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HomeMy WebLinkAboutTR-5805 James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall Annex 54375Main Road P.O. Box 1179 Southold, New York11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0850C Date: May 2, 2013 THIS CERTIFIES that the elevated rear addition and moving of shed from wetlands At 2245 Little Peconic Bay Lane, Southold, New York Suffolk County Tax Map # 90-1-16 Conforms to the application for a Trustees Permit heretofore filed in this office Dated August 22, 2003 pursuant to which Trustees Wetland Permit #5805 Dated September 24, 2003, 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 elevated rear addition and moving of shed from wetlands. The certificate is issued to THOMAS & PEGGY PROKOP owners of the aforesaid property. u~h~or~ed Sig~na? .lames F. King, President Bob Ghosio, .Ir., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY ! 1971 Telephone (63 I) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE O,F INSPECTION: L/'/' Ch. 275 Ch. 111 INSPECTION SCHEDULE __ Pre-construction, hay bale line/silt boom/silt curtain __ 1st day of construction ¼ constructed ~/Proiect complete, compliance inspection. COMME~NT,,S: ,~ ~ · CERTIFICATE OF COMPLIANCE: 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) 765-6641 August 24, 2005 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Garrett A. Strang, Architect P.O. Box 1412 Southold, NY 11971 RE: THOMAS & PEGGY PROKOP 2245 LITTLE PECONIC BAY LANE, SOUTHOLD SCTM#90-1-16 Dear Mr. Strang: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, August 24, 2005: RESOLVED that the Southold Town Board of Trustees grants a One-Year Extension to Permit #5805 as issued on September 24, 2003. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:lms c ¢tt Amh~tect August 15, 2005 1230 Traveler St., l~x Southold, New York 1197 T~ephon¢ (C~I) Fax (~81) Mr. Al Krupski, President Southold Town Board of Trustees Main Road Southold, NY 11971 Re: Permit # 5805 We respectfully request a one year extension of the above permit which will expire on September 24, 2005. Enclosed is my client's check in the amount of $50.00 for the~ Thank you for your courtesy in this matter. I! ~J ~.~~!!~_~!!~'...ff~ Garrett A. Strang, R.A Architect Enc. C: T. Prokop Board ©f $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO ....... DALE: ...S..~pt,. ~,.. g0o3 Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the ~w~ of the State of New York 1952; and the Southeld Town Ordinance en- titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS end the REMOVAL OF SAND, GRAVEL OR OTHER IdATERIALS FROId LANDS UNDER TOWN WATERS?. and in accordance with the Resolution of The BOard adopted at a meeting held on .~.0.~....., and in consideration of the sum of $.-50;-~e ......... paid by ...Gar.~e.~: ..~...$t~a~g... Arch~te~t. oR. b e h ~g.-.o f -.-T. horr~a-s..--~... ~ eg gy of~.~.~ ................. ~gY.~h~ .................... N. Y. and subject to the Terms and Conditions llded on the reverse side hereof. of Southold Town' Trustees euthorlzes and permits the folk>wlng: Wetland Permit for an elevated rea~-addition ~nd moving the shed 90 feet from the wetlands as per plans dated 9/25/03 per Garrett A. Strang Architect. all in accordance with the det~i{ed specifications as presented in the originating application. IN WITNESS WHEREOF. The ~ald Board of Trustees here- by causes its Corporate Seal to be at, xed, and these p.resents to be subscribed by a majority of the sa~d Board as of th,s date. TERidS end CONDmONS 2245 Little Peconic Bay, Southold, N. ¥., ~ pan o~ d~e comkletadoa for the Lsmaace of ~he P,~at does ea&era't~md and peer, cribe to the 2. That tbLs Petmk b' valld ~ ~ perlod of 24 m~ qd]k~ b com&le~ed to be die ~ted ~ tequlzed eo complem the wodc iavobed, but should citcumsunc~ wamnt, request for an exnmsion may be made to the Board at a !_~ 5. That th~ Petmlt should be retained i~definltely, or'as long s~ the saki I~nlt~ee wt~es to ~*~- the structure or,project involved, to provide evidence to anyone mncemed that o~zafion was ori~flally ob~in,~cL 4. That the wot:k involved will be subject to the ~ and approval o~ the Board m ia ageau, and non-come!;,,,ce with the provisions o~ thc otigln~iag application, may be cause for revocation of this pe~'mlt by resolution of the said Board. 5. That fl~ete will be flo un~uotx~le interfex-ence with mtvigatlon as · result of the wodt hete~ mkhorlzed. 7. 'That if {utuze opet'miom of the Town of Southold zeqnlze the removal and/er ~.mtem lntbe location of the wofic herein amt~:~ized, or if, h the option o~ dae Bo~d o~ Tmste~ the. ~ shall cause ~e obstmc~oa to free navigation, the said Pem~tee will be ~ upon due notice, to remove ot alter dais work or project he,dh stated without ezpemes to the To~n 8. That the s~id Board will be notified by the Petmittee ot the cempleden of the wodt auth- orized. 9- That the Permittee will obtain aH o~er pennits and consen~ 4hat may be mluived sup- plemental to this permit which may be subject to revoke upon f~l,,~e to olxain same. 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 $OUTHOLD September 29, 2003 Garrett A. Strang Architect PO Box 412 Southold, NY 11971 RE: SCTM#90-01-16 Thomas & Peggy Prokop 2245 Little Peconic Bay Southold, NY Dear Mr. Strang: The Board of Town Trustees took the folloxving action during a Regular Meeting, held on September 24th, 2003 regarding the above matter. WHEREAS, Garrett,4. Strang, ,4rchitect on behalf of THOMAS & PEGGY PROKOP applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated August 22~°, 2003 WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on September 24, 2003 at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standard set forth in Chapter 97-18 of the Southold 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 of Trustees approved a Wetland Permit for Thomas & Peggy Prokop for an elevated rear deck addition and moving the shed 90 feet from the wetlands as per plans dated September 25, 2003 per Garrett A. Strang, Architect.. 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. Fee must be paid, if applicable and permit issued within six months of the date of this notification. If inspections are required, at a fee of $5.00 per inspection (See attached schedule). FEES: None Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees ^JK~cjc cc: DEC Building Department Garrett A. Strang Architect September 25, 2003 Mr. Al Kmpski, President Southold Town Trustees Main Road Southold, NY 11971 1230 Traveler St., Box 1412 Southold, New York 11971 Telephone (631) 765-5455 Fax (631) 765-5490 Re: Proposed Deck Addition to Residence, 2245 Little Peconic Bay Boulevard, Southold, NY 11971 SCTM #1000-90-01-16 Dear Mr. Krupski and Members of the Board: Enclosed please find three signed and sealed copies of the amended site plan showing the new location of the storage shed as per the outcome of last evenings proceeding. Please call my office when the permit is prepared and ready for pick up. Thank you for your consideration of this matter. Very truly yours, Garrett A. Strang, R.A. Architect Encs. Telephone (631) 765-1892 Town Hall 511095 Main Road P.O. ~ox 11'/9 Southold, New Y~k 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conseh/ation Advisory Council held Tuesday, September 23, 2003, the following recommendation was made: Moved by Donald Wilder, seconded by Bo5 Ghosio, it was RESQLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Permit application of THOMAS & PEGGY PROKOP to construct a rear deck. Located: 2245 Little Peconic Bay Lane, Southold. SCTM#90-1-16 Vote of Council: Ayes: All Motion Carried Garrett A. Strang Architect 1230 Traveler St., Box 1412 Southold, New York 11971 Telephone (631) 765-5455 Fax (631) 765-5490 August 22, 2003 Mr. A1 Krupski, President Southold Town Trustees Main Road Southold, NY 11971 AUG 2 2 2003 Bosrd of Tl'ust~lI , Re: Propose~l Deck Addition to Residence,'2245 Little Peconic Bay Boulevard, Southold, NY 11971 SCTM #1000-90-01-16 Dear Mr. Krupski and Members of the Board: Enclosed please find the following in co~mection with the above referenced premises: l. Original and two (2) copies of completed application, Short EAS, L.~etter of Authorization from Property Owner, Disclosure Form; 2. Fee in the amount of $50.00 for minor application; 3. Three (3) copies of sealed SP-1; 4. Photographs of the site The work that falls within your Board's jurisdiction is proposed expansion of waterside deck and addition of a storage shed. Please review and if you have any questions, or require additional information prior to scheduling this for a public hearing, call my off~ce. Thank you for your courtesy and cooperation in this matter. Very truly yours, Garrett A. Strang, R.A. Architect Encs. \lbcrt. ?upski, PreMdent .James: ,g, Vice-Presldent tlry Smith :tie Poster } ,~ Poliwoda Town Hall 53095 R.ute 25 P.O. Box 1179 Southold, New York 11971-095" Telephone (63 D 765-1 S92 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _~oastal Erosion Permit Application _e Wetland Permit Application Major , Waiver/Amendme~/~h. anp~es _ i.eceived Application: l?~eceived Fee'S ~- -- ompleted AppSication _ ~ ncomplete _ :EQRA Classification: Ty;: I .Type II Unlisted , oordination'(date sex~)~__~, -- ~' &C Referral Sent: ~:~F~.~? ~ ;~ate oflnspection:__9/t _ !:eceipt of CAC Report: _ cad Agency Determination: __ ' 2chnical Revie,,v: I't~blic Hearing Held: r.',esolution: Mn]or AUG 2 2 2003 $outhold lowo Board of Trustees ~ I1 J}'7[ Phone Number:(4::~) Sutt; tk County Tax Map Number. Prop,.;ty Location.__ /~7! (pro tde LILCO Pole #, distance to cross streets, and location) AG} 'qT' t If al 0licable) Ad& .:ss' Board of Trustees Application Land ..\rea (in square feet): Area Zoning: Previ~us use of property: Intended use of property: GENERAL DATA 6 Prior permitsdapprovals for site improvements: Agency Date ~'/' No prior permits/approvals for site improvements. Has any pe~mit~approval ever been revoked or suspended by a governmental agency? - ." /No Yes If yes, provide explanation: Project Description (use attachments if necessary): Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: w['t/A/t~g_E ~'~t/z.~' &$/D6a./~ Area of wetlands on lot: - ~ - square feet Percent coverage of lot: 'D- % Closest distance between nearest existing structure and upland edge of wetlands: a0/a feet Closest distance between nearest proposed structure and upland edge of wetlands: ~ feet Does the project involve excavation or filling? __k~ No Yes If yes, how much material will be excavated? ~ cubic yards How much material will be filled? ~ cubic yards Depth of w, hich material will be removed or deposited: ~ feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: 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 Applicatzon Countx of Suffolk State ,,~' New York ~0~.~.~;~' 4- &~a~/~' 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 1N THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGRI: I S TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMI.ESS 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 Signature SWORN TO BEFORE ME THIS /gin DAY OF ,~/fl~//$1' ,20~.~ /~otao, Public Barbara A. NOTARY PUBLIC, New York No. 4730095 Qualified - Suffolk County /~,'r.m Expires July $1, Zoo Aoaendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--2ROJECT INFORMATION (To De completed by Aoplicant or Pro~ect soonsor) S ~:. WILL ::OPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING ,_z'~D USE r~ESTRICTIONS? :0. QOES -£TIO~4NVOLVEA PERMIT APPROVAL. OR FUNDING, NOW OR ULTIMATEL; :=OM ANY OTHER GOVERNNtE'~TAL AGENCY 11. 0CEd ~NY ASPECT OF ThtE ACTION HAVE A CURRENTLY VALID PERMIT OR APC~OgAL? ~ No !f ye.". li~t agency name and permltlapproval the action is in the CoGstal Area, and you are a state agency, complete the Coos:al Assessment Form before proceeding '.',,dh this as~essmen; OVER I ?aRT IH--OETERMINATICN CF S[GNIFICA, NCE [To ~e com01e[ed Dy ;,gency) _ ;bec,'( [his ~,c× !f you ,~sve ,cen[ifiea one or ,'note coten[lalIv large or sJGn~fic~n[ ~cverse i~oac;5 wnac~ M~':' occur. Then ~rccaec cirec:ly :o :ne FULL EA~ ~na/or ~re~are ~ ;ositJv~ceciara[icn. ~ Checx =~is Jox :~ you ~ve de[ermmeQ, 3aseo on [~e informs[ion ~nd analysis ~bove and any 5ucoor:.~ TRANSACTIONAL DISCLO.';URE FORH The Town oS $ou~hold'a Code of Ethics prohibits conflicts of interest on the part of tow[_~ office_fa and emplo, ee~ees. The purpose of ~hte form is to provide information which can alert tile town of possible conflicts of interest and allow it to take whatever action ia necessary to avoid same. other entity, such 9s a .-Olnpany. Ii SO, Indicate NATURE OF APPLICATION~ (check ali Lh~t applY'.'). Tax grievance A~p[~al of plat , E~ption from plat or official map (If "other," name tits activity.) interest" ~ean~ a business, imploding a partnerahip~ In vhich ~he toun of Efcer or employee hns even a o.nersbip sE (or employmen~ by) a corporation In .hicb bhe to~n of Cicer Dr employee ovn~ a,oro than 5~ or ~he If you anavered "~gS,#. complete the balance of ~hi~ form and date sod sign vhere indicated. Name of person employed by tho Town of Bout|told Title or po~ltion of that person Describe the relationship between yourself (the applicant) and the town officer or employee. Either check the The town officer or employee or Ilia 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 tile applicant (when the appl{cast is a corporation); B) the legal or bbneflolal owner of any l~terest in a non¢orporate'~stity (when the applic~nt ia sot a corporation); C) an officer, director, partnor, or emplcyss of ~he applican~; or D) the actual applicant, DESCRIPTION OF RELATIONSIIIP APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of inte~-st on the part of town officers and employees. The purpose of ~is form is to prov/de information which can alert the town of ~ossthle conflicts of intercst and allow it to take whatever action necessary to avoid same. (Last name, first name, middle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Change of Zone Approval of plat Exemption from plat or official map Other (lf"Other",namctheactivity.) ~"~C-' 5 ~'~'E'.5 Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of $outhold? "Relationship" includes by blood, marriage, or business interest "Business interest" far,ns a business, including a partnership, in which the town officer or employee has even a pm'Ual 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 answered "YL~, corc~lete the balance of this form and date and sign where indicated. Name of person employed by the Town of Sonthold Title or position of that person Describe the relationship between yourself (the applicantlagentffrepresentative ) and the town officer or employee. Either check the appropriate line A) through D) and/or dcserib~ in the space provided. Thc town officer or cmployee or his or her spouse, sibling, parent, or child is (check all that apply): A) the owner of greater than 5% of the shasez of thc corporate stock of the applicant (when the applicant is a cooperation); __.B) the legal or beneficial owner of any interest in a non-corpprate eniity (when thc applicant is not a corporation); C) an officer, director, partner, or employee of the applicant; or __.D) the actual applicant. DESCKIPTION OF RELATIONSHIP APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the oart 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 iT necessary to avoid same. (Last name, first name, middle initial, unless you are applying in the name of someone else or other en6ty, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Change of Zone Approval of plat Exemption from plat or official map Other (If "Other", name the activity.) ~ 6' 5 '~'~/.~ ~ ~ Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, man-iage, 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 answered "YE'~ complete the balance of this form and date and sign where indicated. Nar~ of person employed by the Town of Southt~ld 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 ofgrenter 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-coqoorate entity (when the applicant is not a corporation); C) an officer, director, partner, or employee of thc applicant; or __D) the actual applicant. DESCRIPTION OF RELATIONSHIP PROOF OF MAILING OF NOTICE ATTACH CERTII~IED M~H. RECEIP~I Name: Address: #1000-90-01-15 Phylis Gunn 2145 Little Peconie Bay Bird Southold, NY 11971 #1000-90=01-17 Mr. and Mrs. Robert HoHis #1000-90-01-18 Clyde G and Mildred B. Bailey, as Trustees 53 Brlarcliff Road N. Merrick, NY 11566 417 Bogie Street Palmdale, CA 93551 #10000-90-01-11 Town of Southold 53095 Main Road Southold, NY 11097 I, GARRETT A. STRANG, residing at 1230 Traveler Street, Southold, New York, being duly sworn, deposes and say that: On the 15th of September 2003, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite their respective names; that the address set opposite the name of each person is the address of said person as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at Southold, NY, that said Notices were mailed to each of said persons by (certified) (registered) mail. Signature Sworn to before me this 15th day of September 2003 (Notary Public) B//~arbara A. Strang~2r'' NOTARY PUBLIC, New York No. 4730095 Qualified - Suffolk County Comm. Expires July 31, ¢_.~__0.~ .... ; MAILING OF NOTICE C~ ~TIFIED MAIL RECEIPTS Name: Address: #1000-90-01-15 Phylis Gunn 2145 Little Peconic Bay Blvd Southold, NY 11971 #1000-90-01-17 Mr. and Mrs. Robert Hollis #1000-90-01-18 Clyde G and Mildred B. Bailey, as Trustees 53 Briarcliff Road N. Merrick, NY 11566 417 Bogie Street Palmdale, CA 93551 #10000-90-01-11 Town of Southold 53095 Main Road Southold, NY 11097 I, GARRETT A. STRANG, residing at 1230 Traveler Street, Southold, New York, being duly sworn, deposes and say that: On the 15th of September 2003, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite their respective names; that the address set opposite the name of each person is the address of said person as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at Southold, NY, that said Notices were mailed to each of said persons by (certified) (registered) mail. Signature Sworn to before me this 15th day of September 2003 (Notary Public) /~ Barbara A. ~tran~j~ NOTARY PUBLIC, New '(~r~, No. 4730095 Qualified - Suffolk Co_unty Comm. Expires July 31. g ~O~ ~ of 'trustees NOTICE TO ADJACENT PROPERTY OWNER SE? ]7 2%.] J In the matter of the applicant: THOMAS AND PEGGY PROKOP YOU ARE HEREBy GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: Construct proposed rear elevated deck addition 2. That the property which is the subject of Environmental Review is Located adjacent to your property and is described as follows: 2245 Little Peconic Bay Boulevard, Soutbold, NY SCTM #I000~90-01-16 3. That the project which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment on: Septmber 24, 2003 at approximately 7:00 p.m. 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 Southald and does not reference any other agency that might have to review the same proposal. OWNERS NAME: ~THOMA$ AND PEGGY PROKOr MAILING ADDRESS:c/o Strang PO Box 1412 PHONE 0: South#Id, NY 11971 631 76~ 5455 Enc.: Copy ofsketch or plan showing Proposal for your convenience. ^/ J Board of Trustees Application County of Suffolk State of New York g rts /c BEING DVLY SWO 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 1N THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOAKD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIIVlS 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. Signature SWORN TO BEFORE ME THIS /~r~ DAY OF ~/,,]~ ~/$/" ,20~3 Barbara A. ~ral1~ NOTARY PUBLIC, New York No. 4730095 Qualified - Suffolk Co_unty Comm. Expires July 31, Zoo& Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application ............. COUNTY OF SUFF(i~K~ ~ STATE OF NEW YORK) SEP 1 6 2003 So~oM Town ~oard ~ Troll AFFIDAVIT OF POSTING That on th~ day o~200~, I Dersonally ppst~ ~e propc~ ~o~ ~ . by placing ~e Bo~d ofT~stces o~cial poster where it c~ c~ily ba seen, ~d ~at I have checked to bc s~e ~e poster h~ rem~ed in p lacc~r ei~t ~a~ prior to the date of ~c public _ he~g. Date ofhe~g not~ ~er~n to bc held ~ -~, (signature) Sworn to b~fore me this day of~O*/~2005 N~ary Public ~' ~ ,ml~/~. ~trallg . !AIRY PUBLIC, New York No. 4730095 /;lualified ~ Suffolk County · tm E×pires July 31, ¢-~DZ~, I I 817,21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION (To be completed by APplicant or Proiect sponsor) SEC 1. PLICANT ~SP oN OR 3, ~ROJECT LOCATION: 5. IS PROPOSED ACTION: ~ New ~ Exuansion 5. 0ESCRIEE PROJECT ERIEFLY; 7. AMOUNT OF LAND AFFECTED: ~ q=_s,dent,al r,~.'nous~rlal ?~ GommercJ&, DOES ACTION.I~VOLVE A PERMIT APPROVAL. OR PUNDING. NOW OR ULTIMATELY FROM STATE O~ LOCALJ? ryes No If yes. !i$~ agencyts) and permitlaoo¢ovals l~, OO~S ANY ASPECT OF THE ACT)ON HAVE A CURRENTLY VALID PERMIT OR APPROVAL Southotd Town E~oard of Trustees DERAL. 12. AS A qESULT OF PROPOSED ACTlOiq WILL E;([STfNG PERMIT/APPROVAL REQUIRE MOOIFICATION? ... ~ CE~Ti~ THAT TH~ iNFORMATION PROVfO~D ABOVE ~S TRUE TO THE B~ST OF MY KNOWLEDGE I If the action is in the Coastal Area, and you are a state agency, complete the I Coastsl Assessment Form before proceeding with this as__.s, essment OVER ! e i i PART iII--0ETE.qMINATICN OF SIGNIFICANCE ~To be completea by Agency) -- Chec× mis 3ox !f you nave identified one or more ~o[en{ia{l? large or significant acverse imoac:s wmcn MAY occur. Then grcceea airec:ly ~o me FULL ~.AF ~n~/or prepare ~ gosidv~ c6claradcn. _ Checx :ms ;ox :f you have de[ermined, based on ~he inicrmadon aha analysis ~bove and any SUDDOr~]~ cocumen[aucn. :n~[ the ;rooosea ac:ion WILL ~lOT resul~ in~n'! significant zdverse envircnmemz[ imcac:: AND provmce On &[t~cnmen[s zs necessary, the re~sons suscordng roms determine[ion: APPLICANT TRANSACTIONAL DISCL'}SURE FORM $outhold Town Beaird of ~,rd}tees Tile Town o~ $ou~hold's Code of Ethics prohibits conflicts interest on the par5 of town Officer~s and emplo, ee~ 7'lie purpose of this form is to provide [n~ormation ~h-6-~-ffch can alert ~be town of possible conflicts of interest and allow YOUR NAMEr NATURR OF APPLICATION, (Cheek ail ~hnt apply.) Variance Appall'al of plat . Rxe~ption from plat or official map (Ig "other," name the activity,) parent, or child) hsv~ a relationship with any officer or interest" means a business, ineludi.[I a partnership, ovnership of (or employment by) ;, corporation in vhich YES NO If you ansvered "]~ES,# complete the balance of [hie Eorm and date sod sign ~rhere indicated. Name of parson employed by the Toys ,~f Soul{laid Title or position of that person -- Describe the relationship between y{,drself (the applicant) and tbs toun officer or employee. Either check the p~ovid~d. 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 55 of the shares of the corporate~etock of the appl~ca~tt (when the appliaaet iea corporation); the legal or b~neficial owner of say interest in a corpora tics) I C) as off~cer~ director, paring:-, or employee of the applicant t or _D) the agtual applicant. G.A.STRANG,ARCHITEOT PAGE LETTER OF AUTHORIZATION Premises, 2245 Little Pec, onic Bay Boulevard, Southold, NY I (WE) THOMAS PROKOP AND/OR PEGGY PROKOP AUG 2 2 200~~.,~ Southold Tewn Board of Trustees AUTHORIZE GARRETT A. STRANG, ARO-HTECT TO ACT ON MY (OUR) BEHALF(S) WHEN MAKING APPLICATION TO THE UlxqTED STATES OF AMERICA, STATE OF NEW YORK, SUFFOLK COUNTY, TOWN OF SOUTHOLD OR ANY OTHER GOVERNMENTAL AGENCY IN CONNECTION WITH THE ABOVE REFERENCED PROJECT. Sworn to before me this Day of/f~ , 2003. Notary Public State of New York N0r~'ARY PUBLIC, New ~ No. 4730095 Qualified - Suffolk County c:omm. ~pir~ ~ 31, ~. OlOH.lflO N Om ,kg Hoc, SITE AREA TAX MAP # FILED MAP DATA ZONING FLOOD ZONE WATER SUPPLY USE EXISTING PROPOSED SITE DATA .487 ACRES - 21,20E SQ. FT. 1000-90-0t -15 MAP OF CEDAR BEACH PARK FILED DECEMBER 2{}, 1927 AS # 90 SOUTHOLD, TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK R - 40/RESIDENTIAL "AE" (elevation 8) and 'X" SUFFOLK COUNTY WATER AUTHORITY SINGLE FAMILY DWELMNG SINGLE FAMILY DWE[ LING BUILDING AREA EXISTING 2,450 SQ. FT. PROPOSED porch addition 436 SQ. FT. deck addition 290 SQ. FT, shed 198 SQ. FT. TOTAL 3,343 SQ. FT. LOT COVERAGE EXISTING 11.55% PROPOSED 1 $.77% TOTAL IMPERVIOUS BUILDING AREA EXISTING PROPOSED 3,350 SQ. FT. 4,243 SQ. FT. TOTAL IMPERVIOUS LOT COVERAGE EXISTING 15.80% PROPOSED 20.00% OWNER THOMAS AND PEGGY PROKOP 2246 UTILE PECONIC BAY BLVD. SOUTHOLD, NY 11971 NOTE: THIS SITE PLAN WA~ PREPARED WITH INFORMATION TAKEN FROM A SURVEY MADE BY PECONIC SURVEYORS, P.C., SOUTHOLD, NY, DATED: JULY 2~, 2003 GAI:II:IETT A. STIqANG architect 1230 Travele~ Street Southold N.Y. 11971 631-765- 5455