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Home My WebLink AboutTR-6923A --(- . . 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 SOUTH OLD 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 151 day of construction Yo 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 SOUTH OLD TO: ~(';r'f Lo(V1o..n~"f'\() Please be advised that your application dated YuJ~ \ . .;l.(X)~ has been reviewed by this Board at the regular meeting 0 '.J{)/'4 ~~' &ooV and your application has been approved pending the completion 0 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) ~h Constructed ($50.00) Ii 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: C/c:;8- TOTAL FEES DUE: $ -./0 BY: James F. King, President Board of Trustees . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTH OLD Permit No.: 6923A Date of Receipt of Application: July 1, 2008 Applicant: Anthony Lomangino SCTM#: 116-4-25 Project Location: 375 Beachwood Road, Cutchogue Date of Resolution/Issuance: July 23, 2008 Date of Expiration: July 23,2010 Reviewed by: Board of Trustees Project Description: Relocate the accessory storage shed on the existing gravel parking area. 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 Peconic Permit Expediting, received on July 1, 2008. Special Conditions: The accessory storage shed is not to exceed 100 square feet in size. 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. .t:F:~~m Board of Trustees JFK:eac ".:t~ .r" ,'. ':";:: ;,., " /:~.:. : ~~; .. .~. '../,: ..:. .r.r:.,.... ~,~.,.ji - - .... ,.( . .' ." " . , ~..,..,.....", ~ .'" II \ . James F. King, President Jill M. Doherty, Vice--President Peggy A. Dickerson Dave Bergen Bob Gbasia, Jr. P.O. Box 1179 Southold, NY 11971 Telephone (63\) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field InspectionlWorksession Report DatelTime: I{" I b~O)( Peconic Permit Expediting on behalf of ANTHONY LOMANGINO requests an Administrative Permit to relocate the accessory storage shed on the existing gravel parking area. Located: 375 Beachwood Rd., Cutchogue. SCTM#116-4-25 Ty~f area to be impacted: . ./" .\,LSaltwaterWetland _Freshwater Wetland _Sound ~ay Distance of proposed work to edge of wetland PartefTown c~oposed work falls under: ~hapt.275 apt. 111 _other Type of Application: ~etland _Coastal Erosion _Amendment _Administrative_Emergency _Pre-Submission Violation Info needed: 5~ o.f ~~ f\l;' R,..<I\.f\. f J wCL.J.cr , 6 )(( (/ I Modifications: Conditions: Present Were: ~ng ~oherty ~ickerson ~ergen ~hOSiO' D. Dzenkowski _Mark Terry~er '5 ~ Form filled out in the field by Mailed/Faxed to: Date: Environmental Technician Review- . PECONIC PERMIT . EXPEDITING Building / DEe / Variance / Marine 32645 i\fain Road. Cutchoguc. NY 11935 [-Mail ot:conicocrl11itsm\mtollline.nct Ph 631. 734.SJ61 . Fx 631.734.2276 Photo showing cxisting gravel parking arca. Shcd is proposcd to bc locatcd whcrc dumpster currently sits. ~.,. ,_. ....''''''-1.<1'-':. I_MOO Il~ leI ,_ 1>.1. -- I:::::': -~ ',-- .\ c:-- -1"-"'''' 1--' I.... ".o.,con""'''.''''''"'' -r- l-T- ~"<;''''''10> --T-- --+ "".0.."". "".."'''''. '''........., "..",,-NO. ""..t."', ,"_OH'" ) -N- ~ " ". . _.~ -~. ="..,,,,""',, u u.. <D .. ,~" .. ". ":'~t'::~' PECONIC ...5liC.ro11" ~, ~ ,.,,,<, ".0.30 ~ .... ~- I I Gfl.E./..r L _~~.,_ E_,-_ c_..."" ~ "-,.... ,_. -..""'... .........". ,",w-"'" -"""""" ..........,.. -......". .........,,,. ...........,"" ....-"."", '::0'" .,,:;''' !..::"'~~~:~ ~- ~ :: ~J:..... -- _.., """.,,,,, Of SUffOLK <!J @ CDUNTYt Tax,Service ~geocy NGTICE ReaPr~./~~Tmot "","","-"0'1001''''-':1>( . Cod'Ir; ,ItiLEwru;T.. .. :'~ot'~:.':;':_1EO' .. ::= ~~ "-,,::;' ':cr':, .....""""mT" ~ :r-:--t::,. SOOTHOlD w~"",,",1Il1000 ~ ", -,""""." """""",..",....""" SECTION NO 116 o (21) _.. ----.. .....,... -- " ==-12., MOI,:;:"-:- ::':' PROPERTYIoI,\S' ~ ..,.,.........-...- . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765.6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _sPastal Erosion Permit Application -JLWetIand Permit Application _ Administrative Permit AmendmentJTrans~ r xte . L~eived Applicatio~: 7. I ---ItReceived Fee:$ . ~ompleted Application _Incomplete _SEQRA Classification: Type I_Type II_UnIisted_ _ Coordination:( date sent) ./'LWRP Consistency Assessment Form ~ CAC Referral Sent: ./!Jate ofInspection:~ _Receipt of CAC Report: _Lead Agency Determination:_ Technical Review: --L'l'ublic Hearing Held:~ _Resolution: '{OJ ~ C ~ D w ~lm lflJl JUl -11008 ~ SOUlhho/d Tow. Board .f Trustees tom ilfl151n 0 /lvl- I ?v./.-ei ()'j ve , - Phone Number:( ) 1J1b5/-2 b:2 ;;': /4 J R Suffolk County Tax Map Number: 1000 - II' - I/- - 2 S- 8-c.AC), wpop[ If c:1 Address 37S A h II, Oil v , 8each H/oo-d Name of Applicant Property Location: 37~ (provide LILCO Pole #, distance to cross streets, and location) AGENT: P -e ? Ph I (;, /-c/ WlI I- /: X;' -c A, /111/3 (If applicable) Address: 3.21' f ~ M MI VJ C~./..tJ,~v"/ ~/ ) / / 13!J ilA Phone: 7 3/j- ~3 61 r--... 4Itard of Trustees APPlicati~ GENERAL DATA Land Area (in square feet): -L- /- t?- 40 /2) S-1~ Area Zoning: Previous use ofproperty:_V a~p" f Intended use of property: -Y At: e;;" f "" / ,4 c C.c'5:5t1/y " 5IdrA7.(:.. ~eJ. Covenants and Restrictions:_Yes If "Yes", please provide copy. X No Prior permits/approvals for site improvements: Agency Date ~ 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): if) t:.1f )"'- '5 1-&71'" p~ --<- ~ A el jJ(;(J' J.r I ~ y a ctc..55oyy /' -..e t I '5; I ".:J 411 ,:;rIlV"! -' -"f I't:-/A , ~ard of Trustees APPlicatitlt WETLANDrrRUSTEE LANDS APPLICATION DATA '5 jo(' Pi:f C-- iJelir Jr,n ~ , 5hel /n1i...l/ ttltCU:S'5t:?IV / / eXI'lJ'n~ ,:J/'ltv&-I Purpose of the proposed operations: ~rt A- Yt5A.; , Area of wetlands on lot: 4J- L tJ J ~PO square feet Percent coverage oflot: tJ , f? % Closest distance between nearest existing structure and upland edge of wetlands: 0 feet Closest distance between nearest proposed structure and upland edge of wetlands: ~ 2. tJ feet Does the project involve excavation or filling? X No Yes If yes, how much material will be excavated? IV I hcubic yards How much material will be filled? N / If cubic yards Depth of which material will be removed or deposited: IV / A feet Proposed slope throughout the area of operations: /.J /1+ Manner in which material will be removed or deposited: ,AI / /1 Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): Thuc- /lvl / / 6e /'1.9 elh? I- ~n .JA~ Wr-.f/AYI)'5 .,(5 <'( ""TAvel iJtJir1Y17 ~'vt:A .::(/ rcp~ -' , ex, "]),5 t II, c- jJ T I? I'I/.J '7.cd -'5/ rl/?/VJ'v INI / / 5/.f ifill f , f).,/~ I{; f ~ t:tJ 4Ilard of Trustees APPlicati~ COASTAL EROSION APPLICATION DATA Purposes of proposed activity: tott/J. J<- acccss~t'y 5 ./-OYIt~-e.. " ? A 1:).. tP n e'X /1Jm.5 ?ffivJ /Al f,J~ I"[,e-t:t. Are wetlands present within 1 00 feet of the proposed activity? No X Yes Does the project involve excavation or filling? >( No Yes If Yes, how much material will be excavated? }I / /J (cubic yards) How much material will be filled? IV IIJ (cubic yards) Manner in which material will be removed or deposited:----,A/ / tJ TA ~'/c. fA e ~"Vln?YI M ~rl t:tcJ"n. Jh,~ II I PROJECT ID NUMBER . I . 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 1. XPLlCANT I SPON710R I Yee,n,,, f'ertll/Jrr 3.PROJECT LOCATION: Municipality ~ J-e~ ,,-t;. 4. PRECISE LOCATION: Street Addess and Road Bc",~ ~M./(/QJ. 2. PROJECT NAME t Aa-e<S5Pf County Intersections. Prominent ~" Jk landmarks etc - or orovide mao 37r !<A J ?v..ftjl{~/v-e 5. IS PROPOSED ACTION: ~ New 6. DESCRIBE PROJECT BRIEFLY: D Expansion D Modification I alteration tp?~ It:-- ~I'Pvel ~~?~<S<S(/'/ 51-pre(. J "- fpy l, Y)/ Ofl'vA .. -f'),~) INI ~XI~ ~n.:/ 7. AMOUNT OF LAND AFFECTED: 3 Initially , 3 acres Ultimately ., acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~ Yes IS] No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY ~ Residential 0 Industrial D 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) IE Yes ONO If YS~:s/;:;)"me a7r:~rm;;;:o/ ?dv.)~i)),) $J~ tJ~ 1-. 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? DYes ~NO If yes, list agency name and permit I approval: 12. AS A RE ULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION? []ves No INFORMATION PROVIDED ABOVE IS TRUE TO THE I'c,l, 1(").5 BEST OF MY KNOWLEDGE Date: /-.$ (/- ()R Applicant Signature If th ac ton is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment I' . . PART II - IMPACT ASSESSMENT ITo be eomDleted bv Lead Aaenev} A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? It yes, coordinate the review process and use the FULL EAF. DVes DNO B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. Dves DNO C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: I I C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: I I C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: I I 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: I I C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: I ~ ~_d~~ I C6. Long term, short term, cumulative. or other effects not identified in C1-C5? Explain briefly: I I C7. Other lmoacts (includino chanoes in use of either auantitv or type of enerav? Ex lain brieflv: I I D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? {If yes, explain briefly: I o Ves 0 No I E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: o Ves DNO I I PART 11I- DETERMINATION OF SIGNIFICANCE (To be compleled 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 conneclion wilh its (al selling (I.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e> geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL EAF and/or prepare a positive declaration. Check this box if you have determined, based on the infonnation and analysis above and any supporting documentation, that the proposed actio 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 in Lead Agency Signature of Preparer (If different from responsible officer) II -.-- Town of South old . . o ~ ~~ J Wi ~ ,1!"rr\\I' L WRP CONSISTENCY ASSESSMENT Fin I JUL - 1 2008 !~ A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold age cies, shalh:~'~Westhis CC for proposed actions that are subject to the Town of Southold Waterfront Consistency eVI This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. * Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects UDOn the coastal area (which includes all of South old Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the L WRP policy standards and conditions contained in the consistency review law. Thus. each answer must be explained in detail. Iistine: both supportine: and non- supportine: facts. If an action cannot be certified as consistent with the L WRP policy standards and conditions, it shall not be undertaken. A copy of the L WRP is available in the following places: online at the Town of Southold ' s website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# -1lL - 4 2 S- PROJECT NAME L If} m If "..? / n () J)~~ ~~5Pf V / 5Je?'If<~ ~,J. - The Application has been submitted to (check appropriate response): Town Board 0 Planning Board 0 Building Dept. 0 Board of Trustees ~ 1. Category of Town of South old agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) o o (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: )?1 Nature and extent of action: Lo/a/G- a/~e~~,ry -' ~ h e-J ~ " ~ XI1 )II?~ ~r;?ve-I 5 fe?F;?O 7 <- 1''''' ) II'J if re,t;. Location of action: '1 7 !) Site acreage: I 3 8e",t:h wPi'tl . ;<,/ . / ?,,/c j t?"'i"~ -' . Present land use: VA ~ Ifn i- I?- 4 p Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: P-? ~"nlc, P,rl'tll f ~J(~~J, f,n..:J , t p/. J ti,-I-I'; h P'5v t:.- , - (b) Mailing address: ~~ pl}!: J /lq "5~ , fi1A I n tVY , (c) Telephone number: Area Code () 1'3/- 7 j 4 - ? 3 P / (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes D No~ If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See L WRP Section III - Policies; Page 2 for evaluation criteria. DYes D No l&1 Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See L WRP Section III - Policies Pages 3 through 6 for evaluation criteria DYes D No.KJ Not Applicable . . Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of South old. See L WRP Section III - Policies Pages 6 through 7 for evaluation criteria DYes 0 No r.:8T Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for evaluation criteria DYes 0 No ~ Not Applicable Attach additional sheets ifnecessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See L WRP Section III - Policies Pages 16 through 21 for evaluation criteria DYes 0 No ~NotAPPlicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See L WRP Section III - Policies; Pages 22 through 32 for evaluation criteria. o o ~ II Yes No . Not Applicable . Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. DYes 0 No!Z' Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See L WRP Section III - Policies; Pages 34 through 38 for evaluation criteria. DYes 0 No Ig] Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See L WRP Section III - Policies; Pages 38 through 46 for evaluation criteria. o YeO No g] Not Applicable Attach additional sheets if necessary . WORKING COAST POLICIES . Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See L WRP Section 111- Policies; Pages 47 through 56 for evaluation criteria. DYes 0 No IXf Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See L WRP Section III - Policies; Pages 57 through 62 for evaluation criteria. DYes D No IKI Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See L WRP Section m - Policies; Pages 62 through 65 for evaluation criteria. DYes D NoR?J Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. DYes D No,l8l Not Applicable PREPARED BY ,er;1btr) t~hn~"f TITLE A'5 ~'1 f- - DATE I'-J~-()R II . . APPLlCANT/AGENTIREPRESENTATlVE TRANSACTIONAL DISCLOSURE FORM nfliet fi the t wn of w t fficer d m ees. and allow it to take w f hib' . ~ nn' t rov' e inti rination which can nece~~ to avoid same. YOUR NAME: R tJ 6-er';- t-ehn~'" r (Last name, first name, .!piddle initial, 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 APPLlCA nON: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If "Other", nllftle the activity,) Building Trustee Coastal Erosion Mooring Planning 'X Do you personally (or through your company, spouse, sibling, paren~ or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or buSiness interest "Business interest" means a business., including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. x: NO YES If you answered "YES", complete the balance of this form and date and sign where indicated. NlIftIe of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) andlor describe in the space provided. The town officer or employee or his or her spouse, sibling, paren~ ot child is (check all that apply): _A) the owner of greater than 5% of the shares of the corporale stock of the appliCllllt (when the applicant is a corporation); _B) the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); . _C) an officer. director, partner, or employee of the applicant; or _D) the actual applicant. DESCRIPTION OF RELATIONSHIP S?bmittedth~C"OO K" SIgnature : . Print Name ~r " <,r Form 1'8 I -r--- . . Board of Trustees Application County of Suffolk State of New York R () b.e,.. .J- t ~ h n <,. .)- BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF 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. SWORN TO BEFORE ME THIS ~ Om DAY OF 7J ,v-e- ,20 oS> ...... _~r h~ IIO"U -.e.... Of .... ... ....".... etJl'JIRU III ..... c...., .... CJTJ'lIfJ ............_ Notary Public .. ~ . . . PECONIC PERMIT EXPEDITING BUilding / DEe / Variance / Marine E-Mail neconicnermits@ontonline.net 32645 Main Road' Cutchogue, NY 11935 Ph 631.734.8361 . Fx 631.734.2276 June 27, 2008 Board of Town Trustees Town of South old P,O, Box 1179 Southold, NY 11971-0959 RE: 375 Beachwood Road, Cutchogue, N.Y. Attn: Mr. James King, President Dear Jim, This letter is to authorize employees of "Peconic Permit Expediting Inc." to act as my agent in obtaining a permit from the Southold Town Trustees, If you have any questions, please feel free to call me at any time, Respectfully yours, ~ Mr, Anthony Lomangino - Property Owner ...... i~ c ;~~fy;: ~.'~"~"...i;:-::~,~.:~:.:"::.-~., '''--"'~''''''''''!':C,''''''-'''''~ - <c~-"," ~""O,'~' ""; "'0 \',i'i" , \ ' \ '" \ \ ~ \ \ <, N' \ '" \ 0 \ ~ \ \ /~% \ o2':w M ~(~\ ~" \,u '\)\11\ t ~~~\ ~ , ~~ 0\ .. , '~~\~~," . '~:,' jib "_ - ,,\, 'i::-::~-~~,. ,,=,,()\ " '. ~t\~o.i ~ " 4',2, (r(~ ~., ;;' .~y):0,,", P, 'R6\ 01> " '~:-J, , ~\~ " N~' \() (), , , ~,(:-l~, . ,^, \ ,,~~;~~,!!-. ,;"Y( r=- .<;~.: '. LAND , /\/000/'30" W / ( /..93, :) I ,""~ it; ," ~~' ~f' ,?,- r\ U '~ (!J () III I' '> 't:j ') i, . :>: . .. ',"..L ~' /C~8:'.s,i-:r:;;", a"'"'." - ".,""-,'."" -. ,-" - - ---'" :_.: -'-::..;. ,,~'~!_'. ,', ~ ): L:v'/,ves i'b l> ~' () III f' '\ ~ '" ''', '.", .< " " "'\"'-,,;':,,~:, i _<.:' ':i{:'<~':Y'":' i~'\' ~ ""- f1\ , ~' s H " \' f!- t^ ,A , , F/ ,/.::4R.CEt.. , II: ~. II? tu '. .'~ .? ~ o ~ "- o o o ~ ~ o .() < " \J "C'=J ~~-~.-- ,::. '''',-'' - . '~ '>:';:. , ~ ~. (i -- --- , 'i ~.. -,-". ..,-., 'k. ,,,- -C' .'''"",. .'C. ~.,,,;-,,,",:o;.~~_,,,,""'''--- N 890 58' 30' E ~ '" '" EXISTING GRAVEL PARKING AREA ;: b '" G5.0' "' " o " ;: " '" o " z .. .. , ... . 'I..., ",'". ;, .. .,..:". "': . . o " <f) SITE PLAN SCALE: 1"-30' G1.1G' PROPOSED LOCATION OF ACCESSORY SHED ~ ~ Ii: ~ 0 w ~lfIJ JUl - 1 2008 ~J PROPOSED ACCESSORY SHED AT THE B Southhold Town oard of Trustees LOMANGINO RESIDENCE 375 BEACHWOOD ROAD CUTCHOGUE, NY APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTHOLD DATE 7/;' }/o ii fR{A, S.C.T.M. # 1000 - 116-4-25 " '.~.:~-';"'. ,,' " ....' . ~ '~"~"\((~:. - ~. )NIC PERMIT PEDITI NG PHONE: G31 .734.83G I PROJECT NUMBER SHEET NUMBER 0826 A-I