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Home My WebLink AboutTR-5798Albert J, Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone(631) 765-1892 Fax(631) 765-1366 December 17, 2003 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Peter Cosola 116 Weyford Terrace Garden City, NY 11530 RE: 2880 MINNEHAHA BLVD., SOUTHOLD SCTM#87-3-43 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 3'X 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:lms NioIF S. 88'59'00' N/O/F RR&D. 187.18' PRIETO OP£CHEE ,4 VE.. LEADERS AND GUTTERS ~I~_L B6 INSTALLED BY COMPLETION OF CONS TRUC TION CERTIFIED TO PETER COSOLA ABSTRACTS~ INCORPORA TED FL. OOD ZONE AE lei 8) FIRM 36103C0166 G May 4, 199,c3 ELEVA NONS ARE REFERENCED TO NGVD. SURVEY OF PROPERTY A T LAUGHING WA TERS TOWN OF SOUTHOLD SUFFOLK, COUNTY, N Y. 1000 - 87- 03- 43 Scale: 1 = 30' July 18, 2003 Aug. I$, 2003 (Certifications) C,~ gq~ 2°03(''e~''s'°'~ '" AREA = 24,380 sq. ft. to tie lines ANY ALTERATION OR ADDITION TO THIS SURVEY ~ A VIOLA TK:IN OF SECTION 7:Z09 OF THE NEW YORK STATE EDUCATION LAW. E~CEPT ,45 PER S~CTION 7'Z09 - SU~I~It41$10N E. ALL CERTIFtC~ TtON~ SAID MAP OR CO~E$ B~.~R THE ll~a~E~ SEAl. OF THE SURVEYO~ ~ SIENA TURE APPEARS HEREOt( ADOITIONALLY TO COl~PLY ~ ~ LA~I T~ ' ALT~ BY ° MUST BE USED BY ANY AN~ ALL ~VE¥OR$ UTm r~v~ A COPY OF ANOTHER SURVEYOR'S MAP, ~ SUCH ° INSI~CTED ' AND ° BI~U~MT - TO - DATE ° ARE NOT IN C~ WiTH THE LAW. 03- 206 Telephone (631) 765-1892 Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held 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 3'X 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 James King, Vice-President Artie Foster Ken Poliweda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 25, 2003 Alpha Consulting PO Box 447 Greenport, NY l 1944 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, Albert J. Krupski, Jr. President, Board of Trustees AJK:cjc Telephone (631) 765-1892 Town H'a~.. 53095 M~in Road P.O. Box 11/9 Southold. Ne~v Yo~k 11971 SOUTHOLD TOWN CONSF__~VATION 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 CO$OLA 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 $outhold Town Trustees SOUTHOLD, NEW YORK ISSUED TO PETER COSOLA Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893: and Chapter ~ of the Laws of the State of New York 19521 and the Southold Town Ordinance en- titled "REGULATING AND THE PI.AGING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS:U. and in accordance with the Resolution of The Board adopted at a meeting held on .....~.g~....~O, · 20.0.~....., and in consideration of the sum of $..~.O.:..O.g ...... paid by Peter Cosola of ......... ~f~.?~.~d ...................................... N. Y. and subject to the Terms and Conditions listed on the reverse slde hereof, of Southold Town Trustees authorizes and permits the following: Wetland Permit to add a second-sl;ory to the existing dwelling, with the condition that gutters and drywells are installed to contain the roof run-off and a silt fence is installed 25' from the house, prior to construction, and as det0icted on the survey l~st all in accordance with the detailed specifications as presented in the originating application, re¥ised ^u~ust ~, 200~. IN WITNESS WHEREOF, The said Board of Trustees I~ere- by causes its Corporate Seal to be affixed, and these p.resents to be subscribed by a majority of the sa~d Board as of th,s date. .---'/'_. . d/Y J TER~S and C. ONDmONS The Petmittee Peter Co$ola ~idi~g ~t 1130 Minnehaha Blvd. , Southold N.Y. as ~ of dae comideratio~ foc the issu~nt-~ of ~e la~i~ does under'stud ~ p~,cri~ to the lowing: i.. That the said Board of Tmste~ and the Town of Southold axe released from any and ~,,,~.g,~ oc ,.J.i,~ fa~ ~ of suks Lr'isio~ disec~ er inditecdy as · result of any op~- 2. That thisPennitisvalldfo~aperiodof 24 na~ whlch is comideted to be the es~mnted ti~e_'tequlred ~o complete ttxe ss~otk involved, I~t dmul--d c~o,m~ances wan-am, requ~ for an ezx~sion may be made to the Board at a later daw. 3. That ~hl~ Permit sh<mld be re~l~cl indeFmltely, or as long as the said pe~dt~e wish~ to maintain the structure oc project involved, to provide evidence to anyone cof, c~ed that auth- orizatlon wt~ originally obtalnecL 4. That the work involved will be subject to the inspection and approval of the Board its agents, and non-compliance with. the provisions of the orlg~-~1,,g application, may be cause revocation of this Petmlt by re~ludon of the said Board. 5. That there will be no ~le interfex'ence with nzvigadoo as · result of the walk herein s~thorized. 6. That there shall be no intedetence with the fight of dae publk to pass and repass along the beach becween high and low water mazks. 7. Th~tt Lf future operations of the Town of Soutbold requb~ the xemov~l and/at *Iterations in the location of ~e work herein audmdzed, or i~, in the opinion of the Boasd of Trustee& the work ,hnll cause um~asoaable obstx'ucuon to free navigation, the said p,.nnlttee ~gl be tec~ upon due notice, to remove or alter ~ wo~ ot project heseln stated without expenses to the Tram 8. That the said Board will be notified by the Permlttee ot the w~Aedoo o~ the v~gk auth- orized. That the Pet'mittee will obtain all other permits tad con.set~l that tnty be tequlted sup- plemental to this permit whlth may be subject to revoke upon failuze to obtain same. Albert J. Krupski, President James King, Vice-President Artie Fester Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southeld, New York 11971~0959 Telephone (631) 765-1892 Fax (631) 765-1366 August 20, 2003 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Peter Cosola 1130 Minnehaha Blvd. Southold, NY 11971 2880 MINNEHAHA BLVD., SOUTHOLD SCTM#87-3-43 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, 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' fi:om 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 fi:om 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 James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Roa~ P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTE~ES TOV~N OF SOu'rHOLD Please be advised that your applicat£on, dated 9/~)03 has been reviewed by this Board, at the regular meeting of ~'.103 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 fees will be necessary. / COMPUTATION OF PERMIT FEES: "- - -. --. days or re-application SIGNED: PRESIDENT, BOARD OF TRUSTEES BY: SOARO OF rSUSTE S 4~98 Albert J. Krupski, President James King, Vice-President Ar~e Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 766-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF $OUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction ¼ constructed __ Project complete, compliance inspection. Telephoue (631) 765-1892 Tow~ H',dl. 53095 ~ Road P.O. Box 11'/9 Southold, New Yo~k 11971 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 BARGAIN AND SALE DEED WITH COVENANT AGAINST GRANTOR'S ACTS (INDIVIDUAL OR CORPORATION) STANDARD NYBTU FORM 8007 CAUTION: THIS AGREEMENT SHOULD BE PP. EPARED BY AN ATTORNEY AND REVIEWED BY ATTORNEYS FOR SELLER AND PURCHASER B FOR/~ SIGNING. THIS INDENTURE, made the August '~ 2003 between EDWARD J. BAGE and SANDRA BAGE, husband and wife, residing at 2880 Minnehaha Blvd., Laughing Waters, Southold, New York 11971 party of the first part, aad PETER COSOLA and STEPHANIE COSOLA, husband and wife, residing at 116 Weyford Terrace Garden City, New York 11530 party ofthe 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 graat 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 certaio plot, piece or parcel of laud, *vith the buildings and improvemeuts thereon erected, situate, lying and being at Sonthold, Toxvn of Southold, County of Suffolk aad State of Ne~v York. Tile grantors hereia are tile same persons as tile grantees in deed dated October 23, 2002 in Liber 12218 Page 315 on 11/4/02 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 iu and to any streets and roads abutting the above described premises to the center lines tbereof, TOGETHER xvith the appurtenances and all the estate and rights of the party of the first part in and to said pre~nises, TO HA VE AND TO HOLD the premises herein grauted unto the part5, of the secood part, the heirs or successors and assigns of the party of the second part forever. AND tile 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 xvith Sectioa 13 of tile Lieo Law, covelmnts that the party of the first part will receive the consideratiou for this conveyance and will hold the right to receive such consideratiou 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 paymeut of the cost of the improvement before using ally part of the total of the same for any other purpose. The word "party" sball be construed as if it read "parties" xvheuever the sense of tiffs indenture so requires. IN WITNESS WHEREOF, tile party of the first part bas duly executed tiffs deed tbe day and 5'ear first above writteu. Nh SBA Res de al Real £sta e Fomls on H ~tDocs (9 00) Copyr~g t Capsoft Development PETER & STEPHANIE COSOLA To: Southold Board Of Trustees Att: Charlotte Re: 2880 Minnehaha Blvd Southold NY 11971 December 9th 2003 Please accept this request to "withdrawer' the permit to install a new septic system at the above refercnced 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. ll (C EO~ [~ $outhoid Town Board of Trustees TO,/IO 399d DNI 9]OSOD ~BIBd TIIEE6£OIi £E:OE EOOE/60/EI ~ J, Kr~ki~ Pr~iden~ Jame~ ~i-5 V~*-Pr~ident Artie Ken Poliwoda Peg~, A. Town Hall 53095 Route 25 P,O. Box 1179 ~uthold, New York 119714)959 Telephone (631) 765-1892 Fax (6~1) 765-1~66 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD API~LICATION FOR AN AMENDMENT TO A PERMIT PROP~_~LTY LOCATXON ~ ~ ~ LJ fiZ D ,S'oJ ,go .p ~.)/T~'~,lJ~uq .... TO 1"1-1~' J';'~o,"u'T OF' ~.a- F/O~E /~/~.~..00J~J~['OcT ~,9. 2003 SiEued By: //~ uoard of Trustees 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. ~~ITER C~SOLA OCT 29 20o3 ~uthoId Town Board o! Trustees ~,1-11"'. Postal Service,,~ r- CERTIFIED MAIL,,, RECEIPT Po~ ~'~L3'~J ~ Service=. CERTIFIED MAIL:.~ RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) CERTIFIED MAIL.., RECEIPT (Oomestic Mai/On/y; No Insurance Cove, age Provide_d}_. U.S. Postal Service,:~ CERTIFIED MAIL.., RECEIPT (Oomestic Mail Only; NO I~)surance Coverage Provided) ~ ~.. 0..]7 0NIT ID: 0708 (E.~ '-.1.7~ Frl 11/14/2003 i5~00 7183922111_,~ Alber~ g. Krupaki, President Jem~ King, Vice-President ArtJe Fester K~n Poliwoda Pegl~ A, Diekerson PETER COSDLA INC PAGE 53095 l~ou~e 25 P.O, Box 1179 Southold, New York 11971-0959 01/'01 Telephone (631) 765-1892 Fa~ (631) 765-1366 BOARD oF TOWN TRUSTEES . · ri"OWN' OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING being duly sworn, depose and say: That on tile ~ day of ~J0Lk,'-~,~ 200'~, I Rer~ofially posted the propexty known as by placing the Board of Trustees official poster where it ca easily bc seen, and that I have checked to be sure the poster has rernaincd in plat~f, or e_ight rdc prior to thc date of tb~e public hearing. Date of hearing noted thereon to bc held __/~-,f, [~- , "~'-~., ~'~,- ~ Dated: (signature) Sworn to before me this day of 04~O0~ Notary Public ~OARO OF TKUST~3~_, TOWN '0F-S0~.OLD In the matter of a[~llcan~: · OU ARK' HEREBY GI%rEI~ NOTICE: .~e~ from =he B~ of T~te~s ~o:/ , ~f - 2. That ~he gropertT which is the subject of Kn%iroamental ~eview i~ locat~ adjacen~ to ~ p~p~nd ts des~ed as 3. That the proje~c which is subject to KnvironmentaI Review ~ ~ve' r~e~a~c~ proposal .is ~d~ review cf the ~ o~ Trustees o~ 'Lhe Town c~ 8ou~hoLd and does not ref~ other agency ~ha: might have ~o review same'propos OCT .2 9 2003 ~u~old T~w~ Copy of sketch or ~[an shmeing proDo-~al for Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only C oastal Erosion Permit Application tland pemut Application Major 'aiver/AmendmenVChanges __Received Application: Received Fee:$ __Completed Application __Incomplete __SEQRA Classification: Type I Type II Unlisted __Coordination:(date sent) CAC Referral Sent: __Date of Inspection: __Receipt of CAC Report: __Lead Agency Detem~ination:__ Technical Rex iew: __Public Hearing Held: Resolution: Minor Name of Applicant Address_ ,~m~ ~[,~t&A~7~__Phone Number:( ) c~/7- ~:~ 7Z -- Suffolk County Tax Map Number: 1000- ~'- ~1~'~ ,~/~' (provide LILCO Pole *~, distancc to cross streets, and location) AGENT: d:f applicablel Address: t $outhold Town ~c,.,;d ~ TrusteB~ Board of Trustees Application GENERAL DATA Land Area (in square feet): 2'~..~o Area Zoning: .~,~_n ~ Previous use of property: Intended use of property: 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~ Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: .-~/.~,-~'Az./_ ,.ff~-/o 7'/c ~'/'-,'.~.r'~S,,d . Area of wetlands on lot: _square feet Percent coverage of lot: ,,4~,,wox,. ~ % Closest distance between nearest existing structure and upland edge of wetlands: ,~ ~ feet Closest distance between nearest proposed structure and upland edge of wetlands: //~ -/- feet Does the project involve excavation or filling? ~ No Yes If yes, how much material will be excavated? /~/0 cubic yards Hmv much material will be filled?_ /~/~ cubic yards Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: feet Statement of the effect, if any on the xvetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate) Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: 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? How much material will be filled? Manner in which material will be removed or deposited: (cubic yards) (cubic yards) Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed (Use attachments it'necessaD9 Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York i1971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland~r. ad~kla~cation Major ."~Waive(fAmendm en~.hange? -- ~'R~eceived Ap p~T6~T6'fi~--':':':':~ J .,'"ffeceived Fee:$ ~/_~ ' '. _~ompleted Applicaiion Incomplete SEQRA Classification: Type I Type I[ Unlisted__ Coordination:(date sent)~ _ ~AC Referral Sent?~ -"Oate o f Inspect ion: ~f~_ Receipt of CAC Report: Lead Agency Determination: Technical Review: .-'Public Hearing Held:. ~__ Resolution: ECEgVE AUG 2 § 2003 Southold Town 8card of Trustees Name of Applicant Address 8zvo so 'm o It?7 I Phone Number:( ) q/'7' (]72-1sgF/76S-ZZTZ Suffolk County Tax Map Number: Property Location: ~ oca'W ot O (provide L1LCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity:_ 2 ~'5 JD~O~} ~ ~ Are wetlands present within 100 feet of the proposed activity? No ~ Yes Does the project involve excavation or filling? No 7 Yes If Yes, how much material will be excavated? How much material will be filled? .(cubic yards) (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) Board of Trustees Application Land Area (in square feet):. Area Zoning:. GENERAL DATA Previous use of properly:__ Intended use of property: Prior permits/approvals for site improvements: .. Agency . ____ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspe, n~ded by a governmental agency? ~ No. Yes lfyes, provide explanation:' Project Description (use attachments ~rnecessary):_ t f uv~ ,,,.,,- ,,, PROJECT I.D. NUMBER 817.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT iNFORMATION (To be completed by AoDlicant or Project s0onsor) SEC 1. APFUCA,~¢~R 2. PROJECT NAME 5. IS PROPOSED ~ New x~ansion ~ Moaiflcalionlalterallen 8. DESCRIBE PROJECT BRIEFLY: [] Agriculture · ',~P~rklForesUOoen sD~ce L-~Other . 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDff.!G. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL &GENCY (FEDERAL. STATE R LOCAL)? ~P~es [] ,'1o If yes, list agency(s) and ~ermitlagprovals 11. [~OES ANY ASPECT OF THE ACTIOt,~ HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes [] NO if yes, list agency name and ~ermitlaooroval 12. AS A RESULT OF PROPOSED ACTION WILL BXISTIN PERMIT/APPROVAL REQUIRE MODIFICATION? the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this as._.s, essment OVER PART iII--DETERMINATION OF.S;G,~[FiCANCE To oe como eted ~y Agency) ,il ALPHA ~11 CO.SU.T,.O PO Box 447. Greenport, NY 11944 (631) 477-0444 Fax (631) 477-3933 LETTER OF AUTHORIZATION ALPHA CONSULTING IS HEREBY AUTHORIZED to represent (me) (us) in Che securin§ of all required permits for water£ront improvements at: ~ ~/~H~ ~V~-~O"U"-~ New York. Albert J. Krupski, President Jamea King, Vice-Preside~t A,rtie Fo~ter Ken Poliwoda Pe~Ky A. Dickerl~n Town H~II 68095 Rouf~ 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (681) ~'65-1892 Fax (631) 765-1366 BOAP,.D OF TOWN TRUSTEES .. TOWN OF SOUTHOLD ............ BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application STATE OF NEW YORK) AFFIDAVIT OF POSTING 1/77/ being duly sworn, depose and say, That on the I ~ day of ~g.~'ffft 2003, I personally posted the property known as by placing the Bored 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 dato of the public h.h_,earin~g. Date of hearing noted ~ereon to be hel~e~/ r-~ ,~/~ ~ ~ ~ . . . [/ , (signature) Sworn to before me this · -~ day of'~.~O0~ Notary Public [ C0..J0 35Vd DNI ~90500 ~3±3d IIIgE668II 2~:6I g00E/~[/60 PETER COSOLA To: Board of Town Trustees Town of Southold Att: Charlotte Re: 2880 Minnehaha Blvd September 22nd 2003 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. APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the oart of town officers and employees. The purpose of this fo.t~ is to provide inforomtion which can alert the town of ~ossible conflicts of interest and allow it to take whatever action is necessary to avoid same. (Last name;first name/middle iniua~lT, unless you are applying in the name of someone else or other entity, such as a company. If so, thdicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zoan Approval of plat Exemption from plat or official map other Of"Other",nametheactivit~.) .~-~a-,o~o /h~/'r~O~,~t. OT 7-0 ~.~,~--,~'~'FF~ ~'o~.~ Do you personally (or through your company, ~ouse, sibling, parent, or child) have a ~elationship 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 employe~ has even a partial ownership of{or employment by) a corporation in which the town officer or employee owns more than 5% oftbe shares. YES NO answered "YIn, complete the balance of this form and date and sign where indicated. If you 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. DESCR/PTION OF P~ELATIONSHIP Submitted this Signature Print Name day of 200 ~Board of Trustees Applicat~ County of Suffolk State of New York t~.e~,.~.ll~l~ ~ ~O,5'0[~ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY V1RTUE 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 O~S APpliCATION Signature ' ,200~ No. OlDOSOOS,~. Albert J. Krupski, President J~mes King, Vice-President Henry Smith Attic Foster Ken Poliwoda Town Hail 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application ~,,"~'etland Permit Application __ Major -,'"'Minor Waiver/Amendmenff.Changes , · .... ~,~Received Application: r.] i~]~:~ ,,,R' eceived Fee:$ ~'k.~, CXl'~ ' ' m _ _ .,6~ompleted Applicatio~'~ Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) ~CTkC Referral Sent:~' ___.~ate of Inspection:~ Receipt of CAC Report: .. Lead Agency Determination: Technical Review: ~Public Hearing Held: ~ !,,3t~ !~.~ Resolution: Name of Applicant p~3C~/V- 2(~<~(3kC~ Phone Suffolk County Tax Map Number: 1000 Property Location:ZO ~0 ~i~g~fl kq (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: / Board of Trustees Application Land Area (in square feet): Area Zoning: ~ood Previous use of property: Intended use of property: GENERAL DATA Prior permits/approvals for site improvements: Agency Date ~0 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 ~o% -to or, a~.'~c~,--~ Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: -~'0 Ltl~d~tJ~ OJ%~ ,cm~,/2)v< Vc~ ! t Area of wetlands on lot: '-/~ _square feet lq0c~ or~ 0ce~t Percent coverage of lot: 3 % Closest distance between nearest existing structure and upland edge of wetlands: / 0 ~ feet Closest distance between nearest proposed structure and upland ~$~t,~ edge of wetlands: feet 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 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): Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are wetlands present within 100 feet of the proposed activity? __~ No Yes Does the project involve excavation or filling7 ~) No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled7 _(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: COso\ sc #1ooo- YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: 2. That the property which is the subject of Environmental Review-is located adjacent to your property and is described as 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:~ You may contact the Trustees Office at 765-1892 or i~ 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: ~'~ 4--ZC MAILING ADDRESS': ~%%0 Q~-'~'~ ~,&~'~ Enc.: Copy of sketch or plan showing proposal convenience. for your PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK ~,~--~ J, .'~-t. t\d~l I ,beingdulyswom, deposes and says that on the ?_'_g~ day~' O'/J~'{ ,2003, deponent mailed a tme copy ofthe 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 ~'OLf/-blobD , that said Notices were mailed to each of said persons by (certified) (registered) mail. Albert J. I~upski, President James King, Vice-President Artie Foster Ken Poliwoda PegKy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING , residingat ~l,~ I~q-~,'~x~2X~Cx ', being duly sworn, depose and say: That on the 55 day of ~v~- ~ , 200~, I personally posted the prope~ ~own ~ by placing the Bo~d of Trustees Official poster where it c~ e~i~y be seen, ~d that I have checked to be sure the poster h~ remained in place for ei~t days prior to the date of the public hearing. Date of he~ng noted thereon to be held . .._ ~ ~ Dated: (signature) Swom to before me this ~'~ay o f,b~e)&t 2003 Board of Trustees Application County of Suffolk State of New York .~J~./~'- }~o ~,O~O~ ~r~~C.~bO[g[ BE~GD~Y SWO~ DEPOSES ~ ~F~S THAT ~/S~ IS ~ ~PLIC~ FOR T~ ~O~ DESC~ED PE~T(S) ~ ~T ~L STATE~NTS CONT~D ~ ~ ~ TO ~ BEST OF ~S~R ~O~EDGE ~ BEL~F, ~ T~T ~L WO~ ~L BE DO~ ~ T~ ~R SET FORTH ~ ~S ~PLICATION ~ AS MAY BE ~PRO~D BY T~ SOUTHOLD TO~ BO~ OF TRUSSES. ~ ~PLIC~T AG~ES TO HOLD T~ TO~ OF SOUTHOLD ~ T~ TO~ TRUSSES H~ESS ~ F~E ~OM ~Y ~ ~L D~AGES ~ CL~S ~S~G ~ER OR BY ~T~ OF S~ PE~T(S), ~ G~D. ~ CO~LET~G ~S ~PLICATION, I ~BY AUTHO~E T~ ~US~ES, T~ AGENT(S) OR ~P~SENTATI~S(S), TO EN~R ONTO ~ PROPERTY TO ~SPECT T~ P~SES ~ CON~CTION ~ ~W OF T~S ~PLICATION. P~i~'d~ture SWORN TO BEFO~ ~ ~S ,~ DAY OF ,2~ Notar~Publie LYNDA M. BOHN NOTARY PUBLIC, State of New Oua~P- 9~ B06020932 Term ?e~ in Suffolk County cxpJres March 8, 20,~ Oard of Trustees Applicati0 (where the applicant is not the owner) (print owner of~property) residing at ~0 (mailing address) do hereby authorize ~ ~ ( Agent ) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. 617.21 Appenclix 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) SEQ 5. iS PROPOSED ACTION: [] New [] Exoansion ~odi~icationtalteratlon 5. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND .AFFECTED: /~s Resident,al ~,!naustnal ~ C.;mmercml 10. DOES ACTION INVOLVE A PERh~IT APPROVAL, OR FUNDING, NOW OR ULTIMATEL,¢ PROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCALI? ~ NO If yes. list a§e~c¥(sl and oermitlao¢rov&l$ DOES ANY ASPECT OF THE ACTIOI4 MA',rE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes ~No If yes. list agency name and perm~tlaggroval ( If the action is in 'the Coas[al Area. and you are a state agency, complete the Coastsl Assessment Form before proceeding with this assessment OVER I PART III--OETERMINATICN OF SIGNIFICANCE ~To me commie[ed my Agency) INSTRUCTIO NS: For e3cn adverse effect identified a~ove, cetermine 'Nne~ner ~t is sucs~antial, large. :,nlcor~an[ or o~Mer~ise Ezcn ~ffec: should be sssessed in c~nnecdon w~m ,~s (a) setting (i.~. urban or rural); lb) prooa~d[ty of occ~g; (c) duradorr based Print 1) 2) or Type: ACCESS CONSENT FORM I Office use Only FOR ACCESS ~File I THROUGH PRIVATE PROPERTY IP~rmit ~:_ (Name of Applicant) ~ (Address) 3) 4) 5) 6) (Name & Address of Contractor Involved) ~ ~A~n~,~ ~t~, Cr~O~ 1000- ~-. - (23 - q (Project- Lo~n} .... (S.C.~.M. ~) (Name of Road or Private Property Involved) (Hamlet) (Name~ A~ress of Associa{io~ / Property Owner) (Brief Jo~ Description) J ~ 7) 8) 9) Starting Date: ~\I,!~ Completion Date: ~/l!o~ Cost of Proposed Work: ~I~tOCLO.O~ Estimated Insurance Coverage: A. The coverage required to be extended to the Property Owner: B. Insurance Company: C. Insurance Agent Name & Telephone # : D. Policy # : ~-O ~ E, State whether policy or ~ert~fication is on fi]e with the Trustees Office: (If no, Provide a copy with Application) Bodily injury & Property Damage; $300,000/$500,000 Bodily Injury & $50,000 Property Damage. C/h bb Co. (yes/no) of Appl i~;~nt ) (Date) (Signature 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. (Signature of thelProperty Owner or duly authorized represent at ire) TR~NS~CTIONA~ DISCLUSURE FURH i The Town o~ Sou~hold*e Code of E~hicu ~toh{b{be con{l{cte o[ inbetesb on bhe pa~ nE ~own officers and employees. The alert bbs town nE possible uonflicbe o[ ~nberesb and allow it bo ~ake whatever action is I~eoeesar¥ to avoid same. ~ .. . NATURE O~ APPblCATIONt (Check all that apply.) Bxe~p~ton from pl~ or o~ficial map (I' "o,her," name the activity,) ~ employee o~ th~ Town cE 9ou~holO? 'Relabionship~ includes which (he ~oun officer or eeployee has even a pa;~lal ownership of (or employmenb by) a corporation in which shares. Y~S -- NO~ da~e and sign vh~re Name ct person employed by the ToWn o[ Soutbold Describe bh~ telabionship between yourself (~hm mppliuan~) appropriate line ~) through D) and/or deeculbe in the apace provided. The born o~Ciuer o: employee o~ his or her spoumm~ miblinU, pareng~ or child is (cheek al~ ~ha~ app~y)~ A) bhe owns: o[ grea~er tha~ 5~ o[ ~he shares ct corporate sto~k o~ the appliein~ (when ~he appli~an~ . is a corpora~ion)~ e) ~he legal or b~nefioial owner of a~y in~e~em~ in a non~orpora~e'en~iEy (~hen ~he appli~an~ la no~ a ~orpota~ton)~ __.C) an o/~ieer~ 6itec~or~ pa~b~er, or employee o~ Ehe appliea~l or D) ~he a~ual appli~sn~. ,.