The URL can be used to link to this page

Home My WebLink AboutTR-6076AAlb Ja~ .~rt J. Krupski, President ~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 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE 0052C Date August 4, screened enclosure on existing deck THIS CERTIFIES that the 2225 North Sea Dr., Southold 20O5 Suffolk Count, Tax Map # 54-4-23 Conforms to the application for a Trustees Permit heretofore filed in this office ~ated 2/11/05 pursuant to which Trustees Permit # 6076A Dated 2/16/05 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 the screened enclosure on the existing deck he certificate is issued to ~oresaid property.. JOSEPHINE PEARLSTEIN owner of the Authorized Signature Albert J. Krupski, Preside~ · ~. James King, Vice-Presider] Artie Foster Ken Poliwoda Peggy A. Dickerson BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone(631) 765-1892 Fax(631) 765-1366 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. INSPECTION SCHEDULE __ Pre-construction, hay bale line __ 1st day of construction % constructed c,,'~roject complete, compliance inspection. · ~ Albert J. Krupski, President James King, Vice-President Artie Fester Ken Poliwoda Peggy A. Dickerson Town Hall 53095Route 25 P.O. Box 1179 Southold, New York11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6076A Date of Receipt of Application: February 11, 2005 Applicant: Josephine Pearlstein SCTM#: 54-4-23 Project Location: 2225 North Sea Dr., Southold Date of Resolution/Issuance: February 16, 2005 Date of Expiration: February 16, 2007 Reviewed by: Board of Trustees Project Description: To construct a screened enclosure on an existing deck. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 97 of the Southold Town Code. The issuance of the Administrative Permit allows for the operations as indicated on the survey prepared by August 4, 2004. Special Conditions: None If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 97 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Albert J. Krupski, Jr., President Board of Trustees 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-~1 TO: BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated reviewed by this Board at the regular meeting of g//~/D~ following action was taken: (---~..) Application Approved (see below) (__) Application Denied (see below) (__) Application Tabled (see below) has been and the If your application is approved as noted above, 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: TOTAL FEES DUE: SIGNED: PRESIDENT, BOARD OF TRUSTEES SURVEY OF TOI~IN: .~=OLK COUNT~, SURVEYEE> Ot5-O4-2OO4 SUFFOLK COUNTY TAX # IOOO-54-4-2D N / '/o --/, ./ Board o') Trustees NOTE~ f"1ONUMENT FOUN[2 ELEVATIOND REt=tEt~,tENC, E N~VI:P'2q FEN1A ZONED ~,7,ALED FROtq FIRM NAP D&IODC, OI54 D NAY 4, Iqct8 C,.E.H.L. F:~OM N.¥.S. D.E.C,. C, OADTAL EROSION HAZARD ARt~A MAP SHEET q OF 4q PHOTO # .~:~~.~"/0-8~' AREA = 2l~D2 SF or O.4q Ad, RES ®RAPHIC SCALE I"= 2~O' JOHN C. EHI,~ LAND ~UhV~Y;R 6 EAST M~ S~ET N.Y.S. LIC. NO. ~E~, N.Y. 11901 369-8288 F~ 369-8287 ~F.[~p se~e~d~ROSX~-249.pm Albert J. Krupski, President James King, Vice-President Artie Fester 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) BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland Permit Application ..~'Administrative Permit Amendment/Transfer/Extension ~ece~ved Applica~on: ~/~ ~ceived Fee:$ e~.s~Y~ . ~E-ompleted Application ___Incomplete ___SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) --..42'~C Referral Sent: ~ ...,.~te of Inspection: __Receipt of CAC Report: __Lead Agency Determination: Technical Review: ~'ffublic Hearing Held: ~//~//)~' Resolution: FEB 11 2005 j_.~, Name of Applicant Address 2 [ 2. ~- Phone Number:(63~) 7b~' Suffolk County Tax Map Number: 1000 Property Location: (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: ~.o. Phone: ~$1 Board of Trustees Application Land Area (in square feet): Area Zoning: GENERAL DATA Previous use of property: Intended use of property: 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? )C No Yes If yes, provide explanation: Project Description (use attachments if necessary): I~,~,t,~ ~ a ecee,~k. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: l~o.~tJ .~c..c~_~. e~.o_[ozwc~.. Area of wetlands on lot: .square feet Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands: I ~.o feet Closest distance between nearest proposed structure and upland edge of wetlands: I ~o feet Does the project involve excavation or filling? ~ No Yes If yes, how much material will be excavated? o~.l~cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: feet 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): Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity:_ ~,..,~.~ $c..,c~..,_ e.v,.r~-~ ~-¢-~ o ~ Are wetlands present within 100 feet of the proposed activity? ~ No Yes 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) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting fi.om implementation of the project as proposed. (Use attachments if necessary) 617.20 PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART '1 - PROJECT INFORMATION ( To be completed by Applicant or Project Sponsor) 2. PROJECT NAME SEQR 1. APPLICANT / SPONSOR 3.PROJECT LOCATION: Municipality 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide mac 5. IS PROPOSED ACTION: [] New [] Expansion []ModificalJon/alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially ~o~-~... acres ~/'o..e... UIUmately /Vows. acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [~]Yes [] No If no, descdbebflefly: 9. WHAT IS PRESENT LAND USE IN VICINFP/ OF PROJECT? (Choose as many as apply.) ~-'~Residential ~']lndustflal []Commercial E~]Agriculture [--'JPark/Forest/OpenSpaca r~ o~er (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ]Yes F-~"]No If yes, list agency name and permit / approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ~'~Yes []No If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? E es []No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/Sponsor Name Date: ~j,~..~.j~ Signature ~'~ ~"~ If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, coordinate the review proces,. ~Yes [~No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6~ declaration may be superseded by another involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, ~f legible) C 1. Existing air quality, surface or groundwater quality or quanti[y, noise levels, existing traffic pattern, solid waste production or disposal, petentJal for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic agficultural archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or er~dangerad species? Explain briefly: i . I C4. A community's existing plans or goals as officially adopted, or a change in use or intsnsity of use of land or other natural resources? Explain briefly: C5. Growth, subsequent development, or related acflvfties likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in C1-C57 Explain briefly: C7. Other impacts linc[udin~l chan~es in use of either [{uantit~ or t'/pe of enemies? Explain briefl~,: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA~? Ill yes~ explain briefl~,: E. IS THERE, OR iS THERE LIKELY TO BE~ CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If}es explain; PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, detarmine 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 adversa impacts have been identified and adequately addressed. If qcestion d of part ii was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULl EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analys~s above and any supporting documentation, that the proposed ac'flor WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thti determination Name of Lead Agency Date Tlfie of Responsible Officer Pdnt or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer In Lead Agency Signature of Preparer (If different from responsible officer) Board of Trustees Application County of Suffolk State of New York ~7'7~. ? ~.~//vn/~ ./o~c/z~ ~ ~y ;,~/,~ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. SWORN TO BEFORE ME THIS ,20 ' No(a}y Publi~ - MELANIE DOROSKI NOTARY PUBLIC, State of Ne. 01004634870 Ou~lifled in Suflotk Coun~ ,~^ Commission Expires SepU~ of Trustees Ap~ ~ AUTHOP. I ZATION (where the applicant is not the owner) (print owner of property) (mailing address) do hereby authorize ~%~ (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. 8 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nrohibits conflicts of intcrust on the hast of town Officers and emnlovees. The nurcose of this form is to nmvide information which can aiet~ the town of nossible conflicts of interest and allow it to take whatever action is necessary to avoid same. (Lust name, first anme,~iddle inifiai, unle~ you are applying in t~ name of ~omcene else or other entity, such as a company. If so~ indicate, thc other person's or company's name.) NAME OF APPLICATION: (Check all flint apply.) Tax grievance Building Variance Trustee Change of Zoue Coaztai Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other", name thc activity.) Do you personally (or through your company, spouse, sibling, patent, or child) have a relationship with any officer or employee of the Town of Southold? "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 If you ansxvered "YES", complete the balance of this form and date and sign where indicated. Name o£perann employed by the Town of Southold Title or position of that person Describe thc 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 (cheek all that apply): __.A) tl~ owner of greater than 5% of thc shares of the corporate stock of the applie~nt (when the applicant is a corporation); __.B) the legal or beneficial own~ of any interest in a non-cofl~omte entity (when the applicant is not a corporation); __.C) an officer, director, p~mer, or employee oftba applicant; or __.D) thc actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Submitted this _____day of 200 Signature . Print Name 1'~ Cc~x~,..& I~_o ~,. ,...'~