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Home My WebLink AboutTR-6538A l Glenn Goldsmith,President ®g s®U��. Town Hall Annex A. Nicholas Krupski,Vice President ®� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 C®Uf19�,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 14, 2023 Patricia C. Moore, Esq. 51020 Main Road Southold, NY 11971 RE: JOSEPH BUCZEK & CHRISTINA SPORNBERGER 1605 NORTH PARISH DRIVE, SOUTHOLD SCTM# 1000-71-1-15 Dear Mrs. Moore: .On September 11, 2023, a Field Inspection was performed and it was determined that the work was not completed on the above-mentioned property as permitted under Wetland Permit#6538A. Permit is expired. The following action was taken at the Southold Town Board of Trustees regular meeting held on Wednesday, September 13, 2023: RESOLVED, that the Southold Town Board of Trustees DENIES the request for a Transfer of Administrative Permit#6538A from Bernard and Carol Kiernan to Joseph Buczek & Christina Spornberger, as issued on March 21, 2007. If you have any questions, please contact our office at (631) 765-1892. Sincerely, Glenn Go smith President, Board of Trustees GG/dd i 1 m gOFF04 Glenn Goldsmith,President �0 419, Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 CO Eric Sepenoski 0 ,? P.O.Box 1179 Liz Gillooly �A • o�� Southold,NY 11971 Elizabeth Peeples l �a Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: 11 W3 Completed infield by: A116 0 4 k PtGql?j Patricia C. Moore, on behalf of JOSEPH BUCZEK & CHRISTINA SPORNBERGER requests a Transfer of Administrative Permit#6538A from Bernard and Carol Kiernan to Joseph Buczek & Christina Spornberger, as issued on March 21, 2007. Located: 1605 North Parish Drive, Southold. SCTM#: 1000-71-1-15 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other Typ"f Application: Wetland Coastal Erosion Amendment V Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: 2 ErArttryctS (r�xkcrtar) tb WI&Y- }r*Ae Whas emir t t� Present Were: G. Goldsmith N. Kr ski E. Sepenoski L. Gillooly N. Peeples t Ls ID Ecce 'u , E PATRICIA C. MOORE Attorney at Law A U G 1 7 2023 51020 Main Road Southold,New York 11971 Southold 'Town Tel: (631)765-4330 Board of Trustees Fax: (631)765-4643 August 17, 2023 Board of Trustees Town of Southold PO Box 1179 Southold NY 11971 hand delivered RE: PERMIT TRANSFER Dear President and Board: Please let this serve as a permit transfer request of permits: #483, #5171, #10236, #6713A, #6538A, (copies enclosed) for property located at 1605 N. Parish Drive, Southold NY 11971 (sctm:1000-71-1-15) from Kiernan and McCulloch-to Joseph Buczek and Christina Spornberger. They just purchased last week; I am also enclosing a copy of their deed. I am enclosing the Affidavit signed by the owners , authorization and disclosure together with my escrow check in the amount of$500.00 for said fee. Thank you and please do not hesitate to call should you have any questions. Verytours, riicia C. Moore PCM/bp encls. r.� ard of Trustees Applicat AFFIDAVIT CBEING DULY SWORN DEPO ES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Si a f ro Owner /Signature of Pr erty Owner t SWORN TO BEFORE ME THIS DAY OF r Public BETSYA. PERKINS Notary Public,State of New York No. 01 PE6130636 /. Qualified in Suffolk Cou9�J Commission Expires July 18, ; Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) , I/We, owners of the property identified as SCTM# 1000- _ _in the town of New York, hereby authorizesr�^ to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. Pro wn is Wgnature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF AiL [�t S , 20 No ublic 1 BETSY A. PERKINS Notary Public,State of New York No. 01 PE6130636 Qualified in Suffolk Count J, Commission Expires July 18, 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 emnlovees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same YOUR NAME: CZ ek JO (Last name,first name,diddle initial,unless you kr6 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 Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) l_. M 1 --Q2 A-70-S r� 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 NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title br position of that person Describe the relationship between yourself(the applicarit/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): _aA)the owner of greater than 5%of the shares of the corporate stock of the applicant _n (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 of 20 L J x Signa e a Pri ame j b Form TS 1 Y -e' �/ ac /:4- C-fl 00 — 02 007 3 Bargain and Sale Decd, with Covenants against Grantor's Acts—Individual or Corporation. CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUiMENT—THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY. THIS INDENTURE, made the 3 r day of August, 2023 BETWEEN KENNETH McCULLOCH AND ELIZABETH McCULLOCH, husband and wife, residing at 15 Middle Dr., Plandome,New York 11030 party of the first part, and JOSEPH BUCZEK and CHRISTINA SPORNBERGER, husband and wife, residing at 3895 Wells Ave., Southold,New York 11971 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 in the hamlet of Southold,Town of Southold, County of Suff6lk and State of New York, known as 1605 North Parish Drive, Southold,New York, and which said lot is more particularly bounded and described as follows: See Schedule"A" attached. BEING AND INTENDED TO BE the same premises described in a deed made by Bernard W. Kiernan,Jr. and Matthew G. Kiernan, as Executors of the Estate of Bernard W. Kiernan,late who died on July 13, 2010 and recorded November 16, 2020 in Liber 10378, at page 196. 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 all the estate and rights of the party of the first part in and to said 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. AND the party of the first part covenants that the party of the first part has not done or suffered anything whereby the said premises have been encumbered in any way whatever, except as aforesaid. AND the party of the first part, in compliance with Section 13 of the Lien Law, covenants that the party 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 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 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. 1 FIDELITY NATIONAL TITLE INSURANCE COMPANY TITLE NO. 7404-016601 SCHEDULE A-1 (Description of the Land) For Tax Map ID(s): 1000-071.00-01.00-015.000 ALL that certain plot, piece or parcel of land, situate, lying and being at Bay View, in the Town of Southold, County of Suffolk and State of New York, bounded and described as follows: BEGINNING at a point on the northerly line of North Parish Drive which said point is distant 70.0 feet westerly along said northerly line from its intersection with the easterly line of Northfield Lane, from said point of beginning; RUNNING along said northerly line of North Parish Drive, North 71 degrees 24 minutes 50 seconds West, a distance of 155.0 feet to land of Hoolahan; THENCE along land of Hoolahan, North 18 degrees 35 minutes 10 seconds East a distance of 164 feet, to ordinary high water mark of Southold Bay/Peconic Bay; THENCE easterly along said high water mark, 155 feet more or less to a point which is a tie line course and distance of North 88 degrees 43 minutes 20 seconds East 164.81 feet; THENCE along land now or formerly of H. Sayre, South 18 degrees 35 minutes 10 seconds West a distance of 220.0 feet, to the point of BEGINNING. THE POLICY TO BE ISSUED under this commitment will insure the title to such buildings and improvements on the premises which by law constitute real property. FOR CONVEYANCING ONLY: Together with all the right, title and interest of the party of the first part, of in and to the land lying in the street in front of and adjoining said premises. END OF SCHEDULE A Commitment for Title Insurance Printed: 07.25.23 @ 04:19 PM Schedule A-1 Description NY-FT-FRVH-01030.431004-SPS-1-23-7404-016601 IN WITNESS WHEREOF,the party of the first part has duly executed this deed the day and year first above written. IN PRESENCE 0 G ntor: Grantor: KE ETH McCULLOCH ELIZABE H CULLOCH STATE OF NEW YORK ss.. COUNTY OF tit On the 3 day of August, 2023 before me, the undersigned, personally appeared Kenneth McCulloch personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to 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 instrument. Notdy ' BRIAN A. ANDREWS Notary Public, State,Of New York No. 02AN5014509 Qualified In Suffolk County Commission Expires 07/15/.. STATE OF NEW YORK ss.. COUNTY OF On the day of August, 2023 before me, the undersigned, personally appeared Elizabeth McCulloch personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to within instrument and acknowledged to me that she executed the same in her capacity, and that by her signature on the instrument, the individual, or the person upon behalf of which the individual acted executed the instrument. No ry ANDREWSBRIAN A Notary Public, State Of w York No. 02AN5014509 mf�15untiComission Expivalitied In res � 2 1 BARGAIN AND SALE DEED WITH COVENANTS Title#7404-019901 Grantor: KENNETH McCULLOCH And ELIZABETH McCULLOCH TO Grantee: Joseph Buczek and Christina Spornberger ADDRESS: 1605 North Parish Dr. Southold,New York 11971 DISTRICT: 1000 SECTION: 071.00 BLOCK: 01.00 LOT: 015.000 TOWN: Southold COUNTY: Suffolk Record and Return to: Patricia Moore, Esq. 51020 Main Rd, Southold,NY 11971 3 Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 17, 2010 Ms. Ruthie Love McCarthy Management, Inc. 46520 Route 48 Southold, NY 11971 RE: BERNARD & CAROL KIERNAN 1605 NORTH PARISH DRIVE, SOUTHOLD SCTM# 71-1-15 Dear Ms. Love: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, March 17, 2010: RESOLVED that the Southold Town Board of Trustees grants the last One-Year Extension to Permit ~6538A, as isSued on March 21, 2007. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, President, Board of Trustees JMD:eac McCarthy Management, Inc March 11, 2010 Town of Southold Board of Trustees P.O. Box 1179 Southold, NY 11971 RE: Extension on permit # 6538A Dear Lauren: Please let this letter serve as written request for a one year extension on permit # 6538A, to construct two exterior entrances to cellar. Applicants are Bernard & Carol Kieman, 1605 North Parish Drive, Southold. I understand that your next meeting will be held on March 17, 2010 at which time this request may be addressed. Enclosed, you will find a check in the amount of $50.00 for the extension fee. ~ S.~.in rely~x~_~ , Ruthie Love Office Manager enc 46520 Route 48 Southold, NY 11971 Tel. 631.765.5815 Fax.631.765.5816 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hail Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD March 18, 2009 Ms. Ruthie Love McCarthy Management, Inc. 46520 Route 48 Southold, NY 11971 RE: BERNARD & CAROL KIERNAN 1605 NORTH PARISH DRIVE, SOUTHOLD SCTM# 71-1-15 Dear Ms. Love: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, March 18, 2009: RESOLVED that the Southold Town Board of Trustees grants a One-Year Extension to Permit #6538A, as issued on March 21, 2007. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, James F. King President, Board of Trustees JFK:eac anagement, Inc. 46520 Route 48, Southold, New York 11971 (631) 765-5815 (631) 765-5816 FAX FEB 2 3 2009 February 20, 2009 Town of $outhotd Board of Trustees P.O. Box 1179 Southold, NY 11971 RE: Extension on permit # 6538A Dear Lauren: Please let this letter serve as written request for a one year extension on permit # 6538A, to construct two exterior entrances to cellar. Applicants are Bernard & Carol Kiernan, 1605 North Parish Drive, Southold. I understand that your next meeting will be held on March 18, 2009 at which time this request will be addressed. Enclosed, you will find a check in the amount of $50.00 for the extension fee. Ruthie Love Office Manager enc Construction Management · General Contracting · Custom Homes McCARTHY MANAGEME~ INC. 46520 Coun~ Road 48 SOUTHOLD, NEW YORK 11971 (631) 765-5815 FAX(631) 765-5816 ATTENTION RE: WE ARE SENDING YOU [~ Attached [] Under separate cover via > [] Shop drawings [] Prints ~ Plans [] Samples [] Copy of letter [] Change order [] the following items: [] Specifications THESE ARE TRANSMrl-rED as checked below: [] For approval [] For your use [] As requested [] Forreview and comment [] FOR BIDS DUE [] Approved as submitted [] Approved as noted [] Returned for corrections [] [] Resubmit [] Submit [] Return copies for approval copies for distribution corrected prints [] PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO PRODUCT 240T SIGNED: If enclosures are not as noted, kindly notify us at once. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. 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 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. INSPECTION SCHEDULE __ Pre-construction, hay bale line __ 1st day of construction ½ constructed l'///~Project complete, compliance inspection. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. 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 Please be advised that your application dated /')~r-~,/,~ ~)¢ ~(::PO'~ has been reviewed by this Board at the regular, meeting of /')3~fc.[n ,~1..,2OO2' 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 Chapter 97 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: BY: James F. King, President Board of Trustees James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. 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 Permit No.: 6538A Date of Receipt of Application: March 9, 2007 Applicant: Bernard & Carol Kiernan SCTM#: 71-1-15 Project Location: 1605 North Parish Drive, Southold Date of Resolution/Issuance: March 21, 2007 Date of Expiration: March 21, 2009 Reviewed by: Trustee Bob Ghosio, Jr. Project Description: To construct two exterior entrances to cellar. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the survey received on March 9, 2007 and approved March 21,2007. Special Conditions: None Inspections: Final inspection If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. J~ames F.~K in ,'~resident Board of Trustees JFK:eac SOUTHOLD TRUSTEES Issued To ~~~(~~~~ Date~ Address/i~~~ ~'~ I~-;v~_. ~~~ THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765-1892 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. 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 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: Name of Applicant: Name of Agent: '~4,,,rs 3 , Property Location: SCTM# & Street Type of area to be impacted: __Saltwater Wetland Freshwater Wetland Sound Front Bay Front Distance of proposed work to edge of above: Part of Town Code proposed work falls under: __Chapt.97 Chapt. 37 other Type of Application: Wetland __Coastal Erosion __Amendment l~dministrative __Emergency Info needed: Modifications: Conditions: Present Were: __J.King __J.Doherty __P.Dickerson Other: D. Bergen ~ Bob Ghos±o, Jr. Mailed/Faxed to: Comments of Environmental Technician: Date: FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17387 Date OCTOBER 6~ 1988 THIS CERTIFIES that the building ADDITION Location of Property 1605 NORTH PARISH DRIVE House No. Street County Tax Map No. 1000 Section 71 Block 1 Subdivision Filed Map No. SOUTHOLD ~ N. Y. Lot 15 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 16, 1988 pursuant to which Building Permit No. 17127~Z dated JUNE 20f 1988 __ was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is DECKING ADDITION AS P~R~IT~ED BY ZBA #3715 AS APPLIED FOR The certificate is issued to BERNARD & CAROLE KIERNAN (owner, of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 FORM NO. 6 TOWN OF $OUTHOLD Building Depe~nt Town Hell Southold, N.Y. 11971 765- 1802 APPLICATION FOR CEPTIFICATE OF OCCUPANCY In~truotione D ' BLDG. DEPL TOWN OF $OUTHOLD A. Thia application mu~ be filled in typewriter Off ink, and mbmltted -. Imm.m~ to the Building In~ec- tot with the following; for newbulldings or new ute: 1. Final mrvey of property wish accurate location of ell buildings, property lines, meets, and unusual natural or topographic featura~. 2.Final approval of Health Dept. of water ~uppl¥ and sewerage di~osal--(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4, Commercial buildings, Industrial buildings, Multiple Residences end sitnllar buildings and installa- tlone, a certificate of Code compliance from the Architect or Engineer re~ponelble for the building. 5.Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1967), Non-conforming ubs, or buildings and 'pra-exi~tJng" land usas: 1. Accurate survey of p~operty showing all property lines, ~treets, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner as to ute. occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. 'C. Fees: 1. Certificate of occupancy $5.00 , 2. Certificate of occupancy on pre-existing dwellina $15.00 3. Copy of certificate of occupancy $1.00 4,V~.cant. ~.and C.O. $5.00 5.Upda~.ed C.O. $15'.00 Date .. ~. ..... ,~ ....... NewBulldlng...×.........OIdorPre.exl~ingduliding ............ Vacant Land .................. 1605 h Drive .............. Location of Property North Paris , Southold, NY Hou~ N~ 6'treat H~mlet Owner or Owners of Property .......... ~ ~ ~e.~ ~,~,~..C.A~.~ ~.e..~. ~ .e .~.~.~.~. ..................... 'o7¥- . '" ............. County Tax Map No. 1000 Section .......... Blor. k ,0.1, ...... Lot... 1 Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ].7.1.g?~... Date of Permit .~./.8.~. .....Applicant Garrett S~ran9 , Arch±teat Health Dept. Approval ........................ Labor Dept. Approval ........................ Unden~riter~ Approval Planning Board Approval ' Request for Temporary Certificate ..................... Final Certificate ........ ~. ............. Fee Submittad $ ................. Conetruction on above described building and permit meets all applicable codes and regulations. Applicapt .................................................... .w. ~o.~;e GARRETT A. STRANG FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & .FLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: !212~? ~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION ZST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [~/FINAL DATE .... . _ _ ~a~e~o~ ~o~ma~on yo~ have ~ubml~ed, of Environmental Conservation has determined that the parcel ~ project ' · Greater than 300' from inventoried tidal wetlands. Landward of a substantial man-made structure /' greater than 100' ~s length which was constructe r~or to Landward of the 10' above mean sea level elevation contour on a gradual, natural slope. Landward of the topographic crest of a bluff, cliff or dune which is greater than 10' in elevation above mean sea level. Listed in Part 661.5 of 6NYCRR (Tidal Wetlands Land Use Regulatione) as a use not requirin9 a permit or notification letter of approval. Therefore,. ho permit is required under the Tidal Wetlands Act (Article 25 of the Environmental Conservation Law). Please be advised, however, that no construction, sedimentation or disturbance of any kind may take place seaward of the 10' contour or topographic crest without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or dist~bance to the ground surface or vegetation in this area as a result o'~your project. Such precautions may include providing adequate work area between the 10' contour or topographic crest and the project (i.e. a 15' to 20' wide construction area) or erection of a temporary fence, barrier, or hay bale berm. Please note that any additional work, or modification to the project as described, may require authorization by this Department. Please contact this office if such are contemplated. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. Very truly yours, gional Permit Administrator TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTIIOLD, N.Y. NOTICE OF DISAPI'ROVAL ................................ Date..'-d .,o~...W..~..'~ ~ ~K' -, File No 19~~. 'to ~ ~,,gt. .*... . .~. . . .,¥ .~:,:,~... ?~. .'z.. ..~. ~, . . . .~ ~.~4 &_. . . to :ff. , . J ~. ~ ~ ~ ....... for I,~m, it to constr,,ct. ~~.~ ........... .T.~. . ."~. ... at Location of l'rop~rty . .)..~.o. ~.....;,0.~..'~).4..~....(Q~.'.:... ,~~.g .......... t/mtso No. Streot Cotltlty ~['~× Map No. 1000 Section . .'. ~.'1 } ...... Block ..... e>.l. ...... Lot . .I..~'~ ......... Subdivi',ion ................. Filed Ma ) No ................. Lot No .................. is returned herewith and disapproved on the following grounds .{2,,,.~.~..~.. ~,~..d,-,-, ?.~.. 711.~.. ~.. _ Building Inspector HENRY P. SM[TH JOHN M. BREDEMEYER, III, President John Bednoski, J Jr. ALBEgr KRUPSKI, JR., Vice-President BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 March 25, 1988 TELF~HONE (515) 765-1892 TOWN OF SOUTHOLD Mr. Garrett A. Strang Architect Main Road, P. O. Box 1412 Southold, New York 11971 Re: Mr. & Mrs. Bernard Kiernan Dear Mr. Strang: Pursuant to your request for a waiver of the Wetland Ordinance for the above referenced, please be advised that the Trustee~ have inspected the property on March 17, 1988. The Board has approved your request for a waiver for the construction of a deck, gazebo, and stairs landward of the bulkhead. The Board declared lead agency on the remainder of the application. Should you have any questions or concerns, please do not hesitate to contact this office at the telephone nua%ber listed above. Very truly yours, John M. Bredemeyer, III President Board of Town Trustees JMB:ip cc: Bldg. Dept. HENRY P. SMITH JOHN M. BREDEMEYER, III, President John Bednoski, .;Jr. ALBERT KRUPSKI, JR., Vice-President BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 .... -,: ,,~- March 25, 1988 ' ' Mr. Garrett A. Strang Architect Main Road, P. O. Box 1412 Southold, New York 11971 Re: Mr. & Mrs. Bernard Kiernan Dear Mr. Strang: Pursuant to your request for a waiver of the Wetland Ordinance for the above referenced, please be advised that the Trustees have inspected the property on March 17, 1988. The Boa,~ff has approved your request for a waiver for the construction of a deck, gazebo, and stairs landward of the bulkhead. The Board declared lead agency on the remainder of the application. Should you have any questions or concerns, please do not hesitate to contact this office at the telephone number listed above. Very truly yours, Board. of Town Trust~_.~. Southold ,Town Board of Appeals MAIN ROAD- STATE ROAD 25 SOUTHOLD, L.I., Nty. ]1~?1 Appeal No. 37]5 TO: / ~ ...... ~ [Appellant(S)] / Mr. Garrett A. Strang, archi'tect [ as Agent for BERNARD KIERNA.~_ ~ Main Road, Box 1412 ~t a ~oet±n~ o~ tho gonin~ Board of ~ppoals ~eld.on ~ay 12, 1988, the above appeal was considered, and the action ~ndic~ted below was taken on your [ ] Request for Variance Due to Lack of Access to Property New York Town Law, Section 280-a [ ] Request for Special Exception under the Zoning Ordinance Article , Section IX] Request for Variance to the Zoning Ordinance Article X~], Section ]00-]]9.2(B) [ ] Request for Application of BERNARD KIERNAN. Variance to the Zoning Ordinance, Article XI, Section 100J1]9.2 for permission to construct additions to dwelling and accessory structure(s) within 75 feet of ordinary high- water mark along Southold Bay. Location of Property: 1605 North Parish Drive, Southold, NY; County Tax Map parcel No. 1000-71-1-15. WHEREAS, a public hearing was held and concluded on April 14, 1988 in the Matter of the Application of B~NARD KIERNAN under Appl. No. 3715; and WHEREAS, at said hearing all those who desired to be heard were heard and their testimony recorded; and WHEREAS, the Board has carefully considered all testimony and documentation submitted concerning th~s application; and WHEREAS, the Board Members have personally viewed and are familiar with the premises in question, its present zoning, and the surrounding areas; and WHEREAS, the Board made the follow, n§ findings of fact: 1. The premises in question is located on the north side of North Parish Drive with frontage (lot width) of 155.0 feet and total lot area of 29,760 sq. ft. 2. The subject premises is identified on the Suffolk County Tax Maps as District 1000, Section 71, Block l, Lot 15. Page 2 Appl. No~715 Matter of BERNARD m~mL~ERNAN Decision Rendered May 12, 1988 February 3, 1988, and Drawing A-1 dated March 8, 19~8 for all dimensions, elevations, size and shape]. · i 5. Article XI, Section 100-119.2(B) requiresiall buildings and structures located on lots adjacent tQ tidal water bodies other than the Long Island Sound to beiset back not less than seventy-five (75) feet from the ordinary highwater mark of such tidal water body, or not les~ than seventy-five (75) feet from the landward edge of the tidal wetland, whichever is the greater distance. ~ 6. For the record, it is noted that the dwelling structure as exists is presently nonconforming wtthian insufficient setback at 64 feet from the ordinary highwater mark, and 50 feet from the existing bulkhead. I 7. Also shown on the maps submitted hereunde~ are stairs and stairway landings proposed northerly of ~he deck additions which are deemed not within the purv!ew of this Board and are subject to review and consideration by the Southold Town Trustees under Chapter 97 of the Code of the Town of Southold. 8. In considering this application, the Board finds and determines: (a) that the dwelling as exists has a nonconforming setback; (b) that the variance in relation to the existing nonconforming setbacks in the area is not substantial; (c) that there will not be an increase in population density by this variance ~nd accordinglyino undue burden on available governmental facilities; (d) the grant of this variance, as conditionally noted below, wil) not produce a substantial detriment to adjoining properties; (e) the practical difficul~q.es are unique to the p~operty and are not personal in nature; (f) there is no other method feasible for appellants to pursue other than~a variance; (g) in view of the manner in which the d!ffi- culties arose and in consideration of all the aboveifactors, the interests of justice will be served by allowing!the variance, with the following conditions. Accordingly, on motion by Mr. Douglass, seconded by Mr. Grtgonis, it was RESOLVED, to GRANT a Variance under the Provibions of Article XI, Section lO0-119.2(B) of the Zoning Cpde in the Matter of Appeal No. 3715 - BERNARD KIERNAN forlthe construction of a main deck, dec'~ landing, gazebo(ahd deck construction at grade level),SUBJECT TO THE FOLLOWING OONDI,TIONS: 1. No structures be located closer than 25 feet to the outer edge of existing bulkhead; 2, The deck landing (if raised) shall be not'closer than 25 feet to the outer edge of existing bulkheadl; 3. The decks and landings remain open, unroofed and unenclosed [as proposed]; : 4. Any and all liahtinq shall be shielded to~ the 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 ', TEL.: 765-1802 Examined ' ' ~d'~°~' "~' '°' ' ", 119 '~ ?'. . Approved . .~']w'(,xc'gg~ . .~.'~.o... 9g. .~. Permit No./. V./..'~.7. ~ Disapprovedla/c. ~./.x. % .~ .~.% ..... L~, ~. ................... ?-- .................. ............ (Building lnspectorl Received. , ~~O_LO'"' -----'~T DE ~ . APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stree or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app cation. c. The work covered by this application may not be commenced before issuance of Building Permit. ' d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such .. shall be kept o~{ the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupam ' shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to ti Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building cod. o, housing code, and regulations, and admit authorized inspectors on premises and in building for necessary~inspe io _:.. ~or qame, if a corporation) Garrett A. Strong. R.A. P.O.Box 1412 Sou{hold, N.Y. ].]97] (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde: ........................................... ~r ~h~.~ ~.~, ......................................... Name of owner of premises ...B..e.r.n.q r..d..&..C, 9.r.o.]:?...K.£.~.r. 99.n' .......................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. No{ Selected Yet Plumber's License No. " " " Electrician's License No ....... 3 N of we k (check pplicable) New Building ' Addition X Alteration · ature r t : ........................... Repair .............. Removal ............ Demolition .............. Other Work ............ $ 3~, 000.00 (Description 4. Estimated Cost .......... I ........................... Fee ................................... ~ (to bo paid or~ filing this application) 5. If dwelling, number of dwelfing units .... .O.n.e. ....... Number of dwelling units on each floor .... if garage, number of cars . ,~,. ................................................................. 6. If business~.,c, ommerci~l or m, ixed occupa, ncy, specify nat~rt~ and extent of each^type of use ........... ,.,., ..... 7. Dimensio~siO~xistingstructures, fishy: Front .6o . I~*~- aU l~nth Height . . .J.l.g. .... Number o~ Stories .. Dlmens ',~a~ct.u~e, with a orions or a itio s ~ ...... 8. Dimens~o .!entire new co,nstruct~/f~ ,Front ........ Rear ........ 10. Dat of Purch.ase ...... . ..................... Name of Forro. er Owner 11. Zen or uso &strict an' which: premises' are sltu' fired " A n_ R es1 de n t ~.oe ' ~. ......................... ' 12. Does proposed construction fiolate any zonin~'l~v ...................................... ordinance or regulation: Y e a : ........... 13 Will lot be regraded Y · s ' ............................. · · ............................ Will excess fill be re~loved from premises: X Yes 14. Name of Owher of premises K~. p.r non ~4,q~ ................. , ~ ................... ess PJ. ainvJ, ew N.Y..PhoneNo. 433-0873 Name of Archite~:t ...... .$.t:.. q .n.g .............. Address ' $ o u 1; lq o ~, d Phone No. 'f ~ ~- ~5'~J ~' ' Name of Contractor ...... i .................... Addrcs.~ ................... }"hone No ........... ... PLOT DIAGRAM Locat,e. eloat~ty and distinctlyi all buildings, whethe.r existing .or proposed, and. indicate all set-back dimensions fr property lines. ~ive street and block number or description according to deed, and show street names and indicate interior or corner lot. EE ATTACHED ! ~TATE OF NEW YORK, ~OUNTY OF .... ,S,u.~ f. 9 .]..k .... i S.S Garret~ A. ,Strong ............................................, · · being duly sworn, deposes and says that he is the applic~ I I BAY j ~ COUNTY OF SUFFOLK James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob ~nosio, Jr. 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 Office Use Only Coastal Erosion Permit Application Wetland Permit Application / Administrative Permit Amendment/Transfer/Extension ,'~Received Application: '~- Received Fee:$ ~' ~.--Completed AppliCation Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) LWRP Consistency Assessment Form -- CAC Referral Sent: (1 _.~-Date of Inspection: ~ Recexpt of CAC Report: Lead Agency Determination: Technical Review: ~--Public Hearing Held: Resolution: Phone Number:( ) Suffolk County Tax Map Number: 1000- 3/~-/-/~ Property Location: /~),0' ~ ~. '~-q~# (provide LILCO Pole #, distance to cross streets, and location) (I£ applicable) Address: ~ ~ ~'D ~ (~ ~, q~ 11 7 / Phone: · , OBoard of Trustees ApplicOn Land Area (in square feet): Area Zoning: Previous use of property: Intended use of property: GENERAL DATA Prior permits/approvals for site improvements: [~ Agen.cy Date t t __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ~ No Yes If yes, provide explanation: Project Description (use attachments if necessary): c?~0~?~-U dO 14 S ¢~"'~ oBoard of Trustees ApplicOn WETLAND/TRUSTEE LANDS APPLICATION DATA Pu.oseof eproposedoperations & II Area of wetlands on lot: D ~',~ - .square feet Percent coverage of lot: ~ ~)0 % Closest distance bet~veen nearest existing structure and upland edge of wetlands: --] ~ t feet Closest distance betwegll n~arest proposed structure and upland edge of wetlands: ~0 feet Does the project involve excavation or filling? No ~// Yes If yes, how much material ~vill be excavated? ~P~ cubic yards How much material will be filled? ' ~ cubic yards Depth of which material will be removed or deposited: ~t feet Proposed slope throughout the area of operations: /~ ~ Q{~c~"~ Mam~er in which material will be removed or deposited: ~ ~ 0 ~"/ Statement of the effect, if any, o_n }he wetlands and tidal w.a_~ters of the town tha} may re_s_ult by reason of such proposed operations (use attachments if appropriate): PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1 APPLICANT / SPONSOR 3.PROJECT LOCATION: Municipality 4. PRECISE LOCATION: Street Addess and Road Intersection~ 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2, PROJECT NAME co.nty Prominent landmarks etc-or provide map 5. IS PROPOSED ACTION: [~ New [] Expansion [] Modification / alteration SEQR 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT F acres ~/~ Ultimately Initially ~ LAND AFFECTED' acres 8 WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [ Yes [] No If no, describe briefly: 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~Residential []industrial ~'qCommercial E~Agricullure E~]Park/ForestlOpenSpace [~ Other (describe) 10/DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) [~Yes [~No If yes, list agency name and permit / approval: 11, L)Ub~ .ANy A~SHbGI Oh IH~ ACIION ~-~TL? VALID PERMIT OR APPROVAL? ~Yes ~No If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? CE~FY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE If the action Is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 6f 7.4? If yes, coordinate the review process and use the FULL EAR F'] Yes B. WILLACTION RECEIVECOORDINATEDREVIEWASPROVIDEDFORUNLISTEDACTIONSIN6NYCRR, PART617.67 IfNo, anegative declaration may be superseded by another involved agency. E~TM ElNo ;. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air qualib/, 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 goa~s as officially adopted, or a change in use or intensity of use of tan~! or other natural resources? Explain briefly: C5 Growth. subsequenl development, or related activities li~eiy to be ieduCed by th~ proposed ;¢ii0n? Explain briefly: C70theril~pactsi (including changes in US~ oieith~r quantity Or type of eoe;g~? ~xpi~i, biiefly;' D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA ? If es, ex lain brie§: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadversee~ectidenti~edab~ve~de~erminewhetheritissubsta~ti~iarge'imp~rtant~r~herwisesigni~cant~ 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 (t~ 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 :,,es, the determ[~tiop, cf ci.-3n!fice, nce muct cvc~uatc thc pc. te~tiaH mpaetc f thc prcpcc, cdc, ct[or, o~, th6 c. nv~ro~,m 6~,t~ chara cteristics-ofthe-¢ EA. Check this box if you have identified one or more potentially la rge or significant adverse impacts which MAY occur. Then proceed directly to the FULl EAF and/or prepare a posgive declaration. Check t~is ~i(you'i~ave (~e~eTm~ned~ based on the information and analysis above andany supporting documeniation, that ~he propos~ci a(~ti0i WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi= determination. Name of Lead Agency Date Title of Responsible Officer Signature of Preparer (If different from responsible officer) Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Board of Trustees ApplicOon AUTHORIZATION (where the applicant is not the owner) ~ ~i~ residing at [~ ~ ~ ~'~/~b~ (print owner of property) (mailing address) do hereby a~thorize ~~ '~~/ ( Agent ) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner s signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nrohibits conflicts of interest on the nail of town officers and ereolovees. The ouroose of this form is to nrovide information which can alert the town of ~ssible conflicts of interest and allow it to take whatever action is necessary to avoid same. ~ IJL,~"~-4 (Last name, first name, middle initial, unless ydu are applying in the name of someone else or other entty, such as a companY f so, thdicate, the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat _ Mooring Exemption from plat or official map Planning Other (lf"Other", name the activity.) 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 NO ~ /~ If you answered "YES", complete the balance of this form and date and sign where indicated· Name of person employed by the Town of Southold Tille 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, parmer, or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1