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Home My WebLink AboutTR-5604 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel 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 SOUTH OLD CERTIFICATE OF COMPLIANCE # 0133C Date July 24, 2006 THIS CERTIFIES that the single family dwelling and 50' buffer At 850 Private Road, #22 Suffolk County Tax Map # 76-1-15.6 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 7/2/02 pursuant to which Trustees Permit # 5604 Dated 8/23/02 Was issued, and conforms to all ofthe requirements and conditions ofthe applicable provisions of law. The project for which this certificate is being issued is to construct a single family dwelling w/basement, and a 50'non disturbance buffer. The certificate is issued to Victor Rerisi owner ofthe aforesaid property. ro<~ Authorized Signature James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel Town Hall 53095 Ronte 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 August 23, 2006 Gail A. Rerisi Attorney at Law 5 Bethpage Rd. Hicksville, NY 11801 RE: 850 PRIVATE RD.#22, SOUTHOLD SCTM#76-1-15.6 Dear Ms. Rerisi: The following action was taken at the Southold Town Board of Trustees regular meeting held on Wednesday, August 23, 2006: RESOLVED, that the South old Town Board of Trustees APPROVE the request for a Transfer of Permit #5604 from Stephen E. Brander to Victor Rerisi, as issued on August 21, 2002. If you have any questions, please contact our office at (631) 765-1892. Sincerely, JCKi: ~ President, Board of Trustees JFK:lms . . GAIL A. RERISI ATTORNEY AT LAW 5 BETH PAGE ROAD HICKSVILLE, NEW YORK 11801 (516) 939-0669 FAX (516) 939-9006 .July 26, 2006 Board of Town Trustees Town of Southold 53095 Route 25 PO Box 1170 Southold, NY 11971 r RE Permit 5605 Permit 5604 JUL 2 8 2006 L. Dear Board of Trustees: This is a request to transfer Permit # 5604 issued to the prior owner,Stephen E. Brander, on August 23, 2002 to the current owner, Victor Rerisi, PO Box 112, Bayvil/e, NY 11709. Likewise, this is a request to transfer Permit # 5605 issued to the prior owner, Patrice M. McCaffrey, on August 23, 2002 to the current owner, Gail Rerisi, PO Box 112, Bayvil/e, NY 11709. Enclosed is a check in the amount of $100.00 to cover the fee for both of the above. If you should have any further questions, please contact me at your convenience. S;tPo~ "Gail Rerisi 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. ,6 Iòt. VI. ct -(J-- INSPECTION SCHEDULE ~ Pre-construction, hay bale line 1.., <" .... ·,1-',,1' .... ,. . ¡.......t ., '. .... ,-- ':':i _,7,· _ 1st day of construction ."'.. , t .: _~. ~ I.. . ,'", ---. -- .'~"""''-''~ ...- l .......-.~ /'% constructed _ Project complete, compliance inspection. Board Of Southold Town Trustees SOUTH OLD, NEW YORK PERMIT NO. . SItJO;' STEPHEN E. BRANDER ISSUED TO ouu .u......m Autqnrilutinn DATE: .,<\.~gust 23, Pursuant to the provisions of Chapter 615 of the Laws of the State of New Yorlc, 1893: and Chapter 404 of the Laws of the State of New York 1952: and the Southold 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 Böard adopted at a meeting held onm~~&: u2o~.'. 2002., and in consideration of the sum of $..?O~..~O . paid by St~Pl1en E,I~rancl"'r . ....Om. of .uBaþylon, . . N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, . of Southol.d Town Trustees authorizes and permits the foRowing: ~ W~tland- Perml~ to construct a single-family dwelling w/basement. 1 wlth the conditIOn that drywells and gutters are installed to con ! the roof run-off an~ hay b.ales are placed down beiore the project' . begms,along the 50 non-dlsturbance buffer line,and as depicted aU in accordance with the detailed specifications as presented in the originating application. on the survey dated July 1, 2002 and last revised August 20, 2002. IN WITNESS WHEREOF, The said Board of Trustees here- by causes. its Corporat~ S~al to be a~xed, and these P!esents to be subscribed by a maorlty of the said Board as of this dat.e. Truslt.. . . TERMS and CONDmONS The Pennittee Stephen E. Brander residing at 79 Ketewamoke Ave.. Babylon N. y~ as put of the coosideratioo for che i""onœ of che Peaoit does uødcnwJd and prescribe to the fol- lowing : 1. That the said Board of Trustees and che Town 01 SouthoId are released from my and aU damages, « claims fOf: damages, of aula aåsiag dùccdy « Iaditecdy as a result 01 my o~. atioa performed punuaat to this permit, and che said p,.. J!{"" will, at his « bet 0II'II at' [ROO . defend my and aU such lllits°ådtiaœd by tbkd potties, and the said 11 .¡,!~ ,- faI1lJa1>i1ky wich respect thereto, to the """'f'Iete exdasioo of the Board of Trasues of the TO11'II of ~ 2. That this Petmit is° nIid for a period of 24 mos. wbich is (1O...ldcted to be the estimated time 0 requited to compleœ the wodc ù>~Md, but sboa1d årcmiiow>ces warnar, request for IUl exœnsion may be made to the Board at a 1ater cIaœ. 3. That this Permit should be reUiøed indef"lDÌtely, or as loag as the said Perm/uee wishes to m.¡....¡n the structure or project ù>volved, to provide evidence to &"7OfIC œocemed that aad>- orizatioo was originally obtained. 4. That the work iarolved will be subject to the iaspection and approva1 of the Board Of: ¡IS agents, and non-œmpliaaœ with the provisioas of the origi....,;'" oppliatioa, may be cause f« revocation of this Peaoit by resolution of the said Boatd. 5. That there will be DO IlDnaSODable inteeferenœ wich navigation as a result of the wod: herein ....thorizcd. 6. That there shall be 00 interference wich the right of the public to pass and lepUS aIoag the beach between high and low _tee marks. 7. That if future operations of the Town of Southold require che --.I and/Of: aItaadoas ù> the Iocatioa of che wodc he.rei.n ...tbodzed, or if, ù> che opùùon of che Board of Trnstees, the 0 wado: shall cause unreasonable obsttuc!1on to free navigadoa, the said PemIittee will be required, upoa due notiœ, to remove or aItt;r this work or project herein stated wicbout upeoses to the Town of Southold. 8. That che said Board will be notified by the Peaoittee ot the CIOtIJf>Iedoa of che "f9'Otk aad>- orizcd. 9. That che Permirtee will obWn aU other permits and conseoll chat may be required IUp- plemental to chis permit whkh may be subject to revoke upon foi1ute to obtain ....... 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 August 23, 2002 Mr. Slephen E. Brander 79 Ketewamoke Ave. Babylon, NY I 1702 RE: 850 Private Rd., #22, Soutbold SCTM#76-1-15.6 Dear Mr. Brander: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, August 21, 2002 regarding the above matter: WHEREAS, STEPHEN E. BRANDER applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated July 2, 2002, 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 August 21, 2002, 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, 2 . . NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of STEPHEN E. BRANDER to construct a single-family dwelling with a basement, with the condition that drywells and gutters are installed to contain the roof run-off and hay bales are placed down before the project begins, along the 50' non-disturbance buffer line, and as depicted on the survey dated July 1, 2002 and last revised August 20, 2002. 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 ofthe date of this notification. Inspections are required at a fee of$5.00 per inspection. (See attached schedule.) Fees: $10.00 Very truly yours, t2~ ~ ß!r..._t>J&.' G.. ,£ ¡ " Albert J. Krupsk'i, Jr. President, Board of Trustees AJKllms ---.-" --.-"- --- FRX NO. 6316696682 . Rug. 20 2002 10: 10RM Pi FROM : STEPHEN BRRNDER Stephen Brander & Patrice McCaffrey 79 Ketewamoke Ave Babylon, NY 11702 Ph & Fax 631-669-6682 20 August 2002 it ,- Southold Township Board of Trustees PO BOX 1179 $cuthald, N.Y 11971-0959 631-765-1892 ¡ ."\ ~~¡'i:~2 :~ To-tne..attentùm of La~ren; .' Re: Submittal of Site Plans showing Wetland Buffer Zone Boundary 2 properties SCTM # 1000-76-1-15.3 & 15.6 Dear Lauren: Thank you for your call informing us of the Trustees' approval of lot 15.3 and the conditional approval of 15.6. We agree with the Trustees' findings and have' instructed our Surveyor to position the building on lot 15.6 10' landward of its current position on the survey. We will resubmit the survey with the requested change; however, as we were traveling and only received the voicemail yesterday I will be unable to have the survey updated before the meeting.tomorrow night. Please accept this letter as our agreeing to the recommendation and be assured that as soon as we reCeive the updated survey we will forward it to you. ~:~_'~Mé .- .. Stephen E. Brander &Patrice M. MCCaffre'i~ . . Stephen Brander & Patrice McCaffrey 79 Ketewamoke Ave Babylon, NY 11702 Ph & Fax 631-669-6682 ~.. 30 July 2002 11 ì II: , I P AUG - I :ï'li ; ~ I: . ~ . ., I Ms. Charlotte Cunningham Southold Township Board of Trustees PO BOX 1179 Southold, NY 11971-0959 631-765-1892 Re: Submittal of Site Plans showing Wetland Buffer Zone Boundary 2 properties SCTM # 1000-76-1-15.3 & 15.6 Dear Ms. Cunningham: Following up on our conversation of 11 July 2002 I have had my surveyor add the necessary information regarding the above matter. He has also staked the seaward boundaries of the proposed structures on the Ic!!s in question. Please review and advise your findings. I would like to point out that these lots are much larger than the surrounding; lots in the bordering neighborhoods. The coverage of the adjaceni land is very low, as the driveway and parking areas will be porous aggregate; and the elevation of the land where we propose placing the structures i$ 12 to 18 feet above the high water level. Our adhering to the 50 ft. buffer along with these factors shall make their Impact on the wetlands inconsequential. In fact due 10 the shape of the Wetlands boundary only the northwesterly corners of the structure approach the buffer. On average the distance of the structure from the boundary is more like 60 feet on lot 15.3 and far greater on 15.6. We hope that you can approve these applications in an expeditious manner. The Suffolk County Water Authority is putting in the water this month and we would like to get moving on the structures as soon as possible. Sincerely, ~atriL~¿;(~ , . . . Telephone (631) 765-1892 Town Hall. 53095 Main Road P.O. Box 1179 Soutbold, New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the South old Town ConserVation Advisory Council held Wednesday, July 17, 2002, the following recommendation was made: Moved by Drew Dillingham, seconded by Nicholas Dickerson, it was RESOLVED to recommend to the South old Town Board ofTrustees DI§APPROVAL of the Wetland Permit Application of STEPHEN E. BRANDER to construèfå' sin9'e-fåmily dwelling with basement. . Located: 850 Private Rd. #22, Southold. SCTM#76-1-15.6 The CAC recommends Disapproval of the application because the project was not staked and flagged. Vote of Council: Ayes: All Motion Carried FROM STEPHEN BRANDER . 4IÞ FAX NO. : 6316696682 ... ~l. 172002 11:14AM Pi Stephen Brander & Patrice McCaffrey 79 Ketewamoke Ave Babylon, NY 11702 Ph-.&..Fax.53 ~-669-6682 \ 11 July 2002 Ms. Charlotte Cunningham Southold Township Board of Trustees Re: He.aring OIl the. Wetlands permit ñJr.lctsJ OQQ-76-1-15.3 and..15.6 Dear Charlotte: We. wo.wd Ilke to reque.s.t. arescheclufing,of our hearing on the Wetlands.permit in order that we can have our surveyor stake the property and include the 50' ' wetlands do not disturb area on the surve~s in qµestion. \ Could you please table the issue for this coming Wednesday, July 24th. and reschedule for Wednesday, August 14th? We will get the required issufi!s in order. I Sincerely, ~~~~~~, íf~ " \, ~ .-,--'·r~~ , L. . ~ 1 , 1·\ Ucl \ :\C" ?Sj'01 . jljL \ 1 ,..~. \ o· . &l1'" ..... .~. \. .~. \~ ~J ~ - ... 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M3IMW NI'dW !! ~ g! ~ 76.-1-15.6 850 PRIVATE = OWNER & MAILING RERISI VICTOR & MATASSA VINCENT 5 BETHPAGE lID HICKSVILLE NY 11801 DATE: 01/19/2005 ROLL SEC TAXABLE TOTAL RES SITE TOTAL COM SITE ACCT NO 10 1======== ====== ASSESSMENT DATA =========== I **CURRENT** RES PERCENT lLANO 1,200 **TAXABLE** I TOTAL 1,200 COUNTY **PRIOR** TOWN I lLANO 1,200 SCHOOL I I TOTAL 1,200 ==DIMEN~IONS ===1======= SALES INFORMATION ================================== ACRES .90 IBOOK 12255 SALE DATE OS/28/03 SALE PRICE 225,000 I PAGE 181 PR OWNER BRANDER STEPHAN E =======TOTAL EXEMPTIONS 0 =============1== TOTAL SPECIAL DISTRICTS 3 ===== CODE AMOUNT PCT INIT TERM VLG HC OWN CODE UNITS PCT TYPE VALUE IFD028 IWW020 I SWOll I F3=NEXT EXEMPT/SPEC F6=GO TO INVENTORY F9=GO TO XREF lID #22 INFO ===I=MISC IRS-SS I 1 I BANK 1,200 1,200 1,200 473889 SOUTHOLD 4iSRPS ASSESSMENT INQUIRY . SCHOOL SOUTHOLD SCHOOL RCLS 313 WATRFRNT VAC Fl=NEXT PARCEL 75.10- 03-050 F4=PREV EXEMPT/SPEC FlO=GO TO MENU U 1;)('(' C\i \'c'-a tC(:..~" 5/& . 9":- C)- O(cb 1 TbwN I ,.8 I S'" A. B c 0,/'1 G H. -,,- ''''', I. .,.,,',. 31. Et"'ntC o Hispanic 0 Un". [] Non-Hispanic 36. AllasINicknamelMaiden Name (last. First. 'Middle) B ResIdence ~tCltus 0 Temp Res. - Foreign Nat. a Resident 0 Tourost 0 Student P. Other Commuter 0 Military 0 Home eu 0 Unk 37. Apparent Condition o Imp.allred Drugs 0 Mental Dts 0 Un;,. o Impaired Aleo 0 InJ / III 0 App Norm J. K. SIEyes 52 Glðnes DYes 0 Contacts o No 53. Build o Small 0 U,rge o Medium 'Jl.MI« o Home o Work l. No. Apt. No., City, State. Zip) 44. Race o White 0 Black 0 Other o Indian 0 ASian 0 Unk. 47.o<cupation M N. "'7J¡B! ~'- .~: 'r.i~ ~~:~-,: d. 64. Value I :;" I" 74. Inquiries (ChKk all (hilt i!lpply) o DMV 0 WantMarrant o (rim. History 0 Stolen Property 75 NY'iPIN Message No 76. COmplainant SIgnature 78 'ONe 79 SupervIsor's Signature (Indude Rank) 8010 NO 84. I ~e. M - .,L. 81 'Statu!> o Viet Refused to CooP o CBt 0 Ju~ -No Custody o Unfounded o Warrant AdvIsed o btrad Dt'c"" iJ Unknown B1. Status Date 83 NOllfll~d,'TOT ...age Off Pages I f'¥ IS" OCJ5-3205 (2/971 "'FALSE STA íEMENTS ARE PUNISHABLE AS A CRIME. PURSUANT TO THE NEW YORK STATE PENAL LAW f . . . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Albert J. Krupski, Pre.ident James King, Vice-President Henry Smith Artie Foater Ken Poliwoda Telephone (631) 765-1692 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Ofliu Use Only 21Iý\CJ;)-tI - mÙUQ. ro\..lSQ (Jet [Qos"t 10' (.l~ ·tram ~u~, ('15 Y\()o-dJst,) _Coastal Erosion Per~it ~pplicatioj} . vWetland Permit Application 1 Major Minor . . Waiver/~~ndme~Çh?g~ _Received Apphcatl9,n:-+1/Y¡J? Received Fee:$ ó<h . , . Completed Application 7/'"1oy Incomplete - SEQRA Classification: Type I_Type "_Unlisted_ -~~~~:~~~~;(~:~~~~ o¡:l Date of Inspection: .I-J JI14fl-?' _Receipt ofCAC Report: Lead Agency Detennination: Technical Review: .., d _Public Hearing Held: '1/IJ4/ 0 Resolution: \1:. j !f '~I~\I æ Name of Applicant S+e+'ifBrJ F. S'/Mß)¥d..._ Address 79 K.ef-euJ/hfeIJ"'-i!J ~. li~~. IJ'.hJ//,vJ( Inn... PhoneNumber:( ) 61/- 6~9-¿'/.R1- ~ .ý' S"ffoIkCowrtyT"'....N""""" 1000- 7b-P¿-/r,(.. ~SO p~r Property Location: O'IJ 8ooseCrp.£1"'.. OPt'" HIf"v A"",v'('~' heh,}6- J ("; . LILlif 'v (provide LILC Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: e!IPrd of Trustees ApPlicatio~ GENERAL DATA Land Area (in square feet): 3~ 1.(3 c" Area Zoning: "D - 'Í'D Previous use of property: V 1tr:-1I7V"í Lhn/Î) Intended use of property: '?t'\vHr~ ~1f\J'/...e F/JA.-tIL.' .("e..(II'w.JE..e Prior permits/approvals for site improvements: Agency Ç'PU71f.M) ï;,.."" ~""",,;j Date Ie}? 2- !+PprDlJ!h_ H,c#tf-e(..6..tt'k ?/A-/-:- ~No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or susp~~ by a governmental agency? No_ Yes If yes, provide explanation: Project Description (use attachments if necessary): C ChV 0;. m~ I F....." ¡"y ~T{Cllrl'((·t...- fA) iJH ~A-<eM~ ~ ~(¿·fJnI.~1 ' , 0".,- I . '5/~ 4/¿/¡)~ "'~-"------ ------ . . Board of Trustees Application WETLANDITRUSTEE LANDS APPLICATION DATA í' ~f Purpose of the proposed operations: CNolS7Ytuu- '5/,,) ¡;L~ . ii, 'J' '7 ~ Area of wetlands on lot: 42../ b square feet /1).'¡ % Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands: N (¡;- feet Closest distance between nearest proposed structure and upland edge of wetlands: IOÇJ feet Does the project involve excavation or filling? No )( Yes If yes, how much material will be excavated? -.lICL- cubic yards How much material will be filled? ç cubic yards 8"' Deptb of which material will be removed or deposited: " 'b,'- feet Proposed slope throughout the area of operations: ~ +1.... -0 ~ Manner in which material will be removed or deposited: ..Ç,c) ,.. NhM"1 ~ ::b.. bt.. Ju'j ~y '\,."A-(( .doir.w.... ~M:-c"rlr>e , -:~-nc.r by b~/'toe. Statement of the effect. ifany, ?n the wetlands and ti~aJ waters of the town that may result by reason of such proposed operatJons (use attachments ¡fappropriate); IJ"""P'. 'ß".,t¿¡JfNj r? b./N/ .,..9£../..,.. ç;,./!JYk uJ~L.'Þr<,i),¿vJT;r 9'hJr) ýrC'--Ah) (!¿-,/f2./ r r-#~ . 4/1<> ~~?U/.. {A,f/J~ _lv.. t#- f3.(!+ ¡rIJ~ w;mv ft".d"'/ , , ,..16.~ [21(7) Texl ''Z ¡PROJECT :.D. NU"BE" . . SEa 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLlSõED ACTIONS Only PART I PROJECT INFORMATION (To be çompleted by Applicant or Project sponsor) '. APPL!CANT ¡SPONSOR I" 2. PROJEC.7 NAME .,./1. ,..,..._ þ r; p,41'r ot-- ~(Aov)€,(' - !1.'c.-,t/H(''j' 3. PROJECT LOCATION' MunlClø.lUv S"""T++Oc.. c.,unty S"", ~ 4. PREC:Se LOCATION (Street aedreas and road intersections, promin"nt landmarKs. etc., "r prevIae map) ~~ ¡:m-¡teAteð ,...~(St.o{rv~) 0"" SoJ..fVey -,"-'-s ~T S- Pl!t' 5. IS PROPOSED ACTION: ew 0 &pansion 6. DESCRleE PROJECT 6R1EFL Y: o Moøiflcatlonlslteratlon e ÞW SõYt~ S, ¡V i·1 e .f:,A.w, '"Y ~ ..... ~ ~ ß.#::S"e..t.e...r II:f (J er ~ 100( (oI~. ~,. AMOUNT OF UND AFr:eCTeO: rnl!iaHv . 0" acres Ultimatel'!' . 09 acres 3· "filL' PRCP0SED AC·'ON COMPLY WITH êXlSTlNG ZONIN.G OR OT:-<E. EXISTING ""NO USE 'ESfRICTIONS, I ,Ky.. .ONO !!NO.OOW'ooO".!!y eo"¡n'~ ,$ 2>.~ ?~~ptkry ~ ?~r()F ¡ '!i...&'!:>'¡)0S0'.,.) iI(f'()ý~uPb".'~n ¡oJ ¡r:nz..( H;C+<(>B~ -¡",_ "?),tk ) ~. \/.JHAT:S PRESENT lANQ LJeë IN VICINIT"f OF P~OJECT? ~Re5Idenla O.!nOustfia, C ';.;mmerc!al Describe: [J Agriculture- ï Park/ForestfOCln s)ace L.; Other 10. OOES A.CTION INVO...vE A peRMIT ":'PP'tOVAL. Oft =UNDrNG. NOW OR U1.;IMATEL'f FROM ANY OTHER GOVe¡:¡;NMeNTAI. AGENCY (FED!:¡::AL. STATe 0" LOC';'l)1 }Ii! Y.. 0 No If yes. :i~: açe-t'!cy(s) ana øermlt/aDørovalS r "DE(:. - -n> þ~ sl4þ...., H-etV ~/Á.~U;..Co"..;vfy 'y¡e¡r(fh ~·t OOES ANY "speer OF THE ACTIOU HAVE A CURRENTLY VALlO F'EAMIT OR APPROVAL'? DYes C!NO It 'es. list ags"cy name and peNTHlfapQroval .s' '( ~.....r&~ ':r 11. 12. AS A AESUL7 OF PROPOSED ACTION WILL '::XISTlNG PERMIT/A.PPROVAl. RECU!RE :-.10DIF\C~j¡ON·1 Oy., DNa , I CERTIFY rHAT THE JNFOAMATlON PROVIDED "'-BOVE IS TRUE -0 THE 3EST O~ '-,.1Y I\NOWl:'ÛGa App"<an[/,pon,o' .wno: ~úM~ u ..L7e-t. Da.., .-d. ~ I 2..-~ 0 '- Slgnam'o: 9-~~ £. ¡3r'h1Aú7 If Ihe action is in the Co~stal Area, and ,OU are a state ac;ency, complete the Coastal Assessmen~ Form before proceeding wi In ~his a~~essment OV!:R 1 c ... ?A?ï 1'_::N'JIP.ONME~.t7~· =- - - - , ~-'ef-"'rt ....( ;,-........1.: 'SS ,1I:.N\ ,.oJ 'J"=r:=,.....,__.~~~~_~ ..,,- .,.. ,.JS. 7¡...,;:E,Si-GL.] '~I -5 .'~"::?¡::;. :I;,.... ~. I, .. .1 . .'5. :~ ;1"1. r~'I"'W ::rOC~:5:S !nCl JSð :,".9 ::;":L_ ::)\;: ! _. JCE,5 ~C7 .C:"t =..';CS=':' ":"N't' , I ,-, Iii ;-"0 þ . . Yu /~. __ . __ .;.Ç7;ÇNS IN:) ,\I',,=i=!R ~.1.~7 'S¡7".:Î a. ".\IIl.¡'" ),C7:C,'II. .~E·::::¡V: :~CP.CIN"'7ë.:J .~é··J!E'W;.S .='Þ,C'/ICE;J .-·w¡=¡' UNLS,::.~ I may 08 $\Jljerse<::ea :ry !noH~er ¡n'W'Qlvea .a.çency. CV&S CNO . . 'Ve-o:c'" ~---...-S J.SS-C·· -:0 Vli".,¡ -'_1: :''JL' ":WI:-.IG; :).nSWers :'nav :8 .'\a.r.awrI!ten. .1 .e;/orel I' "" C::UI...C "='C7ICN ,::::I.eSUL7 iN AN.Y A... 1"'.;>c, ::-:--:...... . v,........ , .. ··~~'Iejs~ ~~st¡nCJ ~:"a.ft1C :al~arns. solid Nas:s ;HQCl.:c:::;::r. ç,. :"tistlng 1,( Qual/t'(. 11.1ttace ~r ~ra1JnQwa~er cualily ::' :I.:annty, ;'L011. I potential 'or erosion, ::r&lnaçlt or ~1C)oainq JrQclems? ::t.'tDlaln :)(Ierly; I I I I .1 ·~CJ. 3. :'1~1;.:.t:ve :'i':J(~ )( 'JI~:: 'f"."S-'O"'I'"3.I. :"'IIS:OfIC. J( ~tt1er 'at~ral Jr cultural ~asourc~s; or .::)mmunlty ~r ;"I81C;nCCrnooa '::1<!r3.c:ar? ~Cl1aLn ~ C2. .l..estneth::. ¡c;ric:.i!1ural. ........... 'I'" , "sn ,",LUisn or 'Nlit3lite '.Itlecles 3,1"nliic;ant ~aCita.:s ·~r :ntt3tened or 1nca.nc;erea 1;;:ec¡es? 'S..,(::I,IO ':IrI&Ily: C:;. '/eqelluon Of ,au/'la. ." . ., . CJ. A c::mmunlty'S eXISU"9 ;)1&."$ or goals.as orne:.II"! o1Iaoetea. or & cN~ge in:.lU (Jr Intensity 01 un ot !¡¡nd or other :1Stural tesolJrcas? E.xola~n :r c.s. Grow(tI. SUO$eOuant :evetcQrnent. :)r r.laUQ ac::vlile.s likelY !O :]9 ,noueeo ::JY !ne :;:lrcoosea '¡C:lon'? :x;:,Uun Jrleflv. ':;5. '.on; :erl'Tl. snort :ar:"l'1. .:~mUlauve. ojr IJttler '!ftec:s not ioemlfied in C-:·":;5'? :::;C:;Jlaln ~r1er!'f. ';lr:e! -meae:s .ínc::Jc.nc;¡ :::'a'\~es ,n '.15& of al:her quantlly or :yça or :lInerg"l/? ::.x::JIa.ln ~rletl'f. ,. 'J. ,5 -:-rteRe. :R :5 -:-neRe ,-:K.:::.::, -:-C ae. :::Nïë:lOVE~S'( ;:¡el.,.\.ïë~ :"Q ;JQTiH·lÏ!;"i,. ),OV'E-?S¡; ~\N1ACNME~J7;'L. ;.'.1P'-C-:-S? '- ~~S '_ No :1 ':'es. :!XClam :'rI&ll~ PARi IIt-OETERMINATION OF SIGNIFICANCE (:0 ~e comcleted ~y Agency) rNSïRUCiIONS: rat e.sc:'1 ad\'erse !!fett :dentlfled 3Cove. Cetermine 'Nnettter it;s suÞstantlal. :a(ge, :rncort.arn or ott1erwise sjçr.Jt!c. Ë.ac:J. ettec-:: snoud ::»e assessed in C:Jt\nection 'Nlttl Its (a) setting (I.e. uroan or :tJral); (b) ;)rObaDllity of acc~g: (C) duration 'rrevefs¡òillty; ~et geoqracnlc .ic:Jce: a.na {f magnlttJoe. It necessary, aOd attac~rnents or reference succonlng matenals. :':'1sure eXClanations contain $utfic:ent ~eIail to snow that aJl ,-a¡evant 3dtterSe impacts nave been identified ano adequatelY accressec. C:'ecx :t1is box it fOU l'1ave Ide~ti1ied one or '-i1are :otenciallv lar¡;e Of slgmficant aC'Iersa imoac:$ 'Nnlcn ,',':..::, OC:::.Jf. :h.en :JrGc~ea airec~ly to :118 FULL ~:J..;: anQJor ~reoare a positive' declaraticn. , C;'eck this ~OX: :t 'Iou nave je!ermin~d. ~asea an the information and analysis :bove and any siJcçor~inç ,:oc·.Jmenrarlcn. :~a{ ¡he :JrOCOSêO aC:IOn 1."11LL ~JOT result in~r:y significant aC!verse en.vironmental imcac::: ~ND ;:)rQv!Qe en ai:aC.'1menrs as ,1ec.essary, (he ~easons supcortJng [his determination: ........~ "" .<:.uJ "',"cnc" ,"",.,1 Jf . .¡':t' .....,I'IO!' :)L <~·'I:<I),,\.O!II' ....:rl'C!4r n ~......:r ~~o:t'.: I "Ur: 01 ,.....~CtJn"OIt' url'':!4r ¡,,,n,.(un:" )/ <"1~on\"o,1!' '''::I:lc~r 1'1 "'~.ja ....l;cI'lC... }',<".:<,¡r~ ) 1.·'!'~.It!!1 ,If ":'I:e-"n1 :ram 'l!'c(rH.Q,,~ .J"':~'I .J,,¡!t' .- o . . Board of Trustees Application County of Suffolk State of New York ~+~ £. 8rlJM£(l BEING DULY SWORN DEPOSES AND AFFIRMS THAT HElSHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMlT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF IllS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN TIllS 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 PERMlT(S), IF GRANTED. IN COMPLETING TIllS 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 TIllS APPLICATION. ~.AAAßL/\. _ Signature SWORN TO BEFORE ME TillS J.;Jf DAY O~ 20 0 J.., ~ÚÛv)1 fJ y~~ø-i--j V Notary Public . JAYNE E. BA~ewYork Public State 0 Notary N 01SA6016514 . o. . Suffolk County Quahfieldss'~on Expires Nov. .J:<' d. (\ 0 ;;¡ Comm ,-ýølt" ArPLt~J\NT TRANSACTIONAL DISCLOSURE FORK . . The Town of Sou~holdts Code of ~thic8 prohibi~s conflicts of interest on, the part of town officers and employees. The purpose of ~his 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 N)\HE I ¿- : .:.' .,,;~I~·:'t.:::{~~~:~~~~, \ J e,.J.£ Last name, first name, n t aI, unless you are applying in the someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NATURE OF APPLI~^TIONI (Check all tha~ apply.) .: "':~):~ .:.... ,~~. '-';.',;: .: !~:. Tax grievance variance change of zone ^p'p~~al of plat . Exemption from plat or official map other X , '"":"") (I f "other," name the act! vi ty.) 1A)e¡-1-197VL)$ re.rr'1-~ t Do you persona11y (or through your co~pany. spoune, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold1 -Relationship- includes by blood, marriage, or business interest. -Dusiness interest- ~eans a business, including a parl;nership. in which the town officer or employee has even a parl;ial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO ;>CJ If you answered MYES,N. complete I;he balance Of ~his form 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) and the town officer ør employee. Either cheek the appropriate line ^) 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 than 5% of the shares of the corporate stock of the applicånt (when the applicant is a corporation), B) the legal 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. .. . . Dear Neighbor: BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: SCTM# IOOO-76-01-15.6 YOU ARE HEREBY GIVEN NOTICE: I. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: Construct a single family dwelling on the above reference lot. 2. That the property which is the subject of Environmental Review--is located adjacent to your property and is described as follows: All that certain plot, piece or parcel of land, situate, lying and being Bayview in the town of Southold, County of Suffolk and the State of New York, being bounded and described as follows: Beginning at the southwest corner of the premises herein described, said point being the following three courses and distances from a point on the northeasterly side of Main Bayview Road where the boundary line between the westerly line of land now or formerly of Michael F. Zukas and May Zukas and the southerly side of lot No. 17 as shown on Map of West Creek Development, Map No. 1236 Intersects Same: 1. North 39 degrees 55 minutes East, 563.96 feet; 2. South 48 degrees 50 minutes 30 seconds East, 90.00 feet to the southwest corner of the 30 foot Right of Way; 3. North 39 degrees 55 minutes East along the westerly side of the 30 foot Right of Way, 30 feet to the true point or place of beginning¡ running thence north 39 degrees 55 minutes East along the easterly side of other land now or formerly of Michael F. Zukas and May Zukas, 385.00 feet, more of less, to the centerline of West Creek; THENCE Easterly along center line, 65.33 feet, more or less, to a Right of Way, THENCE along said right of way the following three courses and distances: 1. South 04 degrees 30 minutes West, 85.00 feet, more or less; 2. South 41 degrees 01 minutes West 360.00 feet; 3. North 48 degrees 50 minutes 30 seconds West, 92.23 feet to the point or place of BEGINNING. APPLtCANT TRANSACTIONAL DISCLOSURE FORM . . The Town of Southo1d's Code of Ethicð prohibits conflicts of interest on the par~ of town officers and employees. The purpose of ~his 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 NAMB I <5 e..J.£ .' . ':~1~' ~~<-}~~:~?f~, ~ Last name. first name, n tal, unless you are applying in the someone else or other entity, such as a company, If so, indicate the other person's or company's name.) . NATURB OF APPLICATION, (Check all that apply.) " . ", ~?,):;r, :.... '[F~' :.....'.1.. . t."': Tax grievance variance Change of zone ^p'p~~al of plat . Exe~ption from plat or official map other X , -:J (If "other," name the activity.) !AJør/.-/9rVD$ re..--........ t Do you personally (or through your ~OMpany, spouse, sibling. parent, or child) have a relationship vith any officer or employee of the Tovn of Southold? -Relationship- includes by blood. marriage. or business interest. -Dusiness interest- Means a business, including a partnership, in vhich the tovn officer or employee has even a partial ovnership of (or employment by) a corp.oration in vhich the tovn officer or employee ovns more than 5% of the shares. YES NO ;><:J . If you ansvered -YES,N. complete the baiance of thiö form and date and sign vhere indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself (the applicant) and the town officer ør employee. Either check the appropriate line ^) 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)1 ^) 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 noncorporate'entity (when the applicant is not a corporation), c) an officer, director, partner, or employee of the applicant, or D) the actual applicant. \ '\ , \ \ \ \ \ , \ \ \ - \ - - -- - - ----'I ¡ ---1 I I. --------j ... -. ¡ . 9:: t- -.-- \ ? ~ _______.. I· -,,~ -_.- " ~ --< ~ - g$! I .~ I . . ~ ¡¡ § " gg ; .~! --~- 15" .J- - - ~---- ... o~ ~- .'''0' ,... .................. .