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TR-6135
Albert J. Krupski, President James King, Vice-President .hxtie 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 Y2 constructed Project complete, compliance inspection. Board Of Southold Town Trustees SOUTHOLD, NEW YORK May 2005 PERMIT NO. (O.!~,-3 .... DATE: RICHARD KLtB I AK ISSUED TO .................................................................................................................. },ufl]nri atiml Pur~uanf to fhe provisions of Chapter 615 o( fhe Law~ the State of New YorJc, 1893l and Ghapter 404 of ~e ~ of t~e State of New Yor~ 1952: and ~e So~hoJd Town Ordlnen~ i~led ."R~U~TIN~ ANO ~E P~CIN~ OF OBSTEUCT~NS IN AND ON TOWN WATERS AND PUBLIC ~DS and ~ REMOVAL OF SAND, ~VEL OR OTHER MATERIA~FROM ~NDS UNDER TOWN WA~ES;". end in acc~d~n~ with May [8 Re~ol~ion o~ ~e Board adopted ~f ~ me~fin9 hdd o~ ........... , ...... 207. , and in consideration of fha ~um of $..~9.,..9.©. . pMd by RSchard Kub ~ak of SourhoZd .................. N. Y. and subject fo of Souihold Town Tr~iees *uthodzes and perml~ the following: Wet[and PermS~ ~o construct a oneTstory additSon,approx. [4.9~X[7.4~ ro ex~8t, hous~[andward of the exLsLLng deck, ~5[h the condL~[on drywe[[s and gutger5 are Lnstal[ed Lo the ro~[ run-off and a line of hay bales is piace do~n ba~or~ ali in ~ordance with the defa~d sp~ffications as ~nt~ in on the survey prepared by John Metzger last da~ed 6/13/05. by ~u~s ifs ~r~rafe Seal fo be a~xed, a.J ~ese ~esenh fo be su~ed by ~ ~jm~ of ~he sa~d ~ard as of Jhls Ar~00o ~E~ (absent) TERMS ,,nd CONDITIONS ~ Richard Kubiak · - 185 Willow Poin,t ,p.r,, Southqld. , , -,, N. Y~'~ 5. TI~ ~ ~dl be no untea.~3abte intet[e~enc~ ~ mvig-~ u · te~lt o{ t~ ?. That if future opet~om ~ the Town Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Totem Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone(631) 765-1892 Fax1631~765~6641 May 18, 2005 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. James E. Fitzgerald, Jr. Proper-T Permit Services P.O. Box 617 Cutchogue, NY 11935 RE: RICHARD KUBIAK 185 WILLOW POINT DR., SOUTHOLD SCTM#56-5-25 Dear Mr. Fitzgerald: The Board of Town Trustees took the following action during its regular meeting held on Wed., May 18, 2005 regarding the above matter: WHEREAS, James E. Fitzgerald, Jr. on behalf of RICHARD KUBIAK applied to the Southold Town Trustees for a permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated April 22, 2005 and, 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 May 18, 2005, 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 Southold Town Code, 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 approve the application of RICHARD KUBIAK to construct a one-story addition, approx. 14.9' X 17.4' to existing house landward of the existing deck, with the condition drywells and gutters are installed to contain the roof run-off and a line of hay bales is placed down before the project begins, and all as depicted on the survey prepared by John T. Metzger last dated June 13, 2005. 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.) Fees: $50.00 Very truly yours, Albert ,~. Krupski, Jr., President Board of Trustees AJK/Ims Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peg~- A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telep ho ze (631) 765-1892 Fax (6311 BOARD OF TOWN TRUSTEES TOXVN OF SOUTHOLD Please be advised that your application dated reviewed by this Board at the regular meeting of followin9 action was taken: has been and the ( -/)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 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: $ ~--0, O0 SIGNED: PRESIDENT, BOARD OF TRUSTEES Telephone (631~765-1892 Tox~m Hall 53095 Route 25 P.O. Box I I79 Southold, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Tues., May 10, 2005, the following recommendation was made: Moved by Jack McGreevy, seconded by Alicia Marin, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit application of RICHARD KUBIAK to construct a one-story addition, approx. 14'.9'X 17.4' to existing house landward of the existing deck. Located: 185 Willow Point Dr., Southold. SCTM#56-5-25 Vote of Council: Ayes: All Motion Carried ~I{.. OTO A: Looking SW at proposed construction (4/7/05 at 1245 hrs) Looking NW etlon m'ea a canal offBudds Pond. (4/7/05 at 1250 l~'s) James E. Fitzgerald, Jr, P__ROJECT SITE PHOTOS ApplicatiOn regard~ngthe p}operty of Richard Kubiak SCT~I #1 (}00-56~5-25 Represented by PROPER-T PERMIT SERVICES p , .O, Box 617, Cutchogue~ NY / 1935 63 I-7~4-~ 800 April 7. 2005 EXEDON piPES COVE ~ .~...- THE AREA OF THE PROPOSED PROJECT IS CIRCLED / / SOU'THOLD BA VICINITY MAP Application regarding the properS.' of Richard Kubiak. SCTM ~I000-50-5-£5 Represented by PROPER-T PERMIT SERVICES P.O. Box 617. Cutchogue. NY 11035 James E. Fitzgerald. Jr. 63 [-7q3-5800 Avril 7. 200'3 THE SITE OF THE PROPOSED PROJECT IS SHADED M&TC~ TAX MAP Application regarding the properb.' of Richard Kubiak. SCTM ~1000-56-5-25 Represented by PROPER-T PERM[T SERVICES P.O. Box 617. Cutchogue. N",' 11935 James E. Fitzgerald. Jr. 631-734-5800 April 7. 2005 ON JUNE 16, 1966 AS FILE NO. 4652. SURVEY OF PROPERTY AT ARSHAMOMAOUE TOWN OF SOUTHOLD SUFFOLK COUNTY, N. K ooo-56-o.5-z_5 SCALE: I ~20 MARCH 29, 2004 April 4~ 2005 , DUO CANAL Ngo190'OO"E 152,00' V~9ODBULKHEAD FL OOD Z¥'t/£ A,_ ~- 'e~. ~.; FIRI~ 5¥t050.0/58 G 'ro~E FE 15' LOT 23 ~_- ' r ~rOp. sty, addi ion s~O~R finished floor el. 9.7 t.~.7g . B4' gl LLOIg po IlqT ROAD AREA:IT, g18 SQ. FT. £LEVA lIONS ARE REFERENCED TO N.G.V.D. ANY ALrERAI/ON OR ADD/lION 1-O THIS SURVEY IS A V1OLA170N OF SECTION 72090F THE NEW YORK Si'ATE EDUCATION LAB< EXCEPT AS PER S£C~?ON 720g-SUBDIVISION 2. ALL CERTIFICA[IONS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR B, HOSE SIONA TURE APPEARS HEREON. Alber~ J. Krupski, Preside~ James I{]ng, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hail 53095 Route 25 P.O. Box i179 Sou:hold, New York 11971-0959 Telephone (63D 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF $OUTHOLD Office Use Only .Coastal Erosion perrmt Application -~Wetland Perrmt Applicauon Major __Wai;'e rtAmendme~v Change$. ~-~-~ceived ^pplicatmn: z'//t~lO'~ ~'?,eceived Fee:$ ,~N."/)~' ,~ompleted Applicstion C __lncon~lete __SEQRA Class~ficanon: Type l___Type tl Unlisted__ Coordmauon:(date senn Referral Sent: ~__,l~te of Inspection: ~ I__Receipt of CAC Report:_ __Lead Agency DetemUnauon: Te~:hmcal Review: --""fublic Hearing Held: __Resoluuon: Minor Name of Applicant Richard Kubiak Address 185 Willow Point Drive, Southold' Phone Number:( ) 765- 613~ Suffolk County Tax Map Number: 1000 - 56.--'5- 25 Property Location: 1~5 Willow 7oint Drive, Southold (provide LILCO Pole #, distance to cross streets, and location) AGENT: James E. Fitzgerald, Jr. (if applicable) Address: F0 Box 617 Cutchogue ~4¥ 11935 Phone: 631-73~-5~00 C Board of Trustees Applic~on Land Area (in square feet): Area Zoning: GENERAL DATA 17,91~ Previous use of property: Intended use of property: SFD SFD Prior permits/approvals for site improvements: Agency None known Da. re __ No prior permits/approvals for site improvements Has any permit/approval ever been revoked or susp~in)~ed by a governmental agency? '~ No Yes. If yes. provide explanation: PROJECT DESCRIPTION: Construct one-story addition, approximately 14.9' X 17.42 to existing house landward of existing deck structure. Board of Trustees ~on WETLAND/TRUSTEE LANDS APPLICATION DATA P/~rpcseoftheproposedoperations: Expand living space in existing SFD. Area of wetlands on lot: - 0- square feet Percent coverage of lot: - 0- % Closest distance between nearest existing structure and upland edge of wetlands: - 0- feet Closest distance between nearest proposed structd~e and upland edge of wetlands: - 0- feet Does the project involve excavation or filling? No ×X Yes If yes. how much materiai will be excavated?. How much material will be filled? - 0- Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: Manner in which material will be removed or deposiied: 3 0 cubic yards cubic yards approx ~Fprox o5 backhoe 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): It is expected that zhe project will have no sigrti__ficant effect on the wetlands and tidal waters of the Tcwn. 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION (To be completed by A~plicant or Project Sponsor) I1. APPLICANT/SPONSOR {2. PROJECT NAME James E. Fitzgerald, Jr. / Kubiak house expansion 3. PROJECT LOCATION: Municipality Southold County Suffolk I 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide mapt 185 Willow Point Drive Southold. New York 11971 See attached maps. 5. PROPOSED ACTION IS [] New [] Expans,on [] Mod,ficat,on/alterat,on 6. DESCRIBE PROJECT BRIEFLY: Construct one-story addition, approximately 14.9' X 17.4', to existing house landward of existing d,:ck structure. 7. AMOUNT OF LAND AFFECTED Initially LT0.0I acres Ultimately N/A acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ~ Yes J~ No If NO. describe bnefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? [] Res,dentia, [] Industr,al [] Commerc,al Describe. Medium-size pm, ate waterfront residences. ~] Agriculture [] ParVJForest/Oper Space [] Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE OR LOCAL)? L~ Yes LJ No If Yes. hst agency(s) name and perrmb'aDprOvals: Southold Trustees 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? U Yes ~ No It Yes. hst agency(s} name and permit/approvals: 12 AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ['~ Yes []No i. CERT, J~-Y THAT T,(~a'INF~MATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE I If the~-~tion is in the/C/oastal Area, and you are a state agency, complete the [ 'Coastal Assessment Form before proceeding with this assessment OVER Reset STATEMENT TO THE SOUTHOLD BOARD OF TOWN I RUSTEES County ofSuflblk / State of New York ) I. Richard Kubiak. being duly swom, depose and affirm that I am the owner of the property located at 185 Willow Point Drive, Southold, New York 11971. and identified by Suflblk County Tax Map No. 1000-56-5-25, and that all work will be done in the manner set forth in the present application and as may be approved by the Sou/hold Board of Town Trustees. I agree 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. I hereby authorize the Town Trustees or their agentts) or representative(s) to enter upon my property to inspect the premises in conjunction with the review of the present application. ...... Richard Kubiak. MD Sworn to before me this ...~....%... ....... day of...~...~.. ............ 200....5... Notary Public ~ L. ASSETTO NO. 185 Willow Point Drive Southold, New 'fork 11971 President Board of Town Trustees Town of Southold Town Hall, 53095 Main Road Southold, New York 11971 Dear Sir: Please be advised that I hereby designate and authorize James E. Fitzgerald, Jr. of Proper-T Permit Services to act in my behalf as my agent in the submission and processing of an appli- cation for a permit for additions to my house located at 185 Willow Point Drive, Southold. and designated by Suffolk County Tax Map No. 1000-56-5-25, and to furnish, upon request, supplemental information in support of the application. Sineerely. Richard Kubiak, MD AFFIDAVIT OF POSTING TO THE SOU~FH()LD BOARD OF TOWN TRUSTEES IN THE MATTER OF THE APPLICATION OF: Richard Kubiak STATE OF NEW YORK COUNTY OF SUFFOLK I. James E. Fitzgerald. Jr., residing at 385 Haywaters Drive, Cutchogue. NY 11935. being duly sworn, depose and say that on the 10th day of May, 2005. I personally posted the property known as 185 Willow Point Drive. Southold. 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 Ibr eight date is noted thereol*'~o,,ffe,l~rednesday. May days prior to the date of the public hearing, which , (~ 18. 2005 at or about 7:00 PM. %~~~~ AFFIDAVIT OF MAILING TO THE SOUTHOLD BOARD OF TO~'N TRUSTEES IN TH['_' MATTER OF ]'HE APPLICATION OF: Richard Kubiak STATE OF NEW YORK COUNTY O}: SUFFOLK James E. Fitzgerald. Jr.. residing at 385 Haywaters Drive, Cutchogue. NY 11935, being duly sworn, deposes and says that on the 10~'th day of Ma3,', 2005, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of I he named persons at the addresses set opposite their respective names: that the addresses set opposite the names of said persons are the addresses of said persons as shown in the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office a~: Cutchogue. NY 11935, that said Notices were mailed to each of said persons bv Certified Mail/Return Receipt Re- quested. APPLICANT TRANSACTIONAL DISCLOSURE FORM The Town of $outhold's (['ode of Ethics prohibits conthct~ of mtclcbt o1~ thc part ofToxui ol'ficcrs and cmnlovees. The purpose ofth~s form ~s to provide mfonnanon, v, hich can alert the Town of possible conflicts, ,f interest and allow it to take whatever action is necessm'v to avoi i same YOURNAME: Richard Kubiak, MD (Last name. first name, middle initial unless )ou are appl_~ mg in tile name of someonc else or other eatity, such as a compan) If so. iu&catc tile other person or company name ) NATURE OF APPLICATION: (Check all that apply.) Tax Grievance Variance Change of Zone Approval of Plat Exemption fi.om Plat or Official Map Other X If "Other", name the activity.: Wetlands permit Do you personally, (or through .','our company, spouse, sibling, parent, 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 X~ If you answered "YES", complete the balance of this form and date and siva where indicated. Name of person employed by the Town of Southold: Title or position of that person: Describe that relationship between )'ourself (the applicant) and the Town officer or employee. Either check the appropriate line A through D (below) and/or describe the relationship 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 Submitted this-- -.-,4~,~;f Signature: ~::5~. ~_ Print Name: Richard Kubiak, ProPer-T Permit Services POST OFFICE BOX 617, CUTCHOGUE, NEW YORK f 1935-0617 (631) 734-5800 President Board of Town Trustees Town of Southold Town Hall. 53095 Main Road Southold, New York 11971 April .2005 Re: Application for Permit on Behalf of Richard Kubiak, SCTM #1000-56-5-25 Dear Sir: Attached are documents which have been prepared in support of the application tbr a pemfit to expand the existing single-family dwelling and renovate the interior on the property of Richard Kubiak in the Town of Southold. Proper-T Permit Services represents Dr. Kubiak in this matter, and a lel:ter of authorization is part of this submission. If there are ally questions, or if additional intbrmation is needed, please call me. Enclosures: Application Fee ($2501 Letter of Authorization Notarized Statement of Applicant Transactional Disclosure Form Survey of Property/Project Plan (Peconic Surveyors, last dated 4/4/05) t3 copies) Application Form (3 copies) Short EAF (3 copies) Vicinity Map (3 copies) Tax Map (3 copies) Project Site Photos a subsidiary of THE PECONIC EASTERN CORPORATION