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Home My WebLink AboutTR-5304 Albert J. Krupski, President .-- . Town Hall James King, Vice-President 53095 Route 25 Artie Foster P.O. Box 1179 Ken Poliwoda Southold, New York 11971-0959 Peggy A. Dickerson Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 22, 2002 Ms. Bobette Suter P.O. Box 1709 Quogue, NY 11959 RE: 855 Fisherman's Beach Rd., Cutchogue SCTM#l1 1-1-20 Dear Ms. Suter: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, March 20,2002: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit #5304 to replace the concrete patio witl> a deck. This is not a detennination from any other agency. If you have any questions, please call our cfñce at (631) 765-1892. Sincerely, ():I. I.-I <1 l6--ï~'1..rt.·l 0· ;' Albert J. Krupski, Jr. President, Board of Trustees AJK:lms Board Of Southold Town Trustees SOUTHOlD, NEW YORK . , PERMIT NO. .S.3CJ~ E April Z6. ZOOl DA T : n' '_00 uu n...·. ISSUED TO .....n..:I3.<?I3.¡;::r.':I:¡,;.n§µ:J::¡;:~. nnu" ..................................--......... .Autfløri1!atiøn . Pursuant to the provisions of Chapter 615 of the Laws of the State of New Yon, 1893; and Chapter 404 of the Laws of the State of New Yon 1952; and the Southold ToWn Ordinanc:e 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 W A TERS:!~. and in accordanc:e with the Resolution of The BOard adopted at a meeting held on n:i\-'p'.:..i.ln.~.~I... 209:1.00" and in consideration of the sum of $Uh.?~_On:.QO.u paid by Bobette Suter .. ". .. ........---.--........-......... .-................ .. ....-....... .....-...-.............-.....-................._.........-................-...... of ..........h...~':l.t.~þ?.g':1.~....n....n.................n. N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the folowlng: Wetland Permit to raise the existing house (elev.+5.l5) up to and above (elev. +9. 75) for required FEMA flood elevation. ~ Install ZOO cy. of clean fill. all in accordance with the detailed specifications as presented in . the oñginating apprlCatior.. IN WITNESS WHEREOF, The said Board of Trustees har&- by causes its Col'flor&t,: S~al to be a~xed, and these J:~ to be subscn"bed by a malority of the said Board as of IS det.e. . Henry. Smith -. Absent - . Trruien . . " ~.~~....!'-._~--!~~~.....--!.-~~-~._._~._. _.__.~._-.!~~~-.!~._~-~~-~~-_.~._~_._~-~_. _._~_.... . . . TERMS and CONDITIONS · · · The P-nl_ Bobette Suter r---u,u 855 Fishermans Beach Road, Cutchollue N. Y.,u put. of the coasideøcioa for cbe jSoo....~ of me Pamk cIoea ~Þoðd aød pœKrlbe 10 the £01- Iowiag: . 1. n.!be said Baud of T.- aød me T_ of ~d _ reIeuecI &em ur lUll! all cIamIoca. or clam. for ~ of sa/a adsiag dhettIy or ÙIIIined1- . ~ of ur 0(*- aâoa ~ j>ul.......t 10 dois peaait. lUll! the said II ],.... wIJJ, It Ids or bet owa. at'<- "t. cIefead ur lUll! aIllIICh 1IIits· LoIoI.-I by Ibhd p.me.. lUll! the said P IJ~ "- faIlliabIIiq wich nipect tbereIO, 10 !be ~ .~ of the Baud of n- of 1be Towa. of ~ 2. 1'hat Ibis PeImit is' ~ £or . pedod of 24 -. ..taich it ! 1 ".. ¡ J 10 be die ..;.......¡ cime' œquhed 10 ~ the wod< iø.~ bat IboaId ~- wunac, nqaest foe III eøeasi.oa may be made 10 the Baud at . ~ dale. , ~. 1'hat tbis Pamit sboald be fttaiø.ed iø.cle&icely. or as 10ag as die said P ",I."'e 1risbes 10 ....1....1.. the sttacI1Iœ or project imotftd, to pto\'ide eñcImœ 10 U1JOOe (IO- '......t !bat aach- odzatiOQ was origiø.a1ly obtaiaed.. .. 1'hat doe wodc Imobed will be subject to the 1"S(*ttoa lUll! apptoft1 of the Baud or ia agmts, lUll! IIIOIMOIIIpUaøœ with. the prcmsïoas 01. die ,....,;"g IppIiadoa. may be aase for revoc:aåœ of this Pemdt by .......".'Íon of the said Bo.cd. 5. 1'hat tbece will be 110 _soaable iøterfaeøce with aøiptiaa as . ~ 01. the 'WOIk . beteiø ..;m...~ 6. 1'hat tbece rbaU be DO amereaœ with the right 01. the pabIic 10 pus lUll! IepaI aIaag !be beach between high aød low __ marks. .' 7. Tbat if fucure opendoas 01. !be Town of Sooacho1cI nr¡aiœ cba~ aød/or aJ.,..·J"n. . IA die Iocadoa 01. die wod< beteiø ...¡J..~¡..II. oe if, ia!be opiaIaa of·dIe Baud of T-. die. wade rbaU callie _""","'e ubot._ 10 free am~ die said p..-I- will ... nqaIad. apoaþ DOCiœ, to t.......e ot alter1his. 'W'Oå: oc project beteiø staled ..IlL..,.( e:q..... 10 the T_ 01. SoaIboId. 8. n. the said Baud will be DOIified by tbe .......,1_ ot the .<Ilr 1L r ~ Of cbe work. IIIth- odacI.. .,' 9. That cbe Pf-I_ will obcaiA all othee I"" "üa aDd ......-.. dIat may be requited . 1"-tool II> Ibis permit wbicIa may be aabject to œ¥OIIe apoa fIiIare to obtaia _ .. _C'"-," ~<. . .' --,,--. -..--.--. -.--. -.-.-.-.----. .-.-.---.~~ -.-----.---¡,-............---.---"-,, -. -.-.-.-.-.--.---.-----------.., .,.~.-........--..-.-.----.----.----.---.--.-.-.-.---.-.. . . Albert J. Krupski, President Town Hall James King, Vice-President 53095 Route 25 Henry Smith P.O. Box 1179 Artie Foster Southold, New York 11971-0959 Ken Poliwoda Telephone (631) 765-1892 I Fax (631) 765-1366 , , . , BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 26, 2001 Ms. Bobette Suter ·f P.O. Box 1709 Quogue, NY 11959 RE: 855 Fishennans Beach Rd., Cutchogue SCTM#11l-1-30 Dear Ms. Suter~ I The Board of Town Trustees took the following action during its regular meeting held on Wednesday, April 25, 2001 regarding the above matter: WHEREAS, BOBETTE SUTER applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of South old, application dated March 19, 2001 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 April 25, 2001 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, ¡ I WHEREAS, the Board has considered all the testimony and documentation submitted \ concerning this application, and, I . 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, 2 . . ; NOW THEREFORE BE IT, . , RESOLVED, that the Board of Trustees approve the application ofBOBETTE SUTER to raise i the existing house (elev.+5.15) up to and above (elev.+9.75) for required FEMA flood elevation. I Install 200 cy. of clean fill. .. J , . 1 BE IT FURTHER RESOLVED that this determination should not be considered a determination I made for any other Department or Agency, which may also have an application pending for the t same or similar project. Permit to construct and complete project will expire two years from the date it is signed. Fees I 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, {k/. ~-I (1. I~'~ ,. Albert J. Krupski, Jr. President, Board of Trustees AJKJlms cc: DEC Bldg. Dept. , ; : . Town Hall. 53095 Ma1ø Road P.O. Box 1179 TelepbOlle Soutbold, New York 11971 (631) 765-189Z SOUTROLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, April 16,2001, the following recommendation was made: Moved by Bill McDermott, seconded by Melvyn Morris, it was RESOLVED to recommend to the Southold Town Board ofTrustees APPROVAL of the Wetland Permit application of BOBETTE SUTER 11·1·30 to raise the existing house (elev. +5.15) up to and above (elev. +9.75) for required FEMA flood elevation. Install 200 cy. of clean fill. 855 Fisherman's Beach Rd., Cutchogue Vote of Council: Ayes: All Motion Carried . . DEPARTMENT OF THE ARMY NEW YORK DISTRICT. CORPS OF ENGINEERS JACOB K. JAVITS FEDERAL BUILDING tJ/\a I NEW YORK. N.Y. 10278~O90 REPLY TO ATTENnON OF March 1., 2001. Eastern Permits Section SUBJECT: Joint Application with New York State Department of Environmental Conservation Mr. Rick Suter 1.24 Jessup Ave. Quogue, NY 1.1 q 34 Dear Mr. Suter: We have recently received a copy of the Joint Application for permit you filed with the New York State Department of Environmental Conservation (NYSDEC) . Please be advised we have reviewed the copy of the Joint Application sent to this office by NYSDEC. Based solely upon the information provided, it appears that a Department of the Army permit is not required for your proposal. The Department of the Army regulates construction activities in navigable waterways and discharges of dredged or fill material into waters of the United States, including inland and coastal wetlands. If your proposal would involve such work, and has not been portrayed as such in your Joint Application, you should contact this office immediately so that a project-specific determination can be made as to whether a Department of the Army permit will be required. Any inquiries can be directed to this office at (212) 264- 6731. ~ es W. Haggerty ief, Eastern Permits Section · t , S UTE R AND S UTE R , ARCHITECTURE 0 LANDSCAPE 0 DESIGN ¡ ,I I DATE: TO: , I COMPANY,! FROM: f.(!1r1 RE: s- r/(() MEMO: MAR I 9 ~ØJ¡ =r::. ~~ N:::fT .KWW W~ '"I~E" Fcb' 1ëJTAL :r:s FbIZ... I~{? faeMlTo A-LSð¡ W ~V~ A- d2E"Qtr fb!,e -rH E" Wa<1{ I 'tJf;;" ~PE" ALL rs \4E"U- ¡ I :::r::-. INILL j~5¡';:~j '-tJc,£Q1u... { f . ~ P.O. BOX 1709 QUOGUE, NEW YORK 11959 ~.1^,~ 5 3 3877 FAX 631 653 3878 .--' . . ~. . New York State Department of Environmental Conservation ~ Div'ision of Environmental Permits, Region One Building 40 - SUNY, Stony Brook, New York 11790-2356 ...... F:ïCjjç; (ð:-n -t44-v3ô~ ï=AX; \ô~~ì 444-v~ôQ ......". Website: www.dec.state.ny.us Jonn P Cahill --......-- -..",~ - ~ -- ~ - February 23, 2001 Mr. Rick Suter P.O. Box 1709 124 Jessup Avenue ~f\R \ 9 Quogue, NY 11959 RE: 1-4738-02811/00001 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECl) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please read all conditions carefully. If you are unable to comply with any conditions, please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Sincerely, " ~ '(j/ J// ........ . r '/ '--_jj,J~/~ Evelyn Stewart Agency Program Aide EMS/Is Enclosure I . ., - NEY YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION I DEC PERMIT -+lUMBER I EFFECTIVE DATE I I 0 1-4738-02811/00001 February 23, 2001 I FACILITY/PROGRAM NUMBER(S) EXPIRATION DATE(S) I PERMIT I Under the Environmental Conservation law February 23, 2005 I TYPE OF PERMIT. New o ~enewa l o Modification o Permit to Construct o Permit to Operate I, , 0 ~:~~~~~ '5, :~~~~ 5: O~~!~~t;~r. 0 6NYCRR 508: Wet2, Q~al~ty 0 .\:-'::::~~ 27, -:":~:~ 7; ~~:':'~:-!:!: of Waters Certification 360: Solid Waste Management 0 Article 15, Title 15: Water 0 Article 17, Titles 7, 8: SPDES 0 Article 27, iitte 9; óNYC~R Supply 373: Hazardous Waste Management 0 Article 19: Air PoLlution 0 ArticLe 15, Title 15: Yater Control 0 Article 34: Coastal Erosion Transport Mana¡:;ement 0 Article 23, Title 27: Mined 0 Article 15, Title 15: Long Land R.eclamation 0 Article 36: Floodplain Island Wells Management 0 Article 24: Freshwater Wetlands 0 Article 15, Title 27: Wild, 0 Articles 1, 3, 17, 19, 27, 37; Scenic and Recreational Rivers . Article 25: Tidal Yetlands 6NYCRR 380: ~~d'=!~~~ ~~~tr~~ I. , I PERMIT ISSUED TO I TELEPHONE 'UMBE, II Rick: Suter (631) 653-;:877 ADDRESS OF PERMITTEE P.O. Box 1709 124 Jessun Avenue Quogue NY 11959 CONTACT PERSON FOR PERMITTED YORK TELEPHONE "uMBE" Libertv penmit & Research, P.O. Box 5, Center Mor;che~, NY 11934-0005 (631) 345,5111 NAME AND ADDRESS OF PROJECT/FACILITY Suter nroftartv. 355 Fishenman's Beach Road (Aka Havwaters Road) LOCATION OF PROJECT/FACILITY Cutchogue NY 11935 COUNTY TQ\I/ WATERCOURSE NYTM COORDINATES Suffo l k Southold Cutchogue Harbor DESCRIPTION OF AUTHORIZED ACTMTY: Elevste existin9 dwelling from 5.15' to 9.75' by installing new foundation. All work is to be done in accordance with the attacned plans stamped NYSDEC approved. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compl1ance with the ECl, all appLicabLe regulations, the GeneraL Conditions specified (see page 2 & 3) and any qpecial Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS Mark C. Carrara (EMS) Bldg. #40, SUNY StonY Brook: NY 11790-2356 AUTHORIZED SIGNATURE .--. ^ . DATE II /$// Pa.ae L ',)7" 4 februarv 23 2001 - NEWYfJRK STAT':: DEPARTMENT OF ~NV'RONME"ITl\.l ":ONSERVATION ~ NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS ltem~: Pennittee Accepts legal Responsi~jty and Agrees to Ind~mnification . _ , I lie permHle8 ò,,(ple~SIY i:3grees LO Inaemnll'\} ana nOlo narmtess me ueparrmem or t:(lvtronmenral c....,onservatlon I of the State f')f New Y'1rk it~ 1"'9~r~sp.ntati\l~c; empl()Y~8:Cj. :::agi7!"\t'5-, ~n~ ~'5-s¡gns ~0r ~!! ".:!~rl'T'l'3. S'~!~o::, :!".:~~crs. tj2rn.ag8s. and costs of every name and description, ansing out of or resulting from the permittee's undertaKing of activities or I operation and maintenance of the faciiity or facilities authorized by the permit in compiiance or non-compliance with I the t:l.rrT'IC: ~T"IrI ,.......r-rliti,...nc:: ....f thc. ""c........,¡t I .. - - ._. .- _. - .,-. _..._. - .,. ...- ¡--....... I Item B: Pennittee's Contractors to Comply with Permit The permittee is responsible for Informing Its Independent contractors, employees, agents and assigns of their responsibility to compiy with this permit. including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvals, iands, easements and nghts-of-way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor aoes It authonze the impairment of any nghts, title, or interest in I"'~al nl'" I')Arc:,.,n~ll')rnl")prt\f hplrl nr 'fP.~tP.r1 ;,., ~ ~p'rc::t"\1'\ n~.t =? ~,:?r+f tl) ~h,=, ,)8rmlt I GENERAL CONDITIONS I General Condition 1: Facility Inspection by the Depanment The permitted site or facility, including relevant records. is subject to Inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECl. Such representative may order the work suspended pursuant to ECl 71-0301 and SAPA 401 (3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be avaiiable for inspection by the Department at all times at the project site or facility Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. General Condition 2: Relationship of this Permit to Other Depanment Orders and Detenninations Unless expressly provided for by the Department. issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirements contained in such order or determination. General Condition 3: Applications for Pennit Renewals or Modifications The permittee must submit a separate written application to the Department for renewal. modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Poliutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities (HWMF), major Air Pollution Control (APC) and Solid Waste Management Facilities (SWMF); and b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administrator, Region 1, SUNY Bldg #40, Stony BrooK. NY 11790-2356 General Condition 4: Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to modify, suspend or revoke this permit. The grounds for modification, suspension or revocation include: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of the ECl and pertinent regulations is found: b) the permit was obtained by misrepresentation or failure to disclose relevant facts: c) new material information IS discovered: ûr d) environmental conaitions. relevant technoiogy. or appllcaGle law ar regulation have materialiy changed since the permit was Issued OEC PERMIT NUMBER I P/,GE 2 OF 4 1-4738-02811/00001 ~. NEWYQRK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION . ADDITIONAL GENERAL CCNDITIONS FOR ARTICLES 15 (TITLE 5), 24, 25, 34 AND 6NYCRR PART 608 I ( TIDAL WETLANDS¡ I 1. If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or Ii, in [he opinion 01: ~he ûeparrmem or Environmental Conservation I( shali cause unreasonable I obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the peopie of the Stare, or cause ioss or Jesrrucrion 01 ¡he natural resources 01 the State, me owner may oe oreereo by the Department to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed, the owners, shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigabie and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. 2. The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused ~y or ,esult from future operations undertaken by the State for the conservation or improvement of navigation, or for other purooses, and no claim or right to compensation shall accrue from any such damage. 3. Gtãiiting ûf this pèíiiiit dOEs net ¡sHave the app:icâì1t of the ."asponsib¡ity of obtaining any other permission, consent or approval from the U. S. Army Corps of Engineers, U. S. Coast Guard, New York State Office of General Services or local government which may be required. 4. All necessary precautions shall be taken to preclude contamination of any wetland or watelWay by suspended solids. sediments. fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. 5. Any material dredged in the conduct of the work herein permitted shall be removed evenly, without leaving large refuse piles, ridges ecross the bed of a watelWay or floodplain or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a watelWay. 6. There shall be no unreasonable interference with navigation by the work herein authorized. 7. If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 8. If granted under 6NYCRR Part 608, the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301, 302. 303, 306 and 307 of the Clean Water Act of 1977 (PL 95-217) provided that all of the conditions listed herein are met. 9. At least 48 hours prior to commencement of the project, the permittee and contraytor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work and, if required, a survey. 10 Ail activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. Such approved plans were prepared by: Liberty Permit & Research on 11/27/98 last revised 12/18/00 ! DEC PERMIT NUMBER I PAGE 3 OF 4 1-4ì38-02811/00001 .- . NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION I . SPECIAL CONDITIONS ¡ . I , C:.;r:ng v::r.stnlctiûn, e::;nc;-ste vi" :e¡;,¡c:-:ata :;;-;õ:: ,-;C~ 23':d¡;a :;,-::'ë ,j¡6c;iaigê~. nGr- 3;-ldJ; ,võ6,-;u-,ÿ5 ¡:¡"O/ll ..{an:3j~ i1Hx I I trucks, mixers, or other devices enter tidal wetlands and or protected buffer areas. 2. Any debris or excess matarial from ';v¡¡5tjuC~¡ù(¡ 0f ~hi6 ~(0J¿Ci 6tlêjj Je: t,;omp''=LeJY ,emüvea :rom Ü1e adjacenr area I I (upland) and removed to an approved upland area for disposal. No debris is permitted In tidal wetlands and or I j:iûtëctad buffar areas. I I 3. Aíi areas of soii disturbance resuitiny rram d-I~ tJfoJecr snaii ùe S£âDliizea JmmeOlaCery rCllcwlng prOjeCt comple(on I or prior to permit expiration, whichever comes first. The approved methodologies are as follows: a. Stabilization of the entire disturbed area with appropriate vegetation (grasses. etc ) 4. The storage of construction equipment and materials shall be confined to within the project work site and or upland areas greater than 75 linear teet from the tidai wetland bounaary. 5. Necessary erosion control measures Le., haybales, silt fe!"!cing, etc. :!re to be ~!acac ':~ !he :1c'NnsJcpe 2dç~ ~f I any disturbed area. This sediment barrier is to be put in piace before any disturbanc!ò cf the gr'JUnd occurs and is to be maintained in good condition untii thick vegetative cover IS eStablisnea. I 6. Roof runoff shall be directed to drywells a mir.imum cf75 fast ~âr:~'·....aj::: vf~:-;a :;':a! ;~·'::~â;:C ::C;",--:~â,-j :Ci" ,.7;;"'iiecjate on-site recharge. 7. This permit does not authorize any alteration, expansion or replacement of existing septic systems. 8. This permit does not authorize any modification or expansion of the existing footprint of the house. DEC PERMIT NUMBER PAGE 4 OF 4 1-4738-02811/00001 -------" -"------------ "-~- ~ , ~ -~ ~ u ~ - ß" ~ /~ C .. n.!.,." ;;i -< ->- ~ -=~"-==- _:7 § COÑ1C ~ I p£ - , ~ ~ IJ!~'£ - , ... , l {' ì D--I~ '/1 I Jlli; I G .~rt¡ , . . Albert J. Krupski, President Town Hall James King, Vice-President 53095 Route 25 Henry Smith P.O. Box 1179 Art· F te Southold, New York 11971-0959 Ie os r Ken Poliwoda Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTH OLD Office Use Only Coastal Erosion Pennit Application .........Wetland Penn it Application ~ajor _ Minor _Waiver! Amendment/Changes V"""Received Applic . I' ~Received Fee:$ '01 v"Completed ApplicatIOn _Incomplete _ SEQRA Classification: Type I_Type II_Unlisted_ __çoo""'mtion'<......- IO\R I 9 vtAC Referral Sent: 3 I .....-oate of Inspection: 71 0 _Receipt ofCAC Report: _Lead Agency Determination: Technical Review: /Public Hearing He~ Resolution: Suffolk County Tax Map Number: 1000- propertyLocation:~?5"" ~ç t~1d (2ß CUTC~8t.UE (provide LILCO Pole #, distance to cross streets, and location) ~: ~ (Ifapplicable) rJ e Address: J} ~rP( \, ~ 'J...\"'~ Phone: J\ d . . . '. , , Board of Trustees Application Previous use of property: Intended use of property: Prior pennits/approvals for site improvements: AID PæAcr Date~ to... 'Ç;---I%'T-Aoomð,.f ~ ll>. ---1JYS OR: 'L -1.-' ' 'Lc;o t -Ør-\~F ~ ~1\;-€5~~ /1. $ , 1CkJo - Ch:1< _ No prior permits/approvals for site improvements. Has any pennitlapproval ever been revoked or sus~ by a governmental agency? _No_Yes If yes, provide explanation: Project Description (use attachments if necessary): ~(~U?-tÇ,l5Ì.rLíO i AbJe-(FLt?tQ,-=1?) , .:trJ STALL /LæJ aJ&J c t{þ¡£()} dE- C~L .. . . . . Board of Trustees Application WETLANDffRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~ l\~--o r~ flöo~ tL8AA-~ -W "2.Q;J~ AF~ T8.o -wt S~C~ t Wa~~WJJ~ W ~ pW:Jf) Area of wetlands on lot: (') square feet 114~$, 1.'1.1~¢ Jq 84- % I Percent coverage of lot: , Closest distance b:3n n~est existing structure and upland edge of wetlands: c:; feet t<AtSeP Closest distance b~est propos~cture and upland edge of wetlands: 'feet Does the project inv7vation or filling? No Yes If yes, how much material will be excavated? 0 cubic yards How much material will be filled? r¡ C'JC) cubic yards Depth of which material will be removed <€.eposit~ 3 feet M4K 1,Q +- Proposed slope throughout the area of operations: - O(!anner in Whi~~ wi~töC~~poSite9 CtJr£~T~ E" :I:f ~ :i::N ~t1J 8QLE>\ LHF STte~~ 3." ALL NI?\4iHbter HME" t'ZM\? TQ g QUe~ U U oeE1~ UJ{]6f \~ "OF Tð£ ~alL mH~ ~ :t:S tJd œl"~ vJI#f tatement of the e ect, I any, on t e wet an santI waters of the town that may result by . reason of such proposed operations (use attachments if appropriate): .1jQt-Je- - .. . . , Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity:-.MlÇ P .Id({ fTItJ ø fbu~e- Are wetlands present within 100 feet of the proposed activity? No / Yes Does the project involve excavation or filling? No ..,./" Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? I)(}ð± (cubic yards) Manner in which material will be removed O~Sited'y~I:r::....HOJS e:- ¡:S' :JW 1'1 L~l..e:-· TH\? ~-W.FE-l -:t Þt 1 ~~ ~* ~Se:P THet~, VJF f1'2a~e Tð Btw~ Qtja. Gi~ tJ(' 1ð THe:t() wI Ct. .sAN Flu.. ~ A~ISf4 DteF5Ç u.aTH 11l.~ q-=: TaP-XJlL.. Describe the nature and extent of the environmental impacts reasonably anticIpated resulting from implementation of the project as proposed. (Use attachments if necessary) -1J&I~ . J 1.4.i~... 12Itl7)- Text 12 .. . .. j P1'!OJECT I.D. NUMaE" I 617.21 SEQ Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNL/SiED ACilONS Only PARi I-PROJECi INFORMAilON lio be completed by Aoplicant or Project sponsor) I,·tð~s I 2.~~ S'~~ ä~~~IS~~~~ County 4NA~ŠtkrON r¿;ïf-j"r": 'eað~Šs. p'Ft?ir~:r t~~ ~ CU TŒð6tlJ t:? - 5. [S PROPOSED ACTION: ¿()(lnC3t10n/alleration .. o New o Exøansion 6. DíSCRIBECâ,JBRI . ~\7. ~ ~15'r; ~ A- ~ ~ iIA Sl7 ùf¡ 0éxP ~ SkrKWf rz&, œ, ~T\QJj.. FlU- ~ G{A-f') tJi (J~ Rr'<JW.ç-; t ~ ß~uJ ft..a::1O ~TlOAl, ? TED: too Initially acres Ultimately ð. V~!=IO?I'JSëD ..a.CTION COMPLY WITH ëXlSTING ZONING OR OTHER EXISTING LAND USE .~E5TR[C710NS? . Yes 0 No If No. describe briefly I 9. "ø; IS PRESENT LAND LJSë IN VICINITY OF PROJECT? o Agnculture - I I Residential O.!nausmaJ [j CùmmerClat U ParklForesuOoen ,>caee L..; Other I Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY iF=.iJERAL. STATE OM LOCAL)? ~es ONe If yes, list agency(sl and øermit/approvals S~ D..e. C, 'r 11. ø:,ES ANY ASPECT OF THE ACTIOI, HAVE A CURRENTLY VAUO PERMIT OR APPROVAL? Yes 0 No If y'!s, list aQel"lcy name and permiUapproval . SThn;; ~~. 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REOUIRE ."AODIFICAïJQN? DYes NO -.. r CEi1TIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE 70 THE 3ESï OF MY KNOWl2.iJGE ApPlicanl/spo D.,3· C). 'ld:J1 Slgnalure: / If the action is in the Cot!stal Area, and you are a state ac;ency, oompiete the ¡ Coastal Assessment Form before procaeding with this a~~essment OVER 1 . . .P~;;T ¡!-::NVIRONMENï~' . =e\tENï ,70 :::8: c:)r:-:::,e~aa :y ~çe!;c __ I. :... JCE3 AC7;C.~ ~ :"NY ,-=c::. 7MRE5~CLJ 'N -5 ,~"'c¡::¡::;. ;).:.F.¡ 5'7 'Z" it ¡as. .:ocrOLna[S :,'8 feYIp'w :roces:!I !na 'Jse :r.e ::.JL:... ~~.=- ! i:y"ls .\10 3. 'NIL~ .:.C7iCN ,;:¡,ë.·::;:::V!:: :::CRCINA7i:.~ .~EVIEW"5 ,:IFI.C·JlaE~ .::·:R UNL.S7:=::J :.::7¡CN$ iN .3 .'HÇ::::R. ;).!..;;7 -j~ ;-.57 :1 .'~O. .! .,eç:¡[:ve -:~C:2.r;:¡ I :TI~ t)e sucerse~!.130[:".er ,n"Olved açenc"f. L'(~s ~so i C. C':ULD AC7iCN .::::J,ESUL7 ,N ~NY ,J,Dve::;'SË ::::=:·:75 A$SCC:.:.ïE!J ',v\Í!-! -~Ë ,=·::>U...CWING. :AnS"Ners ·-:1ô.v:e 'anClw((:e~..f :e:;J!:h!! I C1. ::"<l5[1n9 301t ~ualltï. 3urtac~ ,Jf 'JrOL:naWafer cuaify ~r ~t..:antlty. ,'015e ;eveIS. :!x!s;lnq ::-allic :at:err.s. sOlie ...,as;e JrCGl.:c::::n Jf Jls.:c I JOlen[lal for :!fOSlon, :::ra,lnaqe or ~Ioocinq JrOOlems? S1.gla," :;!(lelly: I ¡ø ! c~ A<!slne!Jc. aC;¡rlc:Jlturat. :w::1aeologlcal, :-Its'OtlC, Jr :JItter .,a,I:.Iral :J( ctJUur:1I ~esourc~s: Jr '::Jmmunlty 'Jr .,e'<;ilccrnOOd .:::¡¡rac:~(" ~olaJn ;:: r o. .,.,,,,,"'.. ,".,". .," .,,"," " .."" ".'- ~,,'-, ....".. " -".." ., ,",~'.. "..., .".. .."" IÑð - - - Co:. A c~mmunIIY''S exisnng .::IIans or 1calS as ollle:all'f aoooteo. or a cnange in use or intensllY or use at !ano or orhe( natural resources? :xolaln :: f.1O I ~s. Glcw,n. 'ucsecuem 'eve,ocmen!. >' <o,a'eo ac:,.'Ues 'ike,y <c be ,noucec 'y '00 >,oooseo sc:oon1 =""a,n ,nettv. I C3. '-cng :erm, "nort :i!rm. ::,UTlUlauve. 'Jr <::lIner grfee:s not Identifiea in C:-C5? :XOlaln :mefly. 1'1° '::-. :t::~~ :moac:s .inc:~c:nç :~anc;es In :Jse of !llher quanllly r.lr :ype or !nerqy)? :x.:)taln =rrerly. ~Ò J. 5 ":;-S'S. OR ~RE _:<::~., CO 3E. c:::Nr~OvERS" 'E!..ATE~ CO ?OTENTlA!. A:::VSRSE SNVIRCNME.'IT;'!. .'.:P,Ç3' _ ':"es . :'10 :f ·:"e$. ~XClaln 'J(elly I , I ''''RT III-OEïE:=IMINATICN OF SiGNIFICANCE (To ~e comoleted ~y Agency) iNST¡::¡UC;-IONS: For !3C:1 adverse !tfect identified acove. Oetermine w[1etne( it is substantiaJ, large, imconam Of otMel"'Nlse SIÇ:1J fic ::3C:"l ~ifec: S:1ould ::3e ;,ssessed in connection with its (a) setting (i.e. urban or rural); (bl ;¡rooacllity of occo=wq; :,c¡ duratIon irre'¡erSlbllity; :eJ ¡Jeogracnlc ;scoce: ana (t) msgnltuce. If necessary, aOd attachmentS or :-eterence SUPDoning matertals. =:'1sure ~xClanallcns c::nraln suttic:ent aetali !o :snow that all :'e!evant adverse impactS have been identified ano adequatelY aCCressec. = C:'ec!< 'his :Jox ;f you 11ave identiiieo one or ¡TIore ;Jotemially large or signijicant ac:::'¡ersa :mo2c:s ·....mc;) ',1..:''':' .LcC:'.Jr. Then :Jrcceea direc:Jy to ~ne FULL ::AF anOlor preoare a positive- decara~icn. -..: C:-:ecx :his ::OX :f you have de!ermined, :Jased on the information and analysis above and any s¡jCOO(~;;"":;: cOC:J~en(a(cn. :hai ~he :Jraoosea ac:ion '.VILL ~~OT result in~ny significant acverse -anvlrcnmen:::! :mcac:: AND Jrcvlce ·::n :3.;:;:ac:1ments as necessary. the reasons SUDcorting [his determination: i ",...,... <'II .o:..u "'=~"C" Jo,n{ )f .Ct: ""..m.. )1 ~"'won\,O't: "';II,CO:( n ;'':010 .....I.""c·, :.11.: ~I -<""oon~'OIt: 0rl'c~' ;""..ILlf!;! )f .(~'CO""OII!' ·~r:'Co?t·A .c:'.tO ....¡;t:"cv )."nd:U/~ }I r'.·~-:JJ.ft:' ·rr ":":t:.~,.,{ :ram ·...~oon''')... )I'·c~rl - ,J..I!;! ~ " . . . . .. . Board of Trustees Application County of Suffolk State of New York _~ßeT~ ~uTg{ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMlT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF IDSlHER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN TIllS 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 PERMlT(S), IF GRANTED. IN COMPLETING TIllS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF TIllS APPLICATION. o#~re Jd!J SWORN TO BEFORE ME TIllS /~ DAY OF M(}J~ 200 { '- ~cu-6tVuo- h¡f(~L Notary Public WOTA IlARIWIA McC!'_ - -~ . RV PUBliC, Stale of NewTCIIII No. 4988983 Oua!t¡ioo ill SuftOik Couftty Commlosion ExpiJæ Nov. 25, ~ · '. . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: L'{ tJr-J -:t F1I3WK ~ú2QNe 40 1- e--A-ST 10 'f.}¡ ~"'f: t-JC( j NIf lQO{1 \S'A-NE?r G'OU' -:res" FlS~ ~BIlC« «J), OJ ICH06î 1.18, N I.f CMoLI/N * ~(M ~ef 4}-'l1 øŒJ.JNuJ~() S~· L\ TTL~ ..JccK1 N.'1. I ~b5 ~:, ( .'..1 STATE OF NEW YORK COUNTY OF SUFFOLK \~~~reSiding at ~dUIY sw~~~,deposes and says that on the -::::¡.. day of 'iD~, 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¡ tha~s ~e mailed at the United States Post Office at , that said Notices were mailed to each of said pers ns by (certified) (regiotered) _11. MlId ~ Sworn to Þ.øfore me this /.5 day of ¡v{O/cÅ ,!9-- ()DO I 0WOAJ;- h ~uL Notary Public IlARBARA McCARfIC'( 'faIk NGl'AR'( PUBLIC. StaIB 01 ~ No 4·~8983 Quahr,od in Suttolk ~o I i Coøomi&E;nq expirœ Nav.. j Albert J. Krupski, President . . Town Hall James King, Vice-President . 53095 Route 25 Henry Smith P.O. Box 1179 Artie Foster Southold, New York 11971-0959 Ken Poliwoda 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 _~~t~~_((__________________ COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I,~ .s-~esiding at ViA t:JB"S~ur AJfi, , Gù0IÍÌLle- being duly sworn, depose and say: That on the l Cf da ~ property known as by placing the Boar 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 ~~dlb~ng, Date of hearing noted thereon to be held ~~I~/~' 1;0:> OW"t. Dated: Sworn to b~ this ¿;¡ ~ day 0 200/ - No y P b ic A IG-/J/LA. IJI/¡Gk(IAhi /Jot,., p)ÞI(~/.sr-,.k~»w ýo-J. (il,...p. --....~I/rml. ~o. No. óa.wr'110 '/- 287/ C()"'rfJ/~.$Ið...J ¡;"f'/~ 9/3ð/O¡ .' . . . , NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: _~~l"1"Ë" SlTT"e~ SCTMiHOOO- W-Ol:3o YOU ARE HEREBY GIVEN NOTICE: 1- That it is the intention of the undersigned to request a ~~~1ji~~d ~¡:fJ: ~JJ~~~f of cL.eAtJ Fl~~ 2, That the property which is the subject of Environmental Review-is located adja~t t~ur ~erty and is described as s~~~~~~;i~~~e~L_ ~.4'- ~-r ~ cJ'P'îc<t ~~I~t:Ç -u1!-rö pJS)~~~«~ð , tiåt ~ prOject~i~ iS~U jec to nv~htal Review under Chap~or 97 of the Town Code is open to public comment on -~ You may contact the Trustees Office at 765-1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: ~ T~ &m:l. MAl I DDRE~ ' - Enc.: copy of sketch or plan showing proposal for your convenience. ]. S . .. . . Print or Type: TOWN OF SOUTHOLD HIGHWAY DEPARTMENT Offi·ce use only PECONIC LANE File #: PECONIC, NEW YORK 11958 Permit #: PERMIT & BOND APPLICATION FOR ACCESS THROUGH TOWN OWNED PROPERTY 1) ~ SUmG tJ. 'L:J ~q9t (Name of Applicant) (Address) .d. 2) t..W~\l!=? (Q)JS1ØJCfJOt.!)~ ~H Ñ~ I q;~ (Name & Address of Contracto Involved) 3) fAJ5S~ : 1000-0t -~ - (Project Location) . (S.C.T.M. #) 4) J..{4~ UlA:'fQ'2J r<o : (t1TL~&- (Name of Road or Town Property Involved) (Hamlet) 5) J.LE.:r ~ ~~ (Brief Job Description) 6) ,..ct,". oa..~ C§l'C" oata;!7ILL 1.Oðl 7) Est i mat ed Cost of Proposed Work: ,O(J(J 8) Insurance Coverage: A. The coverage required to be extended to the Town: Bodily injury & Property Damage; B. $300,000/$500,000 BAiJ. Injury & $50,000 Property Damage Insurance Company: ~ cS~ C. Insurance Agent 5. 1q. Name & Te 1 ephone # : - '2>J D. POlicy # {]O IQS1-0801- 01 E. State whether policy or certification is on file with the Highway Department: ( yes/e- (If no, Provide a copy with Application) .~ (Dat e) ------------------------------------------------------------------ To be completed by the Superintendent of Highways: Bond Amount Required: (Signature) ru .-'t fTl fTl or Jl or <0 Postage $ 0.50 Certified Fee fTl CJ CJ CJ Return Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) CJ CJ or fTl . Total Postage & Fees $ -::/:~:;~:;-:w~-----_::~~-=~~~-------------------------.-- n- n- CJ ['- -Ciiy,-siiiti,'l(pi.T--- ru <0 ru fTl or Jl or <0 . Certified Fee Postage 1.90 1.50 3.95 CJ CJ or fTl Total Postage & Fees $ Name (PIesse Print Clearly' b~~ mailer) -Simet:-;,p-t:-No.;-or-P(j"So;-No.------------.- . 11365 0.76 1.90 1.50 4.16 CJ CJ or fTl Totel Postage & Fees $ Name (Pl=~~_~~~~_~~~~?;.__;l~:~.~.~i:~~,:. 'sii8er'Apl. No.; or PO Box, No ~--;;;--1 fTl CJ CJ CJ Return Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) n- n- CJ ['- "Ci;y:siiie,.l(P+4..------ .-'t Ul ru fTl or Jl or <0 Postage $ Certified Fee fTl CJ CJ CJ Return Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) n- n- CJ ['- -tiry,-siiiti,'l/pi.;i--' -. . APPLtCAN't . TRANSACTIONAL DISCLOSURE FORH The Town of Southold's Code of gthic8 prohibits c~ntlicts at 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. TOUR NAHEI ! ':'>\:~t ~::,t/~'~,..~i~~>.~ Last name, rirst name, m dd~e 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 OV APPLICATION! (Check all that apply.) .:: ;:,~ ~.;:~-:.;:~,; ,:;:::::' 'i~~ Tax grievance Variance Change of zone Ap'p~~al of plat . Exe~ption from Pl~r orcicial map other I =r:@J5 ~ (If "other," name the activity.) ~--S . .. Do you personally (or through your COMpany; spouRe, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? -Relationship- includee by blood, .arriage, or business ioterest. -Dusiness interest- .eans a business, including a partnership; in which the town officer or employee has even a partial ownership of (or employment by) a corp,oration in which the town officer or employee owns more than 5% of the shares. YES NO ~ ~; :,~.' ,. If you answered MTES,-, complete the baiance of ~bi~ form and date aod sign vhere indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself (the applicant) and the town officer 0r employee. Either cheCk the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply). A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation), _____B) the legal or beneficial owner of any interest in a noncorporate'entity (when the applicant is not a corporation), _____c) an Officer, director, partner, ~r empl~yee ot the applicant, or _____D) the actual applicant. DESCRIPTION OF nEL^TIONSlltP .. .. , """"1 '," .~ c. .. .' , '-., ...... ,'.,C ".- ,...'~.' ~.....1';".. d' , f, '" " ...".. Subm!. Hed signatllre 'print , ."v.; ., ;':l.f.-'..~ " ,.,'~~Oi.;-.J '-"' . STANDARD PROPERTY POLICY ISSUED ON BEHAA MEMBER INSURANCE COMPANIES OF NEW YORK PROPERTY INSURANCE UNDERWRITING ASSOCIATION 100 WILLIAM STRB!!, , Nl1W YORK, NEW YORK 10038-4599 70 1* 112 ENDDRSEMENT- CONDITIONS UF POlley ARE R~VIStD TO Rt~D AS FOlLO~5 ~ve Date TeRn I expiration Dele I -Tal1ft' Number Policy Number Uc14-01 10 DAYS 02-24-01 520-2210811<:i 0010570861 EFFECTIVE 12:01 AM (STANDARD TIME) TO EXPIRATION 12:01 AM (STANDARD TIME) AT THE DESCRIBED LOCATION OF PROPERTY COVERED, 01 I INSURED PRODUCER 2-tl62b41:1 BOBE TTE " Su TE R PO 80X 1109 QUOGUE "y 1195<J-1709 UUNAlD STRIPLIN ell.. ALLSTATE Jo9 MAIN 51 eE"ltR MCRleHtS ~y 11934-3510 ff\!lI!ljIQU I:, 'AIolfJWT RATE ~ DEDUCTIBLE PREMIUM CO\IEReO CAUSE(S)'OF LOSS AND COVERAGES 1 100000 250 2119.00 f I Rt & LIGHT"ING -ELILOING )(XXXXXX 250 1l4.00 t;x TENDED COVERAGE -BUllOI"G X)()(XXXX 250 13.00 VANDAL ISM -BUllOI"" !iI:':.:h ~;ANDL.OqAnON-OF PROPERTY COVERED -------- TOTAL FRAME OWNER OCCUPIEU $ 41b.00 PREMIUM .0.00 DWElLl NG NOT CVER TWO fAM Illl:S 0.00 N.Y. FIRE FEE 0.00 855 fISHERMANS BEACH ROAD " "" DEDUCTIBLE CHARGE eUTCHOGUE NY 11935 41b.00 TOTAL $0.00 1 BUILDING Subject to DP 0001 7-88 Form No.(s) UA-531:1 1-97 First Mortgagee or l.oss Payee as applicable Second Mortgagee or Loss Payee as applicable DATE 02-15-01 E DEe ~J-&t1. AUTHORIZED REPRESENTATIVE --- -J8(RfV 5196) IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. ' L I NEW YORK PROPERTY INSURANCE UNDERWRITING ASSOCIATION P.O. BOX 2325. NEW YORK. NY 10272-2325. (212) 208.9700 NOTICE OF PflEMIUM DUE INSURED CCPY THIS IS NOT A dILL