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Home My WebLink AboutTR-5992AAlbert J. Krupski, President James King, Vice-President .~tie 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 Permit No.: 5992A Date of Receipt of Application: September 16, 2004 Applicant: Patricia Wiederman SCTM#: 90-2-15 Project Location: 450 Cedar Point Drive East, Southold Date of Resolution/Issuance: September 22, 2004 Date of Expiration: September 22, 2006 Reviewed by: Board of Trustees Project Description: As-built 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 Joseph A. Ingegno dated July 26, 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. Board of Trustees N£Clr THE SITE OF THE PROPOSED PROJECT IS SHADED BAY TAX MAP Application regarding the proper~y of Patricia Wiederman, SCTM # 1000-90-2-15 Represented by PROPER-T PERMIT SERVICES P.O. Box 617, Cutchogue, NY 11935 James E. Fitzgerald, Jr. 631-734-5800 May 30. 2002 HOG NECK BAY THE AREA OF THE PROPOSED PROJECT IS CIRCLED DON SOUTHOLD B A Y~.~ \ / SHE VICINITY MAP Application regarding the property of Patricia Wiederman, SCTM # 1000-90-2-15 Represented by PROPER-T PERMIT SERVICES P.O. Box 617, Cutchogu¢, NY 11935 James E. Fitzgerald. Jr. 631-734-5800 May 30, 2002 Ali~ert 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 I1971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Pemfit Application · ,~X~etland Pern:nt Application ___ Major Waiver/Amendment/~h~mg~'s ~'~eived Applicon: ~ ~ ~ __ ~eived Fee:$ ~ ' ~{ ~ ~ompleted Application ~11~1~ ~Incomplete ~SEQ~ Classification: T~e I T~e II U~isted~ ~oordination:(date sero) CAC Refe~al Sent: __Date of I~pecfion: ~Receipt ofCAC Repom ~Lead Agency Dete~ation: Tec~ical Review:~ m rmg m d: Resolution: Name of Applicant ..~k~ 7- ~'lick~xLe Suffolk Cowry Tax Map Number: (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: Board of Trustees Application Land Area (in square feet): Area Zoning: Previous use of property: Intended use of property: GENERAL DATA Prior permits/approvals for site improvements: __ No prior permits/approvals for site improvements. Has any permit/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 o£the proposed operations: Area of wetlands on lot: ~r~C)O ~/- square feet Percent coverageoflot: < I % (le~ ~ '~ Closest distance between nearest existing structure and upland edge of wetlands: O feet (~,d,~j ~.t~k.,.dJ Closest distance between nearest proposed structure and upland edge of wetlands: 6o ,c/- feet Does the project involve excavation or filling? .~/ No Yes If yes, how much material will be excavated? How much material will be filled? 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: cubic yards cubic yards 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: 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 from implementation of the project as proposed. (Use attachments if necessary) ' PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1. APPLICANT / SPONSOR 3.PROJECT LOCATION: 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2. PROJECT NAME 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc - or provide map SEQR fi 5. IS PROPOSED ACTION. [] New [] Expansion [] Modification/alteration r~o~ 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? r'-"~Yes [] No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) []Residential []Industrial [~Commercial [--'1Agriculture [] Park / Forest l Open Space []Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ~.,4~.~.O{g] ~Yes []No If yes, list agency name and permit / approvah ~.~/"~[~"~.)h~,, 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? I es J No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name '"~(~v~. '~', r~,~[.~-~'t ~-"-{"'. Date: ~::~1! Signature (~,.~'t~.... (~ ~ ~. ~~-. 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 tN 6 NYCRR, PART 617.47 If yes, coordinate the review process and use the FULL EAr. B W~LLACT~~NRECE~VEc~~RD~NATEDRE~~E~ASPR~V~DEDF~RUNL~STEDACT~~N~~N6NYCRR~PART617~6? IfNo. anegative declarabon may be superseded by another involved agency. C COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may he handwritten, if legible) C1. Existing air quality, sudace or groundwater quality or quantity, noise levels, existing traffic pattam, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, amhaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: I C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened o~ endangered species? Explain briefly: 1 C4. A community's existing plans or goais as officially adopted, or a change in use or iniensity ot use of lar~d or other naiural resources? Explain bdefly: C5 Gr~>wth subsequent development or r¢l~t~ activities likely to h~ [odueo~l'tiy the proposed action* Explain briefly: CB. Long term, short ternS, cumulative, or other effects not idenfified'ih Ci-CS? E~plain hri~fly: ' C7. ither impacts (including chan~es in use of either quanfit¥ or t~e of ener[I}t? ~xplain briefly: 1 D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEAI? Ill yes. explain bdefi},: [~] Yes [~No J 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: F~reachadversee~ectidenti~edab~ve~detsrminewhetheritissubstantia~~~arge~imp~rtant~r~therwisesigni~cant~ 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 significence must evaluate the potential impactofthe 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 FAF and/or prepare a posiUve declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actim WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessa~/, the masons supporting thi: determination. Name of Lead Agency Date Title of ResponsibJe Officer Print 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 BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN AKE TRUE TO Tim BEST OF mSa-tER K~OWLEOGE At'4D ~3EL~EF, AND THAT ALL WORK WILL BE DONE 1N THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE AP 'V. OVED THE SOUTnOU) TOWN BO a D OF TRUSTEES. THE APPLICANT AGREES TO [[OLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY ,tO~D ALL DAMAGES AN"I) 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 \~"~ DAYOF ~~ .20e~r TAt< HOSP ~DICAL '~C~R~S +~;137~3010 {Where the. a~p:l£can~. SG ~3o~'. t~e owne~) T-24r P 001/C01 ~-08~ ~ j So~thold Board o~ ToW~ Tr~tSte~s on IFf behalf. '(O~e~ ' s s~g~c~e)- APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold'$ Code of Ethics nrohibits conflicts of interest on the hart of town officers and emnlovees. The nurooso of this form is to provide information which can alert the town of oossible conflicts of interest and allow it to take whatever action is necessary to avoid same. (Last name, first name, middle initial, unless you are applying in thc name of someone else or other entity, such as a company. If so, indicate thc other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Emsiun Approval of plat Mooring Exemption from plat or official map Planning Other (If"Othef', name the activity.) Do you personally (or through your company, spouse, sibling, parenL or child) have a relationship with any officer or employee oftbe 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 coqooratiun in which the town officer or employee owns more than 5% of the shares. YES NO ~- If you ansxxered "YES". complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold 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 linc 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 thc shaves of the corporate stock of the applic0nt (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 Form TS I LOT SURVEY OF 107 & P/0 LOT 108 MAP OF CEDAR BEACH PARK FILE No. 90 FILED DECEMBER 20, 1927 S£TUA TED A T BAYVIEW TOWN OF $OUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-90-02-15 SCALE 1"=30' JULY 26, 2004 AREA -- 72,710.82 sq. ff. 1.669 DC. / / / / / / ZONE AE (E~- 4) / / / ~ / / ~ NOTE: FLOOD ZONE INFORMATION TAKEN FROM: FLOOD INSURANCE RATE MAP No. 36103C016g O ZONE AE: BASE FLOOD ELEVATIONS DETERMINED ZONE X'. AREAS OF 500-YEAR FLOOD; AREAS OF IO0-YEAR FLOOD WITH AVERAGE DEPTH OF LESS THAN 1 FOOT OR WITH DRAINAGE AREAS LESS THAN 1 SQUARE MILE; AND AREAS PROTECTED BY L~VEES FROM IO0-YEAR FLOOD ZONE X: AREAS DETERMINED TO BE OUTSIDE SOO-YEAR FLOODPLAIN. THE EXISTENCE OK RIGHTS OF WAY AND/OR EASEMENTS OF RECORD, iF ANY, NOT SHOWN ARE NOT GUARANTEED. CERTIFIED TO. GABRIEL SCIBELLI PECONIC ABSTRACT INC. SEP Land Surveyor PHONE (651)727-2090 Fax (651)727-~727 24-242