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HomeMy WebLinkAboutTR-4955 Michael J. Domino, President ��zf sojyo Town Hall Annex John M. Bredemeyer III,Vice-President �� lQ 54375 Route 25 P.O. Box 1179 Glenn Goldsmith Southold, New York 11971 A. Nicholas Krupski • Q Telephone(631) 765-1892 Greg WilliamsyCou O Fax(631) 765-6641 � �m,��' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1457 Date: March 23, 2018 THIS CERTIFIES that construction of a single family dwelling 2 car garage, driveway, septic system and a 50' non-disturbed buffer area from edge of wetland area; At 8516 Main Bayview Road, Southold Suffolk County Tax Map#1000-87-5-23.10 Conforms to the application for a Trustees Permit heretofore tiled in this office Dated July 31, 1998 pursuant to which Trustees Wetland Permit#4955 Dated August 31, 1998,was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for construction of a single family dwelling 2 carag�rage, driveway, septic system and a 50' non-disturbed buffer area from edge of wetland area. The certificate is issued to Marie Jones &Kevin R. Middleton owners of the aforesaid property. Authorized Signature Michael J.Domino, President OF SUUryo Town Hall Annex John M.Bredemeyer III,Vice-President h0 lQ 54375 Route 25 P.O. Box 1179 Glenn Goldsmith Southold, New York 11971 A. Nicholas Krupski G • Q Telephone(631) 765-1892 Greg Williams ��� Fax(631) 765-6641 ycoum,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: u Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction '/2 constructed 7L Project complete, compliance inspection. INSPECTED BY: COMMENTS: 7T CERTIFICATE OF COMPLIANCE: In" cz g �� A'-���►" M � SSL G�--, � f jr�� �Y�c� 7`�� SC,TM g7 3.,1a ID) ECEIVE-I nn IjAn IUUk so meson Southold Town f Tr Board Of Southold Town Trustees k; / yJ SOUTHOLD, NEW YORK y PERMIT NO. 41 DATE: Aug. 31, 1998 ISSUED TO . ..MARIE JONES 85 KEVIN R. MIDDLETON r � ,�1utl�nri�tttinn Pursuant to the 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 .Aug.. . 26., 1998 19 98, and in consideration of the sum of $ .150...0.0 paid by Marie Jones of .... Southold . . N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, ' of Southold Town Trustees authorizes and permits the following: s Wetland Permit to construct a single family dwelling, 2 car l garage, driveway, septic system and a 50' non-disturbed buffer g. k area from edge of wetland area. i all in accordance with the detailed specifications as presented in r 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 majority of the said Board as of this date. FF0(,rt�o� .: � ' f' ' I Trustees s r Albert J. Krupski, President • James King, Vice-President Town Hall �OSUFFO(�-C'�T • Henry Smith =O OGy 53095 Main Road l P.O. Box 1179 Artie Foster y 2 Southold, New York 11971 Ken Poliwoda 0 • .j ` Telephone(516) 765-1892 WJE,( * Fax(516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 31, 1998 Marie Jones & Kevin Middleton 2390 Union Blvd. Apt. 3A Islip NY 11751 Re: SCTM #87-5-23 . 10 Dear Ms . Jones & Mr. MIddleton, The following action was taken by the Board of Town Trustees during its Regular Meeting held on August 26, 1998, regarding the above matter: WHEREAS, MARIE JONES & KEVIN MIDDLETON, applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated July 31, 1998 and, 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 August 26, 1998, 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, RESOLVED, that the Board of Trustees approves the application of MARIE JONES & KEVIN R. MIDDLETON to construct a single family dwelling, 2 car garage, driveway, and septic system, with a 50 ' non- disturbed buffer area from edge of wetland area. 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. Permit to construct and complete prosect will expire two years from the date it is signed. Fees must be p and permit issued within six months of the date of thisicable, notification. Two inspections are required and the Trustees are to be notified upon completion of said project. FEES: None Very truly oyours, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. DEC Dept. of State Bldg. Dept. ACE Dept. of Health 0 Town Hall. 53095 Main Road Telephone P.O. Box 1179 (516) 765-1801 �,�01 0� Southold. New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL The following recommendation was made at the meeting of the Southold Town Conservation Advisory Council held August 24, 1998: No. 1580 Moved by Sharon Shine, seconded by Scott Hilary, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Permit Application of KEVIN R. MIDDLETON and MARIE JONES 87-5-23.10 to construct a single family dwelling, garage, driveway and septic system. 8516 Main Bayview Road, Southold Vote of Council: Ayes: All Motion Carried M M•I 4 / .y T t•pY V. �� • .J d 4.W WI r ' ♦ tl / p � d SAO AMX ��� _ _ ® COUNTY OF --a�—w © C SUFFOLK w.r BOUTMOLD •++�+ + •n ......... Rwl Prnr•th'Tm� Swvie• AR•�. " gUFFO(,� Albert J. Krupski, President OHO COG Town Hall r�`t` y� 53095 Main Road James King, Vice-President < P.O. Box 1179 Henry Smith W Southold,New York 11971 Artie Foster Ken Poliwoda y� O\� Telephone(516) 765-18.92 Cj .1L �a Fax(516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application D D Wetland Permit Application 3 ' _Grandfather Permit Application Waiver/Amendment/Changes Received Application: TOWN OF SOL)TH"It D Received Fee: $/.r 0 Completed Application Incomplete SEQRA Classification: Type I Type II Unlisted Coordination: (date sent) CAC Referral Sent: 7- Date of Inspection: -4y - Receipt of CAC Report: D Q Lead Agency Determination: Technical Review: Public Hearing Held: - - AUG - 4 1998 Resolution: Name of Applicant G✓�O �, �(ft��c�c�(eF0 ,1 j )Y(ctr i' C _�arleS' Address_ e;U 9Lt3 n,o n 4 - LI, « 7-51 Phone Number: (S!(o (o 7 Y� Suffolk County Tax Map Number: 1000 - 7 23 . /D / r t4 Property Loeation: L r"GT�Y on 11740 cony „ eul �c d fri�•io�S �K ! Ui K l&A( /V Y Y a/c (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: FAX# : 1 Oard of Trustees Applicati• GENERAL DATA Land Area ( in square feet) : Area Zoning: e-Re5(fJe�n-6-1 Previous use of property: Vac�E L.J Intended use of property: �e �[�r real F [ ��u. � ,-F S�H�Ie �oM� ly duel4 a gece hof jjr'JMre'5 x arc O 1 . Prior permits/approvals for site improvements: Agency Date 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 explanation: Project Description (use attachments if necessary) : iZeSio� a l CtVe tLk 2 Ard of Trustees Applicatio c/ WETLAND/TRUSTEE LANDS APPLICATION DATA ( / Purpose of the proposed 'f operations: Ck l���eYvt� 1V Ctu1 ��(i ^c amino( i� eeessw 1/ Jr�T�U�S C4 I've_wt� 4 n� (3ar Qa Area of wetlands on lot: (�o square feet Percent coverage of lot: * 001 % Closest distance between nearest existing structure and upland edge of wetlands: AIA feet Closest distance between nearest proposed structure and upland edge of wetlands: 7*7 feet Does the project involvexcavatio or filling? No�� Yes If yes, how much material will be excavated? l0 cubic yards How much material will be filled? )-P2_0 cubic yards Depth of which material will be removed or deposited: al feet o� Proposed slope throughout the area of operations: MpX Serf c -Sys Manner in which material will ben removed or deposited: L'_-sci Uc� 4 V C4`- 2S ( ( c; ole�– , 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) : R6n IQ- ( 16 C res �_ 6(- We_4 Vknds 0-1 �a gG 5Cr�A.s� irc • tj rc�n-f- 6 Ca err, of (cr{ �z ao I �o The ��o�Fc"nc leo c tt w;i1 C�1me C� fFt� , 3 1r-16-A(2167)—Text 12 • • PROJECT LD. NUMBER 617.21 Appendix C SEC State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I—PROJECT INFORMATION (To be completed by Applicant or Project SDonsor( 1. APPLICANT rSPONSOR I 2. PROJEC' NAME EAMOUNT JECT LOCATION: ItisI Mun¢Ipanty J<_T1 County k C:SE LOCATION (Street address and road intersections/pro Ynt landmarks, etc., or provide reap) r � arc e� ROPJdSED ACTII�ON: t� Ne"! U Expansion L,Moaification/alteration rpe AIBE PROJECT BRIFELT: sc.,e Chi 7q( anIfr-f `J "� `UNT OF jx L.ANO AFFECTED:lly /• acres Ultimately facres �pIOPOSED ACTION COMPLYWITH EXISTING ZONING OR OTHER EXISTING (LAND USE .RESTRIC7IONS? e, Nd If No. describe briefly B. WHAT PRESENT LAND USE IN VIC:NITY OF PROJECT? rLrYResidential IJ.!ncustnal r'Commercial ❑Agr¢wture —'ParwForesVOoen space De Sc' L Otner 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE G OCALI? Yes ❑No If yes, list agency(,) and permnlaoorovals 11. DOES ANY ASPE OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑YesNo If yes, Ilse agency name and permiVapproval 12. AS A RESULT OFFIPPq OSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE .MOOIFICATION? ❑Yes 9Nd I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applican -lame:ame: �PiVIt'1 {� f r /C c//t ` C Un Dale: 67 ([� Signature: ­61� 0(__L If the action is in the Coastal Area, and you are a state acency, complete the Coastal Assessment Form before proceeding with this assessment OVER NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: Ke.nv\ SCTM#1000- YOU ARE HEREBY GIVEN NOTICE: 1 . That it is the intention of the undersigned to request a Permit from the Board of Trustees to: ,Ue a Co✓ a }ruc o � (2, 51 51 e FawIIy ckor2ihoj a,id acessory )1ruefare,5 driveway � �5ar4ge , '5 2 . That the property which is the subject of Environmental Review is located adjacent to yo proper y and is described as follows: I r1oe1.+g ,+ }Lre 9-o,�J� oy '°+ lhol FF(k 4 !J- y Y ) l �o {y o4 5 t SF o 6 o,..,dra� +- U GstriNrd a3 �oL(nw5 ; r+hr�,� yl . J 6q de �ee! 07 ena�) Lrz 4 -05iAe HFw A,•Y J,tr kd. Abi So.H, ry cl e r°e�eJ oo NeMu(t¢J rp � t?O.Co FF ! -d now e(/aa} 1♦«yI Jca-rstJ ion, b� A).-N 11 C( 1eQ,oe A'44e, ,JwV loo m r[p4tCj) d.-{'L' 6Yo 07 J -7060;(%) Ne'u''� °mssnv 2a /1a4'i r. yysavru��l}� (.•t eL bc.F bltia a,d bcgt b�.�a w 1 r�/ rrry w t < AVTs}e� e // 'P.o�e'ct which�3s siib`joqec /to Envirorunenfal4 Review`�Y�" �+pw8,f ✓pgr under Chapters 32, 37, or 97 of the Town Code is open to public comment. You may contact the Trustees Office at 765-1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: Keu�h R . Mlddl�ko� 11nQr,F ' nem MAILING ADDRESS: 23 n�o� 61od. L}pf 34 S61, `, N - 14. Im PHONE #:1516 27'7 - G'785 Enc. : Copy of sketch or plan showing proposal for your convenience. S Print or Type: ACCESS CONSENT FORM Office use Only FOR ACCESS File #: THROUGH PRIVATE PROPERTY Permit #: R nA `, olnn a'n 131A AeL38 .is l AI/ 1175-/ (Name of Applicant ) (Address) I Ipo ) s�n S}. 2 ) Sa h (Y1 a re5c c1 - Q le s CIO,` A PUL'% "31d�,a1 S(A4 4L I (Name & Address of Co tractor Involved) P4 'vYke- 1IT7.1 3 ) PYlain 2!4Jleco Roc . SbAr- d i000- 91 -o�-a3• to (Project Loc tion ) (� (S.C.T.M. ##y) 4) �Aln V, o.. �Q% i �u O� dC • a� l� -e4 -(eE� (Name of nRoa or Private Property Involved ) (H mlet ) �/ 5) IL�V�n k' 1YAj� --' a3 U•nccrn 13W - A .39- �Sl,�nl / ns-1 (Name & Address of Homeowners Association / Property Owner) 6) I S:/l``e �um ��/ �u�el�in� oi-4 Adcesscr y -s -,4c, -j (Brier Job Description) Cc►i`G arEz�� � c• S y s-le,,,,, _ V f}S S060 cca 2 CECVIV& Per M4-1 3 r4 c.1-41, 's- 7 ) Starting Date- Completion Date: 8) Estimated Cost of Proposed Work: d ol � odo 9 ) Insurance Coverage : A. The coverage required to be extended to the Property Owner: Bodily injury & Property Damage; $300,000/$500,000 Bodily Injury & $50,000 Property Damage. B. Insurance Company: C. Insurance Agent Name & Telephone # D. Policy # : E. State whether policy or certification is on file with the Trustees Office: ( If no, Provide a copy with Application ) (yes/no) Xi-- -:0-11, �4k&- - (Signature of Applicant ) (Date) ---------------------------------------------- To be completed by the Property Owner: I/We the undersigned, fully understand the nature of the Proposed Work referenced above and have no objection to allowing the Applicant to cross My/Our Property to do the work . (Signature of the Property Owner or duly authorized representative) Print or Type: TOWN OF SOUTHOLD HIGHWAY DEPARTMENT pFFCp Office use only PECONIC LANE File #: PECONIC, NEW YORK 11958 '_„ Permit #• p • � PERMIT & BOND APPLICATION FOR ACCESS THROUGH TOWN OWNED PROPERTY 1 ) Ke.0%h � . (+AA� ,'Iov\ 2393 ldnio^ glvc . 4R44SA 51to N41173-1 (Name( of Applicant ) _I (Add`esos )kLLSWn %-k 2) 30hvX PJCZreSCA - jpeDple5 ao;c� Ru��c%� eJRur31j, . 1S�t °F7 (Name & Address of Contractor` Involved) oc�� 1177 a. 3 ) Mc-x(.r\ ��cy`��w-�J �6��l 100047 (Project � Location ) (S.C.T.M. #) 4) Ina,n Q)!}4 v,e4A26CJ &lel"dd1�o1� e(c(f (Name of Riad orTown ` Property Involved) (H mlet ) 5) . 1 S�/K.IP r`�Mcl�{ �orLSTf4S-T�cnn �£ati in� {�CCESS C�S'�/ S�ru. _4 l tesr- (Brief -Job Description ) B r �} SA � 6) Starting Date: Completion Date: 7 ) Estimated Cost of Proposed Work: 8) Insurance Coverage: A. The coverage required to be extended to the Town: Bodily injury & Property Damage; $300,000/$500,000 Bodily Injury & $50,000 Property Damage B. Insurance Company: C. Insurance Agent Name & Telephone # D. Policy # : E. State whether policy or certification is on file with the Highway Department : ( If no, Provide a copy with Application ) (yes/no) (Signature of Applicant ) (Date ) ------------------------------------------------------------ To ---------------------------------------------------------- To be completed by the Superintendent of Highways : Bond Amount Required : (Signature) �UFfO(,� � �� CD Town Hall Albert J. Krupski, President �i��� r_- 53095 Main Road James King, Vice-President P.O. Box 1179 Henry Smith �1 y = Southold, New York 11971 Artie Foster a p • Ken Poliwoda Telephone (516) 765-182 Fax(516) 765-1823 BOARD OF TOWN TRUSTEES 11 TOWN OF SOUTHOLD L:MG7 E% BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- Tov�(r� F;; T,.� , In the Matter of the Application of A. ft DJb (._E7-0A) COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING 0f M I , A.01IjAk:t& residing at .2313 U,^lo„t 1,1,,x,1 34 �r6lt o W . V - W751 being d ly sworn, depose and say: r�Rrt„ti6loco-67-o6- That on the 131D ) Z day of ALlg , 199%, I personally posted the property known as i� % �oy �,rw Road k r3lnald r+y 1197! 214 +n e.s+ s,k c� J,00—, or. by placing the Board of Trustees 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 6 __-0z6 /per Da/ 02 Ad "7 ;7 ; /J/o,M ' Dated: (signature) Sworn to befo me this /3 day of d6 1998 - _ � _,.• FI. LYONS bi State of New YG* O a Y iyO•Suf[4 Count Ard of Trustees Applicatico County of Suffolk State of New York Kevin R , M , dd) tam- 4 /lgrIBEING 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 SWORN TO BEFORE ME THIS DAY OF , 19 Notary lic ANGEUNA ERUNO NOTARY FUE,IC ''`3'e of New YorIF No. 49� :.+72 Qualified in SuIJCounty Commission Expires July 22, 19 7 Ard of Trustees AppLicatice AUTHORIZATION (where the applicant is not the owner) egIyl R . M18AIe-40v-, residing at 2 39 3 (anio.� BI 0j. (print owner of property) (mailing address) Aa! 3A Ts I1 r NY W! S�do hereby authorize (Agent) to apply for permit( s) from the Southold Board of Town Trustees on my behalf. Uwne� • s signature) 8 Z M 225 fl58 • • US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse )F OF MAILING OF NOTICE Sent to ---qra.>LeS +�S :H CERTIFIED MAIL RECEIPTS Street 8 Number Address: P5� SWte,B IP Cod9 , / 11 p P 5 ed Delivery F R � N Relum R vring to M e Ji v t,d q Ralum R C Data,d esse's y l Ll % . l I 70 t / TOTAL Pa g� as f EPosbnark or Da o` LL rA a 1 STATE OF NEW YORK COUNTY OF SUFFOLK fYlo r f e. �neS residing at Z93 uA,t- n slv4, /4j4. zzr_s I'P r 1 "l� being duly sworn, deposes and says rL that on the day of ,19 , 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 Qtices were mailed at the United States Post Office at _ �1,P , that said Notices were mailed to each of said persons by (certified) (registered) mail. r7 �Sworn to Pefore me this 3 � � day of Notary ublic M WNFAW04 Wrl'lltt.01F1 beUah Y Mon Eta Ftt6ntttry�,WD 6 ANIL 1 ggenry 0mu-cin. New York State 3 ORI 1W 4 ® pig s case No 6 modes[Nn I _ T r J "I 3 INCIDENT REPORT NY rj 1 5 1 El Suoo bct_ �O y ' Floor,Day B Date 9 Nep,;•I time Or erred 10 Day I I D". 12 Time Occurred 13 Day li DAIe nff . w-"` 'A `1 1 0I w 23uL Otom. - - - I - - To15 rine—� - - - = 16 Incident Type 1r B.......NimP µ:nhl IS WPA V 19 Incident Address 3SNeet No,Street Name Bid] No act tiJ I z 10 CG1y,State.Zip([]C ❑ T ❑ VI 11 -.Caton Code 12 OFF NO. LAW SECTION SUB CL CAT DEG ATT NAME OF OFFENSE CTS tJ 110 o1 ,tum, C 1 24 NO of Suspect, 25 Person Type;CO=Complainant OT=Other P1=Person Interviewed PR=Person Reportmg IM Witness III=Not In[ervlewed VI=VlttimU�a TYPEMO NAME(LAST,FIRST,MIDDLE,TITLE) Dateof STREET NO..STREETNAME.BLD,.NO.,APO.,CITY, STATE, ZIP 26 a1R1m also complainant ❑Y❑N E Z Bi h O TNephone No. us ( t W I-� T. •J..i 1 ��.j i'F Y-' ly — C/, r /BOJ -� 'ci 3 F C. QI' D-" Qc11a. G- . . 19. ,eti12d �c -f� 1d - -1 Iljll O ,n H— N at I f 1HDate rth28 Age 19 Sp, 30 Race 31 Ethnic =Haod, 33 idence S[a[ut ❑TempRei FJre,yn Nat❑ MF ❑ White ❑ RIaC4❑Other ❑ H's an,,❑ UnM dent Tounu S[uen[ Omer U ❑Indian ❑Asian❑ Unk NOm ❑ �1❑ Hispanic muter SMiINary ❑HOmeUs❑Unk Z 34 TYpell'10 35.Name(Last.First,Middle) 36 AliaVN¢knamemaalden Name(Last,First.Middle) 31 Apparent Condition us ❑ impaired Drugs E) Mental ❑Unk Rus ❑ 1mpaImpaired!Alco ❑In,I III III ❑ AWNorm 0.w38 Address(Street No,Street Name,Bldg No.Apt No.C,ty.State.Zip) 39 Phone NO 40 Social Security No FO ❑ Home t W ❑ Work aW a1 Dateof Birth A2 age a3 Se, m,Race vt¢ ❑ M ❑ f ❑ White❑ Black 45 Ethnic 46 Skin 4T Occupation ]� ❑Other ❑ Wspanic❑ Unk. ❑ Light ❑Dark ❑ Unk M ✓ta ❑ U ❑ Indian ❑ Asian❑ Unk ❑Non-Hispanic ❑Medium ❑ower -- 48 Height 49 Weight 50 Han i1 Eyes 51 Glasser 53 Build 54 Earployer.Zcheol 55 Address z ❑ yet❑ Ccnta;ts ❑Small []Large N� N ❑ NO ❑ Medium 56 Scary Marks/Tattocs(De,cobe) 57 MHc ElSB.ViRImIX SGperty PropeIle!rty Duantltyl Makea ❑ M r r T Model Serial No. Description Value 2 ElT so a Y 59 Vehicle 64.License Plate NJ FW1 Q. Status C] 61 Stale 61 E,p v 61 Plate iypp 64 value O Part a'❑ ❑ a n V 65 Veh.Yr 66 Make 61 N+Jael 68 5[vle 69 VM S W6 10 Color(,) 71 1.-,,By ro „. a C>C -Fia-JS =7 4 o F dg cc < s Be 'cam y J ds 9❑ Pew c �s i ✓ B F- ata r a at z 3 � 13 24.Inquiries(Check all that apply) 75 NySPWMessage NJ 16 Complainant Signature p 1 ❑ DMV ❑ Wa p'Wanan[ ❑ 5colt U,, ❑Cnm.Nistory ❑Stolen Property ❑ Omer Usual se 46vb a heet 1- 1 1)ppo O i S nature( c de ) e 18 ICNc )95uperwipr'i Signature(Include Rank) BB 1D No z SIL �g� as O L Via ❑open ❑twit-y(d closed me,1W,b0cy,) ❑Unlouneeo B2 Status Dale 83 NonLed4or of ❑Nn RefusM lO Copp ❑arrest Pros Declmetl a ❑CBI ❑m+ .No Custodl ❑A„ea 1 ❑ 11 ❑Warrant Aa.ised /-� 'h ❑0 Offend”Dead 1]E.[rea Den,n TrnO..n I 2 ItyJ Pa --.,.r .1 ..-, • n 11[1111 n m,,., ,,,Is n . rn Pages FROM Kevin Middleton 40 SPNE NO. : 516 277 6785 • 05 1999 10:33AM P1 MARCH 5 , 1999 UA Re : Admendment tg Permit Number 4955 Dear Southold Toj(n Trustees Kevin Middl*on and Marie Jones are respectfully requesting a admendment to Permit Number 4955 to include a Swimming Pool the Size of 16x32. I,�; was not in our request earlier because we did nc-" Know that we should have requested it then . We are sorry for any inconvenence this may have caused you_ Thank You, 9 jPt/f { . i DEPARTNAT OF STATE • George E. Pataki Got ernor Division of W Alexander F.Treadwell Coastal Resources Secretan ofSrare 41 State Street Albany, NY 12231-0001 October 6, 1998 James W. Haggerty Chief, Eastern Permits Section U.S. Army Corps of Engineers 26 Federal Plaza, 19th Floor New York, NY 10278-0090 Re: F-98-710 U.S. Army Corps of Engineers/New York District Permit Application f/98-10790-L2 Kevin R. Middleton & Marie Jones, Corey Creek Town of Southold, Suffolk County Letter of Permission Issuance Dear Mr. Haggerty: The Department of State has reviewed the information received on October 1, 1998 describing rh;: above proposed project. Based upon the information submitted, the Department of State has no objection to the authorization of this Proposed project by Letter of Permission. No further review is required by the Department of;tat:;. We appreciate your referring this information to the Department of State for review. Sincerely, William F. Barton WFB:VAB:dlb Chief, Consistency Review and Analysis cc: DEC/Region 1 - John Pavacic Town of Southold - Albert J. Krupski, Jr. Kevin R. Middleton & Marie Jones Voice (5]S)474-6000 Fax.013)473-2461 E-mail coastal@dosata[e.nv.us w wu'.dosstate.nyus/csItIcsllwww.hEml ,,FROM Kevin Middleton PHONE NO. : 516 277 6785 • Feb. 11 1999 12:09PM P2 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER EFFECTIVE DATE 1-4738-02019/00001 February 1 1999 FACILITY/PROGRAM NUMBER(S) n T EXPIRATION DATE(S) Under the Environmental Conservation Law February 1, 2003 TYPE OF PERMIT ■ New ❑ Renewal ❑ Modification ■ Permit to Construct 0 Permit to Operate ■ Article 15, Title Si Protection ■ 6MYCRR 609: Water auelity ❑ Article 27, Title 7; 6NYCRR of tasters Certification 360: Solid Waste Management ❑ Article 15, Title 15: Water ❑ Article 17, Titles 7, 81 SPDES ❑ Article 27, Title 9; 6NYCRR SuppLy 13 Article 19: Air Pollution 373: Hazardous Waste Management 0 Article 15, Title 15: Water Control ❑ Article 36: Coastal Erosion Transport 11 Article Artieto 23, Title 27: Mined ❑ Article 15, Title 15: Lay Land Reclamation ❑ Article 36: floodplain Island Wells Management ❑ Article 24: Freshwater Wetlands 0 Article 15, Title 27: Wild, ❑ Articles 1, 3, 17, 19, 27, 37; Scenic and Recreational Rivers ■ Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control PERMIT ISSUED TO TELEPHONE NUMBER Kevin Middleton and Marie Jones (516) 277-6785 ADDRESS OF PERMITTEE 2393 Union Blvd. t. 3A Istip, NY 11751 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER MANE AND ADDRESS OF PROJECT/FACILITY Middleton B Jones property, Main Bayview Road, Southold, NY 11971 LOCATION OF PROJECT/FACILITY SCYM 51000-97-05-23-1 COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold Corey Creek DESCRIPTION OF AUTHORIZED ACTIVITY: Construct a single family dwelling with associated sanitary system, deck, driveway, pool and catwalk, ramp and float. ALL work shall be done in accordance to plans stamped NYSOEC approved. BY acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all appLieable regulations, the Gsneral Conditions specified (see page 2 i 3) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS Mark C. Carrara CKw aide- 560, SUNT, Stay Break, NY 11790-2356 Page 1 of c AUTHORIZED SIGNATURE DATE February 2, 1999 PART II—ENVIRONMENTAL AS SMENT (To be completed by Agency) A. GOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, °AFT 617.12? It yes, coordmate the review croces3 and use the FULL E)A.F. ❑Yes ❑NO e. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR. PART 9:7.67 If No, a negative deblaratic may ce superseded by another Involved agency. ❑Yes ❑No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, it legible? Ct. Existing air quality, surface or groundwater quality or quantity, noise levels, existing !raffic patterns, solid waste production or discos, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological,historic, or other natural Or cultural resources;or Community Or neignbornood character? Explain brie C3. Vegetation or fauna, fish, shellfish or wildlife species- significant habitats, or threatened or endangered species? Explain orlelly: C4. A community's existing plans or goals as officially adopted.or a change in use or intensity of use of land or other natural resources?Explain brei C5. Growth, subsequent development.or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, snort term,cumulative.or other effects not Identified in CI-057 Explain briefly. „7. Other impacts(including changes m use of either quantity or type of energy)? Explain briefly. 0. IS THERE. OR IS1�T�+IERE LIKELY TO BE.CONTROVERSY RELATE) 70 POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? 'J Yes IL.Iwo If Yes. explain briefly PART III—DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For eacn adverse effect idem)fled above,determine whether it is substantial,large.important or otherwise signi ficz Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occafill (c) duration; irreversibility: (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure If explanations 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 MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. - ❑ 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 in�gny significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: V"niC ni Li'l) Ayen[V Trml m 10e game of Kprponsrole Juicer .n Lean -xency lion or ifeeoon,.we On¢er S,.' lure 6' Keso6ntio1e JI[.Cer ,n Leeq AgvncY )q(nalulp a! Irrp U-iler(If tlJierenr ir6m res06n Loip olr¢pq DJiC 2 . ' nn • DEPARTMENT OF THE ARMY � � � � � u r _ --� D In NEW YORK DISTRICT, CORPS OF ENGINEERS ns O� _ J JACOB K.JAVITS FEDERAL BUILDING I_I I NEW YORK, N.Y. 10278-0090 September 30 , 1998 REPLY TO ATTENTION OF Eastern Permits Section SUBJECT: Application Number 98-10790-L2 by Kevin R. Middleton and Marie Jones To Whom It May Concern: The New York District , U. S . Army Corps of Engineers, has received a request for Department of the Army authorization for the following activity: APPLICANT: Kevin R. Middleton and Marie Jones 2393 Union Blvd. Apt . 3A Islip, NY 11751 ACTIVITY: Construct a 4 foot by 24 foot fixed pier, elevated a minimum of four feet above the grade of the marsh, a 2 . 5 foot by 16 foot walk-ramp, and a 6 foot by 20 foot float secured to two 2-pile dolphins . The purpose of this project is to provide mooring facility for the applicants' vessel (s) . WATERWAY: Corey Creek, Little Peconic Bay LOCATION: Town of Southold, Suffolk County, New York As this is minor in nature, authorization may be by Letter of Permission. This is in accordance with current Federal Regulations governing work in navigable waters of theUnittedhe States . To accomplish the coordination required,ew priothe enclosed issuance of a Letter of Permission, y drawings is requested. Pursuant to Section 307 (c) of the Coastal Zone Management Act of 1972 as amended (16 U.S .C. 1465 (c) (3) (A) ) , the app licant has certified that the activity complies with and will be conducted in a manner that is consistent with the approved state coastal zone management program. To allow for the timely processing of the subject application, your comments are requested within 15 days of the date of this letter. Sincerely, a es W. Haggerty C ief , Eastern Permits Section Enclosures ® DEPARTMENT OF STATE George E. Pataki Division of ' Gmet w Coastal Resources Alexander F.Treadwell 41 State Street SecretatN of Stat`' Albany, NY 12231-0001 I . September 21, 1998 199P TOWN OF lo�g!T : . Albert J. Krupski, Jr. Trustee, Town of Southold 53095 Main Street P.O. Box 1179 Southold, NY 11971 Re: F-98-710 U.S. Army Corps of Engineers/New York District Permit Application - Kevin R. Middleton & Marie Jones, Corey Creek Dear Mr. Krupski: Enclosed is a copy of the information submitted to the Department of State for review of the above-referenced project with respect to its consistency with the Coastal Management Program for your information and preliminary review. Please contact Vance A. Barr, the DOS reviewer assigned to this project, at (518) 474-6000 to discuss your concerns, and any additional information which may be necessary to assist you in reviewing this project. Any comments you may have will assist the Department in reaching a decision as to the consistency of the proposed action with the approved NYS Coastal Management Program. We would appreciate hearing from you on this proposed project by October 21, 1998. If we do not hear from you by that date, we will presume that you have no objections to the proposed project. Sincere &tK4 7 William F. Barton Chief, Consistency Review and Analysis Fnclosures WFB:dlb oN,474-6000 Fay:iilhi 4'3-'_464 Gmdd d,n mte.m'it, dox.�mte.m.u./e+dtc.tlu a 1.hnnl NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: Keviv\- + Mae Toh rc S SCTM#1000- 0pt7— YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: Djew CoAaf✓UCfto, o c.' Stople Faw +ly d� Elll�q o � d gcessory O}rac }ures dr�vew� 2 . That the property which is the subject of Environmental Review is located adjacent to yo r proper�y and is described as follows: Iy'� Y bele ,� {-U a q-o,J,n o c5°K y/ � f �,mc cm�.,+1 o� a �r.1 k � sckte a� N. Y Ueseriwrd as Xodow5. ;..nw\�� J°J+1�. 6 ' S0.46ei y t,44 �e4j�edA. ej 107 Hca+Fea e+a Hr 1a2 .� ais . -Iy Jim Haw b'.y uie.J IE'd. AI;hP Soa1M /U �I ty reel of N�NuFeJ �/tp�-, 13D.eo f� l.va� nrw ���ol 3c�ur+cJ ia� afJU\ N :+-ti 77d rteloa .«i"kterWedF 1mc n¢ a i JOO PF�(3) Nm'J*+ f ye•Fc1l* aP ° e.w4 /la�'�' -h• SOUfs U. h = �eSp3Yojesct wh`ichts ..efb1 13m(aK mt-E-o hcE.fnvbiaJri onrmseo,nA tbaclt4rReview 'ev1n)iwe.Jw•-�`'4�-YeGvi`Poyt wr0 nder or �:y�NG�✓,� ' Chapters 32, 37, or 97 of the Town Code is open to public �• ' comment. You may contact the Trustees office at 765-1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: J(e\3kh (ruciF --7�r1C� MAILING ADDRESS: 23 Bio ald. A ,j 34 i175 PHONEv#: Sib 29 r7 - C 215 Enc. : Copy of sketch or plan showing proposal for your convenience. s Print or Type : ACCESS CONSENT FORM Office use only FOR ACCESS File #: THROUGH PRIVATE PROPERTY Permit #: a773 Lk&7LLW1 21LAI (Name of Applicant ) (Address) foo us�in S}. 2 ) Sb�,n Maresca - c�les CL" Aysk�n APrzA 3��.,1 sw4 1 (Name & Address of Co tractor Involved' ) t)v� ' 1. 1(77 a- 3) 3) ryAal n 2% 0IP�: ROC�1 � �l ON 1000 97 (Project Loc tion ) (S.C.T.M. #) 4) Mr��n �! V i buIU1G� d l O�eV C f`ee,� (Name of Road or Private Property Involved) (H mlet ) 5 ) K--WA iL m AJtc- c,, a3 CtA,0v, '20-d 3k 'L5 d7s-1 (Name & Address of Homeowners Association / Property Owner) s) s;.1�`e 'i�Lrm<< y )ue-t(Zn5 amp /�crcess�ry S� ru acr (Brier Job Description) '— 7 ) Starting Dates boon a� CCCei✓(' P@3 rMrf✓ ,✓1c.7-4L.J Completion Date: 8) Estimated Cost of Proposed Work: 9 ) Insurance Coverage : A. The coverage required to be extended to the Property Owner: Bodily injury & Property Damage; $300,000/$500,000 Bodily Injury & $50,000 Property Damage . B. Insurance Company: C. Insurance Agent Name & Telephone # D. Policy # : E. State whether policy or certification is on file with the Trustees Office: ( If no, Provide a copy with Application) (yes/no) --- -X A ------- (Signature of Applicant ) (Date) ------------------- To be completed by the Property Owner: I/We the undersigned, fully understand the nature of the Proposed Work referenced above and have no objection to allowing the Applicant to cross My/Our Property to do the work. (Signature of the Property Owner or duly authorized representative) Print or Type: TOWN OF SOUTHOLD HIGHWAY DEPARTMENT Office use only PECONIC LANE File #: PECONIC, NEW YORK 11958 Permit #: o PERMIT & BOND APPLICATION :061 ��4! FOR ACCESS THROUGH TOWN OWNED PROPERTY 1 ) ,Seu%v\ MJAIAov�, 2393 ldhio^ 61vd• 4p443A alto IJV 11751 (Name of Applicant ) (Add`eso ),t,,, +1 z ) J°��l mgresel4 - 1QPpples &o;ce Quslc� ,plaza 31d�. ;)- 7 (Name & Address of Contract_orl Involved) asu�,nt • , 11�7ot 3 ) WLG (\ �dr�lytetiJ 26�%�l 1000-97 - os- 9-3. iD (Projec(t� Location) (S.C.T.M. #) M 4) Lo"(1 (Name of R ad or Town Property Involved) (H mlet ) f 5 ) IS� I, l onsT�vsri�� �(Eu 4n� {{cCeSsc*sY S Y�ctt�mS (Brief -Job Brief Job Description ) pl f� ue c.J A-�l C1a✓�4���c S�s'�,.2� _ 4 � J 3 6) Starting Date: Completion Date : 7 ) Estimated Cost of Proposed Work: 8) Insurance Coverage: A. The coverage required to be extended to the Town: Bodily injury & Property Damage; $300,000/$500,000 Bodily Injury & $50,000 Property Damage B. Insurance Company: C. Insurance Agent Name & Telephone # D. Policy # : E. State whether policy or certification is on file with the Highway Department : ( If no, Provide a copy with Application ) (yes/no) (Signature of Applicant ) (Date ) ------------------------------------------------------------ To be completed by the Superintendent of Highways : Bond Amount Required: (Signature) Albert J. Krupski, President Town Hall y Oy James King, Vice-President 53095 Main Road 41 � tq' P.O.Box 1179 Henry Smith `y y Z tt Artie Foster O Southold, New York 11971 4 � Ken Poliwoday� O� Telephone(516) 765-1892 Fax(516) 765-1823 _�"�-�zzrcr6�fi p R 2 R 9 W C BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD T 19% i p BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- �. In the Matter of the Application 701AI w OF ST_'TP�° of — -. D�L ETDA) COUNTY OF SUFFOLK) STATE OF NEW YORK) `� AFFIDAVIT OF POSTING IU HIDA1 JL"7residing at3 393 C1 oto yin R- `l S being duly sworn, depose and say: 13.10 That on the JZ day of A491 1998, I personally posted the Tac MaPA-Iow-6`j-Oy- property known as �lutn buy „ , Rood PSp l Id Ny 11971 214 +e east Sk c( d,L4on-, or. by placing the Board of Trustees 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 A K . 02( /yipf Qd 02 A"A47 7 : i� Dated: (signature) Sworn to befor�q me this /3 day of / UG' 199&9 �N H. LYONS o dry Public State of New YGA :.'y�,SUtfO�t{(t County C��L�G Ard of Trustees Applicatis County of Suffolk State of New York �\evk vl k • M l d d' k� -. "} n art T� h e 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 ��- SWORN TO BEFORE ME THIS DAY OF , 19 Notary lic ANGETINA BRUNO NOTARY FUc!JC ''a'e of New Yoh No. 49 1,192 Qualified in Sui,olk County Commission Expires Juiy 22, 19 7 Ord of Trustees Applicatico AUTHORIZATION (where the applicant is not the owner) I, begin R �A1881e-40v�- residing at 2 39 3 (jnion glad. (print owner of property) (mailing address) Aer 3A 1'7 S do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. %uwne� , s signature) 8 i Z 0 225 258 • • US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail as reverse )F OF MAILING OF NOTICE Sent to --3a.t1PS �� ��$ :H CERTIFIED MAIL RECEIPTS Street&Number L` �` h0` - W • Address: Post Otli State,8 IP Cod§ 5I O da� M $ l 1 9 7 Delivery PAe" R � Rehom m R vdng to (�' (_ QRealm RA li /0 `� 1J��4i t n�=�i� 1— Date,8 's T C0 TOTAL P qd s l� % 76 EoaPknark or Da t !(( o` LL A 87- 5 - 23 2 83 l � ,� ��y � sou o ^� �• I( q 71 STATE OF NEW YORK COUNTY OF SUFFOLK q Mar Ie_ �oneS , residing at Zcl3 LU1�m ��v�(� slrPr n1 Y' IIS-1 being duly sworn, deposes and says that on the day of , 19 , 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 gtices were mailed at the United States Post Office at J , that said Notices were mailed to each of said persons by (certified) (registered) mail. l � Sworn to 13efore me this day of , 19 — Notary ublic MWEVAMM 1lM� Yat Owilo�n 6�Yw r�wrr�.t1N 6 1 agency inn'P'pt'n, New York State I ORI a Or. 5 Case NJ s o I T `5t,3 INCIDENT REPORT NY Lj 5� � 9 6 In;.dr°`r"' I , SuPP L'U - ✓L)5, ' Repdn Day B Gate 9 ReF•tn 1.mx Occurred 10 Day 11 Garr 1 OnrFrom - 11 Dine Occurred I) Gay r° Date 15 f.me I� w l3uL, I _ _ To 15 _ _ _ k_ 16 Inadent3yM n guy smlm= 2 18 weapcnls) o �.:•..�..> C-v rl.>_ L,1 1 c1 l-A+r p,.t a V 19 ndent Address(Sbeer N0,5treermame ad, 20 Gty,State,Zip(❑C ❑ r El ZI Location CM 21.OfF.NO. LAW SECTION SOB CL CAi DEG qR - -- NAME OF OFFENSE CTS 23 NO pl o.cum, 1 C _ 2 7 24. No.Of Suspects / 25 Person Type:CO=Complainant Or:Other PI=Person Interviewed PR=Pelson Reporting WI=Witness NI=Not Intervlevyl VI=Victim [, N iVPEMO NAME(LAST,F3R5T,MIDDLE,TITLE) Date of STREETNO..STREETNAME,BLDO.NO..gPT.NO.,CITY, STATE, Z1P Z6 v,aim also compla.nam QYQN = Birth O Telephone No. Ise 1 I LL � �'+'�r, d NL 11ct71 O _ h m,a —roti — c k ,,,,a,.` f _n ` ( d 6 O us V1 H- 27 — 22 Date of Birth 28 Age 29 Se, 30 Race ' 31 Ethnic Hispa ❑ M ❑ F ❑ Wnrte❑ Black Q Other Q Hispanic 32 He,d.caO Re 3❑) Rescent'S❑ta TO Qipmp Res Other Nal U ❑Indian CO]Asian Q Unk Q Non�Hispa❑nicUnk ❑No ❑Commenter❑Mdrtary❑QPHomeres,,[:)Unk I°TYPe:NO 35 Name(Last First.Middle) Z 36 Abi VNicknamMm e, aen Name(Last.First.Middle) 32 Apparent Vy Q lmpaImpairedead DrugsDrugs ❑ Mental Dis E]Unk kote K ❑ ImpairM 4qo F1Inl/111 Q app Norm -- W 38 Address(street No.Street Name.Bldg No. No City.State.Zip) fi 39 PHOne No �0 ❑ Home 40 social Security No ❑ Work dWy, 41 Dace Of Birth 42 Age 43 Sea a4.Race W � 45.Ethnic qfi fillip ❑ Hisa ❑ Unk ❑ El Q Unk❑ M ❑ F White 81-1f, ❑ower m Occupation r,Q Indian Asian❑ UnkQ Non-Hppamc QVed,um M Q O[M1er -- 48 Height a9 Weyht 50 Hall 51 Eyes 52 Glasses 53 Biala S4 Emplo—,,,nod Z ❑ yes❑ Contain Q Small C]Large a 55 Address ,r j C] No Q Medium N, 56 Scarst Marks Rattoos(Descnpe) 52 Msc 58.ViRlmM Property Property Quanthyl MakeEsf�No. M Status i W9asure Or T Model Serial No. Description ❑ Valu! 2 ------------------------ w El w59 vehicle 60 License elate No ❑ OStatus FuoQ 61 State 62 Elp Y, 63 Plate Type 6a Value ° Partial o ❑ a V 65 Ven.Yr. 66 Mase 6y MWei 66 Style 5 F 69 VIN ❑ W 6 10 COIOr(5) 11 r OwF9 Ry _ 22 Vehicle Notes ❑ FO / 13. n ItJ e5S Or ❑ 1/o Lg 416.,j, =� 6%e T C ✓ ❑ JL'c�i rJ qs- 9 o ✓ ii. o I_ 4T s r... ❑ K - - r�,. Q Z I 13 24 Inquiries(Check all that apply) 25 NYS➢IN Massa eNo ❑ DMVHn[or ❑ Want/Warrant Q Scofilae 9 26 Complainant Signature .r-__ _._ .-'_ R Q ❑ y ❑ Stolen Property Q oma. ---""�-- Y 2 MD s natmel c ex use cover N 1 c o r8 a 29 Super,io,%S.gnamre(Include Rana) 801D No emelt 81 status ❑open ❑FO{ed(n CIpod meck LV r below Qma Retuned to CoopDec ) ❑IlnfountlpA 82 Status Date 83 NonfiedrtOr of Q QA.rxv Qwl,nc,r bed ❑War,ant ae.bed 12 I'„) ❑cei Qlu+ No c�stod. ❑Anew-,�, ❑Dripnaer Dead ❑E.traa Genn �ndrrn iG Pagn .. .,...,. . nncmrc Hoc n..,.. ,., c ,• , �o.n,� n. .�...,,.r. �., ,i . s.np..nr,-�,.�,.,. ,,,. FROM Kevin Middleton WE NO. : 516 277 6765 • 05 1999 10:33AM Pi IIARCH 5 , 1999 %619 _ MW P.e : Admendment tp Permit Number 4955 Dear Southold T p Trustees Kevin Middl��tt on and Marie Jones are respectfully requesting a admendment to rmit Number 4955 to include a Swimming Pool the Size of 16x32. I was not in our request earlier because we did noi' Know that we shopld have requested it then. We are sorry for any inconvenence this may have caused you. Thank You, f i t DEPARTAT T OF STATE • George E. Pataki Governor Division of Alexander E Treadwell Coastal Resources - Secrerun�•ofSrure 41 State Street Albany,NY 12231-0001 October 6, 1998 James W. Haggerty Chief, Eastern Permits Section U.S. Army Corps of Engineers 26 Federal Plaza, 19th Floor New York, NY 10278-0090 Re: F-98-710 U.S. Army Corps of Engineers/New York District ♦}.Anil Application 1198-10790-L2 Kevin R. Middleton & Marie Jones, Corey Creek Town of Southold, Suffolk County Letter of Permission lssttance Dear Mr. Haggerty: The Department of State has reviewed the information received on October 1, 1998 describing be abovr. proposed project. Based upon the information submitted, the Department of State has no objection to the authorization of this Proposed project by Letter of Permission. No further review is required by the Department of.^,tate. We appreciate your referring this information to the Department of State for review. Sincerely, William F. Barton WFB:VAB:dlb Chief, Consistency Review and Analysis cc: DEC/Region I -John Pavacic Town of Southold - Albert J. Krupski, Jr. Kevin R. Middleton & Marie Jones Voice.(518)471-6000 Fax:15131473-2464 E- mail coutal@dusstate.ny.us wwl-dos.siale.ny.us/csti/esliwwwht[nI ,FROM Kevin Middleton + PHONE NO. : 516 277 6785 • Feb. 11 1999 12:09PM P2 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBEREFFECTIVE DATE 1-4731-02019/00001 Februer 1 1999 FACILITY/PROGRAM NUMBER($) n M T KPI RATION DATES) Under the Environmental Conservation Lw February 1, 2003 TYPE OF PERMIT ■ New ❑ Renewal ❑ Modification ■ Permit to Construct ❑ Permit to Operate ■ Article 15, Title 5m Protection ■ 6NYCRR 605: Water Quality, ❑ Article 27, Title 7: 6NYCRR of Waters Cart if feat i on 360: Solid Waste Management ❑ Article 1S, Title 15: Water ❑ Article 17, Titlam 7, 8: SPDES ❑ Article 27, Title 9. 6MYCRR fly El Article 19: Air Pollution 373: Hazardous Waste Management O Article 15, Title 1S: Water Control ❑ Article 34: Coastal Erosion Transport Management ❑ Artielo 23, Title 27: Mined O Article 15, Title 15: Lona Land Reclamation ❑ Article 36: Floodplain Island Wells 13 Article Article 24: freshwater Wetlands O Article 15, Title 27: Wild, ❑ Articles 1, 3, 17, 19, 27, 37: Scenic and Recreational Rivers ■ Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control PERMIT ISSUED TO TELEPHONE NUMBER Kevin Middleton and Marie Jones (516) 277-6785 ADDRESS OF PERMITTEE 2393 Union Blvd. t. 3A Islip, NY 11751 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER NAME AND ADDRESS OF PROJECT/FACILITY Middleton 8 Jones property, Main Sayview Road Southold, NY 11971 LOCATION OF PROJECT/FACILITY SCTM iMOOD-87-DS-23.1 COUNTY TOWN WATERCOURSE MYTH COORDINATES Suffolk Southold Carey Creek DESCRIPTION OF AIITSORIZBD ACTIVITY: Construct a single family dwelling With associated sanitary system, deck, driveway, pool and catwalk, ramp and float. ALL work shall be done in accordance to plans stasped NYSDEC approved- BY acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified (see page 2 i 3) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS Mark C. Carrara CKM Aldo- *&0, SW1T, story swede, NY 11790-2356 AUTHORIZED SIGNATURE DATE February 2. 1999 Page 1 of < APPLICANT TRANSACTIONAL DISCLOSURE FORM The Town of Southold' s Code oP Ethics rohibits conflicts of interest on the part of town off cera and employees . The purpose of this form is to provide information which can alert the town of Possible conflicts of interest and allow it to take whatever action is necessary to avo d same. YOUR NAME: Mi on I L& ym ' Last name, f ret namt, middle snit al, un ess you are applying in the name of someone else or other entity, such as a company. If so, indicate the other person 's or company ' s name. ) NATURE OF APPLICATIONt (Check all that apply. ) Tax grievance Variance Change of zone App PMal of plat Exe ption from plat or official map Other (If "Other, " name the activity. ) Do you personally (or through your company, "pons*, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "nusiness 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 the town officer or employee owns more than 5% of the shares. YES No if you answered "TES, ". complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself ( the applicant) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply) i A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation) ) B) the legal or bbnoricial owner of any interest in a noncorporate entity (when the applicant in not a corporation) ; C) an officer, director, partner, or employee of the applicantt or D) the actual applicant . DESCRIPTION OF RELATIONSIttP Submitted thin ' .. . . ...day of.: 199_ signatuta_ Print name .'i,';J: 'j5h.l:id'Ar:�"c.�.:dk•2 i �"..iD�51Nar.'• .'e ,b/ w �J�• \ \ O s \ \ '40 r N rye. ? 0 c /a./ O 490 y a pp�� � ;. �1Z � a � ��. �� •. sa . a 'k J �a 6 E �/ b ) y TEST HOLE w/ i¢e G + lfl p \ TEST HOLE f 2 DW* Mow �'Pv1 ry ` O 0 so* Mae aL s4bj. / lL 0 bro% f, Blom r N`P),00�- I `\ Asear SAi 3ir ova saw r 4.4 grow dqW fw VACANT do' >aa a Brew SN7 3.3' 3.8 Am /�. / 40 'send Wdar 6 Mw o 7�.4 / Pah Mown 6 N%el sand SC 20 c - v,i . .' _ ✓.•i-r AND''rte/r /q coria saw 8. NOTE, Ge REMOVE ALL A&PERVIOIIS SOL BELOW L 3' Wo/aihpale Waler N brown NOTE, LEACHNG P S BA brow nap {he to meaesn W/SAAV 3 aRA VEL saw sand SP LOT MAIIBER REFER TO 'ANVOR SUBDIVISION' MADE FOR JAMES W. DAWSON I3' 1 14' o nn,r.!,ecc �racee, e�%o I an fam lbr with the STANDARDS FOR APPROVAL [raw' AND CONSTRUCTION OF SUBSURFACE SEWAGE r o00 T DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES !E''3 �"''� .9a /£ lot JE ar' C.P(cNlel� 2' and wX abide by the condlflons set forth therein and on the el Q E rnnk , . 3'- permit to construct. _ Cir. wQt= GRADING PLAN (hi9He=r e>,pxtoc,.) FLOOD ZONE LINES FROM FPAI '2 ` = P/aP con fou/- 'F4W36103C0/66 G MAY 4, /agAVAILABLE _ prop �'eV SURVEY OF PROPERTY FLQpD NSIXlAMCE NOT AVAA ABLE F teEw cObISTRt/CTAT AT - COASTAL BARKER NO SLISSLWACE SEWAGE DISPOSAL BA YVIEW ELEVATIONS ARE REFERENCED SYSTEM DESOV TO N.G.V.D. BY, JOSEPHFX"TTI, P.E TOWN OF SOUTHOLD SOUTHOLD,N.Y. 11971 SUFFOLK COUNT Y r NY The locations of wells and cesspools (516) 765 2954 Wo - 87 - 05 - 23.10 shown hereon are from field observations SCALE I" = 40' and or from data obtained from others. to Y 19, 1998 AhVE 24 1998( TOB) ASK Y 15, 1998(prop. hse &pool) AREA = 1. 113 acres t0 te9 6►1e Aug. 14, 1998 ( revisions ) Sept. 1, 1998 ( test hole #2 J Jan. 25, 1999 (additions) ANY AL TERATAON OR ADDITION TO THUS SURVEY IS A VIOLATION Mar. 3 99 (revised FN?M1 OF SECTION 7209 OF THE AEW TOM( STA TE EDUCATION LAW EXCEPT AS PER SECTION 7209-SLMNMVISM 2 ALL CERTFICA�IONS M91FON ARE VALID FOR TMS ANP AAD COPES THEREOF ONLY F { Sao MAP DR COPES BEAR TAE AIPRESSED SEAL DF THE suWVEroR R (2 a (1� ]� L� O.P� .Y.S. LIC. NO. 49618 IWnOSE SIRVATLRE APPEARS AERE0ACA0OF l5 l5 U MUST USE BYCANYY AAV ALL SSL#?VErORS t ATERM OAL�By, D �( 6) �` 20* P.C. OF A/NOT/ER SURVEYORS ANP. TERMS SUCH AS YVSPECTED'aro _ 3 P O. 9 '9W0(KNT-TO-DATE'ARE NOT,N COWLIAACE WTH TIE LAW. O 1 REE OLPI'S 11971