Loading...
HomeMy WebLinkAboutTR-5505 Albert J. Krupski,President Town Hall James King,Vice-President o�OSQFFU(/�'c 53095 Route 25 Artie Foster �� ®�jZ P.O.Box 1179 Ken.Poliwoda � Southold,New York 11971-0959 Peggy A. Dickerson y Z Telephone(631) 765-1892 Oy ! Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 25, 2002 Mr. Martin Kosmynka 1985 Pine Tree Rd. Cutchogue,NY 11935 RE: 1985 Pine'Tree Rd., Cutchogue SCTM#98-1-11.2 Dear Mr. Kosmynka: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday,April 24, 2002: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit #5505 to move the previously approved sunroom with an above-ground pool, in line with the existing ramp. This is not a determination from any other agency. If you have any questions, please call our office at(631) 765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:Ims cc: Bldg. Dept. AF�EALS $OARD MEMBERS S13FFSouthoO(,� h0 COGy 530951d Town Main Road Gerard R Goehringer, Chairman Lydia A.Tortora y P.O. Box 1179 George Horning • Southold,New York 11971-0959 Ruth D. Oliva ZBA Fax(631) 765-9064 Vincent Orlando �Ol �a Telephone(631) 765-1809 http://southoldtown.northfork.net BOARD OF APPEALS TOWN OF SOUTHOLD i; April 11, 2002 - S d APR 2W Mr. Martin Kosmynka N OF ��U w'.f,�q �^ 1 1985 Pine Tree Road �VTOIY P Cutchogue, NY 11935 Re: Appl. No. 5104 —Variance Request Dear Mr. Kosmynka: Enclosed please find a copy of the determination with grant of alternative relief issued by the Board of Appeals. You may wish to contact the Building Department as to the next step in the building permit review process, and submit revised plans to conform to the conditions of the variance, for this new construction area, and any other agency that may have jurisdiction. The Building Department personnel may be reached between 8 and 3 p.m. at 765-1802. Please feel free to call our office if you have any questions regarding this determination. Very truly yours, Gerard P. Goehringer Chairman Enclosure Copy of Decision to: Building Department , Trustees (Attn: Charlotte) AP.1?EAJS,BOARD MEMBERS SVFFO��► Southold Town Hall Gerard P. Goehringer, Chairman �� y1 53095 Main Road Lydia A. Tortora y = P.O. Box 1179 George Horning 0 • Southold,New York 11971-0959 Ruth D. Oliva ZBA Fax(631)765-9064 Vincent Orlando �Ol �►a Telephone(631)765-1809 http://southoldtown.northfork.net BOARD OF APPEALS TOWN OF SOUTHOLD FINDINGS, DELIBERATIONS AND DETERMINATION MEETING OF MARCH 28, 2002 Appl. No. 5104 — MARTIN KOSMYNKA Parcel: 98.-1-11.2. BASIS OF APPEAL: Building Department's Notice of Disapproval dated February 20, 2002, denying a permit for an addition with in-ground swimming pool, for the reason that Section 100-244B of the Zoning Code requires a setback of 10 feet on one side yard and 15 feet on the other side yard, for a minimum total side yard area of 25 feet. AREA VARIANCE REQUESTED: Applicant wishes to construct a new swimming pool attached to the dwelling with a setback of three feet on the west side of the house instead of the code requirements. The total side yards are proposed at seven feet. FINDINGS OF FACT The Zoning Board of Appeals held a public hearing on this application on March 21, 2002, at which time written and oral evidence was presented. Based upon all testimony, documentation, personal inspection of the property, and other evidence, the Zoning Board finds the following facts to be true and relevant: PROPERTY FACTS: Applicant's property contains 16,306 sq. ft. in area and is located on the easterly side (House #1985) Pine Tree Road in Cutchogue. The property is improved with a single-family dwelling and structures as shown on the survey prepared by Kenneth H. Beckman, revised January 11, 2002. REASONS FOR BOARD ACTION: IN ACCORDANCE WITH THE REVIEW STANDARDS SET FORTH IN TOWN LAW 267B-3 "AREA VARIANCES," THE BOARD HAS CONSIDERED THE BENEFIT TO THE APPLICANT IF THE VARIANCE IS GRANTED, AS WEIGHED AGAINST THE DETRIMENT TO THE HEALTH, SAFETY AND WELFARE OF THE NEIGHBORHOOD AND COMMUNITY BY SUCH GRANT, AND DETERMINES THAT: 1. Grant of the area variance as requested will produce an undesirable change in the character of the neighborhood or detriment to nearby properties. The proposed addition would extend toward the adjacent lot leaving a setback of three feet. 2. The benefit sought by the applicant cannot be achieved by some method, feasible for the applicant to pursue, other than an area variance, because the applicant desires a pool area due to the medical need requiring constant physical activity. Q Page 2 March 28, 2002 ! Appl. No. 5104—M. Kosmynka Parcel 98.-1-11.2 at Cutchogue 3. The variance requested is substantial and represents a seven-foot reduction in the code requirement.of 10 feet, and total reduction of a combined side yard setbacks. 4. The variance granted will not have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district. No evidence has been submitted to suggest that this variance will have an adverse impact on physical or environmental conditions in the neighborhood. The applicant has agreed to accept alternative relief with conditions. 5. Grant of the requested variance is the minimum action necessary and adequate to enable applicant to enjoy the benefit of a swimming pool attached to the dwelling, while preserving and protecting the character of the neighborhood and the health, safety, and welfare of the community. BOARD RESOLUTION ACTION OF THE BOARD: In considering all of the above factors, and applying the balancing test under New York Town Law, motion was offered by Member Orlando, seconded by Chairman Goehringer, and duly carried, to: DENY the application as applied for, and GRANT alternative relief for setbacks from the easterly side property line at six (6)feet at its closest point and nine feet at the opposite point, SUBJECT to the following CONDITION: That the walkway, if placed, shall be located only on the south side and extended from front to rear. This action does not authorize or condone any current or future use, setback or other feature of the subject property that violates the Zoning Code, other than such uses, setbacks and other features as are expressly addressed in this action. Vote of the Board: Ayes: Members Goehringer (Chairman), Tortora, Oliva, and Orlando. (Member Horning of Fishers Island was absent as authorized.) This Resolution was duly adopted (4-0). C% L .Gerard P. Goehringer, Chairman 3. h AA1,,0s CHAR Pip r3 -or A 04F,4Or'r,,'-1 E Q� „ r. ..r.. - - i r `� t Albert J.Krupski,President Town Hall James King,Vice-President QSVFF01/r 53095 Route 25 O P.O.Box 1179 Artie Foster 'y Southold,New York 11971-0959 Ken Poliwoda o= Peggy A.Dickerson y Z Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 22, 2002 Mr. Martin Kosmynka 1985 Pine Tree Road Cutchogue,NY 11935- RE: SCTM#98-1-11.2 Dear Mr. Kosmynka: The following action as taken by the Board of Town Trustees during a Regular Meeting,held on March 20, 2002,regarding the above matter. WHEREAS,MARTINKOSMYNKA applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated February 20, 2002 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 20, 2002 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. 2 RESOLVED, that the Board of Trustees approved the application of Martin%smynka for a Wetland Permit to add sun rooml4'x29-1/4' with above ground fiberglass pool 7.8'xl3' 48 inches deep above ground with drywells. 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. Fee 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 when project is started and on completion of said project. FEES: NONE Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/cjc Cc DEC Building Department 3 '1�x .i�."�\\ l',. (('�Y {�� / �7��-_. V` .".' 3 ,� \ 1` � �i '� •�4 fin,:�. . ry'��_� _��..•-_%��i!',71hpr'=y:•�.1t•1r Board Of Southold Town Trustees - >. SOUTHOLD, NEW YORK :.. DATE: 0' ` ,.; March 2 2 1 PERMIT NO. ... r• MARTIN KOSMYNKA 1 ISSUED TO ................................ .' 1`� •' � • � Pursuant to the provisions of Chapter 615 of the Laws of. j the State of New York, 1893; and Chapter 404 of the Laws of the • State of New York 1.952; and the Southold Town- Ordinance en- c`� 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 accordance with the ! March 20. ' Resolution of The Board adopted at a meeting held on .............................. ,n . • 2002 200 00 aid b4 z. , and in consideration of the sum of �.......... P Y ..:..Mar.tin......Kosmynka........................................................ �.� Cutcho ue ` N. Y. and. subject to the z Terms and Conditions listed on the reverse side hereof, :. ). yam of Southold Town Trustees authorizes and permits the following: !' / trig: x. �5 Wetland Permit to add sun room i4'x21-1/4' with above ground - " fibreglass pool 7.8'x13' 48 inches deep above ground with . r drywells. all in accordance with the detailed specifications as presented in � .the originating application. a IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these rts to ��' •e• be subscribed by a majority of the�said Board as of iesens date. -� • .•. 4 VAC 'pY Artie Foster (Absent) ' ,( Truslecs ' J TERMS and CONDITIONS Permittee Martin Kosmynka I'heresiding at 1985 Pine Tree Road Cutchogue - N. Y., as part of the consideration for the issuance of the Permit does understand and prescribe to the fol- lowing: 1. That the said Board of Trustees and the Town of Southold are released from any and an damages, or claims for damages, of suits arising directly or indirectly as a result of any opa- ation performed pursuant to this permit, and the said Permittee will, at his of her own ezperue, defend any and all'such suits initiated by third .parties, and the said.Peranttee assumes full liability with respect thereto, to the complete'exch lion of the Board of Trusties of the Town of Southold 2. That this'Permit is valid fora period of 24 mo& which is considered to be the involved, estimated time'required to complete the work but shonld drauostances warrant, request for an extension may be made to the Board at a later date. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to'maintain the structure or project involved, to provide evidence to anyone concerned that auth-orization was originally obtained 4. That the work:involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with.the provisions of the originating application, may.be cause for revocation of this permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations _ in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the. work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work or project herein stated without expenses to the Town . of Southold. 8. That the said Board will be notified by the Permittee of the completion.of the work auth- orhwd 9. That the Permittee will obtain all other permits and consents that may be required sup- plemental to this permit which may be subject to revoke upon failure to obtain same. oSUF�o�co� . v = Town Hall. 53095 Main Road P.O. Box 1179 0 • Southold. New York 11971 Telephone �. (631) 765-1892. � SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, March 18, 2002, the following recommendation was made: Moved by Bill McDermott, seconded by Bret Hedges, it was RESOLVED to recommend to the Southold Town Board of TrusteescAPPROVAL of the. . Wetland Permit Application of MARTIN KO.SMYNKA to add a sunroom 14'X 29' with above ground pool 7.8'X 13'. The pool is fiberglass and 48".in depth. Located: 1985 Pine Tree Rd., Cutchogue. SCTM#98-1-11.2 Vote of Council: Ayes: All Motion Carried EUGENE & ANN BURGER 2215 Pine Tree Road Cutchogue, NY 11935 March 19, 2001 Southold Town Trustees/ZBA Main Road Southold,NY 11971 RE: MARTIN KOSMYNKA—LAP POOL To Whom It May Concern: This letter is written in reference to the proposal for the construction of an indoor lap pool addition to the home of Martin Kosmynka on Pine Tree Road in Cutchogue. As you may know Mr. Kosmynka has a heart condition and is paralyzed from the waste down. Every day he must overcome many hardships, which we, easily mobile and transportable persons, take for, granted. Simple movable acts such as "getting out of bed" each morning requires patience, time and extreme physical concentration. These feats are not only physically taxing but mentally also. His request for a small addition surrounding a pool, in which to aid blood circulation and slow down the muscle degeneration in his legs is very important to his well-being. Any opposing Feedback should be considered insignificant in light of the reality of the situation- he is a victim of an unfortunate physical handicap. A small addition, although close to the property line, shielded with the correct vegetation, will have minimal impact of both the environment and the neighborhood. His home is presently one of the more aesthetically pleasing and well maintained homes in our neighbothood. Sincerely, Eugene and Ann Burger 4-' Dear Sir, This is a letter of medical necessity for Martin Kosmynka to have an indoor lap pool. Aquatic therapy would positively impact in his reaching and maintaining his maximum physical potential. His independent mobility is limited to trunk and upper extremity use secondary to a spinal cord injury that is permanent. The ability to exercise his body in water on a regular basis could be key to his survival, as swimming exercises his heart and lungs as no other exercise that he is capable of performing could. It would allow him to remain a productive taxpayer and member of society. Sincerely, P.T. `` FEB 2 7 2002 North Fork Family Practice Associates Dr. Richard Cappello Dr. Luigi Buono PO. Box 153 7905 Main Road Mattituck, NY 11952 (631) 298-2030 February 26,2002 Southold Town Zoning Board Route 25 Southold,N.Y. 11971 FEB 2 7 2002 To whom it may concern: My patient has paraplegia and is wheelchair confined.He has CAD disease, high blood pressure,Cardiac Arrhythmia and CABG X 2.He requires daily exercise to maintain his cardiovascular health. Due to his physical limitations an indoor exercise pool is medically required. Sinc rely, Richard Cappello,D.O. RC:cdk L �tl9 1,:•�, .d. ,,'4 - � '-n'0.^t+.r�, �!f 1.• I' a. �.,.,� ,J i • -al.. .; � eS� 1 rL' i "�iH � tom._• � c � .. yt •` • .sky �� � �+t.a^� A9 R4fv� y ..`� .y ! � � '! �' .ICI —._ - -.:1 ��ac� � a•� � y w.�+as.of Endless Pools Inc., c " has architects and �� ® engineers on staff. ' I 1 "%%!1% Please feel free to i. f 4w, ! <; ; call or write us. ' � + • _ r ` `N 4 J A '* ��� � is�� . 1, Albert J.Krupski,President OSUFFO(�►C Town Hall James King,Vice-President .� �G 53095 Route 25 y� P.O.Box 1179 Henry Smith o Southold,New York 11971-0959 Artie Foster y Ken Poliwoda rY G Telephone(631) 765-1892 A �aO� Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Applicatio}� _Wetland Permit Application M/ Major Minor _Waiver/Amendmen Cha.ges _Received Application: 6-< , _Received Fee:$ 9" _Completed Application _Incomplete _SEQRA Classification: Type I Type II Unlisted Coordination:(date*_sentLCAC Referral SentDate of Inspection:Receipt of CAC Re Lead Agency Determination: _Technical Review: _Public Hearing Held-*S b E Resolution: Name of Applicant / ��n �%y jd s /qx�t/� Address �jJ ��1�0 ►l� Phone Number:( Suffolk County Tax Map Number: 1000 - Property Location: —O&�__/� (provide LIL (0 Pole#, distance to cross streets, and location) 5 AGENT: / (If applicable) n/ 0 Address: Phone: Board of Trustees Application GENERAL DATA Land Area(in square feet): Area Zoning: Previous use of property: Intended use of property: ���� !' ' � ° ,/0el)v OwL40 KP Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspende y a governmental agency? No Yes If yes, provide explanation: .Project Description(use attachments if necessary): 6 / J � Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: �y 4L fg Area of wetlands on lot: square feet Percent coverage of lot: , �a % Closest distance between rst existing structure and upland edge of wetlands: feet Closest distance between st proposed structure and upland edge of wetlands: 7 feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: 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): 14-16-4(2/87)—Text 12 • PROgECT I.D. NUMBER 617.21 SEC Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I—PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. A LIC NT ISPONSO 2. PROJECT NAME 3. PROJECT LOCATION: Municipality U Lti' County 4. PRECISE LOCATION(Street address and road intersections, prominent landmarks, etc., or provide map) � .�5 p�� 5. IS PROPOSED ACTIOf: ❑New Expansion ❑Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: p v ILL eoom — � 7. AMOUNT OF LAND AFFECTED: ��� + ��� Initially ��4 'dio Ultimately 8. WILL PROPOSE&A ON COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? CYes No If No,describe briefly 9. WHAT IS PRESENT LAND USE IN ICINITY OF PROJECT? Residential ❑.!ndustrial f i Commercial ❑Agriculture E]Park/Forest/Ooen space L!Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)? ❑Yes 2rNo If yes, list agency(s)and permitlapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes' A No If yes, fist agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑Yes ❑No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: / ( Date: Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment 0 V E R PART I1--NVIRONMENT ' A S���3!N1'aMT i o be cpr piet2d by :�g2nc• %.4Yt t?E i �HRESRGLD IN o NYCRR. ?ART 5i7..Z? It yes, cocralnate me review :rocess and use the F°JL_ El Yes I,_:No B. WILL ACTICN RECEIVE _C CRCINATED REVIEW AS RRCVICEG FCR UPIL:STEJ ACTICNS iN 5 N'(C=R,PART 5t7.57 if.to, a negative _ec!ara may be superseded my anctner Involved agency. LY-'S `'.1l0 C. CCULC ACTION RESULT:N ANY ADVERSE EFFECTS ASSOC:ATcC WITH E FOLLOWING:'Answers may :e nanewritten, if ;egiblel 1-1. Zxisting air quality, surfaca or'grounawater quality or ouantity, noise ieveis, existing :raffic Patterns. solid waste procuc:ion or afscc potential for erosion,drainage or'looding problems?_:plain briefly: C2. Aesthetic, agricultural, arcaaeological, historic,or other iaturai or cultural resources:or community or neignbornood character? Explain CO. Vegetation or fauna. 'lsn, sneilfisn or wildlife species, significant ialnitats.or threatened or=_ndangerea species? _ clam orfatly: C». A community's existing plans or goals as officially adopted,or a change in use or intensity of use of!and or other natural resources?Explain�r C5. Growth, subsequent cevelooment,or related activities likely to be induced by the ofobosea action? Explain briefly. iC3. !ong term,snort ;arm.cumuiative,or other effects not identified in C1-CS? Explain briefly. I i ...,. Other imoacs iinc:ucing c::anges in use of either quantity:7r type of energy)? =.:piam crieily. I i .. I i 0. ;S i HERE. OS !S THERE _!KELP 70 BE.CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL:,'.'.PACTS? _Yes _NO If Yes. explain orietty ?ART III—OEiFaMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS. For each adverse effect identified at:ove,determine whether it is substantial,large,imponant or otherwise signific. teach effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b).probability of occajng; (c) duration: irreversibility; (e) geogracnic scope: and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure exolanations contain sufficient detail to snow that all relevant adverse impacts have been identified and adequately addressed. Check this box if you have identified one or more potentially large or significant adverse impacts which iMAY _ occur. Then oreceed directly to the FULL F:aF andlor prepare a positive-declaration. Check this box if you Have determined, based on the information and analysis above and any supporting docurnentation, :hat the proposed action HILL NOT result in_zj�ny significant adverse environmental imcac:s AND provide on attac:Iments as necessary, the reasons supporting this determination: I � i i N„u!e nr '.eju Agency I i i ;Irtn!OI ;VLC Ni me 7i lei eonitoie ;tltcer en .via.{gene+ ttI1C OI :t,.•:OOni,OIC UlnCef :,gn.]ture'J! {CSCOni3OtC'_t:,Car.n �C7a Agency ),gndture or 01' 111:erent rfam resoonitow wfic2rl 1 I Jacc n G Board of Trustees Application County of Suffolk State of New York 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 HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE 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. Signature 4/1 SWORN TO BEFORE ME THIS H DAY OF 20 K3 Z_, U-NDA d-.KOWALSKI Notsry Public,State of New York, k1o.52-4524771 O—ualiffied in Suffolk County ! coy millssioal Ex ;Fas Nov.30,7'�oo '14otary Public MAR i 120�2 PROOF OF MAILING OF NOTICE ATTACK CERTIFIED MAIL RECEIPTS Name: Address: blln 5 J/9/1-/r r0�Tfl&L & 3 9� Tc Ho 5;' STATE OF NEW YORK COUNTY OF SUFFOLK rlAl 5(r jae ,residing at �� being duly sworn, deposes and says that on the jC ky of M� %I , 20 ,deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at that said Notices were mailed to each of said persons by (certified) (registered)mail. �Z / LlNDA r KOMAALSKI Sworn to before me this Notary Public,vtata NenrYorIc Day of l C� �) , 20,19 Z No.62-4524771 nualified in Suffolk countyj 1ov.so,1b., Of7' _ Notary Public PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: TC STATE OF NEW YORK COUNTY OF SUFFOLK MA ,f/L" R05�-t residing at y being duly sworn, deposes and says that on the �day of 20 ©&deponent mailed a true copy of the Notice ' set forth.in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at ✓4-1- ,that said Notices were mailed to each of said persons by (certified) (registered)mail. PrIND..r KOWALSKI [.'slam+Public,estate of NOW York Sworn to before me this No.52-4s2477, Qualified in Suffolk Cotin Day of 20-4 Notary PIlic ------ i PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: 47 STATE OF NEW YORK COUNTY OF SUFFOLK residing at l cI rf ����✓7s� r� 1'�" � cv r�l��M-ay�f �� ,being duly sworn,deposes and says that on the , 20�tleponent mailed a true copy of the Notice set forth.in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold;that said Notices were mailed at the United States Post Office at Z v Tv90 that said Notices were mailed to each of said persons by (certified) (registered mail. Sworn to before me this r KOlnALS,KI L Notary public,wtaty Of Pd���'®rl� Day Of C�1 , 20, vz lac.52 4524771 "v3ua11'ied in suffolk C C aesnty .ssr,;s Notary Public A>ppL#CANT '.r i TRANSACTIONAL DISCLOSURU FORM :I The Town ok Southold ' s Code of 9thic•s gkohibibs conflicts of nterest On the part of town officers and emplo ees. The purpose of this form is to ro'vide information which can alert the town of possible conflicts of Interest and allow it to take whatever action is .necessary to avoid same . YOUR NAME! Last name , first name, m aa.le n t ai , unless you are applying in the name of someone else or other entity, such as a company. If not indicate the other person ' s or company ' s name. ) NATURE btu APPLICATIONs (Check all that apply. ) Tax grievance Variance Change of zone AP p Arai of plat Exe pbion from plat or official map Other (if "Other, " name the activity. ) T CJ� ���.,• Do you personally (or through your cbwpanyp npeune, niblinq, parent', or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" Means a business► including a partnership, in which Ehe town officer or employee has even a partial ownership .of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO ✓ . If you answered OYES, ". complete the balance ' or thin corm and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person _ Describe the relationship bet'ween 'youraelf ( the applicant) and the town officer or employee . Either check they appropriate line n) through. D) and/or, describe in the space provided. The town officer or employee or his or her spousal sibling, ' parent, or 'child is (check all that apply) s A) the owner of greater than 516 of the shares of the corporate stock of the applicant (when the applicant' is a corporation) t b) the legal or beneficial owner of any interest in a noncorporate 'entity (when the applicant is not a corporation) ; C) an officer, director, partner , dr emplbyee• of the applicantt or D) the aptual applicant . DESCRIPTION OP RELATIONSHIP , ..,.' ••.. .'. ` t11',(!' t�).� '1`f ':N'ti:,...:r :. S�rtl.it�. .,i {•k�" ' su'benittedl this°`` 'e�t; d W Signa burs. r: . y'Print nam��name-',', �.'•� :•:r.r',,;.L;�.., � t,ti .:3'.•.�'h ��TA'i >> i.. ,';"`r;,1 r �t�i" ;.• :r••: :�S•;.,. .i "r, i•yy(f,'" r• rn•',157h 1, ..�:,..::�: ..y,"��! y�i+,r. •.,y.'.'�kV i,�:'• oT Al eZ/A 0 G o T/V'Z/ 0 N ZZ h B•��i� an/!i� Gor N ToroG A,QEA= i IPA RA,,P rj w Z57X VVCIQO o•o OG.2CC/,�Jp • 2 SToRy v �oo�. ss •pip FF2.aME o wEc.urv� �,ES N OWELG.. � 9 F�ccoSE1� "rM/A/4-IAL i2.o POf2CrS� . J AS PER �F/RM " R•�P n s�'� StJRAnlC6 BATE /'9AP Wgao C/,/Ep •.7t&JiV OF.SOUTyOL� Roio�- "�� O 'E/S,/9E33 -sNEG wood O A/ COA.M-raC7/0AI a � . S7'�apo ,Z•o, h� 0 !ll Al GAR, a� G J 0 C 0 1 03.7 pf NEW y. NP R 1 53. BFCiS-'9¢ S� * �2., 9 1r 0•2 30• B Z dr a� _ �/N� ��s•5 !mac Hp pAgO JQ, RIGHT OF WAYS /3•G �NSED LPtA'S 7S OF RECORD IF CERTIFIE 0: ARE NOT CHR/ST/iIJE MART-IAJ K0SMYA1KA FLEET MARKET CORK MON OR ADDITION TRW 'T/TLE //VSl1RAll/CE QF VIOLATION OF NEW YoRff /ivC` 3 9 k , 5 sltx.y�'t 4 !" }a{ dh f ,Ne •i. 4" r:, N f .- , ,.f C f'.:w j. .f f:�, ,t ,'Y4'7-' .r"` , 'W ,"A♦+.i'a:l?"`^,ra;. f � � � � .. � '.t<,`• / r `� qr - ai K.. �+� `i e { »•",r"F:`%'',r `'Jf'^�'`":'� •a�r'"i�t°�t." .• .. 'n ,n 3'. �s �'., �'Y b 4 I. �A, 1 !✓,M1 � _ 1 .. .. - - ! ° i ,M f G : -• _J� r -lY h�y�jty 1 1411 � } � 't t., . '•. F ,�. ' •�• .dye Oj � � � - ,. _ _ rah :µ�`6,f•E",.;., ;'.,;:.,1yy. ., i - �. _ - -� - � � .. ' ,r'+` � ., , ,., � �'. , to ,., M1k •�*��p 1� l',it*j, ' r _ '`'- a t _ ` a- .Y"• t t y �1 ?k f•.g I � r .� ', �. .. - r- � 4� '' �''Y; d+ j:•{`ter, . � - { M1 t � ': , •. � •. :� { t .. +'v s 'ft. 4, a ry'Yg? _4 .. ; - ..r. - ... ..�. .._ ' f � � q ..©�� " , .. ,; ! .. ,p� "s q•` a Y, i Y.1` "",p:d 1. 4F.X1-dTr1 h 1G A1A0k140/GAf? ILL�/+��y�, �/�[ /��/,//��/ram/ - i , ,!t ,y9 yt. +N .,•� 1 ` } -x%STfAAS A�00&:•� ExiS7`in!'cam R©f f' 'bSErD 4 �n}i:► s i -, � ' - 1 ` Jj , *rr t ., �/•1,•/��vy r./�/,'/�� ! _ / } uy �I //►►��//w��/� Z i� '.L R F iP t•, r, h I 1 •F r ° r / / L .. � (•,/(/'�,r/ 15 �Dw I_�+..� \ ,., ;r A y4DCi�I�`!'ov \ - t ,. ,r k r' rr S' ,`;4 f 9 d♦ 9 -:�, a; ��'. ,; .. l .,L� r _ ) t' L ° '�,,'t' ..5t`r'ir�'q• ' r , - ,. � `�Mbt � - ,n;� � F- r.. •t 4r r3 y .i• ° -if T'y'„f � �g", g•, a� 1 / I '..+w.h+itc.r • d t n 1 - ., •,C r .t, , :..-1A,;, •''• 4 e .i by `� . '� 'g� s -tR 9 x. , gg 'i M a �����•,,,� ,t P' .ALL 4rAli 00, it =}•"'4t d °.a."`• t. W+.. � I /`" '+,"�.. � r 'wy x�,' I/ c 1 i•A a :Y''�3' ..�'�'' i 4 � _ ..., _>^.,',•'"�, I + , tri L. �4 4 u}}' ,vi' A-1�, ,.'M,r' '-✓r, .� E"'X�' i .r" � � , - ` re "' '• '�R i P i__ ''� f k.k S3'r}i'S^ Y ,4 a W•A W -��.�, I,4`�/y/,y ram_ �r,i I I �Y .. .. �r } •t d 'ro'"'i•f}t''w `f'' t,'+'! `�44,'. t : A br+ J r k "z A5( ' L , 1,' . I 1 � - �R�.�/r� / ., + - _ ,.,7+ .,i.L•,+r{ y�;.i,'4'd ✓„F..y>p,r ... -+ .I i c z, � /,,l'7, �.• , e•st,,fit:, ,ry' "-„;,{,,�,r�,* } s t-f `f t r , ' , ♦ e a / _ "'. :-m.,"g.z;a+xrwa+m+s"4++lamr*s _ , _ "'y ., " f' - �' _ _ 't 't re.ro:,,; '4= ,',t+ ',i,rd.,'•^n\^ • ... .«..... ..-.�.r � .w„I�M/AY/iM�IIY , � � .. ' ,',• •4 � .{,s ,Y {I A t'I't. mr: A. 'a s , ^ -"r r " ' ' .P.r �v� ._.«._-,,._..:iT:?',•.ti Y,..,,ww. ._.�..�w...,.'I't"�+tOseee�.Y^:^ � - `t" a }'.' `A ':,; ,yy• �f ( �d +.1 { � R 4 '�'Ott `} ..•, .. , 'h? 'ia'' ..�, a"+.5. M1,P', ) tl .S& 4� (• � �\ , 7 � - 6 � v4 � - ,* -P n1'r �4 J J N i,l a'rllf'i'..,"yy,�li • ..w..,,..w.,:+..•.•,�.+.,•,v�+„w+v.,.,r�...�- ..r«w1-+,rt, o .,i. - , 4 .- ..L i� �. � .w M p.,�' ,�}, ', s ,i i a .r F. f t Ft 6 )) {{ a' _ •�' .w,._.r"w.++_•rw,+,._.__++.,._..,•_.,.. _,r♦. w• wr ..,m..•u_. ..._w ,.•a f t ?l,;t a .. � - ,: � ! � - W.' � � � - `S+l' r"' t• l.rt J k ���, ,1 t4 .,a:,:}6";Y'� 1 , ' , ~ _ _ • _ n «., ,v 'q t r! `z 'i.'n't., ,w Tf..'r�` '�-a., r ",rTr,`' � � - : , • ',d, r .. , 1 , , � iw" r.,, }d,,'r V'; K,y'•R'' ',�••'ry ry--; '!. - • _ � , ,. ' 7 .! � . .. • ., .�p` _ ..-!'' t,-, iY",,„,n' ; ti I '9 <,'fr'..'"r .�Fs}'yy. 6 {!Y `�. - - - �'�^�'�" "--�'•-ate.: A - V ,� k r _ !a.< «. # .,t4•�, ai /� am—v_'^r— �� � ; .. ,y r - , ,., �,''� •¢. 1^ ,t d,a },•�P- ° r .1 .rk if' .�,,a ��' J�, •� , - I , I. , - k i e •k, r, I,,Y �'lr'.'ed,3,p,, t Y .. •� ���t i.Y" � a 3 .. - _. �. 4+ t ,fry # ,'. I 3 n•r,' M�J^' .r�'"�, rT,t `5 F 6 k;,k', Y f,f•4ii•,r' v" _ - .'• ., - _ ., - i` 'nf�•�,, s'S 4 ,S; .d" �' '•i•• a. �.,f,` f�++r W:� d'''' t-''S ^.f+ c.�n 4�„e+ ' .. , -a � � ' r• i ',s y, 9 � « _ 'x y,i ,a' h. �rpi'r�tn7c I _ r _ g �'J 'f.N � p i, T �1 .s�'r�r:"`"♦,+r 'A,. ',A2:':t ,K:Xic•.•*,:.,,y .. � .. 4 x.,' •.�, ;11;r .,,, "t(, ,i*':.�•: l DEC' p ., t , , - .. �,`H a� 4. ;'�` ems' 7, '.x. .,{. , .•Yr; e ,� },., A � � • .. n ., a +it 1 - .1' 'e F �tyi 'r �}ry "t^•r l:$q- tj`•°t''�')"w � ,P:} C?�14�'t ±iu? ♦ ',31 > , ' � f • 1.. � t Y ,MT:t fiy. t { r�7„T�`'t,' eM1ld"t,. k'yb!<�i>� A o - .'t - - - - .. r r ",f r �.�.yy�'�,•�„� ;n Z _- ,�j',�"f�R RAWl.+'y l r, t'W' '�' al' � '� +;.,'P.i;'e•0'P' A4 4 stir •Z , r. .. a ,y''. f �' :R t? '�'n' ' •, - - ''t' 1.?'r F. 1 x,E # r`Dvd•kp, �7 -. - i 1 r", �>y :�e ir�rK ,r <x?-�,.=: i•.�^`.e,'6...9` �,„w; ♦z~4 �"° i .l �r"q>?;��i W � . , _ ` �r' - .. � .. � ' •P�, l yf.F����,ry��� �•� ���� �- 'Y�'�'u{'n�.ro�'t. �"°',..rr,,at day,1" :k"&',°t a9sd,'� ,.aa.��7,iY�. , 1 3� ,i�"t yT x 't' ':�'. '�i,;w#, b;+, �„, 4 /. {:tt�•, �,., r u.w�.e ,'�" �,,'��y`,4, ' J ,. - �, � � 9 - , � 'r: `�� ',A „�'h- "Nc".,aY' .:�" ..•e��i' >�'�, T^"' ..e`„.e.-r' •;�',$ ;x°q,4tx �?i�".i**. >'k;�h> 1+,, U • � I � -� .. .. •. t: .r' . � I - ,.. ,i� -J, 'I fi1t.° l t • r ',l •� , n " _ `'S 's3✓„ {- i" «�^ .4'yfd:, APP}tov ItY , ft isY bw' •r-• �,' �}.r~" '`+r:°„'',i: `�:"'"�. j �/ '.Z - � � d , .. .. ,y .,X ''3: 3" .t "#- '-�''.` 5:4 i :"?,:,, 3r ,^T4i r •g,�f', t J !,n x trt -mt"`• �Y. y�r p� r 4 y �J t r '1 Y'i •tf v,4 'q.r�' •h "t 's'r OCKDRAFTINO FORM WO.1o14e t r 1 w• f J X 1 K 'k r* s t t f .� .fir.. °s 'S t $$�A M'" { ni ✓ 4'f t• P a �'v ,• - 'y } ,�, :4''•/' :Y. ,dam {{y# , n .. f .. .t. `,K.'a w > df'' . �iN +'�Y`•^ a tP• �'-' ♦ '°4•''.`,'.e• 1 .n • .. i v Y i• � , _ -...--�- _ _ -.- '4tC }+4N�i.e:. t,r" ...�4rd. SLe J . , dtl.,, ,. , h . evnv,.tlrS'..u.r:,.,rn w_Y'..'i$.,K=;', Ik ., .ro " . vxh., %R. „i,'_ -- - �:.•a1"` :.t.Kd'rv-4';,y �'�:�`., ax '&$n.'4 xE3rodn:•<vi;at.;cw6+.r-ti'�.i,r.a`+k:°.`he.,�t5'' aa`_ w�aa,,SR:, .,wb.Sa:a3J,:'�i r..,,.L..,�Y`•u,:r. ,J.ua z::;'�h3+4"