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