HomeMy WebLinkAboutTR-4249 Glenn Goldsmith,President ®��®F SO�� Town Hall Annex
A. Nicholas Krupski,Vice President ® 54375 Route 25
P.O. Box 1179
Eric Sepenoski Southold, New York 11971
Liz Gillooly
G � Telephone (631) 765-1892
Elizabeth Peeples Fax(631) 765-6641
C®ublf�,�
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
October 20, 2022
Eric Von Ammon Baiz
Paul Aloysius Skierczynski
3130 N. Delaware Street
Indianapolis, IN 46205
RE: 1260 BAY HOME ROAD, SOUTHOLD
SCTM# 1000-56-5-1.2
Dear Mssrs. Baiz & Skierczynski:
The following action was taken at the Southold Town Board of Trustees regular meeting
held on Wednesday, October 19, 2022:
RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a
Transfer of Wetland Permit #4249 from Eric Baiz & Robert Baiz, to Eric Von Ammon
Baiz & Paul Aloysius Skierczynski, as issued on October 28, 1993 and Amended on
July 27, 1995.
Any other activity within 100' of the wetland boundary requires a permit from this office.
This is not a determination from any other agency.
If you have any questions, please contact our office at (631) 765-1892.
Since ly, -.
m
Glenn Goldsmith, President
Board of Trustees
GG/dd
Glenn Goldsmith,President O��SOfFO(,�COG Town Hall Annex
A.Nicholas Krupski,Vice President yJ2 ` '54375 Route 25
CO
Eric Sepenoski ,? P.O.Box 1179
Liz Gillooly �y • ��� Southold,NY 11971
Elizabeth Peeples � �a Telephone(631)765-1892
Fax(631)765-6641
Southold Town Board of Trustees
Field Inspection Report
Date/Time: 0 7' Completed in field by: r
ERIC VON AMMON BAIZ & PAUL ALOYSIUS SKIERCZYNSKI request a Transfer of
Wetland Permit#4249 from Eric Baiz & Robert Baiz, to Eric Von Ammon Baiz & Paul
Aloysius Skierczynski, as issued on October 28, 1993 and Amended on July 27, 1995.
Located: 1260 Bay Home Road, Southold. SCTM#: 1000-56-5-1.2
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
Type of Application: Wetland Coastal Erosion Amendment
Administrative Emergency Pre-Submission Violation
Notice of Hearing card posted on property: Yes No Not Applicable
Info needed/Modifications/Conditions/Etc.: C�'I! +C> *'q'6 y'4::2f
Present Were: G. Goldsmith N. Krupski E. Sepenoski
%� L. Gillooly E. Peeples
Glenn Goldsmith, President Zf so�ly Town Hall Annex
�0� O 1 54375 Route 25
A. Nicholas Krupski,Vice President
P.O. Box 1179
Eric Sepeng$ki JL : , Southold, New York 11971
Liz Gillooly G Q Telephone(631) 765-1892
Elizabeth Peeples �Ol� �� Fax(631) 765-6641
- BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
APPLICATION FOR TRANSFER OF WETLAND PERMIT
DATE: .
PROPERTY OWNER NAME: rr rr �C(,f z- `4'PC(C,
3(30 e 5�` �� �� a a
MAILING ADDRESS '.: �..- l r�W.rc.0'� c�
PHONE: - Gam..-�.3� nD E C.E I V
AGENT:
22 ..
:.PHONE
0old Town
Board of TNstees
ADDRESS:
PROPERTY LOCATION: .��6 O �ac� ./j�,►� �oacf. Socc ��
TAX MAP NO.: SC T/YIJ�,/DOaPat.
�-y
zl21t.7 .
-request a.Transfer of.Permlt
from: C!'r`c Act r'Z.:
Signed by.
BARGAIN AND SALE DEED WITH COVENANT AGAINST GRANTOR'S
ACTS(INDIVIDUAL OR CORPORATION)
STANDARD NYBTU FORM 8007
CAUTION;THIS AGREEMENT SHOULD BE PREPARED BY AN ATTORNEY AND REVIEWED BY ATTORNEYS FOR SELLER AND
PUR HASER"BEFORE'SIGNING.
THIS INDENTURE,made the ' %.;"r day of " •.J U/�)C
between ROBERT LANG BAIZ residing at 411 WALNUT STREET,UNIT 12470,GREEN COVE
SPRINGS,F132043
party of the first part,and ERIC VON AMMON BAIZ and PAUL ALOYSIUS SKIERCZYNSIU,residing at
130 N DELAWARE STREET,INDIANAPOLIS,IN 46205,as joint tenants with rights of survivorship
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
SEE SCHEDULE A ATTACHED(DESCRIPTION OF PREMISES)
BEING AND INTENDED TO BE the same premises described in a deed made by Eric Von Ammon
Baiz,as executor of the last will and testament of Mary Lang Baiz,deceased and recorded FEBRUARY 27,2018
in Liber 12951 page 822
TOGETHER with all right,title and interest,if any,of the patty 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 I3 of the Lien Law,covenants that the 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 purpose of paying the cost of the improvement and will
apply the same first to the payment ofthe cost of the improvement before using any part of the total of the same
for any other purpose.
NYSBA Residential Real Estate Forms on HotDocs'(9/00) Copyright Capsoar Development ,
-1-
j
Numberof pages
f 7 2-';1"-'1K
This document will be public
record.Please remove all
Social Security Numbers
prior to recording.
Deed/Mortgage Instrument Peed 1 Mortgage Tax Stamp Recording I Filing Stamps
3 FEES
Page I Filing Fee Mortgage Amt.
1.Basic Tax
Handling 20. 00 2. *Additional Tax
TP-584 Sub Total
Notation Spec./Assit.
or:
EA-52 17(County) Spec,/Add.SubTotal-_
EA-S217(State) TOT.MTG.TAX
Dual Town—Dual County
R.P.T.S.A. Held for Appoint 1;nt
Comm.of Ed. S. 00 TransferTa
Affidavit Mansion Tax
Certified Copy The property covered by this mortgage Is
or will be Improved by a one or two
NYS Surcharge 15. 00 family dwelling only.
Sub Total YES or NO
Other
Grand Total If NO,see appropriate tax-claus on
page# of thlsgn en,7
22036161 moo osfioo o-goo 001002 5 Community Preservation Fund 1 -
Real Conside'ra�tib,Am6unt$- �4'0 1;Gad
Tax S Property
P T /0
;e"c:y- I�ILIT CPF Tax Due Agency I011®111111'
Verification
Improved
6 Satisfactions/Discharges/Releases List Property Owners Mailing Address
RECORD.&RETURN TO: Vacant Land X
j- TD P,4 T-41-1,C"A
.,,5/0,QO fY)A"-" IZean.SZ , TD'-
AJ� /1 -7 TD
Mail to:Judith A.Pascale,Suffolk County Clerk 7 Title Company Information
1901 1.
310, Center-Drive,! Riverhead, NY, Co.Name
VAMSUffolkeountyny.gov/clark Title# 7zlo,:I- /,;?3 YR'
81 , Suffolk County R&ordhig,& Endorsement Page. ,,
This page forms part of the attached made
by. (SPECIFY TYPE OFINSTRUMENT
cob T Lank, -E6;2., The premises herein Is situated In
SUFFOLK COUNTY,NEW YORK
TO In the TOWN of L Up Am M "i IntheVILLAGE
84L,_1 - or HAMLET of
BOXES 6 THRU 8 MUST BE TYPEDOR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
over
CHICAGO TITLE INSURANCE COMPANY TITLE NO.7404-012348
SCHEDULE A-1
(Description of the Land)
For Tax Map ID(s): 1000.056.00-05.00-001.002
AMENDED 6/0312022
ALL that certain plot,piece or parcel of land,situate,lying and being in the Town of Southold,County of Suffolk and State
of New York,bounded and described as follows:
BEGINNING at a point on the southwesterly line of Bay Home Road where the same is intersected by the southeasterly
line of land now or formerly of Eric Von Ammon Baiz;
RUNNING THENCE from said of point of beginning along the southwesterly side of Bay Home Road,South 37 degrees 16
minutes 00 seconds East 418.38 feet to the mean high water line of Southold Bay;
THENCE along a tie line of the mean high water line of Southold Bay,South 47 degrees 07 minutes 32 seconds West
110.53 feet to land now or formerly of Dekka LLC;
THENCE along land now or formerly of Dekka LLC,North 37 degrees 16 minutes 00 seconds West 429.18 feet to land
now or formerly of Eric Von Ammon Baiz;
THENCE along said land now or formerly of Eric Von Ammon Baiz,North 52 degrees 44 minutes 00 seconds West 110.00
feet to the southwesterly side of Bay Home Road at the point or place,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
ComrmtmenttorTittoinsurance Printed;06.1522 @ 11:14AM
Schedule A•1 Descnption NY-CT-fRVii•01010.431074-SPS-1-21.7404-0123i8
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: IU64d I(� ,
ROS RT LANG BAIZ
ACKNOWLEDGMENT
2
STATE OF FL1eRl1>A-r
COUNTY OFF<.,� _!-)
On the I5�f4` day of '_>ar ,Mri&foie me,the undersigned, personally appeared ROBERT
LANG BAIZ 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 whichthe individual
acted,exec d the instrument and that such individual made such appearance before the undersigned in the
iz-7 .l .(Insert the city or other political subdivision and the state or country or other.
place the acknowledgment was taken.).
f�p,RA.C
Q'P'•0 TA �•'� �+r
Notary Public R�,
My Commission Expires ' 4 � i
June 15.202.7 111311C' %
t�rt4 IN
lA
NYSUA Residwtiiat Real Estata Forma on Hotnocs?(9100) Copyright CapsoR'Umelopment
.2-
J
PATRICIA C.MOORE
Attorney at Law
51.020 Main.Road
Southold,New York 11971
,Tel:(630`765-4330 '
Fax:(631)765-4643
Betsy Perkins Paralegal
Jahnie Lengyel
Kylee DeFrese
September 2,2022
Eric Von Ammon Baiz
Paul Aloysius Skierczynski
3130 N.Delaware Street
Indianapolis,IN 46205
RE: 1260 Bay Home Road,Southold
Dear Eric&Paul:
.Enclosed please find the original Deed for the above referenced matter which has been
recorded in the Suffolk County Clerk's Office.This is an important document.Please put it in a
secure place for safekeeping.
Once again,thank you for allowing our office to be of service to you and please do not
hesitate to contact our office should you have any questions.
Very truly yours,
Patricia C.Moore
PCM/kd
Encls.
I IIIIIII IIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII
I IIIIiI IIIII IIIII IIII IIII
SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEED Recorded: 08/15/2022
Number of Pages: 4 At: 10:58:59 AM
Receipt Number : 22-0130599
TRANSFER TAX NUMBER: 22-01660 LIBER: D00013169
PAGE: 272
District: Section: Block: Lot:
1000 .056.00. .05.00 001.002
..EXAMINED AND CHARGED AS,FOLLOWS
Deed Amount: $600,000.00
Received the Following Fees For Above Instrument
Exempt Exempt
Page/Filing $20.00 NO Handling $20.00 NO
COE $5.00 NO NYS SRCHG $15.00 NO
EA-CTY $5.00 NO EA-STATE $250.00 NO
TP-584 $5.00 NO Notation $0.00 NO
Cert.Copies $0.00 NO RPT $200.00 NO
Transfer tax MOO NO Comm.Pres $10,500.00 NO
Fees Paid $11,020.00
TRANSFER TAX NUMBER: 22-01660
THIS PAGE IS A PART OF THE"INSTRUMENT
THIS IS NOT A BILL
JUDITH A. PASCALE
County Clerk, Suffolk County
Michael J.Domino,President �o��OE soUlyOIO Town Hall Annex
John M.Bredemeyer III,Vice-President 54375 Route 25
P.O.Box 1179
Glenn Goldsmith Southold,New York 11971
A.Nicholas Krupski Telephone(631) 765-1892
Greg Williams y Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
June 20, 2018
Eric Baiz & Robert Baiz
3130 N. Delaware Street
Indianapolis, IN 46205
RE: 1260 BAY HOME ROAD, SOUTHOLD
SCTM# 1000-56-5-1.2
Dear Mssrs. Baiz:
The following action was taken at the Southold Town Board of Trustees regular meeting
held on Wednesday, June 20, 2018:
RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a
Transfer of Wetland Permit #4249 from Mary L. Baiz to Eric Baiz & Robert Baiz, as
issued on October 28, 1993, and Amended on July 27, 1995.
Any other activity within 100' of the wetland boundary requires a permit from this office.
This is not a determination from any other agency.
If you have any questions, please contact our office at (631) 765-1892.
Sincerely,
Michael J. Domino, President
Board of Trustees
MJD/dd
ti
Michael J. Domino, President r O�S1�FFDt'�C' � N Town Hall Annex
John M. Bredemeyer III,Vice-President �� � � 54375 Route 25
Glenn Goldsmith y P.O.Box 1179
A.Nicholas Krupski ® t Southold,NY 11971
Greg Williams ?, pl,, Telephone(631)765-1892
Fax(631)765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Date/Time: ro Completed in field by:
ERIC BAIZ & ROBERT BAIZ request a Transfer of Wetland Permit#4249 from Mary L. Baiz to Eric
Baiz & Robert Baiz, as issued on October 28, 1993, and Amended on July 27, 1995. Located: 1260
Bay Home Road, Southold. SCTM# 1000-56-5-1.2
CH. 275-3 - SETBACKS
WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required
1. Residence: 100 feet
2. Driveway: 50 feet
3. Sanitary Leaching Pool (cesspool): 100 feet
4. Septic Tank: 75 feet
5. Swimming Pool and related structures: 50 feet
6. Landscaping or gardening: 50 feet
7. Placement of C&D material: 100 feet
TOP OF BLUFF:
1. Residence: 100 feet
2. Driveway: 100 feet
3. Sanitary leaching pool (cesspool) 100 feet:
4. Swimming pool and related structures: 100 feet
Public Notice of Hearing Card Posted: Y / N
Ch. 275 Ch. 111 SEQRA Type: I II Unlisted Action
Type of Application: Pre-Submission Administrative Amendment Wetland
Coastal Erosion Emergency Violation Non-Jurisdiction
Survey :5 5 years: Y/N Wetland Line by: C.E.H.A. Line
Additional information/suggested modifications/conditions/need for outside
review/consultant/application completeness/comments/standards:
Z, z,af Inw,�4 ce�
��-� -�
I have read & acknowledged the foregoing Trustees comments:
Agent/Owner:
Present were: J. BredemeyerDomino . Goldsmith N. Krupski
Williams Other
Michael J.Domino, President \\0f SUbry� Town Hall Annex
John M.Bredemeyer III,Vice-President O op� 54375 Route 25
P.O.Box 1179
Glenn Goldsmith Southold,New York 11971
_ Nicholas. G • Telephone(631) 765-1892
iir-1 ! GregWilliams'� �0 Fax(631) 765-6641
- �ycOUNT`l,Nct�
MAY ® 1 2018
s ;
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
APPLICATION FOR A TRANSFER OF A WETLAND PERMIT
DATE Ma`� 0
OWNER f7r i G r Z U47h et+- �( �- PHONE 3(7- 626 - 6j,6
MAILING ADDRESS 3(3o r), 7elaW awe S"T��� , c��ar.�,n��rS q6ze!)
AGENT PHONE
ADDRESS /�
PROPERTY LOCATION 6 c) 2d,
TAX MAP NO. ®® • ® 7 00 -- ®®l ®® �-
I/We c Z`� 4����� request a Transfer of
Permit# ;z y from by
Signed By:
{
CC#: C18-8114
COUNTY CLERX'S OFFICE
STATE OF NEW YORK
COUNTY OF SUFFOLK
I, JUDITH A. PASCALE, Clerk of the County of Suffolk and the Court
of Record thereof do hereby certify that I have compared the annexed with the original
DEED
recorded in my office on 02127/2018 under Libber D00012951 and Page 822 and,
that the same is a true copy thereof,and of the,whole of such original.
In Testimony Whereof, I have hereunto set my hand and-affixed the seal of'said County
and Court this 02/2712018
SUFFOLK COUNTY CLERK
�ca oLurc.. LC. rUct-a.�G-.p��
JUDITKA.PASCALE
SEAL
I
I
k
I
I
I
f -
am
SUFFOLK COUNTY CLERK
FI RECORDS OF ICE
RECORDING PAGE
Type of Instrument: DEED Recorded: 02/2-7/2018
Number of Pages: 5 At: 04 :01 :56 PM
Receipt Number : 18-0036873
TRANSFER TAX NUMER: 17-23425 LIFER: D00012951
District: Section: - PAGE :,Block: Lot: 822
1000 056.00 05.00 001.002
EYJU4INED AND CHARGED At FOLLOWS
Deed Amount: $1,065,000 .00
Received the Following Fees For Above Instrument
Exempt Exempt
Page/Filing $25.00 NO Handling $20.00 NO
COE $5.00 NO NYS SRCHG $15.00 NO
EA-CTY $5.00 NO EA-STATE $250.00 NO
TP-584 $5.00 NO Notation $0. 00 NO
Cent.Copies �6.2-5 NO RPT $200.00 NO
Transfer tax $0.00 NO Comm.pres $0.00 NO
Fees Paid $531 .25
TRANSFER TAX NUMBER: 17-23425
THIS PAGE IS A PART OF THE INSTRUMENT
THIS IS NOT A BILL
JUDITH A. PASCALE
County Clerk, Suffolk County
1 2
RECORDED
Number of pages
2010 Feb 27 t t:.�1:5c FPi
JUDITH A. FASCA _
_ CLEFU, OF
SUFFOLK COUtIT;,,
This document will be public L D000j^g;I
record.Please remove all P S22
Social Security Numbers
prior to recording.
Deed/Mortgage Instrument Deed/Mortgage Tax Stamp
P Recording/Filing Stamps
3 FEES
Page/Filing Fee 42r2 Mortgage Amt.
Handling 20. 00 1.Basic Tax
2. Additional Tax
TP-584 Sub Total
Notation Spec./Assit.
L�EA-52 17(County) � Sub Total �7 or
Spec./Add.
EA-5217(State) TOT.MTG.TAX
R.P.T.S.A. — Y Dual Town Dual County
Held forAppointment
Comm.of Ed. S. 00 Transfer Tax
Affidavit ° b Mansion Tax
Certified Copy `41� The property covered by this mortgage is
or will be improved by a one or two
NYS Surcharge 15. 00 Sub Total family dwelling only.
5
Other YES or NO
Grand Total If NO, see appropriate tax clause on
Page# of this instrument.
1-7
ReafPrope `
4 Dist. 8005650 '" -002 5 Community Preservation Fund
100a Q56a0 0500 0010
0,
Tax Service RP T S Consideration Amount$ —
Agency
venficatic CPF Tax Due $
6 Satisfactions/Dfscharges/Releases Ust Pro arty Owners Mailing Address Improved
RECORD&RETURNpFO:
RICHARD W.VANDENBURGH,ESQ. Vacant land
SOOT OAK DRIVE TD_____�y
SOUTHOLD,NY 11979
TD
TO
Mail to:Judith A.Pascale,Suffolk County CJerk Title Company Information
310 Center Drive, Riverhead, NY 11901
www.suffolkcountyny.gov/clerk Co.Name
Title if
8 Suffolk County Recording & Endorsement Page
This page forms part of the attached DEED
by: made
(SPECIFY TYPE OF INSTRUMENT)
ERIC VON AMMON BIAZ EXEC LW&T MARY LANG 9AIZ The premises herein is situated in
SUFFOLK COUNTY,NEW YORK.
To to the TOWN of SOUTHOLD
ROBERT LANG BAIZ In GEVILLAGE
ERIC VON AMMON BAIZ In HAMLET
BOXES 6 THRU B MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
over
—Executor's Deed—Individual or Corporation(single sheet)
Al
THIS INDENTURE,made the 1 Ll "day of SEPTEMBER,in the year 2017
BETWEEN
ERIC VON AMMON BAIZ
CIO Richard W. Vandenburgh,Esq.
42155 Main Road
Peconic, NY 11958,
as executor of the last will and testament of M RY LANG BAIZ, deceased,
party of the first part,and
ROBERT LANG BAIZ,as a Tenant in Common
817 Elm Spring Road
Pittsburgh,PA 15243, and
ERIC VON AMMON BAIZ,as a Tenant in Common
3130 North Delaware Street
Indianapolis,IN 46205-3919,
Parties of the second part,
WITNESSE'TH,that the party of the first part,to whom ANCILLARY LETTERS TESTAMENTARY were issued
by the Surrogate's Court of the State of New York for the County of Suffolk on October 12,2010, and by virtue of the
power and authority given in and by said last will and testament, and inconsideration of TEN ($10.00)dollars and
other good and valuable consideration paid by the party of the second part, does hereby grant and release any and all
remaining interest that the party of the first part may own unto the party of the second part,the heirs or successors and
assigns of the party of the second part forever,and constitutes 100%of the entire interest in and to the subject premises
in the party of the second part,
ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate, lying
and being in the Town of Southold,County of Suffolk and more particularly described as follows:
SEE SCHEDULE"A"ATTACHED HERETO.
BEING AND INTENDED TO BE any and all interest conveyed to Mary Lang Baiz and John Baiz by deed dated
7/23/73 and recorded on 7/24/73 in the Suffolk County Clerk's Office in liber 7449 cp 17 and as corrected in deed dated
8/31/73 and recorded on 9/10/73 in the Suffolk County Clerk's Office in hoer 7484 cp 224 and under the deed to Mary
Lang Baiz dated 7/13/96 and recorded on 8/16/96 in the Suffolk County Clerk's Office in Tiber 11787 cp 883.
TOGETHER with all right; title and interest, if any, of the party of the first part of; 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;
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 incumbered 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 pam, of
the first partxvill receive the consideration for this conveyance and will hold the right to receive such consideration
ws a trust fund to be applied first for the purpose of payin-the-costof the improvement and'will apph.,the shine first
to lite payment of the cost of the improvement before using"ar*,part of the totar of the same fibr,any other purpose.
The word shill be construed at;if it read-,parffes,,whenever the sense of this indenture so requires.
IN,WITNESS,WREREOF, 11WPI'M of the first part has duly executed this deed' the day and year first Awe
written.
IN
L
I k1C VO'.,\-,AMMON BAIZ, s Xecut
as
the Estate of Mary Lang Bajz
orary Pubitc.seal
State of laujank
MY Corn ISS
(on E,%Plfes Aug 23,20,9
BEGINNING at a point on the. southerly boundary line of land of
Mary bang Baia distant south 52 degrees 44 minutes 00 seconds
West 110 feet from a point an the Westerly line of Bay Rome Road
which is the southeasterly comer of said land of Mary Lang Baiz;
running thence from said point of beginning along said land of
Mary Lang Bair. North 52 degrees 44 minutes 00 seconds East 110
feet to the said westerly line of Bay Home Road; running thence
laYong the said westerly line of [gay Home Roadv'South 37 degrees 16
minutes 00 seconds East 394. 11 feet to the ordinary high wager
ark of Southold Bay; running thence along the said ordinary high
water mark of Southold Bay southwesterly then southerly along a
r'm a
Jetty, then southwesterly to a point which is South 37 degrees 16
minutes 00 seconds East about 394 feet from the point of begi
ning herein above mentioned; running thence along other lan of U QL
Clara E. Lang North 37 degrees 16 minutes 00 seconds West about
394 ,feet to the point of BEGINNING.
1l iv i , glad , + l , + ��
t d i n in -ro oi- S)Uftld., C0u
tr. F Uew York,
ACKN0%vLEDC.CN1UNTTAKfN UN ZNFW VORK SUATf. A(-KNONVLEDGV,*tlE.NTT.�,K�\'I�,NEN�'YORK STATE
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ifiat executcd the:,xnv.6 Ws;hc0h6,, md- exccuked tile swric in Cer"wa)ties".and Ild
tal by lhhnslamrru.t3le hwhutrAss by NVNNM07�1�xnzmj%(S)i1r,th,t m_,r(irrcjm the indv.idualts),iirthc
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w be tm. it;di idual aescrihed in.an'l,M-a-, c\polzurd thk
111-mu"Ical.thul said prC."C'11 and awAd to Y;eh,tndivkuq}_,n3U.Juhappearwr=hctem ffit-and crsigncd in
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I rmlllejsj is iA wjlmr,�._:bcritt(t
FIxeculor's-Deed O,4(ATtfRVN ANDRY Aug
23.2
AN
019
Notary Public-Seal
S!,C HON'W�6(k StsU of Indian's
Camr*sivn Expres Aug 23.2019
L: WoUns,
SOMMAM NEW SAK RrJURN BY .NIAIL TO:
Title No.
P UCHARD \V. VANDENBUIRoH. ESQ.
1405 OAK ESTATE',OF NIJARY L.A.NG BAIZ IS0 U THt, LID.-DRIVE Y 11971
T() I
ROMIU LANTIG FIAIZ
E-AIC ON AMMON BAIZ
TP- (4/13) New York State Department of Taxation and Finance
Combined Real estate Recording office time stamp
Transfer Tax Return,
Credit tine Mortgage Certificate, and
Certification of Exemption from the
Payment ®f Estimated Personal Income Tax
See Form rP-584-1, Instructions for Form TP-584,before completing this form. Print or t e.
Schedule A® Information relating to conveyance
Grantor/Transferor Name(if,ndividuai,last,first,middle initiag(❑ check if more than one grantor) Social security number
Individual BAIZ,ERIC VON AMMON,as Executor of the Estate of Mary Lang Baiz
❑ Corporation Mailing address Social security number
❑ Partnership CIO 42155 MAIN ROAD
9 Estate/Trust City State ZIP code Federal EIN
❑ Single member LLC PECONIC NY- 11958 27-6241715
❑Other Single member's name if grantor is a single member LLC(see instructions) Single member EIN or SSN
Grantee/Transferee Name(f individuat,last,first,middle initial)(x check if more than one grantee) Social security number
fl Individual BAIZ,.ROBERT LANG and BAIZ,ERIC VON AMMON 057-36-2012
❑ Corporation Mailing address Social security number
❑ Partnership 817 Elm Spring Road & 3130 North Delaware Street, Indianapolis, IN 46205, 186-48-8191
❑ Estate/Trust City State ZIP code Federal EIN
❑Single member LLC PI-ITSBURGH PA 15243
❑ Other Single member's name if grantee is a singe member LLC(see instructions) Single member EIN or SSN
Location and description of property conveyed
Tax map,designation— SWIS code Street address City,town,or village County
Section, block&lot (six digits)
(include dots and dashes)
056.00-05.00-001.002 1260 BAY HOME ROAD SOUTHOLD SUFFOLK
Type of property conveyed(check applicable box)
1 Q One-to three-family house 5 Q Commercial/Industrial Date of conveyance Percentage of real property
2 Q Residential cooperative 6 Q Apartment building conveyed which is residential
3 Q Residential condominium 7 Q Office building 09 1 14 1 2017 real property 100
4 ® Vacant land 8 El mon.n aaY rear
(see instructions)
Condition of conveyance(check all that apply) f.❑ Conveyance which consists of a I.❑ Option assignment or surrender
a. ON Conveyance of fee interest mere change of identity or form of
ownership or organization(attach
b. ❑Acquisition of a controlling interest(state Form TP-584.1,Schedule F) m.❑ Leasehold assignment or surrender
percentage acquired °/a) g.❑ Conveyance for which credit for tax n.❑ Leasehold grant
previously paid will be claimed(attach
c. ❑Transfer of a controlling interest(state Form TP-584.1,Schedule G)
o.❑ Conveyance of an easement
percentage transferred %) h.❑ Conveyance of cooperative apartment(s)
d. ❑ g 1.❑ Syndication Conveyance to cooperative housin y p•❑ Conveyance for which exemption
corporation from transfer tax claimed(complete
Schedule B,Part 11V
j.❑ Conveyance of air rights or q.❑ Conveyance of property partly within
e. ❑ Conveyance pursuant to or in lieu of development rights and partly outside the state
foreclosure or enforcement of security k.❑ Contract assignment
interest(attach Form TP-584.1,Schedule E) g ❑ Conveyance pursuant to divorce or separation
For recording officer's use Amount received S.® Other(describe) ESTATE BEQUEST
Date received Transaction number
Schedule B.,Part t $
Schedul
e B..Part 11 $
S
Page 2 of 4 TP-SSS4(4113)
Schedule,B — Real estate transfer tax return{rax Law Article 31) -
Part It-Computation of tax due
1 Enter amount of consideration for the conveyance(if ycu are cixmng a torai exemption from tax,CnECri the
exemption clvinlBC tax,enter cansr"aeration and aroceed to Pali 1P1).,,.........
................ Q Exemption claimed i J 1065000 00 .
2 Continuing tier,deduction(see Instructions if prcp< ny is to,ken s tiled to mortgage or iien)...................................,.....� 2; r
3 Taxable consideration,(subtract tine 2 From fine f).............................................. ................................................... 3,! i
4 Tax:S2 for each S500,-or fractional part thereof,of consideration on line 3....................................................... 4A
5,Amount of credit claimed for tax previously paid(sve instructions anaartacn Form TP-584.r,Sct:eau,e G) ,.,..•,...., �.
6 Total tax due'(subtract line 5 from line 4) ......................... ........................... ........................................
Part It-Computation of additional tax due on the conveyance of residential real property for S1 million or more
1 Enter amount of consideration for conveyance(fror,part 1,line 1)....................................................................... 1.
2 Taxab?e ConsideraYson(rwhv Jrttre t tsyrne pezonraga cf t p*erra ses a d`c %s rEsdant:ai red+rearer,,v.as sno:,a;r,Sct educe F,... 2
3 Total additional transfer,tax due(muWDly flre 20y 3°h(.ot))................. ..............................................................J. 3.1 i
Part Ill-Explanation of exemption ctaimec on Part t. line 1 (crec�r any boxes that apply)
The conveyance of real property is exempt from the real estate transfer tax for the following reason:
a. Conveyance is to the United Nations,the United States of America,the state of Nev,York,or any of their instrumentalities, 1
agencies,or political subdivisions(or any public corporation,including a public corporation created pursuant to,agreement or
compactwith another state or Canada)..........................•.......................,..............,............................................•........................... a E(
b. Conveyance is to secure a debt or other oaligation...................................._........_.......................................................................... b r�
r. Conveyance is without additional consideration to confirm,ccrrec;.m odity,ar supplement a prior conveyance............................ c
d- Conveyance of real property is without consideration and not in connection witn a sale,including conveyances conveying r�
realtyas bona fide gifts........................................ ,...................,,...............................•................................•.... .......I.................._.... d
e, ,Conveyance is given in connection with a tax sale...........•......................... .... e t
f. Conveyance is a mere change of identity or form of ownershio or organization where;here is no change in beneficial
ownership.(This exemption cannot be claimed for a conveyance to a cooperative housing corporation of real property
r
comprising the cooperative dwelling or dwellings.)Attach Form:TP-564.1.Schedule F.................................................................. f iJ
g. Conveyance consists of need of pa*tition.............................................................. ................................................... ....• ..... g J
n. Conveyance is given pursuant to the federal Bankruptcy Act............................... .................................................I.......................
i. Conveyance consists of the execution of a contract to sell real property,without the use or occupancy of such property,or tr��tt
the granting of an option to purchase real property,wdnout the use or occupancy of such property......................................... ... i t_>
f
} Conveyance of an option or contract to purchase real property v,ith the use or occupancy of such property where the
consideration is less than S200,000 and such property was used solely by the grantor as the grantor's personal residence
and consists of a one-,hvo-.or three-family house,-an individual residential condominium unit.or the safe of stock
in a cooperative housing corporation in connection.vita the grant or transfer,ol a proprietary leasehold covering an _
individual residential cooperative apartment...,.......:....... i
k. Conveyance is not a conveyance within the weaning of Tax law;Article 31.section 1401(e)(attach documents
supportingsuch claim) ... ........ ......................... ................................,.,...............................,..........,..._..... k
a
r•
t 'The total tax(from Part 1,fine 6 and Part 11,line 3 above)is cue within 15 days from the gate conveyance,Please make check(s)payable
to the county clerk where the recording Is to take place.it the recording is-to take place in the New York City boroughs of Manhattan,
Bronx.Brooklyn,or Queens,make check(s)payable to the iNYC Department of Finance.if a recording is not required,send this return
and your check(s)made payable to the NY a Department of Taxation and Finance,directly to the NYS Tax Department,RETT Return
Processing,PO Bdx 5045,Albany NY 12205-5045.
Page 3 of 4 TP-584(4113)
Sc�tielufe C•— Credit Rine 1►�ottga�ge C:e:�i6dc�t,e(Tax Lavr,Article 11)
Complete ft following only if the interest being transferred is a tee simple interest.
i(we)certify that:(check the appropriate box)
1• L^__J1 The real property being sold or transferred is not subject to art owstanaing creait fine m
orgage.
2. ED The real ro
P perty being sold or transferred is subject to an outstanding credit line mortgage.However,an exemption from the tax
is claimed for the following reason.
The transfer of reai property is a transfer of a fee simple Interest to a oerson or persons who held a fee simple interest in the
real property(whether as a joint tenant,a tenant in common or otherwise)immediately before the transfer
' The transfer of real property is(A)to,a Person or persons related by blood,marriage or adoption to the original obligor or
to one or more of the original obligors or(B)to a oerson o�entity where 50%or more of the property after the transfer is held oy tie transferor or such rel oeneficial interest in such real
ated person or Persons(as in the case of a transfer to a trustee for
the oenefit of a minor or the transfer to a trust for the benefit of the transferor).
�Li The transfer of real property is a transfer to-a trustee in bankri;ptcy,a receiver, assignee,or other officer of a court.
t_(The maximum principal amount secured by the credit line mortgage is 53,000,000 or more,and the real property being sold
or transferred is not principally improved nor will it to improved by a one to six-family owner-occupied residence or dwelling.
Please note:for purposes of determining whether the maximum principal amount secured is S3,000,000 or more as described
above,the amounts secured by two or more credit line mortgages may be aggregates under certain circumstances.See
f�1 TSB-M-96(6)-R for more information regarding these aggregation requirements.
U Other(attach detailed explanation).
3. The real property being transferred is presently subject to an outstanding credit line mortgage However,
fff-�olll1rowing reason: . er,no tax i s due for the
t_._. A certificate of,discnarge of the credit tine mortgage is being offered at the time of recording the deed.
[�A check has been orawr payable for transmission,to the creait line rrortgagee or his agent for the balance due,and a
satisfaction of such morgage will be recorded as soon as it is available.
r--
a. !5 The real property being transferred is ser- ubject to an outstanding creait lire mortgage recorded in
,/fiber vid pair or rest or Other iperltifi
by the CaiiOn of me margagey,Tars rraxsmum principal amount of debt or obligation secured \
is tie mortgage is
is being paid herewith.(Make check payable to c,No exemption from tax is claimed and tne'tax of
ounty clerk where deco will be recorded or,if the recording is to take place in
New York City but not.in Ricnmond County,make check payable to the NYC Department of Finance.)
Signature(both e grantors)and grantees)roust sign)
The undersigned certify that t-:e above information contained in schedules A, B.and C.inclucir;g any return,certification,schedule,or
attachment, is to the best of his/her knowledge,true and complete,and authorize the person(s)submitting such form on their behalf to
receive a copy for purposes of recording the oeed or other instrument effecting the c nveyance.
Grantor signature
+i:fe GraritBct Stitt ire
l tCc,
Gramor
-• Grandee signature
Rwmirxisar.hid you complete all of the required information rn Schedules A g,aril C?Are you required to complete Schedule D?It you
checked e,f,or g in Schedule A.did you complete Fort;,TP-58.4.1?Have you attached your cneck(s)made payable to the county clerk
where recording will take place or,if the recording is in the New York City boroughs of Manhattan,Bronx, Brooklyn, Queens,to the NYC
p
Department of Finance?it no recording is required,send your check(s),mace payable to the Department of
directly to the NYS Tax Department,RETT Return Processing,PO Box 50�45,Albany f�Y 12205-5045. Taxation and Finance,
Page 4 of 4 TP-584(4/13)
Schedule D Certification of exemption from the payment of estimated e
1omp1ete the following only if a fe rsonal income tax(Tax Law.e simple interest or a cooperative unit Is being transferred by®n individual r estate oet lion 663j '
If the property is being conveyed by a referee pursuant to a foreclosure Proceeding, ��
underExemprions f®rrtorrresiaent transferor(s)ls®1i®r(s)and sigmas foreclosure
bot Pro. 9,proceed to Part II,and check the se and box
Pan t-New York State residents
;t t,nl,a?re a New York State resident transferor s r ller(s)Ifsteci-in Schedule A of Fora,TP-5Bd{or an 3itachment to Form TP-58 ) you mu
s'911 Tile Certification bellow,If one c-more tra sierorsfseJl2rs Of the real property or cooperative unit is a resident of New York
t%srdenf transf@r�7r/seller muse signY must
ir.tat;space residProvient
Iran if more space is needed,please photocopy this Schedule D and submit as many
schedules as necessary to accommodate a)i resident transferors/sellers.
Certification of rosfdent transferors)/seller's)
nts is to certify that at the time of the sale or transfer of the real property or cooperative unit.the transferors)/seller(s)as signed below
-3 res,aeni of New York State-and therefore is not requirec to pay estimated Personal income tax under Tax Law,section fi63 a
Sale or transfer of this real Droperty or cooperative und, p was
s in :u = r { )upon the
owe
Xj
'art^f r„t; /y 12c l i
P•:n:f4;,7 narre
Date
Jate
Note:i rasrdent of New York State rnay;till oe required to pay estimated tax under Tax Law,section 685(c), out not as a condition of �
recoraing a deer.
Fart tt-Nonresidents of New York State
f VOL;are a nonresident of New York State listed as a transferor/setter in Schedule A of Form TP-58,(or an attachment to Form TP-584
aut are not required to pay estimatec personal income tax because one of the exemptions below applies under Tax Law,section 663 c
:7lEck the box of the appropriate exemptionany )
ransferos s/seller(s)is not required to pay esbtimatecfPe Personal income tax tpol Vev York Stage es unto th trLavreser(t)fsetter(s),that ( )
( )' One
ra�sferorfseller who qualifies under ana_of the exempticns oelow must Sign In;
section 663.Each nonresident
rnatocopy this Schedule p and submit as many schedules as necessary to accommodate all nonresident transferors/sellers.
9 ne space orovided.If more.scace is needed,please
none of these exemption statements a 1 . nu must complete Form IT-2663,Nonresident Reat Property Estimated Income e>�rrr,ur Fvrrq ir-Z®tgµ,Nonresident Coops 3t��Utttt Estimated income Tax Payment Form. For more information,see Payment,of
ersonw income tax. on page 1 of Form TP-a$w-t. a Tax payment
xeinption for nonresident transferor's)/seller's) estimated
"is is to certify that at the time of the sale or transfer of
the'cnert;or cooperative unit was a nonresident of Nevr York Seale bual t not required to pay estimated personal income tax under
property o. Cooperative unit.the transferors)/seller(s)(grantor)of this real
:ctrory 663 due to one of the following exemptions:
Tax Law,
the real property or cooperative unit both� v
g.solo or transferred qualifies in total as the Transferor's/seller's principal residence
(within the meaning of Internal Revenue Code,section 121)from to
3a;E D'— z"'a(see insrrJtt,ons).
--i The transferar/seller is a mortgagor conveying the mortgaged property to a mortgagee in foreclosure,or lieu of foreclo '
no'additional consideration
7-7
sure with
1 The transferor or transferee is an agency or authority of the United States of America,an agency or authority
"Jew York,the Federal National Mortgage Association,the Federal Home Loan Mortgage Corporation,the Government Nati onal
L—Mortgage Association,or a private mortgage insurance company. of the state of
tr.rt:.r: ---_
rr�^S iL'1'nan'a '
t Date'
Pr,n;iu's na nc '
Dale
I
Townships:
Easthampton 03
reconic Bay Region Riverhead 06
Shelter Island 07
Commun* Preservation'Fund
Southampton 09
iq Southold to
Proceeds of this transfer tax are disbursed to the
Townships in which the transaction takes place for
its acquisition of land,development rights,and-
other interests in property for conservation
purposes.
Schedule A Information Relating to Conveyance —'—
6'c R�Idual,-.last first,r;Fd@-eTrkia-dJ-----
Grantor Name(, 'Social Security Number
0 Individual BAIZ,ERIC VON AMMON as Executor of the Estate of Mary Lang Baiz
.0 Corporation- Matting address cu socialseritir Number
0 Partnership. .C/O 42155 Main Road
aiv� state ZIP code t-
Other Federal employ.,ld..
Peconic NY 11958 ?27 6241715
Grantee Name(individual,last,first,middle—Inqtal) — i Social Seculy fi6iWbjr_
,J@ Indivioual BAIZ,ROBERT LANG and BAIZ ERIC VON,AMMON i
'T 057-36-20112
0 Corporation fir�g address isci cialsecurliv Number
0 Partnership :817 Elm Spring Road & 3130 North Delaware Street 186,48-6191
City - state ZIP code --dT.-I-- --
0 Other F. iinip r crier,
Pittsburgh&Indianapolis PA&IN 15243,&46205
Location and description of property conveyed
Taxmap designation
Address Village 0
Dist Section , Block I Lot
1260 BAY-HOME ROAD
1000 056.00 05.00 001.002
SOUTHOLD
Type of Property conveyed(Cheek cipplichi,box)
Date of conveyance Dual Towns.
0 Improved
-9 Vacant land J-41412017
Condition of conveyance(check aii,tizot apple)
a.-Conveyance of fee interest b.-Acquisition of a f. -Conveyance which consists of a mere L-Contiact assignment
,controlling interest (star. change of ideiitivir or form of ownership or I. -Option assignment or surrender
Percentage acquIreo.__" %l. organization rn.-Leasehotd assignment or surrender n.-
c.-Transfer of a controlling interest(state g-Conveyance for which credit(or tax Leasehold-grant
percentage transferred-___%) Previously paid will be claimed' o. - Conveyance of an easement p.--
d.-Conveyancete cooperative housing
corporation IL-Conveyance of cooperative apartment(s)1. Conveyance for which-exemption is
I Syndication claimed(complete Schedule 9,Part 11)
e.-Conveyance pursuant to or in liewof
1� -Conveyance Of air rights or development q-Conveyance of property partly within and
foreclosure or enforcement of security rights panlywithout the state
interest -Other(&=r;he)ESTATE BEQUEST
Schedule B - Community Preservation Fund
Part I-Computation of Tax Due
1.Enter amount of consideration for the conveyance(from line I TP584 Schedule B) IT565,000-00
2.Allowance(see below) 21
3.Taxable consideration(subtract line 2 from line 1)
4.2%,Community Preserv' f 31
Preservation Fund(of line 3)make certified check payable to SUFFOLK COUNTY CLERK
5.Property not subject to CPF Tax(See Schedule Q 41
1 For recording officer's use # Amountreceived
11 Date received Transaction number
Allowance:
East Hampton $250,000.00 improved $100,006-00 Vacant Land(Unimproved)
Shelter Island $250,000.00 Improved $100,000-OOVaCant Land(Unimproved)
Southampton $250,000.00 Improved $100,000-00 Vacant Land(Unimproved)
Riverhead $150,000.00 Improved $75,000.00 Vacant Land(Unimproved)
Southold $150,000.00 Improved $75,000.00Vacant Land(Unimproved)
C -------------
{mntinued}
v 11 Wii
'Pe rea6 estate Mir-'sfe,tat for the
biTC jrrI,,d,00iiifCal S adrV�Illll Mr anS rj2'
zonipa.1 woo,another�me Ur c2nac�aj a =Wt: Ma:ed cwm�tjrd to Avoomem or
Li
aeot
or Ottler
L 2
C.C4n4evzme is whout and"
to tanfirm,cz;"ev"MC."'V or!zIpplenner't,a Prot'Crve"Ir"-e
of real ornDeriv is wqtcuc to,,,CUA404 Wd n3i�ri colnevion W v!a sate,tnC1.!p`ng convevarbces cojr.ayjng
reA(TY as Iona file gifts
Cen,eydricu b given in canrieCtiop Wit
cof;veyaq isme'tl change of Identity or mir M,of cvctrsh p as cvgam:a*'3on Wn'fe tn'ift'i no mange in irn is-xP'ADt1on cann'cz be cWmt'd fW a MzPerilltsve dweiiing or cwe�ijigs cfrea!Drvoertv comprfsing ter
C.rnveyarre con ststs of Cee'd ol Dertiticn
h COO
epic}act
c*nslr,.'Of Me exe"ttcn of'p contract Lcsettrea= aerci w4t"c)".Vle use all 01=oam .of szzh property of tna
yyan"MR or an Option 10 rurcnase iea!Pn:lC'f"tv'wqt';PU!the LLS4 of Z.V CrOpttly
1xil"evailce of reak Property wn'cr,rs 54bJeLt to festnCt"Ont wtqcm prvt'zi
crsept agntulture, x`-r0V-'0A Or 40n. 'vl$
Ccr%siry&'' a I
r
tsie reguir At to SecrIza "449-ve (2) or (44 Aiticte 3:-0 of tt;o, Ta. L
er:Town approval,below)
canvevenceaf real pvcDtrry fbi-ope-1 spice,Da'Ks'or h.aIortr
mi-oricip-r'A
"'vt exp6glhtions in space lt>g*lh i6q
li,Conveyance of rCaf property as a pri'mat'v
jattachen aoorowd applicaTFGnff
Of real properly to a Taxexerrlpt'4-*"fO1-Drm%'Corc"ra"'W"tGr inr.Aa.rROSe of
Lj
t}-Dw conveyancil is approweti for an examptscm fronr,tte C0!%v%ru'jV Prewv
Article 3.1-D of the Tax taw.(See 1,.,r.Scr,edulk,Ck
'ax-�rJef SLICton 1,49,ee it
7=77
Atmrrsef ar oln cede lfgvalea cffi�—al
Pmalfien and Interest
Penattles
Interest
Any CrA"Tcj a"sran:ee-famng To fi!e a return or to Dav aw"ta.V..""'n 'D4PV'"00A;�dtd Merest wift tl�'ha'eez an tt-2 amcm 00
vie t9me lleawred snan De Sucject to a '�Of WA CUV 01�j&3n fntereSt penal, 01 1%01 SUth ampurs of
ea,
onnrim of 6,&,ay of fraction t1jere2f after tfie
after Sum return was requ}red tc be filed of :he zax'teC3-mf
dt.v ,however, Inc in,.Oreit Pen,41, ncl ._xceen
-98tegate
Signature (both the grantor(s� ana granteetsi must the 4md*"S igrecf certjt�, that 'ne ab—' e 'eturr' 4"zk "
sign).3'n 5:1V c"rtcatce, �Cl%eaule Ora-ak&rner-, l� h%noMwleoge,true ano co,"p?0je_ e nett of hWner
A
ORMuNl'y USF CINLY ilFli)c: nssors S:2"El:rt,U-z
C".sydis Code Nttvii York State Depatm*rlt of
Taxation and Finance
Cz Data Dew Atociordoe
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Sul"%'no Cmcnpt;on which MOM ACCU'Alely dateibs,tr, ChOok the coxes
"Sit Of lhil PlOPCnj It the Vmq of S&jw.
9, CVWIp�*W,W Ala=
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ALF1 INFORMATION
Cnit w one or more of ttleSe Cond,t7oftq
!Z3 A S§t peM!,-,,t6:,r co,-
11 54-0 Centra.1 oat,
au Z'
Data of salmrTra'alk,
U ruff Cale pint, V Fa=,x4t v,-4,s F j jj I S'O:,1 Bc_.,l
S�:'4-
ct�tr Sadl reot
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On Coldnior-
14 IeakLatu the Value of p6m0n81
tir-POMW i"Wittled in ttto uji,
ASSESSMENT INFORMATION Da,j
Me'AteSt npi Assess Raj,a 73.O'n
I :Cal
'20.70.Map'd*nbfK(SPRO4
mor,than lour,death DMegj et, �06".
rpstl
C-'t,fy"'at 03 Of Me 4*nl of mfomnAt,on snared a,$tnM 1,_
Pso Statement of malonAl fact hantin sujajAA me to
--watst4n4 til't Mit nkmq at any w"If,,j
SELLE"IGNATURE 'talit'19 and Mov al fVve mstrumtnts
BUYER CON aA9MWFOR&AATlQN
BUYER SIGNATURE
-77
It t
pt
C
-..
1
Board Of Southold Town Trustees
SOUTHOLD, NEW YORK
it PERMIT NO. '-lei DATE: . 10/28/93
ISSUED TO ..__MARX L. _.BAIZ_. 1
Aut4arization ! ,
Pursuant to the provisions of Chapter 615 of the Laws of
the State of New York, 1893; and Chapter 404 of the Laws of the k»
State of New York 1952; and the Southold Town Ordinance en- ka
titled "REGULATING AND THE PLACING OF OBSTRUCTIONS-
IN AND ON TOWN WATERS AND PUBLIC LAUDS and the
{ REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM '
�. LANDS UNDER TOWN WATERS;" and in accordance with the
Resolution of The Board adopted at a meeting held on 10128/93..
19 _ 9� and in consideration of the sum of $ 150A0 paid by
i
a Costello Marine Co., for MARY LAND BAIZ
o{ Southold___ N. Y. and subject to the
l Terms and Conditions listed on the reverse side hereof, 4 ,
of Southold Town Trustees authorizes and permits the following:
Resheath approx. 102' of existing timber jetty, extend in- P7
shore 24' landward and backfill scoured void with approx. i
64 cy of clean fill. Southold
all in accordance with the detailed specifications as presented in
" the originating application. '^
v�
?d IN WITNESS WHEREOF, The said Board of Trustees here- �#
'I, by causes its Corporate Seal to be affixed, and these presents to
\ a be subscribed by a majority of the said Board as of this date.
i a 5�FF 44� l It�
Trustees `
r ,s
/ AI "i ter.: {„ Flu _ � «� ✓"' ' E7 `
SOUTHOLD TRUSTEES
No.p R m I T
r
Issued T om AU L - 8#9 (z Date '° '6
Address AAy 140MF Pb, sd uy�vejt- ls
THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION
A
TOWN TRUSTEES OFFICE DOWN OF SOUTHOLD
SOUTHOLD, N.Y. 11971
TEL.: 765-1892
Albert J. Krupski,President �O�' OG Town Hall
John Holzapfel, Vice President y� 53095 Main Road
William G. Albertson y x P.O. Box 1179
Martin H. Garrell O .Ze Southold New York 11971
Peter Wenczel y'11p1 �.a�! Telephone (516) 765-1892
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
July 28, 1995
Mary Lang Baiz
P.O. Box 726
Southold NY 11971
Re: SCTM #56-5-1.2 & 2
Dear Mrs. Baiz,
The following action was taken by the Board of Trustees at their
regular meeting of July 27, 1995:
RESOLVED that the Southold Town Board of Trustees approve an
Amendment to Permit #4249 to add 14' of split rail fence on
jetty and chain link fence upland as per drawing approved and
signed by you on July 27, 1995 meeting.
If you have any questions, please call our office.
�Very truly yours, Q
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/djh
cc. CAC
Bldg. Dept. -
J YLE JlEQy Ei, EoX 726
_ f cSouLfiotd, Zany Yiland, IJVzw VO4 11971
�o��. dl �4 , Z .� . �11 •�• lly`7�
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JUL 101996
,OF SOUTHOLD
TRUSTEES SUFFO SUPERVISOR
John M. Bredemeyer, III, President O�� �'p SCOTT L. HARRIS
Albert J. Krupski, Jr., Vice President �Z' Gym
Henry P. Smith ti '° Town Hall
John B. Tuthill • 53095 Main Road
William G. Albertson P.O. Box 1179
Telephone (516) 765-1892 �Ol �[ � Southold, New York 11971
Fax (516) 765-1823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
October 29, 1993
Susan Long
Costello Marine Contracting
P.O. Box 2124
Greenport NY 11944
Re: MARY L. BAIZ
SCTM #56-5-1. 2 & 2
Dear Susan,
The following action was taken by the Board of Town Trustees
during its regular meeting held on October 28, 1993 regarding
the abovematter:
WHEREAS, Costello Marine Contracting on behalf of MARY L.
BAIZ applied to the Southold Town Trustees for a permit under
the provisions of the Wetland ordinance of the Town of Southold,
application dated September 10, 1993 and,
WHEREAS, said application was referred to the Southold Town
Conservation Advisory Council for their findings and
recommendations, and,
WHEREAS, a public hearing was held by the Town Trustees with
respect to said application on Thursday, October 28, 1993 at
which time all interested persons were given an opportunity to
be heard, and,
WHEREAS, the Board members have personally viewed and are
familiar with the premises in question and the surrounding area,
and,
WHEREAS, the Board has considered all the testimony and
documentation submitted concerning this application, and,
WHEREAS, the Board has determined that the project as proposed
will not affect the health, safety and general welfare of the
people of the town,
NOW, THEREFORE BE IT
RESOLVED THAT THE Board of Trustees approves the application of
MARY L. BAIZ to resheath approx. 102' of existing timber
jetty, extend inshore 24' landward and backfill scoured void
area with approx. 64 c.y. of clean fill from approved source.
Permit will expire two years from the date it is signed. Fees
must be paid, if applicable, and permit issued within six
months of the date of this notification. Two inspections are
required and the Trustees are to be notified upon completion of
said project.
Permit will be issued upon payment of the following fees for
work to be done below Mean High Water Mark:
Fees:
Very truly yours,
John M. Bredemeyer, III
President, Board of Trustees
JMB/djh
cc. - CAC
OFF0 SUPERVISOR
John M. B edemeyerTRUSTEEIII, President �ON�S COG SCOTT L. HARRIS
Albert J. Krupski, Jr., Vice President o y` Town Hall
Henry P. Smith y x
John B. Tuthill 5309.5 Main Road
William G. Albertson P.O. Box 1179
Southold, New York 11971
Telephone (516) 765-1892
Fax (516) 765-1823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
S.E.Q.R.A.
NEGATIVE DECLARATION
NOTICE OF NO SIGNIFICANT EFFECT ON THE ENVIRONMENT
APPLICATION NO. 1000-56-5-1. 2 & 2 Chapt. 97 - Wetlands
NAME: Mary Lang Baiz Chapt. 37 - Coastal Erosion
DATE: September 30 , 1993
RESOLVED that pursuant to Article 8 of the Environmental Conservation
Law, State Environmental Quality Review and 6NYCRR Part 617,
Section 617 . 10 and Chapter 44 of the Code of the Town of Southold,
notice is hereby given that the Southold Town Trustees, as Lead
Agency for the action described below, has determined that the
project will not have a significant effect on the environment.
Please take further notice that this declaration should not be
considered a determination made for any other department or agency
which may also have an application pending for the same or similar
project.
TYPE OF ACTION: Type: II
DESCRIPTION OF ACTION: Applicant requests permit to resheath
approx. 102 ' of existing timber jetty, extend inshore section 24 ,
landward and backfill scoured void area with approx. 64 c..y. of
clean fill from approved source. Located Bay Home Road, Southold.
LOCATION: SCTM #1000-56-5-1. 2 & 2
REASONS SUPPORTING THIS DETERMINATION:
1. An on site inspection has been conducted by the Board of
Trustees.
2. An environmental assessment, submitted by the applicant and
reviewed and completed by the Board of Trustees, has indicated that
no significant adverse effects to the environment are likely to occur
should the following mitigation measures be implemented.
Cc: CAC
2
Moved by Robert Keith, seconded by Patricia Isaksen, it was
RESOLVED to recommend to the Southoid Town Trustees APPROVAL
WITH REQUEST of the Wetland Application of HELEN M. AND
ROBERT W. RUST 111-14-34 to replace approximately 104' existing
bulkhead in-kind, in-place. Backfill with 20 c.y. clean fill from
approved upland source. The Council recommends approval but
request the applicant maintain a 10' natural vegetative buffer behind
the bulkhead.
Wunneweta Road, Cutchogue
Vote of Council: Ayes: All
Motion carried.
Moved by John Holzapfel, seconded by Robert Keith, it was
RESOLVED to TABLE the Wetland Application of HIRANT AND AYDA
CANDAN 44-1-18 to construct a bulkhead 38' front , 24' return,
CCA materials, 3 x 10 x 8 sheating, 5 x 6 stringers, round pilings
8" every eight feet apart, penetration 4 1/2 ' galvanized hardware,
with filter cloth on back.
The application was tabled until the CAC receives better plans and
applicant need to clarify his intent.
Vote of Council: Ayes: All
Motion carried.
55955 North Road, Southold
Vote of Council: Ayes: All
Motion carried.
Moved by Bruce Loucka, seconded by Stephen Angell, it was
RESOLVED to recommend to the Southold Town Trustees APPROVAL
WITH STIPULATIONS of the Wetland Application of RUSSELL McCALL
116-6-7 to remove approximately 2000 c.y. of fill, concrete and
other debris dumped in marsh by previous owner. Present owner
seeks to install disturbed area to former condition as a marsh and to
re-establish tidal flow via presently blocked drains to marsh to
east. He does NOT intend to develop or otherwise build upon this
property. All material removed will be disposed of in Town of
Southold landfill or other suitable location.
The Council approves the project provided the applicant does not
leave a "hole in the ground". The CAC recommends the applicant
contact the Cornell Cooperative Extension or an environmental
consultant to provide assistance and knowledge to reestablish the
marsh quickly and in an environmentally sound way.
New Suffolk Avenue, New Suffolk
Vote of Council: Ayes: John Holzapfel, Bruce Loucka, Stephen
Angell, Betty Wells, Patricia Isaksen
Abstain: Robert Keith
Motion carried
Moved by John Holzapfel, seconded by Bruce Loucka, it was
RESOLVED to recommend to the Southold Town Trustees_ APPROVAL
AS IS of the Wetland Application of MARY LAND BAIZ 56-5-1 .2 & 2
to resheath approximately 102' existing timber jetty, extend inshore
3
s section 24' landward and backfill scoured void area with
approximately 64 c.y. clean fill from approved source.
Bay Home Road, Southold
Vote of Council: Ayes: All
Motion carried.
Moved by John Holzapfel, seconded by Bruce Loucka, it was
RESOLVED to recommend to the Southold Town Trustees APPROVAL
WITH STIPULATIONS of the Wetland Application of BARBARA
CIEPLINSKI 89-3-9 & p/o 8.1 construct a timber dock consisting of a
4' x 100' fixed elevated (3'6" above grade of marsh) walkway; 3' x
16' ramp; 6' x 20' float secured by (2) 8" pilings.
The CAC recommends approval provided the project does not block
the navigation of adjacent neighbors and the walkway is elevated 4'
above grade of marsh. —
Orchard Lane, Southold
Vote of Council: Ayes: All
Motion carried.
Moved by Stephen Angell, seconded by Patricia Isaksen, it was
RESOLVED to TABLE the Wetland Application of CANDACE CORLETT
99-3-17.1 to construct a 4' x 8' fixed dock leading to a 3' x 10'
ramp leading to a 6' x 10' floating dock in a dredged canal.
Lagoon Lane, Mattituck.
Vote of Council: Ayes: All
Motion carried.
Moved by Bruce Loucka, seconded by John Holzapfel, it was
RESOLVED to recommend to the Southold Town Trustees APPROVAL
WITH A STIPULATION of the Wetland Application of JOYCE R.
ANDERSON 53-4-21 to extend existing southerly return by 101.
Construct new 20' northerly return. Replace tie-rods and deadmen in
existing bulkhead and backfill with 25+/- c.y. of clean sand fill to
be trucked in from upland source and delivered over owner's
property. Remove and replace an existing 4' x 8' stairway.
The Council recommends approval provided a 10' native vegetative
buffer be maintained.
2625 Bayshore Road, Creenport
Vote of Council: Ayes:, All
Motion carried.
Moved by Stephen Angell, seconded by Robert Keith, it was
RESOLVED to recommend to the Southold Town Trustees APPROVAL
of the Wetland Application of MATT-A-MAR MARINA 114-3-1 to add
a green chain link fence to the existing retaining wall on south side
of property 5' in height, then runs inside property along Wickham
Avenue (east border) to north side.
Wickham Avenue, Mattituck
Vote of Council: Ayes: All
TRUSTEES O�pSUFFO(,+Co Cal ]I PY
John M.$rederneyet,111,President Gyp SUPERVISOR
Henry P. Smith,Vice Presideht epic > SCOTC L. HARRIS
Albert J. Krupski,Jr. _
John L. Bednoski,it. �'f� Off{ Town Hall
John B.Tuthill 53095 Main Road
- P.O.Box 1179
Telephone(516)765-1892 BOARD OF TOWN TRUSTEES Southold,New York 11971
Fax(516)765-1823 TOWN OF SOUTHOLD
COASTAL EROSION MANAGEMENT PERMIT APPLICATION
TOWN WETLANDS PERMIT APPLICATION
TRUSTEE LANDS PERMIT APPLICATION
Office Use only:
Atoastal Erosion Permit Application
Wetland Permit Application Q [ D
Trustee Lands Permit Application
✓Grandfather
Completed Apps. Date r—pq3 ( 010 !°
ariance Required,
Neighbors notified Date: iHOLD
SEQRA Type `y�a��3 t MVIN OF SOU
Coord. Review-opt. ,mand.
Ittsp. comp. /date:T43673 -
SEQRA Determin. /date: --- —
Public Hearing/date:
Findings: SFF ! 0
Permit Vote: (Y/N) : Ir
Special Conditions: —
( also see file)— 'Appileatien Fees
Application Number; SCT14 #1000- -
Project Name (If any) MA LA MC- AA IZ
Date Prepared: q / /q 3
Applicant: C.11CT 1,n M /><1211�IE Co lraacTi C n P
Address: p , hbya
Phone (SRO LI-7-7 W19
Interest: (owner, consultant, lessee,etc. ) A Q EIJ -F
Owner of Property: MARV I,A Mc (3412_
Address h 0 , Ro x 7a(
l FM I Phone
Subject Property Location: 136Y }1p M F 1:DA
( Pro ide LILCO Pole # , Distance to cross Streets if not on
location map)
THIS IS NOT A PERMIT
Yds. to be excavated: Q Yds. to be filled!
Manner in which material will be removed or deposited:
I nAA h Fr- I BAct t+NF-
Width of canal, cree .o'/ �r bay fro tang property:
Depth at low tide. "FA Aver. rise in�R ance pr tide: NIA
Distance to nearest channel: Distoject
extends beyond similar projects in area: n1Js1
Area zoning: Qcane�r.T1A� Land area in acres: lees / X �43, '
Is project for private or business use: 1>R1V AT E.
Intended use of property: CwsTIt.» ca1Dfk1 IA1
Describe known prior operations conducted on premises:
1110 KI E-
Has any prior license or permit been issued to erect structures,
dredge, or deposit fill on said premises:
Has any licrnse' o er ?t ,e er been revoked or suspended by a
Governmental Agency: Ta
Proiect Description
The project description must also include plans for reclamation
of land disturbed during...gonstruction of the principle and
accessory structures nd Iunderground structures. ( i.e. , pipeline
and septic system; ma ditional attachments if necessary) .
'j;p,5)}FJRTH q'p�12i IC>a' EXISTING T1MAF {' TE-i'T�' I
R P1LL SCnc�R>c-� VOID PfREA LL11TH r4PPRQXIMATELV
Authorization (where the applicant is not the owner)
I residing at
(Print-owner of subject property) (Mailing address-phone)
do hereby authorize to apply for
Coastal Erosion permits) from the Southold Town Trustees
Signature
THIS IS NOT A PERMIT
County of Suffolk )
State of New York )
S 1?, BEING DULY SWORN DEPOSES AND
AFFIRMS THAT HE/SHE IS TH APPLICANT FOR THE ABOVE DESCRIBED
PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO
THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT WORK WILL BE
DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE
APPROVED BY THE SOUTHOLD TOWN BOARD Of TRUSTEES. THE APPLICANT
AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES
HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING
UNDER OR BY VIRTUE OF SAID PERMIT( S) , IF GRANTED.
IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,
THEIR AGENT(s) OR REPRESENTATIVE( s) , TO ENTER ONTO MY PROPERTY
TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS
APPLICATION.
AATURE
Tk
SWORN TO BEFORE ME THIS 7 DAY OF SEPTE M p 19 cr--,
Gw yft
llftfl8d In ' fj::"�
NOPARY PUBLICkq to
Suggested space for location Map
THIS IS NOT A PERMIT
i
617.20 _.
Appendix C
Stbld Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I Project Inlormbllon (To be completed by Applicant or Project Sponsor)
t Applicinbspontor 1 Project Name
C_r 11 1J I. Z
Protect local.*..
Municipality County V F F 0 t_
a Is proposed action.
❑ New ❑ E.pansmn ElMudificalmruallom F—
atn RPAI Iz RECuK35TKUCTIDIJ
5 Describe protect briefly.
' c W. LV a4
b Precise location troad intersections, prominent landmarks. etc or provide map)
7 Amount of land airected:
I ndiallY -- >uei -"-Ultimately acres --- - - -
a Will pr *sed action comply with e.utme toning or other anting land use resincponsl
Yet ❑ No 11 No,describe briefly
9 What resent land use in vicinity of project?
Residential ❑ Industrial ❑ Commercial., ❑ Agriculture ❑ PsAland,open space ❑ Other
Describe: UJ QJlk
10 Does acti involve a permiit.approval. or funding, now or ultimately. bom any other governmental agency(federal, state or local)?
rd Yes El❑� �No If yes, lift agencv(s)and pem rcappr*vals
S ^rw�� Tina
11 Does anv aspect oft action have a conentiv valid permit or approval?
❑ yes S* If yes.list agency name and pemm.t.apwoval tope
11 At result of plopos action will e..sting permit approval requok moddaatiool
❑ Yet No ..
1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF A1)' KNOWLEOCE
Applicant.sponsor name. XI Dale ---
Sgnature. AA
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 11 tnvifonmigniAl Assesimint be completed by Agency)
A Does Action
�o oo Action e%cred Any first 1 threshold in NKRR. Part 612127
EJ yet II
vet, c ,dmate the review process and uce the fUtl (AF
e N'JI itlwmrecav!coordmaled fAvrew is Isfdvided stir Units lkd A[honl In 6 NY
involved action CRR. Part 61f 21 If No.A negative declaration may be w
❑ Yes ID NO perceded by another
C. Could Action result in ANY Adverse effects on. la. ar Anaing from the lollowm CI tuning Air gminv. surface or poundwater quality or quantity,none Ieveb,(Mrtbnn may be 1 Andwneen, d legible)
drainage or Iloodmg problemsi faplbn briefly
g tiAltic Patterns. solid wasir production or disposal,polenna)lot Noaon
C2. Aesthetic. aprzuhural, archeological, historic. or other natural or cultural resources or community or neighborhood characters IAplarn bnelly.
O. Vegetation or iauna.;movement of fish or "ldlde 'Pell". nemhcant habitats, or thrtatrned or andange,rd speu"i [grUrn Lnd1v
Ca. A community} twitting plans or goals as officially adopted. or a change in use or mlennly of use of land or other natural resour<es, F'Plain briefly.
C5 Crowth, subsequent development. or related aci,vities likely to be induced by the proposed actions F.plain briefly.
C6. Secondary. cumulative, or other esiects not identified in C1.C6, tAplain briefly,
l�
G. A change in use of either quantity or type of energy? Explain briefly
PART III Delerminallon 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.
❑ Check this boa 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 here. and on
attachments at necessary, the reasons supportng this determination-
Agency ]am!
Agencv Pcepa,er's name
Preparers 5qn ture.Tale
Ogre
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AUTHORIZATION FORM
Date:�A L tCj
I
1 /• D �°*n• e. -P.a owner ofT p re-
n Business/ operty name
located at I ate it 1� . h I Ike
do herby give Costello Marine Contracting Corp. the authority to
act as agent in my behalf in applying for all of the necessary
permits in order for work to be done on my property described
above. n
l..�L
Signature
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