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Home My WebLink AboutTR-6090 June 15, 2005 Field Ins June 15, 2005 Fk June 15, 2005 Field Inspecti~i} Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southo]d, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction ½ constructed v'" Project complete, compliance inspection. Board Of $outhold 'Town Trustees SOUTHOLD, NEW YORK PERMIT NO .......................... DATE: March 23, 2005 ............................ MICHAEL FERBER .......................... ISSUED TO .......................................... ~ ............................................................... Aut'harizatia - Pursuant Jo the provisions of Chepte. r 61~, .o,f ,~e L~w,s,,of the Sta~e of New York, 1893; and C~apter 404 ot the ~ws ot the · State of New Yor~ 1952; and ~he SouJhold To~n Ord,nanca ~ifled ."REGULATING AND THE PLACING OF OBSTRUCI%O ~NS IN AND ON TOWN WATERS AND PUBLIC LANDS and'-lhe REMOVAL OF SAND, GRAVELOR OTHER MATERIALS-F-J~JI')M LANDS ·UNDER TOWN WATERS;."..!, and in acex~clance wi~h 'the Resolution of The Board adopted at a meeting held on ..I~.a.~i'~.3. .... ~0(~..5........, and in consideration of the sum of $..ZS.Q ................ paid by Michael Ferber ........... Of Greenport ', ' . .......... N. Y. and subject ~o Terms and Conditions haled on fha reverse ride hereOf, . _, of. Southe.~d Town' Trudees authorizes a~,d permits the follow~ncj:. ;wec~ana permit to construct a 54' x cat~zalk, 12' x 3'ramp, and a 6' x 20' float parallel to ~he shoreline with a 3 pile system to hold the float, ~fith the total length from the bulk- head not to exceed a total of 70', as depicted on the plan by M. F-erber dated 3/.2..4/05 ~npt.e ~rawi~ ~s not ~)j~ all in accordance wlJh the deta~e~ S~cnI~aTEOm as .~e odginaf|flg application. IN WITNESS WHEREOF, The said Board Of Trustees here- i.,, ..~,.~c ifs ~orate Seal ~o be affixed, and ~ese pres_enh~ fo be sul:is~'bed by a malodfy of the satd Board .as of fhls darn. Albert J. Krupski, President James King, Vice-President Al'tie Foster Ken Poliwoda Peggy A. Dickerson 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 OFSOUTHOLD March 23, 2005 Mr. Michael Ferber 5 Washington Lane Edgewater, New Jersey 07020 RE: MICHAEL FERBER 1825 GULL POND LANE, GREENPORT SCTM # 35-4-15 Dear Mr. Ferber: The Board of Town Trustees took the following action during its regular meeting held on Wednesday March 23, 2005 regarding the above matter: WHEREAS MICHAEL FERBER applied to the Southold Town Trustees for a permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated February 12, 2004 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 March 23, 2005 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 standards set forth in Chapter 97 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, RESOLVED, that the Board of Trustees approve the application of MICHAEL FERBER to construct a 54' x 4' catwalk, 12' x 3' ramp, and a 6' x 20' float parallel to the shoreline with a 3 pile system to hold the float, with the total length from the bulkhead not to exceed 70', as depicted on the plan drawn by M. Ferber dated March 24, 2005 (note: the drawing is not to scale). Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) This is not a determination from any other agency. Fees: Final inspection $50.00 Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/hct Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-tCCC, ~l BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated reviewed by this Board at the regular meeting of following action was taken: V/ Application Approved (see below) (__.) Application Denied (see below) (__.) Application Tabled (see below) ~-,. l~, ~,00~; has been ~O¢~k z'5, 2005 and the Southotd Town Board of Trustees If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: t. TOTAL FEES DUE: SIGNED: PRESIDENT, BOARD OF TRUSTEES Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-~0'~1 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated ~. 12~ 200¢ reviewed by this Board at the regular meeting of /'~or~ z '~ 2oo~ following action was taken: has been and the (V/) Application Approved (see below) (__.) Application Denied (see below) ( ) Application Tabled (see below) If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: _~-J o~0 _ ~, lOC, TOTAL FEES DUE: SIGNED: PRESIDENT, BOARD OF TRUSTEES Albert J. Krupski, President James King, Vice-President Arkie Foster Ken Poliwoda Peggy A. Dickerson 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 YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction ½ constructed Project complete, compliance inspection. March 17, 2005 Field Insp~i~on March 17, 2005 Field InsP~l~on Telephone (631) 765-1892 Town Hall 53095 Route 25 P.O. B6X l'F~9? Southold, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Tues., March 15, 2005, the following recommendation was made: Moved by Doris McGreevy, seconded by Jack McGreevy, it was RESOLVED to recommend to the Southold Town Board of Trustees APROVAL WITH A CONDITION of the Amendment application of MICHAEL FERBER to Amend Permit #398 to rebuild and extend the existing catwalk and return the floating dock to its previous position, and to Transfer Permit #398 from Walter Honings to Michael & Marlene Ferber. Located: 1825 Gull Pond Lane, Greenport. SCTM#35-4-15 The CAC recommends Approval of the application with the Condition of a 6'X 20' floating dock, and the total length of the docking facility does not exceed 1/3 the width of the creek. Vote of Council: Ayes: All Motion Carried 85/04/2885 15:11 7347955 Albert J. Krupeld. Presid~n~; James King, Vlee-Presi&nt Henry Smith Arfie Fo~ter ~ Po~wod~ BROWN HARRIS PAGE 8309§ Main P.O, Box 1179 ,%uthold, New Y~k 11971 Telephon~ (516) 765-1892 (516) 785-1823 01 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 25, 1998 Eugene Kessler 1825 Gull Pond Lane Grsenport, NY 11944 P,.K: SCTM Dear Mr. Kessler: The following action was taken by the Southold Town Board of Trustees at the regular meeting on Wednesday, June 24, 1998: RESOLVED that the Southold Town Board of Trustees Deny an Amendment to Permit %398 to add 30' of float to existing 30', the'Board's current policy is to have no more than a 6' X 20' float. This doe~ not constitute approvai from any other agencies. If you h~ve any further questions, please do not hesitate contact this office. Albert J. Krupski,. Jr. President, Board of Trustees AJK: Jmd Natal, of, C'reek~ ~-ul~ a ~' ' .'~{ ~'/'"~/.9' . BOARD OF TOWN TRUSTEE5 TO~.OF SO.OLD To~ H~I, 53095 M~ ~o~d Pi0. Box 728 ..... · ~out~eld, New Y~k 1 ~971 5. Telephone N~ber: Year Of Construction: 6.. 'Ma~kloif on the map a~tached, where your proper{y is located using an X. Please note tha~ there is a $5,00.~ilimg fee, which is a one time fee, for this application. 85/84/2885 15:11 7347955 BROWN HARRIS PAGE 83 J_ Ir~upsk~, FAn~, V~ce-Presic~nt Axt~e Fa~te~ Ken Tow~ 58095 M~ Rosd P,O. ~ox 1179 ~ut~, New Y~k 1~971 Tel~hone (5~6) 7~-~ F~ (516) 76~18~ BOARD October 23, 1998 Patricia C. Moore, Att'ny. 51020 Main Street Southold NY 11971 RE: EUGENE KESSLER SCTM # 35-4-15 Dear Mrs. Moore, The following action was t TrUstees meeting on 0ctob~ RESOLVED, that the South'] request for an Amendment f'loat as per Trustees sug~ 3FTOWN't'~USTEES ~OFSOUTHOLD ken at the Southold Town Board oi 21, 1998: Town Board of Trustees grant the Permit #3998 to relocate existing stion and diagram %3 dated end received September 10, 19! However,'thl~ does not co~stitute agproval from any 'other ~gencies. .. if you have any que~tions please call our office at 765-1892. Sincerely, ~. Albert J. KrupSkl, Jr. President, Board of Trust~es AJK/dJh 05f04t~005 15:11 7347955 PAGE 05 · Town .TrUstees :',,,,, SOUTNOLD, NEW YORK J .................... · ,.- DATE=' Sept. 05/04?2005 15:11 7347955 permits Sec.tion BROWN HARRIS SiNS DEPARTMENT OI~ THE ~' ARMY . , NEW YORK DISTRICT, cORps aP ENGINEERS JACOB K. JAVITS PIDIRAL BUILDIHG N~ YORK, N.Y, 1~1 PAGE 07 January 29 1999 SLr~,.TgCT:. Applicatio~ Number 1998-16140-L2 by Eugene Kessler To Whom It' May 'Concern: ' ''" The New York District, U.S. Army Corps of Engineers', has received a request for Department of the A_~my auth6rizatton for the following activity: APPLICANT: Eugene Kessler 182S Gull Pond Lane Greenpo~t, NY 11944 ACTIVITY: Rep0sitlon an existing 6 foot by 30 foot float and associated mooring piles from an "L"-shaped configuration to a straight-out position from an existing ramp and pier, and secure to one 2-pile dolphin. The purpose of this project is to '~ ... accommodate the applicant's larger size vessel. WAT~RWA~ ..... Gull ]~gnd Inlet, Shelter Isiand Sound · :'.-.I.iOCAT~ONi: :": ~reenport, Town of $0uthold, Suffolk County, NY · '~;:.~ ~i. .'.' ' .':" "' · , As this is minor in na:ure, authorization may be by Letter of Permission. This is in accordance with current Pe~eral Regulations governing work in navigable waters of t'he United States. To accomplish the coordination required, prior to the issuance of a Letter of Permission, your review of the enclosed drawing is requested. ' Pursuant to Section 307 (el of the Coastal Zone Management ACt Of 1972 aa a~ended (16 U'.S.C. l~6S (c)(3)(A)), the applican~ has certified that thm activity complies with and will be conducted in a manner that is consistent with the approved state coastal zone managemen~ program. To allow for the timely processing of the subject application, your comments ars requested within 20' days of the date of this letter. Enclosure Sincerely, / u~mes W. Hagger~y ~'~/ ' ~ief ~ Eastern Permits Section' 05/04/2005 15:11 7347955 BROWN HARRIS STEVENS PAGE 02 12/13/2004 11:19 7347955 BROWN HARRIS STEVENS PAGE 01 · '.TOWN -$O.UTHOLD BQAR:D-Of TOWN..TRUSt:EE$ i~bi~ ~t~ ~spe~' thereto to the ~m~ete .ex~uaiOn ~ s~ '~o~ o~. ~s and ~he Towa o~ ~d. 2. 3. 4. subject to the f6Ao~tng terms nnit' conditions: Thatl. there shall be, no. unreasonable'.in~rferehce with mavl~ation' a~ a result of tile .wo~-k. herein aUthorLzed. Tha~, th6re shall he, no interference, with'the right ~f t.~e PUblic tO;pass and re- pass. along that potion of the beach.between .low and high .;vatar mark. Thai~ the 'iv//rk shail l~e ~ubiect I~ :the supervislom amd 'approval of the ss. id Board of T. rustees ~r lis agent. That~ if futu~ operations af the Towo of ~outhold require the removal .~nd/c!r alter&tion in the l~ation of flae work hereim authoriZed, or ~f, .lin the opirllon of.-the t~a~d of Trt~ees c~f the ~'own of Southold, stlch work' ahall:~.,,.~, 734?955 BROWN HARRIS STEVENS PAGE 03 The .=iUth0.rlf~..conferred by this .t~ilt rn~/b:a~8:~, the 'B~rd:a~ T~es With .the re,' and c*ditio~, hain ~,~, 'In the .~ ~ .:~ recision, pe~it ~o1~ be de~'re~k~ five.(5) da~ ~ffer ~e -~. ~ ~e B~ 0f T~es shotl: ~it t~. ~ ~1~ .............. :,~.-~t--.~,.e.~,~,.:,.,. ~ the ~ in his ~pl~i~, a ~'c~ of c ~uti~: ~ t~:-.~rdr~T~ees : - .; · .]~ , · . - - . torp0ra~e., ~a~:;to be :he~eun. t~.; M]fixe~l '.and these pr~er~ '.ha :be,~b:ed by a rndjofi~ .c~f .the Tn,~tees, STATE OF NEW' ,YORK ) SS: rC:OUN~' OF SUFFOILK .. ) i=ll~ I~r~no'Uy known · to me~, who, beLng by-me cluly sworn,.semrol!y ~i~ tf~t they .each r~[ded.'Jn,the ;Town Of So~thold, _Coun~ ~f. Suffolk, State of New-York, and were members, of'tree.BOard,of Trustees of said Tawn of $outhold and con~itut~d ,, ,~,~..~. ,- ....... ~ ..... 12/13/2884 11:19 7347955 BROWN HARRIS STEVENS PAGE 04 12/13/2884 11:19 7347955 BROWN HARRIS STEVENS PAGE April 25, 2005 Board of Trustees Town of Southold Southold, New York 11972 Beard 0[ Trustees Re: Permit # 6090 issued March 23, 2005 After our meeting I was issued a permit which contained all the things which we discussed except one part which I think was the result of a misunderstanding on my part. Please let me clarify, I do not want to rebuild the present floating dock which is 6 x 30. I would like to turn it to an L position with the entire unit reaching only 70 feet into Gull Pond, therefore shortening the distance of the dock which presently reaches to 80 feet. This size change was agreed upon. If this change can be made in the new permit I can have the construction completed for the 2005 season. If you need my presence at another Board meeting I will be glad to make myself available. Thank you. Sincerely, Michael Ferber 1825 Gu!! Pond Lane ORIGINAL I~A~ 2_ 8 2005 Scut~o ~ Board of ?[ustees FEB. 15.B005 9:45AM A~:ia Poe~er , Ken Poliwode Peggy A, Dlak~rson BECK MO. 599 . P. 1/2. ~/~/~ Town Hell $$095 Route 25 I~.0. BOX 1179 Telopho~e (6B1) "}'65-1892 F~.x (631) 765-1365 FEB 1 4 ?no5 r~t~'~ ~,~tees BOARD OF TOWN TRUS~E TOWN OF $0UTHOLD API~ICATION FOR Ai~ AMENDM~M DATE AGENT PHONE ADDRESS_ By:. FEB, 15.2005 Ferber, M,i<e Subject: 9:45AM BECK M0.599 P.2/~ Reconstruction of catwalk and resetting of floating dock back to I. shape, To Trustees Town Of Southold The reason for my request to rel~uild and extend the current catwalk and k~ return the tioating dock to its previous position is to accommodate my boat in 7 feet of water along the floating dock. By puttir~g ~e dock in an L shape to the catwalk I will be able to secure it both bow and stem to Ne floating dock. To entend the ourrent catwall( to 64 feet will in the opinion of the builder ~ enough to secure the boat irl t~e needed 7 feet of water at Iow tide, Thallk you lil advance for your consideration of this project· County of Suffolk State of New York Boar~f Trustees Application FEB Seetheld To'~e Board o! Trustees DEPOSES AND AFFIRMS THAT HE/SHE IS TH~- APPLICAR'I' FOR THE ABOVE DESCRIBED pERMIT(S) AND THAT ALL STATeMEnTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPRO¥~D BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANTAGREES TOHOLDTHETOWN OF soUTHOLDANDTHETOWN TRusTEEs HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING uNDER OR BY VIRTUE OF S~ID PERMIT(S)} IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENT~ ONTO MY PROPERTY TO INSPECT ~7{E pREMISES IN CONJUNCTION WITH REVIEW OFT HIS swo To BEFO_ THIS /! DAY or otary Publi 7 Alber~ J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson 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 BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING residing at being duly sworn, depose and say: That on the^~ day_of blfill.0~, 200~I personally posted the property known as by placing the Board of Trustees official poster~where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held ~ Dated: ./2 ~ ~ f Sworn tclbefore me t.~ 7 mublic ~NCE ,~ ~ Albert J. Krupski, President James K/ng, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson BOARD OF TOWN TRUST TOWN OF SOUTHOLD APPLICATION FOR AN AMENDMENq Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 DATE '~ ADDRESS AGENT PHONE ADDRESS TAX MAP NO. I/W~.~ ~,,~ L ¥'~_A~f~O request an Amendment to Permit Signed By: APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees. The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same..~. (Last name, first name, middle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Variance Change of Zone Approval of plat Exemption from plat or official map Other (If"Other", name the activity.) ~ ~--~ ~ ~, g,~t'~ ~'~'",-G ~L.I~ Do you personally (or through your company, spouse, sibIing, parent, or child) have a relationship with any officer or employe9 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% oftbe shares. YES NO ~ If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicantJagent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); __.B) the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); __.C) an officer, director, partner, or employee of the applicant; or ___D) the actual applicant. DESCRIPTION OF RELATIONSHIP S~bmitted tt~t~d~ o~.~''~''~'a' ' 200 ~" APPLICANT/AGENTfREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics ~rohibits conflicts of interest on the part of town officers and employees. The purpose of this form is to ~rovide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessatw to avoid same. (Last name, first name, middle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Variance Change of Zone Approval of plat Exemption from plat or official map Other ~ '~'~ 0 ~. ~'~ C ~r'~ [,~ ~ ~ (If "O~er", n~e ~e activin.) _ _ Do you personally (or t~ough your co~y, s~use, sibling, p~ent, or child) have a relationship wi~ ~y officer or ~lo~e of the Tom of Southold? "Relationship" includes by blood, ~iage, or business int~est. "Business ~t~est" ~s a business, including a p~ership, in which the tom officer or e~loyee h~ even a p~ial o~ership of(or ~lo~ant by) a co~ratiun in which the tom officer or e~loyee ores more th~ 5% of the sh~es. YES NO ~ If you ~swered "YES", co~lete the balmce of~is fo~ ~d date md si~ wh~e indicated. Nm of~on e~loyed by the Tom of Southold Title or position of fiat ~on Des~be the relationship be~een you~elf (fie applic~ffagangrepres~tative) ~d the to~ officer or employee. Either check the appropriate line A) through D) ~&or describe in ~e sp~e provide. ~e tom offi~r or ~loyee or his or her spouse, sibling, p~an~ or child is (ch~k MI that apply): A) the o~er of ~t~ ~ 5% of~e sh~ of~e ~r~e st~k of~e ~pli~t (~ ~e ~pli~t is a co~ion); ~B) ~e leg~ or benefici~ o~ of~y int~e~ in a non-co~e ~ti~ (wh~ &e appli~t is not a co.ration); ~C) ~ o~c~, d~tor, p~, or e~lo~ of~e applic~t; or ~D) ~e ~1 ~pli~t. DESCRIPTION OF RELATIONSHIP Submi ea t 200 ' Signature SURVET OF= LOT I1 HAP OF= F=ORPHAH ACRES, SECTION ONE FILE~ MA~OH 1, Iq62 FILE No. ~51q 51TUATE-. ~R, ,',m-NPORT TOHN-- ..~:;~THOI_ D ..SUFFOLK ¢_,OUN~, NY 5URVE'fEE:) 10-14-2004 SUFFOLK OOUNT'f TAX ~ 1000-~.5-4-1-5 Michael F~ber l~ule~ Fcd~ North Fork Bank Stewa~ Title lmurancc Cvuv~my NOTES: · MONUMENT FOUND 0 PIPE FOUND AREA = 21,544 5F OR 0.6~ AORE5 ®RAPHI6 5GALE I"= ~0' x,\ N JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 RIVERHEAD, N.Y. 11901 369-8288 Fax 369-8287 KEF.-\~I-Ip server\d~PROS\04-292.pro