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Home My WebLink AboutTR-6130 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 # 0066C Date March 6, 2007 THIS CERTIFIES that the renovations/additions to dwelling At 950 Park Ave.. Mattituck, Suffolk County Tax Map # 123-7-13.1 Couforms to the application for a Trustees Permit heretofore filed in this office Dated 4/22/05 pursuant to which Trustees Permit # 6130Dated 5/18/05 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 renovations/additions to the existing dwelling The certificate is issued to LYNNE ANGELS ON owner of the aforesaid property. r07~ Authorized Signature Mar 03 07 08:45a Bertani Builders 6317653816 John Bertani Builder Inc. . 1380 Oakwood Drive Southold, N.Y. 11971 (631) 765-1594 FAA (631) 765-3916 March 2, 2007 Marilyn F. Angelson, Permit # 6130 Mr. James King, President Soulhold Town Trustees P.O. Box 1179 SOU1hoId, NY 11971 Oea" Mr. King, We are requesmg a project complete, compliance inspeCtion for Marilyn ArgeIson ResidenCe, 950 Park Avenue, MaItiluck, pennit # 6130. Thank you. SinoereIy, _'--7 " --- .l-:J..-.-.:...'{:, -. -~.~ "-1"~-"'.r(-~~ -. Unda D. Berlllni VIOe Presidert ,/ ,\}7/ ))- \ I,,' ..:'1' i- rr":-' p_l Albert J. Krupaki. Preoident James King, Vice-President Artie Foeter Ken Poliwoda Peggy A. Dickerson . . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971'()959 Telephone (631) 765-1892 Fax (6311 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 q I:>. ~ Ie ~ C I<- J ~ _ 1" day of construction 11:0 constructed ..L Project complete, compliance inspection. 31c; 101 f) 1/ . j~ y, ~- " 1"1 . . . . "_", >.... .1 I . -" . . _ > . . :1' , . ." I·' _.:,,-_,.__~__.~._._ . . TERMS end CONDI11QNS 'I1e Permittee Lynne Angelson ....... at 950 Park Ave., Mattituck ',. N. Y 'IS ~ doe coosideraûoo tor !be 1<$0··..... of che PCaait does uøðeøÞod .Ad pœKdbe to the "fot. L That !be Pic! JIoatd 01. TrusteeI aod che Town 01 Sotuho1cl ate re1eued -£rocn my aod all damap, « claims for dauap. of .,.. adÄa&, dhec:dJ ar tadirecdYIS . ~ of aay o~' adoa pdom>ed pu'III1Gt'.,4bIa.~ ,U!!,~ PI4 ~ '. ~,~, ~ Ids arllet OW!' e:t:peBK. dd'eød uy and aIllIKh suIts·nltl.~ bllb1td fudes, eacI the aid 1\ I .I(IIM~ fall UabUIty wich reSpect chetCto, to·~I<te '--'-1"'1 of che IIøucI of TmsIteI of doe Town of ~ 2. That this I'eunk is ~ f« . pedod of . 24 -. wbJd¡, Js ~ to be che eøI....teII time required 10 CIOinplete che wodc Io~ f>at'fhoaJd ~...... -. request, f« ... CDelJSioo ....y be made to che Ðou4 al a bIu d-. ' ' , ' 3. ThaI this PeQDÎt should be reCaIoed Jadáudtely. or as loog as che Pic! PHmI_ 'II'ishCs ' to '....I....ln !be _ or projea InToIved, 10 provide eridcoœ to anyotIe ex>aœmed chat aøch- «Izadoo was odgIoaI!y obÞIocd. .(. ThaI che wodc involved will be IUbjea to the Io$(>ecdoø. eacI approval of doe JIoud or Its ..,IS, aod aoa.-œmpUaoœ with che prarisioas 01. the notgIn.fI..g applkadoa, maybe CII!Se for mocadoo of this Permit by mol11doo 01. the said Boud. S. That chere will be no uøreoSONblt InlCd_ with aa~ .. a rauk 01. the wod:: LmIø uithodzed. ' ' . '6. That chere sbaU be no iaterfereaœ with che rigbt 01 cbe public to pass aod ft(>US ÚGaf the beach betweeo fII&b eacllow _let ~ 7. That if future opcratioos of che Town of Souchold reqaIre che ftIDCJftl ød/or alœndœs 10 the Ioc:aûoa 01. the work bereIa ,IIICJIO. 1-1, or If, In che opInIot> 01. Boarð 01 ~ die. wodtsball cause anreasooaI>Ie obsttllCt1OO to free aavig2doo, che aid P-nI- will be reqaIœII, apoo 1fue nodœ, 10 remove or alter this work or project herein stated "kboI.at err eosfl to che T_ , 01. $o!achold. ' :. ' . 8. That !be aid Board will be nodfIed by lhe Peøoittte or die ~......... Of the wad<: aøch- orbed. ~. ThaI che .p.......¡~ will d>caIø. all ocher peaaits aad ~h 'that mar be required . ...--. ..1 to this permit ~ _Y'be IIIbect to œvoIœ upoo faIIare to obtain ame. ., , . ~. - , '- I. " ,. . . , '. . . Albert ,I. 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) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 18, 2005 Mr. Thomas Samuels Samuels & Steelman Architects 25235 Main Rd. Cutchogue, NY 11935 RE: LYNNE ANGELSON 950 PARK AVE., MATTITUCK SCTM#123·7·13.1 Dear Mr. Samuels: The Board of Town Trustees took the following action during its regular meeting held on Wed., May 18, 2005 regarding the above matter: WHEREAS, Samuels & Steelman Architects on behalf of LYNNE ANGELSON 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 April 22, 2005 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 May 18, 2005, 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, 2 . . 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 LYNNE ANGELSON to renovate and construct additions to the existing residence, and all as depicted on the site plan prepared by Thomas C. Samuels dated April 21, 2005. 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 $50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, ~.j 1/ ~.t}. Albert J. Krupski, Jr., President Board of Trustees AJK/lms . . 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,~"".31 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: c7{r Il1nQ , (ì. f1 r { 1\ 0, Please be advised that your application dated reviewed by this Board at the regular meeting of following action was taken: £.f I d-.J.0 \" S]IRlor; has been and the ( ../; Application Approved (see below) 1-) Application Denied (see below) 1-) 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. COMPUTATION OF PERMIT FEES: ç'-n,a.-t t'ìSfeC--k\, - -.SSD, OJ TOTAL FEES DUE: $ . 5l'7, 00 SIGNED: ~.-f ? ~. ~e PRESIDENT, BOARD OF TRUSTEES . . Telephone (631) 765-1892 Town Hall 53095 Route 25 P,O, Box 1179 Southold, New York 1 1971,0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the South old Town Conservation Advisory Council held Tues., May 10,2005, the following recommendation was made: Moved by Doris McGreevy, seconded by Jack McGreevy, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Permit application of LYNNE ANGELSON to renovate and construct additions to the existing residence. Locåted: 950 Park Ave., Mattituck. SCTM#123-7 -13,1 Vote of Council: Ayes: All Motion Carried , , , , II ì i j ;¡: . ¡; ¡ 1'1 ¡ I I I ! j II 1!1 II! 1 " '" 'I' 'I ( Ii ,Ii 1:1 t".i, If 'f' '," II I' II , II' I, I ,II ! I ¡ i L L , I' " < '7. - ;1 ~'--- \.",.. ' .~~ C2', '~;2,:,7~~,\ < <~~~). '. \\! ;;;"b. 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Î'>,..-.,' " /~ '0"/ \,/ , "-", 'I, \,"" / e <''1::: ',,~ , /' > , / ~--,- , 0, " ,I ~ " (, -' ~ I ,_ II , ~ ¡ . ~ u . ~ i ~':' ~' ~ -; l '" ~; :!¡ I ,,< L· ,l ,:'4.,--- -- ~ ~ i 2 ) ~ ~ -1.",. :i ,I c l~ " , n 0, ~ ': ¡ ~ w , "~'" ¡'.,' , , ~-~ ~.. ê'~ 'j;~ . ~·t'" :::;~J , '-" ; ~~ ....._~. 0.;:-.; ~~§ . ~"O (j ~'h - . ~. ';'c ,; ~ ¡ \ - ~." ~ ..,: - ~; ~ ¡ ~ ~ ;" E1¡ '111' ¡'III ::;i¡ ~d,~! Iii ; II .. HP ", I I'!' ¡III !!!! HH ie! I I . , ¡ j L ; ~. d-¡ ¡<I, íÎ'l II1I ~I " II" ,I, ;J'!: '-L! ~~<>"': . . 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 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 - _ W aiverl Amendment/Changes ~eceived Application:-':f/JJK:J'S: _-1t"eceived Fee:$ .:JSD"' .....-completed Application L. \';¡.1IO \" _Incomplete ~ \1JE ír\\ _SEQRA Classification: ~~~: ¡¡.; ," Type I_Type II_Unlisted_ Coordination:( date sent) I o ' "'/-::;: -CAC Referral Sent~O~ ' Ar'K " -.-.$ -...ð>ate ofInspection: ':,1/1 }O r,; L- ,-~ _Receipt ofCAC Report: _Lead Agency Detennination: p' " . ,..-' .__.-~ ----... Technical Review: """'þblic Hearing Held: ~I¡¡/~ Resolution: Name of Applicant J...o/NNC AN 6ttS6tJ Address 37(; (¡ìRK AufNOf. ¡(fltJ C¡OR..k. lilt¡ 1m2 J PhoneNumber:( ) 'tlf, 5r1 C¡(P(;7 Suffolk County Tax Map Number: 1000 - IJ3 ,07 -/3. / . Property Location:~.50 ( µ k A-1lflJf()£ I ¡fJ1ft77 rvd:: H ¡A/7Ff(,s[(;T!OO ($pJ mrI//Æ1t) uy ¡/J<¡.RÆ1è;o,tA ¡¿p. (provide LILCO Pole #, distance to cross streets, áÍid location) AGENT: Tom SJ-rt¡ (/flS JvffJt uflS t{J STfEJ.¡fJ(p¡ t/fi.{1'I rtt~ (If applicable) , Address: r25235 ðl¡¡'rN,e{),/ Q.CtfC'{k;6 a , Phone: 13 (. - (Ç t.f-ð5 c~ s,p-~~\~~ . . Board of Trustees Application GENERAL DATA Land Area (in square feet): Area Zoning: æ - tfO //r;t gJ~ 81' . f Intended use of property: ParOFMtliL ~¡f¡tf f Previous 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 suspenØed by a \tQyemmental agency? ...L No~ Yes If yes, provide explanation: Project Description (use attachments if necessary):-f BVCV4/7(}(/(.s ¡. ¡fJ{)/)lòr Ao{JlrrW..s fo r:-XtSTfI(6 REùrOWCè, A/oNE , TO EtVcRO/k H C'Ú:£r;p 7õ IPE7L-41VJ>S . . Board of Trustees Application WETLANDITRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: »0 t/KC" ¡. ¡/(()j) (?;;7Lr¡ èt\f 1M; D Rrc5rl¡f6' l'-6StakcC Area of wetlands on lot: - squarefeet lXIL¡;1161P CII/fWL Percent coverage of lot: o % Closest distance between fearest existing structure and upland edge of wetlands: y,g -7 II feet Closest distance between nearest proposed structure and upland ) edge of wetlands: crt!./ ~ feet (MiW /bRUf AtJ/1/ ((r:tfJ Does the project involve excavation or filling? v No Yes If yes, how much material will be excavated? cubic yards Æ/t1 cubic yards How much material will be filled? Depth of which material will be removed or deposited: -- feet Proposed slope throughout the area of operations: ¿Fva Manner in which material will be removed or deposited: ;./ A- 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): 7Uf1F Idn gc: #0 IflP4-C.í 01./ tdf:!tÁ1Væ;, fJ .frfF /0' ,>z¡BST/11VMLl/l //llf//(Of/il) IfJ/ EXrórr¡f6 !WI/SF. Ilto/61tET í/ftL f'tGIIENT KqiVoH j)tIl!t/VG CorYs17ël/C17e# . . Board of Trustees Application County of Suffolk State of New York 71fOI/IA9 C!, ~ ¡fm(/&~ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HElSHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HISIHER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR. AGENT(S) OR REPRESENT ATlVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. ~~!: . fa- &llf;/?cl/R7OU CEfl&z SWORN TO BEFORE ME THIS ~ \ DAYOF~ ,20flÍ ~~ÁDNIV Notary Public PATRICIA RICHARDS Notary Public. State of New York No. 01 RI6042467 Qualified in Suffolk County' I~' Commission Expires May 30, 20Qt-v'-f . . --:-Y'I""-+"'P--0 .1vrc¥~~ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: ?J,"ù œ.. --+ f}acJL {ÒVYlsW ~ 8tìùtb€kJ, S~~ Address: ? 0 . {~. '3 q7 MaMivcJC0v4 /1 fr;:z lf~ fA) [Sq -/1-t S. &. r0vf ú\l-11 òò a y STATE OF NEW YORK COUNTY OF SUFFOLK ~~ fZ)~ residing at Wo ~ VLM- f!-e/ ) l C,j : being duly sworn, deposes and says that on the (0 day of VVlr.u-ø, 20o-r: 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 e Town of South old; that said Notices were mailed at the United States Post Office at '. that said Notices were mailed to each of said persons by (certified) (registered) mal . Gk (Q,-~ Sworn to before me this I 'b-t!:l. Dayof m~ ,2005 dt>A '" GLUQ<. NOTARY PUBliC, STATE OF NEW YORI( NO. (}1..GUI062340 QUALIFIED IN SUFFOlK COUNTY MY COMM1sc'nN F';',Ré:~ 12..11,20~ £~K.~. Notary Public . . 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,_""~1 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of ~o~~~-'1~-i~F-------------------- STATE OF NEW YORK) AFFIDA VIT OF POSTING I, ÎoY'VI 2:,(11r1-\V-QJs , residing al 7 d12 ¡(j¿,w fk ø ¡¿¡'-" A/?ij'4/ cfù $e£ , being duly sworn, depose and say: That on the 10 day ofM ,20.0.5:' I personally posted the property known as vI:: by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held {j J~. -rYII'IJI ~g!Jua.tð'i. ' on (J t 1;00 (lm, Dated: 57/q;)ØD) ("~JZ, Sworn to before me this Jr dayof~20.0.~ Q~~ Notary Public PATRICIA RICHARDS k . t of New Yor Notary Public, Sta e42467 No. 01 RI60 nt Qualified in S,UffO~ co:O ~0IJ2'" 0 \.ç commission ExpIres ay , SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART I-PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) .. I .. 14·16-4 (12/97)-q ¡PROJECT 10 NUMBER 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SEaR 2. PROJECT NAME tre Munic; .,i 14 rTU eK nO/.../J Coun 4. PRECISE LOCATION: (Street address and ro d intersections, prominent landmarks, etc.. or provide map) 5ðD ftfl¿e Iltlt;, t1J4-TTiTttCk; 1fT JbuíHt<J~r (!()R/()t;R t»';1J1-te4TãXA RB ON 6REif-T I'mcwlC ð,1« 5. IS PROPOSED ACTION: o New [J Expansion 6. DESCRIBE PROJECT BRIEFLY: ~Odificatron/alteration £WCf/¡1-Tf tWl> (JU&-fTt-V )@IJ ?D FkrW/VtP fNlOtlVCb> MJ IVOV 6-/¥..16f? rtrf/O I2é/VO(¡ffTG ¡fe(!fJ'.fœC¡ §UtUY,ý6---S' 7. AMOUNT OF LAND AFFECTED: Initially o..:? acres UhimBtely d acres 8. WILLYROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ar'Ves 0 No It no, describe briefly 9. WHAJ IS PRESENT LAND USE IN VICINITY OF PROJECT? 5rResidential 0 Industrial 0 Commercial 0 Agriculture Describe: o Park/Forest/Open Space. o Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTlMATELV FROM ANY OTHER GOVERNMENTAL AGENCY (Federal. State or La.,,)? I!!' Ves 0 No If yes, list agency(s) and permit/approvals \fCPf(~ J[.U'/J Tl2t<<.S-æc=s.. ~/LLr/V6 ¡;¡p¡-:- 11. DOES ANV ASPpcT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? o Yes at' No If yes, list agency name and permltJapproval 12. AS A RESULT OF PROPOSEO ACTION WIll. EXISTING PERMIT/APPROVAL REQUIRE MOOIFICATION? o Ve, IY'No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGe ApplicanUSpon,o, Namo .J Q, rJ; CI.. D.'e --?í (/ as- Signature If the action la In the Coaatal Araa. and you are a state agency, complete the Coaatal Assassment Form before proceeding with this assessment OVER . . LETTER OF AUTHORIZATION Marilyn F. Angelson 876 Park Avenue New York, NY 10021 March 19,2005 We hereby authorize Thomas C. Samuels of SAMUELS & STEELMAN ARCHITECTS to act as my agent in applying for all permits required by SOUTH OLD TOWN, SUFFOLK COUNTY and NEW YORK STATE for the renovation of and addition to our residence at 950 Park Avenue and Great Peconic Bay, in Mattituck, NY, SCTM # 1000-123-7-13.1 2~t~ ?J.¡&j æ-- Date . AI'PLt~AN'l' . TRANSACTIONAL DISCLOSURE FORH The Tovn of saukhald's Cods of Rbhics iohibibs cantllcbs of nbsrsst on ths psrt of tavn off cera and smplaysss. Ths purpose of thia form is to provids information vhlch can alert the tavn of assible conflicts of intsreeb and allow it; ~o lake whal:.ever act on s necessary bo avo d same. YOUR N/\HB. dtAmms Laøl; name, first name, you are applying in the other entiby, such the other person's ..' ;':~..~"')i:.'..:,::..'i..':'~":"!.~. NATURE 01' APPLICATION, (Check all bhsb spply.) Tax grievance Variance Change of zone Ap'þ~pNai of plat ~ BX8~þbian from plat or official map other ~ (H ·other," name the acblvity.) 7l'USllF '/'é(CIfTCðA/ ,~ Do you perBona11y (or ~hrough ~our cÞMpany, øpoude, bibllng, parent,. or child) have a relntionohip with any officer or employee of the Town of Southold? "Relationship· includes by blood, .arriage, or business interest:. ·Uusiness intel:"est" meanB s buøineBB, including a þal:"tnel:"Bhip. in which ~he town afficel:" or employee haB ewen a pal:"tial ownership of (01:" employment by) a corþ"ratian in which the tovn officer or employee ovna more than 5% oC the sh"ares. /" YBS Nq .:. ~' '. If TOU answered ·~ES,·. comple~e ~he balancö or ~hlø form and da~e and sign vhøre indicated. Nams of person employed by ths Tovn "f Southald Title or position of bh~t person Describe the I:"el~tionship bstveen yaursslf (bhs aþplicanb) and the town officer Gr employee. Either check bhö appropriate line ^) through D) and/or. describe in the space providsd. The tovn offi~sr or employes "I:" hie "r hSl:" ep"USe( sibling. parent, or child is (check all that apply). _____A) the owner of gl:"ester than 5% of the ah~res of the cal:"parate stock of ths applicant (whsn the apþlicant' is ~ cOl:"par~tion), _____Ð) the legal or beneficial owner of sny intsl:"eet in s noncorporate'entlty (when the 8þplicBht 1s not a corporation), _____c) an officsl:", dirsct"r, part~er, or employee of bhs apþlicant, or ~D) the ~ptual ~pplic~nt. ." DESCRIPTION 01" IIBLATIONSIIIP " "",', ·,~L'· . '... . ... ...,.. _.¥ h .. ..- .... ..~... ...... ,~y;'.·.u __ I.'· I', ; ¡;J,i,'. r··' ....~.. .,. sublni tted signa ture 'print . ~ ·~f£:ii· . ~ . II II s A M U E L S & S T E E L M A N . . . April 21, 2005 South old Town Board of Trustees Town Hall Annex Main Road Southold, NY 11971 RE: ANGELSON RESIDENCE 550 Park Avenue Mattituck, NY 11952 TAX MAP # 1000-123-07-13.1 Dear Sir/Madam: We are requesting a Permit for the above reference project. For your review we are submitting the following documents: 1. Application 2, Short Environmental Assessment Form 3. Application Affidavit 4, Three Site Plans prepared by Samuels & Steelman Architects 5, Current Survey 6. Letter of authorization from Owner 7, Check for $~..z5"O ~.~ ~~.~J."ï1 Jl\f\ì ,rAPfI 1 .:' ~nr" , 'j \iL_,~:_, "J~~~_ '".,' ',:,_.:'1 B~.-:-"1 of Trl:,:"t.:;;;s Please call us with any questions or concerns. Sincerely, '~tß Tom Samuels SAMUELS & STEELMAN ARCHITECTS ene. ARCHITECTS 15235 MA.rN ROAD CUTCHOGUE NEW YORK J 1935 (b31'1 ':"H-f:¡403 F.\.X ¡6J r I ~34-h40:-- . . 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) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0066C Date Sept. 29, 2005 THIS CERTIFIES that the renovations/additions to dwelling At 950 Park Ave., Mattituck Suffolk County Tax Map # 123-7-13.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 4/22/05pursuant to which Trustees Permit # 6130 Dated 5/18/05 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 renovations/additions to the existing dwelling The certificate is issued to LYNNE ANGELSON owner of the aforesaid property. @1t4'~u9 ~. 71~' (}. 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 ql;).~lc<; tl~J~ 1 sl day of construction % constructed d Project complete, compliance inspection. NOTES, . o AREA 'SURVEY OF LOTS /0 AND // ' MAP OF "MARRATOOKA PARK" FILED H'TH ' THE COUNTY CLERK ON NOVEMBER I, 1'105 S/TUA 'IE: MATT/TUCK 'TOWN: SOUTHOLD I SUFFOLK GOUNlY, NY SURVEYED MARCH 22, 2004 AMENDED APRIL 15, 2004 SUFFOLK COUNTY TAX " 1000 - 123 - 7 - 13,1 L'!, . ¡ I'LM__.\ 1[» ARK A VENUE , ........m___ 264,00 N85°3J'00"E '" , FP-o'ME_. """'" ' """"rrl ~ ~~....-;....J~~'~,-........,."" 'r","" ~Y""""~.¡ "-,,,,,-,^,J" r\ 'i l ~ " " \, \' rl " r', ,~, I 1 6Rf~ 6....<:£ ~, ~Æe 11"V'£!ioT CERTIPmD TO: MAIm. YN P. ANGElSON SOUTlmA 1( AIIS'TRACJr #S - 645 ~.c:= z ..- ..- ° IV V1 o q ~ (\~\::='" 'l, ~ ...-¿"'--'-''->-, -...-....--_...J. '1 \ , / ì i PI'11!'~' , \. \ ..",01'0 ',-- Î () --ì '~,,_._...__.J' .Ii ~:.~ """""" ~ ;.e.CÒR I,"·~ 04·~. , , I'1R£ "'.... r;.;:;ël ~ VJ ..- ..- ° IV V1 q r~r~ š ¡ ì~ ~O ~O '.~?'i ';1> "''''''- 0":"-, 8 y >ECC . ÎÎ ()c, -1-1 , ~--"--'-<~';t~~-"""t _!: __ '~,.~." 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OR 3.BB ACRES HIGH HATER LiNE RUNS ALONG BULKHEAD RESTRICTED AREA AS SHO~N HEREON is ANNOTATED FROM DESCRIPTION LOCATED IN COVENANT FILED AT THE CLERK OF SUFFOLK COUNTY 'N L,/l'1'14 PAGE 60 6RAPHIC SCALE 1- __-__-- ---- 1"= 60' - F\ __ ....-~-~---__:__ t-- _____~__ : \, - ~""""ND =-- c:::::::::>,Ì'--.LI. 'i '-:-~', ,- = - ," -~"""" ',;, " =",' '..~ ¥ 4't . 0 /. " " ~'f¡.. .." . "'-"'.: ~. ^', f { ~. " \..I1-N \ 1( "'; " ~V- ~. - s.:; '~' 0 . ,.... . " .'v(, ". '\. N W~!/ E r s ~~:~ ; ,i~~~ L_ .,--..J R -1',1 ,:,1 TrL"_ ,",c.- ~ ~ ! JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N, Y.S. LTC. NO. 50202 RIVERHEAD, N. Y. 1190 ¡ 369-8288 Fax 369-8287 REF.IlHp "erverld\PROSI04_133B.pro ';"~C"" - J -. _..... ',...- ""'-"'--0