HomeMy WebLinkAboutTR-5841
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
John Holzapfel
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
# OlOlC
Date March 6, 2006
THIS CERTIFIES that the
One-story addition to existing dwelling
At 1380 Bayberry Rd., Cutchogue
Suffolk County Tax Map #
118-2-12
Conforms to the application for a Trustees Permit heretofore filed iu this office
Dated 11/25/03pursuantto which Trustees Permit # 5841
Dated 12/17/03
Was issued, and conforms to all ofthe requirements aud conditions of the applicable
provisions of law. The project for which this certificate is beiug issued
is for a one-story addition to the existing dwelling
The certificate is issued to
JOHN & JOYCE SAMPlERl
owner of the
aforesaid property.
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PROPOSED 2S0 CF CAPACITY STORM
II'lATER L.EACI-IING BASIN. CONNECT TO
AL.L. ROOF GUTTERS . L.EADERS
Southold Town
Board 01 Trustees
PROPOSED SINGL.E STORY, 11 ~ CA
GARAGE. REMOVE ...1- f>S CU.YD.
PROPOSED ASPI-lAL. T DRIVEII'lAY
PROPOSED COVERED
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ADDITION II'lITI-l BASEMENT.
REMOVE ...1- 118 CU. YD.
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NEIGI-lBORING DII'lEL.L.ING
EXISTING SI-lED AND CONC. PAD
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REMOVE EXISTING FRONT DECI< .
REPLACE II'lITI-l NEII'l
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EXISTING DECI< TO REMAIN
PROPOSED L.OCATION OF I-lAY BA
APPROVED BY
BOARD OF TRUSTEES
TOWN OF SOUTH OlD
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EXISTING DECI< AND PATI-l
EXISTING BUL.I<I-lEAD
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PROPOSED GARAGE TO I-lAVE GUTTERS AND L.EADERS,
BE CONNECTED TO NEII'l L.EACI-lING BASINS.
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BOARD OF TRUSTEES SUBMISSION
DATE
11/20/03
LOT
ZONE: R-40
SCALE: 1 "=40'-0'
DATE: NOVEMBER 20, 2003
DRWN. BY. : AS
DWG No.
MR. & MRS. JOHN SAMPIERI
1380 BAYBERRY ROAD
CUTCHOGUE, NY 11935
S.C.T.M.: 1000-118-02-12
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FAX; 631.959.7956
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TEL 63Hl69-Q900
FAX- 631-969-7956
PROJEC r: 0320D1
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Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971.0959
Telephone (631) 765-1892
Fax (631) 765-1366
..
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
September 22, 2004
J. Kevin McLaughlin, Esq.
P.O. Box 1210
South old , NY 11971
RE: JOHN & JOYCE SAMPIERI
1380 BAYBERRY RD., CUTCHOGUE
SCTM#118-2-12
Dear Mr. McLaughlin:
The following action was taken by the Southold Town Board of Trustees at their Regular
Meeting held on Wednesday, September 22, 2004:
RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to
Permit #5841 for a one-story addition to the existing one-family residence, and all as
depicted on the plan prepared by Busch Associates last dated August 30, 2004.
This is not a determination from any other agency.
If you have any questions, please call our office at (631) 765-1892.
Sincerely,
b~.j- 9. ~'9n.
Albert J. Krupski, Jr.
President, Board of Trustees
AJK:lms
.
.
Telephone
(631) 765-1892
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 Tuesday,
September 14, 2004, the following recommendation was made:
Moved by William Cook, seconded by Jack McGreevy, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the
application of JOHN & JOYCE SAMPIERI to Amend Permit #5841 for a one-story
addition to the existing one-family residence.
Located: 1380 Bayberry Rd., Cutchogue. SCTM#118-2-12
Vote of Council: Ayes: All
Motion Carried
Board Of SoutholdTown Trustees
SOUTH OLD, NEW YORK
PERMIT NO. . SS't t
DATE: I>.e..c: 17, 2003
ISSUED TO JOHN J. & JOYCE A. SAMP~EI<I. ......................
.....................0>............................................h....._......... u..... ....... ...
Autqnrilutintt
Pursuant to the provisions of Chapter 615 of the Laws of
the State of New York, 1893; and Chapter 404 of the Laws of the
. State of New York 1952~ and the SoUthold Town Ordinance en-
titled "REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBUC LANDS and the
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWNWATERS;!~, and in accordance with the
Resolution of The BOard adopted at a meeting held on ..P..~.~..~..PL.
. 20?~.., and in consideration of the sum of $..}lJ.O'.,..9.O'..... paid by
.. ..........,T"I1.r.>...,T, ....&. .J..9Yf.<:'...A.....s <i-mpi,a:J.........................................,...................
of .........c:::.)J.t.!:.h9.g),!.~........... .......... ...... ..... N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the folowing:
Wetland Permit to construct first -and partial second-story
1 additions to the existing one-story residence and construct a
3.5 car garage at the easterly end of the property, and as
depic~ed on the site plan prepared by Busch Associates.
aI in accOl'dance 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 COI'porate Seal to be affixed, and these ~nts to
be subscribed by a . majOl'ity of the said Board as of this dat.e.
Trusiees
.
.
TERMS and CONomoNS
The Pamlttee JOHN J. & JOYCE A. SAM PIERI
--'A:~~ 1380 Bayberry Rd.. Cutchogue. NY N Y
a--& at . ., as
pan' of the coasidetadoa for lhelW"~ of Ihe Permit does ~laJId and ptesaibe to the fol-
Iowiog:
1. That the said Board of Trustees and Ihe ToWn of s-hoId are released from 8lJf IIIICI
all dam8ga, or dalms foe ~ of IUka adIIag dlrectl7 or IncIUec:dy .. . nsuk of .., OJ-
adoa pedoaDeCl parsumt to Ihls permit, and the said p... 1I~0It will. at his or '- own cq>eltll'.
itefend aoy aDd aIllUCh ..u.,..ltI..... by Ihhd "udes, IIIICI the said 11' 111- _faI1ll1b1Ut7
with ~ theteto, to the ClllftI!'1ete 'eox:lusioa of the Baud of 1"rasUes of the Town 01 s"..cI ~
2. That cbls PermIt is wIid b . period of 24 _ wblch Is coaMert~ to .. tile
-.....ted ~requhed to c""'pI~ the .m: 1o'fOhecl, butirbcqJd~ WUftlIf, ..,-
for an eDeDSion _y be made to the Board at . Ia:Iier cIate.
3. That cbls Peaoit should be rdaioecI lodef"mitdy, or as 100g as the said Pamlttee wlsbes
to ""'1....ln the structure or project involved, to provide evidence to IJl)'OOe ClODCetIIed tbat mIh-
orizatloa was originally obtained.
4. That the work involved will be subject to me i~ IIIICI approval of the JloI1'd (It
its agents, and 00CKlllGIp1laoce. wiIh ,the prarisioos of the Clf'lgl....., 8f'pIicatioa, may be ause for
rnocatioa of this PermIt by aesolutioa of the said Board.
5. That tbere will be no UQuuo,'W!e loterfereoce wiIh oa~ .. . result of the work
, beaelo ..;tl.Mzed. ' '
6. That tbere sba1l be QO loterfereoce wiIh the rirJ.It of the pobIk to pass and repus aloag'
the beach between bf8h and low water marks. '
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7. That il future operadoas of the TOWD of Soutbold ~ the ftIIOOftl and/or al<<ndoas '
in cbe Iocatioa of cbe work beteia ...""~l e-I, or if, 10 the opl..w. of cbe Board ol T.-es, the,
work sba1l ~ _,ble obstrucbOCl to free oaYigatioa. cbe said ~ will be nquIrecI,
upon due fIClCb, to remove or. alter cbls 1lOrk or project beaelo ItatI!d wiIbouc go.j_' to cbe T_
, of Soulhold. '
8. That Ihe said Iloud will be notified by tbe p...ml~ ot cbe ~: Of doe -" mIh-
oriaoed.
9. That the PermIttee will obtalo all ocber permits and ~.. &bat ...., be required sup..
p1emeotal to this penult wbich may be oubject to reYoIce upon fallare to obtalo --
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.
.
Albert J. Krupski, President
James KiJ:~g, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
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#1l8-2-12
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 South old, 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 ofthe 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,
b~, $ 9- ~~ 7WG..i' (j,.
Albert I. Krupski, Ir.
President, Board of Trustees
AJK/lms
.
.
J. KMN MClAUGHLIN
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.
Ene.
Hand Delivered
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Albert J. Krupski, President
James King, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
.
.
Town Hall
53095 Main Road
P.O. Box 1179
Southold, New York 11971
Telephone (516) 765-1892
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
TO: -<jtD'n..n'4-"1OJleg, JamplP''l1
Please be advised that your application, dated ,I ~~
has ~~enlreviewed by this Board, at the regular meeting of
I CHI'7 () 3 and the following action was taken:
( V") 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:
JtSDD lMPeC"lU-n ~
TOTAL FEES DUE: $ So Db
SIGNED: ~.I ~ JE{1.'~"'...{' 9.,
PRESIDENT, BOARD OF TRUSTEES
BY: ~A..l r. ~rrl..kOj,.
c , BOARD OF TRUSTEES
4/98
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DATE: AUGUST 30, 2004
DAWN. BY. : AS
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Telephone
(631) 765-1892
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New Yor\:: 11971-0959
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 South old 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
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.
.
Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
APPLICATION FOR AN AMENDME
:G~:~ ~
DATE Auqust 30. 2004
Soutl\old TOl'ln
Board ollrust."
John J. Sampieri &
OVV1iER JoycP A ~"mr;~ri
PHONE (516) 741-5693
ADDRESS 111 Cherry Valley Avenue, M-19. Garden Citv. NY 11530
AGENTJ. Kevin McLau9hlin, Esq.
Winds Way Professional
ADDRESS Southold, NY 11971
PROPERTY LOCATION 1380 Bayberry Road, Cutchogue, NY 11935
PHONE (631) 765-6085
Center, 44210 Rt. 48, P.O. Box 1210
TAX MAP NO. 1000-118.00-02.00-012.000
'>
I/WeJ. kevin McLaughlin, as agenlrequest an Amendment to Permit # 5841
pursuant to attached revised Site Plan for a one-story addition to the
existing one-family residence.
.
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,
.
.
J. KEVIN MClAUGHLIN
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.
Encs.
'---
.
.
Albert J. Krupski, President
James King, Vice-Presiden~
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTH OLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
---------------------------------------------------------------
In the Matter of the Application
of
----.jDt\t\____j:~_Q\\~-f,,-S:l~C2((-------
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
I, J. Kevin McLaughlin
, residing at 680 Old Orchard Lane. East Marion, NY 11939
being duly sworn, depose and say:
That on the gthday ofSeptember2004, I personally posted the property known as
1380 Bayherry Ro"rl, rlltrhngllP, NV (SCTM 111000 liB 2 12)
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 plac,e, (or eight days prior to the date of the public
hearing. Date of hearing noted thereon to be held UJ&tt. , _
fl,
Dated: September dl , 2004
Sworn to before me this
OL.'dayof Sept200 4
~'-9 ~
Notary Public
LINDA .J. COOPER
Nrtary Public, Slale of New York
"G 4222563, Suffolk,.c<"!l).tv -7/'cJ/..
or; .:::;:;"'~;'0S UI3C6iT1lmr .,)1,~
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iwhere the appliQaAt ia GO~ the owner)
I, Jovee A. Sampler1 _
~n~ owner of p~o~~Y)
I
~1t.. NV 11530
rell141.1\9 at 111 c".rry ~,"ey Avenue, M-19,
(Ma111iii" addJ:....)-
do hel:eby au,thor1... J. l(eV11)_J,,~111 in
lAgentl
to apply for penli~(II) from tne
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-I
so~thold
,
Board of Town f~te.. on BY behalf.
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NOTICE TO ADJACENT PROPERTY OWNER
BOARD OF TRUSTEES. TOWN OF SOUTHOLD
In the matter of applicant:
J. Kevin McLaughlin, as
& Joyce A. Sampieri
agent for John J.
SCT11# 1000-118.00-02.00-01?OOO
YOU ARE HEREBY GNEN 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 South old
and does not reference any other agency that might have to review same proposal.
OWNERSNA11E: John J. Sampieri & Jovce A. Sampieri
11AILINGADDRESS: c/o J. Kevin McLaughlin, Esq., P.O. Box 1210,
Snllthn1 rl NV 11 Q7l
PHONE#: (631) 765-6085 .
Enc: Copy of sketch or plan showing proposal for your convenience.
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.
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PROOF OF MAILING OF NOTICE
ArrACH CERTIFIED MAIL RECEIPTS
Name:
Richard & Jane E. Downing
Address:
Myron & Julia M. Matlaw
1280 Bayberry Road, Cutchogue, NY 11935
SCTM #1000-118.00-02.00-010.000
43 W. g3rd Street, #14, New York, NY 10025
SCTM #1000-118.00-02.00-013.000
435 E. 57th Street, #14B, New York, NY 10022
SCTM #1000-118.00-02.00-011.004
136 wickham Road, Garden City, NY 11530
SCTM #l000-118.00-03.00-009.0tlO
Lizabeth & Jennifer J. Burrell
Eleanor S. Nohe & ors, as Trustees
"
STATE OF NEW YORK
COUNTY OF SUFFOLK.
J. Kevin McLaughlin ,residingat 680 Old Orchard Lane, East Marion, NY 11939
, being duly sworn, deposes and says that on the
31st dayof August . 20~ 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 roIl of the Town oCSouthold; that said Notices were mailed at the United States Post
Office at Sou tho 1 d.. NY. that said Noti ai. 0 of said persons by
(certified) ~~ mail.
Sworn to before me this -11
DayofO. .~,. ..*:- ,20~
...~ 8SL
. --;" Notary ~c
LYNDA M. BOHN
NOTARY PU6UC, State of New Volle
No, 01 606020932 .
Qualified In Suffolk County_
Term Expires March 8, 20 .J:[J
.,.
,
J/:.'I) 04 14; 40
5319597%5
.
BUSCH
PAGE 02
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APPLICANT/AGENTIREPRESENT ATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics orohibits conflicts of interest on the oart of town officers and emolovees. The DUroose of
this form is to orovide information which can alert the town of DOssible conflicts of interest and allow it to take whatever action is
necessary to avoid same.
YOUR NAME: .1. Kf'vin Mel ""ghl in
(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 form and date and sign where indicated.
Name of person employed by the Town of South old Karen A. McLaughl in
Titleorpositionofthatperson Director of Human Kesources
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
.
J. KEVIN MClAUGHLIN
.
.
Telephone (631) 765-6085
Facsimile (631) 765-1856
Attorney At Law
Winds Way Professional Center
44210 Rt. 48, P.O. Box 1210
Southold, New York 11971
August 31,2004
South old 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 $50.00 for the filing fee herein, Notice to Adjacent
Property Owners with Proof of Mailing and the Transactional Disclosure Form.
Kindly calendar this matter for your meeting on September 22, 2004.
\5), E i: E i H ~
\ru AUG 3 1 2004 ilW
Southold Town
Board of Trusteos
.
.
Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
, ~ II () \ O~ r- :r ,
~U-~ t JIf4W2.l
hcty beL Lu
_Coastal Erosion Permit Application
~etland Permit Application " Major Minor
_ Waiver/Amenm~h~S
_A(Cceived Application:
~ceived Fee:$~
...6ompleted Appllcation~
_Incomplete
_SEQRA Classification:
Type I_Type lI_UnJisted_
_Coordination:(date sent)
JAC Referral Sent:~
~te oflnspection:~
_Receipt ofCAC Report:
_Lead Agency Determination:_
Technical Review:
......"ll<<blic Hearing Held I~WII~
_Resolution:
^1~
9~~;
Name of Applicant John J. Samp;er; and Joyce A. Samp;er;
Address III Cherry Valley Avenue, M-19, Garden City, NY 11530
0 I!: It; I: n I<~
Suffolk County Tax Map Number: 1000 - 118.00-02.00-012.000 NOV 2 5 2003 0
I"
Property Location: 1380 Bavberry Road ~ MV
Southold Town
(provide LILCO Pole #, distance to cross streets, and location) Board of Trustees
PhoneNumber~16) 741-5693
AGENT: J. Kevin McLau9hlin, Esq.
(If applicable)
Address: Wi nds Way Profes's; ona 1 Center, 44210 Rt. 48. PO Box 1210. Sout ho 1 d, NY 11 971
Phone: (631) 765-6085
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Board of Trustees Application
GENERAL DATA
Land Area (in square feet): 44,615 sq. ft.
R-40
Area Zoning:
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 9arage
Prior permits/approvals for site improvements:
Agency
Southold Building Dept.
"
Date
2/16/78 BP#9619Z for addition to 1 family dwellin9
1/23/95 BP#22571 to alter existin9 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 :...~
- 1Ei:IEHH~
0
If yes, provide explanation:
U NOV 2 5 2003
. . ~lIUlhold Town
_"oard of Trustees
Project Description (use attachments if necessary): construct fi rst and part i a I second story
additions to existing I-story residence and construct 3.5 car garage at the easterly
end of the property near Bayberry Road.
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Board of Trustees Application
WETLANDffRUSTEE LANDS APPLlCA nON DATA
Purpose of the proposed operations: Consturct first and partial second story additions
to existing I-story residence and construction of 3.5 car garage
Area of wetlands on lot: N/A
square feet (property is bulkheaded)
Percent coverage oflot:
%
Closest distance between nearest existing structure and UfJl\lOO< bul khead
llll~ll~lltllllli'ill: appox. 5 feet
Closest distance between nearest proposed structure and 1XJXI;uJi! bul khead
M~Il~lltllllWl~: 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 Si te PI an)
How much material will be filled?
cubic yards (backfill around new foundation area
Depth of which material will be removed or deposited: approx. 80 feet
Proposed slope throughout the area of operations: see attached Site PI an
Manner in which material will be removed or deposited:backfill
around new found a & truck
H ~!: :Q~ ~
remainder of fill offsite
Statement of the effect, if any, on the wetlands and tidal waters 0
reason of such proposed operations (use attachments if appropriate):
No anticipated effect on wetlands. Row of haybales to be
old low.
Board 0\ lreslees
n t at may result by
as shown on Site Plan.
placed prior .to construction,
J. KEVIN MClAUGHliN
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Telephone (63 I) 765-6085
Facsimile (631) 765-1856
Attorney At Law
Winds Way Professional Center
44210 Rt. 48, P.O. Box 1210
Southold, New York 11971
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.
Encs.
Hand Delivered
~ E 0: ~ Ii ':3 ~ W
Southold Town
Board of Trustees
.
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Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Han
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 SOUTH OLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
In the Matter ofthe Application
of
__~b_~__~__~Q\l~~_~.Q:~~~~n_______
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
~ J. Kevin McLauqhlin
, residing at 680 Old Orchard Lane. East Marion. NY
,
being duly sworn, depose and say:
That on the 2nd day of OecerrlJer ,200 3, I 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 UJ~d- b..~Qt''' ~Q(, ~I')~ ~M '?> _
Or\ cr CUi. '10 \'n,
Dated: December 16, 2003
~~ o~c ~,: ~..~ ~
Sworn to before me this
Ii" day of Dec. 2003
1i~
/flI1 ~ 0
LYNDA M. BOHN
NOTARY PUBLIC, State of New Yodl
No. 01 B06020932
Qualified In Suffolk County
Term Expires March 8, ;;:0 U
Southold Town
8f1~rrl ,,: .,.-
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NOTICE TO ADJACENT PROPERTY OWNER
BOARD OF TRUSTEES, TOWN OF SOUTHOLD
In the matter of applicant:
John J. Sampieri & Joyce A. Sampieri SCT~# 1000-118.00-02.00-012.000
by J. Kevin McLaughlin
YOU ARE HEREBY GIVEN NOTICE:
.1. 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 I-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 11 935
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 South old
and does not reference any other agency that might have to review same proposal.
OWNERS N~E: John J. Sampieri & Joyce A. Sampieri
~AILINGADDRESS: 111 Cherrv Valley AvpnllP, M_1Q, Garden City. NY 11530
PHONE #: c/o ,1 Kpvin Mrl ""ghl if.), Es~. (631) 765 6085
Ene: Copy of sketch or plan showing proposal for your convenience.
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PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name:
Richard& Janet E. Downing
Address:
Myron & Julia M. Matlaw
1280 Bayberry Road, Cutchogue, NY 11935
SCTM #1000-118.00-02.00-010.000
43 W. 93rd Street, #4, New York, NY 10025
SCTM #1000-118.00-02.00-013.000
C;arlH. Schultheis, Sr. & ana.
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
, residing at 680 01 d Orchard Lane, East Mari on, NY 11939
, being duly sworn, deposes and says that on the
,a..w!:. day Of~e,^.do~ ,20~ 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 Notices re mailed f said persons by
(certified) (rll~mail.
Sworn to before me this \ '.
, .
Dayof ~ ,20~
~~ Yl1~
- Notary Public
. LYNDA M.BOliN.
NOTARY PUBLIC, Stale of New'lbltl
No. 01 B06020932 '.
Qualified in Suffolk County.:.
Term Expires March 8, za Q.L
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Board of Trustees Application
County of Suffolk
State of New York
J. KEVIN MCLAUGHLIN BEING DULY SWORN
DEPOSES AND AFFIRMS THAT HElSHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF HISIHER KNOWLEDGE AND BELIEF, AND THAT ALL WORK
WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MA Y
BE APPROVED BY THE SOlITHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT
AGREES TO HOLD THE TOWN OF SOlITHOLD 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 AlITHORIZE THE TRUSTEES, THEIR AGENT(S) OR
REPRESENT A TIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH RE W OF S LICA TION.
,
~~~o~; ~vY)U
olary Pub Ie
'i~D"- , i.-,....:..:'_-~'~
Not:uy p~b!i~,'s;~te.~~ ~~-N "':.orl;
Nn.t: ?17!;.G?",SI'! re;k." ,,-~,~nl,Y ~o (;.
T.~"T:: ~:.;;:::.L'(,;;; (.l\.:;"Z."" ''':'';';; ...'i i. 1f;_
DAY OF November
,20~
~ ~ N~V ~ ,n:3 ~ ~
Southold Town
Soard of Trustees
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,',
Au x-.rUTrOlf
iwhere the &pplic&~t ia no~ ~he owner)
!, jO~Jce A. ~amp~ tT 1
(pr1nt owner of prope~yl
residi.n.g at III C"erry V a11 ~y A"'~\Je, M-l g,
I_ilin; addr.")-
~rd~~ Cil~. NY 11530
do hereby authori... J. ~ed'l..~~!:5J\11 H.
(A\lent)
to applY for per1lli~(li) from tne
--+-
Sou~hold Board of Town TrUlte.. O~ my behalf.
'j /7A '
'__'~~ U. ~n,_ '
-:-. /1 er J!l .i\lft&ture -
~IOYV.. 8tnp,el""
8
~~ :,~: ~,;~ ~
South old Town
Board ot Trustees
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1-4.~S.4 (V87)- ,e~t 12
I PROJECT I.D. NUMBE'"
617.21
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 sDonsor)
1. APPLICANT ISPONSOR Jo n J. Sarf\Jieri & Joyce A.
SE
S ie
3. PROJECT LOCATION:
! 2. ?AOJEC7 NAME
Municipality , To.-m of Southold County Suffolk
.4. PAEC:SE LOCATION (Street address and road intersections. prominent landmarl<s. etc., or provlae :nap)
1380 Bayberry Road, Cutchogue, NY (SCTM #1000-118.00-02.00-012.000
5. is PROPOSED ACTION:
o New 0 Expansion l[J Modification/alteration
6. DESCRIBE PROJECT BRIEPLY: construct first and partial second floor additions to ~xisting I-story residence
and construct 3.5 car garage
7. AMOUNT OF LAND AFFECTED:
Initially acres Ultimatelv 44,615 sq. ft. acres
3. WILL. ,:::RO?OSEQ ACT!ON COMPLY WITH exiSTING ZONING OR OTHER EXISTING LAND USe: RESTi=lIC710NS?
C Yos 19 No II No, desenbe b,;efly an area variance will be required for the construction of the partia
second floor addition for a sideyard variance.
9. V/HAT IS PRESENT LANO lJS2 IN VICINITY OF PROJECT?
~ Hesldential [J.!noustrial 0 Commercial 0 AgriCUlture i....J ParklForestfOoen scace
aescnbe: existing I-story residenc with decks, shed boathouse and dock
'_Olher
10. DOES ACTION INVOLVE A PSRMIT APPROVAL. OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (F::DERAl
STATE Crt LOCAL)?
~Yes ONO
If yes. list agency(s) and permiUapprovals
need area variance from Southold Town Board of
Appeals and building permit from Southold Town
Building Department
'r
, 1. DOES ANY ASPECT OF THE ACTIO,", HAve A CURRENTLY VAllO PERMIT OR APP
DYes 83 No I' y.,5. list agency name and permiUapproval
(lIe:
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL FlEQUI
DYes ~NO
Applican!Jsponsor Ilame:
UE 70 TH... y KNCWL:~D
B OU/hold TOwn
oard of r,'
rustees
Signa lure:
If the actio is in the Co"stal A,ea, and 'fou are a state agency, complete the
Co tal Assessment Form before proceeding with this a~~essment
OVc:R
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11-=N1J1RO~~MENIA.SSC:S3MENT ;70
be c:J~=leteo :;y Age~C"
.
PA(;T
I -
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,
I
C:CES ,..l.C:-;C,\l :::\C:=~:J :".\1'(
~'f~s I .,'to
3. 'NIL....:..C7:C." .~E.:~:VS:::CROINA7cD ,~E'IIEW),$ ?RC'Jl0E0 .=':" UNLS7E0 ..:.C7jCNS iN 3 .\u':?A.::I!3,;:;, '5;;'.37
,Tlay :le sucerseCe..: :y :!.ncti:er ~nvol"'ea a;enc.,.
I ,..:~, Ti-i~E3HGL:J !N a .'I'~C?:;::;. ;'':';;7517. ::;:.,
i/ yas. ':::lcrOlnata :ne re"It~'N ::rocess ana 'Jsa 0",9 .=iJL:.. :::'>1.'=
if .'10. :l. .ieG:il:ve ':ec:.:.r
LYes
t--..: \10
C. C'::ULD ..:.G7iCN .~.ESUL"';:N ,.l.NY ,.l..DVE::<Se: ::::=~':"iS ASSCC:.;72iJ ',VI7H -:-'E :;.JU......:;\N(.\lG; ~~nswers :nay::e .1anC',vntren. f :e;:IClel
C1. ~lis:lng 31t cuality. surface or' ~rounowarer cuality oJt .=t.:anttty, ,1015e ie'/els. =x:s:lnq :...ilic: :al:erns. selia .vas;e :JrCCl.;c::::n :r :Is.:
;JetefHlal ler erasion. '::ralnaq& or ~looaing ~roOlems1 :,,:'IOI3In :)neily:
C2. A~sttleltc, a~ric:;ltural. 3.rC:1aeofogiC3.I. his.onc. or olner ,1atWral or cultural ;esourc~s: or -:ommun,ty or ;,et(;ntcrnccc -::-:arac:ar? ~.:llalo1
CJ. \/e~e!aflOn or :auna. :Isn. sr:eJlflsh or 'N.Ic:Ulle seecies. slgmficant :"laoitals. or :hrealened or ~ncan<;ered :;'::ec:es? Selal!; Jrtatly:
Co:. A community's axis,ing ;ltans or .Joals a~ offlc:ally adooted. or a cnange in use or intensity aT use 01 lane or ocher natural resourcas? ~;tDlaln
C5. GlOwlM. suoseouenc::evetoomenl. or relaleCJ ac:ivitie.s likelY (0 be Lnduceo'JY the ::::rccoseo aerion? Stolaln 'J{]eilv.
CS. '..cng :erm, snort ;erm. ,.:umulatlve, or other !ufee:s (lOt icemified in C~".:S? ::.xolam )rleil'!,
Sl.":er :moae:s .inc:.;c:m; ~:-:anc;es ,n :Jse 01 ~lther quantity .,"r :y~e Of ~nergYI? ~"(:J!arn :::r;elly"
J. S ,;...E:;E.JA :S "7";.;E~E ._:!<.::~.::' 70 3E. CONT;:!OVE.~S'! ~E!...AT2~ TO ?QT2NT1AL ...:.QV::.;::!SE =:lVIRONME.'fi;'L ;.',~P,),C7S?
_':'es
:/ ":'e5. ~xclain orieity
~,'lO
o~~\EU'\IJlE
~
?ART III-OETE:1MINATION OF SiGNIFICANCE (To ~e comoleted ~y Agency h"
iNSTRUC-;IONS: i=or :3C:1 adverse effect identified acove. determine whether it is s iaJ, large, imcor1anr or oth (wiSe
=3C~ :ifect silould oe assessed in connection with its {al setting (i.e. urban or r fal); ( I ;)robaoir . (Cl
irre'lerslbllity; (et geoqracnic sc~ce: and (t) magnitude. It necessary, add attach men s or r eren~~d_ macerials.
eXClana[lcns ccntaln sufficient delail to snow that all relevant adverse impacts nay been idenlttfi'l!lb.l~~.t1ijl'~.a
ignifi
ratio
:1sur.s
essec
Cleck this box ;r you have identified one or iTlore ootenrialfy la(~e or signit"icant aG"ersa imoac~s whic:i ".1':"
oc::.Jr. Then .::Jroce2C directly to me FULL =AF and/or prepare a positive- declaraticn.
C~e'::< :his ::ox if you have determined, based on the information and analysis above and any SUODoni:-:
doc:.Hnenraricn. :har :ne prooosea action WILL tJOT result in~{1Y signiiicant adverse envlrcnment2J imcac.
AND .Jrovlce 'In :3.;:{acnments as necessary, the reasons sUDconing this deTermination:
....,,"'~. '11 ~.:..o ""'"enc",
~rr<11 -)/ ,~!.:e '<,,,1'1" )1 -(,',,,O<1\;Ole ~",c~r .n :....."0 ....~t:nc.1
:'lIe ':>1 -,:,,"oon~'Ole 011'C~f
">.;"JII.:'(' JI ~e~cc,.,'.o,ll' ':,:,c<!-..n ~<'.Jo ....~<'nc'f
:',,<n,,:u'e H r'....:l..H~' \11 ';,';<,'~nl ;rom ,,,,~oon,,o,~ ,J1l'C~fl
.J..w
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APPLICANT/AGENTIREPRESENT ATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of South old's Code of Ethics rohibi conflicts of interest on the art of town officers and em 10 ees. The u ase of
this form is to rovide 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: f'cLaughlin. 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 To.-m Wetlands Penmt
Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee
of the Town of South old? "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.
x
YES
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 South old Karen A. f'cLaughl in
Title or position ofrhat person Director of HlJJtan 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 t~
applicant is not a corporation); 0
_C) an officer, director, partner, or employee of the applicant; or
~D) the actual applicant.
~ (C [I; 0 wn, W
DESCRIPTION OF RELATIONSHIP
Karen A. McLaughlin is my wife.
Southold Town
Board of Trustees
.
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APPLICANT/AGENTIREPRESENT A TIVE
TRANSACTIONAL DISCLOSURE FORM
The Town ofSouthold's Code of Ethics
this form is to rovide information which
necessary to avoid same.
i 'ts conflicts of interest on the art of town officers and em 10 ees. The u cse of
alert e t wn of ssible conflicts of interest and allow it to take whatever action is
YOUR NAME M:Lau9hlin. 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. Ifso, indicate the other
person's or company's name.)
NAME OF APPLICATION: (Check all that apply.)
Tax grievance
V manee
Change of Zone
Approval afplat
Exemption from plat or official map
Oilier .
(If "01her". name the activity.) Southold Town Wetlands Penmt
Do you personally (or through your company. spouse, sibJing, 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.
x
YES
NO
If you answered "YES", complete the balance of this fonn and date and sign where indicated.
Name of person employed by the Town of South old Karen A. M:Laughl in
Title or position of that person Director of Hunan Resources
Descnbe the relationship between yourself(the applicant/agent/representative) and the town officer or employee. Either check
lhe 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 thai apply):
_A) rhe 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);. If" fl': n liP \\': D
_C) an officer, dlrectar, partner, or employee of the apphcant; ar ~ IE \0 IS" U 'i'J .
~D) the actual applicant.
DESCRIPTION OF RELA TIONSHlP
Karen A. McLaughlin is my wife.
Soutllold 10WIl
oard Df 1rustees
~
in
.
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APPLICANT/AGENTIREPRESENT A TlVE
TRANSACTIONAL DISCLOSURE FORM
The Town of South old's ode of Ethics 0 ibits co ct of interest on the art of town officers and em 10 ees. The u OSt of
this form IS to rovide information which can alert the town of ssible conflicts of interest and allow It to take whatever aCllon is
necessary 10 avoid same.
YOUR NAME r'cLauqhlin. 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 gnevance
Variance
Change of Zone
Approval afplal
Exemption from plat or official map
Other .
(If''Other'', name the activity) Southold TQNI1 Wetlands Penmt
Do you personally (or through your company, spouse, sibling, parent, or cliild) liave 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 pannership, in which the town officer or employee has even a panial ownership of (or employment by) a corporal1on
In which the fown 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 South old Karen A. r'cLaughl in
Title or position afrhar person Director of Hunan Resources
Descnbe 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, panner, or employee of the applicant; or
~D) the actual applicant.
~U[UWlIEW
DESCRIPTION OF RELATIONSHIP
Karen A. McLaughlin is my wife.
.
.
~...........-
J. KEVIN MClAUGHLIN
Telephone (631) 765-6085
Facsimile (631) 765-1856
Attorney At Law
Winds Way Professional Center
44210 Rt. 48, P.O. Box 1210
Southold, New York 11971
November 24, 2003
Southold Town Board of Trustees
Feather Hill Complex
Southold, NY 11971
Re: Application of Sam pieri 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.
Encs.
Hand Delivered
IfBJ ~ ~ ~ H Wi ~ rm
IIl1 HOY 2 5 2003 ~
Southold Town
Board of Trustees