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HomeMy WebLinkAboutTR-5824 Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson . . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD .YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. ~. (~"'1 ~", \ \ INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction y" constructed V Project complete, compliance inspection. hI [~ /01 . ~ k)~ ~ Df(J~ i- a'-~- . . James F. King, President Jill M. Doherty, Vice-President Peggy A, Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 021Ie Date: June 18,2007 THIS CERTIFIES that the removal of screen porch and construction of an addition on west side of house, relocate existing mechanical equipment in crawl space under original house to under the new addition, rebuild existing porch and foundation in same footprint, and with gutters and drvwells. At 2025 Smith Road, Southold, New York Suffolk County Tax Map # 98-4-19.2 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 10/1/03 pursuant to which Trustees Permit # 5824 Dated 10/22/03. Was issued, and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the removal of screen porch and construction of an addition on west side of house, relocate existing mechanical equipment in crawl space under original house to under the new addition, rebuild existing porch and foundation in same footprint. and with gutters and drvwells. The certificate is issued to James N. Gemmill owner of the aforesaid property. ~o<'~ Authorized Signature Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction ½ constructed Project complete, compliance inspection. Board Of Southold Town Trustees SOUTHOLD, NEW YORK PERMIT NO.. ,,~..~c~( .... DATE: ..°~?b?'....~.~..... 2003 ISSUED TO JAMES bi. GEMMILL Pursuant fo the provhlons of Chepfer 615 of the I.~ws of the State of New York, 1893; and CJ~pfer 404 of fha ,L~.ws of the State of New Yor~ 1952; and Se Southold ToWn Ordinance en- titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REIvlOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS:~. and in eccoedance w~'h the Resolution of The B6ard adopted at a meeting held on ....Q~.9.~r.....g2, - 2~.?_~.:., and In consideration of the sum of $.....~.g.g.~..0..? ....... I~id by James N. Gemmill of ................ S.c?..uJ.i~.~1. ......................................... N. Y. and subject to the Terms end Conditions lided on the reverse side hereof, of SoufhoJd Town' Trustees authorizes end aermils lira foJlowJnq: aJJ in am:ordaeme wilfl the defal~ed speeificatlons es presented in .~Une originating appficafion. IN WITNESS WHEREOF, The said Board of Trustees here- ib~eY causes its Corporate Seal to be a~xed, end these presents to sub~crlbed by e 'majority of the s~d Board es of thls daf~. . ,,rt~e ~I~ster .-~ Absent T~stee$ TERMS end CONDITIONS The ?etmb~t~ James N. Gemmill te~llng at 2025 Smith Rd., Southold N. p~' o[ the conside~tioa fo~ ~e ls~smmce o[ &e P",'~*. do~ um:~stsmi snd p~scrlbe to the [ol- L That the raid lkntrd ¢~ Tnt~ees__ and the Town o~ Southold ate released [v0m any and · ,i& t~ct thereto, to the c~mt, lete ,-~tnslon o% the Bo~d ~ T ~t,.~__ ~ the Town ~ So.hold l. That thls Pe,:nxk h' ~lld foe a period of ~ · 24 for aa ex,ms/on may be made to the ~ at a That this Petmlt dxmld be ~ /~def~t~y, or'es loag as the tadd ~ ~ 4. ~t &e wodc .involved will be mbje~t to the impectkm and spl~o,~ of the Bosx'd o~ its egrets, *md non-oompflance '~tth the ptovislom of the odginafl~ appiicaflo~ may be ~.,~ fo~ tevucatiea of this Permit by t~olutto~ of the ~id Boat'd. 5. That there will be no uatear~ahle latetfeaz~ce with m~,~tlon as a ~ of ~e work hetehx m/thodzed. 7. That ii ~'t~e ~pemiom of the .Town of Sonthold t~luke the. mnowl ~ ~ ~ ~a~~~ or~,~~~T~. That the said Boazd will be ~lfied by the Pesmktee ot the ~]bf the work auth- plemeatd to this peaalt w~;~, may be ~ject to t~roke upon ffailuee to obtain Albert J. Krupski, President James King, Vice-President ' -' Artie Foster Ken Poliwoda Peg85' A. Dickerson To~vn Hall 53095 Route 25 P.O. Bbx 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD October 22, 2003 Mr. James E. Fitzgerald, Jr. Proper-T Permit Services P.O. Box 617 Cutchogue, NY 11935 JAMES N. GEMMILL 2025 SMITH RD., SOUTHOLD SCTM#98-4-19.2 Dear Mr. Fitzgerald: The Board of Toxvn Trustees took the following action during its regular meeting held on Wednesday, October 22, 2003 regarding the above matter: WHEREAS, James E. Fitzgerald, Jr. on behalf of JAMES N. GEMMILL applied to the Southold Toxvn Trustees for a permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated October 1, 2003, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on October 22, 2003, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 97 of the Southold lown 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, RESOI~VED, that the Board of Trustees approve the application of JAMES N. GEMMILL to remove 10.1 'X 7.3' section of existing porch on west side of house; construct new one-story addition, l 0.1 'X 18.7' on west side of house. Remove existing mechanical equipment from existing house crawl space and relocate to proposed one-story addition. Rebuild 490 +/- sq.ft, of existing porch in same footprint, including a new foundation, and the existing porch to remain the same, all with the condition gutters and drywells are installed to contain the roof run-off and a line of hay bales is placed down prior to construction, and all depicted on the survey prepared by Joseph A. Ingegno last dated July 9, 2004. 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 Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application, dated ~[I]6~ has been reviewed by this Board, at the regular meeting of /0/~o~/~ 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 9~r re-application fees will be necessary. ~f ~ COMP AT ON OF PRESIDENT, BOARD OF TRUSTEES BY: , BOARD OF TRUSTEES 4/98 Telephone (631)765-1892 Town Hall 53095 Rou~ 25 P.O. Box 1179 Southold, NewYorkl1971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Tuesday, October 14, 2003, the following recommendation was made: Moved by Don Wilder, 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 JAMES N. GEMMILL to remove 10.1' X 7.3' section of existing porch on west side of house; construct new one-story addition, 10.1 'X 18.7' on west side of house. Remove existing mechanical equipment from existing house crawl space and relocate to proposed one-story addition. Rebuild 490+/- sq.ft, of existing porch in same footprint, including a new foundation. The existing roof of the porch will remain. Located: 2025 Smith Rd., Peconic. SCTM#98-4-19.2 The CAC recommends Approval of the application with the Condition that no trees are removed and hay bales are placed down before the project begins. Vote of Council: Ayes: All Motion Carried THE SITE OF THE PROPOSED PROJECT IS SHADED TA~ MAP Application regarding the property of James Gemmill, SCTM #1000-984-19.2 Represented by PROPER-T PERMIT SERVICES P.O. Box 617, Cutchogue, NY 11935 James E. Fitzgerald. Jr. 631-734-5800 Semember 5. 2OO3 PECONIC 1958 SOUTHC BAY" HOG NECK BAY THE AREA OF THE PROPOSED PROJECT IS CIRCLED LITTLE HOG NASSAU ! Application reganting the property of James Gemmill, SCrM #1000-98-4-19.2 PROPER-T PERMIT SERVICES P.O. Box 617, Cutchogue, NY 11935 James E. Fitzgerald, Jr. 631-734-5800 September 5. 2003 Proper-TPermit Services P.O. Box 617, Cutchogue NY 11935 Phone: 631-734-5800 Fax: 631-734-7463 MEMORANDUM DATE: July 15, 2004 TO: FROM: Lauren - Trustees Jim Fitzgerald SUBJECT: Gemmill; SCTM #1000-98-4-19.2 Here's a copy of the map revised (7/9/04) to show the staked haybales, etc. ~ J~JL 15 20~ II0aal 0f lmst~ James l~n~ Vice-Preside~ Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only ~_.~aal Erosion Permit Application nd Permit Application ,,'"Major Waiver/Amendment/Changes ,,"Received Application: ,~'F~ceived Fee:$ ~OO ~' ' --'C~mpleted Application ]O/ Incomplete SEQRA Classification: Type I Type II ..Unlisted Coordination:(date sent). _a~AC Referral Sent: ~'"D~te ofInspeaion: ] Receip~ of CAC Report: Lead Agency Determination: __ Technical Review: Hearing Held:~ Resolution: Minor Name of Applicant James I,T. Gemmill Address 35 Hartman Hilt Road, Huntington, NY 11743 Phone Number:( ) 367-9760 Suffolk County Tax Map Number: 1000~ 98-4-19.2 Property Location: 2025 Smith Road, Southold (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Ja~es E. ~itzgerald, Jr. / Proper-T Permit Services PO Box 617, Cutchogue I~Y 11935 Phone: Board of Trustees Appli on Land Area (in square feet): Area Zoning:. GENERAL DATA 27,216 R-40 Previous use of property: Intended use of property:. Private single-family dwelling Private single-family dwelling Prior permits/approvals for site improvements: Agency Date X No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No 'Yes If yes, provide explanation: PROJECT DESCRIPTION: Remove 10. I' x 7.3' section of existing porch on west side of house; construct new one-story addition, 10.1' x 18.7' on west side of house. Remove exist- . ing mechanical equipment from existing house crawl space and relocate to proposed one- story addition. Rebuild 490~= sq. f~. of existing pomh in same footprint, including a new foundation. The existing roof of the porch will remain. Board of Trustees AppliCon WETLAND/TRUSTEE LANDS APPLICATION DATA Pm-pose of the proposed operations- Im'0rove house Area of wetlands on lot: 4000 square feet Percem coverage of lot: 1 ~ % Closest distance between nearest existing structure and upland edge of wetlands: 39 feet Closest distance between nearest proposed structure and upland edge of wetlands: 38 feet Does the project involve ~xcavation or filling? No X Yes If yes, how much material will be excavated? 20 cubic yards How much material will be filled? None cubic yards Depth of which material will be removed or deposited: 3 feet Proposed slope throughout the area of operations: 0% Manner in which material will be removed or'deposited: Backhoe Statement .of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): It is expected that the project will have no significant effect on the wetlands and tidal waters of the Town. IPROJECT ID NUMBER PART 1 - PROJECT INFORMATION t. APPLICANT I SPONSOR James N. Gemmill 3.PROJECT LOCATION: Southold Mu nici~pality 4. PRECISE LOCATION: Street Addess and Rood IntemectJom 2025 Smith Road Southold, NY 11971 61720 O APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED AC~IONS Only ( To be completed by ,a )licant or Project Sponsor) 2. PROJECT NAME Gemmill house Suffolk County SEQR 5. IS PROPOSED ACTION: [] New [] Expansion [] Modiflca~on/altarafion 6. DESCRIBE pROJECT BRIEFLY: Remove 10.1' x 7.3' section of existing porch on west side of house; construct new one-story addition, 10.1' x 18.7' on west side of house. Remove existing mechanical equipment from existing house crawl space and relocate to proposed one-story addition. Rebuild 490+ sq. ft. of existing porch in same footprint, including a new foundation. The existing roof of the porch will remain. 7. AMOUNT OF LAND AFFECTED: Initially 0.02 acres UIt~mataly N/A ac~oo 8. W,LL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Front yard setback does not meet regulatory requirement. 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Chaoeeasroonyasapply.) ~----'lResJdential []Industrial r--']Cammeraal r'--JAgrlcult~e r"-JPan~lForestlOpenSpa~e ' r~o~er (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING, NC~/V OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) []Yes ~"lNo If yes, list agency name and permit I approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLy VALID PERMIT OR APPROVAL? ~--"~Yes [-~]No If yes. Ii. agenoy name and pemlit / approval: l[~SesA Rr,r~ULT OE PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I__JNo I CERTIFY THAT ~j~::)~tMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE s Name Ja Id Agent Date: Signature · J /// . / If the,~on ia a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment 35 Hartman Hill Road Huntington, New York 11753 President Board of Town Trustees Town of Southold Town Hall, 53095 Main Road Southold, New York ! 1971 Dear Sir: Please be advised that I hereby designate and authorize James E. Fitzgerald, Jr. of Proper-T Permit Services to act in my behalf as my agent in the submission and processing of a permit application for an addition and renovations to the existing dwelling my property located at 2025 Smith Road, Southold, and designated by Suffolk County Tax Map No. 1000-98-4-19.2, and to furnish, upon request, supplemental information in support of the application. Sincerely, AFFIDAVIT OF POSTING TO THE SOUTHOLD BOARD OF TOWN TRUSTEES 1N THE MATTER OF THE APPLICATION OF: James Gemmill SCTM #1000-98-4-19.2 STATE OF NEW YORK COUNTY OF SUFFOLK I, James E. Fitzgerald, Jr., residing at 385 Haywaters Drive, Cutchogue, NY 11935, being duly sworn, depose and say that on the l0th day of October, 2003, I personally posted the property known as 2025 Smith Road, Southold, 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, which date is noted thereon~ bet 22, 2003 at or about 7:00 PM. (~ ~ J~sE. Fitzg~ra~, i Sworn to before me this ~2~ day of ~_~:~" ,200~ Notary Public ~-~ xa ~'ednesday, Octo- TO: Date:~October I0, 2003 Adjacent Property Owners (Names and addresses are listed on the attached sheet.) BOARD OF TRUSTEES, TOWN OF SOUTHOLD NOTICE TO ADJACENT PROPERTY OWNER In the matter of.' James Gemmill. SCTM #1000o984-19.2 YOU ARE HEREBY GIVEN NOTICE THAT: 1. An application is being submitted to the Board of Trustees for a permit to: Remove I0. I' x 7.3' section of existing porch on west side of house; construct new one-sto~y addition, 10.1' X 18.7' on west side of house. Rmnove exislmg mechanical equipment from existing house crawl space and relocate to faoposed one-sto~y addition Rebu/ld 490-~ sq. fl. of existing porch in aune footprint, inc!na/ng a new foundation. The existing roof of the porch will ren~qin The project described above is proposed on property adjacem to yours. The street ad- dress of that property is as follows: [ 2025 Smith Road, Southold, New York 11971 The project, which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code, is open to public comment. A public hearing will be held at Town Hall, 53095 Main Road, Southold, New York 11971 at or about 7:00 PM on Wednesday, October 22, 2003. If you wish to commem you may call the office (631-765-1892), or applications may be reviewed and commems may be submitted'in writing up to 24 hours prior to the hearing. The project described above will be reviewed by the Board of Trustees of the Town of Southold. The project may require independent review and approval by other agencies of the Town, State, or Federal governments. PROPERTY OWNER'S NAME: MAILING ADDRESS: PHONE NO.: lames Gemmill 35 I-Iartman Hill Road Huntington, NY 11743 631-367-9760 A copy of a sketch or plan showing the proposed project is enclosed for your convenience. AFFIDAVIT OF MAIL1NG TO THE SOUTHOLD BOARD OF TOWN TRUSTEES IN THE MATTER OF THE APPLICATION OF: James Gemmill SCTM # 1000-98-4-19.2 STATE OF NEW YORK COUNTY OF SUFFOLK James E. Fitzgerald, Jr., residing at 385 Haywaters Drive, Cutchogue, NY 11935, being duly sworn, deposes and says that on the 13t~ day of October, 2003, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the named persons at the addresses set opposite their respective names; that the addresses set opposite the names of said persons are the addresses of said persons as shown in the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at Cutchogue, NY 11935, that said Notices were mailed to each of said persons by Certified Mail/Return Receipt Re- quested. Sworn to before me this day of ~C~\~fe.~ Notary Pubiic'~- 10/7/03 'GEMMH,L: ADJACENT PROPERTY OWNERS NOTICE NOT SENT (PROPERTY OWNER~ 1000-98-4-19.2 James N. Gemmill & Linda A. Gemmill 35 Hartman Hill RoM Huntington, NY 11743 NOTICE SENT 1000-98-3-18 AnnE. Fay 300 I4_aworth Avenue Haworth, NJ 07641 1000-98-4-19.1 LiMa B. Gemmill 35 Hartman Hill Road Huntington, NY 11743 1000-984-20 Carol Doebler Foehr 24 Thomhedge Road BellporL NY 11713 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nrohibits conflicts of interest on the hart of town officers and enmlovees. The nuroose of this form i~; to orovide information which can alert the town of ooasible confli~:~ of interest and allow it to take whatever action is neeessa~ to avoid same. (Last ~ you are applying in the name of someone else or other entity, such as a company. If so, indicate the other Ix'rson's or company's name.) NAME OF APPLICATION: (Cheek all that apply.) Variance Change of Zone Approval of plat ~' Exemption from plat or official map _ Other (If "Other", name the activity.) Do you personally (or through your company, spouse, sibling, paint, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, mamage, 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 ~ If you ar~we~d "YI~S", 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 I~scribe the relationship between yourself (the applicanVaganVrepresentative) and the !own officer or en~ployoe. Either check the appropriale 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); __.I~) th~ legal or bcne,~,,,cial c, wncr of a:ty ~nter ~-~ in a non-corporate catty (v~,~n the applicant is not a corporation); __.C) an officer, director, partner, or employee of the applicant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form #E2 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FOR~ The Town of Southold's Code of !=.thie~ orohibits conflicts of integer on the hart of town officers and emolovees. The nuroose of this form is to orovide infonnation which can alert the town of oossible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOURNAME: James E. Fitzgerald, Jr. (Last name, first name, middle initial, unless you are applying in the name of someone else or other ant/W, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Cheek all that apply.) Vsriance Change of Zone Approval of plat Exemption from plat or official map Other (If"Other",naraetheactivity.) Trustees' Wetlands' ~'ermit Do you personally (or through yom' company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, mamage, or business interest. "Business interest" means a business, including a parmership, in which the town officer or employee has cyan a partial ownership of(or employment by) a corporation in which the town officer or employee owns more than $% of the shares. YES NO X If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or posit/on of that person Describe the relationship between yourself (the applicant/agant/representat/vc) and the !own officer or employee. Either check the appmlmate 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 co~ooration); B) thc legal or bencfi¢ial owner of any interest in a non-corporate entity (when the applicant is not a anrpomion); __.C) an officer, director, pai'~ner, or employee of the applicant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form #E2 ?rintName~'d, Sme~'~:~'. TT~zge~aL~/, ~r. Proper-T Permit Services POST OFF/CE BOX 617, CUTCHOGUE, NEW YORK 11935-0617 (631) 734-5800 October 9, 2003 Ms. Lauren Standish Office of the Board of Town Trustees Town of Southold Town Hall, 53095 Main Road Southold, New York 11971 Re: Transactional Disclosure Form Dear Ms. Standish: As you requested, I enclose a completed Transactional Disclosure Form. Presumably this will apply to all applications I submit in the future. Feel free to make copies as necessary if, for some reason, each application file must include one. Snuthnld Town Board ot Trustees a subsidiary of THE PECONIC EASTERN CORPORATION Proper- T Permit Services POST OFFICE BOX 617, CUTCHOGUE, NEW YORK 11935-0617 (631) 734-5800 September 30, 2003 President Board of Town Trustees Town of Southold Town Hall, 53095 Main Road Southold, New York 11971 Re: Application for Permit on B ehal f of James Gemmill- SCTM # 1000-98-4-19.2 Dear Sir: Attached are documems which have been prepared in support of the application for a permit to remove a portion of an existing porch, construct a one-story addition to the existing house, and rebuild the remaining existing porch, including a new foundation, on the property of James Gemmill in the Town of Southold. Proper-T Permit Services represents Mr. Gemmill in this matter, and a letter of authorization is part of this submission. If there are any questions, or if additional information is needed, please call me. Enclosures: Application Fee ($200) Letter of Authorization Notarized Statement of Applicant Project Plan/Survey of Property (Ingegno, last dated 8/29/03) Application Form (3 copies) Short EAF (3 copies) Vicinity Map (3 copies) Tax Map (3 copies) Project Site Photos (3 copies) OCT - 1 2',j~3 Southold Town Board of Trustees a subsidiary of THE PECONIC EASTERN CORPORATION . . STATEMENT TO THE SOUTHOLD BOARD OF TOWN TRUSTEES County of Suffolk ) State of New York) I, James Gemmill, being duly sworn, depose and affirm that I am the owner of the property located at 2025 Smith Road, Southold, New York 11971, and identified by Suffolk County Tax Map No. 1000-98-4-19.2, and that all work will be done in the manner set forth in the present application and as may be approved by the Southold Board of Town Trustees. I agree to hold the Town of South old 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. I hereby authorize the Town Trustees or their agent(s) or representative(s) to enter upon my property to inspect the premises in conjunction with the review of the present application. Sworn to before me this ..P~. day of ....~'?l-(}-........... , 200.S ..()~<..... Notary Public ,.c- :/.:x../"':::;'3'd'<~',c-- ~ -,,~- ~..-,<~ -::~. '. DA~LA A. FIUS:RTO ';~-. ,..,.,...,~.;1. NarARY punLlC, STY:'~ OF NEW YORK ~.' _ 1..2. ,t). QUAUFIED IN SUFFOLK COUNlY r" " ,,~:.;.;".J: REG. #02FI5055417 ~ _ "'.~ _ j " r.ft"COMM. EXP. 0211 . U"" ....,"" - .. . N/Ohll FOElIR c.tllOL DOEBU . 4O"28'4<4".E , ,. / ,//, " ~- '\ - I .-- \ ~ ,,., \ \ \ \ \ \ .e ......,. \ 1 \ I.:. ) I~ /e . i ':'" I I ",_I IY / / 1 I / 1 I I / t / "" f " - '::.~ -h ~ I ....i.: .:,.i.:t'~~ '''';;-4\ " \ , \V, ',' \ \ "" , \ \ t , \ \ \ Vt, \ \ I \ I I 'I I I I I I I ~ ~ ,...-.,. 1 .. ! .. \ "? .... -'i- I - ! N 39028'12" W .. .. SMITH ROAD (PlUYATE ROAD) 1 ..... -=-- "~"':ft._.-'t_ .. .. , .. .. .. .. .. .. .. .. .. .. l' .. ..