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HomeMy WebLinkAboutTR-5798 6 -pgUFF01,� 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 AJK:Ims m a v �m JR N1 p1F �V. ER j6az� m • � N ,3500 E- o N. u o n O Q O�a 3 , m � � m po% o ✓� ` 9`y io n 3 PI v . ron J La fi ar9• e Q /O OO f - - -_ 3;.3• Or iyl �I R�� � hs� ► 2��ctio.� � Nw mT 9 6r docK O Of e3 �Q 4i x '.Pw4Y Al 00 h o' e,,9 e170 prop .cryk.I� o i x4 �I SRP S. 88'59'00' W. 187.18' M N/O/F R. R. & D. PRIEW 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. _ MUST BE USED BY ANY AND ALL SUVEYORS UTLI216 A COPY (631) 765 - 1797 r, 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 AJK:cjc o�oS�FFot�rco z 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 AJK/lms 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 V I j i 11 f 1fI // �Jill A¢ ib - ad o-c s ' .1`2. >�` •III I ' �, i 1� �� + Mv"'_"l n• ` III{ w j aJ t a HIM Z egg' °+ 9 � •�. ^"�� i_i li I ,I,• '�� .� P� r 1 ' '. II111 Ill 11ID1�117 f ITiI?11Tf 1111T!1TI1I I MIT1TI1TU i 1 I f I I M111TTMI I I mil I T11111Tl1 ,; 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 ■IX'. Postal Service,,, - r; CERTIFIED MAIL.., RECEIPT m °• M Service:,, m (DomeslicMai/O"IWNolnsuranceCoverageprovided o CERTIFIED MAIL, RECEIPT m IDomestic Mai!Only;No Insurance Coverage Provided) m g / [ m r A B 9 m t g. m Postage 6 0.37 Q708 M1 A A� � F 6 +� M Celw"d Fee Sj4®, Pos"g°C3 _ m $ 0•7 UNIT ID; 0708 [] Rstum Redga Fee 0 CenMed Fee (EntlOr9epgrq Requlrbe) 'L' PoamMk O "1'4�t C3 Rntdctad F 1. ..i Mere p Retum Redept Fee "h¢ Poean" Ln (Enepreeme�"� Clerk: KBPM'B 4 (Eneoraement Requhredl `�,i','t.wr Mere C3 0Reshttym D, 'YFee Q¢ Total Poetege a Fees - IEne°reem°ni Required, Jr. (� _ � Kr1F''M4B m $ 4.42 ... 10%28/03 C3 r_ C3r o .. Total Postage a rem $ r✓° 42 N >LM�S d('(�/�1ri o r p 03 bYreet:1P[x6:i- •----•-j-•--•---••---...•.. ...-. C3 n /y� w Pp Borah. �H........... ..................... f`.S !` 1 ab.Bare.ads ....................... 11 6U Y IJ:e�.li11Y111111� 7�7z --Zit P1fTiMJn1Y S arr»L� N�j- q• --------- U.S. Postal .Service:., _ _— ••a�ne.eeluluwnJJF'Jlllr --.. . CERTIFIED MAIL.,., RECEIPT o U.S. Postal Service,., m (Oomestic Marl Only;No Insurance Coverage Provided m CERTIFIED m ) m MAIL,,, RECEIPT (Domestic Mail Only;No Insurance Coverage Provided) m - - m r , ,.9 m m postage c 0.37 IRQlT ID: 0768 n o Certaled Fee pow" i 0.37 m UNIT ID: 0708 n C3 ReNm Rec"pt Fae _Poetmerk a CegMed Fee (Erxlorasment Requlree) - O C] 1•. J 'Mare O (En Reor�"ant' Mee .. Roetmm Lr)O (Epd°S1orsemam RagWretl) q Cl@P�C: K O nr .,1.7 More 'M4B ReaMO"eDeryeyFee To a Pp stag°a Fee, $ 4 S012B/O3/ o (Endo aemam Etaqulred) Clerk: KWM4B m rote( C3p POsl age p'Feee $ J1+42 10/28/03 � tM o tp or Pa Bax Na r- °j„r1-IRf{r t 'C awaec adr.wp.;•ay.shre:zrtia . aPoBQ Vp. .03 J�N 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 ?'<: .