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Home My WebLink AboutTR-6869A . . 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 15t day of construction Y, constructed / 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 Permit No.: 6869A Date of Receipt of Application: April 21, 2008 Applicant: Kristen Frohnhoefer & Joseph Frohnhoefer, III SCTM#: 55-4-25.3 Project Location: 1505 Yennecott Drive, Southold Date of Resolution/Issuance: May 21,2008 Date of Expiration: May 21, 2010 Reviewed by: Trustee James F. King, President Project Description: Remove dead, diseased and overgrown or invasive vegetation and trees; rake and level area; add compost and re-plant with trees, shrubs, flowers and grass. 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 site plan prepared by Kristen Frohnhoefer, received on April 24, 2008. 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. r67~ James F. King, President Board of Trustees JFK:eac . . 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 May 21,2008 Ms. Kristen Frohnhoefer Mr. Joseph Frohnhoefer, III P.O. Box 255 South old ,NY 11971 RE: 1505 YENNECOTT DRIVE, SOUTHOLD SCTM# 55-4-25.3 Dear Ms. Frohnhoefer & Mr. Frohnhoefer: The following action was taken at the South old Town Board of Trustees regular meeting held on Wednesday, May 21, 2008: RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a Transfer of Permit #4983 from Peter DeNicola to Kristen Frohnhoefer & Joseph Frohnhoefer, III, as issued on November 18,1998, and Amended on June 21,2000. If you have any questions, please contact our office at (631) 765-1892. s;;::- ~ ~ James F. King President, Board of Trustees JFK:eac . . 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 To:J(ri5-kn F,ohnh()eb-(::j~h rrohnhoefe.r-~ Please be advised that your application dated ~ ~rr has been reviewed by this Board at the regular me~ 1Yhe?f d/' dCb8'" and your application has been approved pending the compl ion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1st Day of Construction ($50.00) y, Constructed ($50.00) ~ Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: co TOTAL FEES DUE: $ 50- BY: James F. King, President Board of Trustees " Board Of Southold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. "I ~!'"J DATE:.. Jl /18/98. ISSUED TO .. ..... .P.ETER P:ENICO.LA ^ut~nri1!ntinn Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and eMpter 404 of the Laws of the State of New York 1952; and the Southo\cl Town Ordinance .... titled ."REGULATING AND THE PlACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL Of SAND. GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS:~' and in ac:corclance with the Resolution of The Board adopted at a meeting held onHI.1.8.I.~8...... 19 9.~..., and in consideration of the sum of $15.9...9.9 ... paid by PETJ;:R...PE NICQLA ...... ............... of...1:!99-tho.!.!;\...... . .. N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Wetland Permit to. canstruct a 2 .stary single family dwelling and upan receiving a survey shawing pipe extending fram hause far runaff into. the drainage easement and elevatians af proper.ty.' al in accordance with the deteiled specificetions as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trust_ hare- by causes its Corporate Seel to be affixed, end th_ p.-nts to be subscribed by a majority of the said Board as of this dat.. ~9:t:!"...L~ J;;~7~ .~ :;j~~~d.. _.~. ...J-:.~...... ..... T""'ft' - . Albert J. Krupski, President James King, Vice.President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone \631) 765.1892 Fax (631) 765.1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 5, 2000 Mr. Peter DeNicola 1695 Chablis Path Southold. NY 11971 Re: 1505 Yennecott Dr., Southold SCTM#5S-4-25.3 Dear Mr. DeNicola: The Southold Town Board of Trustees give you permission to discharge the basement sump pump for groundwater only, into the drainage easement on the west side of the property. Very truly yours. 2.:-!d 1(- /~'0, Albert J. Krupski, Jr. President, Board 0fTrustees Al1<.: Ims .. , Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Albert J. Krupski, President James King, Vice-Preaident Henry Smith Artie Foster Ken Poliwoda Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 22, 2000 Mr. Peter Denicola 1695 Chablis Path Southo1d, NY 11971 Re: 1505 Yennecott Dr., Southo1d SCTM#55-4-25.3 Dear Mr. DeniCOla: The following action was taken at the Southo1d Town Board of Trustees Meeting held on Wednesday, June 21, 2000: RESOLVED, that the Southold Town Board of Trustees grant the request for an Amendment to Permit .4983 for the addition of a wood deck 14'X 18' to the rear of the residence with the condition that the 2" PVC pipe coming out of the rear of the house be put into a drywell. This is not an approval from any other agency. If you have any questions, please call our office at 765-1892. Sincerely, tia.t-,I ~ ~.~. Albert J. Krupski, Jr. President, Board of Trustees AJK : Ims cc: Building Dept. . , -. -. Albert J. Krupski, President James King, Vice.President Henry Smith Artie Foster Ken Poliwoda t?ffjL~ ~II~~" =:t ~~,o( c::t .. ~ ... :e ~ ~ 'tt~ . i-"'~ Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-18012 Fox (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD November 19, 1998 Peter De Nicola 1695 Chablis Path P.O. Box 841 Southold NY 11971 Re: SCTM *55-4-25.3 Dear Mr. De Nicola, The following action was taken by the Board of Town Trustees during a Regular Meeting, held on November 18, 1998, regarding the above matter: WHEREAS, PETER DE NICOLA, applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated OCtober 16, 1998 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 November 18, 1998, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standard set forth in Chapter 97-18 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, . -. -. NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approves the application of PETER DE NICOLA to construct a 2 story single family dwelling and upon receiving a survey showing a pipe extending from house for runoff into the drainage easement and elevations of property, and, BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency which may also have an application pending for the same or similar project. Permit to construct and complete Dro1ect will eXDire 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. FEES: None very truly yours, tlL~..- t ~ ;{ .'t.'&. ~, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. DEC Dept. of State Bldg. Dept. .., ,..,. ~ '" .., '." 1."'" " ..' , ....0..'" .., " ll....<' .. U g 1.....<, ... ~ " ,." . , ~ W (1) ~~ ".co." 0.-. 01_00_' ",02,' .,,,.,, '-"-0 '-"-0 .-'.-0' .-"." "-26'0 ""-00 '-01-' ,-.' '0-"" + 11 ,1\ ,'i , -;:-J- 11 iJ . . . , LI""-"~,.,," E'''''',,'-.... , ,. N'-"""" ,-- + 1211 (1) '::;,'''.rt::-..,.:'....~,o.';.\,\ ~.~ " " " -..."'" ..m..". tlOTICt: @ COUNTY OF SUfFOLK @ ReclPropertyTCX.SerYkeAQElIlCY c...nfJtont<r ~~rlm1 .. KllE~mT. - . '" - H''''....,.S,OUTHOLD ... .lI ",,",-,,"If' ... '" "'P\TJElOll 1000 5ECTIONt.(l ......, 12.1.....'''.10 ,_,.. 1>.,"'., _.. ...."""","-"",...."",'" ~""""_"'...,,..,".(t'T>( smlJ). C,...." "'""'E ""'"I1HTIl ."'..".."'".._-"'''. Rf"-_"..",.""""",. 055 PROPERTYM.lP '---- COOfIISO<DlTE,_.","" --" . . April 21, 2008 Town of South old Permits Office Main Road Southold, NY 11971 To Whom It May Concern: As the current owners ofthe residence at 1505 Yennecott Drive, tax map number 1000-55-4- 25.3, we would like to request that all existing permits, Certificate of Occupancy and similar for said residence be transferred into our names. Known permits include #4983 issued on 11/18/98, permission to discharge a basement sump pump issued on 9/512000 and an Amendment to Permit #4983 for the addition of a deck issued on 6121/2000. We thank you for your time and efforts. Please mail all transferred permits, etc. to the address below. Do not hesitate to contact either of us with any questions. ~1Er;1E'''E APR 2 1 2008 ~ /~~. / ,/ // .~ I~o oe-fe I .~~. Contact information: lOUlhhOld Town oard of Trustees PO Box 255 Southold, NY 11971 Kristen Cell: 631-478-5122 Joseph Cell: 631-478-5124 Kristen Work: 631-765-3660 x3115 Joseph Work: 631-765-3660 x3134 "--.w: . James F. King, President Jill M. Doherty, Vice-President Peggy A" Dickerson Dave Bergen Bob linosio, Jr. BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 Coastal Erosion Permit Application = Wetland Permit Application -L Administrative Permit _ Amendment/Tra~l~~i~tSiOn ~eceived Application: ~Received Fee:$ l~- _..-completed Application ~ I.J.II (i _Incomplete I _ SEQRA Classification: Type I_Type II_Unlisted_ _Coordination:(date sent) ~ L WRP Consistency Assessment Form CAC Referral Sent: .....-fJate oflnspection: S/rl./I~ _Receipt of CAC Report: ~ Lead Agency Detennination:~ _Technical Review: ~ublic Hearing Held: sf J.I@ _Resolution: Office Use Only /flj) ~ (C ~ 0 Wi ~ lrm IfJ]I APR 2 J 200IJ ~I Southho/d TOWQ Board of Trustees Name of Applicant ^.;. 1_* 11 11'tI.,'/,M .6 Addre~ p() ex ,;;z~~ C"' . 'd ~ODlflJ(J/ ~ a /lei j() s~ ,oJ h nv J) n h (/{' If I~ J:Jr... . r {/ /51)5 L/f/Jruarff Dr, )., . K,,$fen I (..3/- 'I7~- 6/.:l~ Phone Number:( )~Si?iJh &".3/- 47fi-5/.:J1 , Suffolk County Tax Map Number: 1000 - 55 - tf -dS; _ ~ pr-'. Property Location: 151~ 5 f./t'l7l7f( cff I (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: . . April 21, 2008 Southold Town Trustees Town Hall Main Road Southold, NY 11971 Dear Town Trustees: As the owners of the residence at 1505 Yennecott Drive, tax map number 1000-55-4-25.3 we would like to request an Administrative Permit for the following: I. Maintenance of existing and future planting beds and gardens, including, but not limited to addition of new plant material, plant removal, fertilizing, compost application, mulching and pruning. 2. Installation of additional planting beds and/or vegetable gardens adjacent to house, throughout yard and/or in any existing cleared or lawn areas. 3. Maintenance of existing and future lawn areas, including, but not limited to mowing, fertilizing, thatching, aerating, and re-seeding. 4. Installation of lawn in any existing or future cleared area. 5. Removal of dead, diseased, invasive and overgrown vegetation and trees. 6. Planting of trees, shrubs, flowers, grasses and similar in any existing cleared, lawn or planting bed areas. 7. Maintenance of vegetation and removal of dead, diseased, overgrown and/or invasive vegetation which originates on neighboring community-owned lot, but encroaches upon our lot. 8. Maintenance of existing and future trees, including, but not limited to pruning and disease treatment. 9. Establishment of a compo sting site. 10. Maintenance of existing and future irrigation system elements. 11. Expansion of irrigation system as needed to support existing and future planting beds, gardens and trees. 12. Maintenance of driveway, existing decks and exterior of house. 13. Any other generally accepted horticultural practices. We thank you for your time and efforts. Please mail all permits to the address below. Do not hesitate to contact either of us with any questions. Contact information: PO Box 255 Southo1d, NY 11971 Kristen cell: 631-478-5122 Kristen work: 631-765-3660 x3115 ,;/ /~-- ;osefFr1~rrn I Joseph cell: 631-478-5124 Joseph work: 631-765-3660 x3134 T '. ~rd of Trustees APplicatitlt GENERAL DATA Land Area (in square feet): 3::;-: t.51 -t' fCl . ". Area Zoning: 7(es I ~ n.h ~ ( , Previous use of property: 'R 6/cit IZ h VI. / , Intended use of property: Rt'S /df n h a J/L Covenants and Restrictions: Yes If "Yes", please provide copy. X No Prior permits/approvals for site improvements: ___ A!;CY In~c., <; , {/ I {118"/ q f{ d/:>>-/(JV r:t-/-fi}f -3 1~~?C!er Dr N' ~ AmfrdnwfLfjtn /)IcK ~sw~ 7} ))reA _ 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): (J) j(emo-v-e- dedd \ d(5(?cmJ ,OVWJI'ffUm 1M '\ "I die I ' @ IY\J/I1S'It}-f ~dekh~ /. ) Qd Co~cst- SS) r~wsf "";:::It ove,c . , 411rrd of Trustees APPlicat~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose ofthe proposed operations:Yemovtt I % 0f'iAd I d' SfOse J ord (') Ve (5 (D wr;/I/\ \/1.).$ i if P \/eqe~ -h ()Y) ( to /1 () lV (Jd ~ re ria fl-b n; -Iv (fv/M//ZP 'Htl !a/7ds('a,tP . o o Area of wetlands on lot: square feet Percent coverage oflot: % Closest distance between nearest existing structure and upland edge of wetlands: 71(' feet Closest distance between nearest proposed structure and upland edge ofwetlands:_ feet ilia- - /1h ?11J~ s/n{ dwU2... Does the project involve excavation or filling? /NO Yes If yes, how much material will be excavated? o cubic yards How much material will be filled? o cubic yards Depth of which material will be removed or deposited: feet II fa.- n 1r;L-- 11 /to , Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetl~ds and tidal waters of the town thatl11a)' result by reason of such proposed operations (use attachments if appropriate): hP IIYt no c f U r-YJ rl . , I ( PROJECT ID NUMBER 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) . SEQR PART 1. PROJECT INFORMATION 2. PROJECT NAME 3.PROJECT Municipality County s 4, PRECISE LOCATION: Street Addess and Road Intersections. Prominent /505 'jenne-eoit-br. 5. IS PROPOSED ACTION: 0 New o Expansion Modification I alteration 6Y;;;;;7/i~Prt/ c/;~iJ~ and Olll?:j/7JW/J);hvaSltH ve5ekvhon ( IO//()W-€d blj/QPJtlJ1hlCtj I ~ ret/J'kJ/Z-( Wu !?il1dscare- 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 85 PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER l6IYes 0 No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY [l$J Residential D Industrial 0 Commercial OF PROJECT? (Choose as many as apply.) DAgriculture D Park I Forest I Open Space DOther (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) DYes KI No If yes, list agency name and permit I approval: ES DYes ANTASPECOOF THEI\C IIUN HAVe A CURREI'ITLY VALID PERMIT OR ApPROVAL? ~o If yes, list agency name and permit I approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION? []yes 0 No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Signatur Applicant If the tio I a Co al Ar ,and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment . . If yes, coordinate the review process and use the FULL EAF. B. Will ACTION REyEIVE COOROINATEO REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration mq,y t)ll superseded by another involved agency. c=J Yes No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOllOWING: (Answers may be handwritten, if legible) C1 Existing air quality, sunace or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, rtential for erosion, drainage or flooding problems? Explain briefly: I C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: [ I C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: I 1 C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly L C5. rowth' subsequent development, or related aclivilies likely 10 be induced by the proposed aclion? Explain briefly C6. Long lerm, short term, cumulative, or other effects not identified in C1~C5? Explain briefly: I C7. Other impacts (including changes in use of either quantity or type of energ ? Explain brieny: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENT~ AREA (CEA)? (If yes, explain briefly: DYes DNO I E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explail1: DYes DNo L PART III- DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the G1et9FmiAatiGA-Gf-s~ifiGaHGe-ml:l-&t-evalHate-tAe-peteAtial impaet-efthe proposed actioA-efl the-eftVimflffieFttat-ehaiaetertsties-of-theGEA:--- Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL EAF and/or prepare a positive declaration. Chec'kTfilsboiTf yolJ"have-delermTnetf, based-on -tlie Tnformation and analysis -above and-any suppolting- documentation, tha"tthe-proposed actlo- 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 Pnnt or Type Name of ResponsIble OffIcer In Lead Agency Title of Responsible Officer Signature of ResponsIble Officer 10 Lead Agency Signature of Preparer (If different from responsible officer) ',' l, 4IItoard of Trustees APPlica~n " County of Suffolk State of New York Kns-f: n f(o /rm hoe-{P, ..J)~ oh J". TVv hn ho~ 1TL BEING DULY SWORN DEPOSES AND AFFIRMS THAT /SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HISIHER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS 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 REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. ~ / DAY OF 1-pY/ I ,2012ff Q~~ Notary Public ',' . . APPLlCANT/AGENTIREPRESENTATlVE TRANSACTIONAL DISCLOSURE, FORM The Town of South old's Code of Ethics prohibits conflicts of interest on the Dart of town officers and emolovees. The Durnase of this form is to nrovide information which can alert the town of oossible conflicts of interest and allow it to take whatever action is :e~~:a:;:;oi~;;~~(X7~ btrJ Jneph J. F;ohr\htJ1>r ~ (Last name, first name,-J}1iddle itia!, unless you are applying in the name of someone else or other entity, such as a company. Ifso, indicate the other person's or company's name.) , NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If "Other", name the activity.) Building Trustee Coastal Erosion Mooring Planning x 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 bus'iness interest "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. X , YES NO If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of South old Title or position of that person Describe the relationship between yourself(the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, of child is (check all that apply): _A) the owner of greater than 5% of the shares of the corporate stock of the applic~mt (when the applicant is a corporation); _B) the legal or beneficial own~rofany interest in a non-corporate entity (when the applicant is not a corporation); _C) an officer, director, partner, or employee ofthe applicant; or _D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I 200 fl. / / / / / / / / / / .,. / ~ P/O LOT 29 / / / / ~ / / / / / / / / / / / / / / / / ./ / / ~<,~ /. <:J~ / /<9 .. S.C.T.M. NO. DISTRICT: 1000 SE:CnON: 55 BLOCK: -4 LOT{S):24 R010-9B-150 ::i.'. rT;'':.~ 'X'UNTY DBf'AR~~-::::-.- . .m~.'~I., HEALTIISERVlW II.P('P.OVI\LOfCONSTr.:tJC:i_ -\ SINGLE FA;m:V R~rD~:?f::~!i FOR ,,'..dUN 06 2IIlIIl1L....-.". Rlo9l? OISO In'\::''''1l':~~15:;l1l:ll.11Ind'''lIfl:r~1 r; . liiJ':":'lc.'lV;r;:':crtlfldb)'lhis~ -aw1tieJarlhla !~lcInt'....'C been MII~rM.'\C/'}'tl'OR~UMOP ~~e:e-"lesar.Afoandto , B ROO~- J Q. omceO:w.. CO' ~ ~SCl.P.B..Chjer '1SlcWaCcr Mana,- 0/ 0- v {> 0- v ~ .1> .0' .' ~ o <0: o OC 28 I I I I /1/ / I / y/ / €II I I I I 1 @ "" ", _r r~ .;r;s;:u.AA 2sn':":~ ~,EL32.7 .. ..~. ,..r lotl'- _ ~lI#fIII!' i:t ~. ~~~ POND) .~~ ...J ...J I- I- ~ I- 0000" 'J;" 9 "J~' ~ <- " 382.20' :.-- YENNECOIT Q.21.40 @ ,,.l't .. ~ ~.. '}.2 ":i'C']VEO s~lr;.Qu\ Cf)IJ~:TY P/O LOT 29 mn IIAY 30 M; 10: 20 DEPT c;: ll::,',liit ~':;l'.I\CES C~f1C!: ',:','31':',::.1 ::r: t~EHl 1Il o "l o o ... q I~ s I ~.n _.= LOT 30 g>", "0 a.= oS: 0 ffi )> " <S"?J :D N ffi - = N = ~ = ex> ffi .... :;<Q. = -" 00 M ---- DRIVE""'" ~ e 112 F'WAl. $lJIJIIEY .5-17-2000 AREA; 35,659.0 $.F. OR 0.82 ACRES ....-,,~l<<A_ UNAUTHORIZED ALTeRATION OR MJDITION TO THIS SURlif"Y IS A ~A11ON OF SCCOON 7209 oF THe NfW 'fOR/( STArE eDUCATION LAlli: COPIES OF' 1'HIS SURIo['Y MAP NOT BEARING THe LAND SURlif"Yl::R's D/BOSSED SCAL SHALL NOT BE CONSJDCRro TO Be A VALID TRUE: COPY. GUARANTffS INDICA 1m HERtON SHALl.. RUN ONJ.. Y TO THe peRSON FOR WHOJI THe SlJRIo['Y IS PRePARCD ANt) ON HIS BCHALF ro THE TIne COIIPANY, GOVFRNI.tCNTAL AGENCY AND uNDINe INSTITUTION LISrED HeREON, AND ro THE ASSlCNEES OF' THE LENDfNG INSnT/JTION. GUARANrrES ARE NOT TRANSFeRA8t.e. THe OFrSETS OR DlUENSJDNS SHOWN HERrON FRDItI THC ~'TY UNCS rtl rHC STRUCTURC'S ARt FOR A SPECIFIC PURPOSe AND use THCREFORe THF:Y ARC NOT INrcNDED TO UONUIJENT THE PROPeR'TY UNCS OR TO CUID! THt rRtCnON OF rmcES, ADO/TlONAL STRUCruRCS OR AND OTHER IMPROvtlItNTS. eASD.fCNTS AND/OR SUBSURFACE STRUCTUReS RtCORDCD OR UNReCORDCD ARt NOT GUA,RAHTCCD UNt.CSS PH't'SICALL Y C'VIotNT ON THE PRn/lSES AT THC nMC OF SURVEY PUBUC WA rER A VA/LABLE [J IIf"LL irA rm 0 INO/VIOUAL SANITARY SYSTCU 0 CLeVA 1ION OA TlN.: _~________ SUR"'Y Of' P /0 LOT 28 & P /0 LOT 29 "AI' OF, YENNECOTT PARK AT SOUTHOLD OLEO, OCT. 9, 1968 AS fl5187 SITUATED AT: SOUTHOLD TOWN Of, SOUTHOLO SUFFOLK COUNTY, NEW YORK CERTIFlEO TO: PECONIC ABSTRACT- PECONIC COUNTY CONSUL TlNG CORP.' FilE, 98-77 SCA.LE: 1"""'30' DAll:: AUG. 8, 1998 ~",i1. '- 1<1. Y. S. UC: NO. ~D227 . . ~.;(. KENNETH M. WOYCHUK L.S. Land Surveyinc and Desi.n Calvel'ton, New York 11933 (516) 727-5127 ma.ftl..ollll"lUwnconl8otik>be1'LJ. JIo:Il.e..,' S.C. T.M. NO. DISTRICT: /000 SECTION: 55 G{~;d f ~ ~uril1 V Ins'lal} I._...i.. ~ piG n tl !'0) ~ ~ alOM, -kf/CQ I 6 ~yo~ry:J +r~ ~ III -shode pIOYl-k + :3 hrlAbS BLOCK: 4.....~_.._._LQT.L~1;..l~L_...."_.."_......._ _. R010-98-1~O (/5ZJ:;- !je17!7('co!f f;~;vel :",..'1" .',.~ C0UNTt DI::,.,AllTMf.Nr 0P HEALTH SERVICES '\,'" ~",,:>. 1\ PI'P.OV,:.L Of' CON~TI:ucr::CI \i'C:J1K" F ~ ., :"JNGI.E .....M;.m.y RE';'O"'r'(,',,") OR 0 .....r. .... ..., v . .~:,.:J.lltL.O...i.2f M.S. Ref.lo/CI.. f<...lO 9 & 0 ISO I " ,......"t't~ ,..L...",.........' . .. I... ....... ....,....._ t:r1Q ,ViJt;,~r t:u J f,; :r.... . . 's~'~':.:::I 0:.1>110;: ':l:l'litie:1 by this r/:P y .le. It/e. 3t 11u3 IOt~lir'n I".a'.'e been lC qj~li\~tcry fOil A.M. AXI~'.... op~e. r oth~r ;loC.'CI~S Ilr.~ 1'ClInd 10 {"}~ v,Yj ~ DmROOt.~. / 0L'f a, . I 81 het' ~ Ccsla, P A, Chief Office 01' Waf . "....-..- M _"'n__ anar ..: . - ~'=> & v ~ .4) -c' ~, ~ o " DO ~ . New I vQSdOcIJle 60 {de ji ~ $7 Q,,' ~' ~ ,I~\e., , I'i' ., 10" , '\,~ 0' v ~O< ~ (\ , o <( o a:::: -- -- DR\VEcl. 29.09 nftROVED BY C'tOARD OF TRUSTEES 'OvVN HOLD Southhold Town 5;68/1", &::J Board of Trustees y~ r ~ G REA: 35,659.0 S.F. OR 0.82 ACRES ~,;7 ii'72j;---' :~::I8S=~-L~~ UNAUTHORIZED ALTCRA710N OR AOOmON TO THIS SURIICY IS A WOLA71 SECTION 7209 or THE NEW YORK STATE [DUCAT/ON LAW. C MAP NOT BEARING THE LAND SURIICYOR.S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTITS INDICA Tl PIO LOT 28 .i ~ 2~' .Y)~ lip' of) c0l ,,]i. ~F ~l ~I" \)vw(\ ~0 V' ~ .'\~ .n w:f;"'.\;V~ ~ W /'((€ . '4' '0' -.! ....J - I l- :J fBJ~((:~~W~o Ul1 APA 2 4 2008 Ul 1'2 _....~ -- _.- ----- \.01 ~~'I~ :.'; ~, J" PIC I ,:[JD 11 I n~f'l ( , .:c,"c '_", I '.... ~J:j .~ ~ ~ ~ Ui~ ~. / ( e:., d; 9J .. .....c ~ ..s C:: f N -+-- '-I I[l \.J) . '< 0 ~ t.l - HYO. --