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Home My WebLink AboutTR-5350 - ~ TERMS and CONDmONS The Permittee Paul Loeb residing at 347 West 55th St, #4L. New York, NY 10019 N. y~ as pan of the coosideration for the issuance of the Permi, does uadentand and prescribe to the fol. lowing: 1. That the said Board of Trustees and the Town of Southold aœ released from any and all damages, or claims for damages, of suits arising ditecdy or inditecdy as a rauIt of any oper- ation performed pursuant to this permit, and the said Permittee wi1I, at his or her own expense, defend any and all such IIlits· initiaœd by third patties, and the said Peuuit¡,." .-....... full 1.iabi1Ity with reSpect thereto, to the complere exclusion of the Board of Trusua of the Town of ~Id 2. That this Permit Is·...ud for . pedod of 24 mos. wblt:h Is 00DSidetcd to be the estimated åme· required to complete the work invol..ed, but shoa1d cittwiIstances wattmt, request for an exœosion may be made to the Board a, a later daœ. 3. That this Permi, should be retained indefinitely, or as long as the said Permittee wishes to maintain the sttuctUte or project involved, to provide evidence to anyone cooceroed that auth- orization was origina11y obtained. 4. That the work involved will be subject to the iospectioo and approval of the Board or its agen.,., and non-compliance with the provisions of the otiginsting application, may be cause for revocation of this Permit by resolution of the said Board. 5. Tha, there will be no unreasonable interference with navigadoa as a result of the work herein aUthorized. 6. That there shall be no interference with the righ' of the pub1ic to pass and repass along the beach between high and low water msrks. 7. That if future operations of the Town of Southold requite the removal and/or alœraûons in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obsttucnon to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work or project herein stated without ezpeoses to the Town of Southold. 8. Tha, the said Board will be notified by ,he Permittee 0' the completion of the work auth. orized. 9. Tha' the Perminee wiU obwn aU other permilS and consents dJat may be requited 1I1p- plemental '0 this permit which may be subject to revoke upon fallute to obtain same. . . - !_l",.'\.)I'~"I·~\'--;:-\'I.\'~' " ;:. ,.~.,.--;¡".~,-,~,-:-.,--,,-, 7", .. -. -. .-. -.. -.--;.-...-:<"--;.-.----;-.--.. -.-----.-.--.-.. .. ~ -.-.-. I. ",~. Q ð C<~- ll¡ ,c c' ~,~~¿ 1""'\ .iL.'.'- ff; I I~ ill 0... 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L:.; r-( 'F ,- L..' :1; -- t!) ......: r-." 0.:- ŒJ :-J -,. y<- lLl .. Ù ./- tJ Lj L ,,' L ~ ., 1( " ¡--. I; ~ voH _ 1{)\I" a:: 0;:' ~ o:gh >--r--t> .:::- ~ ~ :> C'):~ .> ~þ' W '"! Willi;:. 7 fJr~ ,~..._~:!~ " 0 ..- Ó ~: O != ".. -11;1 r.. ..:,.~ .... If)! ~ -->" -f '.,) (J>- I ;.J.~ I u);'; I t-lO~:~ , () ~ '"'~/: l:, ....-J .,_~ i 1,1 ' 0_',: I...U ;-. M~,) lO ~il " ~ .~~ - ~~< " '",-.¡ i"a .. / ¡"t"'"! dJ . \ (" .-,,.,..- /,/"""I/ ,. , -t- \ \ \ " ................. ¡ ~~\ \ \' C11--- ,. ,,, " ... ... " .' J '.. , i; . f I~ \; ¡~ n): , fJ : "t;! ,_-...' ~ . ¡¡: ~ ¡ ,.,i:! :-:s::: 0::: o .)- ;.~. . ' t~r' "'~ ). '~' t- LIJ: .' ~ müf"~' w a:: tr: 0....0 ...1 Ul Q.. -,j ~ - -..- , ~, -;'. '~-r<~:·~f:J.~>:: . '~ -: :" .. .~ \ I -':¡r-j": ----. . -- . . August 5, 2002 Board of Town Trustees Town of Southold Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971 Attn: Lauren Dear Sirs/Madams: Please be advised that I have completed the work to the driveway at 1215 Main Street (a/k/a 1075 Main Street). Please contact me if you need any other documentation, pictures. etc. &~~ Paul Loeb Paul Loeb 347 West 55th Street #4-L New York. NY 10019 (home) 212-315-2165 (work) 212-554-7630 (9:30a-5:30p) (work fax) 212-554-7700 NjG-Ö 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 11971-0959 . Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 25,2002 Mr. Paul Loeb 347 West 55th Street #4L New York, NY 10019 RE 1215 Main Street, Greenport, N'{ SCTM#34-1-10 Dear Mr. Loeb: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, January 23, 2002. RESOLVED, that the Southold Town Board of Trustees grant an Amendment to Permit #5350 for expansion of driveway. If you have any questions, please call our office at 765-1892. ~9 /~~9v Albert J. Krupski, Jr. President, Board of Trustees AJK/cjc CC Building Department ., . V l/,0 ~ TeJ.éphone )'Í31) 765c 1892 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 Wednesday, January 16, 2002, the following recommendation was made: Moved by Drew Dillingham, seconded by Scott Hilary, it was RESOLVED to recommend to the South old Town Board of Trustees APPROVAL of the Amendment Request of PAUL LOEB to Amend Permit #5350 for an expansion of the driveway. Located: 1215 Main Street, Greenport. SCTM#34-1-10 Vote of Council: Ayes: All Motion Carried . . Albert J. Krupski, President James King, Vice-President Henry Smith ~~ie Faster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 119ï1-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 25, 2001 Mr. Paul Loeb 347 West 55th Street, #4L New York. NY 10019 RE: 1215 Main St., Greenport SCTM#34-l-10 Dear Mr. Loeb: The Board of Town Trustees took the followins action during its regular meeting held on Thursday, June 21, 2001 regarding the above matter: WHEREAS, PAUL LOEB applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of South old, application dated May 31,2001, and, WHEREAS. said application was referæd tv the Sourhold Town Conservation Advisory Council for their tìndings and recommendations, and, WHEREAS. a Publi.; H~aring was held by the Town Trustees with respect to said application on June 21. lOOl, at which :ime all iuœrested µersons 'Nere given an oJpport'.mity to be heard, and, WHEREAS, the Board members have personally viewed and are iamiliar 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 standards set forth in Chapter 97 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, " 2 . . RESOLVED, that the Board of Trustees approve the application of PAUL LOEB to remove windows and screens from porch, replace solid porch rail with open porch rail, add set of steps on south side of porch and widen steps on east side of porch. 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 it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustee~ are to be notitied upon completion of said project. Fees: None Very truly yours. f2!.L-1 (Î. /~._~-vf:.¿. I ' Albert J. Krupski. J r. President. Board of Trustees r ~. AJKjlms cc: Bldg. Dept. . . Telepbone (631) 765-1892 Town Hall. 53095 Main Road P.O. Box 1179 Souchold. New· York 11971 . SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Tuesday, June 12, 2001, the following recommendation was made: Moved by Bob Ghosio, seconded by Scott Hilary, it was RESOLVED to recommend to theSouthold Town Board of Trustees APPROVAL of the Wetland Permit Application of PAUL LOEB 34-1-10 to remove storm windows and screens from porch, replace solid porch rail with open porch rail, add set of steps on south side of porch and widen steps on east side of porch. 1215 Main St., Greenport Vote of Council: Ayes: All Motion Carried " . . May 30, 2001 VIA FED EX Board of Town Trustees Southold Town Hall 53095 Main Road Southold, New York 11971 Attn: Lauren Re: 1215 Main Street, Greenport. New York Dear Sirs/Madams: Hello. my nam..:- 15 Paul Loeb. I am b0i11 and rai~~d in Grè'enport, New York anù µíe~elLtìy li,;e and work in New York City. I was raised about 5 houses east of 1215 Mam Street on the Northroad. I have recently (3116/01) purchased I2l5 Main Street. Greenport, New York. Since I was a chtld 1215 Main Street has been an eyesore. I am attempting to improve 1215 Main Street and provide clean. safe, attracti\'e, affordable housing for several small local families as well as provide an apartment for myself. family and/or friends. I believe this neglected, poorly managed house can be revitalized and add to the community, instead of detract from it. I am attempting to improve the front porch area and have submItted an application to the building department. I ha\'e been told I need to get clearance from your organization tirst. I hope you like my plans and find that they do not contlict with the nature area near/on my property. Please be advised that there is a tenant, John Poliandro and family in Apartment #lA that are vindictive and very diftìcu1t. They are terrorizing me and any workers I bring on the property. You will notice the property is partially painted. They have chased away the painter. I am eVIcting them. I have received a signed warrant from the court and have enclosed it in this mailing. I am waiting patiently for the Sheriff to enforce the warrant. You will notice garbage on the ground of my property, on the porch and along the perimeter of the water/marsh area. I have attempted to clean it up and when I return it appears again. Any objects leti on the property get thrown into the water area. I am quite sure I know who is doing this, but I am unable to prove it, in order to do any1hing about it. . It is very frustrating. Once this problem tenant has been removed by the Sheriff (mid to late June), I will be removing all rubbish from the water (most \\'~s in there '.','h~n I purchased the property) and waters edge afmy property. giving my property a good clean up for myself. the remaining tenants and the community. To attempt this while the problem tenant is still allowed by the law to live there is futile. Please contact me wIth any questions/comments. Q~tAr- Paul Loeb Paul Loeb 347 West 55'" Street #4-L New York, NY 10019 (h) 212-315-2165 (w) 212-554-7630 (fax) 212-554-7700 --a~/L~/LQQ~ ~Q;~I b.:S1L'::I1:I4;'¿14 W1LL1AM C GOGGINS PAGE 02/02 ~ 'r I-IOU . "'.^II IIAN"I·. HII'.III'III. IIlnllk fll:õlrl.:1 ':'11,,1, 111.11:1 ".""..'"II'I":fll.'I,.'"III'I.I'''..",,,,,,,,,,, '~ Wllllr.: nUll ,., III WI Y,..,,,, ,.. ¥. 1''''11 JUSTICE COUR'l' OF 'l~IIE 'l'OWN OF SOU'l'lIOLIJ STATE OF NEW YORK: COUNTY OF SUFFOLK . ..~- ¥ ·~V~-_~_____h .-____._________._n_____..__.___ __ __._ __ _.~.__. ,Iarl 111"('\ Nil. I, t".. 'I' PAUL LOEB 347 West 55th Street New York, New York 10019 l"plllllflr·l· """"""." ., IIfl,..·.~.'f "!I"¡"'d JOHN POLIANDRO Apt 1A 1215 a/k/a 1075 Main Street Greenport, New York 11944 "',·,>:/",",1''111''',,,,,,,, I ",/, '"I{.~ \\'.\ ¡: Il \ NT ,v,,,, /"ff'fI"'''' /'".~, III/''''~ II' (""lIfllIl'!I/'/II'" '·,,,,,.,.It·I''OII f"'/"!f ¡1t·til;,III" atl,! ,,",,',,,,,,'! lu If",;rh/lru'. 1"'1""" i"I,.".r", ,...i"!111I11I.o:!f."~.'t;'" "' 11"·",.'.,/;",../",,,,·,,, ,I,·.o:f"'iI,,·d '''''.''/I'''I,lr·',' tll"f·,f,'II",,' ..I ,I.', ,-",~ TII 1'111,; SILIIIFF lW TilE ,IIIOV¡.;JUSTICE (;OIJlIT, r:H"I';TIN(;, I\'IIEII";,II{ II ¡,..Iill.." PAUL LOEB rul· n nltn JUd¡:IIII"1I1 II' '·I'"O\I'I' JOHN POLIANDRO ill "II~ :11111\'" 'lllil"'11 Jtr'UI't'('dill~ WUN lI'psl'llInl ¡II llti.~ ,'''"''1 1111 I,,.I:III III Inlle"o'" of 1IIf' l1·1·1I1i~';I·..... 11f'7-:1'I'illI'd 1t1"'I'ill, 11f·~}tI"~I"'¡"1I ~Ir ¡.!.Iid ,In"lIIil-l('!'-: anrl 1111' II "'111"1-:11,1 1"·'-1'111111'1' tl-tlm 1110 Apartment lA I'll fill' floc... '"111 I',·,·",i",·. 1:1'''1\'11''" Nil. t215 a/k/a 1\)75 Main.Street, Greenport, New York l~tlllIIl.,r tiC Suffolk , "plllT Ihe' h"I'UIIIIIIIII:II. IIH~ "'III fir Kallr 1'11'llIb:c'~ \\"II¡..: 1111'11 fJ<llil 1111(' uflrlllllhllllgll dilly ,1t'IIII1Iuh,1I '·'JUllhu',' lIupaltl III ,·iolnlitJlI (If 1111' Uf!I'1'I'III(·nl. 1111111'1' whi,'1I 1111' f"'''lld!(I''1 Wl!t'l~ ht!I" I1lId 11,:1' t-:ni,1 '·('NlmI41I'III:-r IlId 1I!llIllIt.!), nllll f'OI¡hllll~ III )(~IiI'¡';:HI(1t or tJ:,id 1I'I'lIIi:-:f'H n'II'I' IIdll II I I III p:I.\. UIt'II or ,.mill "('111 nlld ,,-illuml III(' flt'·'ITI",,!,dnllllf lilt' '1IIIIIIol'd fII" 111C~ I'l'l If 11111,'" :11111 II Ilfll14'I' or !,f'lilill" \\n!{ dilly h~HIII'11 uuf of 11th.! I"~III'I 1IIr"',-h'd III II,," 1"1'NlUIIt'II'''' ttpc"'fr,rllI! 111f' 1""1' Ifill' IlflH'P of 1111' 1(,:tI'ÎII~ flf Ihl' p,'lllillll, IIIHI t1'fIUr III' /O(1'1"\-I,'c! fir Ihl! IHlri,·,'. fir 111'1111011 rlUll 11"lilfllll WIlf4 IH'I'!-:I·lIll'd. '1IIIt 'hn ·"HPlllldt'U'H 1111\"111:: r:lH..d III iflll'I'I"I!:!' III· '¡.:llIhllt-:h 1111-" d,·I!'II:-rI'. Iht, Hlltf" «Iitl fllI"'I'U!'1I1I "(Hull-,' 1111:11 jllflArtH'II' !tWIII'IIIIIg- 'II ffu' pt·lil¡IIlIl't·llIlIdl!ll'd. IIfl/lllI~ ,,'hl'l· 'hill~~ Ih(' 111'11,·(,.,·", flf flU' UII'o'N('Kf(inlt (lr Ih«t Hnlll III'IIII",·I,\". rJlfll·;n':lr·OHI~, III IIU! HlIl1In nr IIw !'c.'''ph! Ur tlH~ ~Iult~ ur N(·w )'m't;, ,r-HI Iln' III'I'HIJ' ,'111111111111111," III 1"1'11111\/' .-nilll'CnlUJlltlenl felllllll: and all olher persons in POSOHS'/'OII JOHN POLIANDRO 1111" IlJI )ht'I' PI''foIOllfC fl'IIIII ~nhl 11·(-I11I~(':-: Ulul pur IH'lilimu~f' Inlld'ur'fl ill ~:Ihl 1"'filil"l q:lllll', ill '-fII'''I~~I:f"'~~:i1l1l ""'I,.,..r, execution by Sheriff shall be stayed to and including May 31, 2001 \\'I''NI':HK,lIulI_ William H. Price, Jr. ~_ IIIII!flrllu!.Iutlf,:I'!:flrIlHl ~::d '~UI"(. 111. till! 1'''Hlllr of Suffolk fr:lIl'(llhc~ /:2- .faJ'lIr May, 2001 l'I'!o:I"IUII'II 11'11:1111,1111" 1"'!-:IU"dPI'( 111I~¡O!"lr'fI:III. ..·...h__. . Price, Jr. , Ita." Le~, 4"~c.k- i5?! c~"'>~ E _ \...- <> ?~~~ ..;3 .~ ¿/ .3 -z; - ,~l'2-~ ~ ~Æ.é:1) s::::.'Qo:::> '- J ><- ~ ::--- d:P ~ v _-S:> ;¿-> I;><=> \;;;. e-> @~ C::or- ¿;) ~_'><:... ~ -2 ~ -¥" _.s~ '>i:=~"" '::><~~ G-= ~ :+ rrnþJ ; . c~ ~& \, \ N o ~ u .. o lL W a: $:10 W'::::: :>:0:° W~ ::;::;on 000 >->-W enen>- ::J::J<{ 000 \Ooz \ 8 k'iW .. 1;11 n. . 'J r . . I.¡' 1.-" _. _. '_' . I r, _J ~ ~ >- Z co 1-'" ona:o ",0. o..r- wzr- I-w... cn:::Jw.!.. mOCl:(T) a:a:CJtO - ¿j ~ ~. .,'~ c. ;~ ,c¡£ <:::::. ,-ç-, .]2 :ø ~~ .~ -0 ~2 ~ -5 --) '0 6~ ..~ -4- ~~ .- ;0 .3 <:::. «::J ~ Q) :-S~ ~~ . ~llau · nwc..-r ""~. ft~ _/1_ c~~~ "- '-----" E - --k -0 'E. 0 ?\>=~~ -2& ~~}!/ .3 ~ ::: 'â ~ ~ ~ ~5E ?-><- ~ ~ _ å:P è'S}cV _ _ s::: \>= \;;;. ðJ~ c =- ¡;5 ~ -X:... "Ù<'. ...2 ~ ~' ~~ ~ 'q "" ~~~ ~~~ N o ~ v m o U. W er ;::,0 WI:::: >a:O W- ::;::;'" 000 I-I-W UHI) I- :::>:::>« 000 ;. . ~ c/ >- Z <X> I-M ",ero ",0. o.r- WZr- I-W... OO=>W' m~~~ . -7j ~ &"~-"" ~~ -1- ~.Cì -¡- c ,-c;:-., ,0 1i3 ~ ~~ ~ j~ Y2-S --r- ~ b~ ,~f .~~ .3 ç:: "V ~ Q) S!j' -~. - 9S-'9-:;'ll0/981--<1 NEW YORK STATE Df1'ARTMENT OF ENVIRONMENT..... CONSERVATION OFFICE OF GENERAl. SERVICES UNITED STATES AAMY CORPS OF ENGINEERS JOINT APPLICATION FOR PERMIT* .. F.i"f.iI ~ us ÞJW.V CORPS OF ENGINEERS DISTRI8UT10N 1ST COPY 2ND COPY 3RD COPY 4TH COPY STH COPY Permit Adminmrator Corps of Engineen Program NYS A¡ency Applicant DEC APPUCATION NUMBER 1. Please read AU instructions on bock. Check permits applied for. A"och additional infonnotion os needed. o FRESHWATER wrnANDS 0 TID..... WETlANDS 0 WATER SUPPLY 0 LONG ISLAND WELL o PROTECTION OF WATERS FOR, o A Construction or placement of docks and moorings 0 B. Construction, reconstruction, or repair of (] DAM or other impoundment structure o C. Disturbance of a STREAM BED or BANKS or excavation in or fill of NAV1GABlE WATERS 0 401 WATER QUALITY CERTIFICATION o COASTAL EROSION CONTROL 0 LAKE GEORGE PARK COMMISSION (Docks and Moorings) 0 WILD, SCENIC OR RECREATIONAL RIVERS o AQUATIC PEST CONTROL FOR: 0 A. Aquatic Vegetation Control 0 B. Fish Control 0 C. Insed Control o lEASE, LICENSE, EASEMENT, or other real property interest in slate-owned lands under water 0 UTILITY EASEMENTS (Pipelines, Conduits, Cables, etc.) 2. LIST PREVIOUS PERMIT/APPLICATION NUMBERS AND DATES (If any) 3_ IF OTHER THAN INDIVIDUAl, PROVIDE TAXPAYER ID NUMBER o lessee o Municipality/Governmental Agency (Check os many as apply) o Agent S. -I.- 6. NAME OF OWNER [If different than number 5 above) o Owne< 0 Agent/Contad Pe",," MAlUNG ADDRESS POST OffiCE TELEPHONE NUMBER lDayt;me} I STATE ZIP CODE DEC USE ONLY NYTM-E NYTM-N .( 9. Nome of USGS QUAD MAP n on starting work without permit, include dates) 1 . PROPOSED USE, PriYote 0 Public 0 Commercial No 15. PROJECT ESCRI ION AND PROPOSED PURPOSE: (e.g. quantity and type of materiol to be eKcovoted, dredged or used to fill or riprop; Iocofion of disposal sites; type of structure to be installed; height of dam; size of impoundment; capcrcities of proposed wœ. sources; extent of distribution s)'$fem; size of marino and types of dads and __Iobe....alled;ek.) ~Dl\(). Df~·(Q,Ì\ ¡f11?\-aœ-lJJi-\h~n~~ra;1 W\òer\ ~or~ !J 0 r'\ ~óìde ck(¡t~ PM ~o~h 6 6 () V\ 60d\-n1ìó.ec£~~ K YES, ~eos.e list: I hereby affirm that· onnofion . ed on this form a 0 crttochmen subm- tie fal~ ~ mode heniin are punishable as a Cau A nmcIemecmor pursuant to Section 210.45 the t'enQllaw. funher, the applicant occepts full NSponSI"btlity for an damage, direct or indirect, of whatever noturw, and by whamrter auffef"ed, arising out of the PfOiect d4tscribed here.... and ogrees to Indemnify and IO'te harn".u the SIc:rIe from suits, octtons, damages and costs of ev.cy nome and description f'ftUfting from saki project. In addition. Federol Law, 18 U.S.C., Sectton 1001 proYides for Q fine of not rnorw than $10,000 or imprisonment for not morw than m. r-aR, or both, where an apprlCOftt knowingfy and' wtllfufIy fakHies, conceals, or ~ up 0 material foci; or knowingly makes or VMS Q false. fictitious or froudutent stotement. q,,""1':","""..................... In 7'J:"' 41'/~ Io~ ~ ~ ap¡'~'a"" on my behaK. ....l'\ ~ ~~~~~~~~~ -~W~ ~ SIgftetuft~~- - . . GENERAL INSTRUCTIONS . ,_..: "è INCOMPlETE OR INACCURATE' INFORMATION MA.Y DElAY PROCESSING AND AflNAL DECISION ON YOUR APPLICATION ,. Type or print clearty in ;nk. Attach FiVe (5) copies of additional information required in A through C betow; A. A USGS mop, or equiyolent showing the project Jocation. Include on the map wetlands.. 5eOSOOOfIy wet stf"eøms'ànd ditches. B. A sketcn pion drawn to scale or with dimensions Qrven or engineering druwincp showing Ioádion and extent of woÁ: as well as view directions of the photographs required in C. C. At least three (3) representative color photographs of the proied area and surTOUodings with time and dote wher. they were token indicated 2. Applications by counl~s. cities, lowns and viUoges must be signed by the chief eJr.ecvtive of Ihat muntcipolity or the head of the deportment or agency undertuking the projed. 3 If someone olher thon owner mo~es appllCotion. wri"en consent of the owner to use the property/facility must accompany the application. .s The applICant is respan~ible for obtolnrng any other req'Jired federal state or 10<01 pe~mit:; Separate authorilatian or letter of NO JURISDICTION should be received from DEC, A~A and the Army Corps of Engineers prior to initiation of work in wetlands or waterways. OTHER REQUIREMENTS 5 If proil'c! ;s on "nlisted actic.n pursuant to the Slate Environmental Quality Review Ad regulotions----6 NYCRR. Part 61 7, a completed Part 1 of a Shan E"vlror.'TIenta ,A~sessmenl Form must be submi"ed with II-,e app:ication 6 If prOlect IS a Type I achon pursuant fa the Slate Environmental Ql.rality Revuõ'w Act regulations - 6 NYCRR, Port 6' 7, a completed Part ¡ of a Full E"""rC'mne"tol Assessme", Form must be Sl'l:ImiHed ""th the application 7 If project.s classified a~ major pursuant 10 tl->.e UniforfTI Procedures Act regulotlons---6 NYCRR, Pari 621,0 completed Part J of a Structuro!- ArcheolcglCal Assessment Form must bp submitted ...-¡th the ap-plica~ion 8 tf the p~oiect reqUIres 0 bderal permit and lies wIth "' the Coastal ZOFle. 0 cOMpleted Federal Conslsle"cy Assessment Farm must be subm'Hed wIth the application. SPECIAL REQUIREMENTS FOR SpeCIFIC PERMIT A~'CA-nONS 9 Applica:ions for the constructi.,n, reconstruction or repaIr of a DAM or other IMPOUNDMENT STRUCTURE must be accompanied by Supplemen 0-1. 10. Applications for DOCK, PLATFORM OR MOORiNG FACILITY PERMITS must be accompollled by S:.¡pplement D.2 11 Applications for WATER SUPPLY OR lONG ISLAND WEll PERMITS must be accC'mponied by Supplement W-I. 12. Applications for 0 permit to apply a CHEMICAL TO CONTROL OR ELIMINATE AQUATIC VEGETATION, FISH OR INSECTS must be accompanied by the proper supplemental form available from the deportment. 1 J Applications for WILD, SCENIC OR RECREATIONAL RIVERS SYSTEM pERMIT must be occomponted by Supplement WSR-l. 14. Applications for 0 federal permit to disturb a wetland or waterway by placing fil; or performing mechanized land deonng, dit-::hing, channelization. dredging Of" e)lcavation activities under Section 404 OT oceon dumping undec Sectoo 103 of the Dean Water Ad should provide a discussion of practicable alternatives considered to ovoid, minimize and/or mitigate the proposed protect impacts Particular justffiéation should be given 05 10 why the alternatives are not suitable. Cantoclthe Regional Permit Administrator, Division of Environmental Pennits, at the appropriate office of the Deportment, or respective Corps Di~rict Office, as given below, for assistance regarding any of the above requirements. Consult other available application instruc!ion materials for the appropriate permit types. . For adivities located withtin the Adirondack Park, this is not on applKotion to the APA.. The APA will be provided with a copy of this material and upon review, may contact you for additional information, if necessary_ DePARTMENT OF eNVIRONMENTAL CONSeRVATION DIVISION OF eNVIRONMENTAL peRMITS legend e Regional Office . Regional Sub-Office ...... I 1ui1d~40,SUN'f SIon,Brook,N'f1119O-73S6 ~"1"'.0J65 ...... . 1 HunftnPailtf'IozCl 41-40 2ht Street lOIIiIslondCify,NYI1IOI.S407 (1'81"'~"7 ...... . tTSouttIPunCornenRood Hew Pultz. NY 12561-1696 ~"I2\6-JOS< ...... 4 IISONorthWtsmttRood SdMMdody, NY 1230t..2ÐI4 SII13S7."" IRIOIf .. s.b-office JeflersonRood,RoIIleIO HCR#I.BoI3A Stamford, NT 12167-9SOJ (607165'.77<1 ...... S ....16. PO leu 296 r.rIroolNTI2977.m6 15'81"'·'234 _S..._ '-_......120 _111"_ (SIIID-WI ...... , SlGIeOfrKeBuilding 311 Washington Street WutertO'llll,NYI360I·3787 (3111785-"'5 """"""'_ ~OftiœBuildlllQ 207~SlretII IItiaI,NY 13501-2185 (JI5)m."" _7.. ,6I.SEritltYt W~, , s,.......NYI:fio<.'~ PISI'26-"J8 ...... 7"'_ 1!8S'....._ ~III'I_"" (602153-109S o f1f!]. ~ ~~ -1.rE. ..... ..., 1..-16."" ......... NY 17fT/ S'q19'_ ...... I 6274EAron·LImClRoød Avon,HYI44I4-9S19 {116726-2466 ...... . 2701Iid;goo"".. ""'~.NYI42VJ·1999 (1161851-1165 -....- 111_- .._III'M2IU66 (1111372_ -" :.. ....... _........ 08......... .....-......... AI1II._..... ...Ioft _'-.._.,....... -....1oR. NY 10218-<1090 To/i;Ioooo , 111~ JIWJt.IIE(......Ü ........._ c..;" ,(ZI~mtl8S.~"'" 3._""""""'_c..;" .....,......' " ''''_'''1II'1t1I8 .....-'-..- lIt'__íoIIiIo.III'M2I1-31ti' ; , __1S1127O-IS88/DSI9.OIC.....H~ .,-..; "". ..__(1I1I829_.OIC........7'.; .' .' " t' . FAX HJ. : 42Ø21~ . Jan. 2S 2001 11:24AM P4' . l 1. f.J lM¡~;¡ -- .. .. . ..__."'-'~~~ h:IJ FJ 1i~S1}§, fr '" t fi fif 1~li~H ~ ~ :r ~.~ ~H:~ '. ,'j. i;~. r~¡f H"N!:;~J ¡ ~.; (1' '" -~ 1~ ~:H" t· 'i'l~' J ,.·d 'i!J;1!!hh I!.¡, ~ '. L ......,\! k ...).. .þ '.:t ¡:!ill:w -~, >!;!' < ¡ "I n' 1'". , ~ w I" Ill} þ! ~ I' ~ f.'~' '. I ,. ~ t~' t( '" 'I I/} ." ':I)- HI t!ë~ HliU:-¡· ;~~ ~ lJ.}. ~ ~. ~. ? ~ \~ ~ ~..è ---.,. :~-~J~~¡~I~ ~~. 0r~r~~t :'~~1:. l¡j~ \.Ii :::i¡}..~'):~.3ï: I ':1. ~ ~ l-'ol ~~ Õ!\I ~,~ ~ ~ I ';:-<"~ ~ ~ ~ ~ ~ ~z¡ ~ \~ o ~ \1 I.. 1,( I \) :~ ~.'~ t It CJ I· \J 2. " ~ '\:- ~ ... t~<:.tt ,-1 ~ ~ G~ Slffi TECI-KLOOY ~~.. ~. ~ r.;,', .....~, I -~~ I '............. '" .~. ~ ..:-': ,l-Si ~ ¡.j :> . L..:" C::: f ,tS "llQ l ,.I; 5<: .('\ qt~ ..¡~ Q :ro:t Q - ¡.. t,Ci '1' Q' ~< .f!. I I " ~ -..... --.... ··-_.w.... ~ (} I( ~ ~~- ~ . 9 -. \J.¡ ~ ~ 1,\ :t:: . .þ- ..-..- -. -, '" .... ................ '" '''''1.. '. -L :3 3 'ò"..L S ,....., I ItY þ,/ I a ! . . . ,;,,-,os , Ir þ!J z 'S -. ,.." ...~...... ()' ·.....os vi ~ ".;:;.." ~ "1.'tlÞ~ '1\- ~ ,~. 4 !' () ¡."'i..... :: ~ ,'{: (I IJ) L., ..t: .... ,tbl "cr :t ~ .:... , ~ :- ~ -........ 0;) ~ Ij \¡¡ .... ? ~ ( Ç) ,'" :, , ~ J "\ (\' 0 , \") I,) 'II t-i , r i ~ ,\ \9 I if. ~ 0 I\J If) ,9 t- ~ 9- .... 1= ~1 ,\,f ,'''' -" _, ,-f /./'0'0' _Jwtl ð£' '~6 '/IA,f'J,I.E:o ~-IV _.~ OnO _ "___ t:1'1d:N:1I..c"";¡;::t: o,;¡"v -- Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 , ~'ìI\)ffOl~~ ~.~ i§ ~ ::. -..:, CI - en :e 'ð ~ ~p. ~!!l "./ . i'9 Telephone (516) 765-18'12 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD LETTER OF REQUEST FOR AN AMENDMENT lOW 17 7 8in DATE OwNER' , ,.', PHONE (À\J-~lf)-J,L0 ADDRESS 31..\1 Weh\-- f)f)ttl0t-(ee+*4 -/..., N~' f)~ \úO¡q I AGENT PHONE ADDRESS PROPERTY LOCATION 1 TAX MAP NO. Y AN ( I/We -.:J {\ t.i \ ~ request an Amendment to Permit # ..s-.:S 3D dJµ", &tU At' ÀH) I ~ 4 ~-F\{ rJj d~7- .7 ' F 1 r ~ SigoedB,jO\& ~ ~~,N ~ / ~ \ J\ ~ ~ , '- ~ December 6, 200 I Southold Town Trustees Southold Town Hall P.O. Box 1179 Southold, New York 11971 :]rr: . U L 1215 Main Street (aIkIa 1075 Main Street). Greenport, New York (near intersection of Main Street and Rt. 48) Dears Sirs/Madams: I would like to expand the driveway at my property. Enclosed please find my survey and drawings I had done of the proposed driveway. The present driveway is a straight line requiring one to back in or back out of the driveway. This was fine when the house was originally built, but since that time traffic at the intersection of Main Street and Rt. 48 has increased dramatically. Backing your automobile up into this busy intersection of Main Street is nervous making and creates a road hazard. By adding the additional space in the back of the property, I can turn my auto around and this road hazard would be eliminated with little or no impact to the environment. This proposed expansion will make the intersection of Main Street and Rt. 48 a little less dangerous than it presently is. rJncer~\r j~eb Paul Loeb th S 347 West 55 treet #4-L New York, NY 10019 (212) 315-2165 (631) 553-5255 Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken poliwoda . . Town Hall , 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- In the Matter of the Application ~~~~~~~;----------------- STATE OF NEW YORK) AFFIDAVIT OF POSTING I,~rk\ LoàJ ' residing at 3'-17 ~)f:bt- ,1.J)th6tí~-f ~-~, N0\}J~()\\¡, fjPIfj ~(i( ¡vû\~ ' being duly sworn, depose and say: That on the 1d-\\\. day of1ah ,20<Q, property known as, I) \ J" , ~ by placing the Board of Trustees official easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date OM the publiC hearin~. Date of hearing noted thereon to be held ~j ó.!::fll. 1. /))( {tv b~ 1)0 u!rJ. (1m .. ) Dated: ~~\~\-- (signa ure) Sworn to before me this 1~)4-. day ofJÛ¡¡UCJ(<..:) 200:) ~ 4 . (J.. &ß!- (. 'L~ Notary ~blic frrÞDt A.I'UIJIO NOTARV PUIRJC._oI_'** No. OIPWIII1IIO ~1n"'CaaIIIr' O'ì' Commi81ion ExpII8JUÞ¡7.1ð~ Telephone (631) 765-1892 Fax (631) 765-1366 Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda . . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- In the Matter of the Application of -j2~l_~______________________ COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I'-::Ya.J LA1J ' residing at 347 CvEðt55th 5r-t~-¿( NtH! \{QL~ I /V~-1 (JO \~ being duly sworn, depose and say: That on the i ().. day Of:J v¡ìe....., 20 property known as by placing the Board of Trustees ffici 1 easily be seen, and that I have checked to has remained in place for eight days prior to public hearing. Dat~! hearing noted thereon DI'\ ()'10..lm...H 7:(1) ~n, Dated: Jùl\€. 15' ~oo / , V()l'~~~' (sigñature) Sworn to before me this ¡Si<t.day of J,)~.e 200 I K~'fYl wdv4 Notary Putslic , IŒRWYN WELCH re...,.¡ PUeuc, 8IIr. of New'tbrtc No. D1WE48e5e7g 0udttecI In a.- County Cornrnturon ExpItw AprIl 23. 2002 12. ~ð.'Ol_JO_:54 FAX ~1.2 :;5.1 ¡¡OO . ~5 \~ 7GlJ- tJbb MOSES & S¡~GER LLP I@oo¡ . A++n '" L~\J(e~ NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOHNOF soUTHOLD In the matter of applicant: -1A,J\ L<*.P SCTMinOOO- 03~JooO\/OlD YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: f'l~I\~~'{j;~(\J dÍ\~W'ª''\1 odòef W\~\ WSla\'\ O\Ú~ \~i~,Í~(V7!J !..tA~ ~0hed6\\;f\0' I 2. That the property which is the subject of Environmental '~ $.elliew is locû.ted adjacent to your property -and is described as follows: I å--\ 5 (Y\G-¡(\ 6\í£e~ Cê0 r--!a IDÎ5 [1\fu-1\ 6\íet\ ') G(~i\~ri~1 ~¡,U~tftt 3- That the project which is subject to Environmental Review ~p.de~ ChaPta~_ ?2, 37, or 97 of ~heTown code ~s open to p~~:ic c~~ent on: You way contac~ the Trustees Office ¿t 76~-12S2 Qr In ~riting. The above ~efe~3~ced proposal is under review cf the Board of Tr~5~ee5 o~ t~e Town of 50uthold and does not reference an, ot;"er agency that !!1Íght have to review Sa.!l\e proposal. PHONE :.: 'r111.-i)Ir¡-í/,I¿:j \1 OWNERS NAME: -=:2 v\ MAILi~G .~DRZSS: Ene.: Copy of sketch or plan showing proposal for your convenience. . . SI:P r ,- I 9 '", September 17.2001 Board of Town Tmstees Town of South old Town Hall 53095 Route 25 P.O. Box 1179 Southold. New York 11971 Dear Sirs/Madams: Please be advised that I have completed the work covered under Permit No. 5350 issued by the Board of South old Town Tmstees. Please contact me if you need any other documentation, pictures, etc. (7;1~ Paul Loeb Paul Loeb 347 West 55th Street #4-L New York, NY 10019 (home) 212-315-2165 (work) 212-554-7630 (9:30a-5:30p) (work fax) 212-554-7700 05: 29: 01 TUE 14: 04 FAX 516 765 1366 . SOULhold Town AccounL1ng . r¡¡¡ '"'" þJb~rt J. Krupski. President James King, Vice-President Henry Smith Artie Foster Ken Poliwod.. Town Hall 5.3095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _CoastaJ Erosion Permit Application ~etland Permit Application _ Maj')r Waiverl AmendmentlChan,ges ~,:d Application: lit S13//~ :-R.eceiwd Fee:$ Sb - rr _....cámpleted Application :;;}'311öJ I~ _Incomplete ' _SEQRA Classification: Type 1__Type II_Unlisted_ Coordination:(date sent) /tAC Referral Sent: S13/ 101 --L.'I'>ate ofInspection:_hJi3/01-:= _ Receip1: of CAC Report: Lead Agency Detennination: Techni,;al Review: .....-Public Hearing Held:-..hr.;}llOt R.esolmion: .-"1~:_ ? ~ !"".llor . " ~ l,j _, MAY 3 I 2001 Name of ApPlican~ \ LG~ Address-3llJiliQl5 51Y\ ,~écl1t1-L I µ~ qJ~_ 100 l g I I G'" t4 PhoneNumber:( ) (1.\ð--~II)-~\£f) h) 0,,\8--554-7(;50 ~ Suffolk County Tax Map Number: 1000- ~ D( -() II DD - 01 0 I 000 (OOO-3~-I-lò7 Property Location: (\ ~' ~ dC\~h(¡\J9f,Ó(Jv\-~ \U .~ ~~()í\ f(\tl'ln:2±feP-f (provide LILCO Pole #. distance to cross streets, and location) AGENT: (If applicable) ~ ':þ\~\~'j \D Address: Phone: 05"29'01 TUE U:O~ FAX 516 765 1366 . Souëhold Town AccOUnëlng . I¡I] no:', Board of Trustees Application , GENERAL DATA Land Area (in square feet):~ Area Zoning:_~~'~~~í ~\ ~"~ofpro__ q~~~~ Intended use of property: 4 . ~~ Prior permits/approvals for site improvements: Agency Date .K No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or SU~~d by a governmental agency? No_ Yes If yes, provide explanation: Project Description (use attachments ¡fnecessary): -W\~\lìY\S ;;-\-\>(11\ lµì\\~QVh ~0~(~t1b~ ~~\A 1~~~I~i:r<th~6f~~\ {JJ\~~" 6~~0 (~~ hì(\ÇJ D~ ~()ili\\ ~ . Southold Town Accounting . 14J0IH 05' 29' 01 TUE 14: 04 FAX 516 765 1366 Board of Trustees Application , " WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose ofthe proposed operations: 0() a \ \ -te1ì1lnH (\ ~~\:fJf; iL ~ r()D\\~ ~n . '--$-0(1\- Ó ,'* Area of wetlands on lot:_ .5 I D () () square feet , :/Œercent coverage oflot: 233 % ~Closest distance betweenllearest existing structure and upland edge of wetlands: :3.u feet 'iI Closest distance between nearest proposed structure and upland -'1'edge of wetlands: 6 () feet Does the project involve excavation or filling? ~ _No Yes If yes, how much material will be excavated?__cubic yards How much material will be filled? cubíc yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations:_ Manner in wlûch material will be removed or deposited: 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): -5 ~M\ I)l-e.. (100 ~~:t C¡ì -t\~ \$st\-a\01¡ ®ct --t\ è\ 11 \ \^-) 1\~í 6 - ,;t Q,~f0;\\{n~e\~ . ttoard of Trustees ApPlicat~ County of §¡Iftàtk NW V cnJc State of New York 1 ~ j)êtv \ Lo~b BEING DOL 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 HlS/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. Jk~~~y Signature SWORN TO BEFORE ME THIS Ktk- DAY OF ~~~;, ~~ TAMMY LAVOIE NOTARY PUBLIC. State of New"/bllc Wes1chester Counly No. 0.1 LA60sq8J.í! CommisBion Expires April 0.2, 20ro ~fiL .2oA ---. . .. v NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: ~L~ SCTM#1000-j4-1-IL YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: ~O"()\ìe., 6ùh~~ùí~h rai\ I \êf\a~~.l}J"'~O~h~(¡ícl\m\ I \,N\~ ~ ~oí~~~e,~6 ð(\ M~'.tJlo.'e..- oCc~fl0\ ftM vúf~6 ~ () Y\ ,~vtR1ìót ck ~~ 2. That the prop rty which is the s ject of Environmental Review--.is located adjacent to your property and is described as follows: 1?-75 m&V\ &\\ee\--; 0~~ot, New~ú{Y- II~~Y 3. That the project which is subject to Environmental Review under Chapter, 3UD 37, or 97 of the Town Code is open to public comment on: ~ ~ 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: MAILING ADDRESS: PHONE Ene.: Copy of sketch or plan showing proposal for your convenience. s "?IT/au · ,..~'-' '-A~. f~ß c~ 'Ç) & <E - ----k' <::> ?\>=~~ ¿)ojÇ2/ S ~ ::: 'd' ~ ~ .~ ~:E 2jj ~ ;;0 ~~'.8 5J~ c -=r- ¡j €-~ ~ ---2 ~ -\"'" _<B~ '<=;ð'" -"'< ~~ 1/\' I I>=~T' ;\ II 1/ .. Cc..+- ~& N o ~ v m o lL W a: \ \ \ ~ ~\ t ~IO Wi:::::: >a:O w'" ::;0::;0'" 000 I-I-W (1)(1)1- =>=>« 000 ,r-', ( , (4 \ '0. ~ '-~&. J >- z <X) 1-(') ",a: 0 ~Ol n.r- WZr- I-W... cn=>WI ~~g~ ~¡ \ "--' \ ~., . '~ <= ~ &..""~ , -. , - ~~ --j- ~£ c .-ç-., ')2 Ð 'ð s::::. ~\Ò .~ --0 ~~ .-22-< -) ~ 6~ ~:f --¿/w ---t; .3 ç;: 'ZJ ~ Q) --0~ -~ - ,. ----. . I .. "1 1441~ (12197)-q rROJECT 10 NUMBER v 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART I-PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) SEaR 3. Coun I a \5 rY\ ~ r\ 6trect- road intersectIons, prOlnlnent Ie dlnarks. eJ ~&r~~~~~ 6vJt~ ~ Cw\~ eel y 8' G(OOì&oIt/ fJw~of¥- Hq~~ D ý\ {Y\ê1ir\6tíæ-t 5. IS PROPOSED ACTION: o New 0 Ex ansian Modification/alteration 6. DESCRIBE PROJECT BRIEFLY; "R~6D\i~~~ í~i\ ¡f~I~(,J\i-hÖ~T\e(jti (ail Wìðefl tbfth b () Y\ Gô6-\-6iðe ~ or~ A&~ ~ D (\ 6où\1\¿; id.e- cÆ r:f0Ì\ 7. AMOUNT OF LAND AFFECTED: Inttially acres Uhimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ~s 0 No If no, describe briefly IO~ b-{te-t' 9.~A IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential 0 Industrial 0 Commercial 0 Agricuhure Describe: o Park/Forest/Open Space. o Other 10. DOES ACTION INVOLVE A PERMIT APPROVAl, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or l.cc:al)? ~es 0 No If yes. list agency(s) and permkJapprovals 6w\ho\ð. -)O()J/\,,\(v61ee6 ù\ 11. DOES ANY ASPECT OF THE ACTION HA A CURR LY VAUD PERMIT OR APPROVAL? o Yes If yes, list agency name and permit/approval 12. ~RESUlT OF PROPOSED ACTION Will EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ~Tes oNo , CERTIFYL;,£E INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Ii APPIICantlS~ Date J¡ "t; I Signature If the action Is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with thIs assessment OVER . 95· 19-3 (10/98)--q NEW YORK STATE DEPARTMENT OF ENVIRONMENTAl CONSERVATION OFFICE OF GENERAL SERVICES UNITED STATES ARMY CORPS OF ENGINEERS DEC APPLICATION NUMBER - JOINT APPLICATION FOR PERMIT" '* f.'Pf.iI ~ US ARMY CORPS OF ENGINEERS DISTRIBUTION 151 COPY 2ND COPY 3RD COPY 4TH COPY 5TH COPY Permit Administrator Corps of Engineers Program NYS Agency Applicant 1. P1eose read AU instructions on bock. Check permits applied for. Attach additional information as needed. o FRESHWATER WETlANDS 0 TIDAL WETLANDS 0 WATER SUPPLY 0 LONG ISLAND WEll o PROTECTION OF WATERS FOR, o A. Construction or placement of docks and moorings 0 8. Construction, reconstruction, or repair of a DAM or other impoundment structure Dc. Disturbance of 0 STREAM BED or BANKS or excavation in or fill of NAVIGABLE WATERS 0.401 WATER QUALITY CERTIFICATION o COASTAL EROSION CONTROL 0 LAKE GEORGE PARK COMMISSION (Docks and Moorings) 0 WILD, SCENIC OR RECREATIONAL RIVERS o AQUATIC PEST CONTROL FOR: 0 A. Aquatic Vegetation Control 0 B. Fish Control 0 C. Insect Control o LEASE, LICENSE, EASEMENT, or other real property interest in state-owned lands under water 0 UTILITY EASEMENTS (Pipelines, Conduits, Cables, etc.) 2. LIST PREVIOUS PERMIT/APPLICATION NUMBERS AND DATES (If any) 3. IF OTHER THAN INDIVIDUAl, PROVIDE TAXPAYER ID NUMBER o Lessee o Municipality/Governmental Agency (Check as many as apply) o Agent -I- 6. NAME OF OWNER (if different than number 5 above) DOwner 0 Agent/Contact Person MAILING ADDRESS POST OFFICE TELEPHONE NUMBER (Daytime) I STATE ZIP CODE DEC USE ONLY NYTM·E NYTM~N 4 9. Name of USGS QUAD MAP n on starting work without permit, include dotes) 12. APPROX ION DATE Private 0 Commercial. No 15. PROJECT ESCRI ON AND PROPOSED PURPOSE: (e.g. quantity and type of material to be excaYOted, dredged or used to fill or riprop; location of disposal sites; type of structure to be instolled; height of dam; size of impoundment; capocities of proposed water :sources; extent of distribution system; size of marino and types of docks and maori...lobe;n...""';",) ~D(\d t)r~(â,Ì\ ¡fl1V~LùM~Y\~mfaj W\ðer\ ~O(~ !J 0 (\ ~ólde ck-@~ AM ~ofth 6 :; () V\ 6od\n;ldec£~rdì I herebY affirm that i onnation provi ed on this form 0 0 affochmen subm· tHt ith I e Folse statements made herein ore punishable os 0 Class A misdemeanor pursuant to Section 210.45 the Penal low. Further, the applicant accepts full responsibility for 011 damage, direct or indirect, of whatever ncrtu.-., and by whomever suffered, arising aut of the project described herein and agrees to indemnify and lOVe harmless the State from suits, actions, damages and casts of evet')' name and description resutting hom said project. In addition, Federal law, 18 U.S.C., Section 1001 provides for 0 fine of not more than 510,000 or imprisonment for not more thon five years, or both, where on applicant knowingly and willfully falsifies, conceals, or covers up ø material fact; Of" knowingly makes Of" uses 0 false, fictitious or fraudulent stotement. g.",,:, ,outho.;", ... 0.... nomod in '7.'J':' ',y"-.,\ IO,:~,,". Ih;, opplkol;on on my be..... ^ () ~ Oate~ S;gnotu...ofOwno.-~y':~ rol. OLVlro- Date $ignotu,. of Agent/Contact Person Trt\e . GENERAL INSTRUCTIONS INCOMPLETE OR INACCURATE INFORMATION MAY DELAY PROCESSING AND A FINAL DECISION ON YOUR APPLICATION 1. Type or print clearly in ink. Attach FIVE (5) copies of additionol information required in A through C below: A. A USGS map, or equivalent showing the projed locotion. Include on the mop wettonds. seasonolty wet meoms and ditches B_ A ~~etch pIon drawn to scole or with dimensions given or engineering drawings showing Iobmon and erlent of work os well os view dlrccloons of the ohotogrophs required In C. C AI le'Jsl three (31 representative ~olor photographs of the project Qrea ond surroundi~ wrth time and date wher. they we.-e faken indicated 2 Applicot.ons 'oJy (ounhe!., cities, lawn.. ond villages must be signed by the chief executive of that municipohfy or the head of the department or agency under1fJking the pro,ect 3 If someone other thon owner makes applicatlan, wriHen consent of the owner to uoçe the Pf"operty/focility mU'50t accompany the application 4 The ap~I'cant IS 'espon~lble for obtaInIng any other req'Jired federc.l slafe or l..xal pe~mrti Separate authorization or leher of NO JURISDICTION should be received from DEC, A~A and the Army Corps of Engineers prior 10 initiation of won.; in wetlands or waterways. OTHER REQUIREMENTS 5 If pr0jp,:t is an "nli~ted act".n pursuant ta the Slate Environmental Quality Review ÂC1 regu1ohons.-----.6 NYCRR, Port 617. a complered Port] of a Short Env,rQ~"nenfal A~sessmenr Forn, must be SubmlHed with ,I,e app:ICajon 6 If pralt',:r IS a T\,pe I aCllon pursuonr to the StaTe Env,ronmental Quality Review A.cl regulations_-6 NYCRR. Part 6 17, a completed Part 1 of a FuJI EnVlr('lllmenta! kse~smen1 Form must be sclJmltted wnh Ihe application :' If proiccl is classified a~ major pursuant to the Uniforr>1 Procedures Act regulahons--6 NYCRR, Part 621. 0 completed Part J of a Structural_ A.rchec.IGYlcal Asse~sment FGrm must bp submitted "'J'h the apphco:lon 8 If the project requires 0 bderal permil and lies wIthin 1he CoasTal Zone. 0 COfrTple1ed Federal ConsIstency Assessment Form mu~t be submitted wllh the applicatIon. SPECIAt REQUIREMENTS FOR SPECIFIC PERMIT AP!ttfCA"!"IONS Q Appl,co 'Ions for the constr....ctl')n, reconstruction or reparr of (] DAM or other IMPOUNDMENT STRUCTURE musI be CKcomponied by Supplamenf D- I. 10 Applrcatlons for DO(K, PLATFORM OR MOOR,NG FACILITY PER-MITe; ",usl be al..compomed by S'-'pplemenr 0-2 11 Applicotions for WATER SUPPLY OR LONG ISLAND WELL PERMITS m....st be occcmponied by 'Supplement W_1. 12. Appkorlons for a permit to apply a CHEMIC\l TO CONTROL OR ELIMINATE AQUATIC VEGETATION, FI'SH OR INSECTS must be accompanied b\, the proper supplemental form available from the department 13 Applicahons for WILD, SCENIC OR RECREATION II,L RIVERS SYSTEM PERMIT mu~t be accompanied by Supplement WSR-I 14. ApplIcaTions for a federol permit to disturb 0 wetland or waterway by placing Fili ar performing mechanIZed land dearing, d,t-:hing, channeli;¡;aflOn dredging ar excavation activities un<:.ler Section 404 01" ocean dumpõng under Sectioo 103 of the C1ean Water Act .s;hould Pf"ovide a discussion of practicable alternatives considEred to ovoid, minlmi;¡;e and lor mitigate the proposed project impacts. Particular iustifj~alion should be given os to why the aHernotives ore not suitable. Contact the Regional Permit Administrator, Division of Environmental Permits, at the appropriate office of the Deportment, or respective Corps District Office, as given below, for assistance regarding any of the above requirements. Consuh other available application instruc!ion maierials for the appropriate permit types. For odivities located withtin the Adirondack Pcri.:, thi'50 is not on application to the APA. The APA will be provided with 0 copy of 'his material and upon review, may contact you for additional information, if necessary. DEPARTMENT OF ENVIRONMENTAL CONSERVATION DIVISION OF ENVIRONMENTAL PERMITS legend o ftegional Office . Regional Sub-OHice ...... I Buildlllg4(1,SUNY Ston,Brook. NY 1I790·23S6 (516444-11365 _2 I HuntenPDintPlara 47-4D1hrSrr&et LongliløndClty.NYI11(11_S40] (7184B1-4997 _2 11 SøutbPurtCørnerlRood Ne.PuItz NY 12561-1696 (914) 156-30S4 -. l1SONørthWe5(OIlRood Sl:hene(tody, NY 11306-2(114 1"'1351·2069 IIGIOII 4 s.6-Office JeflerillnRood,RoutelO tlCR#I,80.3A 5Iømrord,NYI2167_9S03 (6117651-1741 ...... S Route86,POBox2% Ro,Brooll,NYI1917·0296 (518)897-1234 -......... CøuntyRaute40,8oJ:21O Worrwburv. NY 12885·0220 (5181623-3671 ...... . SloteOfli¡eBuildlng 317 Womingtøn Slreer Wølertø.n. NY 136111·3]87 f31S785-2145 IEGIOII 6 Wt-Dffice SrøteOflIteBullding 2(1] Genesee Street UIKCI,NYI3581-1885 (3151]93-1555 ...... 7 6IHneBIYd.W. SyrlKUse, NY 13204.1400 (315)416-7438 . _7"'"", 1285 FisherArenUl (artland,NYI3045·I09O (6077S3-309S - o f!lIJ ~ ~~ .A£. ......., ""'16."" ..........,'1917 (111)19'_ -. 6214f.A'fOn-LlmaRood AlOO, NY 14414-9519 (71611ft-2466 -. 770 MKbi¡anAvenœ Buffalo,NY14103-2999 (716)851·1165 -....- I28SøuthStreet 0IHR,N'I4160-0645 f7l6) 371-6242 ---.......- _.........111"-._ ............ ""'.. '-.,....... _.... bi, NY '07110090 ......... 71l176W3!.IIE{_I)..........._c-;" P'lI,...,as.lIE{_ ¡_........._""',..., ....F8d_ ,....s.r.r, h,:.1f In. ..... (S1'Jm-058B~,Df(RegiolK4.5 ..........., ""''''- 171'.... --......111 t41I7-JI" w.p.. 1716 879-43J, DE( RegiolK 6.7,8.9 APPLICANT TRJ\NSJ\CTIONJ\L DISCLOSURE FORM . .. V-\- The Town of Southold's Code of Ethics prohibits contlicts of interest on the part of town officers 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 avoid same. YOUR "J\HRI . :,~r ,: : <.~~::~~';\- ~ Las name, irst name, m dd~e you are applying in the name of someone else or other entity, such as a company. If eo, indicate the other person's or company's name.) . . ,,?;.lJ,l·. . Or' "...". ,. NJ\TURE Or J\PPLICATIONI (Check all that apply.) Tax grievance Variance ~ Change of zone ^pp~~al of plat Exemption from plat or official map other (If "other," name the activity.) Do you persona11y (or ~hrough your cOMpany, spoune, sib1ing, parent, or chi1d) have a re1ationship with any officer or emp10yee of the Town of Southo1d1 wRe1ationshipw includes by b1ood, marriage, or business interest. -Dusiness interest- means a business, including a partnership, in which the tovn officer or employee has even a partial ovnership of (or employment by) a corporation in vhich the tovn officer or employee ovns more than 5% of the eharee. YES NO x If you ansvered -YES,- complete the balance of thiø torm and date and sign vhere indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between youree If (the applicant) and the town officer ør employee. Either check the appropriate line 1\) 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)1 1\) 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 beneficial owner of any interest in a noncorporate'entity (when the applicant is not a corporation), c) an officer, director, partner. or employee of the applicant, or D) the actual applicant. DESCRIPTION OF ItEL1\TIONSIltP ..... " . ., ".~. . , . ..,..... .....~_~A·.~~~...·. ....'L.. ":i . ::""i~;;,::~;~¡/~W ',.... , Sigl\lI ture '. Print name~ L.Q£,\A,;¡:..ù:¥;,,';,..:.+,;~~ ""'~:~ "." '", ,",' :,1 '(.~~ .~'t.~~~. ": ~~'.~~.'. ,~~..~,.~~~.Jijr-\ f'~~j:><.~...t-I·:!;(~;;J ~~ 9i·~;·~·t:·).t·.v ~ th1, ,:~ .f ....:.\ '. ' ..., ~~~ ;'7:¡)tr~ ;..f.:"::~,,ì._~~,,'-ð~' ~;;." .' submitted .\!\\' .........;,,¡.:.j.