HomeMy WebLinkAboutTR-5706
TERMS and CONDmONS
The Pe<mittee
J&C Holdings LP
residing at P.O. Box 1925. Southald N. y~ as
pan of the consideration for the isSuance of the Petmit does UødeøWId and prescribe to the fol-
lowing:
1. That the said Board of Trustees and the Town 01 Soutbold are released from Ilrf and
aU damages, or claims for damages, of suits arisiøg cIirecdy oe indirec:dy as a result of Ilrf oper-
ation performed poinumt to this pem>it, and the aid p"n.;('~ wi11, at his at her own expeosc,
delead Ilrf and aU such IUÍI$ "/nI<Ioted by third patties, and the said 1'<.. ...iu.e "_ full JiobI1/ty
with respect thereto, to the complete exclusion of the Board of Trustees of the Town of ~
2. That this Petmit is valid for .. period of 24 mos. wbi<h is COtISid:red to be the
estimated time required In complete the wodc iowMd, but shoald dtcumstaoces war:nøt, request
for ao extension may be made to the Board at a laœr dale.
3. That this Permit should be retained indefioite1y, or as long as the said Permittee wishes
to maintain the structure or project involved, to provide evidence to anyooe concerned that auth·
orization was originally obtained.
4. That the work iowlved will be subject to the inspectioa and apptoval of the Board or
lis agents, aod OO<1-compIiance with the provisions 01 the otiginatiog app1i<ation, may be cause foe
revocation of this Permit by resolution of the said Board.
S. That there will be no unreasooable interference with navigatioo as I result of the wad:
herein aUthorized.
6. That there shan be no interference with the right of the public In pass and tepass aloag
the beach between high and low water marks.
7. That if future operatioos of the Town of Soutbold require the ftØ1O\'aI and/or a1œntions
in the location of the _de herein authorized, or H. in the opioioo of the BoaI:d of Trustees, the
work shall cause unte2SOOOble obsttucUoo to free navigation, the said Peaaittee will be required,
upon due noúœ, to remove or alter this _de or project herein stated witbouc upeases to the Town
of Southold.
8. That the said Board will be notified by the Petmittee Ot the comp1cdoa of the wad: auth·
orized.
9. That the Permittee win obtain an other permits and coaseø.lS that may be required IIlp-
plemental to this permit whiA:h may be subject to revoke upon failure to obtain woe.
.
.
,
Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggv A. Dickerson
Town Hall
53095 Route 25
P.O. Box 11 í9
Southold. New York 119íl-0959
Telephone l6311 í65-1892
Fax(631)í65-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTH OLD
TO:
Building Dept.
FROM:
Board of Trustees
DATE:
February 15. 2005
J&C Holdings LP
19625 Soundview Ave., Southold
SCTM#51-1-22.2
RE:
With regard to the above-referenced property. please be advised that the Board of
Trustees will require a final inspection before issuance of a Certificate of Occupancy.
Thank you for your cooperation.
.
.
Albert J. Krupski. President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095 Route 25
P,O. Box 11 í9
Southold. New York 119íl-0959
Telephone (631J í65-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
February 15, 2005
Mr. John Hurtado
J & C Holdings LP
P.O, Box 1925
Southold. NY 11971
RE: 19625 SOUNDVIEW AVE., SOUTHOLD
SCTM#51-1-22.2
Dear Mr. Hurtado:
The Southold Town Board of Trustees reviewed the survey prepared by Michael James
Hillebrand last dated January 21, 2004 and determined the proposed demolition of the
existing dwelling and construction of a new single-family dwelling 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 Udal wetland jurisdictional
boundary and the coastal erosion hazard area and your project or erecting a temporary
fence. barrier, or hay bale berm 100' from the wetlands, as depicted on the survey. In
addition, drywells and gutters must be installed in order to contain the roof run-off.
However. any activity within 100' of a Wetland line or seaward of the Coastal Erosion
Hazard Area would require permits from this office.
.
.
2
A final inspection is required. Please notify the office when the project is complete.
This determination is not a determination from any other agency.
If you have any further questions. please do not hesitate to call.
Sincerely.
.. ¡j,
¡£tIH. -t- ? ;!/k.~
Albert J. Krupski. Jr.. President
Board of Trustees
(þ
AJK:lms
1-
Albert J. Krupski. President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
.
To\Yn Hal!
. 53095 Route 25
P.O. Box 11 í9
Southold, New York 119íl-0959
Telephone i63!) í65-1892
Faxi631)í65-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES
72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN
APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO
SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE
PERMIT.
-::!" , . c 1--1-.. I 11 -. "-~ S
INSPECTION SCHEDULE
/ ~\,'>\<o.:;- 'i-~-~;"
~ Pre-construction. hay bale line C \<-- \S
1S1 day of construction
Y:. constructed
-./ Project complete, compliance inspection. Óíl\IJ...>Q\V;'. '\ qu.--I,-t {í..:;
~~ç.t
.
.
Albert J. Krupski. President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095 Route 25
P.O. Box 11 í9
Southold. New York 119íl-0959
Telephone (631) í65-1892
Fax(631ì í65-1366
Febmary 26, 2003
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Mr. John Hurtado
J & C Holdings LP
P.O. Box 1925
Southold, NY I 1971
RE: 19625 SOUNDVIEW AVE., SOUTHOLD
SCTM#51-1-22.2
Dear Mr. Hurtado:
The Board of Town Tmstees took the following action during its regular meeting held on
Wednesday, Febmary 26,2003 regarding the above matter:
Vv'HEREAS. J & C HOLDINGS LP applied to the Southold Town Tmstees for a permit under
the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of
Southold, application dated January 23, 2003, 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 Tmstees with respect to said application on
Febmary 26, 2003, 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 cansidered all the testimony and documentation submitted
concerning this application, and,
WHEREAS, the stmcture complies with the standards set forth in Chapter 97 of the Southold
Town Code,
WHEREAS, the Board has deternlined that the project as proposed will not affect the health,
safety and general welfare of the people of the town,
2
.
.
NOW THEREFORE BE IT,
RESOLVED, that the Board of Trustees approve the application of J & C HOLDINGS LP to
add a 39.8' X 33' addition to the existing 20.4'X 26.4' residence, with the condition that
drywells and gutters are installed to contain the roof run-off, and as depicted on the approved
plan dated July 27,2002 and last revised March 3, 2003.
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 project will expire two years from the date the permit is signed.
Fees must be paid, if applicable, and permit issued within six months of the date of this
notification.
Inspections are required at a fee of$5.00 per inspection. (See attached schedule.)
Fees: $5.00
Very tru I y yo urs,
a.t.' ,--'-"I 17 /.1, tJ. C.
/' /G!.., _¡' vf:.. I~"
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/lms
Albert J. Krupski. President
James King, Vice· President
Henry Smith
Artie Foster
Ken Poliwoda
.
.
Town Hall
53095 Main Road
P.O. Box 11 í9
SouthoJd. New York 119íl
Telephone (516) í65-1892
Fax (516) í65-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
TO : _\ "+ C. bIc.ì let ( (l ~/) ,,,--p
Please be advised that your application, dated / / J..3jö3
has been reviewed by this Board, at the regular meeting of
d. I ri./(JI03 and the following action was taken:
.
(~ Application Approved (see below)
(____) Application Denied
(____) Application Tabled
(see below)
(see below)
If your application is approved as noted abo~e, a permit fee is
now due. Make check or money order payable to the Southold Town
Trustees. The fee is computed below according to the schedule
of rates as set forth in the instruction sheet.
The following fee must be paid within 90 days or re-application
fees will be necessary.
COMPUTATION OF PERMIT FEES:
o --1T SJ)O (Mft'cti.R:.' J}ß9--
@ fvUJ....D.l'd .JJ.u.u.J,Uj 10 (n (LudJL- ~ LL (Û;¡,a.J q. d./Lli W<'U./LI.
TOTAL FEES DUE: $ 5, (JD
tlttc.·1 ~ 1&. ~....I.: n,
SIGNED: y. ~
PRESIDENT, BOARD OF TRUSTEES
BY: ~auvn J-tñ~
CL ,BOARD OF TRUSTEES
4/98
.
.
Telephone
(631) 765-1892
Town Hall. 53095 Main Road
P.O. Bnx 1179
Southold, New York 11971
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
At the meeting of the Southold Town ConserVation Advisory Council held Wednesday,
February 19, 2003, the following recommendation was made:
J & C HOLDINGS, LP to add a 39.8'X 33' addition to the existing 20A'X 26.4'
residence.
Located: 19625 Soundview Ave., Southold. SCTM#51-1-22.2
The CAC did not make an inspection, therefore no recommendation was made.
I
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SC4(Eb
'PER SUFFOLK COUNTY SEWER WORKS STUDIES
:0 TO BE U.S.C. & 6.5.
SURVEY OF DESCRIBED PROPERTY AT SOUTHOLD
TOWN OF SOUTHOLD. SUFFOLK COUNTY. NEW YORK
~s AN/OR SI/BSVRFACE STRVCn/HES RECORDED OR VNRECOROED ARE
~ANT£EO fJNlESS PHYSICALL Y EVIOENT .4 T THE flUE oF" SVRVEY.
tIS OR OIAl£NSIONS SHOWN HE.REON FROM THE PRoPERTY LINES To
'::TUREs ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY
'NTENDED TO AlOM./MENT THE PROPERTY LINES OR TO GUIDE THE
OF FENCES. ADDITIONAL STIWCTURES OR ANY OTHER IUPROIIEAlENr
'ZED AL TERA nON OR ADDITIONS TO THIS SURIIEY IS A lllOLA TlON
Ii 7209 SUBDIVISION 2 OF THE NEW YORK STA T£ £OVCA TlON LAW.
THIS Sl/RVEY MAP NOT BEARING THE LANa SURVEYOR-S INKED
"BOSSED SEAL SHALL NOT 8E CONSIDEREO TO BE A VALIa TRUE COP
ïONS INDICA TED HEREON SHALL RuN ONL Y TO THE PERSON FOR
SURVEr 15 PREPARED. AND ON THEIR BEHALF TO THE TITLE
¡OVERNI/£NT AGENCY AND LENDINO INSTITUTION LISTED HEREON.
IONS ARE NOT TRANSFERABLE TO AOOIFlONAL INSTITUTIONS OR
r DWNERS.
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PER
OWNER
SCALE' r - 30'
SURVEYED: DECEMBER 16. 2004
PLOT PLAN: JANUARY 21. 2004
SUFFOLK COUNTY TAX MAP
DISTRICT SECTION BLOCK LOT
1000 51 I 22.2
¡¡;, HILLEBRAND LAND SURVEYING. p, C.
II CHURCHILL LANE. SUI THTOWN. NEW YORK JJ
TEL. (63 () 543- 5 ( 39
----
·
..
Albert J. Krupski, President
JarlieS King, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
Co
--:;w
W
Øeceive
./Receive
/Complet
_Incompl
SEQRA
Type I_
Coordin
~CRe
./'1:>ate of
_Receipt
_Lead Ag
Technica
~ublic H
Resoluti
Name of Applicant
Town Hall
53095 Route 25
P.O. Box 11 í9
Southold, New York 119íl-0959
Telephone (631) í65-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
astal Erosion Permit Applica~
etland Permit Application ~ Major Minor
-
aiverl Amendmel.1t/Changes
d Application //aM03
dFee$.ÂÇC:CÐ _
ed Application I J tJ3/o_", ~ Ifill: I< ~ H ~
,
ete
Classification:
Type I1__Unlisted -- JAN 2 4 2003
ation(date sent)
ferral Sent _jJ~.3 Jò 3 Southhold Town
Inspection: ;)..1 J 1103 Board of Trustep~
ofCAC Report
ency Determination: --
I Review:
earing Hel,t;X.)J-lclo3
on:
Address -----12 0 ,...1J. 0 'f-
~..¡. C ¡!òLÐ/J,/CrS L f
/9d-.S ~OU/f(ÙLO ¡V Y //97/
, /
Phone Number( ) 6 3 117 (.§ - r..) 2 ()
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¿) .2-'-_:1...
19';;'5- SOL/IUD I//ËIV AV{;. .5ou//(oLD
77 -:. í- í ? AS ,~ 0 ¡: ('/I It 13 L I 5 ¡? ,A í fl
(provide LILCO Pole #, distance to cross streets, and location)
Suffolk County Tax Map Number 1000-
Property Location:
AGENT
(If applicable)
Address
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Phone:
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Board of Trustees Application
GENERAL DATA
Land Area (in squarefeet) J 5; /J. q ±-
Area Zoning (1..'651 D (<"1V (I A:. L..
Previous use of property fl- b.s I I) (¿N 11 ^ L-
Intended use of property: {lt5/ D l~ 11 A L..-
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):
I I
ADD 39,1 >< 33.D Abf)/Tlv¡/ /0 G)< 15 T/¡</é-
d. ù, 't I X 1 C <f- I (L,iS 1 D C;J/ C ({'
-
.
.
Board of Trustees Application
WETLANDITRUSTEE LANDS APPLICA nON DATA
I I
Purpose of the proposed operations: A f) f) 3 9, ¡ )( 3 }. () æ
t:- 'f./.s T/1/ &-
;¿u ,St
r I
'(C. ;;¿ (" c¡. .l2.iss-L.i2J¡¡v~---
Area of wetlands on lot: ß UL K./-kAOr 0 square feet
Percent coverage oflot:
)/IL
~/o
Closest distance between nearest existing structure and upland
edge of wetlands: rù;t. feet
Closesl distance between nearest proposed structure and upland
edge of wetlands: ðt-)~ feet
Does the project involve excavation or filling'
___No J Yes
[fyes. how much material will be excavated?
/00 cubic yards
,
How much material will be filled?
/ov
,
cubic yards
Depth of which material will be removed or deposited: ? feet
1 %°0
Proposed slope throughout the area of operations: ~_
Manner in which material will be removed or deposited: 8UL L 1J 0 ~(;IL
--
--~~--
Statement of the effect, ¡fany. on the wetlands and tidal waters of the town that may result by
reason of such proposed operations (use attachments if appropriate):
þDA/L
-------
Albert J. Krupski, President
James King, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
.
-
. Town Hall
. 53095 Route 25
P.O. Box 11 í9
Southold, New York 119íl-0959
Telephone (631) í65-1892
Fax (631) í65-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTH OLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
-----------------------------------
In the Matter of the Application
of
~~~-±f~t~j-~{--------------
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
I, ·JCf(A.J t., !-/utt.(A/)Ò, residing at
.ç()¡)í¡/ùL f) /vi Y (I '771
being duly swain, depose and say:
That on the Î day of fLv , 200j, I personally posted the
property known as It',) '" )¡)vil/LJ \/¡{-.vAVr:,uUt! SOUÎI-¡()Lf)
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 eight days prior to the date of the
public hearing. Da~ of hearing noted thereon to be held ~ htb'~~/aC03
on or~ 1i()D ¡.;m.
/0915" ßO, bA / IJ¡{~VJ ((oAf)
,
Dated:
itA
,
/)
'< ~ t-,U \.;/ A
(~i~re) '----~{. \.
.c-
Sworn to before me this
dc' day of FtI5; 2003
--~~#1- \01 ßS)
NOta PubllC
LYNDA M. BOHN
NOTARY PUBLIC, State of New York
No. 01 B0602ú932
Qualified in SL;,'IfO,11< Co~.mt17
Term Expires r..1:-;!ch e. 20.Q
-----
.
.
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name:
Address:
STATE OF NEW YORK
COUNTY OF SUFFOLK
.TOHIJ L l-/rJ(LíADù ,residing at /ð'195 j/, ßA7r.JIL::-1A/ ¡(GAD
SOU 1HoL{) iJ. /' 11'17/ ,being duly sworn, deposes and says that on the
day 6f J:-f5f!. ,2003, deponent mailed a true copy of the Notice
set forth in the Board of Trustees Application, directed to each of the above nanJed
persons at the addresses set opposite there respective names; that the addresses set
opposite the names of said persons are the address af said persons as shown on the current
assessment roll of the Town of South old; that said Notices were mailed at the United States Post
Office at 50u ;1¡/lo L f) , that said Notices were mailed to each of said persons by
(certified) (registered) mail. .1 A ---._
c--_:~~! /d1X:~¿~
. / (/~ -ill
Sworn to before me this ..
Dayof ¡::e8. , 20-D.3-
Þ lp ¡J. Yt1~
Notary Pubhc
LYNDA M. BOHN
NOTARY PUBLIC, Slate of New York
No. 01806020932
Qualified in Suffolk County_
Term Expires March 8, 20Q.j
-
.
.
Board of Trustees Application
County of Suffolk
State of New York
3'01-1;/ 1.... !-t-ll ¡t:( N/Ù BEING DUL Y 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 HISIHER 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 TmS
APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR
REPRESENT A TIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.
~ 7 ~~:L/--o
,. .·"":~~ignature
L-
SWORN TO BEFORE ME THIS d i DA Y OF J A ¡./ __.20 0 :3
'1 fJ ()
.~JL Yh¡~
N tary Public
LYNDA M. BOHN
NOTARY PUBLIC, State of New York
No. 01 B06020932
Qualified in Suffolk CounlY _
Term Expires March 8, 20 ~
,/
·12127<37'3161
JUL-12-2ß02 04:33P FP(lM:
.
CONSENT
Re: SCTM# 1000-5/-/-22.2
19625 Souødview Avenue, Snuthold, NY
We, ~~[ina Couloucoundis, Vice President/Secretary and Roxann Couloucoundis
,¡, President/Treasurer _' as ìfif oili~et"ofVTHOLD CORP" the owner of the
above referenced property, consent to John L. Hurtado, Sr. and Christul(; C.1Iurtado;
J&C HoJðu1gS, L.P., Wickham, Wkkham & Bressler,P.c.; and any of their ~urvcyors,
engineers, or ather contractors retained hy any of [}¡e above, or Wly of Iheir
represcntaliws and/or agents, to make applicntians nece",,11CY for the approval of
constmetion of a welJ (or cvnnc:ction to public water) and ¡;eptic system and approyal of a
building permit for a one family dwelling!U1d accessory improvement' to the Suffolk
County Department ofBeaJth SelViecs, DEC, Town ofSouthuJd Trustees, w1d the Town
of Southold Building O¡:partn:lent and any otht:r mMoritil-1; having jurisdiction, to enter
onto the premises lor the purposes or surveying, water lest" and other testing, plotting
and inspections as rc:quircd for such appJication~. Such app/jcatiofl~ ~hall include all
l!l8tlLTI in cnnnectiol1 therewith, but in na evenl ,hall tbis consent exl.md to permission 10
make physical changes or structural changes or improvements to the premises. I r the
d"sing does not occur, Purchaser will terminate fillY pending applications and void any
permitS obtained. lhis obligation shall survive te.nnillation "fthe contract.
Dated: y /1.. 2002
-.
P:4hj
VIHOLDCORP. ~
' .9 I
BY:~ C...- . -,
Marina Couloucoundis, V1ce ~reSlaenttSecreLary
X~ ~/~~~
Roxl'lnn Cauloucaundis
fre~tdenç/Tr~su¥er
; Ik;on.rtnl,
.
.
H-~6-412.'87',-;'"-?):{ 12
I PROJECT' 0 "uMaE,
61ì.21
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLlS,ED ACTIONS Only
PART I-PROJECT INFORMATION lTo be ,:ample,ed Dy ~pplicant or Proiect sponsor)
SEa
1 _ ,J,PPUCAN, ,SPONSOR
:I..JC
5
Lr
I 2. :::>ROJE'::;-:- ,\I.:..r.1E
J. PAO..:EC7 ~OCÅTI0N:
Munlc10aHty
C.;;umv
4. PRE·::SE lOG~TìON ¡Street aOQress 3.00 roao ,/1terseC;¡ons. prorrlJnenI1anomark:s. ~r::., 0r :;JrQVloe :T1ap~
/9& J S SOu¡/f) VIGiU Al/(Ç,
.50Uíf{OJ...D¡ iJY, //97/
S. IS PROPOSED ACTION:
o New ~pansron
Ô. DE5CFH8E ?ROJEC-;" 9RIEFLY:
o MOdIfication/alteration
A Df)
f
dO i
I
3C(,ð )(33,(J AbblTtov
X :2 (" <f I (è tS i b t- µ(- i?
Tu
G-7/51/,Ue-
'. AMOUNT OF I~ND .:.¡-':ECTEJ:
In,,,.,,, Sf I L- me, Ultimate'" Þ I '- ace>
~ ·!JlL!...~OP'JSE.~ ..:..C:ïON C,:)/.1P!...':' '/VITH ~;( S,ING :crWJG OR "::THE;:¡ EXI5n~IG '_':','~D USE .::t:37r1IC7:0JS:-
?':'es L..! NO If .'10. ::esc~IOe :Jrlerly
3. ,::.::..:".ys .:oRE~ë' T :'-.:'f;C '::;:i:: ~~ IIC:NIT":'2F ,;>""O...:E:'''::-:-""I
'¥;:¡'õ'S¡dentla, '_.'ncus:r:aJ ~ :.;.rnmerc:a.1
:'esc:IDe.
:.....: :'gflcUl:ur~
_' ::"n"/F'Jr~s[/Oo~.'l õoa.;e
'_·Jther
~o. :)0£5 ACTION ItJ'.'OL'/E,.I. ~:MMIT "ppgOV.1..L. OR FUNDlrJG. .'OW OR ULTIMo\ÎELf t::rìOM ,.I.NY ':JTHE::! GO'¡E?NME!\ITAl. .1,GENCY .F::üE¡:¡AL,
S,~¡E :::~ lOC;.U?
¡y<..~s CJ No If yes. ~¡st agenc'(\s) ana .:Jermlt/aoprovJ.IS
-
11.
DOES ANY ~!:;.T OF THE .~CT¡Ot.¡ HAilE A CURRENTLY 'lAUD PERMIT OR .1,ppgOVAL?
DYes Lù1Ja If y~s. lisl J.Qency name ana permit/approval
I
/12. .1,S.1. HESUlT ,::;,F ~¡:¡OPf)SEi) ;.C",;ïQN 'Nil!... :::;':ISTING ?Er:1MIT!AP?gavAL .::¡E'~UIPE ·,1QDIFIC,;.¡CN?
[J Yes ~o
I
I
I
I
I CE;;TIFY THA T ,HE INFORM"\' TICN PROVIDEQ J,eüVE IS T~UE -:-0 ¡L ~ 3E.3. OF \\'1' '~wwl.::::GE
..\,ppl¡c:J.n!lsponsat .,ame. :J ()µ¡v L. If (,/ A í A:-1J Ù
2~
~-~.. J~--;¿Jj\-
c
Q"¡le:
/ /2 ~/(j :3
I
Signature:
If the action is in the CO.::!5tal ...\rea. Jnd feu are .3 state 3çency, .:omplete the
Coas~ôJ ~ssessme!l~ Form Detore proceeaing with this J?....$essment
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---
--
.
.
Print or Type:
Office use
File #:
Permit #:
Only
ACCESS CONSENT FORM
FOR ACCESS
THROUGH PRIVATE PROPERTY
Lf
1 )
J"¡' C IIÙL D {J./G-- S
(Name of Applicant)
/-;0. ßOI- /C¡;J.55()uíf/OL¡)
(Address)'
2)
(Name & Address of Contractor Involved)
3)
/'1(, ;1 § 5ùUI/f)
(Project Location)
V / E-- tv A Vc!. SoufllodJ. 1 000- ~I - / - .;J.;J, :z
(S.C.T.M. #)
4)
(Hamlet)
5)
(Name of Road or Private Property Involved)
.-------
(Name & Address of Homeowners Association I Property
I '2. (
!lIùfos(. A()[)/V& 7í¡,f )(3/,0 A Dð/T/c.v 7<.1
(Brief Job Description)
( I
¡;tc. 'f l<. ;)~, <f (2153/ ()rJV(([
c: ¡:¡J 7/1/(,-
Owner)
6)
7)
8)
9)
fi'tA Ý ~ 7 uu3
Completion Date:
OCT 31. Iou 3
.
Starting Date:
::2 SO. 0./ L)
,
Estimated Cost of Proposed Work:
Insurance Coverage:
A. The coverage required to be extended to the Property Owner:
Bodily injury & Property Damage;
$300,0001$500,000 Bodily Injury & $50,000 Property Damage.
B. Insurance Company: U s,AA
C. Insurance Agent Dj I
Name & Telephone # /- ð 00 ' 5"31- 6 i
D. Po Ii cy #: DO {? - 9 7 - ...1 7
E. state whether policy or certification
is on file with the Trustees Office:
(If no, Provide a copy with Appli at ion)
------------------------------------------------------------------
To be completed by the Property Owner:
IIWe the undersigned, fully understand the nature of the Proposed
Work referenced above and have no objection to allowing the
Appl icant to cross MylOur propertY,to ~~
'\ -~ ,-
'b? -.
q$ignature of the Property Owner
or dul y aut hori zed represent at i ve)
.
III'PLtCIINT
TRANSACTIONAL DISCLOSURI! FOnH
.
The Town of Soulhold's Code of Elhics prohibibs contlicls of
inleresl on lhe parl of lown officers and employees. The
purpose of ~his form is to provide Information which can
alert the town of possible conflicts of interest and allow
it. to lake whatever action is necessarLto avoid same.
YOUR NI\I1I!.
Indicat.e
NATORI! OF APPLICATION. (Check all lh.b apply.)
;¡'M
,.':.;.,.. ~.,><'
TdX grievance
Variance
Chango of zone
IIp'p~~al of pIal ~
Exetñþtion from liat:. or_Official map
O~her (A..dII (
(It "other," nAme the activity.)
..~
Do you peraona11y (or through your cmmpany, 8þoude. ulblthg,
parent. or child) hDve a relatlol1shil ) vith any ofticer or
employee of the ''ovn of Southold1 -Relationship· includes
by bluod, Marriage, or business interest. -DunlnesB
interest.. MaanB a buulneRs, including a part.nerBhlp, in
vhich the tovn officer or empioyee has even a parbial
ownership of (or employment by) a corporation in vhlch
the tovn of ricer Dr e~ployee ovns More than 5% of the
ahares..
YES
NO
If you an vered MYBS,M cOMpiete ~he balahc~ of ~htø ror~ and
date aDd B n vhare indicated..
Name at perse employed by the Town of Sout1101d
Title or posit! of that person
Describe ~he relal nship belween yoUrself (bhe applicanb)
and the town offIcer r employee. Either check bha
appropriate line h) th ugh D) and/Dr. daB~ribe in the space
provided.
_B)
or child is (c~eck a
the owner of greater t
corporate stock of the
Is a corporation),
the legal or beneficial owne
noncorporate'entity (when tile
corporl!l.tlon) ,
an officer, director, þartner,
applican\;., or
the ~~tual applicant.
ot Itie or her spouso,
bhal apply),
n 5% oC lhe shares
a 1ic~n~ (when bhe
sibling,
The 1:.01ln officer
parent,
-^)
oC ~he
applicanl
_C)
_D)
of any inlereab in a
pl1cant Is "O~ a
at lh..
DESCRIPTION or RELIITIONS~IP
I'·
I
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. "'~:'
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SublhiHed ll1i",;2y'~I~;~:'~: ">~V~ð~ ::>
:::::·:::.~~>!¥œ~tJd
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. ,l.. . . '. . ~~'i'!i'.-:, ·~~?~lh·. ,.. ) .t1t~~, ':
--
Albert J. Krupski, President
Jall1eS King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095 Route 25
P.O. Box 11í9
Southold, New York 11971-0959
Telephone (631) í6S-1892
Fax .6311 í65-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
#
0057C
Date August II. 2005
THIS CERTIFIES that the
single-family dwelling
At 19625 Soundview Ave., Southold
Suffolk County Tax Map #
51-1-22.2
Conforms to the application for a Trustees Permit heretofore filed in this office
Dated 1/24/03 pursuant to which Trustees Permit # 5706
Dated 2/26/03
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
~ for a single-family dwelling
The certificate is issued to
J&C Holding LP
owner ofthe
aforesaid property.
~..~ 9- ~-ç,
Authorized Signature
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, New York 119íl-0959
Telephone (631) í65-1892
Fax (631) í65-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES
72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN
APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO
SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE
PERMIT.
--:J {c.. ,-1-"" 1lJ. ~ "--5 S
INSPECTION SCHEDULE
--
/ ~\<-- 1).\,slcÇ 2rx...,..-_J...j\.
..1~ Pre-construction, hay bale line " IJ
1 sl day of construction
Y> constructed
~/ Project complete, compliance inspection. 6D{WQ\\S '\ C'\lI..", {{f.,5
_:~
ßH\b 61J...~