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Home My WebLink AboutTR-6040 James F. King, President Jill M. Doherty, Vice~President Peggy A. Dickerson Dave Bergen John Holzapfel Town Hall 58095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1592 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: FROM: DATE: RE: Building Dept. Board of Trustees March 15, 2006 ANTHONY & NICOLE SPIRIDAKI$ 89'15 $OUNDVlEW AVE., $OUTHOLD $CTM#§9-6-27.3 With regard to the above-referenced property, an inspection was made and it was determined that the single-family dwelling and garage were constructed in compliance with Wetland Permit #6040, as issued on December 20, 2004. If you have any questions, please do not hesitate to contact us. Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 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 ¼ constructed Project complete, compliance inspection. oF 51TUATE: TOINN: ~UTHOLD 5Ut=FOLK GOUNTT, Nh' F~UP. VEYED I0-1~-2004 AMENDED 12-01-2004, 12-14-2004 02-14-2005, 0:~-11-2005, 0~-14-2005, FINAL e~URV'E¥ 02-0-1-200~, 02-0~-2006, 02-29-200(2 E:AJFFOLK COUNT'¢ TAX # I000- ~ - 6 - 2-L~ SUFFOLK COUNT'f' DEPT. OF HEALTH SERVIC. FS REF. RIO - 04 - 0188 N W + S E L~and No~ or Formerl~ of, 6eocene L PennU IV P~elling 253.10' % \ \ \ \ cie~vcw / / 0 PIPE F~NO -~_ s '/ / ELEVATIONS ~FERENOE N¢VO 2q DA~H .... ~ '~ : 4- / PROPER~ ZONE R 40 //~ ~TLANDS AS MARKED B~ ~B FOX DA~D MARCH IO, 2005 F]~/ c ~,, ~,'*~ .... , ~8 NY5 Freshwater ~land ~undar~ Is ¢~u~l ~o R. FOXS line as sho~n on ~ ¢, ~ ] '~ .... [he 5urve~ ~rep~red ~ John Ehler5 R. Marsh ~/6/05 ' gcg~ell locations ae per ~llde¢ - JOHN C: EHE~RS LAND SURVEYOR A~A = qD~ll 5.F. or I.&q4D A6RE5 GRAPHIC SCALE 6 EAST MAI]q STREET N.Y.S. LIC. NO. 50202 RIVERHEAD, N.Y. 11901 369-8288 Fax 369-8287 REF.\\Compaqserver\pros\03\03-249 LOT 27 3FINAL.pro Albert J. tCrupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631,765-1366 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 ~ constructed Project complete, compliance inspection. Board Of $outhold 'Town Trustees SOUTHOLD, NEW YORK PERMIT NO ................... DATE: p.~.c~.~q, ..~P0.~ ISSUED TO ANTHONY \ P i~£C,).~,r ]P[ili,;t~2ZH .................................... ,ttt'l arizatimt P ant to the -rovlslons of Chapter 6l$ of the ~ws of Jhe Ste~ of New Yo&, 1893, end ~pter ~ the ~ of ~he State of New Yo& 1952; and fha Southold To~n Ordinance en- t~ed :'~U~TIN$ AND THE P~ClN$-OF OBSTRUC~S IN AND ON TOWN WATERS AND PUBLIC ~NDS and t~ REMOVAL OF SAND, SRAVEL OR OTHER MATERIALSrF~M ~NDS .UNDER TOWN 'WA~RSY. end in acc~dauce wifh ~fhe Resol~ion of The Board adopted efa meeting held on .?.~.~ Z~.. - .2Q~6...., end in consideration of fha sum of $g50.~ .... paid by Anthony and N$coZe Sp~rLda~s ............................... . ............ : ......... of SouthoLd ........ N. Y. end $ubjec~ fo th~ Ter~"""~'~"""~'~S""'J~s'~e~" .on the rev?.e side ~r~f, ~. .of o~thold Town' Tr~ees eu~ho.zes end ~rm;h fha following: wetian~ ~ermit to construct a single-famil'y dwelling with a garage, sanitary system and pool 'with the conditions of gutters and drywells to contain al~ roof runoff, a 50'non-disturbance buffer and a dry well for the pool, and all as depicted on the .~e ~ginaflng appK~fi~'surveyed by John Ehlers last dated : 2/14/0~jN W~S WHERe, %e sald ~ard 0f T~sfees ~re- by ~uses ifs ~r~raJe ~al fo ~e a~xed, and ~ese p~esenh Jo be su5s~ed by a '~j~ of the sa*d ~rd as of th~s date. uao " Anthony,and. Nicole Spiridakis t~{dlttg ~ Southold .... . ..... N. ~'~ t~ That the said Boud o~ Tt't~ees and die Town o/ So. hold ate tclGt~ed from thy ~ d~m.o~c~ O~ ~4.;~,( for dama6~K~ of mits arising, d/.~ctly ot ]ndLrecdy ~u · ~ of say ope~- rUpect the~e~, ~o .d~e~plete 'eT. dmion of d~e ~ of TDm~e~ of tl~ To~n of So,~hold lot aa ex~on may be n~de to the Bo~d at That ~ Pe~m;t should ~ re~!~ed ~def~ly, or ~ lon~ a~ the raid Perma,tee ~ d~ Kmct~e or project involved, to provide ~ to anyone concerned ~'~za~ion wa~ originally That the ~ iavolved ~ ~ subject to the Jnspec~i<m snd ai, ptoval o~ (he ]Bo~l zt sgem% ~ non-mm~',~".- with the pt'-dom of (he mtg~-,~-g appli(mtion, may be c--~_ for revocation of th~ Pen~t by te~olution o~ the ~M ~ .~. Ths. c d~et'e ,will be no unteuonable interference wid~ mTiglt~OO ~S · result of the we~ het~n au't~otize(L · ' npon due no~ce~ to t'emove or slte~ d~s wod~ ot project I~'e/n st~ed wl~_ ext~en~ to the To~n. 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 TOVCN OF SOUTHOLD December 20, 2004 Building Inspection Services 606 Fox Hill Drive, Baiting Hollow, New York 11933 RE: ANTHONY AND NICOLE SPIRIDAKIS 8915 SOUNDVIEW AVE, SOUTHOLD SCTM# 59-6-27.003 Dear Mr. Scholz: The Board of Town Trustees took the following action during its regular meeting held on Monday December 20, 2004 regarding the above matter: WHEREAS Building Inspection Services as agent for ANTHONY AND NICOLE SPIRIDAKIS 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 November 5, 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 December 20, 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, 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, RESOLVED, that the Board of Trustees approve the application of ANTHONY AND NICOLE SPIRIDAKI$ to construct a single-family dwelling with a garage, sanitary system and pool with the conditions of gutters and drywells to contain all roof runoff, a 50' non-disturbance buffer, a hay bale line at the 50' line from the pond and a dry well for the pool, and all as depicted on the plan surveyed by John Ehlers and last dated 2/14/0~' 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.) This is not a determination from any other agency. Fees: $50.00 Final Inspection Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/hct Albert J. Krupski, President James King, Vice-President .~rt ie Foster Ken Poliwoda Peg~, A. Diekerson Totem 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 Please be advised that your application dated i/~OV, ~, 200 H has been reviewed by this Board at the regular meeting of ~ ~, ;~ % 2oo¥ and the following action was taken: (~) Application Approved (see below) (__) Application Denied (see below) ( ) Application Tabled (see below) If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ SIGNED: PRESIDENT, BOARD OF TRUSTEES Albert J. [~'u t James Ki~g, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickers~m BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971.-0959 Telephone (~31~ 765-1892 Fax (631) 76~1366 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 ¼ constructed V'/ Project complete, compliance inspection. RESOLUTION RESOLVED that the Board of Trustees of the Town of Southold hereby finds that the application of ANTHONY AND NICOLE SPIRIDAKIS more fully described in the public hearing item #13 of the Trustee agenda dated Monday December 20, 2004, is classified as a Type II Action pursuant to SEQRA Rules and Regulations, and is not subject to review under SEQRA. Telephone · fir~ l~ 'Y~ Town Hall (63 I) 765-1892 ~ 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 Tues., December 7, 2004, the following recommendation was made: Moved by Jack McGreevy, seconded by Nicholas Dickerson, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit application of ANTHONY & NICOLE SPIRIDAKIS to construct a single-family dwelling with a garage. Located: 8915 Soundview Ave., Southold. SCTM#59-6-27.3 The CAC recommends Approval to construct a single-family dwelling with the condition hay bales are placed down before construction and a limit to the number of trees removed. Vote of Council: Ayes: All Motion Carried 5t)RVEY OP PROPER'Pr' 51TUA'I'~-- 50U'I'HOLP TOHN.. 5OLm-IOLD 5b~TOLK C.,OUNT~, .GORVEYED A~ENDED I;2-01-2004, 12-14-2OO4 O2-14-2OO5 5,0FFOLK COUNTY TAX =it. lO00- Dq - & - SEPTIC., [?ESI~N BY' MICHAEL MAPE.G P.E. TEST HOLE 6EO561ENbE ®eorc:je L. Penn~j Iq \ NOTES: 0 EC~¢E OF: K, IETLANC~5 ELEVATIONS REFERENCE N~V~ ',~ATUM PROPERTY ZONE R 40 AREA = "/D,~II 5.F. or I.&q45 ACRES ~t::~,/kPHIC, ~C.,ALE I"= ..50' JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 RiN~RHEAD, N.Y. 11901 369-8288 Fax 369-8287 REF.\'ffIp servefxd~PROS\03-249 LOT 27_3.pro Albert J. Krupski, President James King, Vice-President Attic 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 Coastal Erosion perrmt Application ~..~'~'etland Permit Application ~"Nlajor Waiver/Amendment/Chanl~es ~.ece~-vved Application:~_.c~_ ~---~Received Fee:$ --~7ompleted Application ! [ [ ~] Ox/ __Incomplete __SEQR~ Classification: Type I Type II Unlisted Coordination:(date sent) ~-~L'~AC Referral Sent: ] --,,~ate of Inspection: __Receipt of CAC Report: __Lead Agency Determination: Technical Review: ~--_-~P~blic Hearing Held: __Resolution: Minor NOV - 5 2~31D4 $outhold Iowo Board of Trustees Name of Applicant Anthony & Nicole Spiridakis Address 770 N. Bayview Rd. Southold, New York 11971 Phone Number:( ) 0¢,5 '33q9 Suffolk County Tax Map Number: 1000- 059.00-06.00-027.003 Property Location: 8915 Soundview Ave. (west side) (provide LILCO Pole #, distance to cross streets, and location) AGENT: Building Inspection Services - Michael J. Scholz (If applicable) Address: 606 Fox Hill Dr., Baiting Hollow, New York 11933 Phone: (516) 909-9145 .- Board of Trustees Application Land Area (in square feet): Area Zoning: a-4 0 GENERAL DATA 23,277 Sq. ft. Previous use ofpropeny: x,a~ne (~-40) Intended use ofpropeny:. Single family dwelling 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):. Single familydwelling with garage Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Single family dwelling Area of wetlands on lot: 0 square feet Percent coverage of lot: 0 % Closest distance between nearest existing structure and upland edge of wetlands: 0 feet Closest distance between nearest proposed structure and upland edge of wetlands: 5 0 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? N/A 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 Movement of existing soil for placement of family dwellinq foundation 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 COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Single family dwelling Are wetlands present within 100 feet of the proposed activity? No X Yes Does the project involve excavation or filling? X No Yes If Yes, how much material will be excavated? 0 (cubic yards) How much material will be filled? 0 (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) Movement of existing soil for placement of sinqle family dwelling foundation 50' from "Great Pond" PROJECT ID NUMBER SEQR PART 1 - PROJECT INFORMATION t. APPLICANT / SPONSOR Anthony & Nicole Spiridakis 3.PROJECT LOCATION: Municipality Southold 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Pro~ect Sponsor) 2. PROJECT NAME PRECISE LOCATION: Street Addess and Road Intemec§on 8915 Soundview Ave. (west side Prominent landmacks etc-or ~'ovide mad west side of property abuts "Great Pond" .'SPROPOSEO^CT.ON []New [ pan.,on 6. DESCRIBE PROJECT BRIEFLY: Single family dwelling - Approx. 1750 Sq. ft. footprint ?. AMOUNT OF LAND AFFECTED' Initially ac~es Ultimately acms Approx. 2500 Sq. ft. 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS9 []Yes [] No If no. desc~be briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as manyas apply.) ~'~'1Residential [~lndustdal ['~Commercial ~'-~Agdcu~ture ~]ParklForesl/OpenSpace [~Other (describe) 10 DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal. State or Local) ~]Yes [~No It yes. llst agency name and permit I approval 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [~]Yes ~--']No If yes, Iisi agency name and permit ! approval' 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUrRE MOOIFICATION7 I CERTIFY THAT THE INFORMAT~ON PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applican{ / Sponsor Name Date Slgnalure If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II o IMPACT ASSESSMENT (To be completed by Lead A~lencyI A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN S NYCRR PART 617 4'~ · · [] Ye~s [] No . · · ,f yes, coo~'d,nate the rev,ew process and use the FULL EAF. S W~LLACT~~NRECE~vEC~~RDtNATEDREV~EWASPR~V~DEDF~RUNLrsTE~ACT~~NS~N6NYCRR~PART617-6? ifNo. anegaUve declaration may be superseded by another involved agency. l--lYes C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WiTH THE FOLLOWING: (Answers may be handwritten, if JegJb)e} potenUal for erosion, drainage or ilooding problems? Explain bdefly: NO - Erosion control/containment will be used during constructio~ c~ Aes~ ~ric~ ~ ........... C3. Vegetation or fauna, fish. Sh~gniflcant habitats, O~ndangered species? C5 Growth, subsequenl developmenl, or related ~ly Io be induced by the proposed action~ Exp ain bde~y.'~ C6. Longtem~ shorttarrn cumulative orothereffectsnoiidenbfied~nCl.C5? ~ ' ~ C7. Other im acts includin chart es in use of either u~ D WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRIT~ICAi ENVIRONMENTAL AREA (CF~,)? (if yes, explain bde~]}/: [~] Yes {~No E IS THERE, OR IS YHERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If)'es explain: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is subs an al, large, important or otherwise significant. Each effecl should be assessed in connection with its (a) setting (i.e. urban or ~ural): (b) probability of occurring: (c) duration: (d) irreversibilily; (e) geographic scope; and (0 magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain su~cientde~ai~{~sh~wtha~re~evantadverseimpactshaVebeeniden~i~edandadequate~yaddressed If question d of part ii was checked yes, the determination of significance must evaluate the potential impact of the proposed achon on the environmental characteristJc, s of the CEA. Check this box ~f you have identdied one or more potentially large or signil~Canl adverse impacts which MAY occur Then proceed directly ta the FULl EAF and/or prepare a positive declaration Check this box if yo~ have determined, based on the intormation and analysis above and any suppoding documentation, that/he proposed actior WILL NOT result in any signilicanl adverse environmental impacts AND prov de. on attachments as necessa~. /he reasons supporting thi~ determination. Name of Lead Agency Title of ResponsibJe O~ficer Pnnl or Type Name of Responsible Officer in Lead Agency NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES~ TOWN OF SOUTHOLD In the matter of applicant: Anthony & Nicole Spiridakis YOU ARE HEREBY GIVEN NOTICE: 1. SCTM# 1000-059.0-06.00-027.003 Thatitistheintentionof~eundersignedtorequestaPermit~omtheBo~dofTmstees to: Build single family dwelling 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: That the project which is subject to Environmental Review under Chapters 32, 37, and/or 97 of the Town Code is open to public comment on: . 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 tha~t might have to review same proposal. OWNERS NAME: Anthony & Nicole Spiridakis MA~NGADDRESS:770 N. Bayview Rd. Southold, New York 11971 PHONE #: Enc: Copy of sketch or plan showing proposal for your convenience. PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Anthony & Nicole Spiridakis Address: 770 N. Bayview Rd. Southold, New York 11971 STATE OF NEW YORK COUNTY OF SUFFOLK Anthony Spiridakis , residing at 77~ N. R~yv~w R~ Southold t N.Y. 11971 , being duly sworn, deposes and says that on the day of ,20 , deponent mailed a true copy o f 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 of Southold; that said Notices were mailed at the United States Post Office at ., thaLsaid Notices were mailed to each of said persons by (certified) (registered) mail. Sworn to before me this Day of ,20 Notary Public Board of Trustees Application County of Suffolk State of New York Anthony Soiridakis BEING DULY SWORN DEPOSES AND AFFLRMS 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 TI{E TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS DAY OF Notary Public " Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggs' 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 COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, tu[,e.~t.~,"~. ~>q-~ [:g,, residing at &Ore ~"0YJ,~k), being duly*sworn, depose and say: Thatonthe IO dayof~),cC, , 200'(, I personally posted the property known as %~...,,-k~L,&.~. _ _ C_~c.~l~'~ . ..s'9 -r~ -a.'>.oo$ by placing the Board of Trustees officml 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 heating. Date of hearing noted thereon to be held t/D~DD , Dated: Sworn to before me this /d~ dayof,~.. 200~/ Not~{ry./~ublic XATHLEEN ~ COLE NOTARY PUBLIC ~tate 9~ New York Oua!ifred m %ffolk Coun~ Commission Expires February 28, t~gnature)~ of Trustees App~icatio~ Ab'r~OP.I ZAT~ON (where the applicant is not the owner) Clement Charnews (print owner of property) residing at 40655 County Rd. 48 (mailing address) Southold, New York 11971 Services - Michael J. Scholz do hereby authorize Buildonq Inspection (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. ~/ (Owner s signaUure) 8 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM Thc Town of Southold's Code of Ethics prohibits conflicts of interest on thc oat of town officers and cmolovees. Thc ouroos~ vi' this form is to orovidc information which can alcr~ thc town of ~ossiblc conflic~ o£intemst and allow it to take whatever action i~ YOUR NAME: Anthony & Nicole Spiridakis Represented by Building Inspection (L~t name, fzrs~ name,~niddle initial, unless you are applying in the name of Service s (Michae 1 J. 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 Zooe Approval of plat Exemption from plat or official map Other (If"Other-, name the activity.) Building Trustee Coastal Erosion Mooring Planning Sholz) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? ~Relationship" includes by blood, marriage, or business interest =Business interest" means n business, including a partnership, in which {he town officer or employee has even a partial ownership of (or employment by) a conporation in which the town officer or employee owns more than 5% of the shams. 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 o£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 o£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 coq~oration); C) an officer, director, panner, or employee of the applicant; or __D) the actual applicant. DESCRIPTION OF RELATIONSHIP None Form TS I Submitted this Signature Print Name day of 200