HomeMy WebLinkAboutTR-5128Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
DATE: M~'ch 22,. 2000
ISSUED TO ...... ANI;!RE.W .MOORE .&. KAREN SIL'vTIEF.~ ....
Pursuant to the provisions of Chapter 615 of the Laws of
the State of New York, 1893: and CJnapter 404 of the Laws of the
State of New York 1952; and the Southold Town Ordinance en-
titled "REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS:" and in accordance with the
Resolution of The Board adopted at a meeting held on .~z~.,. _22,....2000
lq-2P~,0 and in consideration of the sum of $ 1~0.0(! . . paid by
.. En-Go!7~lzltants f~r ANDREW MOORE. ~...IfAltEI4...SILVIER
of ... MatlLt2.ck ...... N.Y. and subject to the
Terms and Conditions lis~ed '(~n'the reverse side hereof,
of Southold Town Trustees authorizes and permits the following:
~et]a~d Permit to const, a fixed do¢~ 4~90~ ele~. min. of 3.5
above marsh, 3'X16' ramp, & a 6'X20' fit. secur, by (2) 2 pile
dolphins, constr, a 100+' timber ret. wall to tie into exist, landwa
end of returns (north side 5' return south side 21' return) and
backal[ in accordance with the detailed specifications as presented in
fill the originating application, with approx. 100 c.y. of clean sand
from upland source.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes its Corporate Seal to be affixed, and these presents to
be subscribed by a majority of the said Board as of this dat~.
Alber~ 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) 765-18q2
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
March 23, 2000
En-Consultants Inc.
1329 North Sea Road
Southampton NY 11968
Re: ANDREW MOORE & KAREN SILVIERA
SCTM ~106-11-21
Dear Rob,
The following action was taken by the Board of Town Trustees
during a Regular Meeting, held on March 22, 2000, regarding the
above matter:
WHEREAS, ANDREW MOORE & KAREN SILVIERA, applied to the Southold
Town Trustees for a permit under, the provisions of the Wetland
Ordinance of the Town of Southold, application dated February 3,
2000 and,
WHEREAS, said application was
Conservation Advisory Council
recommendations, and
referred to the Southold Town
for their findings and
WHEREAS, a Public Hearing was held by the Town Trustees with
respect to said application on March 22, 2000, 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 standard set forth in
Chapter 97-18 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 approves the application of
ANDREW MOORE & KAREN SILVIERA to construct a fixed dock,
consisting of a 4' X 90' catwalk, elevated a min. of 3.5' above
marsh, a 3' X 16' ramp and a 6' X 20' float secured by (2) 2
pile dolphins, and construct a 100+' timber retaining wall to be
tied into existing landward end of returns (north side 5'
return, south side 21' return) and backfill with approx. 100
c.y. of clean sand to be trucked in from upland source.
Located: 515 South Drive, Mattituck.
BE IT FURTHER RESOLVED that this determination should not be
considered a determination made for any other Department or
Agency which may also have an application pending for the same
or similar project.
Permit to construct'and complete project will expire two years
from the date it is signed. Fees must be paid, if applicable,
and permit issued within six months of the date of this
notification.
Two inspections are required and the Trustees are to be notified
upon completion of said project.
FEES: None
Very truly yours,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/djh
cc. DEC
Dept. of State
ACE
Albert J. Kr~pski, President
James King, Vice-President
Hen~, 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~~~o~
has been reviewed by this Board, at the regular meeting
/~. ~_~, '00 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 necessary.
TOTAL FEES DUE:
SIGNED:
BY:
PRESIDENT, BOARD OF TRUSTEES
CL-ER~{, B./~ARD OF TRUSTEES
4/98
t owner ~ Androw Moor~ ~ ~ $11v~a,
~ Mr, Moor* m~t Mr Silv~J:~',~ ~I~l to
We, Robert and Elizabeth Skinner, own property known as 615 South Drive, Mattituck,
which is located south of and adjacent to that owned by Andrew Moore and Karen
Silveira. We are aware of and have no objection t~Mr. Moore and Ms. Silveira's proposal
to connect their proposed retaining wall to the existing bulkhead on our property, provided
that the project does not undermine the integrity of our bulkhead and that Mr. Moore and
Ms. Silveira assume responsibility for any damages should they occur.
Robert Skfnfier
OElizabeth Skinner
EN- CONSULTANTS, INC.
ENVIRONMENTAL SERVICES
1329 North Sea Road
Southampton, New York 11968
516-283-6360
Fax: 516-283-6136
E-mail: encon @ peconic.net
Susan Acke ~rman
Division of Environmental Permits
NYSDEC
SUNY, Building 40
Stony Brook, NY 11790-2356
February l5,2000
RE: ANDREW MOORE&KARENSILVEIRA. 1-4738-02555/00001
Dear Ms. Ackerman:
As the proposed retaining wall will be constructed differently than proposed on the project plan submitted
with the captioned application, please find attached (4) copies of a revised plan. Specifically, the
proposed retaining wall will be constructed of timber rather than vinyl sheathing, and because of the
steepness and eroded condition of the subject embankment, a batter piling rather than deadman system
will be employed.
By copy of this letter and revised plans, I am similarly notifying the other involved regulatory agencies of
these changes.
Robert E. Heitiisann
Coastal Management Specialist
Attachments
cc: Board of Trustees, TownofSouthold
Kelly Rosendahl, U.S. Army Corps of Engineers, #2000-00141-L2
Coastal Resources Division, New York State Department of State
TON, N.Y.
PI~OPO~I~ POCK ANP
WA.I. FOR ANI:?I~W MO01~ ANP
r,,~N ~IL.V~IRA ON MA'rTIfl,,CK
JO~.r.K, MA'r'i'ITUCK, 51~I~OI.,K CO,,
NY, 5H~l~'r I ~ I ~/22/cz)
2/2/00, 2/II/O0
WM,.I. FOR ,ANPf~W MO01~ ~P
r,,,N~N ~b~IP.A ON MAfqgL'K
C"I~K, MA'rllTLL'K, .51~JDI..K
NY, ~l~'r I CT: I ~/22/oo
2/2/00, 2/II/O0
REPLY TO
ATTENTION OF
Eastern Permits Section
NEW YORK, N.Y. 10278-0090
May 31, 2000
DEPARTMENT OF THE ARMY
NEW YORK DISTRICT, CORPS OF ENGINEERS
JACOB K. JAVITS FEDERAL BUILDING
SUBJECT: Application Number 2000-00141-L2 by Andrew Moore and
Karen Silveira
To Whom It May Concern:
The New York District, U.S. Army Corps of Engineers, has
received a request for Department of the Army authorization for
the following activity:
APPLICANT:
Andrew Moore and Karen Silveira
652 Broadway, Apt. 7R
New York, NY 10012
ACTIVITY:
Install a 4 foot by 90 foot pier, a 3 foot by 16
foot ramp, and a 6 foot by 20 foot float secured
to two pilings. The purpose of the work is to
provide a mooring facility.
WATERWAY:
Mattituck Creek
LOCATION:
Mattituck, Town of Southold, Suffolk County, NY
As this is minor in nature, authorization may be by Letter
of Permission. This is in accordance with current Federal
Regulations governing work in navigable waters of the United
States. To accomplish the coordination required, prior to the
issuance of a Letter of Permission, your review of the enclosed
drawings is requested.
Pursuant to Section 307 (c) of the Coastal Zone Management
Act of 1972 as amended (16 U.S.C. 1465 (c) (3) (A)), the applicant
has certified that the activity complies with and will be
conducted in a manner that is consistent with the approved state
coastal zone management program.
To allow for the timely processing of the subject
application, your comments are requested within 15 days of the
date of this letter.
Sincerely,
ee~, W~' a sH~ner~c ~ 1 on
Enclosure
WM,.L FOR,q',lt;;~W MO~ ,AN~,
r,,N~N 51L.~IRA ON
3~I~K, MAf111'~, F~LFPOI. K CO,,
~. ffl~l~f I ~ I 7/~/oo
Albert J. Krupski, President
James King, Vice-Pres/dent
Henry Smith
Artie Fester
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
May 25, 2000
Mr. Robert E. Herrmann
En-Consultants, Inc.
1329 North Sea Road
Southampton, NY 11968
RE: ANDREW MOORE & KAREN SILVEIRA
SCTM#106-11-21
Dear Mr. Herrmann:
The following action was taken by the Southold Town Board of
Trustees at their Regular Meeting held on Wednesday, May 24,
2000:
RESOLVED, that the Southold Town Board of Trustees grant an
Amendment to Permit #5128 to depict 50-100 lb. stone armor at
the toe of the proposed retaining wall and Anu~ophila
brelligulata plantings on the bank, as per the request of the
DEC.
However, this permit does not constitute any other permits from
other agencies.
If you have any questions, please call our office at 765-1892.
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/cjc
EN-CONSULTANTS, INC.
1329 North Sea Road
Southampton, New York 11968
631-283-6360
Fax: 631-283-6136
E-mail: encon@peconic.net
www.enoonsultants.com
ENVIRONMENTAL SERVICES
Susan Ackerman
Division of Environmental Permits
NYSDEC
SUNY, Building 40
Stony Brook, NY 11790-2356
May 17, 2000
RE: ANDREW MOORE & KAREN SILVEIRA. 1-4738-02555/00001
De~ Ms. Ackerman:
As we discussed during our recent telephone conversation, please find attached (4) copies of a project
plan revised to depict 50 - 100 lb. stone armor at the toe of the proposed retaining wall and ,4mmophila
breviligulata plantings on the bank.
By cop>' of this letter, I am requesting that the Southold Trustees amend their permit accordingly.
Respectfully yo, trs,
Coastal Management Specialist
Attachments
cc: Board of Southold Trustees
'~'~'"~'"~""'
MAT~TITUCK
F~i: r~ r-';~"~'
1:329 NORTH SEA RD.
631-283-6360
~OPOg~12 POCK & I~fAININ6;
WALL POF. ANPI~W M001~ ANP
KAF~N 51L~IP-.A ON MAtTI1'L6K
CI~I~K, MAffllllCK, FLIPPOLK CO.,
NY, .5~-J~1' J ~ J, 2/2/oo, 3/11/oo
~/22/oo, 4/4/oo, ~/17/oo
/vlAffl fliCK C~I~K
~' X 20' ~bOAf
!~1.~ (I0") ODLPHN (~)
8 ~
MAT~TITUCK~
~U~PO~.K F.O. HAF~I~U ~ #2.~
f~'~O,~F_.O, NY;
~CfM
~. WAf¢E FF. PITf5 ff.(..Ol~P ~::~I~IN~ LOW
'~ ( ~:OCT'M, I0/~,/99) ~'
fRLI(Z4~D IN Fti~2M AN LIq,AN~ ~
'"'!' ?~'"r? NYC.
i': ?: ;' :.,' "~',tL N ¥. I]968
'-..~6 :'.2 0.'7.!'0
FROt~OS~g 120CK ,ANI2 ~I'AININ~i
WALL FOR ANI::;~I~W MO01~: ANP
K,AI~N f:,ILV~I~ C;N MAf1111.b'"K
C'~I~K, MAfl111JCK. 5LF;COL. K ¢0,,
NY, ~tf.~f I CTF [
2/2/00, 2/II/O0
Telephoue
(516)765-18qZ
Town Hall. 5309.5 Ma/n Road
P.O. Box i179
· qouthold. New York 11971
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
At the meeting of the Southold Town Conservation Advisory Council held Tuesday, February.
15. 2000, the tbllowing recommendation was made:
Moved by Bill McDermott, seconded by Richard Smith. it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A
STIPU~AIION of the Wetland Permit Application of ANDREW MOORE & KA PEN
SILVEIKA 106-11-21 to construct an "L" shaped fixed timber dock, consisting ofa 4'X 90'
fixed catwalk (elevated a min. of 3.5' above marsh grade); 3'X 16' ramp; and a 6'X 20' float
secured by (2) 2-pile 10" diameter dolphins. Construct a +/- 100' vinyl retaining wall to be tied
into existing bulkheads to north and south and backfill with approx. I00 cy. of clean sand to be
trucked in from an upland source. Located: 515 South Dr., Mattituck. SCTM#106-11-21
The CAC recommends Approval with the Stipulation that the length of the catwalk be shortened
as much as possible.
Vote ot'Council: Ayes: All
Motion Carried
EN- CONSULTANTS, INC.
ENVIRONMENTALSERVICES
1329 North Sea Road
Southampton, New York 11968
516-283-6360
Fax: 516-283-6136
E-maik encon@peconic.net
February 3, 2000
Town of Southold
Board of Trustees
Post Office Box 1179
Southold, New York 11971
Attn.: Diane Herbert
Re:
Andrew Moore & Karen Silveira
515 South Drive, Mattituck
SCTM # 1000-106-11-21
Dear Ms. Herbert:
In regard to the above referenced property, enclosed are the following for the Board of Trustees review:
3.
4.
5.
6.
7.
Three (3) Wetland ' Permit Applications,
( including Notice and Proof of Mailing to adjacent owners).
Three (3) Short Environmental Assessment Forms.
Three (3) copies of authorization & disclosure forms.
Three (3) work plans.
Three (3) copies of survey.
One (I) set of site photographs.
Application fee of $150.00 wetlands.
I trust this information shall allow you to process our permit request. Should any additional information
be required, please do not hesitate to contact our office.
S inccT'ely'
Coastal Management Specialist
/kbs
Eric.
Albert J. Krupski, President
John HoIzapfel, Vice President
2im King
Martin H. Garrell
Peter Wenczel
Town Hall
53095 Main Road
P.O. Box I179
Southold, New York 11971
Telephone (516) 765 - 1892
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
Coastal Erosion Permit Application
~'Wetland Permit Application
Grandfather Permit Application
Waiver/Amendment/Changes
~,'Received Applica~o~:~~__
~-Received Fee:$ ~
~-'Completed Applica=ion~
Incomplete
SEQP~A Classification:
Type I Type II Unlisted
Coordination:(date sent)
~'CAC Referral Sent:~
~,Date of Inspection: Receipt of CAC Report:
Lead Agency Determination:__
Technical Review:
7Public Hearing He~
Resolution:
FEB 3 -
Name of Applicant
Address
Andrew Moore & Karen Silveira
b52 Broadway, Apt. 7R
New York, NY 10012
Phone Number:(212) 673-7803
Suffolk County Tax Map Number: 1000 - 106-11 21
Property Location: 515 South Drive, Mattituck
(provide LILCO Pole $, distance to cross streets, and location)
AGENT: En-Consultants, Inc.
(If applicable)
i329 North Sea Road
Address: Southampton, NY 11968
Phone: 631-283-6360
FAX$: 631-283-6136
eoard of Trustees Applicati6n
Land Area (in square
Area Zoning:
Previous use of property:
Intended use of property:
GENERAL DATA
feet): ~52,564
R-40
Residential
No Change
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 (use attachments if necessary): construct an
"L" shaped fixed timber dock, consisting of a 4' x 90' fixed
catwalk (elevated a minimum of 3.5' above marsh grade); 3' x 16'
ramp; and 6' x 20' float secured by (2) 2-pile (10" diameter
dolphins. Construct a ±100' vinyl retaining wall to De tied
into existing bulkheads
approximately ~00 cubic
from an upland source.
to north and south and backfill with
yards of clean sand to be trucked in
~ard of Trustees ApplicatiO
WETLAND/TRUSTEELANDS APPLICATION DATA
Purpose of the proposed operations: To provide private boat
dockage and staDilize eroding embankment.
Area of wetlands on lot: 0 square feet
Percent coverage of lot: 0 %
Closes~ distance between nearest existing structure and upland
edge of wetlands: N/A feet
Closest distance between nearest proposed structure and upland
edge of wetlands: N/A feet
Does the project involve excavation or filling?
No X Yes
If yes, how much material will be excavated? N/A cubic yards
How much material will be filled? ±00 cubic yards
Depth of which material will be removed or deposited: ±3'
feet
Proposed slope throughout the area of operations: N/A
Manner in which material will be removed or deposited:
Approximately ±00 cubic yards of clean sand fill will be trucked
in from an upland source, dumped, and graded as backfill land-
ward of the retaining wall.
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):
The proposed retaining wall will be situated ±20' landward of
the adjacent tidal marsh vegetation and will serve to stabilize
the toe of the eroding embankment without significant adverse
impact to the adjacent marsh or Town waters. The proposed
dock is similar to adjacent structures and will be installed
to the north of the adjacent marsh in order to avoid all impacts
to the existing wetlands.
14-16-4 (?d87)--Text 12
PROJECT I.D NUMSER 61 7.21
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART P--PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
SEQR
I APPLICANT/SPONSOR ANDREW MOORE & K~REN [ 2. PROJECT NAME
I
5ILVEIRA BY EN-CONSULTANTS, [NC.
$. PROJECT LOCATION:
Municipality M~.TT [TUCK County SUFFOLK
4. PRECISE LOCATION (Street address end road intemection$, promirmnt landmarks, etc., or provide map)
515 SOUTH DRIVE, MA1TrrucK, TOWN OF SOUTItOLD; SCTM #1000-106-11-21- MAP PROVIDED
5 IS PROPOSED ACTION'
[] New [] Expansion [] Modification/alteration
6. DESCRISE PROJECT SRIEFLY'
~ONSTRUCT AN "L" SHAPED FIXED TIMBER DOCK, CONSISTING OF A 4' X 90' FIXED CATWALK (ELEVATED A
~{IN1MUM OF 3.5' ABOVE MARSH GRADE); 3' X 16' RAMP; AND 6' X 20' FLOAT SECURED BY (2) 2-PILE ( I0"
DIAtv~';TER) DOLPHINS. CONTRUCT A 4/-100' VINYL RETAINING WALL TO BE TIED INTO EXISTING BULKHEADS TO
~/ORTH AND SOUTH AND BACKFILL WITH APPROXIMATELY 100 CUBIC YARDS OF CLEAN SAND TO BE TRUCKED
IN FROM AN UPLAND SOURCE.
7. AMOUNT OF LAND AFFECTED:
Initially 1.2 acres Ultimately 1.2 acres
8. W~LL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
[]Yes [] No If No, describe briefly
WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
[] Residential [] Industrial [] Commercial
Describe:
]Park/Forest/Open space [] Other
3EC, CUE, DOS
10 DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,
STATE OR LOCAL)?
[] Yes [] No If yes, list agency(s) and pernlit/approval$ r~-- ~ "~ '~--' ~, '
~ Yes ~ NO If yes, list agency name and ~iUapproval
12 AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
App)icanUspon$oroag'&'~ RO~TE'HERRMANN'-COASTAL MGMT' SPECIALIST Date: FEB. 3, 2000
Signature:
If the action is in the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
OVER
NOTICE TO ~DJACENT PROPERTY OWNER
BOARD OF TRUSTEES~ TOWN OF SOUTHOLD
In the matter of Andrew Moore & Karen silveira
SCTM$1000-106-11-21
YOU ARE HEREBY GIVEN NOTICE:
1. That it is the intention of the undersigned t~ {equ~.est a ·
Permit from the Board of Trustees to: Construct an L -shaped fixed timber
dock, consisting of a 4' x 90' fixed catwalk (eLevated a minimum of 3,5'
above marsh srade); 3' x 16' ramp; and 6' x 20' float secured by (2) 2-pile
(10" diameter) dolphins. Construct a il00' vinyl retaining wall to be
tied into existing bulkheads to north and south and backfill with approxi-
mately 100 cubic yards of clea~and to be trucked in from an upland source.
2. That the property which is the subject Environmental Review
is located adjacent to your property and is described as
follows: 515 South Drive, Mattituck
3. That the property which is subject to Environmental Review
under Chapters 32,37,or 97 of the Town Code is open to public
comment. You may contact the Trustees Office at 765-1892 or in
writing.
February 24, 2000 at 7:00 p.m.
The above referenced proposal is under review of the Board of
Trustees of the Town of Southold and dose not reference any
other adjacent that might have to review same proposal.
OWNEI~S NAME: Andrew Moore & Karen Silveira
MAILING ADDRESs: 652 Broadwa¥~ Apt. 7R
New York, NY 10012
PHONE ~: 2i2-673-7S03
Enc.: Copy of sketch or plan showing proposal for your
convenience.
P'ROP05~.I~ POCK FOR ANI:;~W
MO01~ ANP Ig~N 51L.~IRA 01',
5LI~I~Clr, CO,, NY,
.f~rl ~ i, 21210o
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name: Address:
Shawn & Dawn Williams
405 South Drive
Mattituck, NY 11952
Robert & Elizabeth Skinner
615 South Drive
Mattituck, NY 11952
STATE OF NEW YORK
COUNTY OF SUFFOLK
doing business En-Consultants, Inc.
Robert E. Herr~ann. , ~X~ at 1329 North
Southampton, NY , being duly sworn, deposes and says
that on the 3rd day of February ,~2000, 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 Southampton , that said Notices
were mailed to each of said' persons by ~(erti~ied)
mail.
~O~er ~. Herrmann
Sworn to before me this 3rd
day of February ,~ 2000
~ Notary ~ublic
6
~ ~_~
218 041 528
US Postal Service
Receipt for Certified Mail
No Insurance Coverage Provided.
DO not use for international Mail ISee reverse)
Stre & Numb ~ -
Po I Office State, & ZIP Co~e
tO*AL Pos~go & Fees $ ~ ~ ,~
Z 218 041 529
US Postal Service
Receipt for Certified Mail
No Insurance Coverage Provided.
Do not use for International ~.
Street & Number
P~p, st Office Stale
Postage
TOTAL Postage & Fees
~rd of Trustees Applicat~
AUTHORIZATION
owner of properny)
residing at
(mailing address)
do hereby authorize
(Agent)
to apply [or permit{s) ~rom the
Southold Board of Town Trustees on my behal[.
~Owner' s sfgna~ure)
~rd of Trustees Applicati~
Coun=y of Suffolk
State of New York
BEING DULY SWORN
DEPOSES AbFD AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) AND THAT ALL STATeMEnTS CONTAIR~D ~k~cEIN ARE
TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, A~FD '£nAT ALL
WOR/~ WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION
AND AS MAY BE APPROVED BY Tn~ SOD'£nOLD TOWN BOARD OF TRUSTEES.
THE APPLICAbFr AGREEs TO HOLD THE TOWN OF SOU'£'aOLD 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 HE~Y AUTHORIZE THE TRUSTEES,
THEIR AGENT(S) OR REPRESE~VfATIVES(S), TO ENTER ONTO MY PROPERTY
TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS
APPLICATION.
SWOXN rO /'i
gn e
~LT2~ R. ',~ItlTE
Nouary Public ~o~¥ m~lz. stol. ot ~, yom
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) 765-18~2
Fax (516) 765-1823
BOARD OF TOV~N'r~USTEES
TOWN OFSOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
in the Matter of the Application
of
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
being duly sworn, depdse and .~ay:
That on the ~]~' day of ~. ,-~, I personally the
property ~nown as ~ ~ ~v~ ~f.]~. ?,~ ~ posted
by placin~ the Board of Trustees effJ/.iai p.)sz~r wnera it can
easily be seen, and that I have checke~ to be s~ar,~ the poster
has remained in place for aeven Says ~rJ_o~ t~ 5he date cf ~he
public he~r~.ng,. (date Df ' ~ ' '
(signature) ~ --
Sworn to befo~re me this
~ day of ~L~t~c~,~ 1~_~/3
Noq~y/~b 1 ic -
TRANSACT~ONA~ D~SCLOS~RE FO~H
The Town of Southold's Code of Ethics prohibits conflicts of
interest on the part of town officers and employees. The
purpose of this form is to provide information which can
alert the town of possible conflicts of interest and allow
it to take whatever action is necessary to avoid same.
YOUR NAMEz
]Last name, first name, middle initial, unless
you are applying in the name of someone else or
other entity, such as a company. If so, indicate
the other person's or company's name.)
NATURE OF APPLICATION* (Check all that apply.)
Tax grievance
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, epoune, sibling,
parent, or child) have a relntionehip with any oEElcer or
employee of the Town oE Southold? 'Relationship" includes
by blood, marriage, or business interest. 'Business
interest" means a busineee, including a partnership, irt
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% o£ the
shares.
YES NO ~
If you answered "YES," complete the balance og this form and
date and sign where indicated.
Name of person employed by the Town of $outhold
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
parent,
town officer or employee or his or her spouse, sibling,
or child is (check all that apply):
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
noncorporate'entity (when the applicant is not a
corporation)l
applicant; or
__.D) the actual applicant.
DESCRIPTION OF RELATIONSIIIP
submitted this /~- day ofOc?'- 199)