HomeMy WebLinkAboutTR-2056 GFBoard Of $outhold Town Trustees
SOUTHOLD, NEW YORK
Mooring No. N/A
PERMIT NO .........2..9..5....6. ...............DATE: ...A.._u.g ....... 2.8..,....19 8 5
ISS U ED- TO .......... ..c...........ze.............W..o....o..~.~...e.y. ................................................................................
Pursuant fo tJ~e provisions of Chapter 615 of the Laws of
the State of New York, 1893; and Chapter 404 of the Laws of the-
State of New York 1952; and the Southold Town Ordinance en-
.. 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
Resolution of The Board adopted at a meeting held on
19.....8....5..., and in consideration of the sum of $.......5..~...0...0.. ........... paid by
Terms and Condiflons llsfed on the reverse side hereof,
of Southold Town Trustees aufhorlzes and permits the following:
Application approved-under the:~:Gra,ndfather Clause.
to secure a permit ~fo.r.a bulkhead, and. dQck .in
C6rey Creek, Southold all in accordance with the
all in accordance wifh fhe defaiJed speclf;caflons as presenfed in -
the originating application.
IN WITNESS WHEREOF, The said Board of Trustees here
by causes its Corporate Seal to be affixed and these presents to
be subscribed by a maiorlty of the as of this
Please tear off and return to the Trustee Office.
Ro rct Of qn,,fHnlH Town
TERMS and CONDITIONS ' '~
Private Road, Southotd bi. ¥., ~"~ ' 1[~
pa~. o~ the consideration for the issuance Of' ~he Permit do~ undcnmad snd p~
lowing: l. That the Trustee .Permit most be prcmin~y displayed on the premises
effected there, by du~ing the period of ~rk under ~e ~t.
1. ~ &e ~d B~d of T~s md &e To~ of ~u~old ~ ~l~d Erin my md
a~ flamages, or da~mn for dmag~, of ~m ~g ~y o~ ~y ~ a r~t of my o~-
~ r~pe~ ~ereto, m ~e ~mpl~e ~dmlon of ~e ~d of T~e~ of ~e Town of ~old
2. That ~ Pe~t ~ v~d for a ~ of ' 12 ' m~. wMfi h ~d~ to
~ated ~e r~uk~ m complete ~e work ~volv~ but ~ould O~m~c~ w~
for ~ e~emion may be rode to ~e ~d at a Iater da~
5. ~at ~ Pe~t ~o~d be re~ ~def~tely, or as long ~ ~e smd P~
to mainta~ ~e m~e or pm~e~ ~vOlv~, to pro. de eddmce to ~yone ~ncem~ ~ au~-
4. ~at ~e work ~volved ~ be mb~ to ~e ~sp~on ~d approv~ of ~e ~d'm '"
i~ agents, ~d non-mmphnce ~ ~e pro. iota of ~e ori~na~g appHmflo~ my ~ ~u~e for ~)'~5~'}~?:. .
5. ~at there ~ be no ~onable interf~ence ~ m~on ~ a r~t of
6. That ~ere mall ~ no ~teff~rence ~ the ~ght of ~e public to p~s ~d rep~
7. That ~ h~e op~auo~ of ~e Town of ~old r~e ~e r~val ~d/or ~o~
in ~e lo~tion of ~e work her~ au~o~ or U, h ~e o~ of ~ Bo~ of Tm~
work sh~ ~ u~e~mble obsmmon to free na~gadon, ~e smd Pe~i~ ~
u~n due notice, to r~ove or ~ter ~is work or proi~ herein ~t~ ~out ~ to
8. ~a: ~e s~d Board w~l ~ no~i~ by the Peewee ox ~e c~pleflon of ~e work au~- """~,~:'?' ~ :'.
9. ~at the Permktee will ob~n aB o~er p~ and co~ea~ ~t m7 ~ r~
Name' of Creek:
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
GRANDFATHER APPLICATION
TELEPHONE
(516) 765-1892
1. Name of Applicant:
2. Address of Applicant:
Telephone Number:
Year of Construction:
Sketch of the work including sizes:
6. Mark off on the map attached, where your property is located
using an X.
Signature:
Please note thac there is a $5.0 iling fee, which is a one time
fee, for this application.
Mooring Applications- $5.00 Application Fee and a $5.00 annual renewal
fee each year.
FRANK A. KUJAWSKI, JR., President
ALBERT J. KRUPSKI, JR., Vice-President
JOHN M. BREDEMEYER, III
JOHN L. BEDNOSKI, JR.
HENRY P. SMITtt
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
May 27, 1988
TELEPHONE
(516) 765-1892
Ms. Claire L. Woolley
Pvt. RD #12
Main Bayview Road
Southold, New York
11971
Re: 1000-078-06-06
Dear Ms. Woolley:
The following action was taken by the Board of Town Trustees during
their regular meeting held on May 25, 1988 regarding the above matter.
RESOLVED that the Town Trustees approve the request made by Claire
L. Woolley for a waiver of the Wetland Ordinance to add 11' on to the rear
of an existing residence on property located on a r.o.w, off Main Bayview
Road, Southold.
Please remit the required $25.00 fee for this waiver at this time.
Kindly return to the Building Dept. for a determination on the need
of any other town permits that may be required for this project.
Very truly yours,
Frank A. K~jawski, Jr.
President
Board of. Town Trustees
FAK: ip
cc: Bldg. Dept.
Board of Appeals
file
· ~?.v~ .'. '- .,~ .....
BOARD OF TOWN TRUSTEES
TO~ OF SO,HOLD
Town Hall, 5~09S Main ~oad
P.O. Box 728
Scuthcld, New York 11971
TELEPHONE
(516) 765-1892
APPLICATION IS HEREBY MADE TO THE TOWN TRUSTEES OF THE TOWN OF
SOUTHOLD, SUFFOLK COUNTY, NEW YORK:FOR THE ISSUANCE OF A PERMIT
PURSUANT TO THE LAWS, ORDINANCES AND REGULATIONS GOVERNING THE
COASTAL AND INTERIOR WETLANDS, FLOOD PLAINS AND DRAINAGE AREAS
OF THE TOWN OF SOUTHOLD, AND THE ISSUANCE OF PERM]TS PURSUANT
TO CHAPTER 32 OF THE CODES OF THE TOWN OF SOUTHOLD.
APPLICATION NO.
IDENTITY OF APPLICANT
DATE OF
APPL 1 CAT I ON____. ........
PHONE NO
ADDRESS OF APPL I CANT_____,~__._~"'__~'~____.._~2;_~___.~_.~ ~ :/Z
TAX MAP NO. ~ ~_.~_ ~c'~_~ ~ ~
AGENT
PHONE NO.
PERMIT REQUESTED TO ~_~
LOCATION OF PROPERTY FOR WHICH PERMIT WANTED
HOME ADDRESS OF PERMIT APPLICANT IF DIFFERENT FROM AFORESAID LOCATION
CREEK, BAY OR HARBOR FRONTING
SIZE OF PROPOSED WORK____/~__ ,¥____~!---~'~--~ --
LENGTH
WIDTH
HE I GH.T ABOVE H I GH WATER ~;~? /
DEPTH BELOW LOW WATER
YARDS TO BE EXCAVATED
YARDS TO BE FILLED
WIDTH Of CANAL, CREEK OR BAY FRONTING PROPERTy
DEPTH AT LOW TIDE
AVERAGE RISE IN TIDE
DISTANCE TO THE NEAREST CHANNEL_____~_.~--~< FT.
DISTANCE PROJECT EXTENDS BEYOND SIMILAR PROJECTS IN THE
IS THIS FOR PRIVATE OR BUSINESS USE?
AREA ZONING
F~
MANNER IN WHICH MATERIAL WILL BE rEMOVED OR DEPOSITED
INTENDED USE OF PROPERTY____~_.~____/.i~__.~J/~?.~: ~
DESCRIBE ANY ~NOWN PRIOR OPERATIONS CONDUCTED ON THE PREMISE
AND ~HETHER ANY PRIO~ LICENSE O~ PERMITS HAVS BEEN ISSUED TO E~ECT
STRUCTURES OR TO DREDGE OR DEPOSIT F! ~L ON SAID PREMISES ~ND WHETHER
ANY PERM I TS OR L I CENSES WERE EVER SUSPENDED OR REVOKED ~Y A GOVER~MENT~
-7
DESCRIBE FULLY THE REHABILITATION AND PROPOSED CONDITION OF THE
PREMISES AFTER THE WORK IS COMPLETED INCLUDE AN ADDITIONAL SURVEY OF
THE PROJECT SITE IF NECESSARY
WRITTEN CONSENT OF THE OWNER OF THE PROPERTY, IF NOT THE SAME AS THE
APPLICANT.
ARE THERE ANY COVENANTS OR RESTRICTIONS IN YOUR DEED THAT %ffOULD
PROHIBIT THIS PROJECT?
14-16.4 f2/87~--Te×t 12
PROJECT I.D. NUMBER
SHORT
617.21
Appendix C
State Environmental Quality Review
ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I--PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. APPLICANT/SPONSOR 2. PROJECT NAME
SE(
3. PROJECT LOCATION: /
4. PRECISE LOCA~ ON tStreet address ano road intersections, prominent ~andmarks, e[c., or prOvide mao~
5. IS PROPOSED ACTION:
[] New [] Exoansion
6. DESCRIBE PROJECT BRIEFLY:
[] Modification/alteration
7 AMOUNT OF LAND AFFECTED:
Ultimately acres
8. WILL PROPOSE::) ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
Yes [] No If No, describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
~]' Residential [] !ndustrial [] Commerc,al [] Agriculture [] Park/ForestlOaef- space [] Other
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUND!NC. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL.
11.
STATE OR LOCAL)?
[] Yes ~',fo If yes, list agency(s) and 2ermit/approvals
DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
[] Yes ~No If yes, list agency name and permit/approval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIFE MODIFICATION?
[]Yes
, CERTIFY THAT THE iNFORMAT,ON PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/sponsor name:
Signature: ~/;~//'~ '~4_.-
/
/
If the action is in the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
OVER
1
PART II--ENVIRONMENTA ;ESSMENT (To be completed by Agent_
A. DOES[] YesACTI ON EXCEED[]No ANY TYPEi THRESHOLD N 6 NYCRR PART 617.127 If yes, coordinate the review process and use the FULL DAF.
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67
may be superseded by another involved agency. If No. a negative declara~
[] Yes [] No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: [Answers may Pe handwritten, if legible)
C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or dlspos
potential for erosion, drainage or flooding problems? Explain briefly:
C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain brl
C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly:
C4. A community's existing plans or goals as officially adc ated, or a change in use or intensity of use of land or other natural resources? Explain br
C5. Growth. subsequent Qevelopment, or related activities likely to be induced oy the proposed action? Explain briefly.
C6. Long term. snort term. cumulative, or other effects not identified in Cl-C57 Explain briefly.
C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly.
D. iS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
[] Yes [] No If Yes. explain briefly
PART Ill--DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect ider tiffed at:ove, determine whether it is substantial, large, important or otherwise significs
Each effect should be assessed n connection with its fa) setting (i.e. urban or rural); (b) probability of occurring; (c) duration:
Jrreversibility; (e) geographic scope; and (f) magmtude. If necessary, add attachments or reference supporting materials. Ensure tt
explanations contain sufficient detai to show that all relevant adverse impacts have been identified and adequately addressed.
~heck this box if you have identifiea one or more potentially large or significant adverse impacts which
occur. Then proceed directly to the FULL EAF and/or prepare a positive oeclaration. .
Check this box if you have determined, based on the information and analysis above and any supporting
documentation, that the proposed action WILL NOT result m any significant adverse environmental impacts
AND provide on attachmen[s as necessary, the reasons supporting this determination:
COUNTY OF SUFFOLK )
STATE OF NEW YORK )SS:
BEING DULY SWORN DEPOSES
DAY OF
AND SAYS THAT HE i S THE APPL I CANT FOR THE ABOVE DESCR ! BED PERM I TS ,
AND THAT ALL STATEMENTS CONTAINED HERE I BI ARE TRUE TO THE BEST
OF Hi S KNOWLEDGE AND BEL ! CF, THAT THE WORK WI LL BE DONE I N THE
MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY
THE TOWN BOARD OF THE TOWN OF SOUTHOLD. THE APPL I CANT 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, If GRANTED.
in completing this application I hereby authorize the Trustees,
agent 6r representatzve to enter onto my property to inspect the
premises in conjunction with rev_Le~°f thais ,appLication.
/
· N(~TAR~7-PUBL I C /-
EXAMINED
UNDA J. COOPER /
Notary Public, State of New Yor~
No. 4822563, Suffolk County/J//
Term F~31,
APPROVED "WETLANDS" PERMIT (CHAPTER 97)
APPROVED "BOAT,DOCKS, WHARVES" PERMIT (CHAPTER 32)
DISAPPROVED "WETLANDS PERM iT" (CHAPTER 97)
DISAPPROVED "BOATS,DOCKS, WHARVES" PERMIT (CHAPTER 32)
CONDITIONS, IF ANY
EXAMINING BODY
SIGNATURE OF CHAIRMAN
COMPUTATION OF FEES
Approved 2/27/85