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Home My WebLink AboutTR-6075AAlbert 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 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0081C DateNovember 15, 2005 is The certificate is issued to aforesaid property. THIS CERTIFIES that the second-floor addition At 375 Fisherman's Beach Rd., Cutchogue Suffolk County Tax Map # 111-1-13.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 1/31/05 pursuant to which Trustees Permit # 6075A 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 a second-floor addition to the existing dwelling LAUREN PRAUS & MARK SCHWARTZ owner of the Authorized Signature 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 Permit No.: 6075A Date of Receipt of Applibation: January 31, 2005 Applicant: Lauren Praus & Mark Schwartz SCTM#: 11t-1-13.1 Project Location: 375 Fisherman's Beach Rd., Cutchogue Oate of Resolution/Issuance: February 16, 2005 Date of Expiration: February 16, 2007 Reviewed by: Trustee Peggy Dickerson Project Description: To construct a second-floor addition onto the existing single-family dwelling. 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 last dated June 27, 2003 and amended by Mark Schwartz on January 12, 2005 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 LOT 29& P/O LOT MAP OF PECONIC BAY PROPERTIES, FILE No. 786 DATE: APRIL 5, 1951 SITUA TED A T NASSAU POINT TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-'11'1-0'1-13.1 SCALE 1 "=20' NOVEMBER 4, 2000 SEPTEMBER 7, 2001 ADDED PROPOSED SHED JUNE 27, 2003 UPDATE FOR SHED &: ADDITION AREA = 15,657.68 sq. ff. / / JOLSae2d~ A. Ingegno Surveyor THE £XI~TENCE OF' RIGHTS OF WAY LAUREN PRAUS 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-/,880'~[ [- BOA1LD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office UseOnly Coastal Erosion Permit Application ~Netland Permit Application ~Administraiive Permit Amendment/Transfer/Extension ..'~'ece~ved Application:~ ~l~received Fee:$ ~ , ~C'~ompleted Application Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date sent). ~,~AC Referral Sent:~r ~.~te of lnspection:~ Receipt ofCAC Repod: Lead Agency Determination:__ Technical Review: ~Public Hearing Resolution: Suffolk County Tax Map Number: 1000- I t I" O I - t ~o 1 Property Location: 375' (provide LILCO Pole #,/tistance to cross street~, 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: Agency Date __ 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 of the proposed?perations: Area of wetlands on lot: 0 square feet Percent coverage of lot:~O % Closest distance b~tween nearest existing structure and upland edge of wetlands: A./,~f feet Closest distance between nearest proposed structure and upland edge of wetlands: $~ ~ feet Does the project involve excax6tion 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): cT Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: ~e w~lands present ~thin 100 feet of the proposed a~ivity? No ~ Yes Does the project involve excavation or filling? ~ No Yes If Yes, how much material will be excavated? (cubic y~ds) How much materi~ will be filled? _(cubic yards) ~nner 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) w o c-F 617.20 PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UN~JSTED ACTIONS Only PART 1 - PROJECT INFORMATION ( To be completed by Applicant or Project Sponsor) 1 APPLICANT / SPONSOR ... 2. PROJECT NAME 3.PROJECT LOCATION: County Municipality and Road Intemec6ons. Prominen landmass etc -or provide map SEQR 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially ,. O ~-- acres ~ Ultimately · ~ 7__- acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [~Yes [] No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~] Residential [~ Industrial E~ Commercial [~Agriculture [] Park / Forest / 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) [~Yes r"-] No If yes, list agency name and permit / approval: 11 DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ]Yes r~No If list name and permit / approval: yes, agency 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL RE(~UIRE MODIFICATION? E~Yes [~No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE S/,natureApplicant / S/~~y ~~ ~ Date:/~ (.~/~.~.__ ' If the action is a Costal Area, ano 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 process and use the FULL EAF. [~ Yes "- [~N~o B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If NO, a negative declaration may be superseded by another involved agency, F'-'] Yes E~]No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pal/em, solid waste production or disposal, potanfial for erosion, drainage or flooding problems? Explain bdefly: I 1 C2. Aesthetic, agricultural, archaeological, histori~i"(~r ~)ther ~aturai or cultu~l' reso~:c~si ~:~.ommunlty or neighborhood character? Explain bdefly: I C3. Vegetation or i'auna, ~shl shellfish or wiidiife species, significant habliats, or thraate~d -0~'~nd~n~red'specles? Exi~laln briefly: l I C4. A community's existing plans or goais as officia}ly adopted, o;'a ~h~hge in ~s~ or'intsr~sity o~ use of iand o~' oiher natural C5. Growth, subsequent development, or related activifies likely to be induced by the proposed action? Explain briefly: I C6. Long term, short term, cumulative, or other effects not identified in C1-C57 Explain briefly: C7. ~ther impacts lincludin~l c se of either ua of ess ? n / WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA)? Ill ~'es, explain bfiefi),: [~Yes [~]No I E. IS THERE, OR IS THERE LIKELY TO BE~ CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? [~Yes E~No If ~'es explain: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adveme effect identified above, determine 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) irreversibil[ty; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show tha~ all relevant adverse impacts have been identified and adequately addressed. If question 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 C EA. Check this box if you have identified one or mom potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULI EAF and/or prepare a positive declaration. Check this box if you have determined, based on the informafion and analysis above and any supporting documentation, that the proposed actio~ WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting ~hi~ determination. Name of Lead Agency Date Title of Responsible Officer Print or Type Name et 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 fifff,,q~ , ~H~jw}~ r-L BEmO Dray 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 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 TI-[E 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 Tp INSPECT THE Signatur~ SWORN TO BEFORE m m~S ~ D^Y OF ~/~. ,20 ~ ~ lqotary l~blic ' LINDA J COOPER NOTARY PUBUO, State ol New yo~k .o. o~oo,~?_~ ~: of Trustees Applica~ AUTHORIZATION (where the applicant is not the owner) ~ ~.~ ~/~ ~ residing at ~TY ~-,~/7~ ;f'/~f (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. (Owner' ~ signature)// / 8 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southeld's Code of Ethics vrohibits conflicts of interest on the nat of town officers and emnlovces. The nuroose of this form is to nrovide inforination which can alert the town of ~ossible conflicts of interest and allow it t~ take whatever action is nscessa~ to avoid same, D / //ff- (Last name, fir~t ua~, ~id~ll¢ ini{ial,~nless!you are applyiag in tbe name of someone elr~ or other untiw, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If "other", name the 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, man'iage, or business interest. "Business interest" means a business, including a partnership, in which the town officar 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 "YES", complete the balance of this form and date and sign where thdicated. Name of person employed by the Town of Southeld Title or position of that person Describe the relationship between yourself(the applicant/agent/representative) and the town officer or employee. Either check tbe appropriate line A) through D) and/or describe in the space provided. Thc town officer or employee or his or ber spouse, sibling, parent, or child is (check all lhat apply): A) the owner of greater than 5% of the shares of the corporate stock of the applic4mt (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non-corporate entity (when thc applicant is not a corporation); ___C) an officer, director, Imrtoer, or employeo of the applioant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Submittedthis ~ day, of ,,.]zt~t'~, 200~_~' Signature ':~ff~-'o.~ ~