Wetlands jwisdiction which mayæsult fromyour project Such precautiOllB may include maintaining adequate work area between thewetIand jwisclictional boundary and your project (i.e. a IS'to 20' wide construction area) or erecting /I ~4.¡.u.....Yfence. barrier, or hay bale berm. . Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. . cc:Habitat BMHP V~1t' ~vans ~ ERegional Permit Adminis1rator '. I ~ t > ii, L1 c-_ ", k__.- .1-1_ -1.o__ ~r~ ~~ %~~- ·~~·;'~..i,-'.l ;tM"1<·~~·~·''S::¡ ~-- . .,,:' '.. :...:.,:~ "::;:;;::';;:;':;':.~;~-;;;;~;'::-;,~~".~~~- + From wnparound veranda, guests may be ushered into gallery, introducing living and dining rooms + Kitchen F..n\ò,;", include walk-in pantry and nearby utility room, with bn:aldãst nook LOr family meals + Mastu suite offen romantic interlude via private veranda access, and master bath with Jacuzzi tub + Upstaüs, three ,......ini"g bedrooms all have walk-in closets, and fiont bedroom has private vanity + 2x4 Exterior Wall Pœning FOUNDA11ON OP11ONS: Slab PRoDuCT 0I'110NS: CD-ROM, Itemized List of Materials, Rqnoduåble Set, Minor-Reversed PIán. Next-Day Delivery -. ................. .... IIPPER FLooR YEw IIIIQ u.- RDOII . 4 Bedrooms 2% Baths 2,213 square feet (moinlloor.l,351"!-1I.,...,...1Ioor...."!-1I., _m,,!-ft.) PRIcEs AND IlE1'AlLS ON PAGES 4-9 For blueprint orders or questions, call Toll-Free \ . . ~ PlAN L-215-VSB + PRICE CoDE C /- .. ( - ....... 1 -888-314-6104 ...... FLooR ------ Far IIICft pAm ddUIs. Ke.... ........t. . '-.....- 1157. ...................by......~- I I , I >. d. u. ilJilg~.~~_~..Uul~: ~'." .11 _ J~ ~-~ - ~~~~}i~.L - . ~j"!i. f ,y~"':7-'~ ~~ .- .' -;/::::~;>;~;.:~:~;?~~~'tt::..,~. - .--- -. ..-........ ... UPPER FI.oOR VIEw lIII'O uw.e IlOOII /- .. - ...... _ FI.oOR For__.......... IIŒ.... at......" -- .' "'''0""' ~ .. I + From wraparound vemnda, guests may be ushered into gallery, introducing \iving and dining rooms + Kib:ben facilities indude walk-in pantry and nearby utility room. with bœaIdåst nook fur family meal. + Mastu suite oflèrs romantic interlude via private veranda access, and master bath with Jacuzzi tub + Ups1aÜs, time œmaining bedrooms 011 bave walk-in closets, and front bedroom has private v:mity + 21<4 &terior WoII Framing fQUNDA110N OPTlOllS: Slab PRODuc:r OPnONS: CD-ROM, Itemized List of Materials, Rqnoducible Set, MinoJ'.Reva.ed PIán. Next-Day Delivery . --' \ - ----- PLAN L-215-YSB + PRICE CODE C 4 Bedrooms 2% Baths 2,213 square feet (......lIoor.l,3S1"l-fi-....-IIoor.II6Z"I-fi-. _,I(T7"1-&.) PR1c:Es AND DErAlUl ON PASES 4-9 For blueprint orders or questions, call Toll-Free -888-31 "¡-01 0<-1 . --- ---- 1157 . . - ;:~~~::j. ,~·:::.;l:7~~T~.:·~i:~~~~:: ':~~;~. ~?::: ;~~ :.::~ --- -- --- _ FLooor + From WIaparoUDd v=nda, gums may be ushered into galleIf, introducing living and dining rooms + Kitchen fåciJities include walk-in pantry and nearby utility room, with b....Jdåst nook lOr f.uniIy meals + Master suite offen romantic interlude via priYate vennda access, and master bath with Jacuzzi tub + l1pstaUs, three remaining bedrooms all have walk-in closets, and Iiont bedroom has priYate vanity + 2x4 Exterior Wall Framing FouNDA11ON OI'l1OllS: Slab PRODUCI" OPTIONS: CD-ROM. Itemized List of Materials, ReproducibIe Set, Mirro,..Rn.:nc:d PIán, Next-Day Delivery -. ..........-4" .- VIEW øno I.JVIM; IIooM ~ ~ PuN L-2I S-YSB + PRIcE CoDE C \ - 4 Bedrooms 2% Baths 2,213 square feet (.....~ 1,351 "I-ft.. _~162 "I- ft.. _ 471 "I. &.) PRICES AND DETAIlS ON PAGES 4-9 For blueprint onIers or questions, call ToU-Fæe -- I 13 ..~. ""j .... FLooor -888-31 "¡-6 1 0...1- For more pia..... see plan at _1-.... .' ..__ .' --- - - - - - -- 1&7 's ~.~ <:;-w "- {§... J-èN t¡ ~"¢ i}J ~~ ~(.) ~~ 4J ~ , o .'" .., rv <b - <c. ¡ / I / ¡ / N/O/F JOHN '!;O;:::O;L~NO JOHN C. '" v.CAIIT -------------- 190.83' .>\!k N 84'53:50" [ ,¡¡¡.. ,¡¡,. , ,w.:. ,¡¡¡.. ,¡¡¡.. ..>\1Lc _ FRf.SH'ff"TER WEI\,N4OS _ __ _ - .-- .oil!c'Jil!c ',¡)k~. .....-"-.""'.~.........$ . :'~~;--. :'~""$~" ..~.... ..... ~.....- _.- . 0 -'~! ~ 'fVG ., ..' l'.!~ ,l' ~#/ ~',. I~ ",' " b/ ~,."J", , &'~ . $ ~':' ". / A...TESl '''1' . !"v'" "'8 /r---" ~~. .,....¡. ~"L.~- .- '" I .', ·.1·iS '1 < f.. -ti . .. . f " . " '. '---" ~1; o' ~ I I ._,~~ -, _ . , I '., ¿ 7/'3 .' . 6/0,; , W ___CATCH BASI" -- " 1.07' C\ rusc"O~,;p """i:;;;....""J -CQNC CURB LONG CREEK &/# *-:J#Z-- "Zbí? -Y;;~b-- /hl. '7H£~1d AI,/.//FJ7~ 1~~./-?7'~ ~~ õ- "" '" "'if Jos Þ} Q ~~ :,~~ ~,~ - z I ---~ Southold 1uwß Board of Trustees YENNECOTT DRIVE -.---- ~- _---- LONG CREEK -~ ~ ~~ ~~'b... .---- ~...,>¡. "i>~ . "'"' SURVEY OF LOT 5 MAP OF YENNECOTT PARK F'IL[ No. 5187 RLED OCTOBER 9. 1968 SITUATED AT SOUTHOLD TOWN OF SOUTH OLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-55-03-21 SCALE '"=40' JULY 30. 2003 OCTOBER 9, 2Q0.3 ADDED TOPOGRAPHiCAl SURVEY OCTOBER 29. 2003 AOOEO PROPOSED HOUSE NOVEMBER 5. 2003 REVISED PROPOSED HOUSE AREA = 27,823.94 sq. fl. 0.639 ce. -' TEST HOLE DATA (TEST HOLE No.4-AS SHOM>.' ON nLED IMP) ,. -... ,g ,.. -.- ,g ~. ,,,,. NJJH:ò:. 1. E1.EVA.flOllS ARE RUDÐtCm TO AN N.G.V.O. DAJUW IItZSl OATUW EXISTINO El.£VA.TIONS A.R£ SHOWN THUS; ''; ,:' 2. RERR TO f1LED YAP fOR TEST HOLE DA.TA. 3. WIfrIItotUW 'SEPnc TANk CAPACmES FOR A t TO ¿ 8EOROOW HOlJS[ 1$ 1.000 CIollOHS. 1 TANK; e' lDNG. ,,'-r WIDE, ,'-r D££P ¿. I61NJWUM lL\CHINC SYSTDI FOR A 1 TO ¿ IJEÐROOM HOUSE IS .:soo M¡ fI SIDEWAll. M£A. Z PDOLS: s' DEEP, 8' ella, e PfIOPOS[O ÐCPAMSIOM POOL @P'IIOf'O$[D LEACiWIIG I"OOl ~PIIOPOSmSEP'nCTANt( 5. THE lOCAnON OF WELlS AND CE'SSPOOt.S SHOWN HERrON ARE F1IOW nEiD OØSEMVAT1OH$ AHD/OR DATA O8TAINED f1fOM OTHERS. s. AJf't WE11..ANO __~"'RÆS SHOWN ARE SUBJECT TO VE1IInCATION BY NEW YOlK STAn AHD/OR emu flEGULATOR'I' AGDICI[$. 7. J1.fIS PROPEJnY IS IN flOOD ZDNE x f1.OO0 IISUIWICt ÜTE MAP No. 3ItO.JCOt58 G ZONE 1(·0 Nf9S 0E1'EJMNE0 1'D BE OUTSIDE !IOQ-VENI: fl..OOI)plMt 7. THIS PROP£ATY IS aN ZONING US[ DIS1lUCT: R-4Q ~,- ,.. - '0.,. lVE uÞWJTHORIZED 1IL1ÐIIoTIJH Of! .IOOmON ro 1MIS SOR\Æ'I' IS It YIOlATION OF SECf\OJII 720& IF 1M[ NEW YORK STATE: "'""""""'" COPES Of" lHIS SUfM:V ~ NOT 8£ARINÇ ~ lAIC) ~s INIŒÐ SOl OR EMBOSSED 5(AL StW.L NOT 8E: 00N:5IŒMJ) TO BE A. WU} TRUE COP'I'. camraTJONS NJlCATm HEREON 9W..L RUN ONlY TO THE PERSON FOR Mu. nt[ ~ IS ÞRfJ>NIED, ANO ON HIS EIÐWF TO THE mu: COUPANY. ~AL K1ÐCT AND LÐCIItC tr.mnmON lISTED HEA£ON. HÐ TO THE .«s5I8NŒS Of" 1Hr: tENON; NSTI- TUTION. CER'flRClt.1IONS ME: NOT ~ .' ,/::~' I.;:. ' " ". H.Y.S. lie. No. 49666 Jo eph A" Ingegno Land Surveyor Title Surveys - SubdMelon:l - Site Pfatq - Comtruction Layout PlIO'" (63'PZ7-Z090 Fa.- (631)727-1727 ........ AOORE5S P.o. Bmr 1931 Ri¥erheod. Nn York 11901-0985 THE EXISTtMC[ Of JIOHT CW WAYS lIMO/Oft £ASDWß'S or RE:CORD, IF AilY, NOT SHOWN AM NOT GUARAtßEt:D. OFRCES Locum AT 322 R(WrQ(f AVENUE RIII£RHOO. tin York 11901 --- --e " ___'__.u.' /\ < ~,~ .~- ,';"/\ :. , \ ,~ ~ ----- ~ /:--/ \ ."",- ~ lC1 ~~ _~ ¡'Í\\ I ~;;4/ \ //~'" .~"~' /~,... ~ :g . ' ;:. ~ '-\ y ,¡ /~ , ·f , /~,( ~, Ii, ß ~\tý:" #;'\'; '/4/ .' '¡I .. ,~,/.., II ~ I~ :¡;¡ " /~ \~<' '~" /.~/ , . " \ ::11' ~ . 0\,(~~ ;~~:..~ ~~ \.., / · ~\) !.' ' ::"7 ,. .' '~~.~ ,-', :' ! ;~ ' \ '\_ , \~.\ 1\ l (......,.} '" 1- I, f <t-' .... .~.., '...._-\ '\~ ,-.~,.,.., ..,~, \, ,J , . \ .. , ,~\ t _~_ ~ J1 .¡~ \"\ '. ..... ,~---,. ..' 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'.-~ --I C .- ./!f - "- '; ~ . . E-MAIL: pacatty@optonline.net SIL. ~r<, æa/£~,mÚuU" 53345 MAIN ROAD (FEATHER HILL) P.O. 80X 846 SOUTHOLD, N.\'. 11971-0846 FAX. NO. (631) 765·5902 CAMILLE LUCARINI LEGAL ASSISTANT (631) 765·5900 LISA M. PENNY OFFICE MANAGER (5), IE li: IE n 'iJ IE t,ü IIì1l AU' -, 1004 J;1) Southold Town Board 01 Trustees August 6, 2004 T uwn of Southold Board of Trustees Po Box 11 79 Southold, NY 11971 Re: 50 Tuthill Road, Southold, NY SCTM# 1000-55-3-21 Dear Sir/Madam: 2004. Please be advised that the above referenced property has entered into contract on July 6, At this time we would like to transfer Permit #5899, dated 4/21104 from John and Joan Wee gar to James DeMilt, as contract vendee. Also enclosed is a survey with proposed changes. Please do not hesitate to call if you have any questions. Thank you. Very Truly Yours, . PAC/lp Encl. W~ Paul A. Caminiti ~tJj ) \\-ord.5. deml!ttrusteesJtr BO", of Trustees APPlicatioD4IÞ !( . County of Suffolk State of New York ..JOHN W6E:6-¡C}¡r:. BEING -DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABoVE DESCRIBED PERMIT ( S) AND THAT ALL STATEMENTs CONTAINED HEREIN ARE TRUE To THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE OONE 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 CONJUNCT! REVIEW OF THIS APPLICATION. '. SWORN To_BEFORE ME THIS -:(.\I}I DAY OF filii H :./00</ '- J /Li...(~ t1. /J 1:.4('-'... 'c,-,-- Notary Public MELISSA McGOWAN Notary Public. State of New ~ No. 4995913 Qualified In SuffOlk Cou"!r _" . Comnii8Sion expires May 4, ~ 7 . . Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda 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 _Çpastal Erosion Permit Application ~etland Permit Application /' Major _ W aiverl Amendment/Changes /Received Application:~ .......Received Fee:$~ ..,..eompleted Application~ _Incomplete _SEQRA Classification: Type I_Type II_Unlisted_ ~ordination:(date sent) ~CþC Referral Sent:~ _o15ate ofInspection:~ _Receipt ofCAC Report: _Lead Agency Oetennination: _lJ:ehnica1 Review: ~blic HearingHe~ Resolution: Minor ~~ ~,~,n ~~ ~ Soutlwld 10WIl B03íd ot TrlJsW::S Name of Applicant 1D~. :rO~ \)Jf£('A-f- Address ~6D 1" V'11+-Jl..L.... 12...D I 6DtJl1-tt)lD NLJ . I \q1 J ~ :J¡!50-¡'\f \tA / Phone Number:(~ j~ - 2-2 ~ Z- Suffolk County Tax Map Number: 1000.. 55- D3 - "2.. \ Property Location ~p 1""1IfI4-lu...-- ß/J,4-.) J 1:>0 l)1H-o L.b tv,! LJ 1-1Ft _I--D-( 5 M~ ýEtJNE.l..D"ff PA-f.1C. ~"T1J11-iuL.f l.n.b f'."~L J)f.lV£ (þrovide LILCO Pole #, distance to cross streets, and location) LI L-~0 AGENT (If applicable) Address: Phone: . . Board of Trustees Application GENERAL DATA Land Area (in square feet): 21,tð 2.3. ~ {. (,3 t::t ttc..) AreaZoning:~D ~l¥\t-i/1.\ ?1~le ¡~¡Y\l\~ Previous use of property: Val~..A-'\~ Intended use ofproperty:_t.¿~~tt\ha..\ ~', ~\e... ~~I\!:J Prior permits/approvals for site improvements: Agency . NON~ Atflxro Date ~ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? t/ No Yes -- If yes, provide explanation- Project Description (use attachments if necessary): '" ÛN'!n'IlJJI';:r /)N~ 6IN~~ fA-MILy-..UsiDE"NU -.Í'w>',&1.f: 't>~1"A-r~ f,Heb wI f.ÞrflAf:.E.: Pf>te.ú-es/iAoflD I fetJ~Nt., ;. UWD5CM'eJ) f-..A.LD~t..J5 . . . Board of Trustees Application WETLANDrrRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: -to ~ol'l.s,fvvc+ Dh.~ s.:o'\.J/~ -C....IN\./'rlA re·s,,:deCA.-c-e.... Wli-t.-. de+fA.ch.ed jti-V&Lr-- \ Area of wetlands on lot: ~4""+ square feet Percent coverage oflot: ~ % Closest distance betwe~n}learest existing structure and upland edge of wetlands: ~A feet Closest distance between nearest proposed structure and upland edge of wetlands: IFf feet Does the project involve excavation or filling? ~~f¡p;¡- IÌH~ No ¡,.../' Yes If yes, how much material will be excavated? ~.;f cubic yards How much material will be filled? ./I ¡/ cubic yards Depth of which material will be removed or deposited: /('# feet hJfJh/tJ; ~~ Proposed slope throughout the area of operations: - Manner in which material will be removed or deposited: ~ U,$ eel -?or ÞftC-/(PtLI- 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): AIt) e. t- ~e.-r ~JI W~Ì"1-.4-K~ C . . , 4·!6-4 ¡V871 ¡ex! 12 I PROJECT LD. "UMBE" 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION (To be completed by ADDlicant or Project sDonsor¡ SEa 1. APPLICANT ~~A ¡../ I 2. PROJEC- NA~ 3. PROJECT lOCATION: MuniclDality 5t7~l County ~;., F1=v1k.. 4. PAEC:SE LOCATION {Street aadress ana road intersections. prominenl lanamarks. elc_. Of provloe :nap) 11A--'t-}pU-- MM. J-c?T1F~ ¡Y¡~ Pf- YeK/Veß7ff~ (;) CIYN'?Ý ~ 1ÞZ--/l.-L// rÞ' ~ ,Lj?~ ~ ~vé. LJ /.r.#b 5. 1$ PROPOSED ACTION: New 0 Expansion o MOClificallon/alteralion 6. DESCRIBE PROJECT BRIEFLY: ~I I L. <.' ( .ç ·1 . . I o C-~"-S~vc..\ 0 '"'-"- -'> 'A~ <1- ~''1 res,,, e",-c..~ wl_Cjt<..(D.-se- J fJOVC~, !Pã-.+I'O ':-~c..¡'~...J r0s.s: b,(oz... ~ f-k-c.l....."C-d ~h~¿ cV L/LM-J~c..."-Pe- d()...vdeV\.":.: 7 AMOUNT OF LAND FrECTED: /. Imtiallv acres Ultimalely /¡/4- acres 3. 'IJILL ,::R.O?0Scu ACTION CCMPL':' 'NlTH 8(J$ìING ZONING OR OTHER EXISTING '....AND USE ::ïES7¡:HC7¡ONS? C Yes ~ No If No. 'descnbe brleily J _ (I\'\.. 't-£...- +- !Dee.()....l.IS..... O~ .\v'::'ShvvD.--ter w'€..., b--M-ðS 01"-. 0:' ~ttC; c.~:~\t" ( I t;. ,/...- --. 0 d r T .rVs.-é ~ -e'S p~...--.....,~ , s b~, ~'j a..ffl, ~d .(;. 0"'" 1--0 .......::1. lol.AJ~ pctL-y f;)-\- I 9. Vf.:H TIS ?RE3ENT LA/"~O l';::¡: IN '/IC:NIT':' ~F ?ADJECT? , ¡::¡asldenlial [j.~ncu.s:na ~ C,JmmerCIã.J esc~loe: LJ ,;gncUI!ure ......:. ParKIForestrOcen scace '- Other 10. DOES ACTION INVOLVE A ?~RMIT APPROVAL OR FUNDING. .'lOW OR ULTIMAiELY !='ROM ANY OTHER GOVERNMENTAL AGENCY ,F':iJERAL, STAT..l On LOCAL)? r I ID"Yes DNa If yes. !isl agenc'{(s) and permr!laDprovaJs A ~e ctt'v ð-t- N_oV\- LJu.,.-J l'sd1t.I/o., hlt.S hee~ r'E'ce¡'Je.d ~b""'~ D~~ +0", J....~+-:I!-Ç" ().....l'Ld ('o~\~H6.{t..~~ .-- 11. ,j,J0ES ANY ASP!:CT OF THE Acnor~ HAVE A CURRENTLY VALID PERMIT OR APCROVA~ \ LfJ Yes' 0 No If yes. lisl agel1cy name and permlt/aDproval 1+ L -e ~ 05 N . ~ - ..J ù .r d , c- + \ \. t'\... þH"'- rt'Ct::A'veJ ¿....k- Mt<.<e-t--. .5, Jvo'-f -h-ev----'\k DE:é, f-,I'-S 12. ,J,$ A RESULT 0 PROPOSED ACTION WILL 5:XISTING ?r=RMIT/APP~OVAL ;:1EOUIRE ....100IFIC.:.IICN? OY~s 0 ,J"PPlicant/Sponsor I CEi1T1FY THAT 'HE INFORMATION PROVIDED ABOVE IS T¡:¡UE -0 TH!:: 3ESï OF MY '<NCWL::;CGE D"e~ ~ () 0..- ^ A. \AJe e-.jCL""-- CL.- jN l-t¿ ð!}-""\....- ,1ame: SlgnalUre: If the action is in the C025tal Area. and you are a state agency, complete the Coastal Assessment Form before proceeding with this a~iiessment OV~R ?.J.F.ï 11_:;:~J'JIRO~H.~'=:Jï;" .c:.s3ME~ï ..) ::,:;: .::::~':i~~e~ :'( .J,:;;:=~C" . # .... :::Cë.5 ..:..C7:C.'~ :::(c.=~: :.:JY ,.:S, 7¡...:::E3r-:GLJ N 0) .'~'~::='"'' ~':'':::.Î 3:7_·:-:- ,r i~S. :::crOtnate ::1e r~Vt~W :rocess anc 'J:$~ :r.e ='...!L_ '::>1.'= '/~s .'~O =. .vIL~ ..:..C7:C;\l =<.E·::=:', '= :::CPCIN':" 72J ~E'¡!E'N .:.5 .=PC'JICE::J :::.:,;;; U~ILS;'":'J .:.:::-:-:::,·5 :;\1 .3 .\I'('2?R. :J.1.ñ, 0);;'";7 :nav :Ie $ucersece'.:: :.y ~ncti:er .nvClveo a<;enc"l. ./ .'~o, 1 1e<:;;;,t:va ::C..H" ·....~s '0 c, ':::ULO ...;C7;C~ .:J.E5üL7 N )"NY ..1.Gye::;SE ::::=:=:::·:73 ."\'SS':C:.:.ï~:J .VI7~ -:-:-:= .=JL~·':::"'J!·"G. .,1nswers ·~..v::e lancwrn:erl. 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I_cng :erm, 3nort :er:TI, '::.JmUtàlive, or :ltner '!rtee:s ('{at Icenllliea in C:-.:S? :::x::¡laln :'It1e!!'(. fio :tt:'!~ .mcaC:3 ·inc:...c;nç ::;-:ançes ,n ·Jsa of ~!tner :JUanuty ·-:r :'ce -Jt ~nergïJ? :~.;r;::¡!':;'ln ~rlerl.... (\fv _'~as :S -:-¡..,E;::¡E. ...:~:::;.:~ . C 3E. :::rJÎ:::¡evE?S'( =!2~ 7EQ 1-"0 ,0 .~0T:::.'JT!;'i... ":':::IJ::?S2 :::;'V¡RON,''''E~Jï':'L ..'.:Po..C73? ..J. S :...¡E?;e,:R f ~es, ~XC:laJn :¡nellv "ART III-OETi::\MINATICN OI<.SiGNIFICANCS ,To ~e C0r710leled ~y Agency) INSïRUC¡IONS~ rOf ~3C:1 adverse ~tfec= Identified at:cve. determine whether it is sucstantial. large. ;mcortant or otnerNlse sigmfic. ::'3C:' ~i!ec= silould ~e .assessed in connec:ion 'Nlln Its (a) setting (i.~. uroan or rural); ltJ ,Jrobacllity at oc:::~g; (c duration irre'/erSIDllity; ~el ge~qra.cnrc 3coce: ana (f) magnltuce_ If "ecessary, add attachments or reference supponinq ma[en3IS. ::1sure ,;xPlanaticns '::Jnraln suffic:ent aeIali ~o snow tnat all ~e!e'/ant adverse impacts nave been idenritied ana acequately aCcressec, C:-Jecx ~his JQX if you ¡,a'le Identiiiea cne 'Jr ;nore =otemiaH'I larçe or significant 2G'/erSe :m02c:s '....nIC;) ,·.i.4.'~ QC:::Jr. Then JrCce9':J airec=I'.I :0 :ne I=ULL =..:..r= lnafof ¡:Jreoare a positiv~ oeciaraticn. C:-Jecx :hls :::OX :f you :-tave Je!ermlned, Jased 'In the infcrmation and analysis above and any sucoor;:¡;¡Ç ,:oc'Jr.1entar!cn. :nat :r:e Jrooosea ac~ion WILL ,'JOT result InJf1,! slgmficant aCverse anvlrcnment.::.1 ¡m;:ac:: AND .::Hc'/lce ~n 3.~~ac~r.1en[s 35 necEssar'l. ¡he ~ea50ns 5Uccon:!ng U11S determInation: .....1".· 11 _"..U ....t:"("1 J"", J' . ,1,:<: ".,In" J' {c·,.:;cn;,OI<: _I¡,,:~r n ~"..o ·..;"ntl :.110: :>1 .¡"oOOn\'OI<: ulT,c~r "..:"""lH::' )1 ~~'con',OII!' ':'t'l(o!( " _<,.J{J ".;~n(Y ,.'(n..::.HI!' )I ....·..·J...r~r 'II ":1I:o:'..n( .r-:lm 'I!'\Oon;lo,~ Jr',(~rl J..ll" o . . 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 BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of __jOhrL~LjO~~LUUt4Q{---------------- COUNTY OF SUFFOLK) ST ATE OF NEW YORK) AFFIDAVIT OF POSTING I, J 0............ Þf _ ("J a j............ , residing at ot-S Q 'It.-- -t1.-.. n \ Q 0 c...d ~ol.A-~oIJ r /V.'-/, being duly sworn, depose and say: That on thep day of tlp.-..l ,200+. I personally posted the property known as .p; SO ., !A.:H,,· 1/ l€. 0 e.... d 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 eight days prior to the date of the public hearing. Date of hearing noted thereon to be held I OU1: 1');00 Dated: 41 3 /" t..f ~ Ú-- Jk- ( ature) ~ Sworn to before me this /3'" day ofAp,; I 200 ~ _é! . ......, No. 0 :lr'-.n ~ ~2007 . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: J7i111 n¿;L'-I;1 Address: tJ.s- .LPN'} ðv?&-~ )jy: S&¡<.fi-p'1d· ,¡It¡, 11<}7) ~/Þ.I (.]/J-rrPL , C/t/hl~- ~J¡?)F .3> g') [? Dr> ./o/H-kl /fr e. kN-??~ '-/vA--' mAYj )/7#"d 20 £3Q':; STATE OF NEW YORK COUNTY OF SUFFOLK \0 CLV\.lLJ ~ £.-'r1V" ,residing at óI.. 5"0 -r ",-+1-,.: II eo J So", tho teL . N" II q '1, ,being duly sworn, deposes and says that on the 31 "'"Í day'of f'\.a.-vc.."-. ,20~ deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town ef Southold; that said Notices were mailed at the United States Post Office at ;"D IA +£... 0 fA AI....¡, , that said Notices were mailed to each of said persons by (certified) (registered) ma¡(. ~ A JP' . .~ Sworn to before me this I q H) Day 0 ,20 [.4 ~t CAROl am NaIIIr ....bfic Stale III New'" ft._!\" 0' BE6097127 . _lied In Suffaa CcMdIr t'1 inion ÚIkIS __11; 2007 . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: ?j¢ m/C-Jj Address: fS- ,LpN1 ðv~k.. J)y: ~t<j-ù?'1d· KIf'1191) <JP;Þ./ (!/ì-tYP L C/t? Jt1~- It>/p)F 3 g')¡:? V¿,H'FéJå ðre- kN??~-fo1V WlIWJ)/TA/d 20ßtl6 STATE OF NEW YORK COUNTY OF SUFFOLK \OlLV\.W~""''a:Ar ,residingat ótS-Ò YIA....+-h.;ll Qoø-d 3;0 "'- tho .,i. -, N" I I q '11 ,being duly sworn, deposes and says that on the day of ,20_, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town efSouthold; that said Notices were mailed at the United States Post Office at ~D.... i-t.. D fA A/.--I, ,that said Notices were mailed to each of said persons by (certified) (registered) mad. ~A.J)I~ Sworn to before me tl1is / q 'Hl Day 0 1,,20 Ot/- ..,,r.øm ...=1Io.Olan!;- eel in SuIIaIII ÛiIIIa..- fIII07 . . Board of Trustees Application County of Suffolk State of New York J () fÁ... V\ A- (N~~~W BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) 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 REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. ~- ~~~/ , Signature ' SWORN TO BEFORE ME THIS / qth DAY OF ma r(1v . ,20£1 . . Board of Trustees Application County of Suffolk State of New York J b ("-. "I. A - Lv < e.. ~£.\(" BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE HE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HISIHER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPqCATION 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. ~.. A- Jt-~ / : Signature - SWORN TO BEFORE ME THIS l Q Ih DAY OF mCt rr Iv ,20-fl ~{æ Noll CAAOl 8m ~1..._Il:1ñ . -..ïl2l107 . . APPLICANT/AGENTnREPRESENTATfVE TRANSACTIONAL DISCLOSURE FORM The Town of South old's Code of Ethics rohibits conflicts of interest on the of town officers and 10 . The se of this Conn is to Drovide infonnation which can alert the town ofoossible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: O~V\. €. (Last name, first name. middle initial, unless ou are applying in the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance ../ Change of Zone Approval of plat Exemption from plat or official map Other ([f"Other", name the activity.) Do you personally (or through your company. spouse, sibling, parent, or child) have a relationship with any officer or employee afthe Town of South old? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer or employee has even 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 If you answered "YES", complete the balance of this fonn and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself (the applicant/agent/representative) and the town officer or employee. Either check the 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): _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 Submitted this / q~ay of ¡')\(.L ý(....~ 200..:f- Signature ~ ~ .~~ Print Name A'\· iu..r-