The URL can be used to link to this page

Home My WebLink AboutTR-5678 Albert J. Krupski, Prllsident 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:--1QiW\.t)nriL ct fiM(jloJ .~Llt hUdQcy{,. Please be advised that your application, dated Jlla~l~~ has been reviewed by this Board, at the regular meeting of JJ!t~~ 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: -..t 5. DD - 6<. nO; t l'bP p' TOTAL FEES DUE: $ .t), 0-0 SIGNED: tltJ......./ ~ ~..- .,....t, 9; PRESIDENT, BOARD OF TRUSTEES BY: ~{u.u in J-ta MuJ~ ~ BOARD OF TRUSTEES .. 4/98 . Albert J. Krupski. President James King, Vice-President Artie Foster Ken poliwoda Peggy A. Dickerson BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. St./..(..4... er/4 '" ~ INSPECTION SCHEDULE Pre-construction. hay bale line 1st day of construction Yo constructed t..--" Project complete. compliance inspection. Board Of Southold Town Trustees SOUTH OlD, NEW YORK PERMIT NO. 5"18 DATE: .P.",c.19L.~Q02 ISSUED TO ...J:)?:R.:~f.\~l'l.r;:...~.I:l.:t\:R.:(?I.]) SUTHERLAND AutQllrii!attuu 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 PUBLIC LANDS and the REMOVAL OF SAND, GRAVEl OR OTHER MATERIALS FROM LANDS UNDER TOWN W A TERS:!.~; and in accordance with the Resolution of The BOard adopted at a meeting held on ..I?"'C;:'~'.~?"" 2~g?, and in consideration of the sum of $..5..0...QQ.... paid by .. .......Erl::.c:::<:lI}.S.'1.~ t,mt'?.... II1.c......fo;r.. D9.d"l)l)~ ...&..Uar.Qld..5uther.lan d of .u~gl1~.l.la.tnPt.<>!l... ... 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 121 sL expansion of existing 184 sf. attached timber deck: and install 226 sf. handicapped access ~ ~ ramp; all as depicted on the survey dated Jan.22, 1999 and last revis<:si November 18, 2002. . al in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes. its Corporat<<: S~al to be a~xed. and these p~esents to be subscrIbed by a malorlty of the said Board as of thIS date. Trtlsiees . . TERMS and CONOmONS 1be Pennittee Dorianne & Harold Sutherland residiag It 42 Tilrose Ave., Malverne, N. y~ u put. of the coosideratioa for me lsS..,"Ce of the Pel:mit does bIIdetstaDd and prescribe to the fol- to.riDg: 1. That the said Board of Trustees and the Town 01 Soutbold ate released ftom ...., and aU damages, oe cbims foe damages, of suits arlsiag directly oe incIhecdy u . ~ of ...., oper- ation perfoaaed p;nuaat to this petmlt, and the said p. .i'(e., wl1I, at hls oe _ _ eI!-et,O(. defend ...., aOd aU sadllUits-lnlti.-l by tbkd parties, and cbe said 1'0. .l...e iISS"""'f fo1IliIhl1ity with reSpect thereto, to the CIO"'f'1eteexdusioa of the Board 01 Trusues 01 cbe TOll'll 01 ~ 2. That this Pel:mit is. ~ for . period of 24 mos. wbkh is oollsHeted to be the estimated time required to coiDp1eIe the work hlwhed, butllboa1dcUcmilstaoces 1ntftlIt, request for an eDelISioo may be made to the Board It . 1aw' dale. . 3. That this Pel:mit should be retained iadeflOite1y, or u long as the said ~ wishes to . ",.i_ln the suuaure or ptnject involved, to provide nidence to anyone alflCIOtDed thIt anth- orintioa was origioally obtained. 4. That the work involved wlll be subject to the inspecVoa and approva1 of the Board oe lu agents, and DOtl-ClOlDpIiaoce with. the provisions of the Of'lginofl-.g app1icatioa, may be ause foe revocation of this Pel:mit by resolutioa of the said Board. S. That there will be 00 unreasooable interference with aa~ as . ~ of me work beteia uitborized. . 6. That there sbaII be DO interference with the right of the pubIk to pass and RpISS a10ng the beach between high and low water marks. . ,;, 7. That if .future openrloas of the Town of Southold require the remooa1 and/oe a1uradoas hi the Iocatioo. of the work herein ...lI>oti-l. or if, hi the opiaiotl 01 the Board of T.-, the . wod< shall cause unreasonable obsttucboo to free aa~ the said Pel:mirtee wlll be nqalted. apoo due notice, to remove or alter this work or project beteia stated withouc e.cpenses to the Town 01 Southold. . . 8. That the said Board will be notified by tbe Pel:miuee ot the ~ of the work anth- orhed. 9. That the permittee wlll obtain aU other permlu and consents that may be required ~ p1emental to this permit wblch may be subject to revoke upoa failure to obtain same. 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 December 19, 2002 Mr. Robert E. Herrmann En-Consultants, Inc. 1329 North Sea Rd. Southampton, NY 11968 RE: DORlANNE & HAROLD SUTHERLAND 3715 STILLWATER AVE., CUTCHOGUE SCTM#136-2-12 Dear Mr. Herrmann: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, December 18, 2002 regarding the above matter: WHEREAS, En-Consultants, Inc. on behalf of DORlANNE & HAROLD SUTHERLAND applied to the Southold Town Trustees for a permit under the provisions of Chapter 97 ofthe Southold Town Code, the Wetland Ordinance of the Town of South old, application dated November 22, 2002, 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 18, 2002, 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, WHEREAS, the structure complies with the standards set forth in Chapter 97 ofthe Southold Town Code, 2 . . WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare ofthe people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of DORIANNE & HAROLD SUTHERLAND to construct 121 sf. expansion of existing 184 sf. attached timber deck; and install 226 sf. handicapped access ramp, all as depicted on the survey dated January 22, 1999 and last revised November 18, 2002. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency, which may also have an application pending for the same or similar project. 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, /)'(1 J (J''/ IJ r v_~ . /~-A'JAZ. (,.;::" Albert J. Krupsl(j, Jr. ' ,. President, Board of Trustees AJKIlms . . Telephone (631) 765-1892 Town Hall. 53095 Main Road P.O. BOlt 1179 Southold. New York 11971 _ SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conseritation Advisory Council held Thursday, December 12, 2002, the following recommendation was made: DORIANNE & HAROLD SUTHERLAND to construct 121 sf. expansion of existing 184 sf. attached timber deck; and install 226 sf. handicapped access ramp. Located: 3715 Stillwater Ave., Cutchogue. SCTM#136-2-12 The CAC did not make an inspection, therefore no recommendation was made. . . Town t:lall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken poliwoda Telephone (516) 765-18'2 Fax (516) 765.1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 22, 1999 Carl & Corinne Boos 9015 SW 192nd Ct. Rd. Rainbow Springs CC Estates Dunnellon, Florida 34432 RE: SCTM *136-2-12 Dear Mr. & Mrs. Boos, The following action was taken at the Southold Town Board of Trustees meeting on January 22, 1999: RESOLVED, that the Southold Town Board of Trustees grant the request for a Waiver for an existing 10' X 18' deck with sliding glass door, with condition that no further dumping of debris down the bank onto the marshland be done. However, this does not constitute approval from any other agencies. If you have any questions, please call our office at 765-1892. Sincerely, aa..,1 ~ ~~, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. Bldg. Dept. . . -1 + . Hi ~ .... -1~ I -<>-Z I -/ I ------ j'l\\fj/ --- /' ---. /( / /\, " c# ...1 (as' 0'''' \E)~' " '" ---~ j '-- + . . Figure I. Looking soulhwesl al concrele bulkhead; adjacenllimber bulkhead; and exisling deck 10 be enlarged :z: o <: r--; N "" ~' N Figure 2. Looking nor/heasl from exisling deck 10 be enlarged al concrele bulkhead and lidal wellands adjacenllo Eugene Creek. Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda . BOARD OF TOWN TRUSTEES TOWN OF SOUTH OLD . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fex (631) 765-1366 Office Use Only Coastal Erosion Permit Application /'Wetland Permit Application _ Major ,.- Minor Waiver! Amendment/Changes -1('eceived Application: JJ J .;)~ltl! ~eceived Fee:$ Sb -' . ~ompleted Application J I / .J.~I 0 1) _Incomplete SEQRA Classification: Type I_Type II_Unlisted WYJ 2 2 Coordination:(date sent) ..,....cAC Referral ~ent: :1~/~ ....-r5ate of InspectJon: __~ _Receipt of CAC Report: Lead Agency Determination: Technical Review: ..,A'ublic Hearing Held: I.;JJa /O;;.J Resolution: Name of ApplicantDORIANNE & HAROLD SUTHERLAND Address 42 TILROSE AVENUE, MAL VERNE, NY 11565 Phone Number:(516 )596-9531 Suffolk County Tax Map Number: 1000 - 136-2-12 Property Location: 3715 STILLWATER AVENUE, CUTCHOGUE (provide LILCO Pole #, distance to cross streets, and location) AGENT: EN-CONSULTANTS, 1Ne. (If applicable) Address: 1329 NORTH SEA ROAD, SOUTHAMPTON, NY 11968 ;rfi Phone: 631-283-6360 ~oard of Trustees APPlica~n GENERAL DATA Land Area (in square feet): 16,396.42 Area Zoning: R-40 Previous use of property: RESIDENTIAL. Intended use of property: NO CHANGE. Prior permits/approvals for site improvements: Agency Date SOUTHOLD TRUSTEES WAIVER 1/22/99 (COPY ATITACHED) No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description (use attachments if necessary): CONSTRUCT 121 S.F. EXPANSION OF EXISTING 184 S.F. ATTACHED TIMBER DECK; AND INSTALL 226 S.F. HANDICAPPED ACCESS RAMP, ALL AS DEPICTED ON THE SITE PLAN PREPARED BY JOSEPH A. INGEGNO, L.S., LAST DATED NOVEMBER 18,2002. tlbard of Trustees APPlicat~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ENLARGE EXISTING DECK ATIACHED TO HOUSE. Area of wetlands on lot: +/-3,932 square feet Percent coverage of lot: +/-24 0/0 Closest distance between nearest existing structure and upland edge of wetlands: +/-54 feet (DECK) Closest distance between nearest proposed structure and upland edge of wetlands: +/-52 feet (DECK EXTENSION) Does the project involve excavation or filling? X Yes No If yes, how much material will be excavated? N/A cubic yards How much material will be filled? N/A cubic yards Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations: N/A Manner in which material will be removed or deposited: N/A Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): THE PROJECT WILL INVOLVE THE EXPANSION OF AN EXISTING A TIACHED DECK LOCATED PRIMARILY BEHIND EXISTING BULKHEADING AND WILL HAVE NO SIGNIFICANT IMP ACT ON ADJACENT WETLANDS OR TOWN WATERS. Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION (To be completed by Applicant or Project sponsor) . I . 14-16-4 (21B7)-Texl t2 I PROJECTl.D. NUMBER 617.21 SEQR FORM 1 APPLlCANTlSPONSOR:DORIANNE & HAROLD I 2. PROJECT NAME SUTHERLAND BY EN-CONSULTANTS, INe. 3 PROJECT LOCATION: Municipality CUTCHOGUE County SUFFOLK 4 PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc, or provide map) 3715 STILL WATER AVENUE, CUTCHOGUE, TOWN OF SOUTHOLD, SCTM #1000-136-2-12; MAP PROVIDED. 5. IS PROPOSED ACTON ~ New Expansion D Modification/alteration 6 DESCRIBE PROJECT BRIEFlY: CONSTRUCT 121 S.F. EXPANSION OF EXISTING 184 S.F. A IT ACHED TIMBER DECK; AND INSTALL 226 S.F. HANDICAPPED ACCESS RAMP, ALL AS DEPICTED ON THE SITE PLAN PREPARED BY JOSEPH A. INGEGNO, L.S., LAST DATED NOVEMBER 19,2002. 7. AMOUNT OF LAND AFFECTED Initially 0.38 acres Ultimately 0.38 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? IZIv es DNO If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ~ Residential o Industrial D Commercial D Agriculture o Park ForesUOpen space o Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNIjNG, NOW OR Ul TIMATEL Y FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ~Yes DNo If yes, list agency(s) and permit/approvals DEC 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? DYes ~NO If yes, list agency name and pennltlapproval 12. AS A RESULT OF PROPOSED ACTION WlLL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? DYes ~NO I CERTIFI9 THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWlEDGE Applicant/sponsor name & RT E. HERRMANN, COASTAL MANAGEMENT SPECIALIST DATE NOVEMBER20, 2002 Signature: {J-, ^ If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER . . NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant:OORIANNE&HAROLDSUTIfERLAND SCTM#1000- 136-2-12 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: CONSTRUCT 121 S.F. EXPANSION OF EXISTING 184 S.F. ATIACHED TIMBER DECK; AND INSTALL 226 S.F. HANDICAPPED ACCESS RAMP, ALL AS DEPICTED ON THE SITE PLAN PREPARED BY JOSEPH A. INGEGNO, L.S., LAST DATED NOVEMBER 18,2002 2. That the property which is the subject of Environmental Review-is located adjacent to your property and is described as follows: 3715 STILL WTER AVENUE, CUTCHOGUE 3. That the project which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment on: DECEMBER 18,2002 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: OORIANNE & HAROLD SUTHERLAND MAILING ADDRESS: 42TILROSEAVENUE MALVERNE,NY 11565 PHONE #: 5165-596-9531 Ene.: Copy of sketch or plan showing proposal for your convenience. 5 Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda . . Town Hall . 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- In the Matter of the Application of J)Q(~o,,~~~_furo-tO-~~~ COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I,_eJ,v-l- ~...'" , reSi~!~ at. ttJ -rn1'l~IM-"",k INl" [17/1 ~ ~ ~uJ ~~~pb, btf II'lCIl being duly sworn, depose' and say: That on the rob- day of De..e., 200'2-, I per ona ly posted the property known as rr ~ by placing the Board of Trustees offic al 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. Dat~ of hearing noted thereon to be held ~~C.,~ ,~OOlJ 'C<'I ora.bo...lt '1 ',()O ~~, Dated: sw~n to before me this 1:1 day o~.Rfi-1..<.. 200)- c=,*~~k. No ar Public -'V-JO..,.,......... .......... i ',. - - ". a ~ --~..! - "l --~ _ .' 10M H. srEPH"r,", "'f (',~,'.;i'.' "otl!:! PU.bllc.SlalG Of.'....'..:...,' .~ "'>;'<> C.mn:ls.lDn No "". .. {\!~~.( Cluclmed In ." f,. .:'--.:' ~ "t... COUr.Uea a' ."",' '" Cc~ml..lDn ~,.. A"G." . 0' . I ~ _ _...... v ~ "Ii ""~t.._. -- - ...., . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: RAYMOND KENNEY Address: RRI 3655 STILLWATER AVENUE CUTCHOGUE, NY 11935 ANN & BRUCE JOHNSON 3765 STILLWATER AVENUE CUTCHOGUE, NY 11935 STATE OF NEW YORK COUNTY OF SUFFOLK ROBERT HERRMANN doing business atEN-CONSULTANTS, INC. 1329 NORTH SEA ROAD SOUTHAMPTON, NY 11968 , being duly sworn, deposes and says that on the 20TH day of NOVEMBER ,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 SOUTHAMPTON , that said Notices were mailed to each of said perso by (certified) ~) mail. Sworn to before me this 20TH day of NOVEMBER ,2002 ~ JP. ~k Notary Publ c " lCIIlL&rEPHENS I) ...,~- BIld1 of NJ'Il Verk' com~""" No. 6015031 " OUIDftId In ... , C:JHo:~ Cour.U.. rJ:.. Cc::Iln1B1lon E lre8 Aa uol2, ~ ~- . .Jl ru D U1 ru 0- ", ;:T U.S. Postal Service" CERTIFIED MAIL" RECEIPT (Domestic Mail Only; No Insurance Coverage ProvIded) \ \ ", D D RoIUm Rec~pt Foe r:::J (Endorsement Required) o Restricted Delivery Fee M (Endorsement Required) ;:T ru OFFICIAL Postage $ _, 0 .~.~ fir Certified Fee Total Postage & Fees $ ,-/.0 s ru D D r'- 0- r'! D U1 ru 0- ", ;:T U.S. Postal Service", CERTIFIED MAIL", RECEIPT {Domestic Mail Only; No Insurance Coverage Provided} ", D o Retum Reciept Fee o (Endorsement Required) o Restricted Delivery Fee M (Endorsement RequIred) ;:T ru OFFICIAL Postage $ . G 0 Certified Fee d.] l) ( 7 ~ .\ \ \ u_ ~~ ~/ Total Postage & Fees $ . bS ./". ---~. , ru ~ :::.Jj:N~fJ!.{l~.dmu!r!:./}.(:~uum...uuu.o-oomuu.uuu ~~_~.~:_.Ju~m.:lk2:?....:S.....(.!.~.~u~ Ci!Y.Slale /7 / I <; -3 S-- > BO'" of Trustees AppLication ~ .'. AUTHORIZATION (where the applicant is not the owner) I, t\~..u\J. ~ ~;, a\l\.V\~ S..;\\-....vla....J residing (print owner of property) atLfZ. I. IrQ;!" AI(> (mailing address) t"'\ c.. \ve {"" \ t-J'1 do hereby authorize efJ (Agent) ~"~I.Jhl__-t~ I,...,.c... to apply for permit ( s) from the [ Southold Board of Town Trustees on ~' behalf. 8 . . ". ',.- . B1Ifd of Trustees APPlicatio... .. county of Suffolk State of New York ~~&Su7M~~;));I/1PJJE~~~))BEING DULY SWORN DOSES AFFIRMS T HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT IS) 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 OP. BY VIRTU:!! OF Sl-.!D PERMIT ( S I, IF G:e]l~'.!.'!:;!)" IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT IS) OR REPRESENTATIVES ( S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNC:L'J.,OY WI~ ~~ THIS APPLICATION. ~JL/~ ~~~ ~gnatur SWORN TO BEFORE ME THIS ......... 1'1'1 --.. 3 DAY OF .::;;#UM ~(f!v.QQ . . .- . . hPPLIChNT TRANS^CTION^L DISCLOSUnn FORK The Town of Southold'. Code of Ethics prohibits conflicts of interest on the art of town officers and em 10 ees. The l2J:!f. 08e of this form is to rovide into matton wh ell can alert the town of poss bls confl cts of nterest and allow it to take wllatever action is 11ecessary to avoid same. YOUR NhHI!. 5l..l1\--.E'Y\o.__-^. ~ClYD\ck (C.. (Last name, first' name, midd.le initial, unless you are applying in the name or Bomeone else or otller entity, Buell as a company. If so, indicate tile other person's or company's name.) NATURK OF APPLIChTION. (Checlc all that apply.) Tax grigyanee Variance Change or zone Ap'p\:",val of plat _._ Exemption from plat or official map Other (It "otl\er," name the activity.) Do you personally (or l:.hl:ough YOUI:' company, spouRe, sibling, parent, or chIld) hove a relationsllip vitll any officer Or' employee of the Tovn of Southold7 -Relill:.lonship" includes by bloo~, marriage, or business interest. "DusinesB interest. lIl'teanR a business, inclucling a partnership, in vhich the town officer or employee has even a partial ovnership of (or employment by) a corporation in which the town officer or employee ovnn lIora than 5% of the shares. YES NO v/ If you ansvered "YES," complete the balance of this form and date and sign where indicated. Name of peraon employed by the Town of SoutJlo1d Title or position of that person Deecribe the relationship between your..lf (the applicant) and the town officer or employee. Either check the appropriate line h) tllcough D) and/or describe in the space provided. parent, -^) The town of(!cer or employee or Ills or her spouse, sibling, or Cllild is (clleck all tllat apply). the owner of greater than 5% of the shares of the corporate stoCI( or tile l\pplicant (when the applicant:. Is a corporation), the legal or beneficial owner of any interest in a noncorporate'entity (wilen the applicant is not a corporation) , an officer, director, partner, or employee ot the applicant, or the actual applicant. _8) _0) _D) DESCRIPTION or REL^TIONSIIIP Submi tt.ed Signatur Print name . . ~ EN-CONSULTANTS, INC. 1329 North Sea Road Southampton, New York 11968 631-283-6360 Fax: 631-283-6136 E-mail: encon@peconic.net www.enconsultants.com ENVIRONMENTAL SERVICES November 20, 2002 Albert Krupski Board of Trustees Town of Southold 53095 Main Road Southold, NY 11971 NOV L Z l. Re: Dorianne and Harold Sutherland. 3715 Stillwater Avenue. Cutcho2ue Dear Mr. Krupski: Enclosed please fmd an application for a "Minor" Wetlands Permit to enlarge an existing attached timber deck and construct a handicapped access ramp leading thereto. The Board previously issued a Waiver for the existing timber deck to the prior owners, Carl and Corinne Boos, and a copy of the Waiver, dated January 22, 1999, is also enclosed for your reference. Should you require any additional information to process this request, please contact me at your earliest convenience. Respectfully yours, i'i 4-./ : r-f' Robert E. Rr'rrmann Coastal Management Specialist Enclosures