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HomeMy WebLinkAbout30210-ZFORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PEItMIT NO. 30210 Z Date APRIL 2, 2004 Permission is hereby granted to: JEFFREY VICTOR 15 WEST 84TH ST APT 4B NEW YORK,NY 10024 for : DEMOLITION OF AN EXISTING FOUNDATION AS APPLIED FOR PER DEC APPROVAL. at premises located at 1185 KERWIN BLVD GREENPORT County Tax Map No. 473889 Section 053 Block 0003 Lot No. 006 pursuant to application dated APRIL 2, 2004 and approved by the Building Inspector to expire on OCTOBER Fee $ 407.60 2, 2005. f~ ~-----~ Aut hozVi zed Signature Rev. 5/8/02 ORIGINAL NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER 1-4738-03168/00002 :ACILITY/PROGRAM NUMBER(S) PERMIT Under the Environmental Conservation Law EFFECTIVE DATE March 15 2004 EXpIRATiON DATE(S) March 14, 2009 TYPE OF PERMIT · New [] Renewal [] Modification rq Permit to Construct [] Permitto Operate E Adicle 15. Title 5: Protection of Waters E Article l& Title 15: Water Supply E~ Article 15. Title 15: Water Transpor~ E Adicle 15 Title 15: Long Island WeJls [] Article 15. Title 27: Wild Scenic and Recreational Rivers 6NYCRR 608: Water Quality Certification E Article 27. Title 7: 6NYCRR 360: Solid Waste Management [] Article 17. Titles 7.8: SPDES [] Article 19: Air Pollution Control [] Article 23. Title 27: Mined Land Reclamation [] Article 24: Freshwater Wetlands · Article 25: Tidal Wetlands f- Ar[Me 27, Title 9; 6NYCRR 373: HazardoUs Waste Management Article 34: Coastal Erosion Management Article 36: Floooplain Mecagemen[ Articles 1 3,17,19,27,37; 6NYCRR 380: Radiation Control PERMIT ISSUED TO Jeffrey Victor ADDRESS OF PERMI~I-EE 15 West 84~n Street Apt. 4-B, New York NY 10024 TELEPHONE NUMBER (212) 595-6690 CONTACT PERSON FOR PERMI'FrED WORK TELEPHONE NUMBER NAME AND ADDRESS OF PROJECT/FACILiTY Victor Property, 1185 Kerwin Boulevard, Greenoort NY LOCATION OF PROJECT/FACILITY SCTM # 1000-53-3-6 COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold Pipes Creek 5:719.4 N:4551.5 Description of Authorized Activit7 Remove an existing concrete foundation and place 700 cubic yards of clean sand fil] as shown on the plans prepared by Jeffrey Victor on 12/31/03, and stamped NYSDEC approved on 3/15/04 By acceptance of this regulations, the General Conditions s ]Dliance with the ECL aH applicable pecial Conditions included as part of this permit. PERMIT ADMINI~iRATOR: John A. W~land ! iMRP) AUTHORI~RE ADDRESS Bldg. ¢~40. SUNY. ~tony Brook. NY 11790-2356 DATE I Page 1 of 4 / March 15. 2004 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1. The storage of construction equipment and materials shaLL be confined to within the existing driveway and disturbed area. 2. Necessary erosion control measures i.e., haybales, silt fencing, etc. ate to be placed on the downslope eoge Of any disturbed area. This sediment barrier is to be put in place before any disturbance of the ground occurs and is to be maintained in good condition until thick vegetative cover is established 3. All fill shall consist of "clean" sand or soil (not asphalt, flyasn, broken concrete or demolition debris). 4. All areas of soil disturbance resulting from this project shall be stabilized immediately following project completion or prior to permit expiration, whichever comes first. The approved methodologies are as follows: a. stabilization of the entire disturbed area with appropriate vegetation (grasses,shrubs,etc.) 5. Any debris or excess material resulting from the removal of the concrete foundation shall be completely removed from the adjacent area (upland) and removed to an approved upland area for disposal. NO debris is permitted in tidal wetlands and or protected buffer areas. 6. Development df this parcel will require prior NYSDEC approval (permit). DEC PERMIT NUMBER 1-4738-03168/00002 PAGE 2 OF 4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATIOi', NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permlttee expressly agrees to indemnity and hold harmless the Department of Environmental Conservation of the State of New York. its representatives, employees, and agents ("DEC") for all claims, suits, actions, and damages, to the extent attributable to the permittee's acts or omissions in connection with the permittee's undertaking of activities in connection with. or operation and maintenance of, the facility or facilities authorized by the permit whether in compliance or not in compliance with the terms and conditions of the permit. This indemnification does not extend to any claims, suits, actions, or damages to the extent attributable [o DEC's own negligent or intentional acts or omissions, or to any claims, suits, or actions naming the DEC and arising under article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. Item B: Permittee's Contractors to Complywith Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, including all special conditions while acting as the permiffee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of-way that may be required ro carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order [o perform the 3erm[tted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. GENERAL CONDITIONS General Condition 1: Facility thspection bythe Department The permitted site or facility, including relevant records, is subject to inspection ar reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). The permittee shall provide a person [o acco~npany the Department's representative dudng an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site or facility. Failure to proauce a copy of the permit upon request by a Department representative is a violation of this permit. General Condition 2: Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirements contained in such order or determination, General Condition 3: Applications for Permit Renewals or Modifications The Derm~tzee must submit a separate written application to the Department for ranewal, modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal modification or transfer granted by the Department must be in wdting. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities (HWMF), major Air Pollution Control iAPC) and Solid Waste Management Facilities [SWMF); and b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification are to be submitted to: '~YSDEC Regional Permit Administrator. Region < > <street>. <city>, <state> <zip>, telephone: < > General Condition 4: Permit Modifications, Suspensions and Revocations by the Department The Deoartment reserves the right to modify, suspend or revoke this permit in accordance with 6 NYCRR Part 621. The grounds for modification, suspension or revocation include: a) materially false or inaccurate statements in the permit application or supporting papers: b) [allure by the permittee to comply with any terms or conditions of the permit; c) exceeding the scope of the project as described in the permit application; d) new~y discovered material information or a material change 'n enwronmenta] conditions, relevant technology or applicable [aw or regulations since the issuance of the existing permit: e) noncompliance with previously issued permit conditions, orders of the commissioner, any provis,ons of the Environmental Conservation Law or regulations of the Department related to the permitted activity. 3EC PERMIT NUMBER PAGE 3 OF 4 1-4738-03168/00002 NEW YORK STATE :2EPARTMENT OF ENVIRONMENTAL CONSERVATION ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5), 24, 25, 34 AND 6NYCRR PART 608 ( TIDAL WETLANDS ~ 10, If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill. excavation, or other modification of the watercourse hereby authorized shall not be completed, the owners, shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvemem of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. Granting of this permit does not relieve the applicant of the responsibility of obtaining any other permission, consem or approval from the U.S. Army Corps of Engineers, U.S. Coast Guard, New York State Office of General Services or local government which may be required. All necessary precautions shall be taken to preclude contamination of any wetland or waterway bysuspended solids, sediments fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. Any material dredged in the conduct of the work herein permitted shall be removed evenly, without leaving large refuse piles, ridges across me bed of a waterway or floodplain or deep holes that may have a tendency to cause carnage td navigable channels or to the banks of a waterway. There shall be no unreasonable interference with navigation by the work herein authorized. If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall, without expense to the State. ant to such extort1 and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. If granted under 6NYCRR Part 608. the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301,302, 303, 306 and 307 of the Clean Water Act of 1977 (PL 95-217) orovided that ail of the conditions listed herein are met. At least 48 hours prior to commencement of the project, the permittee and contractor shall sign ano return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work and, if required, a survey. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application Such approved plans were prepared by Jeffrey Victor on 12/31/03. ~EC PERMIT NUMBER 1-4738-03168/00002 PAGE 4 OF ,~ New York State Department of Environmental Conservation Division of Environmental Permits, Region One Building 40 - SUNY, Stony Brook, New York 11790-2356 Main Phone: I631) 444-0365 Matt Penski Phone: (631) 444-0358 Website: www, dec.state.nv.us Fax: (631) 444-0360 Erin M, Crotty Commissioner March 15, 2004 Mr. Jeffrey Victor 15 West 84th Street, Apt. 4-B New York NY 10024 RE: Permit # 1-4738-03168/00002 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70. ECL) and its implementing regulations (6 NYCRR, Part 621) we are enclosing your permit. Please read all conditions carefully. If you are unable to comply with any conditions, please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Very truly yours, Matthew R. Penski Encon Program Aide MRP Enclosure 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; NewYork 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD November 14, 2003 Mr. Jeffrey Victor 15 West 84th Street Apt. New York City, NY 10024 RE: 1185 KERWIN BLVD., GREENPORT SCTM#53-3.6 Dear Mr. Victor: The Southold Town Board of Trustees reviewed the survey prepared by John T. Metzger last dated March 28, 2003 and determined the proposal to remove the existing foundation and fill with clean fill to be out of the Wetland jurisdiction under Chapter 97 of the Town Wetland Code and Chapter 37 of the Town Code. Therefore, in accordance with the current Tidal Wetlands Code (Chapter 97) and the Coastal Erosion Hazard Area (Chapter 37) no permit is required. Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary or seaward of the coastal erosion hazard area as indicated above, without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction and Coastal Erosion Hazard Area, which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and the coastal erosion hazard area and your project or erecting a temporary fence, barrier, or hay bale berm. However, any activity within 100' of a Wetland line or seaward of the Coastal Erosion Hazard Area would require permits from this office. This determination is not a determination from any other agency. 2 If you have any further questions, please do not hesitate to call. Sincerely, Albert j, Kru Ps¢i,' j r~' ,~'1~ President, Board of Trustees AJK:lms TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~ ' SOUTHOLD, NY 11971 TEL: (631) 705-1802 FAX: (631) 765-9502 ww~v. northfork.net/Southold/ Examined App ov l ,20- Expiration / ,2 PERMIT NO. Bmlding ~spector BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 3 sets of Building Plans Planning Board approval Survey. Check Septic Form N.Y.S.D.E.C. Trustees Contact: APPLICATION FOR BUILDING PERMIT A[~R ~STRUCTIONS ~~fion-~e completely fdl~ m by ~e~t~ or m ~ ~d subdued to ~eBuil~g ~pector wi~ 3 sets of pl~, acc~ate plot plan to scale. Fee aecor~g to sc~d~e. ' ' b. Plot pl~ showing location of lot ~d of b~gs on presses, relations~p to adjo~ng presses or public s~eets or ~eas, and wate~ays_ c. ~e work covered by ~s application my not be co~ced before issu~ce of B~l~g Pemt. d. Upon approval oft~s application, the Bffil~g ~specmr will issue a B~l~ng Pemt to ~e applic~t. Such a pe~l shall be kept on the presses available for inspection ~ou~om ~e work e. No bWll~g shall be occupied or used in whole or in p~ for ~y p~ose w~t so ev~ ~t~ the B~l~ng ~spector issues a Ce~ficate of ~cup~cy. fi Ev~ bW~g pe~t s~l expke if~e work au~rizeg has not co~enced within 12 monks a~er the ~te of issu~ce or has not been completed wi~n 18 mm~s ~om such date. ~no zomng men~ents or o~ re~latio~ ~fect~g ~e pr0p~ have been e~cted ad~t~On six mon~.'-~ea~, a n~ pem~ g~ be req~ed. ~PLICATION IS ~BY M~E to the Biffing D~p~ent for ~e iss~ce of a B~lding Pe~t p~s~t ro the B~ff~ng Zone Ore,ce of~e Town of Sou~old, S~olk Cowry, New Yor~ ~d other app~cable Laws, Orates or Relations, for ~e co~cfion of b~l~gs, ad~tions, or ~terafions or for remov~ or dmolition as here~ descdbed. ~e applic~t a~ees m comply wi~>all applicable laws, ordi~c~, ~lffmg code, hous~g code, ~d relations. ~d to a~t au~ofized i~pecmrs on presses ~d ~ b~g for necess~ ~spectio~. ~m~e of apphc~t or nme. ff a co~orafion) ~, ~ t ~afl~g ad,ess of a~c~t) State whe~ applic~t ~s o~, lessee, agent, ~c~tect, entries, gener~ ~n~actor, elec~ci~, plmb~ or b~ld~ N=e of owner of premNes (As on ~e t~ roll or latest de~) If applic~r ~s a co~orafion, si~at~e of d~y au~ofized officer (Name and tide of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: 1185' Blvd. . House Number Street ~ Hamlet County Tax Map No. 1000 Section ,~ Block Subdivision Filed Map No. (Name) Lot 2. State existing use and occupancy of pr~nises and intended use and occupancy ofproposed cons~ction: a. Existing use and occupancy b. Intended use and occupancy Nature of work (check which applicable): New Building Repair Removal ~ Demoh~dvn Estimated Cost 4 ~ OOO. oo Fee Addition Alteration Other Work 1C--~ I ~ o.n ~ ,.,O,r~d~,~,~ (Description) If dwelling, number Of dwelling units Number of dwelling units on each floor If g~mge..numl~e[ of cars If business, commercial ov mixed occupancy, specify nature and extent of each type of use. Dimensions of existing structures, if any: Fron[ ~__c) Rear -q'6 Depth Height c, pX G '~/'~,~4~.4,d,, Number of Stories ~ (To be paid on filing this application) Dimensions of same structure with alterations or additions: Front Depth Height. Number of Stories Rea r 8: Dimensions of entire new constmction: Front Rear .Depth Height Number of Stories 9. Size oflot: Front ~22,~1'~¢. Rear ~gt{'f~. Depth t./(:>~tf/. 10. DateofPurchase A~'~l~2.oo-~ NameofFonnerOwnerJ),,k(~c;~ ~,':'7lO-~[-$ 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zonIng taw, ordinance or regulation? YES 13. Will lot be re-graded? YES /X NO__ 14. Names of Owner ofpremises_-~e.~,'~ Name of Architect Name of Contractor NO/~ Will excess fill be removed from premises? YES NO ,~ Address/,5'60 ~1~,~.6- fly. Phone No.Z/Z .5-75' ~6¢O Address Phone No Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES ~){ NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMiTS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES ~ NO __ *IFYES. D.E.C. PERMITS MAY BE REQU1RED. 'Tffo~l'c~-~a#,~ ~6(-~e*~,'~5 e,wcto$c~-_ 16. Provide survey, to scale, with accurate foundation plan m~d distances to property lines. 17. If elevation at any point, on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OF. (Name of in/I/vidual signing contract) (S)He is the being duly swom. deposes and says that (s)he is the applicant above named, (Contractor. Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are m:e !o the best of his knowledge and belie/'.' and ti*mt the work will be performed in the manner set forth in the application fried t'~ncrewith. JOYCE M. W1LKINS Notary Pubt~o, State of New York ~e, 4952246, Suffolk CoUnty Term Expires June t2, '' Signature 'of Xpplicant x~ _,00. ~c2 .I