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Home My WebLink AboutTR-5590Albert 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 (63i) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0024C Dme 1/26/05 At THIS CERTIFIES that the addition & alteration to existing dwelling 395 North Sea Dr., Southold Suffolk Count, Tax Map # 54-4-6 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 6/24/02 pursuant to which Trustees Permit # 559O Dated 7/24/02 Was issued, and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the addition & alteration to the existing dwelling, dec~ & septic system. The certificate is issued to aforesaid property. Thomas & Cynthia Rosicki owner of the Authorized Signature Albert J. Krupski, President James ~ng, 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 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 Project complete, compliance inspection. Garrett Strang Architect on behalf of Thomas & Cynthia ~osicki Alber~J. Krupski, President James King, Vice-President Arkie Foster Ken PoHwoda Peg~yA. Dickerson Town Hall 53095Route 25 P,O. Box 1179 Southoid, New York11971-09§9 Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD COASTAL EROSION MANAGEMENT PERMIT Permit Number: 5590 Date: July 29 2002 Name of Applicant/Agent: Garrett Strang, Architect Name of Permittee: Thomas & Cynthia Rosicld Address of Permittee: 395 North Sea Drive Southold, NY Description of Activity: Construct a proposed addition and alteration to existing single family residence including deck and septic system. Date of Permit Issuance: July 24, 2002 This permit is valid for a period of two years .5'om thc dates of issuance. SPECIAL CONDITIONS: ...... Bluff restoration through a re-vegetation agreement ~s a necessa~' spec'~al condition of d~is permit. A relocation agreement is attached hereto and is a necessary special condition to this permit. A maintenance agreement as attached with application and is a necessary special condition of this permit. Albert J. Krupski, Jr. President, Board of Trustees AJK:cjc 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 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Thomas Please be advised that your application, dated June 24, 2002 has been reviewed by this Board, at the regular meeting of July 24: 2fin? and the following action was taken: ( X ) Application Approved (see below) ( ) Application Denied (see below) ( ~. Application Tabled (see below) 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 ls 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: One Inspection @$5.00 TOTAL FEES DUE: $ 5.00 BY: PRESIDENT, BOARD OF TRUSTEES 4/98 Telephone (631) 765-1892 Town Hall. 5~095 Main Road P.O. Box 11"~ Southold. New Yo~k 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conse~ation Advisory Council held Wednesday, July 17, 2002, the following recommendation was made: Moved by Jason Petrucci. seconded by Nicholas Dickerson, it was t~E~S,.,O_L_V_,E_.D,_t_o, re. co~men..d to t.h.e .S. outhold Town Board of Trustees DISAPPRQV, AL of = ,-,U~L~, erosion ~erm~ app,ca[lon of THOMAS & CYNTHIA ROSICKI for ~r~' addition and alteration to the existing single-family residence, including a deck and septic systen~. Located: 395 North Sea Dr., $outhold. SCTM#54-4-6 The CAC recommends Disapproval of the app!ication because the project was not staked and the proposed addition is located within the Coastal Erosion Hazard Area. Vote of Council: Ayes: Ail Motion Carried 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 Office Use Only Coastal Erosion Permit Application Wetland Permit Application __ Major Waiver/Amendmep0Ch~ges Received Applicatij;~n] Received Fee'S 4UI ' ' Completed Apphcatlon Incomplete SEQI~ Classification: Type I Type II Unlisted Coordination:(date CAC Referral Sent: Date of Inspection: Receipt of CAC Report? Lead Agency Determination: Technical Review: Public Hearing Held: Resolution: Name of Applicant ~-eot~, ~ C'-/,o~, ~, Address I O~ ~ ~ ~o~o C~c. f&~*e.~ Phone Number:( Suffolk County T~ Map Number: 1000 - Property Location: (provide LILC0 Pole #, distance to cross streets, and location) (If applicable) Address: t~O ~0~ 7~/{ Phone: 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 Dine J No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspen~l by a governmental agency? ~ No Yes If yes, provide explanation: Project Description (use attachments if necessary): /~o~'o~ ~t, Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: . ~gEo,~osa o ~-~t ~'n m 5, o.o ~ Are w~lands pre~nt ~t~n 100 f~ of the pro~sed a~ivity? ~ No Yes D~s the proj~t involve excavation or filling? ~ No Yes If Yes, how much mate6al will be ex~vat~? .(cubic y~ds) How much material will be filled? (cubic y~ds) ~nner in which material will be removed or de~sit~: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessery) 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 BOA~ OF TRUSTEES: TOWN OF SOUTHOLD he Matter of the Application COUNTY OF SUFFOLK) ' STATE OF NEW YO~) AFFIDAVIT OF POSTING , residing at /Z~o ~,~ ~-~ being duly sworn, depose and say: That on the /g~£/~ day of ~&~ , 200z, I pers0~nally posted the property known as ~?~' A/-~'~ /3~ ,b~/~,~ 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~_he~ ]~ub~lic hearing. Date of hearing notec~ thereon to be held~/-~ ( S ig~ture ) ~ Sworn to before me this /~ day of J~J~ !/ 200 Notary Public IBarbara ..%. $iran9 NOTARY PUBLIC, New Yor~ NO. 4730095 Ql~alified - Suffolk Co,Jnt~ Comm. ,Expires Jutv LETTER OF AUTHORIZATION RE: Premises, 395 North Sea Drive, Southold, NY SCTM #1000-54-04-06 Our File #0114. I (WE) THOMAS AND/OR CYNTHIA ROSICKI, HEREBY AUTHORIT~ GARRETT A. STRANG, ARCHITECT TO ACT ON MY (OUR) BEHALF(S) WHEN MAKING APPLICATION TO THE STATE OF NEW YORK, SUFFOLK COUNTY, TOWN OF SOUTHOLD AND ANY OTHER GOVERNMENTAL AGENCY IN CONNECTION WITH THE ABOVE REFERENCED PROJECT. Date: 2002 Sworn to before me this E~aroara A. Strong Notary Public State of New York THOMAS ROSICKI NOTARY PUBUC, New York No. 4730095 Qualified - Suffolk County Corem Expires July 31 ,g_et, v IPR~)JECT i.a, NUMBER 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT iNFORMATION (To be completed by A0plicant or Project sponsor) SEQ PROJECT NAME 3. PROJECT LOCATION; Municloality ~0 ~ County 6. DESCRIBE PROJE~ BRIEFLY: WILL PROPOSED ACTION COMPLY INITH ~XISTING ZONING OR OTHER ~XISTING LAND USE RESTRICTIONS? ~ Yes ~ NO If No. desc;tbe t:)rletly ~ Res,dentlal ~,!ndt~str=al C Commercial 10. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE CR LOC. ALi? [] Yes [] No If yes. lis! agency(s) and oermitlaP0rovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes' ~,No If yes, list age~c7 name and perrnit/aOoroval 12. AB A RESULT OF PROPOSED ACTION WILL ~-XISTTNG PERMIT/APPROVAL REQUIRE MODIFICATION? [] Y.s [] No I CERTIFY THAT THE iNFORMATION PROVIDED ABOVE iS TRUE TO THE BEST OF MY KNOWLEDGE If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this a_s_.s, essment OVER ! PART II--=-NVIRONN be c.~m"-.m~e¢ =y PART [II~OETE.~MINATIQN OF SIGNIFICANCE ~To :e completed ~y Agency) iNSTRUCTIONS: For eac.n adverse effect identified zccve, determine whether it is sul=standal, large, :,mcortant or oJRerwise sight ftc. FSC,~ effect should be assessed in connection witl~ its (al setting (i.e. urban or rural); (bt probal~ilit¥ of occo.~g; (.c) duration: [rrevers~l~Hity; (el geograunic ~coce: &ncl (f~ magnltuce. If r~ecessary, add attachments Or reference supDQr[Jng malerisls. --nsure explanations contain sufficient deJ~lJ (o snow that all relevant adverse impacts have been identified and adequately acOresseo. Chec,~ this box if you h~ve idendfieo one or more .~oten~ially large or significant &cverse impacts wr~ic2 ~,'IA'~ occur, t-hen :~roceed direc.'ly ~o :t~e FULL ~AF ~nc~lor prepare a positive-declaraticn. Checx =his =ox if you ,16ye determined, based on [he information and analysis ~bove ~nd any sucoorti2, c. APPLIUANT TRANSACTIONAL DISCLOSURE FORM The ToWn oi' S~U~hold's Code o~' Ethics purpos~ of this ~orm is to provid~ information which can alert the town of possible con,licks o~ inberes~ and allow ib to take whatever action is necessary ~o avo4d same. . ', you are applying in th~ name o[ som~omg ~ls~ or th~ other p~rso~'~ or company'~ name.) NATURE OF APPLICATION~ {ch~ck ail that apply.) Tax grievance. Variance Change of zone '. ARp~al o~ plat , ~xe~ption from plat or official map obher {Zf "Other," name the activity,} ,~o~ ~e~ ,"r',"., DO yOU personally (or through your company~ spoufle, sibling, parent, or child) have a relationship vith uny officer or employee of the Town of Southuld? 'Relationship' includes by blood, marriage, or business interest. 'Uusiness interest' means n business, including a partnership, in which fhe town officer or employee has even a partial ownership of (or emploympnt by) a corppratton in which the town officer or employee owne more than 5% of the eharee. YES NO ~ If you answered "YES,#.complete the balance of this form and date and sign ~here indicated. Name of person smployed by ths Town of Southold I ? NOTE: ....'~-~--.~-- L--- ~ : -~ ~ 7-- -- 8OUTHOLD, NEWYORK DATED DECEMBER 11, 2001. ~ ALL ELEVATION AND COUNTOUR UIIE8 ARE REFERENCED TO N.G.V.D. ,/ SITE DATA SITE AREA .775 ACRE8 - 33,772 SQ. FT. TAX MAP # ZONING FLOOD ZONE WATER SUPPLY USE Existing Proposed BUILDING AREA ExlBtlng Proposed LOT COVERAGE Existing Proposed O",~IER 1000 - 54 - 04.06 R40/REBIDENTIAL "VE (EL. t3)" AND "AE (EL. 11)" FIRM MAP #36103C0t54G MAY 4, 1999 SUFFOLK COUNTY WATER AUTHORITY 8INGLE FAMILY DWELLING SINGLE FAMILY DWELLING 2,780 SQ. FT. 3,900 SQ. FT. 8.2% 11.6% THOMA8 AND CYNTHIA ROSICKI 1 OLD COUNTRY ROAD SUITE 200 CARLE PLACE, NY 11S14 GARRETT .A- STRANG architect 1230 Traveler Street Southold N.Y. 11971 631-765- 5455