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Home My WebLink AboutTR-5646 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0188C Date March 1. 2007 THIS CERTIFIES that the single family dwelling with covered porch. step areas and deck At 6525 Indian Neck Lane. Peconic, New York Suffolk County Tax Map # 86-6-24 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 9/25/02 pursuant to which Trustees Permit # 5646 Dated 10/16/02 and amended on 12/17/03. Was issued, and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for single familv dwelling with covered porch. step areas and deck The certificate is issued to Ravmond & Agnes Combs owner of the aforesaid property. ~~~ Authorized Signature Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095Route 25 P.O. Box 1179 $outhold, NewYorkl1971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 17, 2003 Mark K. Schwartz, AIA P.O. Box 933 Cutchogue, NY 11935 AGNES S. COMBS 6525 INDIAN NECK LANE, PECONIC SCTM#86-6-24 Dear Mr. Schwartz: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on December 17, 2003: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit #5646 for the proposed additions and alterations to the existing single-family dwelling, and as depicted on the survey prepared by Stanley J. Isaksen, Jr. last revised 1/2/04. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765 - 1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:lms Telephone (631) '/65-1892 Town Hall 53095 F. oute 25 P.O. Box 11 '/9 Southoldu New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTItOLD At the meeting of the Southold Town Conservation Advisory Council held Monday, December 8, 2003, ~he following recommendation was made: AGNES S. COMBS to Amend Permit #5646 for the proposed additions and alterations to the existing single-family dwelling. Located: 6525 Indian Neck Lane, Peconic. SCTM#66-6-24 · The CAC did not make a recommendation because the project was unclear. Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson 95 Route 25 P.O. Box 1179 $outhold, New York 11971-0959 Telophone (631) 765-1892 Fax (631) 765-1366 BOAHD OF TOWN TRUSTEES TOWlq OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE ~" Pre-construction, hay bale line 1~ day of construction Y= constructed U'~' Project complete, compliance inspection. Board Of $outhold Town Trustees SOUTHOLD, NEW YORK ISSUED TO .......... AGN~S S. COMBS Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New Yore 19521 and the Southeld 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 ~ROM LANDS UNDER TOWN WATERS;t!. and in accordance with the Resolution of The B6ard adopted at a meeting held on .(~.~.~:...]:~, 200.~.., and in consideration of the sum of $.....~Q.9~J~.0 ..... paid by .... ~enni.f~.. B l G~cl.~. ~s.q.~ ............................................... .. of ......... ~Y~n. PP~ ................... N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits fha foffowing: Wetland Pevrait to remove the cxi~ling dweUing and construct u new dwelling wi~h covered porch and step areas, foundalion and deck ~o be replaced in kind, and proposed bay window on norlh side of premises will extend I !4' norfl~ nf existing stmcin~c's aJJ ' ~oo~run-o~ t ........=nce with the det~iJed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees he~e- by causes ifs Corporate SeaJ fo be affixed, and thes,e ~.resenfs fo sut~scribed by a '.majority of the said Board as of/tJ~s, d~te. - / T~stee~ ,r / TERkiS end CONDmONS ~ Perm~xee Agnes S. Combs. ~clln~at 6525 Indian Neck Lane, Peconic pan of the consideration fo~ the is~,,~e of ~he P'm~it does understand and ptesaibe to the roi- That the said ~ o/Tr..~__..-~_ and the Town d Soft, old tie re!.'-___.~ Etom say and ~ ~, m ~ ~ ~ of ~T~T~~ 2. That tbls Permit ts' vtLM loc j period of g4 mo~. wl~Ich is mmides~l to be the estimated ~,e_' requlved to complete t~e wodc invob~l, but ~hould chzamstanc~ wamaz, request for an ~on may be made to the Botrd at a ~ d-__~.. 5. That this Pennlt should be t-etained imdefinltely, or as long as the said p,.emlttee wi.d~es to maintain the structure or project involved, to lXOv/de evidence to anyone concerned d~at ~ od~at/o~ was orlgi~ly obt.~,~. 4. Tl~t the work involved will be subject to the insfx~ioo and approval of the Board m its agents, and ma-compliance with the p~ovisions of the o~-~-g ~1~ may I~ ~ foe ~evoc~tion of this Permit by t~olution of the said Board. 5. That there will be no umeasooable interfe~'ence with n~-dg~a~ as a ~ of Ihe wo~ 7. That if future opetsfions of the Town of So~tlz)ld zecIuite the t~moval and/or shern~i_~s in the Jocslioa o~ thc wodc he.t~In ~ or i~, in the opini~ o~ the ]~ltd o~ Tmstee~ (t~ wod~ ~h.I! omse untcxsonable o~Uucuon to free navigation, che said pe~mlttee w~l be neclut~d~ upoa c~e notice, to ten.ye ot alte~ ii, wo& o~ project hex-dh stated without ~ to ~ To~ 8. That the said Board will be notified by the Permittee ot d~e completion o~ the work ~ orize~ 9- 'that the Petmlttee will o~ain aH other petmlts ~ come.ts dzat may ~e vequh'ed sup- pkmental m this permit which may be subject to revoke upon failure to obcsln stone. Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson October 16, 2002 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 Jennifer B. Gould, Esq. 210 Main St. P.O. Box 177 Greenport, NY 11944 AGNES S. COMBS 6525 INDIAN NECK LANE, PECONIC SCTM#86-6-24 Dear Ms. Gould: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, October 16, 2002 regarding the above matter: WHEREAS, Jennifer B. Gould, Esq. on behalf of AGNES S. COMBS 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 September 25, 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 October 16, 2002, at which time all interested persons were given an opportunity to he 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 AGNES S. COMBS to remove the existing dwelling and construct a new dwelling with covered porch and step areas, foundation and deck to be replaced in-kind, and proposed bay window on north side of premises will extend 1 Y2' north of existing structure's footprint, all with the condition that a row of staked hay bales is placed do~m at the top of the bluff before the project begins and gutters and drywells are installed to contain the roof run-off. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency, xvhich 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 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 $10.00 per inspection. (See attached schedule.) Fees: $10.00 Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/lms AJ'oert J. Krupski, President James I{.ing, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095MainRoad P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application, dated ~/~470/-; has been reviewed by this Board, at the regular meeting of /0//~/0~ and the following action was taken: ( ~'/) Application Approved (see below) (__) Application Denied (see below) (__) Application Tabled (see below) If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth ~n the {nstr~t~on :ation 4994 GREENPORT, NY 11944 50-791/2'4 PAY TO THE 'l"O0~q q~"' I$/O DOLLARS m:O 2 ;-~0 ?q s 2m:ll" :% 2 2 q.,,~O ? ? ~.,, ~11. Albert J. Krupsld, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application, dated ~./~70~.; has been reviewed by this Board, at the regular meeting of /~/_]~/0_~ and the following action was taken: ( u'/) 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: SIGNED: PRESIDENT, BOARD OF TRUSTEES BY: ~L-ERI~, BOARD OF TRUSTEES 4/98 - Standing at northwest comer, facing house in N0~h Side of Existing Dwelling 4/02 a southeast direction, 4/02. Telephone (631) 765-1892 Town Hall. 53095 Main Road P.O. Box 11'79 Southold. New Yo~k 11971 SOUTHOLD TOWN CONSF.11VATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, October 7, 2002, the following recommendation was made: Moved by Bill McDermott, seconded by Melvyn Morris, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit Application of AGNES S. COMBS to remove the existing dwelling and construct a new dwelling with covered porch and step areas. Foundation and deck to be replaced in-kind. Proposed bay window on north side of premises will extend 1 ¼' north of existing structure's footprint. Located: 6525 Indian Neck Lane, Peconic. SCTM#86-6-24 The CAC recommends Approval of the application with the Condition that there is no further mowing or cutting of the marsh grasses, and drywells and gutters are installed to contain the roof run-off. Vote of Council: Ayes: All Motion Carried / /CHMOA./D ,7,//i~ 'fL I S' EXIS7~ CESSPOOL 24' LEMMOR FORMEP, L Y KNO~.~'L£S / / CF, O'/, 6?" '/2' ,39 ,4.19 AREA OF ] AL TERA TIONS ~ 7.?)q.~. PROPOSED CHUrNEr ADD TION N/F CHAD WICk' ~ LO[~NHEIM N [PROPOSED1 GARAGE 'A' NOT TO SCALE SCALE JARAN TEED ~ RA~ COMBS - TOIA'N G'F SO,'JTHOLD O. lO DEC OJ SHOW PERCENTAGE OF LOT COVERAGE OF EX/STING AND PROPOSED STRUCTURES, ADD DRY ~.ELL, CHANGE DRIVEWA f~ 1/02/04 10 NOV O~ ADD NOTE "AREA OF ALTERATIONS". 12 SEP 03 SHOt'; PROPOSEO ADDITION &, PROP. GARAGE. 29 JUNE 2000 SEf STAKE ~: SMALL PK NAIL, SHOI¢ BULKHEAD. ..,~; Mark K. Schwartz, AIA - Architect, PLLC P.O. ~ox 9'33 Phone: (631) 734 - 4185 Fax: (631) 734 - 4185 November 10, 2003 TRANSMITI'AL To: Project: Southold Town Board of Trustees 53095 Route 25 P.O. Box 1179 Southold, New York 11971 Combs Property 6525 Indian Neck Lane Peconic, New York 11958 (SCTM# 1000-86-06-24) NOV ] 9 2CC3 Soathold Board o~ Trustees From: Mark Schwartz, AIA We transmit the following by hand delivery: · Three revised surveys with proposed additions and alterations depicted. · Letter of Authorization to act as agent for Mr. and Mrs. Combs. · Landowner: Raymond and Agnes Combs 6525 Indian Neck Lane Peconic, New York 11958 (631) 734-5045 Pleasethis officereVieWwiththiSanyamendmentquestions your° previOUSmay have.permit # 5646 dated October 16, 2002 and call~,~ ~)~,~ CombsTrustees 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 ~kday of 0~C ,2003, I personally posted the property known as by placing thc Board of Trustee~ official poste~w~ere it can easily be seen, and that I have checked to be sure the poster has remained in plac.e for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held {J,3~., ~.~C_O I/~ · [ e~0 ~ ~.. - Oc- t 3 oO.. 'T,C lvt. Dated: (~ignature) Sworn to before me this t 7~day of/)~c 200 3 Notm:y Pablid LINDA J. COOvE~ Notary Public, State of New York .- N~,. 48225~3, St ffo~k lis Jr. eck Lane York 11958 86-6-22 Gerard & Dorothy Lemmon 119 Ridge Crescent Marthasset, New York 11030 86-6-21 Ellsworth Baylis Jr. 6429 Indian Neck Lane P.O. Box 168 Peconic, New York 11958 86-6-25 Mark S. Lowenheim Walter H. Chadwick 6565 Indian Neck Lane P.O. Box 123 Peconic, New York 11958 86-7-3.1 Sue IC Odell 2361 Dunstan Street Houston Texas 77005 87-7-4.1 / Kathleen Varano & ors 5 Colonial Court East Northport, New York 11731-5801 APPLICANT/AGENT/REPRESENTATIVE T1L4,NSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics orohibits conflicts of interest on the part of town officers and employees. The purpose of this 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. (LaSt name, first name[rfiiddle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Variance Change of Zone Approval of plat Exemption from plat or official map Other (If"Other", name the activity.) 7/t~t/$,7~ g.~,,f Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any off~cer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the tow'n officer or employee has even a partial ownership of(or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO L~ If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Toaqa of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The to,~ officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); __.C) an officer, director, partner, or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this Signature Print Name ' Albert J. Krupski, President James King, Vice-President Henry Smith Aa-tie Foster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD Office Use Only Coastal Erosion Permit Application ...-'Wetland Permit Application '"~lajor Waiver/Amendme nt/.C h~?~es ,-'Received Application: _~ooCeived Fee:$ ~(30"' . . mpleted Application Incomplete SEQRA Classification: Type I Type II Unlisted__ Coordinafion:(date sent)~ ~"'CAC Referral Sent: ~]~]~ ,,--Date of Inspection: ]0/~]0 Receipt of CAC Report: Lead Agency Determination: Technical Review: ~qSublic Hearing Held: ] 0//~./0 Resolution: Minor Name of Applicant Agnes ~ Combs Address 6525 Indian Neck Lane, a/k/a Indian Neck Road Peconic, NY 11958 Phone Number:( ) 631-734-5045 Suffolk County Tax Map Number: 1000 - 086.00 - 06.00 - 024-000 Prope~yLocation: 6525 Indian Neck Lane(Road): PPcnnir, NY_ Indian Neck Lane(Road) intersects with State Road 25 - premises between Wood Lane and Parkers Landing Road on Indian Nook l.ano (provide LILCO Pole #, distance to cross streets, and location) AGENT: Jennifer B. Gould, Esq. (lf applicable) Address: 210 Main St., PO Box 177 Greenport, NY, 11944 Phone: 631-477-8607 (p~ono) 631-477-2601 (fax) Board of Trustees Application Land Area (in square feet): Area Zoning: Previous use of property:_ Intended use of property: step areas GENERAL DATA 32,491. 899 R-40 single-family dwelling - cottage (~) single-family dwelline with covered ?rch and Prior permits/approvalsforsiteimprovements: Agency NONE Date X No prior permits/approvals for site improvements, existing dwelling pre-existed Town Codes 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): See survey - remove existing dwelling and construct new dwelling with covered porch and step areas. Foundation and deck to be replaced in kind. Proposed bay window on fiorth side of premises will extend 1.5 feet north of existing structure's footprint. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations:_ Area of wetlands on lot: 1 ,/468 square feet Percent coverage of lot: 4.5 % Closest distance between nearest existing structure and upland edge of wetlands~0.5 feet Closest distance between nearest proposed structure and upland edge of wetlands: 59 feet Does the project involve excavation or filling? No X Yes If yes, how much material will be excavated? 2 3 5 cubic yards How much material will be filled? 700 cubic yards Depth of which material will be removed or deposited: 8 feet Proposed slope throu~houtthe areaofoperations: elevation of proposed slab is 9.7 feet; present sl~ at 9.'~o_h teet. High elevation at beach area is 8 feet. Manner in which material will be removed or deposited: backhoe 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. No disturbance of area north of haybales. (see survey). Haybales in a line 43 feet south of high waterline. Three dry wells proposed for roof runoff. Proposed construction is 70' south of highwater line. NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES~ TOWN OF SOUTHOLD In the matter of applicant: Agnes~. Combs SCTM#1000- 086.00-06.00-024.000 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: remove existing dwelling and construct new dwelling with covered porch and step areas. 2. That Review-is follows: the property which is the subject of Environmental located adjacent to your property and is described as 6525 Indian Neck Road Peconic, NY 11958 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: ]0/16/~? You may contact the Trustees Office at 765-I892 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 N~24E: Agnes~. Combs MAILING ADDRESS: 6525 Peconic. NY ]] PHONE #: 631 Enc.: Copy of sketch or plan showing proposal for your convenience. Board of Trustees Application County of Suffolk State of New York Agnes ~, Combs BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERNHT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. .,.Signature Agnes~ Combs SWORN TO BEFORE ME THIS oQ~.~.,t v. DAY OF~,20 07 JENNIFER B. GOULD Notary Public, State of New Yolk No. 02GO5024640 - Suffolk Cou n['J CommTssion E×~ires March 14, 20C~7_ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: See reverse STATE OF NEW YORK COUNTY OF SUFFOLK Jennifer B. Gould ,residingat 1820 Truman's Path: Fm~t- Ma,~ion, New York , being duly sworn, deposes and says that on the ~ day of ~>,t~prn~ , 2002 , deponent mailed a true copy of the Notice · set forth in the Board-or'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 Greenport, NY , that said Notices were mailed to each of said persons by (certified) (I~Jt~ll) mail. (-'"x~t~AJ/~"x ~~.~ . Sworn tq before m~ this Day of g~J.~-.~tb/J~ 20~)2~ I ~ /// Notary P~blic Notary Public, State of New York '~ ~ No: 524661406 Qualified in Suffolk County Commission Expires Dec.31 CERTIFIED MAIL RECEIPT (Domestic I~oll Only: No hTs[/r,lnce Coverage Provided) PECONIC, NY ~1~=~ 4.42 0.37 UNIT 2,30 /,2 ' L' 1.75 09/25/02 r,-, Mark S. Lowenh~iB. ~i;~;-"Y'~.:.'6~'~'b~;'~. ' .... ~ ~ Indian Neck Lane, PO Box 123 ~ 65 NY 11958 ,} U.S. Postal Service CERTIFIED MAIL RECEIPT (Domestic IVL?il Only; No Insur,~nce Couer,~ge Prowded) 0,37 )~erk: ~WXH?S $ 4.42 09/23/02 :' I U.S. postal Service CERTIFIED MAIL RECEIPT 0,37 Postage Cl/~'rk: KWXH?~ Nmck L~e FOB NY 11958 U.S, Postal Service CERTIFIED MAIL RECEIPT A~bert J. Krupski, President James King, Vic~-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHQLD In the Matter of the Application of ............. COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, ~9f~g 5- C0~q ~ , residing at ~2~- ~q~"~ ~CL ~__ being duly swo~, depose and say: Tha~ on ~he ~ day o~. , 20~, I personally posted ~he property known as [~Z~ ~r~,~ ~C~ ~, ~C0~,6, by placing the Board of Trustees official poster where ~t 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 ublic ~eariNg.. Dat~ of hearing noted thereon to be Dated: Sworn to before me this i~e- day of ~OULD No,ar7 Public. Stale d New York No. 02GO5024640 - Suffolk Count' Commission Expires March 14. 2 0.,,~ ( s i~atu're ) PROJECT [.D, NLJMBE~ $17.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART i--PROJECT INFORMATION (To be comple:ed by Applicant or Project sponsor] SECr 3. PROJECT LOCATION: Mi~nlc[oallty Town of Southold County of Suffolk 6525 Indian Neck Road, Peconic, New York, 11958 SCTM 1000 - 086.00 - 06.00 - 024.000 Indian Neck Road intersects with State Road 25-premises is between Wood Lane and Parkers iSPROPOSEDACTION: Landing Road on ihdian Neck Road r~New [~Exoa~sion ~Mo~ificati~n/alteration remove exlsting dwelling and construct new dwelling with covered porch and step areas 7. AMOUNT OF LAND AFFECTED: ~Yes ~NO ~fNo. describeOr~efly applicant will require one side yard variance to comply with current zoning codes single-[amily d~ell~ng STATE ~ LOCAL~? ~ Yes ~ NO If yes, ~ist agency(s) and 0ermrt/aoorovals SCDHS, ~EC, Southold To~n Building Dept., Southold ~o~n ZBA (s~de yard varAa~ce- o~e s~e o~ly) permit appl&catio~s a~e pend~n8 A~nes~. Combs 0~,,: 9-~- ZOO~ If the action is in the Coastal Area, and you are a state agency, compie:e the Coastal Assessment Form before proceeding with this assessment OVER ! =ART III--0ETEFMINATICN OF SIGNIFICANCE ~T,.3 3e comele~ea 3y Agency) JENNIFER B. GOULD Attorney at Law 210 Main Street · EO Box 177 ' Greenport, New York 1 I944 Telephone 631-477-8607 · Fax 631-477-2601 September 25. 2002 Southold Town Trustees (Hand delivered by JBG) Main Road Southold, NY 11971 RE: Agnes S. Combs - application for wetlands permit Premises: 6525 Indian Neck Lane aka Indian Neck Road, Peconic, NY SCTM # 1000-86-6-24 Dear Soulhold Town Trustees: I represent Agnes S. Combs in the above matter. Enclosed please find the original and 2 copies of her application, along wilh 3 nrigimfi survey prints of the above premises, my attorney's check in the amounl of $20(L01} and my affidavit of mailing (annexed to the application). If you have any questions regarding }he application, please do not hesitate to contacl ibc. Very truly yours, /'-) ~ /~ D Enclosure cc: Agnes S. Combs TRANSACTIONAL PlS~LORURg FoRM The Town oi Sou~hold's Code o[._Eth!os prohibits oon£iiots of interest on the part of town officers and. emplo ~ey_9_9~ The purpose of this [orm 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. Fou are applying in the same of someone else or other entity, such ~s a company. If so, indicate the other person's or company's name.) NATUR~ O~ APPLI~ATION~ (Check all tha~ apply.') Tax grievance Variance Change of zone Approval of plat , Exemption from plat or official map Other X (If "other," name ~he activity,) Trustee Permit ~mployee of the Town o~ Southold? "Relationship" fnuludes by blood, marriage, or business interest. "Business ln~er~s~" moann n buntnens, ine~uflin~ a par~nership~ ,hich ihs ~o=n officer or ~mpXoye~ has even a partia~ o~nership of (or employment by) a corporation in ~hich ~he to=n o[~icer or employee o~ns more ~han 5~ or ~he shares. ,F NO X If you answered "XES,#. complete the balance date and sign ~here indicated. i:hte form and Name of person employed by the Town o~ Southold Title or position of that person Describe the relationship between yourself (the applicant) and the town officer or employee. Either check the appropriate line ~) through D) and/or describe in the spa~e provided. The town parent, A) B) c) D) officer or employee or his or her spouss~ sibling, or child ts (check all that apply)t the owner of greater than 5% of the shares of the corporate stock of the applic~nt (when the applicant' ia a corporation); the legal or b~nsficial owner of any interest in a noncorporate'entity (when the applioant is not a corporation)t an officer, director, part,er, or employee of the applicantt or the a~tual applicant, DESCRIPTION OF RELATIONSIIIP