HomeMy WebLinkAboutTR-5812 O�� Uj,�ol
Michael J.Domino,President '' QF SUTown Hall Annex
Q 54375 Route 25
John M.Bredemeyer III,Vice-President P.O.Box 1179
Glenn Goldsmith Southold,New York 11971
A.Nicholas Krupski gyp@ Telephone(631) 765-1892
Greg WilliamsCOU
y Fax(631) 765-6641
l
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
# 1519C Date: October 3, 2018
THIS CERTIFIES that the replacement within 8"approximately 90' of existing bulkhead,
remove and replace in kind/inplace 2 15' returns on either end remove and replace inkind/inplace an
existing;7' wide timber walk adjacent to bulkhead and the deletion of fill on this project;
At 1060 Little Peconic Boy Road, Cutchogue
Suffolk County Tax Map#1000-111-14-16
Conforms to the application for a Trustees Permit heretofore filed in this
office Dated November 25, 1996, pursuant to which Trustees Wetland Permit#4678
Dated November 25, 1996,was issued and Amended on November 20, 1997 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 replacement within 8"approximately 90' of existing;bulkhead,
remove and replace in kind/inplace 2— 15' returns on either end remove and replace inkind/inplace an
existing 7' wide timber walk adjacent to bulkhead and the deletion of fill on this project.
The certificate is issued to Robert Profeta owner of
the aforesaid property.
Authorized Signature
SURVEY OF X'3.6 _ - - X 16.1 — _ 16.2X
ND
_ - _ L I TTLE - TECON IC BAY
AM-ENI1 E1) MAP _A OFN 45P42' �2 EDGE OF PAVEMENT 9°5 3 6'
--NASSAU POI=NT, 31 .40' 3 E C E V E,
'D o ►D•e'
O BYNED B�' T W.77 2
4� 744 ►• GRAVEL PARKING AREA ° 1
NASSAI� POINT CLUB PROPERTIES, Inc. 73
f\' \ e75.6•►e .�. •;_TIE UNE' ►' D N. I �t LI�U
FI"I -No.- -1'56 FILED. AUGUST 16 '1922 N��
SITUATED. AT TW' ► ., 76: TW.172 ,
-�� qq ��vv T T r.w7§ CONC. RETAINING WALL 74 1
:-N.E- SSA V POINT s�� STEPS a oto 7 12 Southold Town
TOWN, 0 F S 0 U T H 0 L D
APPROX. / Board of Trustee
�o& /'-TIE UNE ' CESSPO�Y "t
-
SUFFOLK' COUNTY, NEW YORK o
CONC FOUND MON.19i m / 1 P< 1 1
- - S..C:_ TAX N0. 10'00—I1- 1 - 14- 16 � 8 , a
SCALE r1 "_20'` ❑ SLATE WALK
1993 I j� i i I s�PR10X' /
' SEPTEMBER -29; 2003 -ADDED PROPOSED ADDITIONS Ips r. X o I T EP1c
NOVEMBER. 3,- 12003 ADDED•TOPOGRAPHICAL SURVEY (L a L' 1 / x 2/ j10
AREA- = 12,061 .43' 'sq. ft. z1.1 IOEL
mo 0 SLATE STEPS /
(TO,TIE;LINES) 0:277- QC. 1 9
/ X 1 $ 20.9'
► 8' dla. X 4' DEEP
CHNN LINK FENCE 'C� I DRYWELL FOR.ROOF RUNOFF
CERTIFIED TO: �, I 1O.g1 236' `
ROBERT PROFETACq
�ti / a 5 PROPO RYCONCI PLAT
4 2nd N ' 1 7 x ,
1
..ADDIT..... ;Om BRRpIO�ry pWALL
........
ENTRA DCEL4 R
qj 1�1 �•.',•,,..,•' ..'',','•.,.,.. E
to BLDG.<
C� 1
13.7' ., 23.5' I
E' CELLAR STORY
o
ENTRANCE EXISTING 1 XI
`y FRAME HOUSE
CONC.2.3'w. HOUSE No. 1060 PR01=05ED 8' dia. X 4' DEEP
FFL J5,2 \" I DRYWELL FOR ROO
CONC. F RUNOFF
- SLATE PLAT 40.6' 23.3' 1
BRL WALLI I
PLAT
R a'aa 8 acs •E]
t 8
9 ' .8' ,.'.••1.39' as
BRICK
1 BAR
SLATE PAno BECUE O J
13 4 13 X
WOOD FENCE \ \ ` ul -NI
\ �nlZ
— to LOT 238
X 103 6-0 \a_ / X$.5
X 'tea'•
j0
M / yy � �5 K
/ / O /
1 000 3 / �� — — \� � ' � / z i3 AP�PARENr HIGN WATER �
00 o / 5 /
� MM"c�,
O g / P) G POD D B
FOUND 1 O / D P OOD WP W BULKHEAD
CONC -MON. Z / / Is 0.B'E.
4*8
FOU
CONND D o T 4 2 p B N y
BULKHEA' t3 9'. B W A-2 pYONG W� J
1-0.7 E •: DOCK B'� P'SF�� J
6-C C. W0p0 N�GN W
2-Q 1 °21 A
_ •fit�� HfAO S
SENT t11GH
APP -�(��
\►� JJ PREPARED IN ACCORD CE WITH THE MINIMUM
V STANDARDS FOR T SURVEYS AS ESTABUSHED
BY THE L.I.A.LS. AN• APPROVED AND ADOPTED
FOR SUCH USE BY HE NEW YORK STATE LAND
TnIE
NOTES: ®f ESS.; ,
1 . TOTAL EXISTING LOT COVERAGE = 3,321 sq. ft. OR 27.53 % OF TOTAL LOT AREA. �AA !
(INCLUDING HOUSE; PATIO, PORCH, CELLAR ENTRANCES, SHED, WALKS & STOOPS) CID
2. THE PROPOSED ADDITIONS WILL BE BUILT WITHIN THE EXISTING FOOTPRINT
OF EXISTING STRUCTURES AND WILL NOT INCREASE LOT COVERAGE. ;
0 ;
3. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM
EXISTING ELEVATIONS ARE SHOWN THUS:
EXISTING CONTOUR LINES ARE SHOWN THUS: — — — —5— — — — N.Y.S. Lic. No. 49668
F.FL. - FIRST FLOOR
G FL. - GARAGE FLOOR
TO. - TOP OF BULKHEAD UNAUTHORIZED ALTERATION OR ADDITION
BB - BOTTOM OF BULKHEAD TO THIS SURVEY IS A VIOLATION OF ®���� A.
�n�e�n®
Tw. - TOP OF WALL SECTION 7209 OF THE NEW YORK STATE
8.w - BOTTOM OF WALL
EDUCATION LAW.
COPIES OF THIS SURVEY MAP NOT BEARING Lend Surveyor
THE LAND SURVEYOR'S INKED SEAL OR
EMBOSSED-SEAL SHALL NOT BE CONSIDERED
TO BE A VALID TRUE COPY.
CERTIFlCATIONS INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY out Title Surveys - Subdivisions - Site Plans - Construction La
IS PREPARED, AND ON HIS BEHALF TO THE Y y
TITLE COMPANY, GOVERNMENTAL,AGENCY AND
LENDING INSTITUTION LISTED HEREON, AND PHONE 631 72
TO THE ASSIGNEES OF THE LENDING INSTI- 7-2090 Fax (631)727-1727
TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE.
OFFICES LOCATED AT MAILING ADDRESS
THE EXISTENCE OF RIGHTS OF WAY 322-ROANOKE AVENUE P.O. Box 1931
ANDEASEMENTS_ OF RECORD, IF
ANY,, NOT -SHOWN ARE NOT GUARANTEED.
RIVERHEAD, New York 11901 Riverhead, New York 11901-0965
N
23-420A
Michael J. Domino,President ��OF S�UryO Town Hall Annex
John M.Bredemeyer III,Vice-President �� l0 54375 Route 25
P.O.Box 1179
Glenn Goldsmith Southold,New York 11971
A. Nicholas Krupski • Q Telephone(631) 765-1892
Greg Williams �A4UNTl,
O Fax'(631) 765-6641
� ��
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
DATE OF INSPECTION: 43116
/,Ch. 275 Ch. 111
INSPECTION SCHEDULE
Pre-construction, hay bale line/silt boom/silt curtain
1St day of construction
% constructed
Project complete, compliance inspection.
INSPECTED BY:
COMMENTS:
Ir- 1`J4'
CERTIFICATE OF COMPLIANCE:
MC) Uwk ?--Q-C�cl 1
0
®cv, CO&A
jl�
�rrIE47 �11
SEP 1 4 2018
q� A 201
Southold Trn;,n
Southold wn Board of
Boar'o(Trnstees
Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095 Route 25
P.O. Box 1179
$outhold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
# 0028C
Date March 18, 2005
At
THIS CERTIFIES that the second story addition and enclosed porch
1060 Little Peconic Bay Road, Cutchogue
Suffolk County Tax Map # 111-14-16
Conforms to the application for a Trustees Permit heretofore filed in this office
Dated 10~21/03 pursuant to which Trustees Permit # 5812 Dated oct. 22, 2003
Was issued, and conforms to all of the requirements and conditions of the applicable
provisions of lass,. The project for which this certificate is being issued
is for the second story addition and enclosed porch.
The certificate is issued to
aforesaid property.
Gloria and Robert Profeta
owner of the
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
Prelconstruction, hay bale line
__ 1st day of construction
¼ constructed
~'/ Project complete, complianceinspec, tion. ~lql°~ r,~'-~-'"~? I~.~_~ ~'
Board Of $outhold 'Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO....~l~ ..... DATE: ...O..c..tg.b.~z:.....~.,. 200!
ISSUED TO ......... .°..~.°.~.~ ~....~....~.°.~.~.~-.~...~.~ Q ~ ~ '~ ,.A ....................................
Pursuant to the provisions of Chapter 615 of'the Laws of.
the State of New YorE, 1893: and Chapter ~ of the Laws of the
· State of New Yor~ 1952: and Jim Southokl Town Ordinance e~
titted ."REGULATING AND THE PLACJNG OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REIdOVAL OF SAND, GRAVEL.OR OTHER MATERIALS FROId
LANDS UNDER TOWN'WATERS~.-?. and in accordance with the
Resolution of The I~srd adopted at a meefincj held on ...O..~t.~.l~?_..~2,
· ..~-.0.0.~ end in eonslderetion of the sum of $......~0....0..:..0.0..... peld by
En-Consultants, Inc. for Robert Profeta
ot Southampton ~
· ....................................... ~.;..: ............................................ N. Y. and subject to the
Terms and Conditions lls~ed on the reverse slde hereof,
of Southdd Town. Tr~|ees authorizes and permifs the following:
Wetland perrmt to construct a second-story addition over and within the footprint of the
existing one-story dwelling and enclose the existing screened porch, with the condition
drywells and gutters and installed to contain the roof run-off, and as depicted on the survey
prepared by Joseph A. Ingegno last revised November 3, 2003.
all in accordance wflh the defa~ed spedfieafions as presenfed in
.the odglneflng apl~fio~.
IN WITNESS WHEREOF, The ~id Board of Trustees here-
ifs Corporate Seal to be a~xed, and these..j~, h to
sul~sr~becl by a 'majorlfy of the said Board as of fhis date.
TERldS end GONOmONS
Robert Profet~
1060 Little Peconic Bay Rd., Cutchogue lq. Y~ '~
for an ex~e~fon may be made ~ d~e Board ~t a ~" date.
otb~
plemem~ to this permit w~l,~ may be subject to ~voke upon ~.;~.-~ to dx~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) 765-1692
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
October 22, 2003
Mr. Robert E. Hemnann
En-Consultants, Inc.
1329 North Sea Rd.
Southampton, NY 11968
GLORIA & ROBERT PROFETA
1060 LITTLE PECONIC BAY RD., CUTCHOGUE
SCTM#111-14-16
Dear Mr. Helrl~aann:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday, October 22, 2003 regarding the above matter:
WHEREAS, Robert E. Hemnann on behalf of GLORIA & ROBERT PROFETA 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 October 6, 2003,
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
October 22, 2003, 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,
NOW THEREFORE BE iT,
RESOLVED, that the Board of Trustees approve the application of GLORIA & ROBERT
PROFETA to construct a second-story addition over and within the footprint of the existing
one-story dwelling and enclose the existing screened porch, with the condition drywells and
gutters and installed to contain the roof run-off, and as depicted on the survey prepared by
Joseph A. Ingegno last revised November 3, 2003.
Permit to construct and complete project will expire two years from the date the permit is signed.
Fees must be paid, if applicable, and permit issued within six months of the date of this
notification.
Inspections are required at a fee of $5.00 per inspection. (See attached schedule.)
Fees: $5.00
Very truly yours,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/lms
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,
October 14, 2003, the following recommendation was made:
GLORIA & ROBERT PROFETA to Amend Permit #-4678 to construct a second-story
addition over and within footprint of existing one-story dwelling and enclose existing
screened porch.
Located: 1060 Little Peconic Bay Rd., Cutchogue. SCTM#111-14-16
The CAC did not make an inspection, therefore no recommendation was made.
Albert I. Kmpski, President
John Hohapfel, Vice President
Jim King
Martin H. Garrell
Pete~ Wenczel
November 20~ 1997
BOARD OF TOWN TRUSTEES
TOV~N OF SOUTHOLD
Town Hall
53095 Main Road
P.O. Box 1179
Southold, New York 11971
Telephone (516) 765-1892
Fax (516) 765-1823
Eh-Consultants Inc.
Roy Haje
1329 North Sea Road
Southampton NY I196'8
· RE: ROBERT PROFETA
SCTM #111-14-16
Dear Mr. Haje,
The following action was taken at the Southold Town Board of
Trustees meeting on November 18, 1997:
RESOLVED, that the Southold Town Board of Trustees approve the
request for an Amendment to Permit %4678 to replace within 8".
approx. 90' of existing bulkhead, remove and replace in
kind/inplace 2- 15' returns on either end, remove and replace
inkind/inplace an existing 7' wide timber walk adjacent ta
bulkhead and the deletion of fill on this project. The Board
also approves the Transfer of Permit 94678 from James Mc
Burnie to Robert Profeta.
However, this does not constitute approval from any other
agencies.
If you have any questions, please call our office at 765-1892.
Sincerely,
Sincerely,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/djh
'Board,Of $outhold Town Trustees
SOUTHOLD, NEW YORK
DATE: ...l! / 25/.96 ......
ISSUED TO ...... /[A,ME$ &..MARIL.}fN..McBURNIE ...................
Pursuant '~o the provisions of Chapter 615 of the L~ws of
the State of New York, 1893: and C~apter 404 of the Laws of fha
State of New York 19521 end fha Southold Town Ordinance eh-
rifled "REGULATINC~ 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:" end in accordance with the
Resolution of The Board adopted afa meeting held on .11/22/~6 .....
19..9.6..., and in consideration of the sum of $.. 1.00...a0 . paid by
.G. ail ~ickham fo~...ZAMES....& .MARILTf .M.cB!JttNIE .......................
of ......~.u.~h9g~t¢ ............................ N. Y. and subiecf fo the
Terms end Condlt~ons listed on the reverse side hereof,
of Southold Town Trustees aufhorlzes and permits the following:
Grandfather Permit for an existing 65' timber bulkhead and
wood walkway.
all in accordance with the detailed speclflca'l'ions as presented in '
~he originafing app[icatlon.
IN WITNESS WHEREOF, The said Board of Trustees h~re-
by causes ifs Corporate Seal fo be affixed, and ~'hese presen~'s to
be subscribed by a majori~-y of the said Board as of this date.
EN-CONSULTANTS, INC.
1329 NORTH SEA ROAD, SOUTHAMPTON, NEW YORK 11968
ENVIRONMENTAL
SERVICES
516-283-6360
FAX NO. 516-283-6136
November 5, 1997
Mr. Albert Krupski
Town of Southold Trustees
53095 Main Road
Southold, NY 11971
RE: ROBERT PROFETA. CUTCItOGUE
Dear Mr. [Qupski:
As discussed during the Board's work session of 29 October 1997, I am enclosing (3) copies ora
revised project plan indicating the bulkhead to be removed within 8".
From speaking with Diane, I understand that this application will be treated as a transfer and
.amendment of Grandfather Permit No. 4678 (copy enclosed) issued to the prior owners of the
property, Mr. and Mrs. James McBurnie, for 65' of timber bulkhead. Accordingly, a check
written in the amount of $50 is enclosed.
If thc Board has any questions regarding the plan, please do not hesitate to contact me at your
convenience.
Respectfully yo~urs,
Robert E. Hea~iu~mn
Coastal Management Specialist
Enclosures
HOUr&
POINT
LIPII'r
WOO0 ~UIKN£AD ~o
REP Z/i C £ D [~I~IN~):
MUNNEWE'TA PONO
EN-CONSULTANTS
1329 NORTH SEA RD,
SOUTHAMPTON N,Y, 11968.
'~16'283-6360
TOW~ OF!.qUTH~.L.~
!" ~ 0~ ~ I~' FOLLOO3~R5
R~uJ' 0 - 0
p~OPO$£D 8"0 ~ lb' PlL~$
a"~lO"~ la'
%")
EN-CONSUL TANT§
~3~'9 NORTH SEA
SOUTHAMPTON N.Y.
~ 16'288'6360
~ ~OPOS~D B~.
[ ROB~ PRO~A O~
CUTCI~OGUE, SUFFOLK CO.,
NY
~HE~I' :2 OF 3 8/12/97
9/16/97
10/30/97
SPARTINA AL?[RNIFIORA
W, ~ .~. q"~ &' £o~tow~
5£CT/ON 7ERU R[T~/~N ON
R£1vlOV£O AND R£PLAf£D
ii'tr,
1
OF oOUTHO..~¢j
0
EN.CONSULTANT~ ~'~,-,
1329 NORTH SEA RD.
SOUTHAMPTON N,Y. 11968'
~ 16-283-6360
PROPOSED BLKD.
m~PZ,ACEm~Z~TIW/m 8") FO~
ROBERT PRO~A ON
~A PO~, ~
CUTCH~, S~FOLK CO.,
SHE~ 3 OF 3 8/12/97
9/16/~
10G0/97
EN-CONSULTANTS, INC.
1329 NORTH SEA ROAD, SOUTHAMPTON, NEW YORK 11968
ENVIRONMENTAL
SERVICES
51 6-283-6360
FAX NO. 5t6-283-6136
Mrs. Diane Herbert
Town of Southold Trustees
53095 lVt'~i. Road
Southold, NY 11971
Deax Diane:
September 25, 1997
RE: APPLICATION FOR ROBERT PROFETA
Rober~ ]~. l-lca*i~nn
Coastal Management Specialist
As per the Board's directive at their regular meeting of September 24t~, the bulkhead
replacement for Mr. Profeta will be a "remove and replace, in kind/in place", rather than a
"replacement within 18 inches." Accordingly, would you kindly withdraw our wetland
application and refund the $150 fees which were submitted therewith.
September 22, 1997
Secretary of S~te
Roy L. Haje, President
Eh-Consultants, ina.
1329 North Sea Road
Southampton, NY 11968
F-97-658
U.S. Army Corps of Engineers/New York District Permit
Application g97-11290-L2
Robert Profeta, Wuuneweta Pond
Town of Southold, Suffolk County
Dear Mr. Haje:
The Department of State baa received the information you provided on September 16, 1997 describing the
above 'proposed project.
We have been informed by the U.S. Army Corps of Engineers that your project was authorized und~an
existing Nationwide Permit. Therefore, no further review is required by this Department.
We appreciate you~ referring this information to the Department of State for review.
Sincerely, .z ~
Chief, Consistency Review and Analysis
WFB:WF:dlb
cc: COE/New York Di~ct - Denise Butts
DEC/Region 1 - John Pavecic
Town of Southold - Alber~ J. Krupsld, Jr.
couNTY
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EN-CONSULTANTS
1329 NOR~ SEA RD.
~UTHAMPTON N.Y. 1~9B~
S 16'283-6360
Buzz BLocKS
Z~UL,~F/Ef~D ~0 ~L~ /E~PLACED ~Cdll~'
EN-CONSULTANT~
~329 NORTH SEA RD,
EOUTHAHPTON N'.'~, ltd~'
Telephone
(516) 765~1801
Town HaH. 53095 Main goad
P.O. Box 1179
%athold, New York 11971
$0UTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
The following recommendation was adopted at the meeting of the Southold Town.
Conservation Advisory Council held Monday, September 22, 1997:
No. 1485
Moved by Melvyn Morris, seconded by Mary Crlffin, it was
RESOLVED to recommend to the Southold Town Board Of Trustees APPROVAL
WITH CONDITION of the Wetland Application of ROBERT PROFERA
111-1a,-16 to replace, wlthln 18", approximately 90' of exlsting bulkhead;
remove and replace, in kind/in place, (2) 15~ returns on either end of the
property; remove and replace, In kind/in place, an existing 7' wide timber
walk adjacent to bulkhead; approximately 50 c.y. of clean fill to be trucked in
from an approved upland source.
1060 Little Peconic Bay Road, Cutchogue
The Council recommends approval with the condition that a 10' non-turf buffer
in established behind the bulkhead.
Vote of Council: Ayes: All
Motion Carried
CLUB PROPffR27E;$,
FI'L~'D AUGUST 16, 1922
TUATED AT
SAU POINT
OF $OUTHOLD
;OUNTY, NEW YOrK
o. 1000-111-14-16
CALE 1"=20'
INE 21, 1993
~1.4~ sq. ft.
TITLE INSURANCE COMPANY
'H FORK BANK
.S C. MGBURNIE
LYN G. McBURNIE
LOT ~ U~
Joseph A. Ingegr
Land Surveyor
EN-CONSULTANTS, INC.
1329 North Sea Road
Southampton, New York 11968
631-283-6360
Fax: 631-283-6136
E-mail: encon@peconic.net
www. enconsultants.com
ENVIRONMENTAL SERVICES
Mr. Albert Krupski
Town of Southold Trustees
53095 Main Road
Southold, NY 11971
Re: Gloria and Robert Profeta~ Cutchogue
12,2003
Dear Mr. Krupski:
As requested, please find enclosed (3) copies of a revised site plan depicting a drainage system
of drywells, which I trust will enable the Profetas' wetlands permit to be issued shortly.
Should you require any additional information, however, please contact me at your earliest
convenience.
Respe?t fully yours,
Robert E. Her~mann
Coastal Management Specialist
Enclosures
SURVEY OF
LOT 238 L I TTLE
AMENDED MAP A OF N 45'42
NASSAU POINT 31.40
OWNED BY '~
NASSAU POINT CLUB PROPERTIES. Inc. '-~.. ~
FILE No. 156 FILED AUGUST 16, 1922 ?z '~-
SITUATED AT
NASSAU POINT
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-111-14-16
SCALE 1"=20'
JUNE 21, 1995
SEPTEMBER 29, 2005 ADDED PROPOSED ADDITIONS
NOVEMBER ,.3, 200.3 ADDED TOPOGRAPHICAL SURVEY
AREA = 12,061.45 sq. ft.
(TO T~ urn's) 0.277 ac.
,PECONIC BAY ROAD,
NOV 1 4 ~.~
CERTIFIED TO:
ROBERT PROFETA
g
EXISTING 1 STORY
FRAME HOUSE
HOUSC No. 10~0
NO TES:
1. TOTAL EXISTING LOT COVERAGE = 5,521 sq. ff. OR 27.53 %
(INCLUDING HOUSE, PATIO, PORCH, CELLAR ENTRANCES, SHED, WALKS & STOOPS)
2. THE PROPOS£D ADDITIONS WILL BE BUILT WITHIN THE EXISTING FOOTPRINT
OF EXISTING STRUCTURES ANO WILL NOT INCREASE LOT COYERAGE.
DATUM
OF TOTAL LOT AREA.
ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929
EXISTING ELEVATIONS ARE SHOWN THUS: ×~
EXISTING CONTOUR LINES ARE SHOWN THUS:
~o.~g
Joseph A. Ingegno
Land Surveyor
Title Su~eys -- Subdivisions - Site P~ans - Construction
PHONE (r~51)727-2090 Fax (651)727-1727
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
Fex (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
~weastal Erosion Permit Application
tland Permit Application ,,'"~ajor
Waiver/Amendment/Changes
~Recei~ed Application: IOItdO
,~-Received Fee:$ ~
,,,,Completed Application Incomplete
SEQKA Classification:
Type I Type II Unlisted
Coordination:(date sent)
~L'~C Referral Sent:
~ate of Inspection:
Receipt of CAC Report:
Lead Agency Determination:
Technical Review:
--~,"'l~ublic Hearing Held:
Resolution:
Minor
OCT 2 1 _:
Southold Town
Board of Trustees
Name of Applicant GLORIA & ROBERT PROFETA
Address 320 ROSE LANE, SMITHTOWN, NY 11787
Phone Number: 631-979-1286
Suffolk County Tax Map Number: 1000 - 111-14-16
Property Location: 1060 LITTLE PECONIC BAY ROAD, CUTCHOGUE
(provide LILCO Pole #, distance to cross sweets, and location)
AGENT: EN-CONSULTANTS, INC.
(If applicable)
Address: 1329 NORTH SEA ROAD, SOUTHAMPTON, NY 11968
Phone: 631-283-6360
Board of Trustees ApplicOon
Land Area (in square feet): 12,061.43
Area Zoning: R-40
GENERAL DATA
Previous use of properly: RESIDENTIAL
Intended use of property: NO CHANGE.
Prior permits/approvals for site improvemems:
Agency
SOUTHOLD TRUSTEES;/0,678
NYS DEC; #1-4738-01735/00001
COE; #97-11290-L2
DOS; gF-97-658
Date
11-20-97
11-3-97
9-9-97
9-22-97
__ 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):
CONSTRUCT A SECOND-STORY ADDITION OVER AND WITHIN FOOTPRINT OF EXISTING ONE-STORY
DWELLING AND ENCLOSE EXISTING SCREENED PORCH, ALL AS DEPICTED ON THE SITE PREPARED
BY JOSEPH A. INGEGNO, LAST DATED 9/29/03.
~Board of Trustees A Dn
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:
ADDITION/RENOVATION TO EXISTING ONE-FAMILY DWELLING
Area of wetlands on lot: 0 square feet
Percent coverage of lot: N/A %
Closest distance between nearest existing structure and upland
edge of wetlands: +/-56 feet
Closest distance between nearest proposed structure and upland
edge of wetlands: +/-63 feet (EXISTING PORCH TO BE ENCLOSED)
Does the project involve excavation or filling?
X No Yes
If yes, how much material will be excavated? N/A
How much material will be filled? N/A
cubic yards
cubic yards
Depth of which material will be removed or deposited: N/A
Proposed slope throughout the area of operations: N/A
Manner in which material will be removed or deposited:
N/A
feet
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):
THE PROJECT CONSISTS OF A SECOND-STORY ADDITION OVER AND ENTIRELY WITHIN
THE FOOTPRINT OF AN EXISTING DWELLING AND THE ENCLOSURE OF AN EXISTING
SCREENED PORCH. THE PROJECT WILL HAVE NO SIGNIFICANT IMPACTS ON ADJACENT
WETLANDS OR TIDAL WATERS OF THE TOWN.
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
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
being duly sworn, depose and'say: ' ~
That on the ~--'l~day of {~.7r - , 200~ I personally posted the propgrty known as
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
hemng. Date ofhearir~g noted thermn tab~ heldLl~,. ~)C~210f' o~-~ ~ -- .
orx Or- fl;{l.3 I-m, · - - -
Dated: ~
(s~gnamre)''~ \
Sworn to b~fore me this
day of/~)c/ 200 g
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 Ol* TOWN TRUSTEES
TOWN OF SOUTHOLD
DATE
OWNER
LE'I-rER OF REQUEST FOR AN AME~
SEPTEMBER 30, 2003
Southold Town
Board of Trustees
GLORIA& ROBERT PROFETA
PHONE 631-979-1286
ADDRESS 320 ROSE LANE, SMITHTOWN, NY 11787
AGENT EN-CONSULTANTS, INC.
PHONE 631-283-6360
ADDRESS 1329 NORTH SEA ROAD, SOUTHAMPTON, NY 11968
PROPERTY LOCATION 1060 LITILE PECONIC BAY ROAD, CUTCHOGUE
TAX MAP NO. 1000-111-14-16
I/We EN-CONSULTANTS, INC. request an Amendment to Permit # 4678
CONSTRUCT A SECOND-STORY ADDITION OVER AND WITHIN FOOTPRINT OF EXISTING
ONE-STORY DWELLING AND ENCLOSE EXISTING SCREENED PORCH, ALL AS DEPICTED ON THE
SITE PREPARED BY JOSEPH A. INGEGNO, LAST DATED 9/' 2 9 / 0 3.
Signed By: BERT~E RRMA
RO NN, COASTAL MGMT. SPECIALIST
NOTICE TO ADJACENT PROPERTY OWNER
BOARD OF TRUSTEES~ TOWN OF SOUTHOLD
In the matter of applicant:GLORIA&ROBERTPROFETA
SCTM~1000- 111-14-16
YOU ARE HEREBY GIVEN NOTICE:
1. That it is the intention of the
Permit from the Board of Trustees to:
undersigned to request a
CONSTRUCT A SECONI%STORY ADDITION OVER AND %qTHFN FOOTPPdNT OF EXISTING ONE-STORY
DWELL[NO AND ENCLOSE EXIST[NG SCREENED PORCH. ALL AS DEPICTED ON THE SITE PREPARED BY
JOSEPH A. [NGEGNO, LAST DATED 9 / 2 9 / 0 3 .
Review-is
follows:
That the property which is the subject of Environmental
located adjacent to your property and is described as
1060 LITTLE PECONIC BAY ROAD, CUTCHOGUE
3. That the project which is subject to Environmental Review
under Chapters 32, 37, or 97 of the Town Code is open to public
comment on: OCT.~,2~3~7P.M. You may contact the Trustees Office at
765-1'892 or in writing.
The above referenced proposal is under review of the Board of
Trustees of the Town of Southold and does not reference any
other agency that might have to review same proposal.
OWNERS NAME: GLOPJA & ROBERT PROFETA
MAILING ADDRESS: 320 ROSE LANE
SMITHTOWN, NY 11787
PHONE #: 631-979-1286
Eric. : Copy of sketch or plan showing proposal for your
convenience.
5
Name:
Carol & Anthony Mitarontondo
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Address:
950 Little Peconic Bay Road
Cutchogue, NY 11935
Jeanette & James McFarland
1130 Little Peconic Bay Road
Cutchogue, NY 11935
STATE OF NEW YORK
COUNTY OF SUFFOLK
ROBERT E. HERRMANN
1329 NORTH SEA ROAD
SOUTHAMPTON, NY 11968
doing business atEN~0NSULTANTS,~C-
, being duly sworn, deposes and says
that on the 15T day of0CTOBER ,2o 03, 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 addressesset 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 SOUT~L~V~rON , that
said Notices were mailed to each of said persons by (certified)
mail.
Sworn to/~ef~re me this
day of
k-_-~/_~-/ \~-Notars; P~blic
ROBERT~E~.~
COASTAL MANAGEMENT SPECIALIST
U.S. Postal Serwce
CERTIFIED MAIL,,., RECEIPT
(Domestic Mail Only; NO Insurance Coverage Provided)
Fee
(Endo~am.er4 Bemired)
Jeanette & James McFarland
1130 Little Peconic Bay Road
Cutchogue, NY 11935
U.S. Pos[al Service
CERTIFIED MAIL,,, RECEIPT
(Domestic Mail Only: No Insurance Coverage Provided)
(~ment Required)
Carol & Anthony Mitarontondo
950 Little Peconic Bay Road
Cutchogue, NY 11935
of Trustees Applicatio~
AUTHORIZATION
(where the applicant is not the owner)
(print owner of property)
residing at 4~ ~0~ ~
(mailing address
do hereby authorize ~-tk3~4DU~)
(Agent)
to apply for per. it(s) from the
Southold Board of Town Trustees on my behalf.
( Owner ' s sign~ure)
'FROM :' ENCONSULTANTS
PHONE NO. : 631 283 6136
Board of Trustees Application
Sep. 30 2883 03:29PM
County of Suffolk
State of New York
O?5' A BE OD,. Y swo
DEPOSES ~ ~F~S T~T ~/S~ IS ~ ~PLIC~T FOR ~ ~O~
~ TO T~ BEST OF ~S~R ~O~EDGE ~ B~F, ~ ~T ~L WO~
W~L BE DO~ ~ T~ ~R SET FORTH ~ ~S ~PLICATION A~ ASMAY
BE ~PRO~D BY T~ SO--OLD TO~ BO~ OF TRUSSES, ~ ~PLIC~
AGeS TO HOLD ~ TO~ OF SOUTHOLD ~ ~ TO%~ TRUSTS
~ESS ~ F~E ~OM ~ A~ ~L DAMAGES ~ CL~$ ~S~G
~ER OR BY ~ OF S~ PE~T(S), · G~. ~ CO~LET~G ~S
~PLICATION, I ~BY AUTHO~ T~ ~US~ES, T~ AGENT(S) OR
~P~SE~ATI~S(S), TO ENTER 0~O ~ PROPERTY TO ~SPECT ~
P~SES IN CON~CTION ~TH ~W OF ~S ~PLICATION.
I~u~ltfi~:l n Ou®en80oun~/ z
C-~mml~Jon ~,pif~ Aul~u$! ~4, ~ ~
FROM ~ ENCONSULTANTS
PHONE N0. : 631 283 6136 Sep. 38 2083 03:29[ PI
APP~AN~
Tile Town of Southold'e cods of_E{.{!lca urohib/Ca conEllltai
alert the town o~ ~amibie coniiictn o~ lntnr~ and alio~
.... : .... ~ m
NATURE OF APF~tCA?IO~t (¢~a¢~ ~ll tha~ app2y.)
Variance
Change of ~ona'
~x~ip~ion from pla~ o~ o~fl¢iai map
Da~ent, nc child) have a relationalltp vi~b any o£ricer
which the town oE~lcer or employee had even a pa~Elal
ownership of (or ~mployme.t by) a corporation in which
the bovn oE£i~er or employee owns mo~e Ehan
dmte mud Blgn where ineloa~ed.
Town of Sonbhold
~am~ of paraon employed by khe
Title or position o~ that person
Describe the relationship batvaan youraa/~ (the applicant
and the town officer or employon, Either ehe~k hhe
appropriate line A) through D) and/or describe in the epa
provided.
The uovn officer CC employee o~ hie or her apouan,
in a corporation)~
9) the legal ac beneficial owner o~ any inbaraab in
corporation)~
__.C) an creaser, dicector, partner, or employee o£ the
app~icanbl or
~D) the at,ua! app2ican:.
DESCRIPTION O~ R~ATIONSIIIP
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics orohibits conflicts of interest on the nsrt of town officers and emolovees. The ouroose of
this form is to orovide information which can alert the town ofnossible conflicts of interest and allow it to take whatever action is
necessary to avoid same.
(List name, first n~u~e, middle initial, unless you are app ying in the name of
sor~one else or other entity, such as a company. If so, indicate the other
person's or company's n~r~.)
NAME OF APPLICATION: (Check all that apply.)
Variance
Ghange of Zone
Approval of plat
Exemption from plat or official map ..
Other
(If "Other", name thc activity,) Ii ~_.~_a ~,r~ ~V~i4
Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employ~
of the Town of $outhold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business,
including a partnership, in which the town officer or ~mplo~e 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 "YE", complete the balance of this form and date and sign where indicated.
Name ofporson employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself (the applicant/agent~represcotative) 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 shar~ of the corporate stock of the applicant
(when the app]/cant is a corporation);
__.B) the legal or beneficial owner of any interest in a non-cosporote enfily (when the
applicant is not a corporation);
__.C) an officer, director, parmer, or employee of the applicant; or
__D) the actual applicant.
DESCRIPTION OF RELATIONSHIP
A'lbert J. Krupski. President
John Holzapfel, Vice President
Jim King
Martin H. Garrell
Peter WqnczeI
BOARD OF TOWN TRUSTEES
TOWN OF SOU'I'HOLD
Town Hall
53095 Main Road
P.O. Box 1179
Southold. New York 11971
Telephone (516) 765-1892
Fax (516) 765-1823
office Use
Coastal Erosion Permit Applicatio
7Wetland Permit Application
,Grandfather Permit Application
, ~..~___~aiver/Amendment/Chan~es
'__.~'Received Application:
ompleted Application ~/~ ~ 7
Incomplete
SEQRA Classification:
Type I Type II Unlisted
Coordination:(d~te seat)
CAC Referral Sent:
hate of Inspection:
Receipt of CAC Repor%%' ' ,
Lead Agency De=ermination:
~ubchnical Review:
lic Hearing
Resolution: !
Name of Applicant, Robert Profeta
Address 439 Wolf Hill Road, Dix Hills,
NY 11746
Phone Number:(516 )427-5178
Suffolk County Tax Map Nuafoer: 1000 - 111-14-16
Property Location: 1060 Little Peconic Bay Roadt Cutchosue~
NY 11935
(provide LILCO.P~le ~. distance to cross streets, and' location)
AGENT: En-Consultants, Inc.
(If app!icaJ01e}
Address: 1329 North Sea Road
Southampton, NY 11968 Phone: 516/283-6360
FAXg: blS/Z~J--bJbU
Board of Trustees Applic&_~on
Land Area
Area Zoning: Residential
Previous use of property:
2ntended use of property:
GENEI~ DATA
(in square feet): 12,061.43
Residential
Residential home
for clients
Prior permits/approvals for site improvements:
Agency *Date
Southold #4678
11/25/96 (see attached)
NO prior permits/approvals for site improvements.
Has any permit/apDrovaI ever been revoked or suspended by a
governmental agency?
x No Yes
If yes, provide explanation:
Project Description (use attachments if necessary):See attached
PROJECT DR$CRIPTION
Robert Profeta
SCTM# 1000--111-14-16
Replace, within 18", approximately 90' of
existing bulkhead. Remove and replace, in
kind/ in place, (2) 15' returns on either end
of the property. Remove and replace, in kind/in
place, an existing 7' wide timber walk adjacent
to bulkhead. Approximately 50 cubic yards of
clean fill to be trucked in from an approved
upland source.
. ~oard of ~rustees Applica'~ ~n
WETLAND/TRU$'~ LANDS A~PLICATION DATA
?urpose of the proposed operations: TO prevent natural erosion
which would occur as a result of the existinq bulkhead in danqer
of failing.
Area of wetlands on lot: 0 square feet
Percent coverage of lot: 0 %
Closest distance between nearest e~sting structure and upland
edge of wetland~: N/A feet
Closest distance between nearest proposed structure and upland
edge of wetla/lds: N/A feet
Does the project involve excavation or filling?
No x Yes
If yes, how much material will be excavated?
How much material will be filled? 50 cubic yards
Depth of which material will be removed or deposited: N/A
feet
Proposed slope throughout the area of opera=ions: N/A
Manner in which material will be removed or deposited: Clean sand
will be trucked in from an a~proved upland source.
N/A cubic yards
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 a~tachmen~s if appropriate):
The project will have negligible impacts on the tidal waters of
the town. Only temporary disturbance to the substrate will occur
during emplacement of the new bulkhead.
61 7.21
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I--PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1 . ApPLICAN?IBI~O~[ ~ 2. PROJECT N/tddE
~,OBER.T PROu~TA b~ EN-CONSULTAN'I~, INC.
3. PROJEOT LOCATIO[~:
MuniMpatity CUTCHO ~LI~ Count~ SUFFOLK
4. PRECISE LOCATION (Slralt i~r~ lad road [hie raeotion~, prominent I~ndnmrks, ~[t., or provld~ map)
SEQR
1060 Ltl ii.,EPECONICBAYRD., N.Y. 11935 $CTM#1000-111-14-16
it. I$ PROPOSED ACTION:
SEE ATTACHED
7. AMOUNT OF LAND AFFECTED:
Initially ,~.'~7 aere~ Ultimately ,277 aoret
r~ No If No, de~oribe bflefly
9. WHAT IS PRESENT LANO USE IN VICINITY OF PROJECT?
[] Residential [~] Indu~abl ~--I C omm~,.oial
De.dba:
10. DOES ACTION INVOLVE A pERMIT APPROVAL, OR FUNOING, NOWOR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,
11. DOE8 ANY A~PECT OF THE ACTION HAVE A CURREN'~Y VAL[D PERMIT OR APPROVAL?
r-lyes [] NO If yes, lilt agenoy name and permlUappmval
)OS, CO~ TOWlqOF SOUTHOLD
12. AS A RESULT OF PROPOSED ACTION '~ILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE I$ I~UE TO THE BEST OF MY KNOIM.EDGE
Applicant/sponsor name: ROY L. HAJE - PRESIDENT
mt.: AUG. 22, 1997
If the action is in the Coastal Area, and you are a state agency, complete the t
Coastal Assessment Form before proceeding with this assessment
I
OVER
Ad4acent Owners
To east:
James McFarland
P.O. Box 1267
Cutchogue, N.Y.
11935
To west:
Anthony Mitarondo
950 Little Peconic Bay Rd.
Cutchogue, N.Y. 11935
Name:
'PROOF OF"'MAZLING OF NOTICE
ATTACH CERTIFIED MAIL P~ECE/PTS
Address:
James McFarland
P.O. Box 1267
Cutchogue, NY 11935
Anthony Mitarondo
PS Form 3800, Apd11995 ~
.
· . ~
950 Little Peconic Bay Rd.
c~h~-ue, NY 11935
..... -. , ~~=u 1329 North Sea Rd.~
R~+hamnton. NY 11968 , being duly sworn, deposes and says
tha= on -~he ~ day of September ,19~] , deponen= mailed
a true copy of ~he Notice set forth in the Board. of Tr=s~ees
Applica=ion, directed =o each of the above named persons a= the
addresses se~ opposite there respective names; fha= the
addresses se~ opposite the names o~ sai~ persons are the address
of said ~ersons as shown on the curren= assessmen= roll of the
Town of $outhold; that said Notices were mailed at the United
States ~os= O~fice at Southampton , that sai~ Nctlces
were mailed to each of said ~ersonz by (c~=ifie~ ~egistered)
O~lifl~inSuflolkCeuntY
Ooard of Trustees Applicat'~
AUTHORIZATION
(where the applicant is not the owner)
FROT A
(print owner of property)
residing at ~ W0~ ~I~RD,)
(mailing address)
(Agent)
to apply.for permit(s) from the
Sou=hold Board of Town Trustees on my behalf.
(Owner' s ~ig'a~ure)
~ard of Trustees Applicat'
County of Suffolk
State of New York
DEPOSES ~ AFFIF/~S THAT HE/SRE IS THE A~PLICANT FOR '~ ABOV~
DESC~B~ P~T(S)
~ TO ~ BEST OF ~S/~ ~E
WO~ WILL BE ~ IN ~ ~ S~ FOR~'IN ~S ~PLI~TION
~ ~PLIC~ A~ES
~ISI~G ~ OR BY
CO~TING ~IS ~LICATION, I ..:w~y A~O~ ~ ~US~,
~IR AG~(S) OR ~S~ATI~(S), ~ ~'&~ O~ ~ PROP~
TO INSPECT ~ P~SES IN CON~C~ON
~PLICATION.
SWOR~ TO BEFORE ME THIS
Signature
Notary Public
KATHLEEN BOOKER
Notary Public, Stste of New
No. 01B05009492
Quslified in Queens Coun~
I~:~mmission Expires M~rch 15,
7
Albert 1. Kmpsld, President
John Holzapfe. l, Vice President
3kn King
Matin H. Garmll
Peter Wencze]
BOARD OF TOWN TRUST~.FR
TOWN OF SOU/HOLD
Town ~
5~95 ~ Ro~l
P.O. Box Il*P)
Southoki, Ne/v York 11971
· Telepho~ (51C) 7~-1892
Pax (~16) 765-1/23
BOARD OF TRUSTRFm: TOWN OF SOUTHOLD
In the Matter of the Application
of
COUNTY OF S~'OLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
being duly s~rn, de~se ~d say%
~at on the'~day of
by placing the Bo~d of T~tees ~fficial
easily be seen, and that I have checke~ to be sure the poster
has r-mained in place for seven da~s ~r£0r to the date of the
public hearing. (date of hearing note~ thereon to be hel~
Dated:
.( signature )
c~wz~r~ctn to ~ me this
ay bef~;
of
Notar~ ~1:~1i¢
GAt STRAT~ON
Nota~ Public, Ste~e of New yodt
Ne. 4772055
~81ifled in Suf~k County ~.~