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Home My WebLink AboutTR-5572 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Ir. 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 # 0182C Date January 8. 2007 THIS CERTIFIES that the two-story dwelling, attached garage & pervious driyeway At 1680 Brigantine Dr., Southold , Suffolk County Tax Map # 79-4-25 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 2/14/02 pursuaut to which Trustees Permit # 5572 Dated 6/26/02 Was issued, and conforms to all of the requiremeuts and conditions of the applicable provisions of law. The project for which this certificate is being issued is for a two-stOry dwelling. attached garage & pervious driyeway. The certificate is issued to RICHARD OLIVO owner of the aforesaid property. ~5<~ Authorized Signature Board Of Southold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. . 5$7~ DATE: ... ...JuIle27, ISSUED TO ..... GARY GERNS (as contract vendee) ......""........... .....--................................ on .m......_...... 1\ut~nrijHttintt Pursuant to the provisions of ChApter 6' 5 of the Laws of the State of New York, 1893; end Chapter.r04 of the Laws of the State of New York 1952; And the Southold Town Ordinançe 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 n:~'.'~.26:.. . 20.~.2.., end in consideretion of the sum of $.f.QP....9.9... ... paid by .. G.":'7nGernr;..n .un.. ....... .u..........n.n.nnnun of .....nI~.lipn:r.e.'ër.<J,":"n.n.u . .. .... N. Y. And subject to the Terms And Conditions listed on the reverse sicle hereof, of Southolq Town T rustees Author~es And J?!Irmits the foRowing: Wetland Permlt to construct a single-family dwelling with the I 1 conditions that hay bales are instaJled prior to construction '-'lith 10' relief during construction but area must be re-vegetated I ,_ after .the const. is com~ete and drywells and gutters installe,~ t cont¡¡¡l} the ropf run.Q: alì as.. Mtnct<>..d = survIIT daten. I AM In acc:oroance WITn CleTallè(-specmc:aTlOns as p<esenfeèl In , the originating epp¡cation. i August 14, 1989 and last revised Ju. 17, 2002. I . IN WITNESS WHEREOF, The said Board of Trustees here- i by Cðuses its Corporat~ ~al to be a~lted, and these p~esents to! be subscribed by e mAlorlty of the said Board as of thIs date. , I de Trrul... Albert J. Krupski, President . J ames Kin~~, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (831) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 27, 2002 Mr. Gary Gems 36 Irving Place Islip Terrance, NY 11752 RE: 1680 BRIGANTINE DR., SOUTHOLD SCTM#79-4-25 Dear Mr. Gems: The Board of Town Trustees took the following action during its regular meeting hel~ on Wednesday, June 26, 2002 regarding the above matter: I I WHEREAS, GARY GERNS, as contract vendee applied to the Southold Town Trjrstees for a permit under the provisions of the Wetland Ordinance of the Town of South old, application dated February 14, 2002, and, WHEREAS, said application was referred to the Southold Town Conservation AdviSory Council for their findings and recommendations, and, I I WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on June 26, 2002, at which time all interested persons were given an opportunity to be þeard, and, I I WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, , I WHEREAS, the Board has considered all the testimony and documentation submitted concenúng this application, and, I I WHEREAS, the structure complies with the standards set forth in Chapter 97 ofthþ Southold Town Code, I , I WHEREAS, the Board has determined that the project as proposed will not affect PIe health, safety and general welfare of the people of the town, , 2 . . NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of GARY GERNS, as contract vendee, to construct a single-family dwelling with the conditions that hay bales are inslalled prior to construction with 10' relief during construction but must be re-vegetated after t¡he construction is complete, and drywells and gutters installed to contain the roof run-off, ¡all as depicted on survey dated August 14, 1989 and last revised June 17,2002. BE IT FURTHER RESOLVED that this determination should not be considered a detqrmination made for any other Department or Agency, which may also have an application pendin)g for the same or similar project. I Permit to construct and complete project will expire two years fTom the date it is sign~d. 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: $10.00 Very truly yours, t2!/. L-I ~ /¿tA_~-v&' (2. Albert J. Krupski, Jr. ' ìI'" President, Board of Trustees AJKJlms Albert J. Krup!lki, President James King, Vice·President Henry Smilh Artie Foster Ken Poliwoda . . ,.. - .. r·,··... Town Hall 63096 Main Road P.O. Box 1179 Soulhold, New York 11971 Telephone (616) 765-1B92 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTH OLD TO: '- jJ OJ)!} ....AdULV'b0 i Please be advised that your application, dated~~/~1J i has ~e¡j~ rce~wed by this Board, at the regular meeting o. () and the following act. ion was taken: . ( ~ ApPlication Approved (see below) (____) Application Denied (____) Application Tabled (see below) (see below) If your application is approved as noted above, a permit ¡fee is now due. Make check or money order payable to the Southqld Town Trustees. The fee is computed below according to the sc~edule of rates as set forth in the instruction sheet. I The following fee must be paid within 90 days or re.-appÜcation fees will be necessary. COMPUTATION OF PERMIT FEES: 4>.- € - C()0~" fU~-\\Ö(") ·Ins~ec.~~ ..g;S,()Ö ~o~\\o..n('o..:r nSVe c.-t~ ..g &.00 {J 1 \ ,~ \t)V ~J. ;:--- TOTAL FEES DUE: $~ ~.I ~ ;'&. .~...l' 9' S.IGNED: y. PRESIDENT, BOARD OF TRUSTEES BY: ~~~¿''dF'~JpT~6J A ~_.._ 4/98 . . Telephone (631) 765-1892 Town Hall. 53095 Main Road P.O. BOI: 1179 Southold. New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town ConserVation Advisory Council held Wednesday, February 19, 2003, the following recommendation was made: I GARY GERNS to Amend Permit #5572 to construct a single-family dwellin~ with a 4d' front yard setback. I Located: 1680 Brigantine Dr., Southold. SCTM#79-4-25 I I , The CAC did not make an inspection, therefore no recommendation was ~ade. . . Telephone (63\) 76:;-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 TliJesday, June 15, 2004, the following recommendation was made: i I Moved by Doris McGreevy, seconded by Don Wilder, it was I RESOLVED to recommend to the Southold Town Board ofTrustees APPRPVAL of the Amendment application THOMAS JORDAN to Amend Permit #5572 to co~struct a two- story dwelling and attached garage; install a pervious driveway, sanitary syf;tem, and public water service; and establish a 42' non-disturbance/non-fertilization bWer adjacent to the freshwater wetland boundary. I Located: 1680 Brigantine Dr., Southold. SCTM#79-4-25 I Vote of Council: Ayes: All Motion Carried . . Telephone (631) 765-1892 Town Hall. 53095 M&in Road P.O. Box: 1179 Southold. New. 'ilorlt 11971 _ SOUTIIOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monþay, March 18, 2002, the following recommendation was made: I I I Moved by Scott Hilary, seconded by Nicholas Dickerson, it was I RESOLVED to recommend to the Southold Town Board of Trustees DISAPPJI{OVAL of the Wetland Permit Application of GARY GERNS (CONTRACT VENDEE) to ¢onstruct a single-family residence. ¡ Located: 1680 Brigantine Drive, Southold. SCTM#79-4-25 I I , The CAC recommendd Disapproval of the application for the following reaso~s: The project requires a 100' setback from the wetlands. i There are concerns with the grade and potential alteration in th$ grade causing run-off. I , A building envelope appears to be impossible to achieve. I Vote of Council: Ayes: All Motion Carried .~ . . 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 November 15,2001 Gerard P. Goehringer Chainnan Zoning Board of Appeals Town of South old Town Hall PO Box 1179 Southold, NY 11971 Dear Board Members: I Upon review of the property located on Brigantine Drive in Southold (74-4-25~26) owned by Jordan, T&A. The Southold Town Board of Trustees request you to 1eny the applicant's request to unmerge lots 25 & 26 for the following environmental refons: I L The property contains an active wetland. I I I 2. Concern about development without meeting the Southold Town Bo~rd of Trustees setback of 100 feet for septic system. I 3. Concern about development without meeting the Southold Town BO~d of Trustees setback of 50 feet of no disturbance upland of the wetland I delimitation line. , 4. This is a substandard lot. ! If you have any questions. Please contact the Southold Town Trustee office. Sincerely, ~9/~0 Albert J. Krupski, Jr. President, Board of Trustees AJK:cjc Albert J. Krupski, President . James King, Vice-President Aliie 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 T~USTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN I APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE 110 DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION PF THE PERMIT. I I I I INSPECTION SCHEDULE ---L 'pre-construction, hay bale line 151 day of construction Y:z constructed V"' Project complete, compliance inspection. of h."--:Jb_(-'!- ~ 1.V\e..... I I r~ p (t'" t Ì\.--~ . . 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 (6~lì 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTH OLD September 21, 2005 Mr. Richard Olivo 285 Route 25A Rocky Point, NY 11778 RE: 1680 BRIGANTINE DR., SOUTHOLD SCTM#79-4-25 Dear Mr. Olivo: : The following action was taken by the Southold Town Board of Trustees at ~heir Regular Meeting held on Wednesday, September 21, 2005: I RESOLVED that the Southold Town Board of Trustees APPROVE the Tra~sfer of Permit #5582 from Thomas & Annette Jordan to Richard Olivo, as issued o~ June 26, 2002 and amended on June 24, 2004. I I , I I I This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, ~·~9·~·ff- 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 TelephoI1e (631) 765-1892 Fax ($31) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 18. 2005 Mr. & Mrs. Thomas Jordan P.O. Box 844 Assonet, MA 02702 RE: 1680 BRIGANTINE DR., SOUTH OLD SCTM#79-4-25 Dear Mr. & Mrs. Jordan: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed.. May 18, 2005: RESOLVED that the Southold Town Board of Trustees grants the last OneJyear Extension to Permit #5572, as issued on June 26, 2002 and amended on J~ne 24, 2004. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, bh-t- '7 ~.~- Albert J. Krupski, Jr. President, Board of Trustees AJK:lms . . ~..- f~.~' rn ~ ~ .:l:! ~. ~", ~o.¡ + i-~~ Albert <f. Krupski, President James King, Vice·President Artie Foster Ken Poliwoda Peggy A. Dickerson BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 24, 2004 Mr. Robert E. Herrmann En-Consultants, Inc. 1319 North Sea Rd. Southampton, NY 11968 RE: THOMAS JORDAN 1680 BRIGANTINE DR., SOUTHOLD SCTM#79-4-25 Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York1:1971·0959 Telephonr (631) 765-1892 Fax (631) 765-1366 Dear Mr. Herrmann: The following action was taken by the Southold Town Board of Trustees ~ their Regular Meeting held on Thursday, June 24, 2004: . I RESOLVED that the Southold Town Board of Trustees grants a One-Yeat Extension to Permit #5572, as issued on June 26, 2002, and amended on June 24, 20~4. I This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, 1/ . 1. (J. J//t4-!?~. r Albert J. Krupski, Jr. President, Board of Trustees AJK:lms . . Albert J. Krupski, President James King, Vice~President .t\1,tie Foster Ken Poliwoda PegKY A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephonf \631) 765-1892 Fax(6B1! 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 24, 2004 Mr. Robert E. Herrmann En-Consultants, Inc. 1319 North Sea Rd. Southampton, NY 11968 ~- RE: THOMAS JORDAN 1680 BRIGANTINE DR., SOUTHOLD SCTM#79-4-25 Dear Mr. Herrmann: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Thursday, June 24, 2004: RESOLVED, that the Southold Town Board of Trustees APPROVE the A~endment to Permit #5572 to construct a two-story dwelling and attached garage; install a pervious driveway, sanitary system, and public water service; and establish a 42' 1n- disturbance/non-fertilization buffer adjacent to the freshwater wetland bou dary, with the condition the three (3) oak trees on the northeast corner of the prope are left in place, drywells and gutters are installed to contain the roof run-off, and all as depicted on the survey prepared by Joseph A. Ingegno last dated June 28, 2004. I This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, ~,..r 9. ~.~. Albert J. Krupski, Jr. President, Board of Trustees AJK:lms . . Albert J. Krupski, President James King, Vice-President Art.ie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (1;31) 765-1892 Fax (631i 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 1, 2003 Mr. & Mrs. Thomas P. Jordan 1550 Brigantine Dr. Southold, NY 11971 RE: 1680 BRIGANTINE DR., SOUTHOLD SCTM#79-4-25 I Dear Mr. & Mrs. Jordan: I The following action was taken by the Southold Town Board of Trustees at their Regjlar Meeting held on Wednesday, April 30, 2003: RESOL VED, that the Southold Town Board of Trustees APPROVE the Transfer of~ermit #5572 from Gary Gems (as Contract Vendee) to Thomas & Annette Jordan. l This is not a determination ITom any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, {t ~~J ~ /4.~~~' ( , ¡ rr" Albert J. Krupski, Jr. President, Board of Trustees AJK:lms ~ EN-CONSULTANTS, INC. I I 1319 North Sea Road Sout~amPton, New York 11968 I 631-283-6360 Fax: 631-283-6136 \ wwwenconsultants.com ENVIRONMENTAL SERVICES mIll: ~ IE I u~ I ~ l L I ~: :1,\ June 29, 2004 Albert Krupski Board of Trustees Town of South old 53095 Main Road Southold, NY 11971 Re: Annette and Thomas Jordan. #5572 Dear Mr. Krupski: , As requested, please find attached (3) copies of a site plan modified to depict a drainage system of dr'wells. Should you require any additional information before a permit can be issued, please let me know. Robert . Herrmann Coastal Management Specialist Enclosures ~ é}~ ~f. · :5 i3,.... ~'~¡¡E ...ã5~ ~"""".~",þ. i? s IE o~s:~ >-f;t~. 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" . . · i ì í \ ~ qHi HH\ ~ \ ' " , ' ~~~l.l~ I I I L ¡ \ ! \ i \ \ ; ; H!! Hnn IdHl \e \ \ \ , \ \ I ~ . ~;! lid I -.. ;=. ~ ~ , Cj . · ~ a . . ' . . ~ \\Hl I JjJIL \ \ \ ¡ \: :¡ " d! ~ i d ¡dB --- ...JI~~~~ . . -- . , Figure 4. Looking across subject parcel at adjacent dwelling to nortbeast. . . 5~ /{)) JIJ05 íÓ : 'â?i<J£b df) ~tlJ;./ ¡;IISTE'§~ - SouT:fIO).}) JJ~ ~ t1. ~ SifnJ-#79-If-JS;1.'4 Ì-.¿j ~ ) »/.f 01- /l'11d 1i¡vt1~ Ú~ 7$ m~dJ ~ ~W ð-4J'ILJ11Jda J OJ¡ Uð (/ -/ :;JS R! J.S;;ý' ~J) PI /~. ) J771 ~ is It" I~ n \' re:; ,-"\ !r:J_I~_h'1 ___L~] _l_._l~.__~_... rl! I, U .' , "r .-: L. 1...._" I ) __~ J SOli!1 ',>1 lu,':~ 8'~'c1i ,i ,~,: ,:r,' - -;0': . #.~i~ f~lI~ ~ + +~, \- i) r.rcOUNTi.\\9 -ß- . . Albert .J. Krupski. President James King, Vice-President Artie Foster Ken Poliwoda Peggy A Dick"rson Town Hall 53095 Route 25 P.O. Box lli9 Southold, New York 11971-0959 Telephon" 1631.' 765-1892 Fax (631) 765·6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 18, 2005 Mr. & Mrs. Thomas Jordan P.O, Box 844 Assonet, MA 02702 RE: 1680 BRIGANTINE DR., SOUTHOLD SCTM#79-4·25 Dear Mr. & Mrs. Jordan: The fol/owing action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., May 18, 2005: RESOLVED that the Southold Town Board of Trustees grants the last One-Year Extension to Permit #5572, as issued on June 26, 2002 and amended on June 24, 2004. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, £L¿.e-J ? )!~ c Ý> Albert J. Krupski, Jr. President, Board of Trustees AJK:lms m\' Albert J. Krupski, preSider. Jamé:s King, Vice-President Henry Smith Artie Foster Ken Poli woda . Town Hall 53095 Route 25 P.O. Box 1179 Southold. New York 11971-0959 Telephone (631) 765-1892 FAx (631) 765-1366 LETTER OF REQUES , '~004 1: I _ I {.... Vi.; ¡ D fol'w(Gl( fT. OD M\ (Q,~ .~ l&~ Clat[¡ - d-n-twill'S 1- q U:i"t~u BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE MAY26,2004 S"utho1d Town Board ot Tru5tees OWNER THOMAS JORDAN PHONE 631-765-5221 ADDRESS 1550 BRIGANTINE DRIVE, SOUTHOLD, NY 11971 AGENT EN-CONSULTANTS.INC. PHONE 631-283-6360 ADDRESS 1319 NORTH SEA ROAD, SOUTHAMPTON, NY 11968 PROPERTY LOCATION 18680 BRIGANTINE ORNE, SOUTHOLD TAX MAP NO. 1000-79-4-25 JlWe EN-CONSULTANTS, INC. request an Amendment 10 Permit # 5572 TO CONSTRUCT A TWO-STORY HOUSE AND ATIACHED GARAGE; INSTALL A PERVIPUS DRIVEWAY, SANITARY SYSTEM, AND PUBLIC WATER SERVICE; AND ESTABLISH A 42-FOOT NON-DISTURBANCE/NON-FERTILlZA TION BUFFER ADJACENT TO THE FRESHW ATE~ WETLANDS BOUNDARY, ALL AS DEPICTED ON THE SITE PLAN PREPARED BY JOSE'1" A. INGEGNO, LAST DATED DECEMBER 1,2003. rs.rØ ~~l"I':')'i- EXTEND PERMIT FOR A PERMIT OF ONE YEAR. ~ Signed By:_ ROBERT E. HERRMANN, COASTAL MGMT. SPECIALIST . . NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant:THOMASJORDAN SCTM#lOOO- 79-4-25 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to r,quest a PeI'mit from the Board of Trustees to: I I TO CONSTRUCT A TWO-STORY HOUSE AND ATTACHED GARAGE; INSTALL A PERvJoUS DRIVEWAY, SANITARY SYSTEM, AND PUBLIC WATER SERVICE; AND ESTABLISH A 42-FOOT I NON-DISTURBANCFJNON-FERTILIZA TION BUFFER ADJACENT TO THE FRESHW A TEB. WETLANDS BOUNDARY, ALL AS DEPICTED ON THE SITE PLAN PREPARED BY JOSEPH A. INGEGI!<O, LAST DATED DECEMBER 1,2003. I I I the property which is the subject of Environmen~al located adjacent to your property and is descriþed as I 2. That Review-is follows: 1680 BRIGANTINE DRIVE, SOlJfHOLD , 3. That the project which is subject to Environmental !Review under Chapters 32, 37, or 97 of the Town Code is open I,to public at You may contact the Trustees ¡Office , , I I The above referenced proposal is under review of the B~ard of Trustees of the Town of Southald and does not referenc~ any other agency that might have to review same proposal. conunent on: 6/24/04 @7 P.M. 765-1892 or in writing. OWNERS NAME: THOMAS JORDAN MAILING ADDRESS: 1550 BRIGANTINE DRIVE SOUTHOLD, NY 1197I PHONE #: 631-765-5221 Ene.: Copy of sketch or plan showing proposal for your I convenience. 5 . . 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(6ß1) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of ~_~t:iC1-()[_---____________________________ COUNTY OF SUFFOLK) STATE OF NEW YORK) I, ¡¿kri- AFFIDAVIT OF POSTING i-IflAW41'1t'&idi4~t~ ==:ma:- IOUIHAII'ION. .. ~ 11988 ..... being duly sworn, depose and say: That on the day of ~ ,20d!; I personally osted the property known as èA by placing the Board ofT stees official poster where it can easily be seen, and that I h~ve checked to be sure the poster has remained in place for eight days prior to the date ofttie public hearing, Date of hearing noted thereon to be held -.::Ih. tr'. ju.V\t~~- o~o("'ob ~ 'i'.OO~ Dated: (signature) Sworn to before me this :;J.0 day of~2001- - IJ/ yj~l-t, ~bliC - IU~STmIEIIi II«iyPJljd1",oIlIørlill CoIitIio1No.~I!I31 fllliliSdllCIaIJO\ c.iiI~t_ . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Robert & Lois Brandsletter Address: 1645 Brigantine Drive Southold. NY 11971 Kenneth & Barbara Poliwoda 1735 Brigantine Drive Southold, NY 11971 Theodore Paraskevas & Kathleen McCarthy 1825 Brigantine Drive Southold, NY 11971 [5) ~ !: ~ ~ jIJ ~'~ Ifù JUN - P ~u04 \b' Southold To,," Board of Trustees STATE OF NEW YORK COUNTY OF SUFFOLK I doing business atEN-CONSULTANTS,IN¡. , , being duly sworn, deposes anf says of JUNE .20 ~, deponentl , mailed a true copy of the Notice set forth in the BoardJof Trustees Application, directed to each of the above nam d persons at the addresses set opposite there respective na1es; that the addresses set opposite the names of said persorjls are the address of said persons as shown on the current ass~ssment roll of the Town of Southold; that said Notices were mailed at the United States Post Office atSOUTHANœTON , t~at said Notices were mailed to each of said per (ce~tified) ~~) mail. ROBERT E. HERRMANN 1319 NORTH SEA ROAD SOUTHAMPTON, NY 11968 that on the 4th day Sworn to before me this 4th day 0 f JUNE .2004 ~ 21 ~~~ OIH.SIB'IÐII /foI¡¡y~'·iIIII~"M CimioiIIIIIL5I1!I31 QuIiiodiSIW~J CoIIiIiI~~ ROBERT E. ERRMANN I COASTAL MANAGEMENT $PECIALIST '. . . U.S. Postal Service." CERTIFIED MAIL. RECEIPT (Domestíc Mail Only: No Insurance Coverage Provided) Ul fT1 r- cT Ul r- ru Ul ':'>."! ....... Postage $ Certffied Fee ? Return Rscrap! Fee 1.75 (Endorsement RequIred) Restricted DelIvery Fee (Endorsement RequIred) Total Postage S J::'__ CI: 4.42 06/04/04 Ul o o o o o Ul o fT1 o r 0 o r- ¡¡¡,;;o;,A¡;r"""-' or PO Sox"No.."' ëitŸ.-Síãtë~Zip.;. Kenneth & Barbara Poliwoda ¡ 735 Brigantine Drive Southold, NY 11971 cr ru cT <0 U.S, Postal Service CERTIFIED MAIL.. RECEIPT (Domestic Mail Only; No I~'!!..a!!.c:!!. £o.:!.e!.8{]e !,,!,v}d!dl Ul r- ru Ul '..-,. i.". " ~J !~~ J:;: Postage $ Ul 0 Certified Fee 0 0 Retum Recfept Fee (EndorSement Required) 0 D R_Dellve<yFee Ul (Endorøement ReqUired) 0 TotaIPostageB P"___ ., 0.37 ? 1.75 fT1 o D r- ¡¡¡,;;o;,..!¡;t:¡q..,. orPO Box No. ëitÿ,-SiåïØ;Z¡P;: 4.42 06/04/04 Robert & Lois Brandstetter 1645 Brigantine Drive Southold, NY 11971 _$ Ul o o o ~Fee o U.S. Postal Service CERTIFIED MAIL. REC~IPT <0 ru ["\- (Domestic Mail Only: No Insurance Coverage Provided) cT ~ rF.r:~:':" .~~" ...~:..,. " .'NU'.'."'"''''''"''~''''' ~ ru L ~!I!f!«D, M¥ 11~ . Ul Return Reclept Fee (Endorsement Required) D Restricted Delivery Fee o (Endorsement Required) Ul D 0.37 UNIT ID: ~ "~'...'\ ~l, . "{ ..... '\ . le~'\ffmFÓ \", 1.75' fT1 o o r- '§i8Bi.7i¡;;:" or PO Box NcJ ëñÿ,-šiãi8;Z¡ 1bIaJ_&F... S; 4.42 Theodore Paraskevas Kathleen McCarthy 1825 Brigantine Drive Southold, NY 11971 . /~....... . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: ANNETTE & THOMAS JORDAN Address: 1550 BRIGANTINE DRIVE SOUlHOLD, NY 11971 SANDRA SIKOWSKI & WILLIAM KELLY P.O, BOX 1680 SOUTHOLD, NY 11971 STATE OF NEW YORK COUNTY OF SUFFOLK I I. I ROBERTE.HERRMANN doing business atEN-CONSULTANTS,INCf 1319 NORTH SEA ROAD I SOUTHAMPTON, NY 11968 , being duly sworn, deposes anq says that on the 27th day of MAY .20 ~, deponent mailed a true copy of the Notice set forth in the Board lof Trustees Application, directed to each of the above nam~d persons at the addresses set opposite there respective na~es; that the addresses set opposite the names of said perso~s are the address of said persons as shown on the current ass~ssment roll of the Town of Southold; that said Notices were ma~led at the United States Post Office atSOUTHAMœTON , tpat said Notices were mailed to each of said persons by (cer~ified) ~,..,":;., ,., L i& I ROBERT E. HERRMANN : COASTAL MANAGEMENT ~PEC[AL[ST Sworn to before day of MAY r me this .2004 27th L IIIlSlIIIIII IIDyPdl·8IIHIIIItII ConaIioIll._ lWeIIilSdot_,v- QøÎIÌ~ . . 0- J] m m 0- f'- nJ LIJ u.S, Postal Service·, CERTIFIED MAIL.· RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) " f~ ,t'· ~~, I . , oil. .:." .,~,~ i""'" . . LIJ o o o _$ O.JI UIHt ,.fM0968 ....1....:1: ~ ~~\\ O '::::5..... ---!~ ... ~~ .. fi; Clerk. -.!1¡¡!)/ ~ $ 4.42 <9~~ ~., o ~ ~~:!l0ï~{}·is~~I-:ff;~q~r:~·;~n_n_.... ëitji.~.z¡..................n.....5............._.....-.._......_...."n.' :.:, 0'" '!'f'", . I ,f /If II 77/ Cenifiod Fee o Aeturn Recfept Fee (Endorsement Required) Aestrk:ted Delivery Fee (Endorsement Required) 1. 75 Total Postage & Fees o <0 f'- :r u.S. Postal Service CERTIFIED MAIL" RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) LIJ f'- nJ LIJ ',. Postage $ certffiedFee LIJ o o o ReÞJm Aeclept Fee (Endorsement RequIred) [:] RestrIcIed Dellv8ry Fee o (Endorsement Required) LIJ o 1. Total Postage & Fees $ [T1 ~ J.,"JI"-- SI"QWSIc, ~ ViI,/I,,,,,,,. k~//y f'- ·SiiéêfAPi·h.'..........nn..............n.....n...........n·.....·_·fhh...... ",Po'_:::' f> û. 'KùO( 11o;?î! ¡;¡¡¡nn...z;¡;;4..hnn.....n';.!.......nnnn.......n..........._............. '~~dro.IJ,^I\. 11'17/ · tlrrd of Trustees APPLicati~ AUTHORIZATION (where the applicant is not the owner) .' 7!joNl/t;S P :Jè ~ p..w I, 'Tt/NItT7£ -:Joæ 1::>1""/ (print owner of property) residing at ;-5"5"0 ß/(I'/rrlfNÌlNE (mailing addtess) J)RI liE ¡ SOI,ó71fctÞ I N 'y do hereby authorize EN- C'{),NSlILI/1NTS. .:4vC_ (Agent) to apply for permit(s) f~om the Southold Board of Town Trustees on my behalf. ~.~ ,::h~ ) (Owner's nature) 8 06'2J/200J 1J:50 F~, 631283"'6 EN-CONSULTANTS. INC. . IilJOOJ Albert J, Krupski, President James King, Vice~Preeident Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 58095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone r631) 765-1892 Fax (63l) 766-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD -------------.--------------------------------------------.---- In the Matter of the Application of ~~ca.(\________________________________ COUNTY OF SUFFOLK) STATE OF NEW YORK) I, AFFIDA VII OF POSTING ¡¿k.-I- ~VJt&ià1¿tiL ::==.:- SOUTHAMPTON. N." 11968 ....... being duly sworn, depose and say: That on the eIty known as by placing the Board of T stees official poster where it can easily be seen, and that lave checked to be sure the poster has remained in place for eight days prior to the date of e public hearing. Date of hearing noted thereon to be held , 0t"I Of' 10 b Dated: ( signature) Sworn to before me this ~ dayof~OO1- ~~~~ blic . IIRS19'IÐIS .1'd;.9IIt~illlYòI _"'1111131 IIIIiII~SlMCllltO\ "!II&IIIaI._ 06/2~/200~ 1~:50 FAX 631283iìÞ6 .. 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'il.·f:.j·'J ~ ;, ."B'f .;. c ..,O.r;1 .,·IS:: ..¡.' '¿.~>'.' :~.''':r·::.~C;;;;¡ I; 1í -;;ID~ ~>- 1:= "¡: ò' ~Q- p:¡,,~ = "' .- >- :§ ~Z_ .....- .", ""-- -p:¡o 13",-: .<:>.".::0 0", 0 o::~", :1 1:"'1 .J~~ ,I ,'¡g ef..,1 'r-,!' . : '. ·>1' ..;c~,1 , .~"-: .' . - ~ '~:;~"" I I '. I·· I"~ f·.· .':f ·..i "·'1 "c.I~,I,,'i:".' ... . !¡!." E' .'. .:8i'¡¡,·~~,··: : ge"""'S.~." , . :~:~·ï'~¡r· ,. :;eiJ! ~:',:.8'[> :o..1!i~E~.[· : JJl~l~ 1 .. il,!Jß:~ g: "'~ ;j:""~l~;s ~: :If.i-~!!·$,¡i. . ;lr,,"'-_i<·!s J!. .:. '.' ," '-, "0'·" __ _._._._u_ ,t . I "l,· _ , .. fI:' '.ê':- . :!(·e.f·"; d"_ .___ ... .~.:_~:.~ . "' -0 " .! "'6u_ ¡:¡.. .~~ ",,t,'" :a¡..¡~ .<:> ,,~ - '" &!'1!~ o'/J§.. .- .", ...-~ 1)CQO , ê ~~ I "r- 0 :<:-'" I I¡! 005 I . .. ", i ;;'f·:':'~~,'.'< I'. <! . ',,< . ~", ""':II', "'. . :-,,:,-:. . ., I',· 'l" L. ' . .)--....' ;···,~i.:'":;::~:':'::~i··.'··.'··., ':~ii.,g.,.:..,. .. <i . '>-... . .. '...... ... ~iI4il:.'!!·~jO"'.!.,....,:. '3'~'~'i:",. .::;..'.'.. .,. .5... ,.,. '.~ ,=.."" iI: .. ,l. ..,' '*''i<.::.iI.<,~ ,'::., .~'5!,~J¡.8.. '~-.. .>..., , '41';~ :ð~',~:! ö">' ':'-' .~:;.", .',' ."-,": ' .&::. ,'''''':1: :-: .'. ' .'. ..' x. >. c. ~!¡ : :"1;; ".l;·I:.,::<:'..-..:....,,;,~,....<~,: . 1,.<, I......··: ~oard of Trustees APPlica~n 7Ho¡t1/1 s P. JïIlU>A-t'v Itfo)/oJE~ 7Jë,æ PI'HY BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABQ>VE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HERfIN ARE TRUE TO THE BEST OF IDS/HER KNOWLEDGE AND BELIEF, AND THAT ML WORK WILL BE DONE IN urn MANNER SET FORTH IN TIDS APPLICATION ANd AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TO\VN OF SOUTHOLD AND THE TOWN TRUSTE* HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAlMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETJtlG TIDS APPLICATION, I HEREBY AUTHORIZE THE lRUSTEES, THEIR AGENT(S) PR REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THf: PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. I ~ ~"'--. ç2.,4I i-;ti{.j :L./ I, SIgna re I I I ,20~ I I I I County of Suffolk State of New York SWORN TO BEFORE ME TIDS \.<g-~ DAY OF ~ <S ~(1,~ CLQJ' ~_ Notary Public BARBARA ANN RUDDER Notary Public, Stata of Na", York No. 4855805 Quallfad in Suffolk County . I Commitlion Explr.. April 14, ...;¡pó l..1 , . -.. . hl'PLIChNT TRhNShCTIONhL DISCLOSURß FORK The Town of Southold'a Code of Ethica prohibit. conflicts of interest on the part of town officer. and emp19yee.. The ur DBe of this form is to rovide information whlcll can alert tile town of DSS bIe conflicts of "tare t and allow it to take wllatever action is flecessar to avo d same. T?-Io ~11-.s p. J""ðRPrlN YOUR NhHR. 1lf/A/~TTe. "J"~ÆÞ;f,./ Last: name, first name, m ddle nl1;181, unless you are applying in the name of Borne ns else or other entity, such as a company. If so, indicate tile other person's or company's name,.) HATURR OF APPLICATION. (Checl, all that apply.) , Tax grl.vance Variancd Change of zone hp.P'iDVal of plat _ Exemption from plat or official map Other I (If ·'otller," name the activity.) Do you personally (or I:;.hcough your company, SPoiRS, sibling, pn~ent, or child) hove D relntionol\lp vitI. any rfice~ or employee of t.he 1.'ovn of Southold7 -Relilt.lonBhi" includeB hy blood, ma~~lage, or bUBiness interest. -Dus neos int.erest.. means a business, incluf.1ing a part.ner1hiP, in which t.he town officer or employee has even a p rtlal ovnership of (or employment by) a corporatio in which thø t.own officer or employee owna more t.han 5% f the shares.. YES ,>C-- NO , Jhlø , form and If you ansvered "YES," complete the balance of date and sign where indicated. Name of person employed by ~he Tovn of Tit.le or posi~ion of that person Sou thold IJ~¡YETTE Jill P/JN" C & Describe the relationship between yourself (the pplicant) and the town officer or employee. Either check the appropriate line A) tllcough D) and/or describe it the space pcovided. Tile t.own officer or employee or Ills or her spous , sibling, parent, or child is (clleck all tllat applY)1 _A) the owner of' greate.: than 5% of the BharfS of the corporate stock or tile applicant (....hen t e applicant Is a corporation), _____B) the legal or beneficial own9C DE any in~ rest in a noncorporate'entity (wilen the applicant s not a cocporation), t _____C} an officer, dicector, partner, or employe ot the applicantr or ~D) the actual applicant. I D~SC~IPTION or ~EL^TlmISIlIP " ~ ¡'úI" T f , fr()¡µ~iz.-¡ In 4'w.r/¡I);'" . SubmItted this ¡g day f:JùI"l~o3 Signature ~,Þr;ï:;l~ Prln~ name 71U)I#1t?J cpjõ~ /)/1,11/ . ~" EN-CONSULTANTS, INC. . 1319 North Sea Road Southampton, New York 11968 631-283-6360 Fax: 631-283-6136 E-mail: encon@peconic.net NWW.enconsultants.com ENVIRONMENTAL SERVICES Albert Krupski Board of Trustees Town of South old 53095 Main Road Southold, NY 11971 ~~ ~N~_I, ~,: ~ May 21,2004 SOU\hOld 10wn d {of 1f'J<;fp:I"S Bn3f" . Re: Annette and Thomas Jordan. #5572 Dear Mr. Krupski: The captioned Wetlands Permit (copy enclosed) was originally issued on 27 June 2002 to Gary Gems, then contract vendee, and subsequently transferred on I May 2003 to the then and current owners, Annette and ~hom. as Jordan (copy enclosed). The plan approved by the Trustees was prepared by Peconic Surveyors and last dated JUlI 7, 2002. Due to objections by the Southold Zoning Board and New York State Department of Environm1ntal Conservation to varying aspects of that site plan. however, the Jordans retained En-Consultants, Inc. to assist them i revising the site plan proposal to meet the requests of those agencies. Because the DECs approval of the revised site plan is imminent and the Jordans' Town Wetlands ~ermit will expire on 27 June 2004, we must now respectfully request that the Board extend and modifY the Tow¡{ Wetlands Permit in accordance with the site plan prepared by Joseph Ingegno, LS" last dated I December 2003, (3 copies of which are enclosed herewith. For your reference, I have prepared a table detailing the notable differences between the Jordans' current plan and that previously approved by the Board for Gary Gems: Site Plan Feature Former Gems Site Plan Current Jordan Site Plan Differen e House Footprint 1,556 square feet 1,096 square feet +30% re uction (460 sf) Frontyard Setback 30 feet 35 feet 5-foot in rease Minimum Wetlands Setback 51 feet 50 feet I-foot re uction Buffer adiacent to wetlands None specified by permit (?) 42-foot non-disturbance Addition of 42' (?) Water Supply Private well, 12' from wetlands Public water No cleari ng of buffer required Because the Jordans' site plan includes effectively neutral to positive modifications to the clems' plan from an environmental planning perspective, I trust that the Board will render no objections to the Jordans' Irequest Should you hII'Ve any questions regarding the changes, however, please let me know. I , Respectfully yours, -7- ,.".' ; 1<H./'-_ Robert ~ Herrmann Coastal Management Specialist Enclosures Annette and Thomas Jordan . Trustee Department Town of South old 53095 Main Road Southold, NY 11971 RE: Lot at 1680 Brigantine Drive SCTM#79-4-25 . 1550 Brigantine Drive Southold. NY 11971 Apri16,2003 . DECEIH~ APR - 7 2003 1¡l1l) Southold Town Board of Trustees Dear Trustees: I On June 27,2002 you issued trustee pelmit #5572 to MLGary Gems for the abol'e mentioned lor. He was the contract vendee at that time, I As ML Gems is no longer involved in purchasing our lot, would you please reisslle the pelmit in our name, as we are the owners. Enclosed is a check to cover the $1 O.(JO fee. I I Sincerelv, I -~pfL~ I . '9 yrr'- ~ é¿}l-l~~_) Thomas P. Jord ' Annette Jordan Thank you very much for your time. ~ . . 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 1631) 765-1892 Fax C63p 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD APPLICATION FOR AN EXEMPTION FROM T E MORATORIUM DATE rf //(1/03 Th orn'= I:) :JD nfa " OWNER /-It?tJp IfF ,Torda./l PERMIT# 55 '72- PHONE 'ifp5 - 52 ADDRESS /5,5-0 IYie-IINr¡ AGENT/ATTORNEY PHONE ADDRESS CORRESPONDENCE SHOUlD BE SENT TO: Júfl1e Q5 abovE PROPERTY LOCATION /&S'O ß,'JC,PCTi,VE .j)iZtvP, S{'u.f-h lei TAX MAP NO. '79 - L/-25 VWe ¡)"h7'JI:!.S /: ,¡ -'In/Jet/.' 5CrzÚt/ ;-('/S'5L:~¿J 1'1) C"~(J. /')t':.tr!(-.5. a âWi1eí5 PLEASE ATTACH A LETTER EXPLAINING WHY YOU QUALIFY FOR TH EXEMPTION TO THE MORATORIUM-BE SPECIFIC REGARDING YO PROPOSED CHANGES. Signed By: -~It.¿.-~Çb,-/.-... ~ )ar..Lð~J , TI,.,y?/t-.5? 0bt¿Dmv !l/"Alf'7!è/(;,;;;;'/ Pnnt Name: FORM NUMBER 97-1000 I .. j Da~\ &, td1-l.Jc.ßO' ;f-'. ~p I I ~ .~0- 0 çi) . ~ ,,{} L .,(\ ()) \ í '\~. - I I I ~ PROPERTY LOCATION /I.,SV 73í?lé~/./I/è- DL.) Jot.»-4fLø IOOD 79-Lf-;;ZÇ- ~ . Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda BOARD OF TOWN TRUSTEES . TOWN OF SOUTH OLD LEITER OF REQUEST FOR AN AMEl I) ¿;n /6:) I I OWNER a~ ~.J). · PHONE ¿3)- ADDRESS (3 G,. ~Ui'vc.] rJ J aCe j ~ SL..; AGENT PHONE DATE JAW 2 3. ~oo- ADDRESS . Town Hall 53095 Main Road P.O, Box 1179 Southold. New York 11971 Telephone (516) 765-18q2 Fax (5161 765-1823 TAX MAP NO. ~Y<OJ ~o- J.;, Cc'\- Ef\"? ~.à-'I: IIWe (31Uetf 0r,¿'¡,J ï;, request an Amendment to Permit # 647~ ~ e )(1/29 t?- <7( D I ~ (//7 j- Ý /l-Æ /) rll ~?fJ()S7"'¿) ---¡¿.)Wu.- aj/jJ/c.;~L ::3 u I ,--"y' ~ ZI3A- ..,'/ I" c_ é Signed By: / /?/ê.z< /91' {'np- tis ~~ecf Albert J. Krupski, President James King, Vice-President Henry Smith Art.ie Foster Ken Poliwoda . . Town Hsll . 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 __~!tl-~-C~------------------- COUNTY OF SUFFOLK) STATE OF NEW YORK) !~/HdaL .ç¡!/O& I;;v AFFIDAVIT OF POSTING I, <34 &~¡U...í. , residing at 3(.., ~vlJ(/ 3 =rSL~;;rrcx¿ being uly sworn, depose and say: I , jJ/~re I --¡-- , Dated: That on the day of R6 ,2003, I personally osted ~he property known as_~f,O dKIG;,/9,Vl-ov'e- Ò..e. OU vi I by placing the Board of Trustees official p ter where i can easily be seen, and that I have checked to be sure the pdster has remained in place for eight days prior to the date o~.~~r public hearing. Dateöof hearing noted thereon to be held II~., ~br~/~ ~ or Q.bô.,rt 1 ',D?> r N'\ . I I Qn&~t;f~k' (signature) ,~ Sworn to bef~e me this 11 day of r~ 2003 Ncl~/~¡~ ¡ LYNDA M. BOHN NOTARY PUBLIC, State of New Yfñ No. 01606020932 Qualified in Suffolk County _ Term Expires March 8, 20 J:kI . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: . ST ATE OF NEW YORK COUNTY OF SUFFOLK G~(ÿ.ovs ,residing at 3f..c,~v"v jc¡r / , being duly sworn, deposes and says that on the day of ,20_, deponent mailed a true copy of the Noticþ set forth in the Board of Trustees Application, directed to each of the above named I persons at the addresses set opposite there respective names; that the addresses set I opposite the names of said persons are the address of said persons as shown on the c~rrent assessment roll of the Town of South old; that said Notices were mailed at the Unite~ States Post Office at £ft.JTXS L, ¡J , that said Notices were mailed to each of said ~ersons by (certified) (registered) mail. ' / ./ ,I .' i·· .- ··U"d / ':"'1/; ,,/ ..", -- '" l'/' ? 'v,;..--- Sworn jre m, Y' ;> 3 Day of <-- /V(.)/9'- ,20~ ( ;), / -, . / l L...... ¿.- (,I,-",-Tv I Notary ublic ELIZABETH A STATHIS NOTARY PUBLIC, State of NewYorll No. 01ST6008173, Suffolk Co,j\1JIY Tenn Expires June 8, 2O~(ò .. -- Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLl: Office Use Only Name of Applicant ~ £!: () tì...t~ # (! '7 =: :c.¿,/_, :'.' ~- f:;J U'",lYcJRí' ,Î\oI. PhoneNumber:() (P3J'5"Ç·)-~'S-C.·.~ ~( Suffolk County Tax Map Number: 1000 - 7 9 _ Q Lj - ~ .$"" V ' _Coastal Erosion Permit Applicati9" _Wetland Permit Application L Major Waiver/Amendment/Changes _Received Application ,)//<1/0 Ý _Received Fee:$ ~.,-' I , _Completed Application '1'4/0 V _Incomplete _SEQRA Classification: Type I_Type II_Unlisted_ _Coordination:(date sent) ~ . _CAC Referral Sent: 41{ /o;;l. Date ofInspection: oÝ Receipt ofCAC Report: Lead Agency Detennination: Technical Review: J / Public Hearing Held: ~f~/6-v Resolution: ' Address a M!I..f Ge¡p AJ.r / .~z. .;;.' ,) ,',. I;) n ( ," :,.t.1/ /- C 31c Property Location: fir k f!) 7~:;.: ¡ (.., F4 I,JT, .u~- 7:?r'JP....: 1..1 v...... I .s:OOThC¡· 0,' . I (provide LILCO Pole #, distance to cross streets, ánd location) AGENT: IV IA (If applicable) o r~ Address: Phone: .. .. Board of Trustees Applicacion GENERAL DATA Land Area (in square feet): 33)049 Area Zoning: Previous use of property: VA-ClUJ' I-AAJÌ) Intended use of property: ('/}{)$IKI1C77()!J OF 5IUG.L£· FAMIL'{ ¿¡¿S,IJX:=J.)(.¿- Prior permits/approvals for site improvements: Agency Date NOIJé /No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agenclf? .."...No_ Yes I I , If yes, provide explanation: Project Description (use attachments if necessary): C.om -r,e..ut" 7'7 ÒI<.J --, ðP s ¡ IJ~( G'" FrJ.1tI11... Y t2e i I Df"'.;..JC'l" .. .. Board of Trustees Application WETLANDrrRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: (' 0 Y) S T /2.UC17 'n ;() () F Sf, /11/-<- 41m, j((/2-f'Sicff'l7{ ~ Area of wetlands on lot: square feet Percent coverage oflot: ss- % Closest distance between nearest existing structure and upland edge of wetlands: ¡:::¡E' 0 feet Closest distance between nearest proposed structure and upland edge of wetlands: ) 7 ' feet Does the project involve excavation or filling? No V Yes 70 13e' If yes, how much material will be excavated?})..rt'Ym.....t:ubic yards How much material will be filled? ~~,~...,f' 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: I Statement of the effect, ifany, on the wetlands and tidal waters of the town that njay result by reason of such proposed operations (use attachments if appropriate): . ·. .. 14-~6-4 121871- Ti!)(t 12 I PROJECT 1.0. NUMBE'1 617..21 Appendix C State Environmental QuaJity Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION (To be completed by Aoolicant or Proiect sponsor) SEQ I ' APPLICANT /SPONSOR ! 2. PROJEC7 \lAME J. PROJECT LOC~TION:f) Munlcloallty ..)·l County 5 ¡.. ..........): . .., ~. PAE~S; L;~1~N (~e~~dä:s~n;;;;nZ~~onb~~ent lanamarks. ~[C_, or ,rovroe mapl ~ () ¡;,; 'y--h c.) I ..::IL IJ'j 5. IS PAOPO~ ACTION: ~w 0 Exoansiol" 6. DESCRIBE PROJECT SRIEFL Y: (!..OIJJ:77ei/(!77~ O,r.::;; -Ý/lvG,U= ¡::~¡"~I¡L.,/ /2e.s., o Mooificationlalteration L·lu..:.."",~ .., AMOUNT OF L)..NO ¡::~CTED: Initially acres Ultimatelv 3. "JIL!.. ,:::~O?I')SEù ~CTION CQMPL'( WITH ~ISìING ZONING OR or ~es L! No If ~a. describe bnet!y 3 ac~es E¡::t EXISTING L.,:.,ND USE .=!~S7HIC7:CNS? , '3. "¡hAT 1$ ?RESENì L.l./,,:0 IJ:;ë IN 'IIC:NITY OF PROJECT'" I X:Sldentl31 n,Inaustrr31 L C.:JmmerClõl Qesc~lbe: . 'P,,,/Folest/Ooen 'oaer I I 10. DOES ACTION INVOLVE. A ?SRMIT APPROVAL. OR FUNDING. .~OW OR ULTIMAiElY -=RQM ANY OTHER GOV~RNME!'IiAL AGENCY (F::ûERAL. STATE G;::!: LOGAL¡? I DYes Cd1'lo If yes. ~ist agency(s) and permIt/approvals ¡ I o Agriculture ~Other ':' 11. DOES ANY ASPECT OF THE ACT!or~ HAVE A CURRENTLY VALID PERMIT OR APpqQVAL? DYes' G1No [I '{I:!S, list ilgency name and permlUaoprOval 112. .~S A RESULT ~POSEÛ ..:.C7!ON WILL '::::<15T!NG PERMIT/APPROVAL FlEQU!RE \10DIFIC;..ïIQN? OY~s ~No .'. I CEñTIF'f THAT THE INFORMATION PROVIDED AeovE IS TRUE -0 tHE 3E.Sï OF MY KNFWL::'UGi: name: IOdle: ).ppllcant/s;¡cnscr Signature: If the action is in the COóOstal Area. and 'IoU are a state açency, complete Coas:aJ Assessment Form before proceeding with this a~~es5Iment ihe OV:::R ?A¡;¡ :1_::;\I\/!RC~IM=~~. .~3ME:-lï .:. 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'/eçe!al1on vf :auna. :lsl1. ;¡r,.eHfisn or 'NllcH!fe 50f!c:eS. ;¡u;miiCanf .'aOrta[~, ~(:h(e3t~ned Of ~nC3nçefecrl:::eç:e5? s-.:ClaHi ~flðrr'/: ND 1- T ~ c::mmunlly's dXlst:ng ,.ans O( ¡DaIS as ùrflc:aJly aoooted. or a cnange In use or inlenslty -:If use of Jan¡j 0t ::Hl'ler natural resourcss.7 =.'(plaln Y' UÙ \ Growln, suoseouent ~eyelooment :J( relalea ac::vltles likelY ~o ,:)s ,noucea JY ~ne ::rCOOSdQ ac:¡on? ~t~lt!n :lfteflv. ~-. -0 ,vù ':3, '...cn~ :erm. :;:ler: :ef:":'1.. :~mula[m~. Of 'Jlner ~riec:s Ile[ ,ce~!ltieQ ,n C:·':.s? ::;(::lIaln )ner!'{. }Jù ..'. :t,-:e: liIoac:$ rne;....ç:nç :.-:'3(1çeS ,n 'Jse :)f ~:tner 'Jt)anlHy ·.,r :"/ce or ~nerçy!"7 ~~::JI.ãln ::flerl'I. /Jv _'fes .S -¡"'Ë~E ~ _:~:2:!..·:':-C 3E. ::':,'JT::1CVE?S'( ~E!....A:ë::J 7"0 ?QT:::'I'!":'L ...:.':'/::.:=!Sê :::'IVIRQN,'.1ej I L ...~P.1.C7:;? ..I. S :-.'"-!E~E. ::R f ·fes. :)Cclaln :Jflel!v .:1ARï ¡1I-OEíE:iMINA TICN OF SiGNIFICANC::: ¡To :Je comp!ered :,y Agency) I INSTRU.C710NS: .=Qr e3C:1 aavers~ e!fec: idemJtieo::l accve. jeter~ine 'Nnetner It is sucstaf'ltial. rafge'j':r:ncorranI,Jr otherwise sign.J fie =3.C:l erfec: SilOuld :'2 ;,ssessed ;n C::1(1necrlon 'Nlth Its la) setting li.e. urean or rural); 1t:1 ;Jrocae IIty of oc::::J::;j.ng; (c) duration' irre'lersJo,lity; ;el geQgracolc 3c::;ce: ana: {f} maqnLtuce. It necessary, aod aUacnmenIS or reference þUDDorting malenals. :::1sur~ ~x~lanalicns c:nra,ln sut:ic:ent aelail to snow that aJl ~e!evant adverse Impacts have been ¡Centifi4d ana adequately accresseG, I C:ïecx ~is ~cx :r /OU ~ave ,c.en:ifie~,cne ;r ~ore :otenliall'! larçe :~ significant. a~'Ierse ;moac:s '..vhlc:1 .·.f:....:· CC:::Jr. : ,1en :Jrccesa aJrac:ly ~O ,he l-ijL!.. =.~r ::!nQlor pre:Jare a oosltrve" aecara~¡cí1l. . - C:ïec:< :h!s ~ox f 'fOU Ilave ùe!ermmed. J3SeO 0n the ¡nferma'tion and analysis lbove and any SUCDor~j;.ç r:oc:.;r.:enra[~cr:. :i12¡ :/":e JrQQasaa ;,c~jon WILL ~JOT result in"";';'f1Y significant acve~sa anvl((:;nmenr2.! im:::;ac:: AND JrC'Jlce :n 3.;:taC:1menrs 3.5 necessar'l. the ~easons 3upconing tJ1Js J8term!naripn: I , ".."'I! 11 .c..o.J ">;...nc·/ "",nl J' '...:~ "',.,n~ )1 ..:c,.':;C""·OI'" '~II,c-:r n _,,"0 ··~"!"IL/ : ,¡k :)1 <"':OO"~'OI'" .jIPC~' "..nJll..'~ / ~"'CQn',QI!!' ~1-'cC'r.n .......:;1 ">;<"nc" ¡,>:n..:u'.. )f ."'"::1.11''' 'If -':Ir:,,"'~ ':I"7m ·!!'\OQn\.o'~ )rr·c~n ~ .],,{C o aA:d of Trustees APPlica.. AUTHORIZATION (where the applicant is not the owner) .' I, 7I-1oJ./AS Jã;iì>A-u (print owner of property) residing at /550 ?>/?~C;4JJTj£Je- (mailing addtess) Ì;¡ ï< . ))D t.l-t--hù I c2 do hereby authorize G/Jætj (J¿,U/r;; (Agen~) to apply for permit(s) frlom the Southold Board of Town Trustees on my behalf. .~~ 8 Albert J. Krupski. President f James King, ViceMPresident Henry Smith Artie Foster Ken Poliwoda . . Town Hall . 53095 Route 25 P.O. Box 1179 SouthoId. 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 ;;:^-- -~_:{!~J!4L~~ ~~;t OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING , I, t1¿M..It!j;/?J 5 , residing at ;.s&J--:7¡<!UI vcr I'/! ~Lt¡'7 '-é'r-/r;Cé'~, /LLf 1/ 7,j---::z. being uly sworn, depose and say: That on the / day of !larch property known as ). 0/1 /7 /. by placing the Board of Trustees official poster here i can easily be seen, and that I have checked to be sure the p~ster has remained in place for eight days prior to the date ot the public hearing. Date of hearing noted thereon to be heldl~4/'~ ¿o P-h :;z. H ~ ~ 70 ¡:-&~rl dY I' Dated: , , I , I , I L , L ì ','. n, )/'/' "ì ;,;'C-(·{.. ~q,. b - r:T (signature) Sworn to before me this ! ~t- day of ¡Aay·d 200t;¡ ~&. ¡/¡2~:d <-ffl5{ary Public MAH-? THERESA V. MILLER NOTARY PUBLIC, STATE OF NEW YORK NO. 01~·':~'J715 QUALIFIED 1',1 c ., ......' r;,)lJtT~ - COMM:SSION EXP'; ~ j .-hl/<i:"r ï . ,. . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: /!t!A-ßÆJ. ¡JO}¡"UJiJj)~ ;J ¡¿ V-.A-I,.es... 70/2 /),AU /..II'- Í(r¡It/ I- S_ SI'i'OWS!<,' /7 :1 ~ ì3 K /<:; AU 7T'ue- / I'(. /S-Ø ;;j/2i6;-{.!\./77,ue k ?o,gO ~ /6 tv / S C! ¡}-f-I-¡ J óL STATE OF NEW YORK COUNTY OF SUFFOLK ~~ ' residing at 3(., 7"J(U,·t.j 6) PL /J-( e -:r:<:J' 'f'1¡ 'e //7 .r¿ , bemg duly sworn, deposes and says that on the 19 day of ¡:::-~d ,201l.,deponentmailedatruecopyoftheNotic 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 cent assessment roll of the Town of South old; that said Notices were mailed at the United tates Post Office at 7S~i: ~rrc;c¿ , that said Notices were mailed to each of said p rsons by (certified) (regis ered) maiL _, I, /' .. .1;1' / /' 11?d3s/ / ~~ /~ Sworn t~ me this I. q¡ y.t, Day of .&j , 20 Od c/-pLc> (' ~1k~ Notary Public THeRESA V. MILLER NOTARY PUBLIC, STATE OF NEW YORK NO. 01~;~4953715 QUALIFIED IN SUFi=0'l"s~~ COMM;SSION EXPIRES '; · Board of Trustees J ApPliCati'!!!' County of Suffolk State of New York Ch ~ (; E /2/UJ BEING DULY swoRIN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABbVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HE$IN ARE TRUE TO THE BEST OF HISIHER KNOWLEDGE AND BELIEF, AND THAT f'\LL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION ANI1> AS MAY BE. APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTE$S HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ~SING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETI1'fG THIS APPLICATION, I HEREBY AUTIfORIZE THE TRUSTEES, THEIR AGENT(S) lOR REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THf PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. I 4 ~// I -..r: /' I ,'\ ,"2 /"/ . ýp~ I Signature SWORN TO BEFORE ME THIs_Jq"'¡" DAY OF ~\J\.,lß.. ð ,20-ºd1: ~7~ JJ~L2: c-l?o~ Pu:c THERESA V. MILLER NOTARY PUBLIC, STATE OF NEW YORK NO.01M14953715 OUAlIFIED IN SUFF COMMISSION EXPIRES ~~~Jf .. .. APPLtCAN'1' TRANSACTIONAL DISCLOSURE FORM The Town of Sou~ho1d's Code of E~hios ptohibl~e contlic~s¡of in~erest on the part of town officers and emPlu.Yeis. The . purpose of this form is to provide information wh oh can ' alert the town of possible oonf1iots of interest and allo~ it to take whatever action is neoessary \;0 avoid same. I , ! YOUR N/\HRt '."' ! .:.' ··:~t ~/:~~èfj~:~, ~ Last name, first name, n tal, un es you are applying in the name of someone else ~r other entity, such ~s a oompany. If so, indi.ate tho other person's or company's name.) I NATURE O~ APPLICATIONt (Check all that apply.) . , .:.,. ;¡" :. ." ; I', . :....;~.! " .: !:,-:.' ; ".·;t·frl!-· ~ Tax grievance Variance Change of zone ^p'p~~al of plat Exe~ption from plat or official map other (If "Other," name the activity.) .~ Do you perøonally (or through your cb~pany. øpouse, Bib~ing, pat:ent, ot: child) have a re!lationship vith any officer cl>t: employee Of the 'i'ovn of Southo1d1 "Relationship· inc1u\)es by blood, mat:riage, ot: business interest. "nusiness : interest" !neanB a busineos. including a partnership. ini vhich the tovn officer or employee has even a partial 1 ownership of (or employment by) a corporation in vhi~h the town of ricer or employee ownB more than 5% of the I shares. I I I I I I If you ansvered ØYES," complete the balance of ~bls ro~m and date and sign where! indicated. ! , Name of person employed by the Town of Sou~holdl Title or position of that person i I Describe the relationship between yourself (~he apþllc~nt) and the town officer ør employee. Ei~her check the I appropriate line ~) through D) and/o~ deecribe in the ~pace provided. I I The town officer or employee or hie or her SþOUSB. sl~lin9. parent, or child is (check all ~ha~ apply). i ~) the owner of greater than S% of the shares of Ithe . corporate stock of the applicånt (when the applicant is a corporation), I B) the legal or beneficial owner of! any in~erestlin a noncorporate'entity (when the applioant is nob a corporation), I c) an officer. direc~or, partner, or employee otl the applican~, or I D) Iohe actual applicant. 1 .1 I ::·::1 .. " .. , YES NO ~/ "..;' DESCRIPTION 01." nEL^TIONS1I1P .~ .... ·";~'~I··t ,~'-' I 1 :\t, ;·.~~.¡I,:.;~:} "':::\",:' . . 1.r·l. · ..: ,_...~. " ·".l~··. , . ... ...,~ .. .,'_" ,; o. ,. · . ~,\...~í. :,.:;~':' · "C;~: \I "...·.,"(.:I,t~,,: ,'¡r:r:'·.)',Tr·', 199_" " sublnltbed " signature ·Print nal11E! '. ~ '5] --'~. 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