HomeMy WebLinkAboutTR-5798 6
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Albert J. Krupski, President �v C� Town hall
James King,Vice-President /�`t` 53095 Route 25
Artie Foster O P.O.Box 1179
Ken Poliwoda W Southold, New York 11971-0959
Peggy A. Dickerson �f. Ott Telephone(631) 765-1892
Fax(631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
December 17, 2003
Mr. Peter Cosola
116 Weyford Terrace
Garden City, NY 11530
RE: 2880 MINNEHAHA BLVD., SOUTHOLD
SCTM#87-343
Dear Mr. Cosola:
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
#5798 to add a YX 30' extension to the front of the house based on the footprint of the
previously granted permit, and as depicted on the survey last revised October 24, 2003.
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
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OPECHEE AVE
LEADS AND GUTTERS WiLL
INSTALLED BY COMPLETION OFE SURVEY OF
CONSTRUCTION PROPERTY
AT LAUGHING WATERS
TOWN OF SOUTHOLD
SUFFOLK, COUNTY, N. Y.
1000_—r87 — 03 — 43
CERTIFIED TO Scale: 1 = 30"
PETER
ABSTRACOTS,, INCORPORATED J64y 18, 2003
Aug. 13, 2003 (Certifications)
A� 23, 200� ( prop uoloc„f,^�
Sept- / 2oo3 (
FL OOD ZONE AE fel 8)
FIRM 36103CO166 G May 4, 1998
ELEVATIONS ARE REFERENCED TO NGVD.
AREA = 24,380 sq. ft to tie k7es
1�p4 nEw rD9
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION �R' �S•ME rz, 'f
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW.
EXCEPT AS PER SECTION 7209 - SGBAI►?SgN 2. ALL CERTO ATAONS
� CALADS OR THIS AL4P AND DEE�OR COPES I?C &&OWSS SEAL THE�VYORY. LIC. NO. 49678
WHOSE SIGNATURE APPEARS HEREONL
ADDITIONALLY TO COMPLY WITH SAD LAW TERM * ALTERED BY • C0 C 5�'D0 C.
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MUST BE USED BY ANY AND ALL SUVEYORS UTLI216 A COPY (631) 765 - 1797
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OF ANOTHER SURVEYOR'S MAP. TERMS SUCH 'MSPECTED 'AAD P t'
BROUGHT - TO - DATE 'ARE NOT IN COA04JANCE WITH THE LAW. 1230 A TREET
SOU THO , 11971
03- 206
�O�SpIFF044,,
Town Hall
Telephone y 53095 Route 25
(631)765-1992 • !� P.O.l3oz1179
y�ol � Sao
Southold,New York 11971-0959
CONSERVATION ADVISORY COUNCIL
TOWN OF SOUTI1OLD
At the meeting of the Southold Town Conservation Advisory Council held Monday,
November 17, 2003, the following recommendation was made:
Moved by William Cook, seconded by Tom Schlichter, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the
Amendment application of STEPHANIE & PETER COSOLA to Amend Permit#5798 to
install a new septic system and add a TX 30' extension to the front of the house based
on the footprint of the previously granted permit.
Located: 2880 Minnehaha Blvd., Southold, SCTM#87-3-43
The CAC recommends Approval of the application however suggest the plans be
revised in order to avoid removal of a large tree.
Vote of Council: Ayes: All
Motion Carried
Albert J. Krupski, President gpFFO(,p 0� CD Town Hall
James King,Vice-President = Gy� 53095 Route 25
Artie Foster o P.O. Box 1179
Ken Poliwoda G Z Southold, New York 11971-0959
Peggy A. Dickerson Oifr Telephone(631) 765-1892
Fax(631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
September 25, 2003
Alpha Consulting
PO Box 447
Greenport,NY 11944
RE: SCTM#87-03-43
Peter& Stephanie Cosola
2880 Minnehaha Blvd
Southold, NY
Gentlemen:
The Southold Town Board of Trustees at their Regular Meeting held on Wednesday, September
24th, 2003 took the following action.
RESOLVED, that the Southold Town Board of Trustees Approve an Amendment to Permit
#5798 for PETER& STEPHANIE COSOLA for an addition of new 13' wide x 28'. 9"
(house depth) foundation and structure with the stipulation that there be drywells and gutters be
installed to contain roof run-off.
If you have any questions, please call our office at 765-1892.
Sincerely,
dzl'c 2e
Albert J. Krupski,Jr.
President, Board of Trustees
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Town Hall. 53095 Main Road
N P.O. Box 1179
(631) 765-1892 Telephone p�yy,� Southold. New.York I1971
*a701 � .�1���
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
At the meeting of the Southold Town Conservation Advisory Council held Tuesday,
September 23, 2003, the following recommendation was made:
Moved by William Cook, seconded by Drew Dillingham, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH
A CONDITION of the Amendment application of PETER & STEPHANIE COSOLA to
Amend Permit#5798 for the addition of a new 10'X 28.9' addition to the existing single-
family dwelling.
Located: 2880 Minnehaha Blvd., Southold. SCTM#87-3-43
The CAC recommends Approval with the Condition no trees are cut down.
Vote of Council: Ayes:'All
Motion Carried
Board Of Southold Town Trustees '
SOUTHOLD, NEW YORK
D ,
PERMIT NO. �� Q DATE: ..August 20,.2003 .
PETER COSOLA "
ISSUEDTO .......................... ........... ................... . . . ........... .....................
Flu#i�nrt�tt#inn
Pursuant to the provisions of Chapter 615 of the Laws of s
the State of New York, 1893; and Chapter 404 of the Laws of the
State of New York 1952; and the Southold Town Ordinance an-
titled "REGULATING AND THE PLACING OF OBSTRUCTIONS
:z. 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 Board adopted at a meeting held on ..._August 20,
2003 , and in consideration of the sum of $. 50.r. 0 ...... paid by
{ Peter Cosola
. . .. ...... ......................................................
of Southold N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the following: t
:z Wetland Permit to add a second-story to the existing dwelling, -
with the condition that gutters and drywells are installed to
contain the roof run-off and a silt fence is installed 25' from the
house prior to construction, and as depicted on the survey last
all in accordance with the detailed specifications as presented in >G
the originating application, revised August 23, 2003.
r
IN WITNESS WHEREOF, The said Board of Trustees kere-
by causes its Corporate Seal to be affixed, and these presents to
be subscribed by a majority of the said Board as of this date.
Zn
Trustees
$ .F
TERMS and CONDITIONS
The Permittee Peter Cosola
residing at 1130 Minnehaha Blvd. , Southold N. Y., as
pan of the consideration for the issuance of the Permit does understand and prescribe to the fol-
lowing:
1. That the said Board of Trustees mad the Town of Southold am released from any and
all damages, or claims for damages, of subs arising directly or indirectly as a result of any oper-
ation performed pursuant to this permit, and the said Permittee will, at his of her own expense,
defend any and all sudh suits initiated by third patties, and the said Permitow anames full liability
with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold
2. That this Permit is valid for a period of 24 mos. which is considered to be the
estimated time required to complete the work involved, but should circumstances warrant, request
for an extension may be made to the Board at a later date.
3. That this Permit should be retained indefinitely, or as long as the said Permitter wishes
to maintain the structure or project involved, to provide evidence to anyone concerned that aarh-
orizaton was originally obtained.
4. That the work involved will be subject to the inspection and approval of the Board or
its agents, and non-compliance with.the provisions of the originating application, may be cruse for
revocation of this Permit by resolution of the said Board
5. That there will be no unreasonable interference with navigation as a result of the wort
herein authorized.
6. That there shall be no interference with the right of the public to pass and repass along
the beach between high and low water marks.
7. That if future operation of the Town of Southold require the removal and/or alterations
in the location of the work herein authoetted, or if, in the opinion of the Board of Trustees, the
work shall cause unreasonable obstruction to free navigation, the said Permitter will be required,
upon due notice, to remove or alter this work or project herein stated without expenses to the Torn
of Southold.
8. That the said Board will be noted by the Permittee or the completion of the work aath-
otized.
9. That the Permittee will obtain all other permits and consents that nay be required sup
pltmeatal to this permit which may be subject to revoke upon failure to obtain same.
Albert J. Krupski,President • �SOFFO(,�C Town Hall
James King,Vice-President �'Z� OGy 53095 Route 25
Artie Foster o .�' P.O.Box 1179
*
Ken Poliwoda Southold,New York 11971-0959
Peggy A. Dickerson y � Telephone(631) 765-1892
Fax(631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
August 20, 2003
Mr. Peter Cosola
1130 Minnehaha Blvd.
Southold,NY 11971
RE: 2880 MINNEHAHA BLVD., SOUTHOLD
SCTM#87-343
Dear Mr. Cosola:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday,August 20, 2003 regarding the above matter:
WHEREAS,PETER COSOLA 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 July 28, 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
August 20,2003, 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,
z � •
NOW THEREFORE BE IT,
RESOLVED, that the Board of Trustees approve the application of PETER COSOLA to add a
second-story to the existing dwelling,with the condition that gutters and drywells are installed to
contain the roof run-off and a silt fence is installed 25' from the house prior to construction, and
as depicted on the survey last revised August 23, 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
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Albert J. Krupski, President gUFFO(,r�, • Town Hall
James King, Vice-President �O� earn 53096 Main Road
y P.O.Box 1179
Henry th
Artie Foster �y Southold, New York 11-971
Z
Ken Poliwoda O Telephone(516) 765-1892
Fax(516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLI) _
7;4
1�
TO: T2� r � C�)U
Please be advised that ycur application, dated
has been reviewed by this Board, at the regular meeting of
and the following action was taken:
( ) Application Approved (see below)
( ) Application Denied (see below)
( ) Application Tabled (see below)
If your application is approved as noted above, a permit fee is
now due. Make check or money order payable to the Southold Town
Trustees . The fee is computed below according to the schedule
of rates as set forth in the instruction sheet.
The following fee must be paid within 90 days or re-application
fees will be necessarv.
COMPUTATION OF PERMIT FEES_
s
t''Cl?4`.4L�1 ;.l'-Ct.Q:� �'\Q`, v.�CC : �`L�1_���.`�l`_• i- ._11.1�'."fF(.:.: (Lv:CI :,\1:� t:.'_',�r°C
TOTAL FEES DUE: $
SIGNED:
PRESIDENT, /BOARD OF TRUSTEE'S
BY: C("( L.^ of �J'[.Le ,Y{�•1 /L
CLERK', BOARD OF TRUSTEES
4/98
Albert J.Krupski,President i Town Hail
James King,Vice-President _p$VFFD�IF'C 53095 Route 25
Artie Foster ,ro D�j P.O.Box 1179
Ken Poliwoda C y� Southold, New York 11971-0959
Peggy A.Dickerson a° = Telephone(631) 765-1892
Oy �yC Fax(631)765-1366
col � Sao
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.
Co Su la
INSPECTION SCHEDULE
Pre-construction, hay bale line
15t day of construction
% constructed
Project complete, compliance inspection.
ri
�o�UFFO�coG
Town Hall. 53095 Main Road
P.O. Boz 1179
Telephone oyol Southold. New York 11971
(631) 765-1892 �9f
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
At the meeting of the Southold Town Conservation Advisory Council held Tuesday,
August 12, 2003, the following recommendation was made:
Moved by Bob Ghosio, seconded by Tom Schlichter, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH
A CONDITION of the Wetland Permit application of PETER COSOLA to add a second-
story to the existing dwelling.
Located: 2880 Minnehaha Blvd., Southold. SCTM#87-3-43
The CAC recommends Approval of the application with the Condition that hay bales are
placed down prior to construction.
Vote of Council: Ayes: All
Motion Carried
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BARGAIN AND SALE DEED WITH COVENANT AGAINST GRANTOR'S
ACTS (INDIVIDUAL OR CORPORATION)
STANDARD NYBTU FORM 8007
CAUTION:THIS AGREEMENT SHOULD BE PREPARED BY AN ATTORNEY AND REVIEWED BY ATTORNEYS FOR SELLER AND
PURCHASER B FORE SIGNING.
THIS INDENTURE, made the August 2003
between � � � � •,,�� � D
EDWARD J. BAGE and SANDRA BAGE, husband and wife, D
residing at 2880 Minnehaha Blvd., Laughing Waters, Z C3 20��
Southold, New York 11971
s�amola?�5tees
party of the first part, and
PETER COSOLA and STEPHANIE COSOLA, husband and wife,
residing at 116 Weyford Terrace
Garden City, New York 11530
party of the second part,
WITNESSETH, that the party of the first part, in consideration of Ten Dollars and other lawful
consideration, lawful money of the United States, paid by the party of the second part, does hereby grant and
release unto the party of the second part, the heirs or successors and assigns of the party of the second part
forever,
ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected,
situate, lying and being at Southold, Town of Southold, County of Suffolk and State of New York.
The grantors herein are the same persons as the grantees in deed dated October 23, 2002 in Liber 12218
Page 31 5 on 1 1/4/02 at the office of the Clerk of the County of Suffolk.
TOGETHER with all right, title and interest, if any, of the party of the first part in and to any streets and
roads abutting the above described premises to the center lines thereof,
TOGETHER with the appurtenances and all the estate and rights of the party of the first part in and to
said premises,
TO HAVE AND TO HOLD the premises herein granted unto the party of the second part, the heirs or
successors and assigns of the party of the second part forever.
AND the party of the first part, covenants that the party of the first part has not done or suffered anything
whereby the said premises have been encumbered in any way whatever, except as aforesaid.
AND the party of the first part, in compliance with Section 13 of the Lien Law, covenants that the party
of the first part will receive the consideration for this conveyance and will hold the right to receive such
consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will
apply the same first to the payment of the cost of the improvement before using any part of the total of the same
for any other purpose.
The word "party" shall be construed as if it read "parties" whenever the sense of this indenture so
requires.
IN WITNESS WHEREOF, the party of the first part has duly executed this deed the day and year first
above written.
ED ARD J. A"
SANDRA BAGE
NYSBA Residential Real Estate Fonns on HotDocs"19/00) Copyright Capsoft•" Development
i
PETER & STEPHANIE COSOLA
December 9th 2003
To: Southold Board Of Trustees
Art: Charlotte
Re: 2880 Minnehaha Blvd
Southold NY 11971
Please accept this request to "withdrawer" the permit to install a new septic system
at the above referenced address. Please proceed with the processing of the permit for the
"house" addition that was tentatively approved at the November hearing. Please forward
the amended permit to 116 Weyford Terrace Garden City NY 11530 after it has been
processed.
Please contact me at 917-972-1589 if you have any questions or comments. I
thank you for your assistance with this application.
Res fully
PE COSOLA D
D C 2
DEC 1
Southold Town
Board of Trustees
TO/T0 39Vd ONI V-10S00 21313d TTTZZ6E8TL EE :OZ E00Z/60/ZT
1V/4J/VJ lIIV VJ.Vy Cffp J1V f•'J 1JVV ]UYGllU LU 1Yf14 KUI;V LLIlILLL� �I UVL
Albert J.Rntpeki,President � c Town Hell
mes,T Ring.Vice-President 65096 Route 26
Artie Foster P.O.Box 1179
Ken Poliwoda M Southold,New York 11971-0959
Peggy A.Dickerson ��
Telephone(631)765.1892
Pax(631)765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
APPLICATION FOR AN AMENDMENT TO A PERMIT
DATE
owNE>t STEP)INT h PETER C0500 PHONE 911- 97 2,- /S 9
ADDRESS /)6 WCNF6RO TCROCC 6P(?D N CiTJ N4 1153o
AGENT or PpPwnac PHONE
ADDRES'S 4
PROPERTYTLOCATION G 9u MWNEHAW4 809 SaKAOI.D N1
TAXMAPNO_ 1ado 87 - 63 J3
vwe STEP)mi E f Rva C(a A request m Amendmiamt to P �O
To INSma R NEW rESSPCoI sNsTN ANC /t00 v
eYTENS)CJ To f14C R010 dF rl C HOVSE POSED E . 9 2003 D
F(30T - PRIM? 0f TH - 0eovc REFE-emaJ P2Ev1 Asti olwc-D
Southold Town
� BoaM of husteen
sigued By: n
�0
0 •
PETER& TEPHANIE COSOLA .,r
2880 Minnehaha Blvd Southold Ny 11971
October 28th 2003
To: Board of Trustees-Town of Southold
Att: Charlotte
Re: 2880 Minnehaha Blvd
Attached please find the completed "application for an amendment to a permit"
form, a copy of the letter to the adjoining neighbors including the certified mail receipts,
and a copy of the revised survey detailing the 3'x30' addition that we are requesting.
Please contact me at 917-972-1589 if you have any questions or comments.
RePER
ly
PEOSOLA
FEFCEd �
n
ees __�
r ,
p E C E I V E
OCT 2 9 2003 D
Southold Town
Board of Trustees
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11/14/2003 15:00 7183922117. _, � PETER COSCLA INC PAGE 01/01
Albert J. Krupski,President • `O$yffQ(�� • - �\
James King,Vice-president .i. Town Hall
53095 Route 25
Attie Poster P.O.Box 1179
Ken Poliwoda CobSouthold, Now York 11971-0959
Peggy A.Dickerson O
Telephone
Fax(6316 7657B3ro
BOARD OF TOWN T'RUBTFES
. TOWN OF SOLYMOLD BOARD OF TRUSTEES: TOWN OF SOUTHow D E C E I VI ED
--------------__-----
____________________Y___
In the Matter of the Application NOV 14 'cG3
D of ,,,
-- �.r1..��-v'ISt� .___._---.-------------- Southold Town
OUNTY OF SUFFOLK) Board of Trustees
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
I Q E2 CDSD'i A residing at Z 3 a o ��I fJ�vlr/1Arl� �L UD
Il 971
being duly sworn, depose and say:
That on tl e S�day of U0L1v7MQX2003,1�L3 ersoltally posted the property known as�o rJ1�P�P�GWAIa� �3LV0
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 plaee);or eight dgys prior to the date of t4e public
kWhearing.Date of hearing noted thereon to be held k . l y � l�Oj� N 07.D94_�" .
Dated:
(signature)
Sworn to before me this
1LtrL, day of,Mo 003
Notary Public
CNANSINONANI PRAKASN k
NOTARY PUBLIC,STATE OP NEW YORK
..No.OTDN80S9993
Qualirod in NASSAU COUNTY _
COMMISSION RXP June 11,200 rT - -
AU/�U/UD 1nu UD:U1 PAA "I (OD 1000
JUVyLV1LL lUbL ACCOVIIylpg
• • 19UUa
i
NOTICE TO. AWACENT PROPERTY OWNER s
HOARD OF TRUSTEES TOWN -bF-SOUTHOLD
In the matter of applicant:
SCTK4Wl000-
YOU ARE HEREBY GIVEN NOTICE:
1. That it is the intention of the undersigned to request a
.permit from the: Board of Txustess to:
[fJSiAit �J _0 CE'S006i, S`�ST�Pr��ROD 3 X ? rya FRON; 0r
�toutt) AhIE OU15k r, TO EXlsnnJU PF"' r
2_ That the property which is the subject of Environmental
Review is located adjacent to your propexty-and is described as
follows: r
; ? �qo M1,ipi L IM1m
��J HoLI} AA 1197f
3. That the project which is subject to Environmental Review
ender Chapters 32, 37, or 9.7 Of the Town Code 4-9 open to public
comrent on: l You may contact the Trustees Office at -
763-1892 -or in writirq.
The above' referanced proposals; under review of the Board. of
Trustees of the Town. of Southold and does not ref
other agency that might have to review same pxopo 0
omits ;w; - E�C�<}S�CFHpn1iE Cosuia OCT 2 9 2003 D
,SAMING ADDRESS- f<� �Y 'L"
FHONE ::. — 8 BnSouthold Town
nf
Enc. : Copy of sketch or plan showing proposal for your
convrenience.
EN.c GoSt_0
' • • g�FFO(,� •
Albert J. Krupski, President 0�� C� Town Hall
James King, Vice-President h'Z Gy 53095 Route 25
Artie Foster o x' P.O. Box 1179
cooKen Poliwoda Southold, New York 11971-0959
Peggy A. Dickerson
'y �� Telephone(631) 765-1892
��j * �� Fax i631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Oftlee Use Only
oastal Erosion Permit Application
'etland Pemvt Application Major Minor
Waiver/Amendment/Changes
_Received Application:
Received Fee:$
_Completed Application
_Incomplete
_SEQRA Classification:
Type I_Type 11 Unlisted
_Coordination:(date sent)_
CAC Referral Sent:
_Date of Inspection:_
Receipt of CAC Report:
—Lead Agency Determination:
Technical Review:
—_Public Hearing Held:_
Resolution:
Name of Applicant P6TGAZ SDL d
Address Z698b /L4A AJO—md41 4 ✓,0 _
JDd Phone Number:(
Suffolk County Tax Nlap Number: ,1000 - el— p3 4,5
Property Location: ZB�G /"IiAI�✓E��/��l�DiC� �edr.�d.GD
(provide LILCO Pole sT, distance to cross streets, and location)
IIJ (I
.AGENT:
(If applicable) — i f
i t
Address: _ Southold Town
Pv,;d of Trustees
•
Board of Trustees Application
GENERAL DATA
Land Area (in square feet): Z¢ jBe
Area Zoning: J�C£rs/0 6.VTi.d-L
Previous use of property: SzV'E&' rz d L
Intended use of property: �1�Si oE.vTi d�
Prior permits/approvals for site improvements:
Agency m Date
Ny57ATE
�,d'oLn Tyd LES
No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a governmental agency`'
C No Yes
If yes, provide explanation:
Project Description (use attachments if necessary) 1�7dAL—
s�eAT.c SysT6M IAJ , ':::" eVAAAeE
Glf/ T,EI J�UFPO A., 4oa urY 1N e4x T.c�
1J6.oT. �G�»s2E 36E 6NtLo3dRE,
Board of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: Z/ST.d`z_ J�FPT/e
Area of wetlands on lot: square feet
Percent coverage of loc y/zeY. S
Closest distance between nearest existing structure and upland
edge of wetlands: S Z _feet
Closest distance between nearest proposed structure and upland
edge of wetlands: //o f feet
Does the project involve excavation or filling?
)<' No Yes
If yes, how much material will be excavated'' /(/A cubic yards
How much material will be filled? IV4 cubic yards
Depth of which material will be removed or deposited IV,4 feet
Proposed slope throughout the area of operations: / 14
Manner in which material will be removed or deposited:
Statement of the effect, if anv, on the wetlands and tidal waters of the town that may result b_v
reason of such proposed operations (use attachments if appropriate)
Board of Trustees Application
COASTAL EROSION APPLICATION DATA
Purposes of proposed activity: �tJ:57-41-[r ��P c Sys%E4-1
Are wetlands present within 100 feet of the proposed activity?
No Yes
Does the project involve excavation or filling?
No Yes
If Yes, how much material will be excavated?N,_(cubic yards)
How much material will be filled? IV4 (cubic yards)
Manner in which material will be removed or deposited:
Describe the nature and extent of the environmental impacts reasonably anticipated resulting
from implementation of the project as proposed (Use attachments if necessary)
• t • Albert J. Krupski, President gOFF014, • Town Hall
James King, Vice-President y.0� GG 53095 Route 25
Henry Smith C P.O. Box 1179
Artie Foster H = Southold, New York 11971-0959
Ken Poliwoda Gy �� Telephone(631) 765-1892
1 � Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
_Coastal Erosion Permit Application
_Wetland ication _Major _Mino
✓Waive Amendment/ hanges
w-Received App is A9 Q3
received Fee:$
!Completed Application q 43
_Incomplete _ n'1W
_SEQRA Classification:Type I_Type II_Unlisted
Coordination:(date sent)weAC Referral Sent: d L?mate of Inspection: g 1?Receipt of CAC Report:
_Lead Agency Determination:
_Technical Review:_
00Public Hearing Held: - A _ �!
Resolution:
Name of Applicant p —YCQ t S TEP NAN I C COSO14
Address 21g 1130 MINNFNAHn 61VD SMIOLO 1197
Phone Number:( ) 91 ! " 972-�5�9 165� 2272
Suffolk County Tax Map Number: 1000 - 97 -0 3 -'f 3
Property Location: Z $S d � INNS HRNA GIVO SOUTHOLD
(provide LILCO Pole #, distance to cross streets, and location)
AGENT:
(If applicable)
Address:
Phone:
Board of Trustees Application
COASTAL EROSION APPLICATION DATA n
Purposes of proposed activity: I` E M- 11 A Z
Are wetlands present within 100 feet of the proposed activity?
No Y Yes
Does the project involve excavation or filling?
No /` Yes
If Yes, how much material will be excavated? (cubic yards)
How much material will be filled? ___(cuubic 'y}ards)
Manner in which material will be removed or deposited: !J l 14A)VO oQ j*eH1AJE
Describe the nature and extent of the environmental impacts reasonably anticipated resulting
from implementation of the project as proposed. (Use attachments if necessary)
A 10/ X29 Pow prmo IV1W- 13E prau owl
go S'F-CO UO S-tW q NOV I't)OA) Iv11.1. 19E ADOGl) Oa/ 'rHE
EX IS'fl Alc 00 f tVVPHThw fJVQ -')iC AEW I=WNoAflugl
Board of Trustees Application
GENERAL DATA
Land Area(in square feet): 12413 ,80 n
Area Zoning: RC- 0 N tIA L
Previous use of property: R ES 10 CNr1A I
Intended use of property: R E S I ON I A
Prior permits/approvals for site improvements:
Agency
OA o f torinl '�ayme5 _ =Z 9 -03
No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspen ed by a governmental agency?
No Yes
If yes, provide explanation:-
Project Description(use attachments if necessary):
28 '9 igx1 NbawOIFPM Fourioaloti
Apo ST UCTU".
Pd6r c more Tt4a-rTHE sreowFtI? R001rloij HAD
PRE W44 95rd APPRov6D
• IW6 A [2/67,)—ie[t 12 • •
PROJECT I.D. NUMBER 6171,21 SEC
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. APPLIC.ifJAlR� NAME
S-r PH�If COSOIA I 2. PROJECT SA�r Le /�
]. PRO CYTION:
AuniclpaaI 2 V v� MiNN ANEnoo o County ("W 1 HOW A/
a. PRECISE LOCATION(street address and road intersections, prominent Ianamarms, etc., or provide maw
Zgau fA1MN15"1ifl a�vo
5. I$ PROPOSED AC O
❑New Expansion ❑Modificatiomalteration
S. DESCRIBE PROJECT BRIEFLY: q . V,0 10/s1QC EXrEVSJbAJ
ROO� no� of Q S9cow s7 A
7. AMOUNT OF LAND AFFECTED:
Initially acres Ultimately G JJ acres
a. VnL1 PROPOSED
ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LINO USE RESTRICTIONS?
AIA L:2s No If Vo. describe briefly
9. JJH ��`T IS PRESENT LAND USE IN VICINITY OF PROJECT?
. Res.dentlal ❑:ndus:nal r Commercial ❑Agricurture :_;ParkJForestl0oen space L✓Other
es nbe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL,
STATE Q.7 LOCAL)?
Ip�J Yes ❑No If yes, list agency(s) and permit/aoprovals
E C Z ory Hu a PEw1n lr No7 RFGR
11. QOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
YM�Yes ❑No If yes, list agency name and permitlaoproval
12. AS A RESULT OF PROPOSED ACTnIO((N�� 'NICE EXISTIN PERMITIAPPROVAL REQUIRE MODIFICATION?
Yes ❑No ag 0r lyusrFes pPw it *PPaovlGo bn/ 7-Z6
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
E'7E2 Cos��
Applicant/sponsor name: Dale:
Signature:
If the action is in the Coastal Area, and you are a state acency, complete the
Coastal Assessment Form beiore proceeding with this assessment
OVER
PART II—=NVIRCtg 67Eil T,:'-'SS c���d E.`IT —] ce ccmcl tec cV =ye.^.0
l COES .ACT�C:+ =iCEcJ _.f _ nREEHC LC 'N i v':Cp R. °.nT i:7. it ya cromate me revn;w :rocess and vse :re =UL_ 7xs
re5 —No
2. ',m LL ACC:CN 9ECE.'vE CCCR GINAtEp REVIE'N.>s?RC'/ICED =:R vi :..::CNs :N i .N'rC=R. =aRT i:'.E: 4 •m, a :zq srye :ec:ar:
may oe sucersecec ❑y andtder nvulved agenc'r.
L "es _No
C. CCULD .CC-iCN RESUL-:N ANY ADVERSE 0000 CTS ASSCC:ATED 'AfTH -:-E FJLLJb`/ING.:Pns-aers .-lay =e tanGwnt:en. .I .egiciel
Ct. Evsn ity.ng air at swfacs or groundwater cuahN or ]uanuty. .teise eyeis. existing :.artic ]arerns. Laic .vas:e JlcCCC::Jn Jr ]ISC:
potential for erosion. ]ramage or -1codinq oro lams? =;olam alelty:
CZ Aesthetic, agncunural, a,c.,aeo,o(,,Cll, his:anc, or omer natural or,:w,uml resources: or =0mmumty or ne,gnocrncas cnaramerl ?.,main
Cc. Vegetation or `auna. `Isn, aneltlisn or'minflfe apec:es, sigmrica it ❑abdal5, or :nreatened or encangeree acectfi Exctam ]Tally:
,__, A community's existing plans or goals as offic:adv aeooled.or a change in use or intensity ar use of!and or other natural resources? =.pram :.
Cam. Srowrn, suoseouent :eveioonfent, or related aC::vmes likely:a is induced oy me :focused action? Explain prierly.
'_ong term. snort Xrns. _:I T.uldtrve,or JNCr?rfEGs lCt denariad T C:-C ' Siplam inertly.
I
I
Cmer.moats inc:ac:n(; cnanges in use or e:mer mantity or :vpe or energy)? Exglam :Telly.
i
7. s -:yE=E. CR .S -i+EioE _...c_f "C ;E. J:rIT7CVE?SY ?ELATED 'O ?CTENTIAL . CVERS'c E`VIRONmt.`ITAL.6:Pko-.3
_ !es No t "es. ?.clam onedv
?ART III—DETERMINATION OF-SIGNIFICANCE (To be como)eted by agency)
INSTRUCTIONS: For Baca adverse effect identified above.determl ne wnetner it is substantial,large.imCcrtant or otherwise sight fic.
=ach effect snould be assessed in connection with its (a) setting (i.e. urban or :Ural); (b) probability of occdr-yng; (c) duration
irreversibility; ;e) geogracnic acoce: and (0 magnituce. If necessary, add attachments or reference supporting materials. ensure
exolanatlont; contain sufficient detail to snow that all •e!evant adverse impacts have been identified and aeeguatefv aderessec.
r hecf: ;his box if you nave identified one or more potentially large pr significant acversa imcac:s which r`i
_ occur. -hen orcCeed cirec:ly to :he FULL cAF anolor prepare a positive•declaration.
_ Chi :his cox f •you "lave determined, based an the information and analysis above and anv sucoortinc
cocamentancn. :hat :he proeosea action WILL NOT result in-any significant adverse environmental imcac:[.
AND provide -n attacnments as necessary, the reasons succorting this determination:
i
,m v .Le .rrnr v t.,;,ons.aie „u,c:r n _,.m 5L i. :,tie m t.;oonvae ..n,cer
:lnJlulC )r 1rConSralP �1',i Cr n ,cap rSenCV trend:urC )1 f'r J.lrrrr Ir _n.t rnt :r'lm :CSOOnS,On JIr.t2l,
]rIC
ICI
ALPHA
I I I CONSULTING
PO Box 447 - Greenport, NY 11944
(631)477-0444
Fax(631)4T7-3933
LETTER OF AUTHORIZATION
ALPHA CONSULTING IS HEREBY AUTHORIZED to represent (me) (us)
in the securing of all required permits for waterfront
improvements at : 28$a /19/✓0IZIIFG00 B1 u U gj New York.
DATE c2D p-,s SIGNED: /"%
pECEOVE
SEP 2 3 2003
D
SeeMOM Town
Board of Trustees
gpfFO(,�
Albert J. Krupski, President O� Cj�_ Town Hall
James King,Vice-President ,t,Z` TGyy 63095 Route 25
r Artie Foster p . P.O.Box 1179
Ken Poliwoda Southold,New York 11971-0959
Peggy A. Dickerson f� Telephone(631)i65-1892
Fax(631) 765.1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
-----------------------------------------------------t--------
In the Matter of the Application
Of 8EP 2$ 2( 3
COUNTY OF e
li�
EW
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
P�)E2 C az�-P' , residing at 113D m),rv/VFHArtA BG jD
Sov �{oi� NEIv yoRe // 7-7)
being duly sworn, depose and say.
That on the f$ day of SEMPT 2003 I personally posted the property known as
233� (V�IrJr�EYtAHI) B�uL N
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 plac or ei t days prior to the da f the pub is
hearin . Date of hearing noted thereon to be he `{ ��3 ti
7? y m - _
Dated:
(signature)
Sworn to before me this
a3„a day of$.IjQo03
Notary Public
DHA NSINGHANI PPP KASH K
..::TARP PQBI.IC''[A'1L UFNEWYORk, _
NO.01DS60,9993 _
QUALIBIED in NASSA f,;COUN;y
COMMISS101i UPI:tB.3 NNE 11,2UOri
�e: :.0 3ECd JNI dIu505 d313d IttZZGEBIL LZ:Gt E00Z/ZZ/60
PETER COSOLA
September 22nd 2003
To. Board of Town Trustees
Town of Southold
Att: Charlotte
Re: 2880 Minnehaha Blvd
Attached please find the notarized "affidavit of posting"the hearing poster. Please
contact me on my cellular phone at 917-972-1589 if you have any questions or
comments.
Res lly
PE R COSOLA
ZO/Tko 39yd ONI d'IOS03 8313d TrTZL6Eal/ LZ:61 E00Z/ZZ/60
10 • ► T
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and emulovees 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. �/ " --�" //
YOUR NAME: Attic,-LL / Ff/ �]fZ/L — y`'fGpy2 - Lg2"O�aJC
(Last name;first name,inuiddle initi-aT,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.) Ipg-T-erz �NIIL
Tax grievance
Variance
Change of Zone
Approval of plat
Exemption from plat or official map
Other
(If"Other",name the activity.) Z� 01U AmAkeV-Ag l 7 2 if.C,7—=/'ii77Z2 CoSo44
Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee
of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business,
including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation
in which the town officer or employee owns more than 5%of the shares.
YES NO V —
If you answered"Yl ,complete the balance of this 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/agent/representative)and the town officer or employee.Either check
the appropriate line A)through D)and/or describe in the space provided.
The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply):
A)the owner of greater than 5%of the shares of the corporate stock of the applicant
(when the applicant is a corporation);
_B)the legal or beneficial owner of any interest in a non-corporate entity(when the
applicant is not a corporation);
,C)an officer,director,partner,or employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONSHIP
Submitted this day of 200_
Signature
Print Name
Board of Trustees Applicat*n
County of Suffolk
State of New York
PEA 1- ��c-f 444* ZSWA
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 HISMER KNOWLEDGE AND BELIEF, AND THAT ALL WORK
WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY
BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT
AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES
HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING
UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS
APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR
REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF DES APP ICATION.
Signature
SWORN TO BEFORE ME THIS aa !� DAY OF Jy� 2003
Notary Pub
sONNIEl.00 M
li to y pok IIMIof NaM
No.OI00609552t l�N
Tenn Eep=kv tat"m.
Albert J. Krupski, President • ��gOFfO(,�c • Town Hall
James King,Vice-President 53095 Route 25
Henry Smith c P.O. Box 1179
Artie Foster a* Z Southold, New York 11971-0959
Ken Poliwoda -y Telephone(631) 765-1892
Fax(631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
Coastal Erosion Permit Application
✓G�etland Permit Application Major •Minor
—Waiver/Amendment/Changes ,
4A,eceived Application:
__eReceivedFee:$ nO,Qn
JEompleted Application91441Q� D
_Incomplete n: JUL 2 8 W D
SEQRA Classificatio
Type I_Type II Unlisted
Coordination:(date sent)
�C Referral Sent' BoaN of s rd out Tot°
Trustee°
•00ate of Inspection: a O
_Receipt of CAC Report:
_Lead Agency Determination:
_Technical Review:
Public Hearing Held: $ �0
Resolution:
NameofApplicant Pe:b?,r CQSo10
Address 1130�,nneh��c !�IJd -%tft(d My IIq It
11l i�vl �0 Phone Number:(SW0
Suffolk County Tax Map Number: 1000 -
Property Location: M it oe 6 h.a S I VA , Soo-tt- dd Icy MI-1(
(provide LILCO Pole #, distance to cross streets, and location)
AGENT:
(If applicable)
Address:
Phone: /
�11;0
Board of Trustees Application
GENERAL DATA
Land Area(in square feet): �5Q20 !&%. F4, -�� -}Ap_1;,,-,5
Area Zoning: IF d - oa a A l�- L et 8-)
Previous use of property: Re Si A 2n C 2.
Intended use of property: Rf 4 C ?/>C 2
Prior permits/approvals for site improvements:
Agency Date
No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a governmental agency?
No Yes
If yes, provide explanation:
Project Description (use attachments if necessary): Ada a SP_Lp-y�
All W N COAIS7rur7 aj
15 ON AN FX1s-r)AJ6- 1= OONDATIOAI - VO FXOW,9r APG
• S
Board of Trustees Application / 6'0(� X �
1 04
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: TO update ari(� i,mpayc ft1e,
Area of wetlands on lot: square feet Wry Gr% AreA rk I-* UGhv,A try
sea wall .
Percent coverage of lot: °/u
Closest distance between nearest existing structure and upland
edge of wetlands: I 0(D feet
Closest distance between nearest proposed structure and upland %b nt 046t%n i 4rt✓ �"�
edge of wetlands: feet
Does the project involve excavation or filling?
-1 No Yes
If yes, how much material will be excavated? cubic yards
How much material will be filled? cubic yards
Depth of which material will be removed or deposited: feet
Proposed slope throughout the area of operations:
Manner in which material will be removed or deposited:
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):
'Ybm An *0-'i i stii n u C/-4 "I .
Board of Trustees Application
COASTAL EROSION APPLICATION DATA
Purposes of proposed activity: 1�10(xe • Sea wk
Are wetlands present within 100 feet of the proposed activity?
No Yes
Does the project involve excavation or filling?
No Yes
If Yes, how much material will be excavated? (cubic yards)
How much material will be filled? (cubic yards)
Manner in which material will be removed or deposited:
Describe the nature and extent of the environmental impacts reasonably anticipated resulting
from implementation of the project as proposed. (Use attachments if necessary)
NOTICE TO ADJACENT PROPERTY OWNER
BOARD OF TRUSTEES, TOWN OF SOUTHOLD
In the matter of applicant:
?maker Coso\a SCTM#loon- 1C1- 03- y3
YOU ARE HEREBY GIVEN NOTICE :
1 . That it is the intention of the undersigned to request a
Permit from the Board of Trustees to:
updahe Cw--Na %r pmLe_ 11n2 f A,,� ��cQ c�td C1�RrCIF 0. Sec eta
Stir y oc_� ors Q y;b tc r-)cj 5tY-aL_hy.,-e .
2 . That the property which is the subject of Environmental
Review-,is located adjacent to your property and is described as
follows :
NAP
3�b M.i n✓�e 1^�h� $\Jd. • S�thd� 1-� 1\ q'11
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,(kq. 3Q, 2_0Q3 You may contact the Trustees Office at
765-1892 or i1Y 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 : P&Per C DSO1 a
MAILING ADDRESS : 11lQ l3\lrc.Q-
PHONE #:_r�,\-'LIoS
cri -
Enc. : Copy of sketch or plan showing proposal for your
convenience.
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name: Address:
Nk. Se 3"9*6n (010 -114• �it, c rlstr!..cl4t f n U 101 IOO-
M�• tb\0c(s p f-ic-to 2-1 sv Nn�ne I�akc,tat VA. ?Aq-a* 2'H so tK" WWI1411 A� 4s-7-3q(
GPeUnce 'o, 63Z 55LT,n04 I.H 11411 +�-K-I_ 3-3J
Mrwvt.n R- klolzmuier 203 Wtfi-ey-,0 Rd • C-o,a�tn CAt 1 , P q wsa3)-
STATE OF NEW YORK
COUNTY OF SUFFOLK
Q0-(jQ residing at 2�Q�p ►�; fie B11J� .
,being duly swom, deposes and says that on the
day o _ U 2-1 200 3, deponent mailed a true copy of the Notice
set forth in the Board of Trustees Application, directed to each of the above named
persons at the addresses set opposite there respective names; that the addresses set
opposite the names of said persons are the address of said persons as shown on the current
assessment roll of the Town of Southold; that said Notices were mailed at the United States Post
Office at SOL94406- that said Notices were mailed to each of said persons by
(certified) (registered)mail.
e—
�6n
Sworn 4fore isDay of20�
j Notary Public L
LYNDA M.BOHN
NoT oI0032N 01B0629
Qualified in Suffolk Courtly_
Tenn Expires March S,20Q
Albert J. Krupski, President 0�� CD Town Hall
James King, Vice-President �`t` Gy 53095 Route 25
Artie Foster p P.O. Box 1179
Ken Poliwoda to = Southold, New York 11971-0959
Peggy A. Dickerson Oy� O�� 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
p-a±-w- cosa4------------------------------
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
residing at 11.3✓ µ�.�v�t h41� a\✓
1
being duly sworn, depose and say:
That on the 5� day of L-N,.sa , 2003, I personally posted the property known as
z� jO�kv xC S^LJ^-A A " a"z>
by placing the Board of Trustees official poster where it can easily be seen, and that I have
checked to be sure the poster has remained in place for eight days prior to the date of the public
hearing. Date of hearing noted thereon to be held O(l rdbCXLi-
7 xx) .
Dated:
(signature)
Sworn to before me this
SAay of�kjS t 2003
Notary Publli
Board of Trustees Application
County of Suffolk
State of New York
EL 'P k— �t. COSfl(C( -t J§j2) d0- CV6A BEING DULY SWORN
DEPOSES AND AFFIRMS THAT HE/SAE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK
WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY
BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT
AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES
HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING
UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS
APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR
REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.
llgiugature
P
SWORN TO BEFORE ME THIS DAY OF 2Q'
1
Nota,qPublic
NOTARY PUBLLIC Sta a of Neyy y�
Qu8tifieo.d in Suffolk kc Co��
Tenn Expires March 8,20
•ard of Trustees Applicati•
AUTHORIZATION ✓ v
(where the applicant is not the owner)
I , �bot-4 %ahv residing at 700 H i(y\
p (print owner of roperty) (mailing (address))
I` do hereby authorize Ae:yx- CD
\_ (Agent)
Qnd ep n%4E- CDS-9`a to apply for permit(s) from the
Southold Board of Town Trustees on my behalf.
Owner s gnatu
8
14.16-A(2/57)-7ext 12
PROJECT I.D. NUMBER 617.21 SEC
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. A, PLPLICANT(SPONSOR 1 2. PROJECT NAME
!-�C'�� a �121Dy�,� �✓v 2 �y Snl Q
]. PROJECT LOCATION; sO
Municlpallty 2fda2 . County u k
a. PREC: LOCAT/IIO__N (Street address a�nd, road intersections. prominent landmarks. etc., or provide map)
y fir.)C� v
-
- S�vtivold 1�-t ►� `l"l 1
5. IS PROPOSED ACTION:
❑New ❑Expansion odi(icationralteration
6. DESCRIBE PROJECT BRIEFLY:
To CAd G Sccand
7. AMOUNT OF LAND AFFECTED:
Initially acres Ultimately acres
3. WIILLL/ RO?OSEO ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING '-:ND USE PEST ROTIONS?
lSY as ONO It No. describe overly
9. ' T IS PRESENT LAND USc IN VICINITY OF PROJECT? ^
Revdenual ❑dndustnal r Commercial ❑Agriculture 'P3fKlFdresvOoen soace CrierD sc.,be:
10. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNME97AL AGENCY(FEDERAL,
STATE OR LOCAL(?
WYes LJ No If yes. list agencyls) and permitlaoprovals
Dp-&- ,f, / of Finn-StNISLi.c}tw. irL
pro Co61 .
r
i t. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
❑Yes EV.0 If yes, list agency name and permit/approval
�12. AS A RESULT lOF RCPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE .MODIFICATION?
❑Yes No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE-0 THE BEST OF My KNCWLEuGE
Applicantlsodnsor name: Pefi� Co a%\ Q X ��F7■ \C./`4�, LC�S'J\ Date:
Signature:
If the action is in the Coastal Area. and you are a state acency, complete the
Coastal Assessment Form before proceeding with this assessment
OVER
?ART II—=V`/IR12NMEN I*SSE SaM ENT . J Gr".O ie,ec cy _,genr*
I A. LGES '..C,C:+ E..CEEC >:+' -_ in=.E3nOL] 'N i '+'.'CPP. '>FT iti.'_ -. _acroinats :na 7. :rocess Ina Ise :he =JL- =o=.
3. -VILL ACT:C.N aEC EibE OCCPOINATED 9EViEN AS -riio VICED =CR'JHL.STEO -;Cr+S N i.N'ec-R. -aRT ii-47 .f `to, a
may ne su=ersecec =y Incrrer nvolvea agent.,.
Yes No
C. '-ZUL0 AC-iCN FE3UL7 N ANY ADVEFSE °PFECTS ASZCC:ATEO KITH -== =3L'-ZVIi.NG.,Answers say =e nancwnt:en. 1 egieiel
,t. =Bing air cuamy, aurraca or groundwater cuality :r :uannty. .noise eveis. existing '.aific :alterrts. saua .vast, smccc:= sr ]Is=-
ootenual for erosion. oratnage or Aoccing oromems? 'E mail, ]nervy: -
N,O,r,e, _
C2. Aesthetic, agnemturai. arcnaeoiegical, nisonc. or other natural or cultural :ascurcas: or =ornmumty or neignecnaod c❑arac:er? =miain
No r.e
'regefaelen Jr 'auna. 'Isn. sneltfisn or xdalite species, ilgmricanf laeNais. or :nrearaneo Or ?ncangere'J 3=ec:es9 1-clan snarly:
}, A ccmmunit'%s existing plans or goals as oufio:alty scooted,or a change in use or intensity or Use of:and or other natural resources?Explain =:
No ne
�... 3rowin. suoseeuent ]evelooment, or related acnyales likely to de inaUaea dy Me =rcoosed ac:lon? Exolain onetly.
_cng :erm, snort ter.-i. _umwauve, or Imer ertees not ices trtiea in C:C'_? E.vmain cnerPr.
No n e
C trier .moac:s incucing =nanges in ose or arner auannty or :vice or energy)? =:oiain .nelly.
7. .F 7' EPE. OR :5�--ap 70 SE. -CNTRCVE=S'( �_..,a7ED TO POTEN v TIAL ADEPS'c -NvIRCNM .`+- L EA .b:P aOTS'
—yes �C'+o 'I "es, exclam onerly
I IIII
?AFT III—OEicRMINATICN OF SIGNIFICANCE ITO oe completed by Agency)
INSTRUCTIONS: For eacn adverse erfect identified above,ceterm ine'xnemer it is substantial,large. imcortant or otherwise sign ific
"bath eifect should he assessed In connection with is (a) setting ii.e. urban or rurai); tb) probability of occa--yng; (c) duration
irreversibility: 'el geographic scope: and (f) magnituce. If necessary, add attacnments or reference supporting materials. E:tsure
explanations contain suCic:ent detail to snow trial all relevant adverse impacts nave been Identifies and adecuateiv acdressec.
Chec:c :his Sox if you have identifiea one or more ootentially large or significant acierse impacs wnicn 'd:.'r
- oCCJr. hen oropeea clrec:P/ to :he FULL EAF ana(or prepare a ocsltive'GEclaration.
C`ec:c ;his box :f you lave determined, based on the inicrmation and analysis above and anv sueeortinc
oc❑menlancn. mat :he oreeosea action ';TILL NOT result In3ny significant adverse envircnmental impact_
AND orcvice cn at-,acnments as necassarv, the seasons succorting this betermination:
i
m � sec `.gym. �i <..oc�..mc ,,:veer n ,.:.o �. v .•m m <.;bon voe vuar
.anawc v <ewo�..ae :c.cr n -u� Nrncv i•gnasure +r r-wrrr v _,r.r-o< .rnm r.00n..o. nn.c�n
Jim
• s
Print or Type : ACCESS CONSENT FORM Office use Only
FOR ACCESS File #:
THROUGH PRIVATE PROPERTY Permit #:
l ) yc�ku US& U4 kwo(6i: '&500 2 AAtf\Ae- l� I��vd
(Name of Applicant ) I (Address) 1\�i11
2 ) �Var\- 06T duognelc AS Qf--fiN/s QKr
(Name & Address of Contractor Involved)
3) Wfly 066A W• 4&Hn12ld 1000- - b3 - 4 3
(Project Location)
4) M.1 nv\y-AeAC'1-'g
(Name of Road or Private Property Involved) (Hamlet )
5 ) � -QUG�1,84 �CAZ - PN2g� rUC. �j1/Y h—/s 3y an- it l vo.%f 2.O 5-'>�
(Name A ress of Hom owner Association / Property Owner)
(Brief Job Description)
0n or a`aw-f On ar ab,x-r
7 ) Starting Date: 1�11T3 Completion Date: 9II10q
8) Estimated Cost of Proposed Work: 417.0i000 .0 O
9 ) Insurance Coverage:
A. The coverage required to be extended to the Property Owner:
Bodily injury & Property Damage;
$300 ,000/$500,000 Bodily Injury & $50,000 Property Damage.
B. Insurance Company: 0 ubb 4. Co.
C. Insurance Agent
Name & Telephone # �J lT �y DILQ 511p �7(0- � y�
D. Policy # : TO
E. State whether policy or elertification
is on file with the Trustees Office:
( If no, Provide a copy with Application) (yes/no)
C105D� -7/JO/03
(Signature of Applicant ) (Date)
------------------------------------------------------------
To be completed by the Property Owner:
I/We the undersigned, fully understand the nature of the Proposed
Work referenced above and have no objection to allowing the
Applicant to cross My/Our Property to do the work .aidb� c��__II __
y( Uu
(Signature of the Property Owner
or duly authorized representative)
• APPLICANT•
TRANSACTIONAL DISCLOSURE PORN
The Town of southold'a Code of Ethles tohibite conflicts of
ntereet on the part of town off care and em to see. The
purpose of this Eorm ie to row de information which can
alert the town of ose ble conflicts of interest and allow
it to take whatever action is necessary to avold same.
_ YOUR NAMES c7 — p
(Last name, fi et n middle
ddle n r'tk le A 1 �G11L/ 1D you are applying in the name of someone else or
other entity, such as a company. It no, indicate
the other person's or company's name. )
NATURE OF APPLICATION2 (Check all that apply. )
Tax grievance _
Variance
Change of zone
AppS5peal of plat .p
Exefiption from plat or official map
other
(If "other," name the activity. ) yyday= reS\
Do you personally (or through your company, spumes, sibling,
parent, or child) hove a relationship with any officer or
employee of the Town of Southold? "Relationship" includes
by blood, marriage, or business interest. -Business
interest" weans a business, including a partnership, in
which the town officer or employee has even a partial
ownership of (or employment by) a corporation in which
the town officer or employee owns more than 5% of the
shares.
YES NO/
if you answered "TES,". complete the balance of this 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 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 or greater than 5% of the shares of the
corporate stock of the applicant (when the applicant
is a corporation) t
B) the legal or bbneficial owner of any interest in a
noncorporate 'entity (when the applicant in not a
corporation)3
c) an officer, director, partner, or employee of the
appiicantt or
D) the actual applicant.
DESCRIPTION OF RELATIONSHIP
submitted th , • day of ff
signature 1
'Print name {�. 3, :•: .:i ?'<: .