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HomeMy WebLinkAboutTR-5841 r Board Of Southold Town Trustees SOUTHOLD, NEW YORK ` ^ DATE ... i� PERMIT NO. Dec.. 17, 2003 . .. .... Y - A. SAMPIERI ISSUEDTO .............JOHN...............J...........&........J.OYCE._.....-........................... ................._._..---.__...... ,�utf�nri�tttinn . Pursuant to the provisions of Chapter 615 of the Laws of I the State of New York, 1893; and Chapter 404 of the Laws of the t State of New York 1952; and the Southold Town Ordinance en- fitted "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 ..Dec. 17, { 2003 and in consideration of the sum of ;....._?00-00....- paid by I t .......John...J......k..Joyce_.A.._Sampiexi....................................... ................... .__ of .........Cutchogue-.........................._..__....._......._. N. Y. and subject to the Terns and Conditions Fisted on the reverse side hereof, of Southold Town Trustees authoress and permits the folowing: t g' Wetland Permit to construct first -and partial second-story 1. additions to the existing one-story residence and construct a x - ; 3.5 car garage at the easterly end of the property, and as x depicted on the site plan prepared. by Busch Associates- al in accordance with the detailed specifications as presented in the originating application. dated November 20, 2003. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these ppresents to be subscribed by a majority of the said Board as of this date. crs s Trustees TERMS and CONDITIONS Pertittee JOHN J. & JOYCE A. SAMPIERI The1380 Bayberry Rd. , Cutchogue, NY N. Y as residing rt at to the fol- pa of the eomidemtioa for the issuance of the Permit does understand and Prescribe lowing: 1. Thar the said Board of Trustees and the Town of Southold ate released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any opa- ation performed pursuant to this Permit, and the said Permittee will, at his or her own cxPwse, defend any and all. such mits-initiated by third parties, and the said Permittee assvma full liability with respect thereto, to the Complete exclusion of the Board of Trustees of the Town of Southold 2. That this Permit is valid for a period of 24 mos. which is considered to be the estimated time required to complete the work involved, but should circumstances wxraot, te9uest for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permttee wishes ro melanin the structure or project involved, to provide evidence toanyone concerned that auth- orization was originally obtained 4. That the work involved will be subject to the inspection and approval of the Board oc its agents, and non-nomplianoc with the provisions of the originating application- may be cause fot revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the wort herein atithorized. G. That there shall be no interference with the right of the public to pass and repass alomg the beach between high and low water marks, 7. That if future operations of the Town of Southold require the removal and/or altetxtiotts in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the. work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work or project herein anted without expenses to the Town of Southold 8. That the said Board will be notified by the Permittee of the completion.of the work auth- orized. 9. That the Permittee will obtain all other permits and consents that may be required sup- plemental to this permit which may be subject to revoke upon failure to obtain same. • � • Albert J. Krupski,President 1fF0(,�C Town Hall James King,Vice-President I`t� Ty� 53095 Route 25 Artie Foster P.O.Box 1179 Ken Poliwoda W Southold,New York 11971-0959 Peggy A.Dickerson �f� � Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 17, 2003 J. Kevin McLaughlin, Esq. Winds Way Professional Center 44210 Route 48 P.O. Box 1210 Southold, NY 11971 RE: JOHN J. & JOYCE A. SAMPIERI 1380 BAYBERRY RD., CUTCHOGUE SCTM#118-2-12 Dear Mr. McLaughlin: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, December 17, 2003 regarding the above matter: WHEREAS, J. Kevin McLaughlin, Esq. on behalf of JOHN & JOYCE SAMPIERI applied to the Southold Town Trustees for a permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated November 25, 2003, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on December 17, 2003, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, 2 WHEREAS, the structure complies with the standards set forth in Chapter 97 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of JOHN J. &JOYCE A. SAMPIERI to construct first and partial second-story additions to the existing one-story residence and construct a 3.5 car garage at the easterly end of the property, and as depicted on the site plan prepared by Busch Associates dated November 20, 2003. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$5.00 per inspection. (See attached schedule.) Fees: $5.00 Very truly yours, it �. �► . Albert J. Krupski, Jr. President, Board of Trustees AJK/Ims 1. KEVIN MCIAUGNLIN Attorney At Law Winds Way Professional Center 44210 Rt.48,P.O.Box 1210 Southold New York 11971 Telephone(631)765-6085 Facsimile(631)765-1856 December 22, 2003 Board of Town Trustees Feather Hill Complex Southold, NY 11971 Re: Application of John & Joyce Sampieri Premises: 1380 Bayberry Road, Cutchogue, NY Gentlemen: I have enclosed my check in the sum of$5.00 in payment of the inspection fee in the above-referenced matter. Ve 1I ul s, Enc. Hand Delivered -4 w Dace-J o 041808 Received FromUl jt) ( C Nine D 2 O r rn Address f— Z o Dollars$ )3 0 l 0 U-! For H O o a LL X o Z c In p y • • r AM' OF Q m ACCOUM CASH 1g O m AMT PAID CHECK RALANDE MDNEV DRDER B /1 !711 (yA"d DUE CREDIT CARD y Albert J. Krupski,President • -p%3FF0jjt • Town Hall James King,Vice-President �� �G 53095 Main Road Henry Smith y� P.O.Box 1179 Artie Foster y Z Southold,New York 11971 Ken Poliwoda %p • 'F Telephone(516) 765-1892 Fax(516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO:- )1���40] fLL �rdf� hl�Lo � 1 Please be advised that your application, dated IIjaS (u3 has bggen reviewed by this Board, at the regular meeting of IdIIr7 �03 and the following action was taken: ( ✓) Application Approved (see below) ( ) Application Denied (see below) ( ) Application Tabled (see below) If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees . The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: ��. OD l(4D�1FCttC�sl TOTAL FEES DUE: ,/$ SIGNED: PRESIDENT, /BOARD OF TRUSTEES BY: (�� n L n 4 CL�k 14, CLERK, BOARD OF TRUSTEES 4/98 m W (yR Q PROPOSED 250 CIF CAPACITY STORM WATER LEACHING BASIN. CONNECT TO ALL ROOF GUTTERS E LEADERS '3 o PROPOSED SINGLE STORY, 3 Y2 CAR GARAGE: REMOVE +/- 65 CU.YD. 12' 1 ' 14' PROPOSED ASPHALT DRIVEWAY 15, PROPERTY LINE IE co 12 Oq j /13'♦7 � g^ /•' • 1 V SET BACK LINE I, I I f � � D � . . , l b' PROPOSED ONE STORY T,/ AUDITION WITH BASEMENT: OT 'ig � 20' REMOVE +/- 262 GU, YD. 4ij ( If !, or EXISTING SINGLE STOR V yr s PORTION OF DWELLIN m TO BE REMOVED. o ul EXISTING ' g �3. LOT BOAT SHED 44 / o TO REMAIN ' V� 0 / fV v ll m 141 27' 4 " / EXISTING ASPHALT DRIVEWAY f TO REMAIN + EXISTING NEIGHBORING GREENHOUSE PROPOSED 720 CIF CAPACITY STORM t WATER LEACHWG BASIN CONNECT TO ALL ROOF GUTTERS < LEADERS fit. REMOVE EXISTING FRONT DECK t REPLACE WfTH NEW NEIGHBORING DWELLING ti T-II�" EXISTING SHED AND CONC.TO BE REMOVED PAD �y ONE STORY ADDITION Omsk EXISTING @? % ' ONE STOONE STORYNS.DWELLING WITH PROPOSED x EXISTING DECK TO REMAIN [� PROPOSED LOCATION OF NAY MALES W - EXISTING DECK AND PATH EXISTING BULKHEAD EXISTING DOCK a N y m y w SITE PLAN a', `°' o SCALE:o N.T.S. rr �o T>re ABOVE arts PLAN PnOPos,u IS /��� LOT . AmoITAL Tft' t" aop,NE PROJECT: StiV1PIE v 8OT euwvEr,LAST R�'ISm DATA 80P'IstAaeR2s.zoact,Aswrouuoey032001-R22 v IK PscompC B V�YORB,P.C. B m LOT AREA=44,615 80}T. OA NO. ISSUE/REYtSION m 1.02 AC. BOAR OF 1RUSTEE3 SUSMISSIQN DATE nl LOTC�ERAOE=l2.476 3 ZONIYGgpgRp ylEW 1112iUp3 © x'ONEr R-40 REVISED SCOPE 1 co SCALE. 1'=40'-& DWG No. ' WEST FOAINSPHT m DATE:AUGUST 30, 2004 1380AYBERRYROAA+�PIERIBAY A O SF-1 CUTCHoGUE, kv 11935 ORWN. 6Y.:AS S.C.T.M.: 10Dp.118 -02.12 ••• 12/10/03 Field Inspection • • 12/10/03 Field Inspection 1 � a: ..ow ..mow-. i I 011`04e 40 Town Hall Telephone y ac, 53095 Route 25 (631)765-1992 0_1 � P.O.Box 1179 Southold,New York 1197"959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Monday, December 8, 2003, the following recommendation was made: Moved by Don Wilder, seconded by Tom Schlichter, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A STIPULATION of the Wetland Permit application of JOHN & JOYCE SAMPIERI to construct first and partial second-story additions to the existing one-story residence and construct a 3.5 car garage at the easterly end of the property. Located: 1380 Bayberry Rd., Cutchogue. SCTM#118-2-12 The CAC recommends Approval of the application with the Stipulation all excavation is moved away from the water. Vote of Council: Ayes: All Motion Carried I 91 {a i rc!� (l�E J, o x qq a Y 1 ai III!III 1 a !r 1'itt� 0iii 1 3 li! illii iT __ 1!l_ �_ FIT"T1[m!IIffullT[fi f[II1J111T[[fTi111! 1111[�Tii1T�i�lilT[II111I111111 - g i Pell 30/299d 1_d: 49 6,31954795E BUGCH PAGE 02 N PROPOSED LEACHING CF CAPACITY CT TO / I N WATER LEACHING BASIN, CONNECT TO r ro ALL ROOF GVTTER9 • LEADERS PROPOSED SINGLE STORY, S 15 CA GARAGE, REMOVE +/- GE CU.7o, 12. 14, i e'Imo\ PROPOSED ASPHALT DRIVEWAT li' 2' c• 50' m R' PROPERTY LINE i.•�O a W Lil�� _ t t� !� Or � SET BACK LINE PROPOSED ON ADDITION WIT" SASEMENT,— OT '1q W, MOV REE r/- 2i2 CV. TD. _.yb/ EXISTING SINGLE 9TOR PORTION OF DW[LLIN TO BE REMOVED. EXISTING •_T , LOT II0 '�p1 BOAT , SE TO REMAIN 1 i4 2 • �TO EXISRETIMNG DRIVEWAY EXISTING NEIGNSORING LOT 117 PROPOSED 720 CFF CAPACITY rRMACITY STORM 9� WATER LEACHING BASIN. CONNECT TO ALL ROOF GUTTERS i LEADER5 REPIOyE EXISTING FRONT DECK REPLACE NTN NEW 8 S i 2• NEIG4BORING DWELLING � 1 ✓(\�\ IS 7'-11j' 701 BE REMOVlD NO CONC. PAD \`` \ ONE STORY ADDITION �r �i-y'y id ONE EXISTING STORYONE STORY DWELLING WIT" PROPOSED ADDITION•'. EXISTING DECK TO REMAIN PROPOSED LOCATION OF NAY BALES {��7 EXISTING DECK AND PATH D EXISTING BULKNEAO ll EXISTING DOCK I { A Ic o So AMP , BoarA�E4a9la��. PROJECT, SAMPIERI RESIDENCE L RR•aanAL R•.u[wer 1NE ax wR.�K wtRs"I[EE en �, •a ays..y rweellees E037001-R22 � a"alar•OIIa P4 NO. LOT M[A.4.,E1s a10.T.aw ISSV"EVI$ION DATE 1.0E AD. 1 T TER$ EMISSION 11 LOr OQVERV10E.1i.4% = AD RENEW[ON!laiip 7 RENEE iL1 $DSOOPE UP BOAR: 1•«aD'ery DwO N0. MR.«MR$.JONN SAMPIERI OATi:AUGUST 00.2904 S`P_.� 1380 S OOUE,RNY ROAD A S 0.1WN.R.eaEl S.C.T.M.;1000-11S.D2-14 0cI/30/2004 14:40 6319697956 BUSCH PAGE 02 WA OPOINFO ACW50 C�A.CAPACCITY STORM I r M ALL RODE GUTTERS 4 LEAD[RS / I V• PROPOSED SINGLE STORY, 315 CA GARAGE, REMOVE CU, 12. e J1 PROPOSED ASPHALT DRIVEWAY K' E• Cla sco 70 \ aR \la PROPERTY LINE Oro a ' N , ; I , I A or I'•` O D I t � SET SACK LILAC 0PROPOSED r ADDITIONWIITT4 SAsEMEl,IT�STORY aT I19 REMOVE N- EEa Cu. YO. � EXISTING SINGLE STOR N or DWELL ,/ •/ O To Be TO Ril'gVED. / • EXISTING _ LOT ttB MO a BOAT SHED TO REMAIN !P 11• • a r E - /' • TO REMAIN IVEWAY "e EXISTING, XI ` LOT 117 PROPOSED Tw CP CAOAcm STORM WATER LEACNING SASIN. CONNECT TO I ALL ROOF GUTTERS 4LxApVt5 b REMOVE EXISTING FRONT DECK 414 ` r ~ REPLACE WITH NPiv a{ \ / NEIGIbORING DWELLING Ii. EXISTING SHED AND CONC. PAD MO TO SE REVED '\ ONE STORY ADDITION EXISTING ONE STORY DWELLING WITM PROPOSED ONE STORY ADDITIONS. EXISTING DECK TO REMAIN PROPOSED LOCATION OP NAY SALES EXISTING DECK MO PATH EXISTING SULKMEAD EXISTING DOCK N SITE PLAN SCALE, N.T.S. «..�A.".R"'L,: R„+r PROJECT: SAMPIERI RESIDENCE 00320014M R. «IRgN1p P1RRRY.RP,PA NO. IBGUNRE�ISXO LOT AREA.4 . @IEOPT.OR DATE _ 1.01 AD. 1 come m.AQ /i.a4 E BLADED EGE `E�R� ScAIL• 1-.q-W D��' 13SO SAYtl �ERI DATl ALIQUOT aD.EDOS SP-'1 C�tt a 4 ' S.C.TA1.:100F11SO242 ee 30/20041 14:40 6319697956 BUSCH PAGE 02 l PROPOSED 2E0 CP CAPACITY STORM WATER LEACHING SATIN, CONNECT TO r y ALL ROOF GUTT[Re 0 LEADERS PROPOSED SINGLE STORY. S CA"RAGE, GARAGE. REI'IOV' #h iS CU.YO. 12. J1 J m 1/' \ ,Ir, p I, PROPOSED ASPHALT DRIVEWAY IS' M Cl w IW w i \ Y O1a PROPERTY LINE a, ' M v �` I I. o /No SETBACK LINE PROPOSED ONE STORY OT mat ADDITION WITH EASEMENT. REI'IOVE -/- TSG CU. YO. EXISTING SINGLE STOR PDRTION OP OWELLI r r TO � r EE RR70Vro, / r / y I` METING _ LOT its BOAT OHIO TO REIMAN r V EXISTING ASPNALT DRIVEWAY 14' r TO REMAIN a 12' `�� RISTE AGLIEOwNG .� E - r�� LOT 117 -.�. pwoNATO ONI CP uIN. CO STORM r� rj tli.N'I WATER LF Gvrra BASIN.L CONNECT TO I ROOF dJT'fLRs S LEADGSB ALL \ SIBS . REMOVE EXISTING FRONT DECK S _S. �fr REPLACE WiTM NEW i -E• \ , ~�'��-NEIGLb01[ING DWELLING TI�11�. EXISTING 9NID AND CONIC. PAD TO e[ RVW.'ED \ r� ONE STORY ADDITION tr EXISTING ONE STORY DWELLING MITN PROPOSED ONE STORY ADDITIONS, - EXISTING DICK TO REMAIN PROPOSED LOCATION OF NAY DALES EXISTING DECK AND PATH /� I� {�/� r� IXISTING BULKMEAD D r II_ I} ,+1/ I} EXISTING DOCK l 11 __V E ll LS 51TE PLAN f al '1ur?n Board of Trustees E � SAMPIERI RESIDENCE F P�AMA�111MOIF••A NO.LOT ARRA.AI.SIS MPS.on SR IEBLIEIREMON DATE _ IAE AO. 1 EONER.aOE TLAS S RNyFp dcAm OM No. MURACAT[ AYpyOT i0.i00 aR Sf-1 CI rmvf P1Ul F•• S.C.TL1.:1000.71S42-72 suFFoc� Albert J. Krupski, President 0�� CD Town Hall James King,Vice-President Gy 53095 Route 25 Artie Foster O P.O.Box 1179 Ken Poliwoda CODSouthold, New York 11971-0959 O Peggy A. Dickerson ifr Telephone(631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD APPLICATION FOR AN AMENDME D &E*IITV AUGED DATE August 30 2004 Southold Town Board of Trustees John J. Sampieri & OWNER Joyca A- Sampirri PHONE (516) 741-5693 ADDRESS Ill Cherry Valley Avenue, M-19, Garden City. NY 11530 AGENTJ. Kevin McLaughlin, Esq. PHONE (631) 765-6085 Winds Way Professional Center, 44210 Rt. 48, P.O. Box 1210 ADDRESS Southold, NY 11971 PROPERTY LOCATION 1380 Bayberry Road, Cutchogue, NY 11935 TAX MAP NO. 1000-118.00-02.00-012.000 IlWeJ. kevin McLaughlin, as agentrequest an Amendment to Permit# 5841 pursuant to attached revised Site Plan for a one-story addition to the existing one-family residence. Cd / � Signed J J. Ke in McLaughlin 1.KEVIN MCLAUCNLIN Attorney At Law Winds Way Professional Center 44210 Rt.48,P.O.Box 1210 Southold,New York 11971 Telephone(631)765-6085 Facsimile(631)765-1856 September 21, 2004 Southold Town Board of Trustees Town Hall Annex Main Road Southold, NY 11971 Re: Amendment Application of John & Joyce Sampieri Gentlemen: I have enclosed the signed Affidavit of Posting, along with three (3) domestic return receipts from adjacent property owners. Very tr y yo rs, J. Ke M i Encs. c 0 gUFFO(,� Albert J. Krupski, President �� C� Town Hall James King, Vice-President .. Gy 53095 Route 25 Artie Foster p P.O. Box 1179 Ken Poliwoda W Southold, New York 11971-0959 Peggy A. Dickerson Oy'� O�� 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 �_Dhrh----i_, c_-sa-pcaK------- COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING 1, J. Kevin McLaughlin residing at 680 Old Orchard Lane, East Marion, NY 11939 being duly sworn, depose and say: That on the 9thday ofSeptembe,r2004, I personally posted the property known as 1380 Bayberry Road CutrhDoup Ny (crTM N100O 116 }2) by placing the Board of Trustees o fficial poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held wo. Q . n Wh• Dated: September d/ , 2004 (signat J. Kevin McLaughlin Sworn to before me this �94dayof Sept200 4 Notary Public GNDA.J. COOPER Notary Public,State of NewyOrk T^� , �P?2F63,Suffolk County .. 3s,,"S:esLrece�nberst•�pUL 1003 16: 51 6741569393 JSAMPIERI PAGE 01 �L+: ..'JV{ 1V. L6 JJ1:OJ1 !r hLO LVMR.�HUR1,'1L 11V PMV6 VL boayd of Tnoteee Mpucation I. AVMO=ZATTOU i (where the appliCaat is not the owner) I ace A. 4 residing at ill Cherr lelley Avenue, Apo a *,as r ppr nt owner o propert�'�� do hereby authariae J• Kev1n_MGLiy9hlin (Agent) to apply for permit(s) from the Southold Board of Tam Trustees oa my behalf. a• P or gnature I I i i i i i II II I I i 9 i NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: J. Kevin McLaughlin, as agent for John J. & Joyce A. Sampieri SCTM# 1000-118.00-02.00-012.Onn YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: amend Southold Town Trustees Wetland Permit No. 5841 pursuant to the attached revised Site Plan. 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 1380 Bayberry Road, Cutchogue, NY 11935 SCTM No. 1000-118.00-02.00-012.000 3. That the project which is subject to Environmental Review under Chapters 32, 37, and/or 97 of the Town Code is open to public comment on: September 22, 2004 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 NA M: John J. Sampieri & Joyce A. Sampieri MAILING ADDRESS: c/o J. Kevin McLaughlin, Esq. , P.O. Box 1210, Snuthold, NV 11Q71 PHONE#: (631) 765-6085 Enc: Copy of sketch or plan showing proposal for your convenience. :4 Ln Ln Er M 'r Nli ym, if I,w" [I- Aiat iY ]j 6. A U, we 4 Ln Post toe (1.37 D: 0971 Ln Postage $ 0.37 UNIT ID: 0971 C3 Certified Fee:ee 2. C3 2.30 C3 C3 Return R.d.ot Fee a". C3 Re unn Redein -ee .37 S(I B-71 an" (Endurs!vn.rQ R.cuusd) C3 (Ento.,sorrent Required) 1.75 He. 0 Pentrided�).W&y Gee W C3 Rest=ed Delivery Fee CI 60 M (Endorsement Requited) -4 M (Endorsomant Required) 14 E3 M ru Total Postage&Fees $ 4. 31/ ru Total Postage&Fees $ 4.42 08/31/04 ('11 - ru C3 Ten 11 e 17=11 es"',r4l z 6,L'4A t 1 C3 l" Ap: ------- r- ub'sof,-Awl.Na.;--------------- L43-5-&.6'7 lqB orPOLIourno. �2 or PO B.No. City,State,ZI P+4 PS Form 3800,June 2002 See Reverse for InstairtiOnS ff�=`IceT. U.S. Postal Serviciew I 0 ff��AILM RECEIPT CERTIFIED MAIL,. RECEIPT :. �# C:3 ' Er jjj�; .o Insurance Coverage Provided) r3 (Domestic man only;No insurance Coverage Provided) M For delivery information Visit our evelosite at vvvvvv.uspsxorn� Er, 31 SIT7 Or e" I A L U Ln Postage $ 0.37 LINIT Ul Postage $ 0.37 D: 0971 C3 Certified Fee M Ceffed Fee E:3 2.30 tark 1-3 2. 13 Return Rectept Fee re C3 (Endorsement Required) ne 1-3 RetunnRedept Fee (Endonswrent Required) JOXW Restricted Delivery Fee rk: M R Fee C K M (Endorsement Required) M M (Endorsementred) 08/3 ru Total Postage&Fees $ 4.42 /W ru Total Postage&Fees A- ru 01 I C3 Sent To C3 �Ionl TO L_'44�O K,'5 OAz, r'j M (V� ---------------------------------- -------- ---------------- ---------------------- r- '*atWt NO.; orPO8ox/Vo.___(_m�_G %,JLDttc�,-kmvY\ orPOiloxNo. -aw.93"a-sklie-lek J� City,SfateZIP.4 ----------.......q ...... Gify�State,ZIR+4 1002 See Reverse for In,troetione, PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: Richard & Jane E. Downing 1280 Bayberry Road, Cutchogue, NY 11935 SCTM #1000-118.0042.00-010.000 Myron & Julia M. Matlaw 43 W. 93rd Street, #14, New York, NY 10025 SCTM #1000-118.00-02.00-013.000 Lizabeth & Jennifer J. Burrell 435 E. 57th Street, #14B, New York, NY 10022 SCTM #1000-118.00-02.00-011 .004 Eleanor S. Nohe & ors, as Trustees 136 wickham Road, Garden City, NY 11530 SCTM #1000-118.00-03.00-009.000 STATE OF NEW YORK COUNTY OF SUFFOLK J. Kevin McLaughlin residinget 680 Old Orchard Lane East Marion, NY 11939 being duly sworn,deposes and says that on the s t y of August 2004.deponent mailed a true copy of the Notice set forth_in the Board of Trustees Application,directed to each of the above named persons at the addresses set opposite there respective names;that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at Southol d NY ,that said Noti ai o of said persons by (certified)(klf&Ww#mail. J. Ke i McLaughlin Sworn to before me this Day of&,,. 20_00 Notary Public LYNDA M.BOHN NOTARY No.078OState of�� Oualified in Suffolk County Term Expires March 8,20 QJ f„ j/2004 14:40 6319697956 BUSCH PAGE 02 A u HArlPROPWlt EpA 1-0 CF DTORM ALL ROOr GIITYERS 1 Lam[ DERSS / 1 rRD1'OE[D�[ STIXIT. v, U R R W, rJ' JI m0 \ A rROROe{D ADrNALT ORIVEMAT 16' IF � Y \ 10 PROPERTY LINE Iro . D, 1 N I`� I � N [ET D{CR LINEPWAWOSW TyE $ OT 119 EXIST1Ns SINGLE [TOR / • / ��((, / �P ra1Tlw or OMtLL . A TO et RE*70VCo. / y GOAT ' LOT 119 /'/ TO RRwN ' p` t 14C \ EXIDTEIS AGP ALT DRNENAY �TO REMAIN ING LOT 117 PROPOSED ► O 1S Cr S STORM NATO LWACWNG BASIN. CONNECT TOALL ROW 6yTT[Ry t LEAypIp IREPLACEDOiTINO FRONT D[aL 1 1 \ TN NDW ` { -r \ . ' ~'�NtKilORINS DWELLING r.11i EXIDTt" D11ED AND CHIC. PAD TO DE Rlp: '\ ONE STORY ADDMTIGN ' [ STORY DWELLING NITN F'IW [p ID[ ONE STORY ADDITION►. E%ILTING DICK TO REMAIN .�n PROPOSED LOCATION Dr WT !A E � � � U D EXISTING DECK AND ►ATH II`VSS EXIDTMG WAXWEAD I . EXISTING DGac AUG %n,04 Southold Town o s [CAL[- N.T.S. PROJEC 3AMPIERI RESIDENCE 'r�wMl rt wAs09.112W9402 LOY ARRA-4 , g o WV.0R NO. EYMpN DATE IAt AO. ComO R�o1A0[.1[.11t 7 R •d1LEt 1-.dv Gw DVJG N0. oATl AYOyeT SO.[00{ SP-.1' C�ii%� �' S.C.TA 41000.11SM-12 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and emplovees.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. YOURNAME: t Kevin McLaughlin (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If"Other",name the activity.) Amendment to Southold Town Trustees Wetland Permit No. 5841 Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES X NO If you answered"YES",complete the balance of this forth and date and sign where indicated. Name of person employed by the Town of Southold Karen A. McLaughlin Title or position of that person Director of—Fan esou ices Describe the relationship between yourself(the applicant/agent/representative)and the town officer or 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 non-corporate entity(when the applicant is not a corporation); _C)an officer,director,partner,or employee of the applicant;or �D)the actual applicant DESCRIPTION OF RELATIONSHIP karen A. McLaughlin is the wife of J. Kevin McLaughlin, the agent for the owners Submitted,&' da of LA s 200 4_ Signature Print J.KEVIN MCLAUGNLIN Attorney At Law Winds Way Professional Center 44210 Rt.48,P.O.Box 1210 Southold,New York 11971 Telephone(631)765-6085 Facsimile(631)765-1856 August 31, 2004 Southold Town Trustees Southold Town Annex Main Road Southold, NY 11971 Re: Application of John J. &Joyce A. Sampieri for Amendment to Permit No. 5841 Premises: 1380 Bayberry Road, Cutchogue, NY (SCTM #1000-118-2-12) Gentlemen: I have enclosed the original and two (2) copies of the Application for an Amendment to a Permit, along with my check in the sum of$50.00 for the filing fee herein, Notice to Adjacent Property Owners with Proof of Mailing and the Transactional Disclosure Form. Kindly calendar this matter for your meeting on September 22, 2004. i pk- ECE UM [ Of AUG 3 1 2004 Southold Town Board of Trustees -pgpFFO�,� Albert J. Krupski, President Ov C� Town Hall James King,Vice-President 53095 Route 25 Artie Foster P.O. Box 1179 W Southold, New York 11971-0959 Ken Poliwoda Peggy A. Dickerson �.y Ot� Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 4 103 f 1 , Once Use Only (0�Aus t AN( E _Coastal Erosion Permit Application J�n , , L6vetland Permit Application �Major Minor I � _Waiver/Amendment/C es Areceived Application: _�._PCeceived Fee:$ iCornpleted Application _Incomplete _SEQRA Classification: Type ( Type II_Unlisted —Coordination:(date sent) _.,eCAC Referral Sent: 1 ate of Inspection: 's 0 _Receipt of CAC Report: _Lead Agency Determination: _Technical Review: _.�lic Hearing Held: 11 Resolution: Name of Applicant John J. Sampieri and Joyce A. Sampieri � 3 Address 111 Cherry Valley Avenue, M-19, Garden City, NY 11530 PhoneNumberR16) 741-5693 p V Suffolk County Tax Map Number: 1000 - 118-00-02-00_012.000 D Property Location: 1380 Bayberry Road NOV 2 5 2003 Southold Town (provide LILCO Pole #, distance to cross streets, and location) Board of Trustees AGENT: J. Kevin McLaughlin, Esq. (If applicable) Address: Winds Way Professional Center, 44210 Rt. 48, PO Box 1210. Southold, NY 11971 Phone: (631) 765-6085 Board of Trustees Application GENERAL DATA Land Area (in square feet): 44,615 sq. ft. Area Zoning: R-40 one-story single family dwelling with decks, shed , boathouse Previous use of property: and dock first and partial second-story additions to existing residence Intended use of property: and construction of a 3.5 car garage Prior permits/approvals for site improvements: A ency Date Southold wilding Dept. 2/16/78 BP#9619Z for addition to 1 family dwelling 1/23/95 1313#22571 to alter existing boathouse, incl . bathroom 2/21/95 BP#22598 for "as-built" storage shed 10/21/96 BP#23764 to construct a deck No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No InD If yes, provide explanation: D NOV 2 5 2003 hold Town oard of Trustees Project Description (use attachments if necessary): construct first and partial second story additions to existing 1-story residence and construct 3.5 car garage at the easterly end of the property near Bayberry Road. Board of Trustees Application WETLANDIMUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: consturct first and partial second story additions to existing 1-story residence and construction of 3.5 car garage Area of wetlands on lot: NSA square feet (property is bul kheaded) Percent coverage of lot: % Closest distance between nearest existing structure and u " bul khead t}t4gexifloweNxxds appox. 5 feet Closest distance between nearest proposed structure and apdavid bul khead L2l � if�W4�41#ifd9�: 61 '2" feet Does the project involve excavation or filling? No x Yes If yes, how much material will be excavated? 183 cubic yards (see attached Site Plan) How much material will be filled? cubic yards (backfil l around new foundation area Depth of which material will be removed or deposited: approx. 8' feet Proposed slope throughout the area of operations: see attached Site Plan Manner in which material will be removed or deposited:bac kf i 11 around new founda & truck remainder of fill offsite 1y t5 V E 2 5 cJ 3 D old Town Board of Trustees Statement of the effect, if any, on the wetlands and tidal waters o n t at may result by reason of such proposed operations (use attachments if appropriate): No anticipated effect on wetlands. Row of haybales to be placed prior .to construction , as shown on Site Plan. L KMN MCLAUGRIN Attorney At Law Winds Way Professional Center 44210 Rt.48,P.O.Box 1210 Southold,New York 1 Telephone(631)765-6085 1971 Facsimile(631)765-1856 December 17, 2003 Southold Town Board of Trustees Feather Hill Complex Southold, NY 11971 Re: Application of Sampieri for Wetlands Permit Premises: 1380 Bayberry Road, Cutchogue, NY Gentlemen: I have enclosed the Affidavit of Posting and Notice To Adjacent Property Owners with Proof of Mailing in the above-referenced application, which is scheduled for a public hearing this evening. I have also enclosed the Certified Mail Receipts and the Return Receipts, which I have received. yo r ,JVe c Encs. Hand Delivered p ECfTown DEC Southold Board of Trustees • • Albert J. Krupski, President SUFFO(,�O� CD Town Hall James King,Vice-President 53095 Route 25 Artie Foster cz P.O.Box 1179 Go, Southold, New York 11971-0959 Ken Poliwoda 1Peggy A. Dickerson �,f. 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 _Jtah(-X_dtoL��e_SamQ�en COUNTY OFSUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, J. Kevin McLaughlin residing at 680 Old Orchard Lane, East Marion, NY s being duly sworn, depose and say: That on the 2nd day of December , 200 11 personally posted the property known as 1380 Bayberry Road , Cutchogue, NY (SCTM #1000-118.00-02.00-012.000) by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held LUIPA, ()12C[1 Mbar I()4 6100 3 — CKN C9L1t %0 q ki M, Dated: December 16 , 2003 *KeviMcLaughlin Sworn to before me this l� day of Dec. 2003 D E C E DEC �I D of ublic - LS 1 ; LYNOA M.BOHN NOTARY PUBLIC,State of New York Southold Town No.01 B06020932 Qualified in Suffolk County Term Expires March 8,23 2.2 NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: John J. Sampieri & Joyce A. Sampieri SCTM# 1000-118.00-02.00-012.000 py J. Kevin McLaughlin YOU ARE HEREBY GIVEN NOTICE: ]. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: Wetland Permit to construct first and partial second floor additions to an existing 1-story dwelling and to construct a 3.5 car garage 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 1380 Bayberry Road, Cutchogue, NY 11935 SCTM #1000-118.00-02.00-012.000 3. That the project which is subject to Environmental Review under Chapters 32, 37, and/or 97 of the Town Code is open to public comment on: December 17, 2003 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: John J. Sampieri & Joyce A. Sampieri MAILING ADDRESS: 111 Cherry Valley Avenue, M-19 Garden City, NY 11530 PHONE #: rho 7 Kevin Mrl a ghl , 9sq (631 ) 765 6985- D Enc: Copy of sketch or plan showing proposal for your convenience. �E�K Bo PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: Richard& Janet E. Downing 1280 Bayberry Road, Cutchogue, NY 11935 SCTM #1000-118.00-02.00-010.000 Myron & Julia M. Matlaw 43 W. 93rd Street, #4, New York, NY 10025 SCTM #1000-118.00-02.00-013.000 Garl H. Schultheis, Sr. & ano. P.O. Box 987, Cutchogue, NY 11935 SCTM #1000-118.00-03.00-009.000 STATE OF NEW YORK COUNTY OF SUFFOLK J. Kevin McLaughlin residingat 680 Old Orchard Lane, East Marion, NY 11939 being duly swom, deposes and says that on the , 2023.deponent mailed a true copy of the Notice set forth in the Board of Trustees Application,directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at Southold, NY that said Notices re mailed f said persons by (certified) (r6gM mail 1' vi Mc Lau in Swom to before me this `. Day of e� 20 03 Notary Public LYNDA M.'BOHN. MOTARY PUBLIC, tale602o oft oMl llbll� Qualified in Suffolk CountMyy Term Expires Mareb a,<J Q L Board of Trustees Application County of Suffolk State of New York J. KEVIN MCLAUGHLIN BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTIO±RE F S LICATION. ffr N SWORN TO BEFORE ME TY OF November ZO 03 Notary Pub i NM'Ary PkMie,state of Nsao`fort: ((�(l� �5 pp (�C IS U IS Yf rF. ♦4. �. �U6 D NOV 2 F "C'u3 D Southold Town Board of Trustees A7EW 1 ZATr0K :where the applicant is not the owner) I , 10 ce A. SampicrS _ residing ak III Cherry Va11=?y Avenue, print owner o propert._. )--., "i1TtaC addrasa cur en f. Ly� ItY 11530 �M do hereby authorize 0. KerSn M�La�hlir, (Agent) to apply for permit(&) from the southold Board of Town Trustees on my behalf. tot ' e er gneture NC Southold Town Boyd of Trustees 14-:6.4 (2167)-7ext 12 PROJECT LD. NUMBER 517.21 SEC Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I—PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANT?SPONS OR John J. Sarnpieri Pv Joyce A. 2. PROJECT NAME Sampieri by 1 Kevin Mclatln_hli -- 3. PROJECT LOCATION: Municipality Cutrhnaue , Tom of Southold County Suffolk J. PRECISE LOCATION(Street address and road intersections, prominent landmarks, etc, or provide mao) , 1380 Bayberry Road, Cutchogue, NY (SCTM #1000-118.00-02.00-012.000 5. IS PROPOSED ACTION: Cl New ❑Expansion 91 Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: Construct first and partial second floor additions to existing 1-story residence and.construct 3.5 car garage 7. AMOUNT OF LAND AFFECTED: 44,615 sq. ft. acres lnitially acres Ultimately ---- 3. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING !-:ND USE RESTRICTIONS? ^Yes ENo If No. describe briefly an area variance will be required for the construction of the partia second floor addition for a sideyard variance. 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? �1 Residential ❑2naustrial rCommercial ❑Agriculture Pa(KJForestiCoen space ._:Other Desenbe: existing 1-story resident with decks, shed boathouse and dock t0. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAI STATE OR LocAu?�U Yes ^No If yes, list agency(s)and permitlapprovals need area variance from Southold Town Board of L1 Appeals and building permit from Southold Tam Building Departneent S ' 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APR r� C ❑Yes 13 No II yes,list agency name and permitlapprov lSal D - E IIIISSSS t� 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REOUI IFIC n4dIN? ❑Yes No - — --- I CERTIFY THAT THE INFORMA MIDED ABOVE IS T UE TO THE 0llthd(d Y KNCWL=C E Board of ustwn J. v n McL g in ees ate; 1 d 01_ Applicant/sponsor name: Signature: — If the acti is in the Coastal Area, and you are a state acency, complete the Co tal Assessment Form before proceeding With this assessment OVER 1 r ?anT II—EV`/IR0?1 M1t E:`ITAASSESSMENT To be r_omcie!ea by . gene A. CCES AC7:CN EXCEED ANY n. 7.,RES'r.01-7:N S NYCA.A. -;AT 51T:Z? !I yes. dacrairate :ne revmw :recess and use :ne 'as _No ?. 'NILL AC71CN .AECSi`/E CCCRCINATc]REVIEW AS?R(OVICED =CR UNLiST=O C-ICNS IN 3 NYCRR, PART it 7,37 :1 `!o. a negatwe oec:ua .may be sueersedec or anomer;nvolv9d agency. veS No C. COULD AC7ICN PESUL- IN ANY ADVERSE °FFECTS ASSCC:A7'c0 'NITY. -E POLLCuvIUG: ;Ansr.ers may ]e nancwnCen. -.t :eg:clel Q1. =%igung air quality, surface or groundwater quality nr :uantlty. ll else levels. ?x!stmg 1•'ll is ]al:ems, Solid xaste JrCCUC::.^.n Or ]ISCC oo(enual :or erosion. drainage or 9ooding problems? Etplaln snelly: C2 Aesthetic, agricultural. 3rcnaeologieal. niswric, at Omer natural or cultural resources:or community or nelgnecrneca cnarac:er? E olam iCO. Vegetation or :dune. ilsn. ;reuflsn or wildlife sbec:es. significant naonats. Or ;nrea[ened or encangereo acec:es? Exclaln Many: C.'. A community's existing plans Of;Oats as Otticlaily addicted.or a change In use or intensity of use of!and or other natural resourcas7 Esolaln a C_. Growln, suoseauent ]ayeloCment.of related ac:Wttles likely to be Induceo oy me crocosea action? Exolaln or:efly. C5. '_ong :erm, snort :erm. oumutative. or other erects not identified in C'CS? Exolam 4+etly. II _ ter. Ctner Imoac:s ,incdc:nq changes In use of e:ther quantity or lype or energy)? =xolam orietly. D. S 7..EP.E. OR IS -�EPE L:RE_.' 70 aE, CONTROVEASr REl.t7ED 70 POTENTIAL ADVERSE 9."IVIRONMENT;L i7.PACTS? —Yes _`Io :f '!es. exclam onefly r� Q 11 IS 61 PART III—DETERMINATION OF SIGNIFICANCE (To be completetl by Agency INSTRUCTIONS: For eacn adverse effect identified above,determine whether it is s to ial,Large. Imconant or oth raise igni f Each effect should be assessed in connection with its (a) setting (i.e. urban or r{ral); ( 1 prooaoilit nLo (c) ratio irreversibility; (ef geogracnia sccce: and (f) magnitude. If necessary, add attachmen.s or r e,enc8rjRtiii*cjP fl materials. nsur; exolanaticnet ccntain sufficient detail to snow that all relevant adverse impacts hav been idert�dti�*dEaagt_ esse. — Checfc This box if you have identified one or more potentially large or Significant adverse imcac:s wnicn M. _ occur. 'hen Proceed directly to the FULL E.AF and/or prepare a positive•declaraticn. ' C. ec:< ;his box f you have determined, based on the information and analysis above and any succor:;; COcumentaticn. :hat ;he proposed action WILL NOT result in��ny significant adverse environmental imbed AND orovice on attachments as necessary, (he reasons supporting this determination: ,gym v .�c .err ul <.+oonr.dle Ju,car .n .c+e♦<en<v :sue m t e:oonvmm Vu4er _ _-- .,� �u,. .i <e,een uoie :ucer.n _eao .r gen<v i¢na:we L lzo�rer ,Ir .i+.e.<nt ,rem rrsoomim! an¢zn J�lc 9 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees The Purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: McLauahl in J. Kevin (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If"Other",name the activity.) Southold Town Wetlands Permit Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES X NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Karen A. MCLaughl i n Tide or position of that person—Director of Hunan Resources Describe the relationship between yourself(the applicant/agent/representative)and the town officer or 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 non-corporate entity(whenE— Board applicant is not a corporation); :Tmstees �C)an officer,director,partner,or employee of the applicant;or �X D)the actual applicant. ,. .DESCRIPTION OF RELATIONSHIP Karen A. McLaughlin is my wife. wn Sub d y f 03 Si e P tName K in M in APPLICANVAGENT/REPRES ENTATI V E TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibit c icts of interest on the art of town officers and em to ees.The Purpose of this form is to provide information which can al the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: McLaughlin J. Kevin (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If"Other",name the activity.) Southold Town Wetlands Permit Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest. "Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES X NO If you answered "YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Karen A. MtLaughl in Title or position of that person _Director of Hurron Re ourC s Describe the relationship between yourself(the applieanttagent/representative)and the town officer or 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 non-corporate entity(when the applicant is not a corporation); „❑ r� C)an officer,director,partner,or employee of the applicant;or ` L x D)the actual applicant. DESCRIPTION OF RELATIONSHIP Karen A. McLaughlin is Iry wife. Southold town oar:+ of 1nislees Submitted this y o Signa Print ame 1 U In 0 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's ode of Ethics prohibits co ict of interest on the part of town officers and employees.The purpose of this form is to Provide information which can alert the town of ossible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: McLaughlin Kevin (Last name,first name,nuddle initial,unless you are applying in the name of someone else or other entity,such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (if"Other",name the activity.) Southold Tam Wetlands Permit Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest. "Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES X NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Karen A. McLaughl in Title or position of that person Director of Human Resources Describe the relationship between yourself(the applicant/agent/representative)and the town officer or 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 non-corporate entity(when the applicant is not a corporation); C)m officer,director,partner,or employee of the applicant;or X D)the actual applicant. D E C E DESCRIPTION OF RELATIONSHIP D Karen A. McLaughlin is ny wife. Southold Town and of Trustees Submitte this of 2 fl3 Signature Print a I' Vi In J.NEVIN MCLAUGNLIN Attorney At Law Winds Way Professional Center 44210 Rt.48,P.O.Box 1210 Southold,New York 11971 Telephone(631)765-6085 Facsimile(631)765-1856 November 24, 2003 Southold Town Board of Trustees Feather Hill Complex Southold, NY 11971 Re: Application of Sampieri for Wetlands Permit Premises: 1380 Bayberry Road, Cutchogue, NY Gentlemen: I have enclosed the original and two (2) copies of the Application, Authorization, Short Environmental Assessment Form, Transactional Disclosure Form, survey and site plan, along with my check for the filing fee herein. Please place this matter on the next available date. Ve tr your , Encs. Hand Delivered pECE E Nov 2 5 2003 D Southold Town Board of Trustees r - �� .rT � vt+. I•, d v �i x� . S �F �t '�i a ..� _ w. ; ,y � ..�- �. •.'.w s . AV y u.