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1000-6.-5-7
I I � n E \ m m co /� U o \ �`j \ MON. // Is'C C 11 N K7 a dil a u (FOUND) / POLE // HAY OA a 5 N194 N F I 1 EDGE Pi PAVEMOEN I WALLACE }-} RBOR N 4184.95 \ �' 6 CALNEY =��� TA pe ° On w / W 2305. i N 56725' W �'�° \ y�y2 E qP PO N w o 62 12.5 ILI ph 60 A6 �ti P U 6° ' of TO ya, °O ii MON. 'Ea fUq i U 0 0 (DURIED) 4V"•" d� '� � rA 12' RIGHT OF WAYPOLE �}yI @ € 3 o ti N 4167.46 -- -- / a W 2263.54 5- PPE U e <' GRAVEL •°y 1O \ f 5 (FOUND) c N DRNE / N/F /e°° // M. SA /h W </\ ELLEN McCANCE PARKERrya\ Ino D' EDGE OF LAWN AREA °p0 •`�� �1 y ~ sya2,e =/ N o N/F MAINTAINED BY ABUTTING 1y I:I N 4141.70N jD JANE H. OWNER- 41833 SQ. Fi. ISI' W 2299.34 y/Jt�\ - " _ U MON. I=' EASEMENT FOR 10 y DOSS - APPB'� , CATI N MAP,-,--. -SCALE-_ 1 "-=4Q0_'_,, N 4572.87 (FOUND) 6N1 POLE UNE NcC W 2486.85 _1 �/°°�9 N 4043.27 IRON FIIJ3S^1l+Ei'NG BOARD THOMAS McCANCE, JR. 'i 4X26' W 2184.52 (FOUND) I-� `' 9 p ry 15.05" t - Cy II FII ss• /v 'i0}P N OF SOUTHOLD U r- ---- - s \ JUN 112007 N ;25'3°" *• ?y IRON }}A�,yo' v( DATE EC 1 5 X006 MON. AREA AE 2.3 00 ACRES (FOUND) 5 °A3j \\ �_ ��� O 0 (FOUND) AREA I i0t ACRES _ - - --I � ;'; J O z O N/F \ 1.) PLAN OF PROPERTY TO BE CONVEYED TO FREDERIC R. PRATT; SAPPHON Q O N p Z R. MASON GOSS ROAD; FISHERS ISLAND, NY,; SCALE: V=40 FT; CHANDLER & PALMER, 2 U w 'o ENGR'S; NOV. 1964 W O z m A\ > 07 = S 2.) PLAN OF MANSION HOUSE COTTAGE SITES; FISHERS ISLAND, N.Y.; Of O d (n CHANDLER & PALMER ENGINEERS; NORWICH, CONN,; SCALE; 1"=40 FT.; JAN, :) I-- £ 949 OnQ U1 Lo N/F N iyoIRON Lu _ JENNY IU N 6932 0g PIPE NOTES O N Ili N p50 (FOUND) O_' KELSEY H KELS Y 1.) THIS SURVEY WAS PREPARED FOR THE PARTIES AND PURPOSE INDICATED 0_ �� HEREON, ANY EXTENSION OF THE USE BEYOND THE PURPOSED AGREED TO BETWEEN THE CLIENT AND THE SURVEYOR EXCEEDS THE SCOPE OF THE p F' ENGAGEMENT. ,�� 2.) IT IS A VIOLATION OF THE STATE EDUCATION LAW FOR ANY PERSON, N 3765.81 N 374Z55W 259454 gyp` UNLESS ACTING UNDER THE DIRECTION OF A LICENSED LAND SURVEYOR, TO . RON W 2669.63 ALTER AN ITEM IN ANY WAY. cHary LINK FENCE IRON PIPE 3,) ONLY COPIES OF THIS SURVEY MARKED WITH THE LAND SURVEYOR'S MON. N 19'39'45' W (FOUND) ,. _ SIGNATURE AND AN ORIGINAL EMBOSSED OR INK SEAL ARE THE PRODUCT OF PIPE TAX REF.7000-009- ES ., •-. (FOUND) 11.11' ., - •^ ._.. ••. "t THE LAND SURVEYOR. q, i}g E FORMER WATER AREA=2.071 ACRES -...,. '.,,:..:« P,1. RESTRICTIONS 42.0e, N TAp3�• STORAGE RESEVOIR =V t I 4,) COORDINATE DISTANCES ARE MEASURED FROM U.S. COAST AND GEODETIC ON THIS AREA 85• CONCRETE TANK) �0�ti SURVEY TRIANGULATION STATION "PROS" z r L1` 4 -� �� , h� 8 In 0 ¢ SEE AGREEMENT U` ,� IRON ��� �I,I - —111 1 I ) OBER 11946 N h. b O I("� I 1 5. SITE IS IN THE TOWN OF SOUTHOLD, COUNTY OF SUFFOLK TAX MAP Z �a z PG 331 h'y PIPE \ U 'L. I� ) rc 1000, SECTION 006, BLOCK 5, LOT 7; SECTION 009, BLOCK 1, LOTS 9.1 & O v m 9.2 — L� p = pTASREF.1006009a-s.2 0, o o w DFC 1 i N/F - AREA= 74"t s e. 4 .h ', m 0 SARAH H. `p'g 6.) TOTAL AREA = 4.543 ACRES. o IRON \\—// _ SMITH / PIPE p�, N 57Da'16'� J _ 7,) SITE IS LOCATED IN R-SO ZONE, > Q / (FOUND) •w�- E.42' f 8 IRON ? Q - 9°•3 • W PIPE Z OERTFlED TD: K N/F s TS5i6 S ..,...,,,.,.- _- - KENNETH HANAU 111 IRO IRON -_--- •" }•"� THOMAS J. SHILLO a & PIPE PIPE y OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY mo RANSON SMITH HANAU/(FOUND) IP IRON IRON METROPOLIS APSTRACT CORP, (NO. MAC 340.22540-50) PIPE Q IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TI 9DRV6W THE o IRON (FOUND) (0� NEW YORK STATE LAND TITLE ASSOCIATION. 1R� 0 H ST 0,9 / F PIPE + RO c2 N/F (FOUND) m c °m ¢ o DIANA W BIRON . m SARGENT s 7 2.20' PIPE • e nl ¢ / J�30" E' (FOUND) IRON o (o N �O m o m N F 70PIPE _ o N / JENNIFER S 76 (FOUND) s' FOUND) IRON `JO' PIPEI Ff.LU S Q SJ`n E a' / MILLER ?QO (FOUND) m w �ON/F NOW OR FORMERLY O w z z y LL QUALITY CONTROL CERTIFICATION I N/F £ N 3560.80 SF SQUARE FEET 0 0 U a GROUP REMIEw6D DATE IPC vnaEcr M.WAGMi KEVIN E. GRANT & W 2349.05 �4' sum g,cZ. I VALARIE J. KINKADE DATE: 12/05/2005 ENNFONMENT& CML 56 25 0 50 SCALE: 1 ° = 50' "um GRAPHIC SCALE IN FEET WHRECN2LL SHEET: 1 OF 1 FILE F I I I MAILING ADDRESS: PLANNING BOARD MEMBERS ��pf s0UTy0 P.O. Box 1179 JERILYN B.WOODHOUSE � �� Southold, NY 11971 Chair r y_ # +� OFFICE LOCATION: KENNETH L. EDWARDS N Town Hall Annex MARTIN H.SIDOR ,�p�p� 54375 State Route 25 GEORGE D.SOLOMONOl��'oU,M N (cor. MaYoungs Ave.)JOSEPH L.TOWN END Southold, ou h d, NY Ave n 11 Telephone: 631 765-1938 Faze: 631 765-3136 PLANNING BOARD OFFICE TOWN OF SOUTHOLD June 12, 2007 Ms. Lauren Stiles Twomey, Latham, Shea, Kelley, et al. P.O. Box 9398 Riverhead, NY 11901-9398 Re: Proposed Lot Line Change for the properties of Parker and Shillo Located at the terminus of Sappho Road, north of Central Avenue, on Fishers Island SCTM#1000-6-5-7 & 12.4 Zoning Districts: R-80 Dear Ms. Stiles: The Southold Town Planning Board, at a meeting held on Monday, June 11, 2007, adopted the following resolution: WHEREAS, this proposal is for a lot line change that will transfer 4,183 sq. ft. from SCTM#1000-6-5-7 (Parcel 1) to SCTM#1000-6-5-12.4 (Parcel 2) where, following the lot line change, Parcel 1 will equal 2.3 acres and Parcel 2 will equal .68 acre in the R-80 Zoning District; and WHEREAS, an application for a re-subdivision was submitted to the Southold Town Planning Board on December 15, 2006, including the map prepared by CME Associates Engineering, Land Surveying & Architecture, PLLC, dated August 2, 2006; and WHEREAS, the resulting lot line does not create or increase any non conformities; and WHEREAS, on February 12, 2007, the Southold Town Planning Board granted conditional final approval on the map prepared by CME Associates Engineering, Land Surveying & Architecture, PLLC, dated August 2, 2006; and WHEREAS, on May 24, 2007, the applicant submitted copies of the new deeds that reflect the lot line change; be it therefore RESOLVED, that the Southold Town Planning Board hereby grants final approval on the map prepared by CME Associates Engineering, Land Surveying & Architecture, PLLC dated August 2, 2006, and authorizes the Chairperson to endorse the maps. Parker/Shillo Lot Line Change Page Two June 12, 2007 Copies of the signed map are enclosed for your records. If you have any questions, please contact this office. Very truly yours, jerri4lyn B. Woodhouse Chairperson Enc. cc: Fishers Island Development Corporation (w/map) Building Department (w/map) Assessors Office (w/map) MATTHEWS & HAM ATTORNEYS AND GOUNSELORS AT LAW ^ 38 NUGENT .STREET SOUTHAMPTON NEW TORE 11968 PHILIP B.MATTHEWS 631-283-2400 (1912-1992) FACSIMILE 631-287-1076 (w(a`1 idf�l x's=Aix STEPHEN L HAM,III RagpE� EMAIL STEVEHAM190@GMAIL.COM —• . „ �b $ .w..__ -,._ .....� -OF COUNSEL- BARBARA T.HAM December 22, 2020 Ms. Heather Lanza Town of Southold Planning Board P. O. Box 1179 Southold, NY 11971 Re: STM No. 1000-006.00-05.00-007.001 Dear Heather: I have enclosed a copy of a 2007 deed by which the owner of former tax lot 1000-6-5-7 transferred a small portion of that lot to the owner of former tax lot 1000-6-5-12, resulting in what are now tax lots 1000-6-5-7.1 and 1000-6-5-12.5, respectively. I have also enclosed excerpts from the same section of tax map showing the sizes and configurations of the two lots in question at the time of the 2007 conveyance and their current sizes and configurations. (There appear to be some other anomalies with tax lot 12.5 but I am concerned only with the transfer from former tax lot 7 to former tax lot 12.) Finally, I have enclosed a reduced excerpt of a survey that shows, in addition to the adjoining improved parcel, the current configuration of the "vacant lot" in question. am writing to inquire (i)whether the Planning Board ever approved a lot line modification between former tax lots 7 and 12 and, (ii) if not and application for one must be made before a building permit could be issued,whether any action by the Zoning Board would also be necessary. Please write or call if you have any questions or require any further information before you can respond to my inquiries. Thank you for your attention to this matter. Sincerely, 15�slll 4.4-1 Stephen L. Ham, III Enclosures • g11FF0jf 0 MAILING ADDRESS: PLANNING BOARD MEMBERS ��� lIy P.O. Box 1179 JERILYN B.WOODHOUSEC Southold, NY 11971 Chair r/+ OFFICE LOCATION: Z RICHARD CAGGIANO G • Town Hall Annex WILLIAM J.CREMERSy�ol � 54375 State Route 25 KENNETH L.EDWARDS (cor. Main Rd. &Youngs Ave.) MARTIN H.SIDOR Southold, NY Telephone: 631 765-1938 Fax: 631 765-3136 PLANNING BOARD OIG ` +^"�"; ra u,• TOWN OF SOUTHOLD 7 DEC Application for Re-Subdivision/ t Line Modification APPLICATION IS HEREBY MADE to the Town of S"tholdn,Rimming.=Boardlifotoffie$14 ,,s proposed RE-SUBDIVISION described herein: 1. Original' Subdivision Name Mansion House Cottage Sites (1949) i 2. Suf`ulk County Tax Map # 1000-6-5-7 and 1000-6-5-12.4 3. Hamlet Fisher's Island 4. Street Location Sappho Road 5. Acreage of Site Approx. .1 acres (4,183 sq. ft. +/-) 6. Zoning District R-80 7. Date of Submission November 30, 2006 8. Please provide the names, addresses and phone numbers for the following people: Applicant: Ellen McLance Parker P. 0. Box 426 Fisher's Island, NY 06390 Agent: Lauren Stiles (631-727-2180) Twomey, Latham, Shea, Kelley Dubin & Quartararo, LLP • • 33 West Second Street (P. 0. Box 9398) Riverhead, NY 11901 Property Owner(s): Thomas J. Shillo P. 0. Box 161 Fisher'g Tqland, NY 0699n Surveyor: Richard H_ Stronse (898-291-12 7) CME Associates 110 Broadway Norwich, CT 06281 Engineer: N/A Attorney: John F. Shea, Esq. (631-727-2180) Twomey, Latham, Shea, Kelley, Dubin 5 Quartararo, LLP 33 WPst Sernnd StrPPt(F. fl. Rnv 9398) Riverhead, NY 11901 9. Briefly describe the proposed lot line change and state reason(s) for requesting same. Applicant and owner are neighbors, They have entered into an option contract which allows Ms. Parker to purchase a lawn area of approximately .1 acre from Mr. Shillo, that is adjacent to her property. Before fining so, they need to nhtain a lot line modif icatinn_ 10. DOES THE PROPOSED MODIFICATION: Affect the street layout in the original subdivision? No Affect any area reserved for public use? No Diminish the size of any lot? Yes, Mr. Shillo's lot will be diminished by .1 acre, but it will still conform to R-80 dimensional requirements. Create an additional building lot? No Create a nonconforming lot? N� Require a variance from the Zoning Board of Appeals? No Impact the future planning of the subject properties? No 11. Application completed by [ ] owner W agent [ ] other UPON SUBMITTING A COMPLETED APPLICATION, THE PLANNING BOARD WILL REVIEW THE PROPOSAL AND DETERMINE IF THE PROJECT IS ELIGIBLE FOR A WAIVER OF SUBDIVISION REVIEW . IF THE APPLICATION MEETS THE CRITERIA FOR A WAIVER, THE MODIFICATION MAY BE AUTHORIZED BY THE PLANNING BOARD BY RESOLUTION AND NO FURTHER REVIEW WILL BE REQUIRED. IF THE PROPOSED LOT LINE MODIFICATION WILL CREATE SUBSTANDARD LOT SIZES, LOT WIDTHS OR MAKE EXISTING STRUCUTRES NONCONFORMING WITH RESPECT TO SETBACKS,THE APPLICANT WILL NOT BE ABLE TO RECEIVE PLANNING BOARD APPROVAL WITHOUT FIRST OBTAINING RELIEF FROM THE ZONING BOARD OF APPEALS. Signature of Preparer ! Date 11/3o/o6 0 Southold Town Planning Board Application Authorization n� // � � n Authorization 1 I Ek,2f1 I"`Cl }MLQ C6C�.4 residing at Y�O C Vls�QA :5�A^A d N\-A (n.Sq O do hereby authorize the law firm of Twomey, Latham, Shea, Kelley, Dubin & Quartararo, LLP to apply for a re- subdivision f('lo^t line modification) from the Southold Planning Board on my behalf. Applicant's Signature 0 0 Southold Town Planning Board Application Authorization Owner Authorization I, Thomas Shillo, owner of Suffolk County tax map parcels 1000-6-5-7, 1000-9-1-9.1 and 1000-9-1-9.2, do hereby grant permission to Ellen McCance Parker, of Sappho Road, Fisher's Island, NY, to apply for a re-subdivision (lot line modification)from the Southold Town Planning Board, with respect to said tax map numbers, in accordance with the attached survey map. Thomas f lo, caner Sworn to before me this day of November, 2006 ROXANNESPAULDING NOTARY PUBLIC,STATE OF NEW YORK No, 01 SPG 113942 OUALIIIf 1)IN SUI 101 K COUNTY MY COMMISSION I x11111 S AUG.9.20ce 0 617.20 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/SPONSOR 2. PROJECT NAME E uvi MSL. PaX WLP' Lv� L-Ine-MCA,Cd110(� 3. PROJECT LOCATION: Municipality ate\ County 4. PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map) Saf 5. PROPOSED ACTION IS: ❑ New Ej Expansion Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: aPpU6kyTV S&K fa Moves ffna lok ltvle 6c,(- -1ckan 124weei }117..2 7. AMOUNT OF LAND AFFECTED: Initially G I acres Ultimately —!9. � acres 8. WILL PRO ED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No,describe briefly 9. WHAT ISP ESENT LAND USE IN VICINITY OF PROJECT? esidential ❑ Industrial ❑Commercial Agriculture ❑ Park/ForesVOpen Space nn Othr Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM MY I-IEIZ70VERNMENTAL AGENCY � (FEDERAL,STATE OR CAL)? Yes © If Yes,list agency(s)name and permiUapprovals: ' •( pEC } 5 ( ( 11. DOES ANY ASPECT OF HE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes ©No If Yes,list agency(s)name and permit/approvals: _ 12. AS A RESULT OF PRO OSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ElYes LNo I CERTIFY THAT THE INF M/nAnTION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE l Applicant/sponsor name: r ICA —`� � 1��yy r� +1_11yr, ajNylDate: Q /p 96 Signature: 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 1 PART II - IMPACT ASSESSMENT be completed by Lead Agency) A. DOES ACTION E CEED ANY TYPE I T SHOLD IN 6 NYCRR,PART 617.4? If yes,coor nate the review process and use the FULL EAF. Yes MNo B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another Involved agency. ElYes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) C1. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: N O C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: IJ G C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: N0 C4. A community's existing plans or goals as officially adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly: NO C5. Growth,subsequent development,or related activities likely to be Induced by the proposed action?Explain briefly: NO CO. Long term,short term,cumulative,or other effects not identified in C1-05? Explain briefly: N O C7. Other Impacts(including changes in use of either quantity or type of energy) Explain briefly: N O � D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? E] yes ©No If Yes,explain briefly: E. IS THERE,OR IS HERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? Yes FVI No If Yes,explain briefly: PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its (a)setting(i.e. urban or rural); (b)probability of occurring; (c)duration; (d)irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. If question D of Part II was checked yes,the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box if you have determined,based on the information and analysis above and any supporting documentation,thatthe proposed action WILL NOT result in any significant adverse environmental impacts AND provide,on attachments as necessary,the reasons supporting this determination Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency itle of Responsible O car S ignature of Responsible Officer in Lead Agency Signature of Preparer(If different from responsible officer) PART II- IMPACT ASSESSMENT To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF. ❑Yes 11 No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. Yes 1:1 No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) Cl. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: C4. A community's existing plans or goals as officially adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly: C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: C6. Long term,short term,cumulative,or other effects not identified in C1-05? Explain briefly: C7. Other impacts(including changes in use of either quantity or type of energy)? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CFA)? ❑ Yes ❑ No If Yes,explain briefly: E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? Yes No If Yes,explain briefly: PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its(a)setting (i.e.urban or rural); (b)probability of occurring;(c)duration;(d)irreversibility;(e) geographic scope; and (f)magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part 11 was checked yes,the determination of significance must evaluate the potential impact ofthe proposed action on the environmental characteristics ofthe CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box if you have determined,based on the information and analysis above and any supporting documentation,that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide,on attachments as necessary,the reasons supporting this determination Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer different from responsible officer) Town Of Southold P.O Box 1179 • Southold, NY 11971 * * * RECEIPT * * * Date: 01/25/07 Receipt#: 58844 Transaction(s): Reference Subtotal 1 1 Application Fees 6-5-7 & $500.00 Check#: 58844 Total Paid: $500.00 Name: Twomey, Latham Shea & Kelley P O Box 398 Riverhead, NY 11901 Clerk ID: LINDAC Internal ID:6-5-7&12.4 • • MAILING ADDRESS: PLANNING BOARD MEMBERS r3f SOUTy P.O. Box 1179 JERILYN B.WOODHOUSE �0`� Ol0 Southold, NY 11971 Chair OFFICE LOCATION: KENNETH L.EDWARDS y Town Hall Annex MARTIN H.SIDOR 54375 State Route 25 Q GEORGE D. SOLOMON • �� (cor.Main Rd. &Youngs Ave.) JOSEPH L.TOWNSEND Vi111 Southold, NY Telephone: 631 765-1938 Fax: 631 765-3136 PLANNING BOARD OFFICE TOWN OF SOUTHOLD MEMORANDUM To: Elizabeth Neville, Town Clerk From: Planning Department Date: January 24, 2007 Re: Checks Enclosed herewith are the checks listed. Please return a receipt to us. Thank you. Project Name & Type Tax Map # Amount Date of Check Parker/Shillo Subdiv. 6-5-7& 12.4 $500 app fee 11/30/06 Brokaw, Bennett Subdiv. 113-7-1.1 $7,000 P&P 1/8/07 Brokaw, Bennett subdiv. 113-7-1.1 $500 app fee 1/8/07 Grigonis Conserv. Sub. 55-1-5.1 & 55- $1,550 sketch 1/11/07 2-8.5 fee LR enc. SF T&MEY, LATHAM, SHEA, KE*Y, Al` DUBIN &c QUARTARARO LLP Attorneys at Law Mailing Address Location of COUNSEL THOMAS A.TWOMEY,JR. KENNETH P.LAVALLE STEPHEN B. LATHAM Post Office BOX 9398 33 West Second Street JOAN C.HATFIELD A JOHN F.SHEA,III Riverhead Riverhead PHILIP D.NYKAMP CHRISTOPHER D.KELLEY New York 11901-9398 NOW York 11901-9398 IAURA I.SGUAZZIN A DAVID M.DUBIN* JAY P.OUARTARAROt CYRUS G. DOLCE,JR.p• PETER M.MOTT Telephone:631.727.2180 LISA A.AZZAT04 JANICE L.SNEAD FaceIngle: 631.727.1767 KATHRYN DALLI JANE DIGIACOMO DANIEL G.WANI t MARTIN D.FINNEGANB JENNIFER A.ANDALORO ANNE MARIE GOODALE www.suffolklaw.DOln KELLY E. KINIRONS BRYAN C.VAN COTT• PATRICK B.FIFE LAUREN E. STILES r* My% I LL.M.IN TA.ATION t LL,M,IN EBTsrE L ' ANNW. jO 'lY A LA BARS 0 May 2S,r 2007 ,•BT BARB A _•'f , V,N •FA AFB y +q 6 NJ SAFE I \ 11 11 L BAk.i 6 FL BARB Y Attn: Anthony Trezza, Senior Planner a CT..FL BARB Southold Town Planning Board t j 1 Southold Town Hall �'-� `I` MAY 2 4 2001 P.O. Box 1179 Southold, NY 11971-0959 I Re: Re-Subdivision Application—Parker/Shillo lois_orrF'rsh&_rs Island; - Lots 1000-6-5-7 and 1000-6-5-12.4 Dear Mr. Trezza: This office represents Mr. & Mrs. Parker in the above referenced lot line modification/minor re-subdivision proceeding. As you may recall, the Planning Board adopted a Conditional Final Approval of the proposed re-subdivision on February 12, 2007, the condition being that the new deed was to be filed with the Suffolk County Clerk and a copy submitted to the Planning Board office. I have enclosed a photocopy of the Conditional Final Approval for your convenience. We have filed the deeds with the County Clerk and enclose a copy herein for the Town's records. Please let this letter serve as a request for Final Approval form the Planning Board and an endorsement of the final surveys we previously provided. If you need additional documentation from our office to finalize this approval, please let me know. Thank you very much for your assistance with this matter. Very truly yours, Lauren E. Stiles 20 MAIN STREET 51 HILL STREET 105 ROUTE 112,FL 1S 400 TOWNUNE ROAD 56340 MAIN ROAD,P.O.BOX 325 EAST HAMPTON,NY 11937 SOUTHAMPTON,NY 11968 FORT JEFFERSON STA.,NY 11776 HAUPPAUGE,NY 11788 SOUTHOLD,NY 11971 631.324.1200 631.287.0090 631.928.4400 631.265.1414 631.765.2300 I IIIIIII III)VIII VIII VIII VIII VIII VIII VIII IIII IIII IIIIIII(IIII VIII IIII IIII SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DEEDS/DDD Recorded: 04/20/2007 Number of Pages: 3 At: 02 :21:20 PM Receipt Number : 07-0039351 TRANSFER TAX NUMBER: 06-30785 LIBER: D00012501 PAGE: 940 District: Section: Block: Lot: 1000 006 .00 05 .00 007 .002 EXAMINED AND CHARGED AS FOLLOWS Deed Amount: $90, 000 .00 Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $9 .00 NO Handling $5 .00 NO COE $5 .00 NO NYS SRCHG $15. 00 NO EA-CTY $5. 00 NO EA-STATE $165. 00 NO TP-584 $5. 00 NO Cert.Copies $0 . 00 NO RPT $30 .00 NO SCTM $0. 00 NO Transfer tax $120 .00 NO Comm.Pres $0. 00 NO Fees Paid $359 .00 TRANSFER TAX NUMBER: 06-30785 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk County ,se be advised this document *e public record. Remove Social SOHO Number(s)prior to recording. [1 2❑ RECORDED Number of pages 2007 Apr '40 02:21.20 PM TORRENS JUDITH A. PASCALE CLERK OF Serial# SUFFOLK COUNTY L D0C 1012501 Certificate# R 940 DT# 06-30785 Prior Ctf. # Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps 3 1 FEES Page/Filing Fee Mortgage Amt. 1. Basic Tax Handling 5. 00 2. Additional Tax TP-584 Sub Total Notation Spec./Assit. or EA-52 17 (County) Sub Total Spec. /Add. EA-5217 (State) TOT. MTG. TAX ,l ��� � Dual Town Dual County R.P.T.S.A. U Held for Appointment Comm. of Ed. 5. 00 Transfer Tax ao p Affidavit a Mansion Tax The property covered by this mortgage is Certified Copy or will be improved by a one or two NYS Surcharge 15. 00 family dwelling only. Sub Total YES or NO Other q z/� Grand Total dIJ'"i J If NO, see appropriate tax clause on J page# of this instrument. �L 4 D. 07011939 i000 00500 osoo 00002 � 5 Community Preservation Fund T Real Pr F2 BSl A �7 Z, Consideration Amount $ 30 Lam, Tax Ser '� Agen t7-APR o CPF Tax Due $ �— Verifrc_ o Improved Vacant Land [� 6 Satisfactions/Discharges/Releases List Property Owners Mailing Address O RECORD & RETURN TO: TD John F. Shea, Esq. TD Twomey, Latham, Shea, TD Dubin & Quartararo, LLP P.O. Box 9398 Riverhead, NY 11901 7 Title Company Information Co.Name N� Title T1e# . / / 8 Suffolk County Recording & Endorsement Page This page forms part of the attached Deed made by: (SPECIFY TYPE OF INSTRUMENT) Thomas J. Shillo The premises herein is situated in SUFFOLK COUNTY, NEW YORK. TO In the Township of Southold Ellen McCance Parker In the VILLAGE Fisher's Island or HAMLET of BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. (over) Form 8002*5-89-20M--Bargain and Sale Deed,with Covenant against Grantor's Acts--Individual or Corporation. (single.sheet) CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY. THIS INDENTURE, made the J_Q day of March, 2007 BETWEEN rbc THOMAS J. SHILLO, residing at Sappho Road, Fisher's Island, New York 06390 party of the first part,and klo ELLEN McCANCE PARKER, residing ratSappho Road, Fisher's Island, New York 06390, party of the second part, WITNESSETH,,that the party of the first part, in consideration of Ten Dollars and other valuable consideration paid by the party of the second part, does hereby grant and release unto the party of the second part,the heirs or successors and assigns of the party of the second part forever, ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate, lying and being at Fisher's Island in the Town of Southold, County of Suffolk, State of New York,more particularly bounded and described as follows: BEGINNING at a point at the Southerly corner of land now or formerly of Ellen McCance Parker, said point being located 4,012.87 feet North of a point which is 2,486.85 feet West of a monument marking the United States Coast and Geodetic Survey Station"PROS"and THENCE Running North 73°25'30" East 15.05 feet to a monument; THENCE North 54°16'00" East 150.08 feet to a point; THENCE South 05'56'13" West 40.91 feet to a point; THENCE South 56°00'06" West 126.14 feet to a point; THENCE North 54°53'47"West 33.54 feet to the point of BEGINNING. BEING AND INTENDED TO BE a portion of same premises conveyed to Thomas J. Shillo by an Executors Deed from the United States Trust Company of New York as Executor of the Last Will and Testament of Pauline D. Webel, dated January 4, 2006, recorded February 15, 2006, in Liber 12436, page 046 in the Suffolk County Clerk's Office, the Grantor herein being the same described as the Grantee in said Deed. TAXMAP TOGETHER with all right, title and interest, if any, of the party of the first part in and to any DESIGNATION streets and roads abutting the above described premises to the center lines thereof; TOGETHER with the appurtenances and all the estate and rights of the party of the first part in and to said Dist.: 1000 premises;TO HAVE AND TO HOLD the premises herein granted unto the party of the second part,the heirs or successors and assigns of the party of the second part forever. Sec.: 006.00 AND the party of the first part covenants that the party of the first part has not done or suffered Blk.: 05.00 anything whereby the said premises have been encumbered in any way whatever, except as aforesaid. Lot: p/o AND the party of the first part, in compliance with Section 13 of the Lien Law,covenants that the 007.000 party of the first part will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the propose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose. The word"party" shall be construed as if it read "parties" whenever the sense of this indenture so requires. IN WITNESS WHEREOF, the party of the first part has duly executed this deed the day and year first above written. IN PRESENCE OF: AHOMAS JJILLO USE ACKNOWLEDGMENT FORM BELOW WITHIN NEW YORK STATE USE ACKNOWLEDGMENT FORM BELOW WITHIN NEW YORK STATE ONLY: ONLY: State ofNew York, County of-Tu,€-E—U} ss: State of New York, County of Suffolk} ss: All / On the,,7 w day of March, in the year 2007; before me, On the day of in the year before me, the the undersigned, personally appeared THOMAS J. undersigned, personally appeared SHILLO, personally known to me or proved to me on personally known to me or proved to me on the basis of the basis of satisfactory evidence to be the individual satisfactory evidence to be the individual whose name is whose name is subscribed to the within instrument and subscribed to the within instrument and acknowledged to acknowledged to me that he executed the same in his me that she executed the same in her capacity, and that capacity, and that by his signature on the instrument, the by her signature on the instrument, the individual, or the individual, or the person upon behalf of which the person upon behalf of which the individual acted, individual acted,executed the instrument executed the instrument. MICHAEL RO®ERT® Notary Public,Stets of New"lark No.31-4732348 Qualified in New York County --_ Commission Expires June 30,2009— r /�/m I cH Aqff L- ACKNORt:EDGMENT FORK FOR USE WITHIN NEW YORK STATS ONLY: ACANUNLEMiZNT FORM FOR USS OUTSIDE NEW YORK STATE ONLY: (New York Subscribing Witness Acknowledgment Certificate) (Out of State or Foreign General Acknowledgment Certificate) State of New York, County of } ss: ..............................................................} ss: (Complete Venue with State,Country,Province or Municipality) On the day of in the year before me,the undersigned,personally appeared , On the day of in the year the subscribing witness to the foregoing instrument, before me,the undersigned,personally appeared with whom I am personally acquainted, who, being by me duly sworn, did depose and say that he/she/they personally known to me or proved to me on the basis of reside(s)in satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and (If the place of residence is in a city, include the street acknowledged to me that he/she/they executed the same and street number, if any, thereof); that he/she/they in his/her/their capacity(ies), that by his/her/their know(s) signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, to be the individual described in and who executed the executed the instrument, and that such individual made foregoing instrument; that said subscribing witness was such appearance before the undersigned in the present and saw said (Insert the city or other political subdivision and the state or country or execute the same;and that said witness at the same time other place the acknowledgment was taken.) subscribed his/her/their name(s)as a witness thereto. BARGAIN and SALE DEED DISTRICT: 1000 WITH COVENANLS AGAINST GRANTOR'S ACLS Title No. SECTION: 006.00 THOMAS J. SHILLO BLOCK: 05.00 TO LOT: p/o 007.000 ELLEN MCCANCE PARKER COUNTY OR TOWN: Town of Southold TAX BILLING ADDRESS: Ellen McCance Parker, P.O. Box 426,Fisher's Island,NY 06390 RETURN BY MAIL TO: John F. Shea, Esq. Twomey,Latham,Shea,Kelley, Dubin &Quartararo, LLP West Second Street P.O. Box 9398 Riverhead,NY 11901 RESERVE THIS SPACE FOR USE OF RECORDING OFFICE • r • • MAILING ADDRESS: PLANNING BOARD MEMBERS �QF SU!/T P.O. Box 1179 JERILYN B.WOODHOUSE 0� �Ql Southold, NY 11971 Chair OFFICE LOCATION: KENNETH L. EDWARDS y Town Hall Annex MARTIN H. SIDOR 54575 State Route 25 GEORGE D.SOLOMONQ� `'�`\ (cor. Main Rd. & Youngs Ave.) JOSEPH L. TOWNSEND �CDUn11 Nv Southold, NY Telephone: 631 765-1938 Fax: 631 765-3136 PLANNING BOARD OFFICE TOWN OF SOUTHOLD February 13, 2007 Ms. Lauren Stiles Twomey, Latham, Shea, Kelley, Dubin & Quartararo, LLP PO Box 9398 Riverhead, NY 11901-9398 Re: Lot Line Change for the properties of Parker and Shillo Located at the terminus of Sappho Road, north of Central Avenue on Fishers Island. SCTM#1000-6-5-7 & 12.4 Zoning Districts: R-80 Dear Ms. Stiles: The Southold Town Planning Board, at a meeting held on Monday, February 12, 2007, adopted the following resolutions: WHEREAS, this proposal is for a lot line change that will transfer 4,183 square feet from SCTM#1000-6-5-7 (parcel 1) to SCTM#1000-6-5-12.4 (parcel 2) where, following the lot line change, parcel. 1 will equal 2.3 acres and parcel 2 will equal .68 acre in the R-80 Zoning District; and WHEREAS, an application for a re-subdivision was submitted to the Southold Town Planning Board on December 15, 2006, including the map prepared by CME Associates Engineering, Land Surveying & Architecture, PLLC dated August 2, 2006; and WHEREAS, the resulting lot line does not create or increase any nonconformities; and WHEREAS, the Southold Town Planning Board reviewed this application at their work session on January 22, 2007 and determined that the project will not have a significant environmental effect or make future planning of the affected parcels more difficult or impossible; be it therefore RESOLVED, the Southold Town Planning Board, acting under the State Environmental Quality Review Act pursuant to 6 NYCRR Part 617, Section 617.7, do an uncoordinated review of this Unlisted Action. The Planning Board establishes itself as lead agency, and as lead agency, makes a determination of non-significance and grants a Negative Declaration; and be it further Parker & Shillo Lot Line Page Two February 13, 2007 RESOLVED, that the Southold Town Planning Board hereby waive the public hearing for this project; and be it further RESOLVED, the Southold Town Planning Board grant Conditional Final Approval on the map prepared by CME Associates Engineering, Land Surveying & Architecture, PLLC dated August 2, 2006, subject to the following condition: the filing of new deeds with the Office of the Suffolk County Clerk pertaining to the lot line change and, upon filing, submission of a copy to this office. This condition must be met within six (6) months of the resolution unless an extension of time is requested by the applicant and granted by the Planning Board. Upon fulfillment of the condition, the Planning Board will issue final approval and authorize the Chairperson to endorse the final surveys. A copy of the Negative Declaration is enclosed for your records. Very truly yours, I- '-Jerilyn B. Woodhouse Chairperson Enc. cc: Fishers Island Development Corporation • • MAILING ADDRESS: PLANNING BOARD MEMBERS QF sour`' P.O. Box 1179 JERILYN B.WOODHOUSE �0� �7QlO Southold, NY 11971 Chair l�f OFFICE LOCATION: KENNETH L.EDWARDS y Town Hall Annex MARTIN H.SIDOR G &Z 54375 State Route 25 GEORGE D.SOLOMON '�Q� • p``�� (cor.Main Rd. &Youngs Ave.) JOSEPH L.TOWNSEND ycoul 11 �v Southold, NY Telephone: 631 765-1938 Fax: 631 765-3136 PLANNING BOARD OFFICE TOWN OF SOUTHOLD February 13, 2007 Ms. Lauren Stiles Twomey, Latham, Shea, Kelley, Dubin & Quartararo, LLP PO Box 9398 Riverhead, NY 11901-9398 Re: Lot Line Change for the properties of Parker and Shillo Located at the terminus of Sappho Road, north of Central Avenue on Fishers Island. SCTM#1000-6-5-7 & 12.4 Zoning Districts: R-80 Dear Ms. Stiles: The Southold Town Planning Board, at a meeting held on Monday, February 12, 2007, adopted the following resolutions: WHEREAS, this proposal is for a lot line change that will transfer 4,183 square feet from SCTM#1000-6-5-7 (parcel 1) to SCTM#1000-6-5-12.4 (parcel 2) where, following the lot line change, parcel. 1 will equal 2.3 acres and parcel 2 will equal .68 acre in the R-80 Zoning District; and WHEREAS, an application for a re-subdivision was submitted to the Southold Town Planning Board on December 15, 2006, including the map prepared by CME Associates Engineering, Land Surveying & Architecture, PLLC dated August 2, 2006; and WHEREAS, the resulting lot line does not create or increase any nonconformities; and WHEREAS, the Southold Town Planning Board reviewed this application at their work session on January 22, 2007 and determined that the project will not have a significant environmental effect or make future planning of the affected parcels more difficult or impossible; be it therefore RESOLVED, the Southold Town Planning Board, acting under the State Environmental Quality Review Act pursuant to 6 NYCRR Part 617, Section 617.7, do an uncoordinated review of this Unlisted Action. The Planning Board establishes itself as lead agency, and as lead agency, makes a determination of non-significance and grants a Negative Declaration; and be it further r � • Parker& Shillo Lot Line Page Two February 13, 2007 RESOLVED, that the Southold Town Planning Board hereby waive the public hearing for this project; and be it further RESOLVED, the Southold Town Planning Board grant Conditional Final Approval on the map prepared by CME Associates Engineering, Land Surveying & Architecture, PLLC dated August 2, 2006, subject to the following condition: the filing of new deeds with the Office of the Suffolk County Clerk pertaining to the lot line change and, upon filing, submission of a copy to this office. This condition must be met within six (6) months of the resolution unless an extension of time is requested by the applicant and granted by the Planning Board. Upon fulfillment of the condition, the Planning Board will issue final approval and authorize the Chairperson to endorse the final surveys. A copy of the Negative Declaration is enclosed for your records. Very truly yours, / Jerilyn B. Woodhouse Chairperson Enc. cc: Fishers Island Development Corporation • • MAILING ADDRESS: PLANNING BOARD MEMBERS QF so�Ty P.O. Box 1179 JERILYN B.WOODHOUSE �0� �l0 Southold, NY 11971 Chair OFFICE LOCATION: KENNETH L. EDWARDS y Town Hall Annex MARTIN H.SIDOR O 54375 State Route 25 GEORGE D. (cor. Main uYoungs Ave.) JOSEPH L.TOWNSEND OI�COUl111 � � Soth d, NY 1111 Telephone: 631 765-1935 Fax: 631 765-3136 PLANNING BOARD OFFICE TOWN OF SOUTHOLD State Environmental Quality Review NEGATIVE DECLARATION Notice of Determination Non-Significant February 12, 2007 This notice is issued pursuant to Part 617 of the implementing regulations pertaining to Article 8 (State Environmental Quality Review Act) of the Environmental Law. The Southold Town Planning Board, as lead agency, has determined that the proposed action described below will not have a significant effect on the environment and a Draft Environmental Impact Statement will not be prepared. Name of Action: Parker/Shillo Lot Line Change SCTM#: 1000-6-5-7 & 12.4 Location: Located at the terminus of Sappho Road, north of Central Avenue on Fishers Island. SEQR Status: Type I ( ) Unlisted (X) Conditioned Negative Declaration: Yes ( ) No (X) Description of Action: This proposal is for a lot line change that will transfer 4,183 square feet from SCTM#1000-6-5-7 (parcel 1) to SCTM#1000-6-5-12.4 (parcel 2) where, following the lot line change, parcel 1 will equal 2.3 acres and parcel 2 will equal .68 acre in the R-80 Zoning District. Reasons Supporting This Determination: An Environmental Assessment Form has been submitted and reviewed and it was determined that no significant adverse effects to the environment were likely to occur should the project be implemented as planned. Parker-Shillo • Page Two Aary 12, 2007 The determination was based upon the following: No substantial adverse change in existing air quality, ground or surface water quality or quantity, traffic or noise levels, no substantial increase in solid waste production, potential of erosion, flooding, leaching or drainage problems will occur as a result of this action. There are no new residential lots being created and therefore no impacts are expected to occur. No significant removal or destruction of large quantities of vegetation or fauna, no substantial interference with the movement of any resident or migratory fish or wildlife species, no significant impacts on a significant habitat area, no substantial adverse impacts on a threatened or endangered species of animal or plant or the habitat of such a species, and no other significant adverse impacts to natural resources will occur. The proposed action is not in a material conflict with a community's current plans or goals as officially approved or adopted. The proposed action will not impair the character or quality of important historical, archaeological, architectural, or aesthetic resources or of existing community or neighborhood character. No major change in the use of either the quantity or type of energy will occur. No creation of a hazard to human health will occur. The proposed action will not cause a substantial change in the use, or intensity of use, of land including agricultural, open space or recreational resources, or in its capacity to support existing uses. Based upon such, no significant adverse impacts to the environment are expected to occur should the project be implemented as planned. For Further Information: Contact Person: Anthony Trezza, Senior Planner Address: Southold Town Planning Board Telephone Number: (631) 765-1938 enc. cc: Applicant/Agent Town Clerk TOOMEY, LATHAM, SHEA, KE Y, r DUBIN & QUARTARARO LLP Attorneys at Law THOMAS A.TWOMEY.JR. Mailing Address Location OF COUNSEL STEPHEN B. LATHAM Post Office BOX 9398 33 West Second Street KENNETH P LAVALLE JOHN F.SHEA. III Riverhead Riverhead JOAN G.HATFIELD A CHRISTOPHER D.KELLEY New York 11901-9398 New York 11901-9398 LAURA I.SGUAZZIN A DAVID M. DUBINO BRYAN G VAN COTT• JAY P.OUARTARAROT PETER M.MOTT Telephone. 631.727.2180 GYRUS G.DOLCE,JR.S- JANICE L.SNEAD Facsimile, 631.727.1767 LISA A.AZZATO+ JANE DiGIACOMO KATHRYN DALLI PHILIP D.NVKAMP DANIEL G.WANT t MARTIN D.FINNEGANB www.suffolklaw.com JENNIFER A.ANDALORO ANNE MARIE GOODALE KELLY E.KINIRONS .* A'lL'NTE TUN rvN t I r LL M NES NYS G O rVV`.,rl A BARS 0 S CT BARS A Decem I'I /1 �,� n :NJ,A EA BARS B 1^, Y e NJ BARS E I ' --------- __, _. C.OA.A FL BARS} Attn: Anthony Trezza, Senior Planner i LLUJJ {f a FL BARB . Southold Town Planning Board `c i Southold Town Hall P.O. Box 1179 Southold,NY 11971-0959 Re: Re-Subdivision Application-Parker/Shillo lots on FLFlier,'s,lslarld,,- _„ Lots 1000-6-5-7 and 1000-6-5-12.4 Dear Sirs: Please accept this packet as a Re-Subdivision (Lot Line Modification) Application for the Parker/Shillo parcels located on Fisher's Island. Included herein is: 1. $500 checkadepayable yaabble to the Town of Southold for the Application Fee; N- 2. a completed Re-Subdivision Application form; 3. Authorization Letter for this law firm to act on behalf of the applicant; 4. Owner Authorization from the neighboring property owner to proceed with this application; 5. a copy of the property deed for each involved parcel; 6. completed Short EAF; 7. six(6) copies of the Re-Subdivision Plan which shows the existing and proposed lot line configurations and lot areas; and, 8. Applicant/Agent/Representative Transactional Disclosure Form Please contact me if there are any questions or concerns regarding this application. Thank you for your assistance with this matter. Since�� Lauren Stiles Law Clerk Encls. 20 MAIN STREET 51 HILL STREET 105 ROUTE 112,FL 1S 400 TOWNLINE ROAD 56340 MAIN ROAD,P.O.BOX 325 EAST HAMPTON,NY 11937 SOUTHAMPTON,NY 11968 PORT JEFFERSON STA.,NY 11776 HAUPPAUGE,NV 11788 SOUTHOLD,NY 11971 631.324.1200 631.287.0090 631.928.4400 631.265.1414 631.765.2300 IlilllllllllllllllllllllllllNIIIIIIIIIIIIIIIIIIIIIIIII . Illlllllllllllulllllllil SUFFOLX COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of instrument: DEEDS/DDD Recorded: 02/15/2006 I Number of Pages s 7 At s 1105 s 21 AN Receipt Number t 06-0015812 i TRANSFER TAX NUMBER: 05-27540 LIBER: D00012436 PAGE: 046 District: Section: Block: Lott 1000 009.00 01.00 009.002 ZKAM33MD AND CHARGED AS FOLLOWS Deed Amounts $625,000.00 Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $21.00 NO Handling $5.00 NO COE $5.00 NO NYS SRCHG $15.00 NO EA-CTY $5.00 NO PA-STATE TP-584 $5.00 NO Cert.Copies $165.00 NO $0.00 NO T $70.00 NO S� RP $0.00 NO Transfer tax $0.00 NO Co=.Pres $11,000.00 NO Fees Paid $11,291.00 TRANSFER TAX NOMBERs 05-27540 THIS PAGE IS A PART OF THE INSTRUMMT THIS IS NOT A BILL • _ ,- Irk � � i 2 1 RECORDED ; 20D6•Feb 15 1105t21 AM ;I Numberorpages CLERKOF jl SUFFOLK COUHTY ' TORRENS L D00012436 i P 046 Serial N DTI 05-27s4o Certificate tl - i Prim Qf N Deed/Mortgage lnatrorttaml Deed!Monplie Tax Stamp Recording/Filing Stumps. 4 FEES I� i Page/Filing Fee _.. Mortgage Aml. {I l Handling 1.Basic Tax i 7P-594 2.Additional Tax Notation .)- Sub Total I i, EA-5217(County) _�� Sub Total SoecJAssiL /6 Dr EA-6217(State) Spec./Add. R T.S.A. - TOT.MTG.TAX Dual Town Died County Carom.or Fa. 5 QO Held for Apportionment I: Affidavit �e Transfer Tax Certified Copy Mansion Tax The property covered by this mortgage is or . opy will be Improved by a one or two family ReC i I .a�- dwelling Sub Tata) / YESO YES' or NO Other GRAND TOTAL_(�__2_._. }'If N0,see appropriate tax clause an pageNl a' orthi /v�Sds-d 5 Rol Property Tax Service Agency Verification a Commu i Preservation Fund n'"-'• .r^t Consideration Amount 0600gU3 1000 00900 0100 009002 p T S 1000 00900 0100 009001 CPF Tax Due. ' '�S 0 pCWA A 1000 00600 0500 007000 Date t Initials Vacant Land 1 Satisfaction/Discharges/Releases List Property Owners Mailing Add RECORD&RETURN TO: \'A TO 1(\.c�nara��"Q(1.�ba.lvst sES�Y TD Ke�V+�M'� �.Llb+•Wj ��\ '�KOCI.m�+.slC1.w.1 �..�� a Title Company Information ��, v� • �� \3 Co.Name Title N fV-% ' o N Suffolk County Recording & Endorsement Page This pogo fonts panbf dx:m1wIxxl nude by: RECIFY TYPE OF INMRUIv47•ff) S\=Nlc-m ruLk (4,r� ag=j The premises herein is situated in an �tp� SUFFOLK(AUNIY.NEW YORK. TO In the Township of. Sr7`12 adv In the VILLAGE or HAMLET'of ISUXIZj THRU 9 MUST BE TYPED OR PRMW IN BLACK INK ONLY PRIOR TO RECORDING OR RUM. EXECUTOR'S DEED THIS INDENTURE,made as of January 4,2006, BETWEEN UNITED STATES TRUST COMPANY OF NEW YORK, a corporation having its principal place of business at 114 West 470.Stmt,New York,New York 10036,as executor of the Last Will and Testament of Pauline D. Webel, a/k/a Pauline Dodge, f/k/a/ Pauline Dodge Pratt,late of 1089 Cedar Swamp Road,Glen Head,New York 11545,who died on the 210 day of October, 2003, party of the fast part, said will being probated in the Nassau County Surrogate's Court on October 30,2003 as file no.330413,and THOMAS J. SHILLO, having an address at P.O. Box 202. Fishers Island, New York 06390,pony of the second part, C4o 1^fCM•s tottmw",B 6 qo 10004 d..lo'6r t i-8 'r-a.t-%4 U WITNESSF,TH,that the party of the first pan,to whom letters testamentary were issued by the Surrogate's Court,Nassau County,New York on November 26,2003 and by virtue of the power and authority given in and by said last will and testament, and/or by Article 11 of the Estates, Powers and Trusts Law, in consideration of Six Hundmd Twenty-Five Thousand and 00/100 Dollars(5625,000.00)paid by the pony of the second pan,does hereby grant and release unto the party of the second pan, the distributees or successors and assigns of the party of the second pan forever, ALL that certain plot, piece or parcel of land, with the buildings and improvements .thereon erected,situate, lying and being at Fishers Island, in the Town of Southold,County of SulTolk and State of New York,being bounded and described as follows: District 1000,Section 009.00,Block 01.00,Lots 009.001 and 009.002 BEGINNING at an iron pipe at the most Southerly comer of the herein described tract at land now or formerly of Fisher Island Utility Company,said point being 3560.80 feet North of a point which is 2349.05 fat West of a monument marking the U.S.Coast and Geodetic Survey Triangulation Station"PROS",and THENCE RUNNING North 06 degrees 31 minutes 20 seconds East, 76.15 feet to an iron; ' THENCE North 19 degrees 42 minutes 50 seconds East, 149.00 feet to an iron; THENCE North 41 degrees 18 minutes 20 seconds East, 103.24 feet to an iron; THENCE North 17 degrees 45 minutes 25 seconds West, 108.76 feet THENCE South 64 degrees 32 minutes 50 seconds West,456.96 feel; THENCE South 28 degrees 39 minutes 30 seconds East, 105.31 feet; THENCE South 55 degrees 28 minutes 30 seconds East, 108.91 feet; THENCE along lands now or formerly of Jennifer Miller, South 73 degrees 48 minutes 30 seconds East,97.20 feet; THENCE along lands now of formerly of Kevin E.Grant and Valerie J.Kinkade,South 76 degrees 28 minutes 30 seconds East,70.08 fat and South 70 degrees 39 minutes 24 seconds East,20.01 fat,to the point of BEGINNING. TOGETHER WITH a right of way for use as a roadway over a strip of land twelve(12) feet in width,running from the Southwesterly end of Sappho Road,across lands now or formerly of Fishers Island Farms,Inc.to the Northwesterly line of premises acquired by Frederic R. Pratt from West End Land Company,Inc.by decd recorded in Liber 5709 Page 95,said right of way being specifically bounded and described as follows: 1328210.1 wunu BEGINNING at a point at the Southwesterly end of Sappho Road, said point being 4184.95 feet North of a point which is 2305.62 feet West of said"PROS"monument;and THENCE running South 54 degrees 16 minutes to 00 seconds West,50.00 feet: THENCE South 12 degrees 30 minutes 00 seconds West, about 58.00 feet to the Northwesterly line of premises conveyed to Frederic R.Pratt by West End Land Company,Inc.; I THENCE North 54 degrees 16 minutes 00 seconds East, along said lands acquired by Frederic R.Pratt about 19.00 feet; THENCE North 12 degrees 30 minutes 00 seconds East,about 38.00 feet; THENCE North 54 degrees 18 minutes 00 seconds East,about 50.00 feet,to said Sappho Road line; THENCE along said mad line North 56 degrees 25 minutes 00 seconds East,about 12.50 feet to the point of BEGINNING. I SUBJECT to the following covenants and restrictions which shall run with the land: 1. The above described premises and any buildings erected or to be erected thereon shall I be used for residential purposes only,and shall not be used for any commercial use or purpose whatsoever, except however the premises or any part thereof may be rented for residential purposes only. 2. The buildings erected or to be erected on the above described premises shall be limited to two one-fatnily residences and accompanying garages. I AND I District 1000,Section 006.00,Block 05.00,Lot 007.000 ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate, lying and being at Fishers Island, in the Town of Southold,County of I Suffolk,State of New York,being bounded and described as follows. BEGINNING at a stone monument on the Southeasterly line of Sappho Road, said monument being 4167.46 feet North of a point which is 2263.54 feet West of another monument marking the U.S.Coast and Geodetic Survey Triangulation Station"PROS"and THENCE running along said Sappho Road line North 60 degrees 49 minutes 30 seconds East,104.72 feet to an iron; THENCE South 27 degrees 15 minutes 00 seconds East, 108.05 feet to an iron; THENCE South 15 degrees 03 minutes 00 seconds West, 117.23 feet; THENCE South 64 degrees 32 minutes 50 seconds West,570.96 feet; THENCE North 02 degrees 35 minutes 55 seconds West, 192.55 feet; THENCE North 73 degrees 25 minutes 30 seconds East,214.88 feet to a monument; TIIENCE North 54 degrees 16 minutes 00 seconds East, 257.34 feet to the point of BEGINNING. SUBJECT to two (2) certain rights of way ten (10) feet in width reserved in favor of Fishers Island Electric Corporation and in favor of Fishers Island Telephone Corporation for the installation,maintenance and repair of overhead and/or underground electrical and/or telephone lies,the center lines of said rights of way being described as follows: 1328210.1 2 , I. BEGINNING at a point on the Northwesterly line of the above described use said point being 414170 fat North of a point which is 2299.34 feet West of said"PROS"monument and thence running South 48 degrees 23 minutes 40 seconds East about 194 feet; 2. BEGINNING at a point on the center line of the above described right of way,said point being 4043.27 feet North of a point which is 2184.52 feet West of said"PROS'monument and thence running north 33 degrees 45 minutes 50 seconds Fast about 105 feet. SUBJECT further to a certain right of way ten (10)feet in width reserved in favor of Fishers Island Farts,Inc. for the installation,maintenance,repair or replacement of the present existing water lines or pipes, running across the Easterly end of the above described premises, and running Southeasterly from Sappho Road and along,or approximately along and parallel to lands now or formerly of Wallace Calney. Being and intended to be the same premises as conveyed by Frederick R. Pratt by deed from Fishers Island Farms,Inc.,a domestic corporation,dated February 20, 1%5 and recorded in the Suffolk County Clerk's Office on March 3, 1965 in Liber 5709 Page 99,as to Parcel 1;and by deed from West End Land Company,Inc.,a domestic corporation,dated February 23, 1965 and recorded in the Suffolk County Clerk's Office on March 3,1965 in Liber 5709 Page 95,as to Parcel 11. TOGETHER with all right,title and interest,if any,of the party of the first part in and to any streets and roads abutting the above described premises to the center lines thereof. TOGETHER with the appurtenances and also all the estate which the said decedent had at the time of decedent's death in said premises,and also the estate therein,which the party of the first part has or has power to convey or dispose of,whether individually,or by virtue of said will or otherwise. I TO HAVE AND TO HOLD the premises herein granted unto the party of the second pan,the distributees or successors and assigns of the party of the second pan forever. AND the party of the first pan,in compliance with Section 13 of the Lien Law,covenants that the party of the first pan will receive the consideration far this conveyance and will hold the right to receive such consideration as a tout fund to be applied first for tbe purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any pan of the total of the some for any other purpose. The word 'party" shall be construed to read 'parties' whenever the sense of this indenture so requires. 1329-210.1 3 IN WITNESS WHEREOF, the party of the first part has duly executed this decd the day and year first above written. UNITED STATES TRUST COMPANY OF NEW YORK,as Executor of the Last Will and Testament of Pauline .Webcl By: Roger W.Kurnmert i Vice President f i ta2ana� 4 STATEOFNEWYORK ) COUv�ssCOUNTY OF ��� u On the L day of Qeccmiei in the year 2005 before me the undersigned, a Notary Public in and for said State, personally appeared Roger W. Kummcrt, personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity, and that by his signature on the instrument,the individual,or the person upon behalf of which the individual acted,executed the 'J� instrument. •O�i r0 /J a- O�rartle�paa'�RIM C , Notary Public (Notarial SM) r� I 1329210.1 5 Mid n � mi H 1000 10060D 0500 012001 ,u,. a; ,y ..® T -u®�..r .5TII,:"',i. �J, f:e' •.G w 000 0590 2- 1—M ,�,y,n }uARKER ELLEN MCCAKE I I 1 0 a-v= gmil y� n y vAR , X975 0 _ dv toxo intim 0590 olmo 012001 -�. I w i a zi w�w,w.waawuia.zu:�unemmu,r�r FM MINOR SOBOMSION PIAN FOR ECPABETN MCCANCE � r =�'� .rt--q i ii 090A3I 14P lEfizaboth F Mc Canca i., C60t3 �j iP Elizabeth F Mc Cance `. a 1. I` and 3 00 4''r� kw Itrun. °1100 PENN Mllmo. 428 119658275 I1 2 $ Imem ) cot Number of page[ 165Tf TORRRNS MAY 261109 99 MAI 26 FM 2155 sergls EUV,,*,.,o '. AGNAINE Cenincatoa TR TAIL LRK OF kqmx SUFFOLK COUNTY Prior Of.e 4 Deed I Mortgage Innmment Dead I Monpge'fax Stomp Recording I Filing Stamps eFKIIS Page I Piling Fee ( Mortgage Amt. �. Ilmdling I.nadc Tax T'P•7Re S 2.Additional Tax Notation Wb Total IA-32 17(County) _ 3 Sub Total "JAeea. RA•5211(State) c Or �aZL _._ Spec./Add. RP.T.S.A. .5 TOT.M'1 0.TAX 7 Comm,0111d. _ 3(a— ` �, � HodforAp_WelCounty_� m IUW for Apportionment Affidavit e Transfer Tax Certiaed Copy 94 Mandan Tax Tho properly covered by this monpye low µ1g,copy will be Improved by a ane or two family Sub totaldwelling only, Other �' YCS or NO ORANU TOTAL If NO,we a�o—pine tax clause on page x i — afth a Instrument. S, h, Real) y 1'axService A a VaiOcntlon a Contritunity ProsarvatlunFund `r Dist. Semon Il lock 1.01 <r n malderailerl Amount unp1000 006.00 .qLa" (.YDS OoL CI31"Una Duo $ N/A IMtlilf v (NIRW NUMB IR)= ��IV� seem Land. (X 7 Salbfac lon✓DlachargWµda 1,61['toppeenyy Ownen Malllrg Add — D 1_ r RRCORD,RRTUHNT'01 MAY 261099 •D LARK f, VOLTS RSQS COMMUNITY D MAIN RD PRESERVATION P 0 ROX 977 IVUND t CUTCROGUR MY 119330977 i I Title Company Information Co. Name µ/A 'Title x N/A Su folk Count Recordm & Endorsement Page This pty(a faire pan of the attached Died !_made by. `r, Thoeau McCana, Jr. and his vire, (SPECIPYTYPE01'INMUMM) I, rrancins J. McComas, as Trustees of the Fishers un Ihcprcmiscahcminlailttmlydin sot ee coos runt er t Aareaeent datedAsril 17. 1995 SURFOLKCOUNTY,NEW YORK d To lathe"foxxlWdpaf Southold Rllen McCance Parker In the VILLAGE r ofILAMLL"I'of Fishers Island BOXES S 11IRU 9 MUSTUB TYPED OR PRINTED IN BLACK INK ONLY PWOR'ITO RE(DRDING OR FILING. Page I of 3 ( I ttra rse xe cease sane NOIY.-w,y.,�wrnrMNt1M Cn.w,e,r,l e,e",d,Mu—W„uru er preere,Me.dr 601"T vase LAWYER N n TNN sMTIYA1611T-vm sNl'6YMwlT 9N111"N ALkwvm way. 110 N.Y.B. lllAl 86TASI 9/83 THavo��made tlr 20th day al MAY aloetern huhu"esd ninety-nine ' BTAIRA tlgr*UN TNOM�ae M ,r a�u„S•!. 3A. end hie tai!■. PAauefu! d. MCCkNc!z ■■ RIQOLAID Tevet■■■ e[ El+e OTAUAe■ rAL.awn ■lATnlNC! TsnATnnd■r -reem■n! dated A ri1 ,7. isea, residing At 26 Cliftwood Attest, Lenox, Massachusetts 01260.5196 party of the Ant Pam sled er.eeu Me Aur! sot■len, residing at 171 San Marcos Avenue, San Francisco. California 96116 i piny of the second pan, Vptl'MR10 1,that the party of the Ant Paprt In aenddemlon of Ton Dollars and other valuable conaldendon paid by IM pony of ft weond pan,doe berth;pal and relwe unto the party of the NWA pan,the bels or suteeeas and wlpu of the potty of The WoM pan lorwe►, ALL that cenaln plot.Plac -,eieNdhya�nd-Ye�ravwlww6VA 0 4NMA4 ekuaN, tAaodbdnA MNte ere ►�tiher■ Island, Town et Aoutho d, County of Suffolk and tate of New York, being bounded and described as follows ,.ol SIOINNINO at a point located at the southerly corner of the herein described tract, said point being located 6012.57 Leet north of a point which is 2666,65 test wet of a monument marking the U.A. Coast And geodetic Survey Triangulation station "PROS" and thence running North 62- 11' 13" Nest 56.61 feet to A point) thence North 32- 16' 01" last 70.69 fest to a point) thence South 26- 35' 200 last 91.09 feet to the point of SIOINNINO. BRING AND INTINDID TO AA part of the same premises conveyed to the party of the first part by deed dated April 21, 1995 and recorded In the Suffolk County Clark's Office on June 26, 1995 in Liber 11710 page 662. The above described property containing 1,262 square feet will be added to and merged with the adjoining parcel aimed by the party of the second part by dead doted July 16, 1993 and recorded in the Suffolk County Clerk's Office on October 6, 1993 in Liber 11666 Page 647 (11M% A1000- 006.00.05.00.012.000) . TAX Aur NATIO`! 1000 •rOORTIIRR with it rllhl,Fide and Int►mt.11 any,of the party of the Arm art In and to any attests and rood.abutting the AWvs deescribed premises to the tenter linea thereof t TOGVHRR whit the appurtenances 006.00 and All the estate and rlhis of the party of the first pan In and to rid pnmleal TO HAVR AND TO HOLD tM premier heilh Iranted unto the party of the second part,the Min or smeeon and Asigns of 05.00 the party of the second part forever. tP/0 3.006 AND the party of tim Ant pan covenants that the party of the Ant pan has not done or suffered anything OOwhereby the said premlees he"been encumbered In any way whatever,except at aloretald. AND the Party of the Anr pan,in tomyylianee with Section 13 of IM Lim 4w,oownanu that the party of 1M Ant part will receive the consideration for this conveyance and will hold thedshl to reel#atNh consw. trillion Asa treat fund to be applied Alit for the purpose of paving 1M tat of tM im t and vdll apply, .1 the same Are 10 the paynwm of the tat of tM imp evemsot lore uing any pen IM ltAal of tM same for any other Qurpae. The word'party"Abell be consirued as If It read"panle" whonaa the sense of this Indenture■o reasdra. IN WffNW W(N11RW1,the party of the first pan has duly exauled this dead the day and year Ant above written. Ix rawxea or: �p f � Thomas McCann , Jr., as ':ruates Francine J. wance, as Trustee euOesme M op 39 11IS beton me w cal 1006 day so ITATI SERYE &w the IV VA.day of Mbn nIe personally Y MCCANCE n me known to be the Individual dsseribd In and who to me known to be the Individual described In and who extevid the foregoing Instrument, and acknowledged that executed the Ion oing Instrument, and Acknowledged that Its ex cutd IV some, she exautd lha IM, ury Public qjetary Publicr G •. ;tnolw�mu; le"him A,B Cee�& msoodaim Co- 11 M Yd " ab :21i ITA"W NOW YMIL COUNTY 01 est $TA"OF NIW YORK,COOIRY 01 ssl On the day of 19 before me On the day of 19 kora me per&orully came personally tame to me known,who,bel by me duly &worn,did depose and the subscribing witness to IM Iongoing Instrument, with say that he resift At No. whom I am personally acquainted who being by me duly I sworn,did depose and soy that ha MIG at No. that he Is theof that Mknowa the corporation describe In and which executed the foregoing Instrument; that he to be the Individual knows the Mal of said torpontlon; that the sual aMxd described in And who executed the foregoing Instrument to uid In&trumont Is such ccrporato seal; that it was so that he, raid subscribing witness, was present and sow alllxd by oder of the board of directors of uid torpors• execua the game;and that he old witness, ton, std that he signed It name thence by like oder. et the tame time subscribe h namt as wrteau thereto, W I I NCANT Ain l 1belt Bell 1 AC I f IaCTION TtTa No. It= LOT THOMAB MoCANCE, JR, and his wife, FRANCINE J. cx1UNrY OR TOWN MoCANCE. es Trustees of the FISHERS ISLAND RESIDENCE TRUST under Agreement dated April 17, 1995 TAX PILLING ADDaas TO ELLEN MGCANCE PARKER %GWMAIbNAMIOr IWOWN&IMM-rs- RMKM BY MAIL TOI LARK { FOLTS ESpt MAIN ROAD . P 0 BOX 973 CUTCNOOUS NY 11933-0973 TICOR TITLE GUARANTEE w Ne Pass 3 of 3 . �99 f M 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 puroose 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: 5k�"tD 1 C� , =' -` (L-7 (Last name,first name,middle initial,unless youVe 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.) cn c NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring C-' ption from plat or official map Planning he r� `�� (If"Other',name the activity.) 12e–& OU�nS it CL 0+- L–l`r`4 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 interesr 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 NO X 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 Title or position of that person 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 Submitted this day of 200 ©( Signature Print Name Layyef l -ze-� Form TS 1 } \ v � a LASER FICHE FORM SUBDIVISIONS ESCANNED JUN 1 4 2007 Prosect Type: Lot Line Changes Records Management Status: Final Approval SCTM # : 1000 - 6.-5-7 Project Name: Parker/Shillo Location: Located at the terminus of Sappho Road, north of Central Avenue on Fishers Island. Hamlet: Fishers Island Applicant Name: Ellen McLance Parker Owner Name: Thomas J. Shillo Zone 1 : R-80 Approval Date: 6/11/2007 PLAT Signed Date: &h 2/D '7 OPTIONAL ADDITIONAL INFORMATION A date indicates that we have received the related information Zone 2: Zone 3: Cand R's : Homeowners Association R and M Agreement: Address: Sappho Road, Fishers Island County Filing Date: SCAN Date: