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Home My WebLink AboutTR-6230A James F. King, President o~~OF SOUjyDI Town Hall Jill M. Doherty, Vice-President ti ~ 53095 Route 25 Peggy A. Dickerson P.O. Box 1179 Southold, New York 11971-0959 Dave Bergen Bob Ghosio, Jr. %2 ~ Telephone (631) 765-1892 ~~~COO~ Fax (631) 766-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0195C Date Apri130, 2007 THIS CERTIFIES that the second-story addition to the existing dwelling At 8265 Soundview Ave., Southold, Suffolk County Tax Map # 59-6-17 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 10/4/05 pursuant to which Trustees Permit # 6230ADated 10/19/05 R'as 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 a second-story addition to the existing dwelling The certificate is issued to DIANE DALEY owner of the aforesaid property. r ~ Authorized Signature James F. King, President ~~~F SOV jyO Town Hall Jill M. Doherty, Vice-President ~O l~ 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson l~( # Southold, New York 11971-0959 Dave Bergen Bob Ghosio, Jr. iO ~ Telephone (631) 765-1892 Fax (631) 76b-6641 ~'~OOUNT'1 ~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 18, 2007 Mrs. Diane Daley 916 Hudson St. Hoboken, NJ 07030 RE: 8265 SOUNDVIEW AVE., SOUTHOLD SCTM#59-6-17 Dear Mrs. Daley: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed, April 18, 2007: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit #6230A to require the removal of the existing 32' walkway, consisting of four (4) 4'X 8' sections, before December 1S` of each year and not installed before April 15` of each year. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, Jam F. King President, Board of Trustees JFK:Ims 04/10/07 09:50 FA% 212 793 ~7 JIM GARNETT ~ X001 ~v~-765"- 66~F I c~'~c~.~a.~-~ ~ ~f-fX-~-~-~- ~ ~ / ~,p i ~ (~-S~S-R -7 8 ~3 APR 1 0 04/10%07 09:50 FA% 212 793 7 JIM GARNETT Ia1002 NEW YO~TATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION /DEC PERMIT NUMBER ~ EFFECTIVE DATE 1-4736.03549/00001 Match 8, 2006 FACILITYIPROGRAM NUMBER(S) PERMIT EXPIRATION DATE(S) Under the Environmental - Conservation Law March 7, 2011 TYPE OF PERMIT ¦ New ? Renewal ? Modlflca8on ? Permit b Construct ? Permit to Operate ? ArBcle 15, Title 5: Protection of Waters ? 6NYCRR 808: Water Quallry ? Article 27, Title 7; BNYCRR 360: - ~ Certification Solid Waste Managemem ? Article 15, TitIe15: Water Supply ? Article 17, Titles 7, 8: SPDES ? Article 27, Tkle 9; 6NYCRR 373: ? Artlcle 15, Title 75: Water Transport Hazardous Waste Management ? Article 79: Alr Pollution Control ? Arttcle 15, Title 15: Long Island Wells ? Artlcle 34: Coastal Erosion ? Artlcle 23, Title 27: Mined Land Management ? Article 15, TRIe 27: Wild, Scenic and Reclamatbn Recreatbnal Rivers ? ArtlGe 36: Floodplaln Management ¦ Article 24: Freshwater Wetlands ? ANcles 1, 3, 17, 19, 27, 37; ? ANcle 25: Tidal Wetlands BNYCRR 380: Radiation Control PERMIT ISSUED TO TELEPHONE NUMBER Diane & Ed Dale 201 653-6610 ADDRESS OF PERMITTEE 916 Hudson Street Hoboken NJ 07030 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER NAME AND ADDRESS OF PROJECT/FACILITY Dale ro 8265 Soundview Avenue Southold COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold DESCRIPTION OF AUTHORIZED ACTIVITY: I Construct a second story addition for an existing single family dwelling. Construct a 4' x 80' woodwalkway i with a wood chip path. Revegetate the area with native plantings. All work must be done in accordance with the attached plan prepared by John Ehlers on 2/10!06 and stamped NYSDEC approved on arch 8, 2006 BY acceptance of this permit, the petmittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulatlons, the General Conditions specifled (see page 2 R 3) and any Special CondlUons (sea page 4+) included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS Region 1 Headquarters Bldg. N40, SUNY, Stany Braok, NY 11790-2358 R er Evans AUTHORIZED SIGN RE 4~QM~ DATE Page 1 of 4 March 8 2008 04/10/07 09:61 FA% 212 793 1~7 JIffi GARNETf • ~II003 a JYd+rn*.tiY~l:'A~~ii~dCn!".~`..C.!sb"r[?!„{'t14~+e`~.N,7:~.C'!J+y'n' '~i j;' Board Of Southold Town Trustees h SOUTi-10LD, NEW YORK s ~ ` PERMIT NO... ~ ~ DATE:.July..2s.,..znoi ~ ~ v THOMAS J. MEYER ISSUED TO ' .~utl~nri~a#inn ; Pursuent to the prorisions of Chapter 615 of tila taws of the Stets of New York, 1893; and Chapter X04 of ibe llswt of the State of Nsw Yoe$ 1952; and the 5oufh°Id Town ea- titied .•°RE6ULATiN6 MID Tf-It: PtACMCy OF 08 UCIIONS IN AND ON TOWN WATERS AND PUBLIC and tIw ;C REMOYAL OF SAND. 6RAYEL~OR OTHER MA FROM ¢ LANDS UNDER TOWN' WATERS;'.4 and in acoordanCa wkh the ~ j Resokrtion of The Board edopted et a maoiing held on ;~°IX,23:..._ 2001 ~ and in consideration of the sum of ;.....ZpO..Op:._ paid by Atexandara Jone$,_91~...b~Ixalf..rxf. THOMAS...3.....i,68Y$;Z.-.__~_._.. of ._Suuthoid._.._...._ N. Y. and fo !ha Terms and Conditions Irsted on fhs revarso ~o hereof, ~o~~°~~ Town Truste(e,.s authorizes sad pern?ffs the Fdowssg: ~u a $ o e sec~c~is~ef B~e~°vab1e evinterytDr r ° F' ~c~e to gall[ ~ 32 con- excavation or permancy of Installation to be placed is phragmtte ' area (wet area) aed upland path wiU consist of wdod chips. No ~ trt~aming of phragmitea -just fgr_the 8~3th. Drs on ~t aq io accordance .with the detailed epee Ka as ~ i 1'~ .the onymating appGeatioa. where path will be~~pplaced, ` IN WITNESS WHEREOF, Tha said Beard of ~rwtaes bsro- ~ , ' by ceases its Corporate •Sss1 to be affixed, ant! 1f~t~ prq~r~t~ to Z be wiiscribed by a'n~siorHy of the said Boand ss of thh dais. ii ~ c~FFi7Q~ ,rd~ r' ~ s' Z'd I3ZE666IE9 16F100 03J QEO~ii SO LI noN U4/10/07 09:54 FA% 212 793 ~ JIffi GARNETT • ~ 001 r 04/lti/07 09:64 FAb 212 793 Jyg7 JIM GARNI•"1T ~ f~002 C~T~'1Q ~~t~ Iaw}en 71os Iowia~oe QO~podlon ~a Qo ~R,,°b Q t ~ ~~K, ~ ` ~ 1dyb6 ~~1 ~`,,Q~'j /Ar ti~~ 'i t4 ~ ~ g i°; ~ ~ i ? o~ ~.y Hr+uec APPR r.; 7;7U A3 P:SR 'tL•RbtB ~ ~ 'Ari Utibl'i IU:VS U ~ PER ~tti"71Sd: 'rJ.3S T / O"U71T~ ~ / DATE i ~ ~ P\ ~ \\~i t' ~ 4~r1'i ~ ~ it 1 1 ~ 5 ~ 1 f t . 1 't i i r 4 S "'>:'I^ sr j ~ f ~e ~ l~ t1t1~ ~ ~ ~ 1II'.. .t ..7 ~ r~ 1: ~ 4^14s I 'C~'~~~~ ~ ~`F.; ,~'•/f •.'M •I~M~,,.S~~~{{~~ t. ~x ~lJ~~. 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'f,41i1 ~ ' y S ~ ~ r ~ 1 a ~ 4~} ,L t.~ ` ~r~ y ~ ~ ' ~ ~f ~s• ti' Yt ,1 ay ~ t~. :~tsY! ' ; 1l ~~~If ',~ita,'~ , YI 'rl..J ~ . ~ ~ 9 ~ yi c, ''y - ~ ~ r~' 4'&wy ~t tr.i.. ' E i^'t { ~T~r t r { k t; ~t. ~ ~ ;~1A4.'t ~ H.t ' ~~.~~>1K rw. ~ ~ yS'~ 1`R e 3j rS 1 C ~:.F ~ : it „"iSyZ.i?~ _ ''r ti ~',r~. r. ~~t~ ' ,Ya~ Y ~ .,r ~ t ' 1 Y + 5 ry~Iy',t ~~!#~~ir ~f f ~ ~J. .rr i i i~~ ~'ylr~~~~"A;j~~`°~ •~6 1 t ~'4 ,e~ iy ~ ~,N \c t~ p~.4111},r ~ C ~ 1~,! ~ ~ ~ i, is !r 1 -b u ~ !1 +a l s J 1 d{~ ,~/'¢G f§~~`~11.. v ~ `etL1 ~~:.e ` r ' ] f ~ S_~+s' i. l t ~rJ / 'Xt ~y~ ? =;~t..2 ~`;Ij S'R~~ kS~i~,l F~ 1~T .c Y ~ti 1 r"i 44++1} "'Sr 1 .ll X~ v+ { t : 1~, .r~ ! ti _ e v~n ..s ( ,emu :f+' + ~,,y~ 11 f~ , ' ix~ta~k'k~A,ir. '.c. 'sL i V' spy ,yt... i .e Z~ ~lVr F 1f s I.'Y 1 ~ YYYY t `~r~ - LL ~ 5 f ~ ~ 'J i~yt ~ 'L.r _ all ~.,i', r j- c} fi ~.r.~_`k"7''"4`---..a,•3Ls_s+ Et ~ x .rr ~f ~a,..!r.?. t•i~. Albert J. Krupski, President ~~Of S~UlyO Town Hall James King, Vice-President ,~O l~ 53095 Route 25 Artie Foster .IL .If, P.O. Box 1179 Ken Poliwoda T T Southold, New York 11971-0959 Peggy A. Dickerson ~ p~ Telephone (631) 765-1892 Olif'C~~~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6230A Date of Receipt of Application: Oct.4, 2005 Applicant: Diane Daley SCTM#: 59-6-17 Project Location: 8265 Soundview Ave., Southold Date of Resolution/Issuance: October 19, 2005 Date of Expiration: October 19, 2007 Reviewed by: Board of Trustees Project Description: Administrative Permit to convert the second-floor of the existing dwelling to living space, as per plans surveyed by John Ehlers last dated 8!16/05. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 97 of the Southold Town Code. Special Conditions: Remove dock. Remove unpermitted fence at completion of project, at Final Inspection, before Certificate of Compliance is issued. 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 Albert J. Krupski, President ~~,oF souryo Town Hall James King, Vice-President ~0 l~ 53095 Route 25 Artie Foster ~ ~ P.O. Box 1179 Ken Poliwoda Southold, New York 11971-0959 Peggy A. Dickerson ~ ~ p ~ Telephone (631)765-1892 ~~~Ct7~~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES ~ TOWN OF SOUTHOLD TO: ~7 ~-`7 C. ~-t s l u.,., ~ S M.~ c-li ati, ~ Z D i un e p~ Please be advised that your application dated / ~ ~ y~° S has been reviewed by this Board at the regular meeting of i ~ / / yl mss' and the following action was taken: C.~J I l rt lll~e Gin cl,r fi~ t- 'C3ti¢ ce <v, .l ( )Application Approved (see below) dock h~ rem, o,x.l GofTl-pct -h-.~ s ~ -Eb-- O Application Denied (see below) der...' { rc ""°'"•t. 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: wo~'C c ~ ~ 50 ~ ~~\1~~ TOTAL FEES DUE: $ 5 SIGNED: ~ PRESIDENT, BOARD OF TRUSTEES ~ i ~ ~ , :b, . ,~r ~.It~~~iti.A_S.KJ6Tli".FQ'~1,:~~--.•~lY.Y~i.Ni.?C~lYF T.f .MLiI~l~L~ail. -,C: sf s-~- t ~ s~, . h. - Board Of Southold Town Trustees ~ SOUTHOLD, NEW YORK . i` PERMIT NO... ~ ~ DATE:..July .as.,..aaol ~ ~ r' ~ THOMAS J. MEYER _ _ ~ ~J tSSUFA TO _ _ i ,~lUf~ilrt~MfiDri Pursuant to the provisions of Chapter 615 of tNe Lews of the State of New York, 1843; end Chapter 404 of the flews of the ~ . State of New York 1952; end the Southold Town Or finance en- titied .."RE6UtATING AND THE PLACING OF OBS UCTiONS IN AND ON TOWN WATERS AND PUBLIC LANDS end the ~ REMOVAL OF SAND, GRAVEL OR OTHER MATERIMLS FROM LANDS UNDER TOWN' WATERS;'. and in aecordan4e with the Resolution of The Board edopted at a meeting held on ~uly 25,..._ cool ~ and in consideration of the sum of ;.....211Q.~Ot)~ paid by .P ~ Aieaandra.Jones...on...bekldlf..af TCiDSdAS...3.,...b11ilGER~............_..-.. s of ._..S9uthold,...._. N. Y. and wti'tect to the Terms end Conditions Bated on the reverse spde hereof, of yy,, hold Tows Trustees authornes and permits file forowing: y~ W.e~jand_~e~mrt tq dace (~e ovab~e fp annter L9ZaIgQ~ 32' con- •i ~ ~ ass ing o sectto s of +s, ~ong 4 ~ vnt~e to wa~ or sit on - no ~ r excavation or permancy of installation to be placed in phragmite ~ 'area (wet area) and upland path will consist of w¢od chips. No ~ trimmipg of phragmites -just fqr the th Draw on u aM in accordance with the detailed spec~icat`wns as prosen~e'~vi'~ly ~ .the ongmating appBcstion. .r ,i where path will bedlaced. 1 IN WITNESS WHEREOF, The said $oard of Trustees here- by causes its Corporate Seal to be sffixed, and tl»s¢ Presents to Z be subscribed by a majority of the said Board as ofl this date. ~ ' a / ~ l ~ . ~ ~ t±~~(/ Trwtses ti, _~7Yi:~~i"~"_e~.~~.dF-~•Yj. '~"Jii~iF~T".Fa"v+!"~7iJi~' ~~".[~l'/T k~ Y r_ +R _ _ Albert J. Krupski, President gpFFO(,~ Town Hall ' James King, Vice-President CD 59095 lioute 25 Henry Smith ~ Southold, New York 11971-0959 Artie Foster - Ken Paliwoda u~ ~ Tele hone (691) 765.1692 ~ a~ Fax (691) 765-1366 ~o! ~ ~a BOARD OF TOWN TRU3TEE8 TOWN OF SOUTHOI.D August 2, 2001 Alexandra Jones 11A Bayview Lane Huntington, NY 11743 RE: Thomas J. Meyer 8265 Soundview Avenue, Southold, NY SCTM#59-06-17 Dear Ms. Jones: The following action was taken by the Boazd of Town Trustees during a Regular Meeting, held on July 25, 2001, regarding the above matter. WHEREAS, Alexandra Jones on behalf of THOMAS J. MEYER applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordi ce of the Town of Southold, application dated June 25, 2001 WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and reconunendations, and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on July 25, 200t 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. 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, } _ • 2 • NOW THEREFORE BE iT. RESOLVED, that the Board of Trustee approved the application of THOMAS J. MEYER ,for a Wetland Permit to place (removable for winter storage) 32' consisting of 4 sections of S' long 4' wide to walk or sit on - no excavations or permancy of installation to be placed in phragmite area (wet area) and upland the path will consist of wood chips. No trimming of phragmites - just for the path. Draw on survey where path will be placed. BE IT FURTHER RESOLVED [hat this determination should not be considered a determination made for any other Department or Agcncy, which may also have an application pending for the same or similar project. Permit to construct project will expire two years from the date it is sigtted. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Fees must be paid, if applicable, and permit issued within six months lof the date of this notification. Two inspections are required and the Trustees are to be notified when,project is started and on completion of said project. FEES: NONE Very truly yours, ~ ~ Albert J. Krupski, Jr. President, Board of Trustees AJK/cjc cc: DEC \ ;I ~ I~ ~y o e ~ ~ a rrc 9 9 °;a ~ o € ~ ''c %tr i i _.,y L i~ I i i ~ ~ J, ~ ' / ~ ' N / f , ram ~ ~ ~ ~ M ~ ~ `.i y ~ v 1 ~ / 1 I Y ~R y i~ ` r• ~ 1 i i. ~ ~ -x , . o>a j i ~ ~ ~ . , ~e j I J+ ~ { E% 1 n j - - - - - - - - - - NOTES': 1. E%ISTING ELEVAI / 2. E%ISTING CONTO 3. ZONING USE DIE ~ 4. FLOOD ZONE II ~ r ZONE A7 (EL n~~~~~ / aw J+ ZONE E3~ ARE / ~ p~, `w~h,Z ~ ~ ~u. ~tpo, ~0,, THE S+ ,u~ ZONE C: ARE `y` ~ ~ ~ ~ 5. PROPOSED ELEV ru. /u~ 6 / o ~3~ w n~Yg, "c~ I / .h ~ 4r ~ yam! 'C~~ ~,G~ ~ ti,° ~ ~ ~ . ~4i /z Y ~ ~ @~. ,v. u~ i a tiRr ~ gyp, ~ ~ ~ ~ ~ y o s~ ~ I N~ M1 ~ ' ~ ` JIYL 1~L ~DO Q ~ ~ 1 ~5~ ~Q Q ~ ~ Y ~ ~ B,D' ^ W d ~ ~ o yF t+> `0~ f / ~n ~r v, r• PROPOSED SEPTIC SYSTEM DETAIL ~ ~'~.y ~ r I strtK roc (~l ~ { 5' r-'91A4e ~ em..a ~ .m..u.. / i i~ l ~ ~ ~~r~rr~tw • ~'Sr° r y0 y7~ I ~N ~~~~i~~i"~5~~ n~.M +a~sr nin / C + ~ r..ot evs si as ~ ~ o~.~. h + ~ ~ i ~ + + }T~+ d \ ~ , ~ i ~~o~~ ~ 1 ~ 4 + \ \ u / . . ~ ~ . , I I 4 I i ~ r / . I , ~ ~ I ~ /1 ~ I f i ~ i A, f ' ~ I oo < ~ ' r ' , J I ~ ~ , ~ . ti ? J1 + ~ •h y i / f, ~7'_f.~OG DATA - f ' ~ , O nuW fl~ wrDOw,ln ~iEUGC~fNG[ Ou di ilv ~ re45 i - p f ~~_~u ~ sf w. waV~~.wu ~ 1~i ~im / '~~i'f wrw ,om we .•y •1 / ~r ~f f rx ~ ~ 6°' r %4 f ~ q O _ - i o ~ 49~ A ~ Bea o~ kR.a a + : ~ ~ ~ s g ~ % p ~ ~ ~ a _ z'q c'`ye-„i a 4r~ ' ® F ei: ~ ~ ~ ~ ..W. ~ Y O~~ <a SI 4~ ~ ~ F P ~ O~z ;I o ~ ~o~ e H ~ _ _ Nth, e § ~ n€~~1 '°j m3' 3 6 ' w O ~ O A~ Y mi ~'E:• ~k~ °~j aj a~ ~ 21 ~ 9Y ~ ~ ~ ~ 5 o Ci •~yy a d 3i 3 ',r. ~ v Q G~ ~ .~'r 'F o~M ~51g }i~i! ' f 4 p pi ~ ~ 6"A L;;~e e~ ~ ,~.r s~y Y ~ I I ~ I I I / { p M - ~ ~ ~ ~ ~ ~S ~~~F5~ ~ g~9 a SaFB[d o lO s k ~ ~I~ y o d p ' l °"D o E ~ ~ a s 3 l 5 3 / , D> F 1 S f e T ~ /i > °a 0 ~.+8 ~ /io e~.aa_ ~ ' .J ~ ~ . tt 3 ~ e oo. .,f. s Oyu ~ ~.q1 ~ ~ k}odwi~ S ~ 1I p Sf5 ~ L _ O aajj E~ N J 2FI~F , Albert J. Krupski, President ~~~F SQVlyO Town Hall James King, Vice-President l~ 53095 Route 25 Artie Foster ~ ~ P.O. Box 1179 Ken Poliwoda Southold, New York 11971-0959 Peggy A. Dickerson ~ ~ O ,t~ ~ Telephone (631) 765-1592 ~ly`,oU~'~~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland PermiC Application ?Adminisnative Permit _Amendment/Transfer/Extension Received Application: Received Fee:$ -Completed Application -Incomplete SEQRA Classification: Type I Type IIUnlisted Coordina[iom(date sent) LWRP Consistency Assessment Form _ CAC Referral Sent: -Date of Inspection: -Receipt of CAC Report: -Lead Agency Determination: Technical Review: -Public Hearing Held: Resoluti~ogn: ! I_ ~ ( NameofApp cant ~ ~t) }prvl ~G~Jt' I2t.~c~tr>--. Address ~d ~X ~~b.~ ~~~-9LlDt-Ot~ ~ lq~~ Phone Number:(~,~1 a ~ g ~ a 3 Suffolk County Tax Map Number~1000 - ~ ^ ~ ~ 1 Property Location: ~cl ~ ~ ~ 11, ~ ~~'Q (provide LILCO Pole distance to cross streets, and location) e 2 AGE~T: ~ Iv t? U 0. ~Q (If applicable) c n Address: ~ `,OUN~J I~~l~ ~OtJ~~10L~ Phone: o`ZGI ~'~3' 6~~y Board of Trustees Application WETLAND/TRiJSTEE LANDS APPLICATION DATTA Purpose of the proposed operations:_~b 1U~4~ ~ ryt~Q J~~~ .-lG ~l~1lrJ~ ~u^_k_ Area of wetlands on lot: 1(,~ square feet Percent coverage of for ` l~ Closest distance between nearest existing structure and upland edge of wetlands feet Closest distance between neazest proposed structure and upland edge of wetlands: feet Does th/e project involve excavation or filling? Y No Yes If yes, how much material will be excavated?cubic yards How much material will be filled?_ ~~~__cubic yards Depth of which 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): ~ ~ ~ ~ t~ Board of Trustees Application GENERAL, DATA Land Area (in square feet): Area Zoning: Previous use of property:._ (~p~}~ (IQ~ L Intended use of property: ~QS I<+ N ~ I-(~~ l? Prior permits/approvals for site improvements: Agency Date ~d~~_ /9Q ~ ~ ~ ~ _,Z No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? 1~ No Yes If yes, provide explanation: Project Description (use attachments ifnejcessaryc)~ 817.20 SEAR . PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW - SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANT /SPONSOR 2. PROJECT /NAME j~ ~5~ DAJ~' ~/I ~ I L~' 1~QJ-cc'~c,,x~ 3.PROJECT LOCATION: ~a~oJ ~L+Cti~ V'j~u~ (J ~ 7 Municipality ~~~.11 IYt~~ County 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks e[c - or provide map 5~~ 5. IS PROPOSED ACTION : ? New ? Expansion ~ Modifcation /alteration 6. DESCRIBE PROJECT BRIEFLY: e 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? 1 ? Yes ? No If no, describe brieFly: C~~ 9 WH IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) esiden[ial ? Industrial ?Commercial Agriculture ? Park / Forest I 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 ? No IT yes, list agency name and permit /approval: !-/'cam 11 DO ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? - Yes ?No If yes, list agency name and permit /approval: eL 12. A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? Lyyes ? No I CER FY T A THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Spc ~ r ame ~ Da[ Signature 0 O If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment Board of Trustees Application r. AUTfiORI2ATION \(wheere the applicant is not the owner) I, ~jkN~ pJ~/ Le~ residing at (print owner of property) (mailing address) ,1 d`7~~C~Sca ~ ~D~, c'/J /~l~do hereby authorize ~~~e jia~C-*en~ (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. r (Owner's signat ) 8 z>'° APPLICANT/AGENT/REPRESENTATI V E TRANSACTIONAL DISCLOSURE FORM The Town o(Southold's Code of Ethics prohibits conflicts of interest on the Dart of town officers and emnlovees The ur ose of this fotm is to rovide information which can alert the town of ssible conflicts of interest and allow it to take whatever action is necessary to avoid same. T f /2 YOUR NAME: ~IkNJ% U/~Lc'v~ I, PCB LP/I;S~LE~~ttk ~GPc~,E'~p ~/~~~ic-,bJ (Last name, firs[ name, ipiddle initial, unless you are applying in the name oC someone else or other entiTy, such as a company. If so, indicate the other person's or company's natne.) 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, 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 If you answered "YES", complete the balance of this fotm 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 applicanUagent/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 of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); - - ,8) the legal or beneficial owner of any interest in a noncorpornte entity (when the applicant is not a corporation); C) an officer, director, partner, or employee of the applicant; or D) the actual applicant. - DESCRIPTION OP RELATIONSHIP Submitted thi day of . 200 Signature- Print Name a Form TS 1 Board of Trustees Application County of Suffolk State of New York Ce~~~ ~ ~c. ~c ~di~~ BEING DULY SWORN DEPOSES AND AFFIRMS HAT 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 Ev THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES 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. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE USTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO ROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REV THIS APPLICATION. c/ Signature SWORN TO BEFORE ME THIS_~DAY OF Dc~ ,20_~'~~ Notary Public ~ryN~o.O16ES6~2New 1bk OuMifiel SuMdk C un ISUR\/~Y O~ PROPERTY j 51TUA~TE: SOUTHOLD N TOWN: SOUTHOLD SUFFOLK GOUNTY, NY ~ SURVEYED O&-16-2005 W ~ GERTIFIGATIONS AMENDED 09-Ob-2005 _ !AMENDED OG-28-2005 , '--------i i ii SUFFOLK GOUNTY TAX a ~ ~ ~ I S ~l.r _ I 1 , i 1000-59-b-I? j ~ - ~ - (!I ~ Edward Daley & Diane Daley ~ 'i Ridgewood avioge Back ` i i Yawyers Tide Inww~en:x a..orpoQadon R'_' , ~ ~ 'i / / i i ~a Qo < <q 4 o- I'~ i ~ 3 c I ' / ~~y''~ Ym ~p I '1f~~2 / ' i ~ ~ k i ~ ~ 2q' ~ f o /F'~~ ti ,0 ~ 0 ~ < o y~~ \ ~0....aQG 4~y k~€ o~`Y ~ / \ ~ h7 n ta o ~ ~ s~ '6g+ ~ 6 ~ ~ ~ 9~9'~o O~ 87.`L ~S S ~ ~i ~n ~o ~ .dp,' ~ ' q~3~ ~ ~ ch ~ ~1T ~ a°"~ ~ " ~ ~ ~ \ c,S e h~ ~ ~ y / ~A + l he F by ' ~ v" o S "c a c~ °o a ~ t o° `X~ qi.~ I S + ~ ~ ch , U ~'V ~ ~ i i ~ 9 ~ l i ae \ i f4 'i ~ I \ ~ i 1 o'bo` ° ~~p \ °i ~ ~ o® i f ' ~F. NFL, 5f+ ~ a ' NOTES: * ' 'k ~ , ~ MONUMENT FOUND .1'y,F~ tLAN g~ f FLOOD ZONE LINE ANNOTATED FROM FEMA I~ FLOOD ZONE MAP NUMBER 3610360154 G JOHN C. FREERS LAND SURVEYOR ' AREA = 31,443 S.F. or 0.22 Acre 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 I GRAPHIC SCALE I"= 40' RIVERHEAD,N.Y.11901 i,_ _ _ ~ 369-8288 Fax 369-8287 REF.Z:\pros\OS\OS-254.pro 1 Albert J Krupski, Presiden~ ~~OF SoUlyo • Town Hall James King, Vice-President ~O 53095 Route 25 Artie Foster ~ ~ P.O. Box 1179 Ken Poliwoda Southold, New York 11971-0959 Peggy A. Dickerson G ~ O Telephone (631) 765-1892 OI~C~~~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application _Wetland PermiC Application _VAdministtative Permit _Amendment/Transfer/ xt~ sion ?Received Application: ~ d, Received Fee:$ --Completed Application ~ ~ f~ Incomplete l~n ~ ~ ` - I SEQRA Classification: _ Type IType II Unlisted Ir~~ 2005 '~J Coordination:(date sent) 0~T LWRP Consistency Assessment Form_ _CAC Referral Sent: to of Ins ection: Sast~,~`~~ T0'"° ~a P 6a,;A of Trus.lees Receipt of CAC Report: Lead Agency Deternrination: _Technical Review: .Ptiblic Hearing Held: l l~ Resolution: Name of App'cant ~r ~ U S ~ M OYl t Address ~d ~X ~`b.~ ~ i~On~ \ Phone Number:(~p,~~ ~ ~ 4702 3 Suffolk County Tax Map Number: 1000 - ~ ~ ^ ~ Property Location: ~a ~ ~ ~ I li ~ tt U'Q (provide LILCO Pole distance to cross streets, and location) c0.,.*Jrr F 2 AGE~T: ~I~~C U0.Le~ (If applica~~b}}le) 11 Address: `b`l~p`~ So~NdJ l 1~J~ 22 SOV~~O`~ Phone: a~~ ~~J- ~~?T ~ ~oard of Trustees Applical~ GENERAI. DATA Land Area (in square feet): 1' t{4 Area Zoning: ~ Previous use of property:~~ IC~P(s 11-(/i' L Intended use of property: Q-S (C(~° ti, t t y~ Prior permits/approvals for site improvements: Agency Date ~ ~4~ _,Z No prior permits/approvals for site improvements. Has any permit/approva] ever been revoked or suspended by a govenunental agency? 1~ No Yes If yes, provide explanation: Project Description (use attachments if necessary): ~ ~ ~ 1~`'l A ~G121 3 l~n, ~oard of Trustees Applica~ WETLAND/TRUSTEE LANDS APPLICATION DATTA Puurpose of the proposed operations:_~~ ~ '02 ,1~QN-{ ,-ltd L~(J~r~~ Area of wetlands on lot: square feet Percent coverage of lot: ~ (0 Closest distance between nearest existing structure and upland edge of wetlands: C~w,Ara A :i feet Closest distance between nearest proposed structure and upland edge of wetlands: feet 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 Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations:__~/ f~ 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): ~ ~ ~ ~ PROJECT ID NUMBER 617.20 • SEAR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 • PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. AP/PL`ICANT / SPONSOnRI n, 2. PROJECT /NAME nJ/ LSD ~KC~ ~ r LQ 1\ ~~~G.~t'.lZ_. 3.PROJECT LOCATION:L'dd(oj ~L~NO tlit:u~ 0 Municipality ~~l'~ T 1'vC~~ County 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map $a(vs ~SLx_ w ~~l~. 5. IS PROPOSED ACTION : ? New ? Expansion ~ Modifcation /alteration 6. DESCRIBE PROJECT BRIEFLY: (~rn~~ ~11~6 a~ ~ ~ ~ ~ 0 . 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ?Yes ? No If no, describe briefly: f_~ ~ ._.pt r 9 WH IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) esidential ?Indus[rial ?Commercial ?AgriculNre ?Park/Forest/Open Space ?Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANV OTHER GOVERNMENTAL AGENCY (Federal, State or Local) Wes ? No If yes, list ~a~gency name and permit /approval: Ll'r-~-. 11. D0 ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes ?No If yes, list agency name and permit I approval: 1 ~ 12 A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? es ? No I CER Y T A THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sp r ame Date: Signature 0 Q If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment ~oard of Trustees Applica~n AUTIiORIZATION (where the applicant is not the owner) I, ~ IkAJ~ ~/~Le~ residing at Q (pr(int owner of property) (mailing address)( {~~P `"}~('SQ~1 ~ ~Q~J(Q,U /«~do hereby authorize ~~~e`a.~ji~~Gea( (Agent) to apply for pern[it(s) from the Southold Soard of Town Trustees on my behalf. (Owner's signat r ) 8 Board of Trustees Applic~ion County of Suffolk State of New York 15~~` ~ F/~- ~c- e6 l ~ BEING DULY SWORN DEPOSES AND AFFIRMS AT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/I-IER 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 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. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE USTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO ROPERTY TO INSPECT THE PREMISES IN CONJiJNCTION WITH RE THIS APPLICATION. Signature SWORN TO BEFORE ME THIS_ ~I' ~ DAY OF ~C~U b~(i~,. ,20_ ~'~S~ Notary Public Nehry PuState~ New lpic Qa OI~E6097127 QoAMd~ l1u t~ Wt ilti Y007 z>'° ~ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees. The purpose of this forth is to provide information which can alert the town of possible conflicts of interest and allow i[ to take whatever action is necessary to avoid same. T /D~ YOUR NAME: DIkNC U ~L'e~~ ~e0 (`DN~~'~IO1tiC~Pn~~~ ~~,~~t~,~l (Last name, first name, rpiddle initial, unless you are applying in the name of J someone else or other entity, such as a company. If so, indicate the other person's or company's name J 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 (lf "Other', name the activity) 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, tyarriage, 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 "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 ([he applicanUagenUrepresentative) and the [own officer or employee. Either check [he 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 allthat 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 anon-corporate entity (when [he - applicant is not a corporation); C) an officer, director, partner, or employee of the applicant; or D) the actual applicant. DESCRIPTION OP RELATIONSHIP Submitted t ' }~`~day o-f~ 200 y ~ Signature_'~516.1-tf[~~ - - PrintName Form TS 1