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Home My WebLink AboutDeLynn, JaneAlbert J. Krupsld, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095MainRoad P.O. Box 1179 Southold. New York 11971 Telephone (516) 765-18~2 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only ~-~Coastal Erosion Permit Application Wetland Permit Application Grandfather Permit Application ~'~aiver/Amendment · :/Cha. nges ~%_ . "~eceived Applic~%~ ~/~I~ ~0 Received Fee: $~ ] -- ,: ~ompleted Appli~ ,/~g,~ ~ncomple~e SEQ~ Classification: ~e I ~pe II Unlisted Coordination: (date 'se~t~-- ;r, 0:~'~- '¥' ~AC Referral Sent: ~/~~' ' '~ ' ~Date of Inspection: Receipt of CAC Report: Lead Agency Dete~ination: Technical Review: 7Public Hearing Held: Resolution: Phone N~er: ( Suffolk County Tax Map N~er: 1000 - (If applicable) Address: ~D Phone: FAX#: I q47 '77-7- ~rd of Trustees Applicati~ GENERAL DATA Land Area (in square feet): Area Zoning: Previous use of property: I ~' Intended use of property: Prior permits/approvals for site improvements: Agency Date A No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ~ No Yes If yes, provide explana~ Project Description (use attachments if necessary): ~rd of Trustees Applicati~ W~i'hAND/TRU~TRR LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: Percent coverage of lot: square feet Closest distance between nearest existing structure and upland edge of wetlands: ~.~ feet Closest distance between nearest proposed structure and upland edge of wetlands: 4~,'~ feet Does the project involve excavation or filling? ~ No Yes If yes, how much material will be excavated? How much material will be filled? ~/~ 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: cubic yards cubic yards 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): ~rd of Trustees Applicati~ COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are wetlands present within 75 feet of the proposed activity? No ~< Yes Does the project involve excavation or filling? ~ No Yes If Yes, how much material will be excavated?JO-- How much material will be filled? --~-' (cubic yards) (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) 4 617.2.1 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS OnJy PART I~PROJECT INFORMATION (To be comoteted by ADplicant or Proiect sDonsor) 1. APP NT/SPONSOR 3. PROJECT LOCATION: SEQ 5. IS PROPOSED A~TION: [~ New '*~¢xoansion [] Modification/alteration 6. OEECRleE PROJECT BRIEFLY: ~Yes [] NO If :~o. 3escnbe [3tletly OOES ACTION ~NVOLVE A PERMIT APPROVAL. OR PUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL .AGENCY (FEDERAL, STATE DR LOCALJ? t 1. OOES ANY ASPECT OF THE ACTIOt4 HAVE A CURRENTLY VALIO PERMIT OR .APPROVAL? Yes '"~o If ,/es, list agency name and oerm~tlaOOroval 12. AS A RESULt' OF PROPOSED CTION WILL EXISTING PERMITIAppc{OVAL REQUIRE MOOiF~CATION? If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this a,~.~essment OVER 1 PART II--ENVIRONMENTAL A~SMENT (To be comcleted by Agency) C2. Aest~letrc, agrlctJztural, arctlaeologzcal, historic, or oUler natural or Cult[Jtal resources; or corT1mu~ity or rle~grlDotrloocl ¢:~aracted? ~,~col&ln ~fleT O. ~S THERE, OR IS THERE LIKELY TO SE, CONTROVERSY RELATED TO POTENTIAL AOVERSE ENVIRONMENTAL :MPACT$? ~ Yes [] NO If Yes. exOlain brtelly PART Ill--DETERMINATION OF SIGNIFICANCE (To be comolete~ by Agency) INSTRUCTIONS.' For eact3 adverse effect identified above, determine whether it is substantial large. Jmoortant or otherwise significar Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) prolaalad[ty ot occo.~'Lng; (c) duration; irrevers~biiJty; (e) geographic scolae; anti (f) magnitude, if necessary, add attachments or reference suoporting materials. F. nsure tn. exDlanations contain sufficient detail Io snow ttlat all relevant adverse impacts have been identifieo and adec~uateiy addresseo. Check this taox if you have identified one or more potentially large or significant at, verse impacts which MAY occur. Then proceed ~aJrectJy to the FULL EAF and/or prepare a positfve'c~eclaration. Check< this taox if you ~ave determined, ~ased on the inform,ation and analysis above and any supporting documentation, Ii, at tile pro!0osed action WILL NOT result Jn._~any significant adverse environmental impacts AND ~rowce on attachments as necessary, the reasons supporting t~is cletermmatJon: ~rd of Trustees Applicati~ County of Suffolk State of New York ~ ~--t~ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR Trt~ ABOVE DESCRIBED PERMIT(S) AND THAT AT.T. STAi'mmfENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND '£~AT 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 T~ TOWN TRUSTEES ~.RSS 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 AUTMORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WIT}{ REVIEW OF THIS APPLICATION. ~Signature swoRN TO BEFORE ~ THIS /X DAY OF ~¥ ,~ ?~ Notary Publid, / ROBERT I. SCOT~J~. Winery Public, State ~ New York Qualified ir* Suffolk CounP/ No. 01SC4.7250~9 T~m Expires M~y 31, -~ 7 Ord of Trustees Applicati~ AU'I'~OP/ZA~ION (where the applicant is not the owner) (print owner of property) residing at ~D Lee-(-,~ Oah/~ (mailing address ) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. 8 Albert J. Krupski, President James King, Vice-President Henry. Smith Artle Foster Ken Poliwoda BOARD OF TOV~N TRUSTEES TO%VN OF SOUTHOLD ~OARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING · residing at ~2 Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone t516) 765-18~2 Fax (516) 765-1823 being duly sworn, depose and say: That on the /~ day of/J/~ , 1997, I personally posted the property known as ~3C--~/~ ~-~/Z~_~ by placing the Board of ~ustees official poster where it can easily be seen· and that I have checked to be sure the poster has remained in place for seven days prior to the date of the public hearing. (date of hearing noted thereon to be held~/. 3~ Dated: ~xworn to bef.ore me this day of~199~ Notary Public BARBARA ANN RUDDER Notary Public, St~,~ ~,l ~ York Qualified iff Sufltdk County ~ommieldon Expirol Agrtl 14, C P 059 550 71& US Postal Sen?ice Receipt for Certified Mail Do not use for Intemalional Mail (See reverse) p 059 US Post~ Service ece~pt ~o~ Certified Uail N~ot (~surance Coverage ~ true copx ~te~ to =~-- ----~ti~e ~a~e-, --- the a=u~- ~.~licstion, ~::-~te there r~ -~id perSO~ ~ the ~ .~es set oPPU~?._ ~he na~eS ~ ~' assessment roll of a~r~--- _~ ~oosl~ ~-- the united ~-~ses s~ -~- ~he current a~u~- as shown on mailed at of said persOnS Town of $outhold; that said Notices were states post office at were mailed to each of mail. persons by (certified) %re9 said ~ before me this Sworn t? ~ .19 %% day of ~ 6 APPLICANT The Town of Southold's Code of ethics Prohibits interes2 on the part of town officers and employees. The purpose of ~h~s form Is to ~rovide Information which can alert the town of possible conflicts el ~n~erest and allow it ~o take whatever action ~s necessary ~o avoid same. YOUR N gt ' ' (~aeb name, ~irs~ name, m~dd.~e ~n~b~al, you are applying in ~he name og someone else or o~her on~i~y, such as a company. ~ho o~her person's or company's name.) NATURE OF APPLICATION, (check all ~ha~ apply, ) Tax grievance Variance ~ change of zone A~p~9~al of plat , Exemption from plat or official map o~her (If "other," name the a~tivi~y,) Do you pereoflulXy (or ~hrough your ~ompany, spouse, sibling, parent, or ~hild) have a reXabionehip with any officer or employee or the Town of Son~hoXd? 'Relationship' includes by blood, marriage, or business interest. "nuainess 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 ~he town officer or employee owns more than 5~ of the eharen. NO ~ If you answered "YES,". complete the balance cE ~hl's'~orm and date and sign where indicated. Name of person employed by the To~n o~ Soubhold Title or position of that person Describe the relationship between yourself and the [own officer or employee. Either appropriate line R) ~hrough D) and/or d, provided. applicant) the in the space The town officer or employee Or parent, or child is (check all __A) the owner of greater corporate stock of ia a ocr[ __.B) the legal or owner noncorpora ty (when the corporeal ; C) an off: director, pa~tner, or __.D) applicant. DESCRIPTION OF or her spouse,· sibling, apply), 5% o~ the shares of the applicant (when the applicant' of any interest in a applicant is not a or employR.~-o~,_ ~ the · ' IJLJ 2 · .,. Albert J. Krupski, President James King, Vice-President Henry Smith Ariie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 1, 1999 Christopher Stress, AIA P.O. Box 821 Jamesport NY 11947 RE: JANE' DELYNN Dear Mr. Stress, The Southold Town Board of Trustees approved the request for a Waiver and Coastal Erosion Permit for a second story to an existing house. Located: 930 Leeton Drive, Southold. However, this does not constitute any permits from other agencies. If you have any questions, please call our office at 765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. Bldg. Dept. Telephone (516) 765- lgq ~. Town Hall. 53095 Main Road P.O. Box 1179 Southold, New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, October 18, 1999, the following recommendation was made: Moved by Scott Hilary, seconded by Bret Hedges, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Waiver Request of JANE DELYNN 59-1-4 for an addition of second-story to an existing one- story house to encompass landward (road) side of house for two bedrooms. 930 Leeton Dr., Southold Vote of Council: Ayes: All Motion Carried li I I[ [ [ [ [ [ [ I [ [ [ / 4/ N.Y.S. L~c. No. 49~ Joseph A. Ingegno Land Surveyor Title .'~ -- Subd~v~o,"m -- .~'te Pinna -- Conltruction Loyout Pt4ONE ($11)727-2010 Fax (516)722-5093 SURVEY OF PROPERTY SITUA TED A T SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-59-01-04 SCALE 1 "=20' AUGUST 6, lg9g AREA = 8,486.06 Iq. ff. (TO TIE UNE)0,195 OC. THIS PROPERTY IS ENTIRELY LOCATED IN FLOOD ZONE AE (EL. 11) AS SHOWN ON FLOOD INSURANCE RATE MAP No. 56105C0154 G, ZONE AR: BASE FLOOD ELEVATIONS OETERMINED JANE DELYNN