HomeMy WebLinkAboutTR-5990
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TERMS end CONDITIONS
ne Permittee
residing at . _ N. Y ~ as
part of che coasideraûon for the i~··~ of «he PCm.k docs IIØCIeøtaod and pæsaibe to the fol-
1owJø :
1. That che IIid JIoud of Trustees and «he Town of SoudJoId are Idelted from Il1J II1CI
aU cIama&es. oe claims for daaIIga. of IIÚII adÄø&. dirccdr oe focIirec:d, as .. ~ of Il1J oper-
.&apetfc-mIeCIf'·-""'·.äis ~ 1IIII.:Ib.e.llid. ~, '''-m!!..~ ~ oc.~ own ~.
delead any and aU IUCh IlÙts'I..ItI.~ bJ chhd f'uda, &Del che said Þ , ..!Ilk IU ..., faUlåbIUtJ
with mpect cheœto, ¡o the ·''i'~-..hosloa of che Bad of ~ of che Town of SoudJoId
2. That chis I'eøbk is· aIid for .. pedod of mos. -wIW:h. Is ciI:/ otl<lc"t>J to be che
estimated time· requited toaÎmplete che 1iOdc 1n'fOhoed, t>utihoaJd cúc:amswxcs wattaOt, rec¡aest
for an ttϿsioo _y be mode to che Poud at .. later -.
3. That this Permit should be retai.aed Indefiolcdy, or as Ioog as the IIid PeauIttee wIsIaa
, to m.I....:.. the strucQIre or pft!ject iavoIved, to provide evidenœ to aoyo<>e coaœrued that IIIIh-
(Jrizaôoo was origlaally ""'-I......
4. That «he work involved wiI1 be lIIbject to che ~ &Del approval of ihe Boatd oe
III agents, and _......,,11._ with che prcrrisioøs of the Nlg/....dag appliadoo, may be aase foe
ft9OCalioo of this Permit by mollsdoo of the said Boud.
s. That tbeœ will be DO WlftlIOII&bk Incerf_ with am,pdoo as I radt of the work
Leœin aùchorized.
6. That tbeœ sbaU be 00 Incerfereoœ wich the ri&bt of che puhUc to pus &Del repus aIoog
che beach bet1v_ tIIøh &Del low _ G*b. .
7. That II Í1âre opetatioos of che Town of ~ nqake che. œmon1 aod¡oe ........tLv.o
In die Jo-ootl.,n ofche 1IIIIk t.ereIn ..,d D\o I~ or If, Iø. che TøIoa of. BoaøI of n-, «he.
wed: sba11 cause 1IIIftII......"'e obstNaIoa to free aavI :aioa. the said p.r...IHH will be ~
IIf'O'1 Dae oodœ, to - or ~ chis 1iOdc or project bcreIn ... wkL."ol ØpCIltCI to «he T_
. of SoIdboId. . .
8. That lite aid Boatd wiI1 be oodfied by the 1\" ./c~ at the ~I ~.. of the work IIIIh-
odzed.
9. That the .p;....~,~ wiI1 dJtaio aU ocher petmIts aM ~ If 6at "., be nqahecI ..p.
...-... 10 this permit ~ _,·be RIJfect to teYOIre IIf'O'1 faIIaœ to obtIIa __
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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
September 22, 2004
Alia Imennova
295 Mockingbird Lane
Southold, NY 11971
RE: 295 MOCKINGBIRD LANE, SOUTH OLD
SCTM# 55-6-15.59
Dear Alia Imennova:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday September 23, 2004, regarding the above matter:
WHERfAS, ALLA IMENNOVA applied to the Southold Town Trustees for a permit
under;he provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance
of the Town of Southold, application dated August 23,2004, and,
WHEREAS, said application was referred to the South old 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 September 22, 2004, 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 standards set forth in Chapter 97 of the
South old Town Code,
2
.
.
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 ofTrustees approve the
application of ALLA IMENNOVA to install a 12' X 16' shed and all as depicted in the
plan prepared by Young and Young received in this office August 23, 2004 (see
attached plans).
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 $50.00 per inspection. (See attached schedule.)
This is not a determination from any other agency.
Fees: None
Very truly yours,
~I 9- ~.~.
Albert J. Krupski, Jr.
President, Board of Trustees
AJKlhct
.
.
Telephone
(631) 765-1892
TO","l1 Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
CONSERVATION ADVISORY COUNCIL
TOWN OF SOUTHOLD
At the meeting of the Southold Town Conservation Advisory Council held Tuesday,
September 14, 2004, the following recommendation was made:
Moved by Don Wilder, seconded by William Cook, it was
RESOLVED to recommend to the Southold Town Board of Trustees DISAPPROVAL of
the Wetland Permit application of ALLA IMENNOVA to install a 12'X 16' shed.
Located: 295 Mockingbird Lane, Southold. SCTM#55-6-15.59
The CAC recommends Disapproval of the application and recommends a 100' setback
from the wetlands and a 20' non-turf buffer.
Vote of Council: Ayes: All
Motion Carried
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Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
.
Town Hall
53095 Route 25
P.O. Box 1179
Soutbold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
~stal Erosion Pennit Applica~
~etland Pennit Application Major
- -
Waiver/Amen C es
.-Received Application: t)
-'Received Fee:$
_..emnpleted Application
_Incomplete
_SEQRA Classification:
Type I_Type II_Unlisted_
_coordinatiOn:(date~en
~AC Referral Sent:
~ate of Inspection:
_Receipt of CAC Report:
_Lead Agency Deterrnination:_
Technical Review:
~ublic Hearing Held: Cf I~ I t/jl{
Resolution:
Name of Applicant
A.tta-
Office Use Only
Minor
ID)IIE Ie IE n ~ ~
l\rtl! AUG 'L 3 2004
Southold ToWII
Board of Trustees
-.
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Address 2!l¡; /77oe 1:.1 ~f?¿I2« ./a.l1e SOwl-k>.J'dt"
)/'1 //911 PhoneNumber:(þ3y ;:¡-£5- .§l2./2
Suffolk County Tax Map Number: 1000 - 5 j- 6 - /5'.29
Property Location: 2q) MOcÍuJ hléJ. Lq, ,~¡". 'th.o{c.Q, NY
(~
10,\1 ~ ,ìS'-\
1\J~
(provide LILCO Pole #, distance to cross streets, and location)
AGENT:
(If applicable)
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Address:
1/ / A
f
Phone:
.
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Board of Trustees Application
GENERAL DATA
Land Area (in square feet): 301 64tO gtj. Ii
Area Zoning: -ze S I 6fe 11 il a -c
Previous use of property: ;zes I .-Ie n 6t ae
Intended use of property: -7<!".s' / ~11 it a-.é:
Prior permits/approvals for site improvements:
Agency
Date
t/ No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a governmental agency?
V No_ Yes
If yes, provide explanation:
~/A
Project Description (use attachments if necessary):
7/JJ'iA~.é'~-fIt?11 o/a .J~e/ .:/t> Sltne ~J
1f;1~Ô~S (Y2) tUr/ '7æb 0"// s)~,( h//¿e
-tk debl/u¿/ au,!' æH~/?76¿"/ tlV S'lie /(/1zt,1/h
/5l/1~ ~r' W?I2e Ivld Æ M ¿!,t(eæf/az7Ø? 02 ~/4r
0/ #e ~PI'.
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Board of Trustees Application
WETLANDITRUSTEE LANDS APPLICA nON DATA
Purpose of the proposed operations:
h:? IlJf"¿o¿¿
2'lV'za f"e.
C/
æ .s.,(~~
?Z d/tJt"/ ÞV'/1a-é'
Area of wetlands on lot:
/q.3~ square feet
6.5' %
Percent coverage oflo!:
Closest distance between nearest existing structure and upland
edge of wetlands: /5'0 feet
Closest distance between nearest proposed structure and upland
edge of wetlands: 50 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?
cubic yards
Depth of which material will be removed or deposited:
feet
Proposed slope throughout the area of operations:
Manner in which material will be removed or deposited:
J/ /,1
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):
;I/o ¢~ i.
t:u? t?ee~/~/
Î/JJ>"¡a~Oh 1f't:?/1 ¿;¡12(/,
V'7
~t/ we.U' - P¿Úne/ ¿¿;¿¿;~
.
.
Board of Trustees Application
COASTAL EROSION APPLICATION DATA
Purposes of proposed activity: h //lfT¡;?.ee :t:f~ S'",(¿ot?/' ~
ú?/~t7t?ñd s70?7t>.
Are wetlands present within 100 feet of the proposed activity?
No V Yes
Does the project involve excavation or filling?
V No Yes
If Yes, how much material will be excavated?
(cubic yards)
How much material will be filled?
(cubic yards)
Manner in which material will be removed or deposited:
piA
I
Describe the nature and extent of the environmental impacts reasonably anticipated resulting
ITom implementation of the project as proposed. (Use attachments if necessary)
A0 .!'IP/7I7í ~ t2u7 ~ 2 lfe-2/?7aa -0,-7'
(/ /
7a/
¿;,?f/I/U)/7/17e-n -
/m,,5æe7 If'
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aaf/t!'1 ,,(¿:v-/.e/,
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I'PROJECT ID NUMBER
PART 1 - PROJECT INFORMATION
617.20
APPENDIX C
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
( To be completed by Applicant or Project Sponsor)
SEQR
,. APPLICANT I SPON&Q,R
tft~ 1;n¿.I1/1p!/tZ/
3.PROJECT LOCATION:
Municipality hWi7 07' Spq-lµ'( County ~ .e.c
4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks ate - or Dfovide map
"tQF /lJocÞ-¿¡..ð1-U( /ane I S'om~-é'¿¡I' ¡Vý //ß# 4~-¿-'" )
£'~e ;n. 1n02~ V",~f- /
2. PROJECT
!GIO¿
NAME
dXe¿f .!'"'n f'7ltZ,ä~æ-Þ Ph
5. IS PROPOSED ACTION: ~ New
o Expansion D Modification I alteration
6. DESCRIBE PROJECT BRIEFLY:
7hdt2¿eø/ro/J 0/ t:Z f'-Æe¿f y0 ~<' -fo.c4>/ .ð77~åS'~..t) t24'q?
~~þ (0/. S'!fR¿;f' WI--f'£ /e ~4'V'U<!'/ aa/ /2í!;f't";n"'--v~ a,-
&Í'ftP IVI-hf/l" Onr /r. ~R Ie//.¿'--é' ð(- #0 -?/re"øU'2 frO;? &2
çIÍ¿~r 0/ 77k ~I'/
7. AMOUNT OF LAND AFFECTED:
Initially O~ / acres Ultimately I /~ acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
~ Yes D No If no, describe briefly:
9. WHAT IS PRESENT LAND USE IN VICINITY
~ Residential D Industrial DCommercial
OF PROJECT? (Choose as many as apply.)
DAgriCulture D Park I Forest I Open Space
D Other (describe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING.
AGENCY (Federal, State or Local)
IX! Yes D No If yes, list agency name and permit I approval:
,Øw ~d!r /J. ,t':Z/V;Ifflev .7'
NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
p4/t/0-/ 1ò1V/I 77k.f'~â'.f/
(Scw-!/¡oåf)
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
:J Yes ~ No If yes, list agency name and permit I approval:
'-
12. AS A ~ULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION?
Ges ~No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant I Sponsor Name
.«'¿~ JmM/lOþ'~
Date ~ý /o¥
Signature
If the action is a Costal Area, and you are a state aQ.l¡.ncy,
complete the Coastal Assessment Form before proéeeding with this assessment
.
.
PART II - IMPACT ASSESSMENT (To be completed by Lead Agency)
A. DOES ACTION EXCEED ANY lYPE I THRESHOLD IN 6 NYCRR, PART 617.4? It yes, coordinate the review process and use the FULL EAF.
Dves DNa
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR. PART 617.6? If No, a negative
declaration may be superseded by another involved agency.
DYes DNa
c. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten. ~Iegible)
C1. Existing air quality, surface or groundwater quality or quantity, noise levels. existing traffic pattern, solid waste production or disposal.
potential for erosion, drainage or flooding problems? Explain briefly:
I I
C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly:
I - I
C3. Vegetation or fauna, fish, shellfish or wildlife species. significant habitats. or threatened or endangered species? Explain briefly:
I I
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 briefly:
I I
C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly'
I J
C6. Long term, short term, cumulative, or other effects not identified in C1-C5? Explain briefly:
I I
C7. Other imoacts includina chanaes in use of either auantitv or tvoe of energy? Explain brieflv:
I I
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
ENVI RONMENT AL AREA (CEAI? (If yes, explain briefly: I
DYes 0 Na I
E. IS THERE. OR IS THERE liKELY TO BE. CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain:
o Ves DNa I
PART 111- DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each
effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e)
geographic scope: and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain
sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked
yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristjcsofthe CEA.
Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed direcUy to the FUL
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 actio
WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary. the reasons supporting thi
determination.
Name of Lead Agency
Date
Print or Type Name of Responsible Officer In Lead Agency
Title of Responsible Officer
Signature of Responsible Officer in Lead Agency
Signature of Prepater (If different from responsible officer)
. .
.
.
Albert J. Krupski, President
Ja:rp.es King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
~
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
That on the /1 day of C"<:I~il-90t, I person~lly posted the property kno~ . Þ'
-¡-' rrrq S- Inoc.l ')1 ?~ '4 ð't2erT~¿"~ A/1" //g
by placing the Board of Trustees official poster where it easily be seen, and that I have
checked to be sure the poster has remained in place for ei ht days prior to the date of the public
hearing. Date of hearing noted thereon to be held . .;) _
Oc'\.()r ~ ()...tt '):0)
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
of
----!:JtJL\~__~~~~_________________________
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
""
I, ,1'-1'4 / In ·0117 (? Y ~siding at
~/-Æ¿t7!, )/l( //gij
being duly sworn, depose and say:
'?.9,7
mOl!:f/I'7/'~ltJ1/' be
o
Dated: gj;3/0i¡
¿fa"
(signature)
~~ee, /
Sworn to before me !}ÚS
¡.JI!; day of 5.¡:hnba,fJo 1-
Gf!4ð-ffud
Notary Public ¡
..
-....
.
.
Board of Trustees Application
County of Suffolk
State of New York
¡¡¿('tV /lnel1/?or4/ 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 mS/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
REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.
I{(~/ /~
Signature
SWORN TO BEFORE ME THIS ;2J DAY OF d Aj'
,20~
/} //
~Øc-éÞ~
lÑotary Public
PATRICIA CORWIN
1I0ta~ Publi~ Slate of New M
NO.OIC05011852
Qualified in Suffolk Cotm\J ~ ....,.)~
~·<r"'!~SII1" ExpiresSept.13...-::::::;¡:,¡~
.
.
APPLICANT/AGENTIREPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics orohibits conflicts of interest on the Dart of town officers and emolovees The Duroose of
this fonn is to nrovide infonn8tion which can alert the town of DOssible conflicts of interest and allow it to take whatever action is
necessarv to avoid same.
YOUR NAME: ÌlnU1/1tJVa, a¿e¿:& .i
(Last name, first naine, .qIiddle initial. unless you are applying in the name of
someone else or other entity, such as a company. Ifso. indicate the other
person's or company's name.)
NAME OF APPLICATION: (Check all that apply.)
Tax grievance
Variance
Change of Zone
Approval of plat
Exemption from plat or official map
Other
(If "'Other". name the activity.)
Building
Trustee
Coastal Erosion
Mooring
Planning
v
Do )'ou personally (or through your company. spouse, sibling, parent, or child) have a relationship with any officer or employee
of the Town of Southald? "Relationship" includes by blood. marriage. or business interest "Business 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
ytJ
[fyou ans\\'ered "YES", complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of South old
Title or position of that person
Describe the relationship between yourself (the applicant/agent/representative) 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):
_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 beneficial owner of any interest in a non··corporate 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 RELATIONSHIP
l/ IIf
.
Form TS I
S~hmitted this ~aY 01 ;, 200
Signature /' ~-
Print Name elf ,(/01//1