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Home My WebLink AboutGreen, JeffAlbert J. Krupsld, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application, dated has be~n reviewed by this Board, at the regular meeting of ~/~/0~ and the following action was taken: ( ~)Application Approved (.__) Application Denied (__) Application Tabled (see below) (see below) (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: SIGNED: BY: PRESIDENT, BOARD OF TRUSTEES CLERK, BOARD OF TRUSTEES 4/98 Telephone (631) 765-1892 Town Hall. 53095 Main Road P.O. Box 1179 Southold. New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Consed/ation Advisory Council held Wednesday, February 19, 2003, the following recommendation was made: JEFF GREEN to construct a garage. Located: 495 Williamsburg Rd., Southold. SCTM#78-5-10 The CAC did not make an inspection, therefore no recommendation was made. 078 Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. DATE: ISSUED TO ...................................... ........................................................... Pursuant to the provisions of Ohapter 615 of the Laws of the State of New York, 1893: and Chapter 404 of the Laws of the State of New York 19521 and the Southold Town Ordinance en- titled I"RE~ULATING AND THE PLAGING OF OBSTRUGTIONS IN AND ON TOWN WATERS AND PLJSt~LANDS and the RE OVAL OF SAND, emVEL OR, TmR TE. ALS LANDS UNDER TOWN WATERS~.!.~ &.~'c.~rdance with the Resolution of The Board adopt~e.t~ meeting held on ................. ~.......... ......... and in cons. Jde..r~fi~ o1~ the sum of $ ................. paid by O~ l.... ~ I ~ I I . ~ 'l~' "~ ~ ~ I ~. I I ~ I ' ' ~l I I ~hJe Terms and C:ondit'l~ns hsted on the reverse slde hereof, of Southold Town Trustees authorizes end permits the following: all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Gorporate Seal to be affixed, and these p.resents to be subscribed by a majority of the said Board as of this date. TERMS and CONDITIONS ~ Permi~ee rmld;n~ at ps~ of the comideratloa for the Ls~uance of the p~i~ does 1~: L ~ ~ ~d ~ ~T~ ~ ~e T~ ~ ~ld 3. ~t ~ Pe~t ~d ~ ~ ~, ot ~ ~ou of ~ ~t ~ ~lu~ ~ ~ ~ ~ &. ~aU~~the ~t ~ ~ 7. ~eo~~eT~of~ld~ ~ ~ ~a ~ ~ ~ ~ ~ or ff,~~~ ~ ~ ~ to ~ve or ~ter ~ ~ o~ p~j~ ~ 8, ~a ~e ~d ~td w~l ~ ~ ~ the ~ o~ Albert J. Krupski, President James King, Vice-President Artie Foster Ken Peliwoda 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 T~tUSTEES TOWN OF SOUTHOLD 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 st day of construction constructed I,/'/Project complete, compliance inspection. JAN 2 7 3)08 Southhold Town Board of Trustees 23,396 sq. ft. ELEVATIONS ARE REFERENCED TO N.G.V.D. N/O/F MA.TORm CLUST 89'28'50" E bulkhead 126,63' ~ SURVEY OF PROPERTY AT BA YVIE W TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK , / z,~,,t ~LTER~,~rL)', OF~ AOD;T;ON TO rH?S SURV[? ;S ~ VtOL~TION Of 5ECTtON 7209 OF ~E NEW vOR~ STATE EDuCaTiON LAW E~CEPT AS PEP SECTION 7209-SUBDiwSION 2 ALe CERTIFICATIONS HE~EON ARE v4L/D ~OR THiS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIEs BEAR THE IMPRESSED SEAL OF THE SUR~YOp WHOSE SIGNATURE ~P~EARS HEREON, S( ~ (516) 765 - 5020 P. 0 BOX 909 7250 TRAVELER STREET SOUTHOLD, N. Y ~971 ) ,'vO 49618 CLUST '50" b.J.),.~,d 126.63' & SURVEY OF PROPERTY AT BA YVIE W TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK '~~ ~_~o~ ~ '~i 1000-78-05-10 ,' SCA!,R: 1"=30' .~-.q,~, ~ ~. ~.. ~B. 11, 1999 ~ = 23,396 ecl. ft.. ~ECONIC gl.~ (516) 765 - 5020 P 0 BOX 909 ~2~0 TRAVELER ~TREET SOU THOLD, N. Y 11971 ELEVATIONS AI~E REFERENCED TO N.G.V.D. O~ ~ECTION 720~ OF fHE NEW vQR~ STATE EDUCATION LAW EXCEPT AS PEP SECTIO~ 7209-SUBDiviSION 2 AL~ CERTIFICATIONS ~EPEON ARE V~L'D FOR TH;S MAP ~ND COPIES THEREOF ~NLY IF SAID M~P 0~ COPIES BEAR THE IMPRESSED SEAL OF THE SUR~YOP WHOSE SIGNATURE ~P~EARS HEREON. 49618 :Albert J. I<rupski, President James King, Vice-President Henry Smith Artie Fester Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, NewYork 11971-0959 Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office UseOnly Coastal Erosion Permit Application ~etland Permit Application /Major Waiver/Amendment/Changes vl~eceived Application: ] ~'Received Fee:$ ~ 7Completed Application~ Incomplete SEQRA Classification: Type I Type II Unlisted.__ Coordination:(date sent) /CAC Referral Sent:~ /' Date of Inspection: Receipt of CAC Report: Lead Agency Determination: __ Technical Review: -.~ublic Hearing Held: ~ ~/~ Resolution: Minor $o~/~hold Town -- Beard of Trustees Name of Applicant ~-~ ~'-f" /C//;/ 1/77/ PhoneNumber:(~,a Suffolk County Tax Map Number: 1000 - ? ~ -- Property Location: (provide LILCO Pole #, distance to cross streets, and location) (If applicable) ~ Address: ~. ~' ~ ~~~ Phone: ~-- Board of Trustees Application Land Area (in square feet): Area Zoning: GENERAL DATA Previous use of property: Intended use of property: 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? p/No Yes If yes, provide explanation: Project Description (use attachments Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA P. se of tbe proposed operations x Area of wetlands on lot: ~ ~ square feet Percent coverage of lot: ? % Closest distance between n.e~rest existing structure and upland edge of wetlands: A///5] feet Closest distance between/nearest proposed structure and upland edge of wetlands: .A////q feet Does the project involve excavation or filling? No l/ 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: Proposed slope throughout the area of operations: ~'/~ Manner in which material will be removed or deposited: 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: '~ go~-w /~C/ wetlands present within 100 feet of the proposed activity? t/ No Yes Does the project involve excavation or filling? No /Yes If Yes, how much material will be excavated? c~ (cubic yards) How much material will be filled? /~ (cubic yards) Manner in which material will be removed or deposited: ~9//2 6~,~ Describe the nature and extent of the environmental impacts reasonably anticipated resulting fi.om implementation of the project as proposed. (Use attachments if necessary) Albert J. ICrupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda 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 of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING berg duly sworn, depose and say: That on the ~ day of ~f~ , 2Q~, I personallv poste~ the property known as ~?~ ~'/~. ~f' 5~o~ by placing the Bo~d of Trustee~ officFal poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Da~. of hearing noted thereon to be held~.~l~ Dated: sworn to befo~re me this °° Nota~ Public ELIZABETH A STATH1S NOTARY PUBLIC. State of New York No. 01ST6008173, Suffolk Co_ug~ Term Expires June 8, 20..~..(z:~ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Nflnle~ Address: STATE OF NEW YORK COUNTY OF SUFFOLK ~et forth, in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective nasnes; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment rgll of,tl)e T, ov~ of So~thold; that said Notices were.mailed at,the?t? S tes?t Office at., ~ O. ~/~/,-.~ ~/'b'/ , that said Notices were maded to eac. m sam persons (certified) (registered) mail. ~ ~ ~q~taryPublic , residing at , being duly sworn, deposes and says that on the ,200 ~, deponent mailed a true copy of the Notice JOYCE M. WILKINS Notary Public, State of New York No. 4952246, Suffolk County Term Expires June 12, ~ ~ o · Complete items 1 2, and 3. Aisc complete item 4 if Restricte, r Delivery is desired. · Print your name a ~d address on the reverse so that we can re~ ~rn the card to you. · Attach this card t¢ the back of the mailpiece, or, on the front if s )ace permits. I Article Addresse o 2. Article Number Crransfer from servic~ label) lelivery address different from item 1 ? if YES, enter delivery address below: [] No 3. Service Type 0 Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 7002 2410 0001 6159 7634 PS Form 3811, Aug~st 2001 Domestic Return Receipt · Complete items 1, 2, and 3. Aisc complete item 4 if Restric ed Delivery is desired. · Print your name and address on the reverse so that we can etum the card to you. · Attach this card to the back of the mailpiece, or on the front i space permits. 1. Article Addressed to: oooc/ 2. Article Number (Transfer from se~ rice label) Printed Name) C. Date of Delivery D. Is delivery address different from item 17 [] Yes If YES, enter delivery address below: [] No 3. Service Type ~ Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise [] Insured Mail n C.O.D. 4. Restricted Delivery? (Extra Fee) t--I Yes 7002 2410 0001 6159 7580 PS Form 3811, August 2001 Domestic Return Receipt · Complete items 1, 2, and 3. Aisc complete item 4 if Restdctec Delivery is desired. · Print your name ar d address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. Agent [] Addressee Date of Delivery Article Addressed to: D. Is delivery address different from item 1 ? [] Yes f~YES>~nter delive~q&address below:~'A [] No I-i Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) _[] Yes ~nn~ 2ul,R 0001 6159 7627 · Complete items 1,2, and 3. Also complete item 4 if Restricted Delivery is desired. · Print your name and address on the mveme so that we can return the card to you. · Attach this card to the back of the mailpiece, or og the front tf space permits. 2. Artich~ Number ~a~l~[,~ from serv,~/abe/) PS Form 381 1, August 2001 Received by (F C. Date of Delivery Is be~very eddre~s different from item 17 [] Yes if YES, enter delivery address below: [] No 3. Se~ice Type [] CertEled Mail [] Express Mail [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C,O.D. 4. Restitcted Delivery? (Ex/ra Fee) [] Yes 7002 2410 0001 6159 76t0 Domestic Return Receipt 102595~JI-M-0381 · Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. · Pdnt your name and address on the reverse so that we can return tha card to you. · Attach this card to the back of the mailpisoe, or on the front if space permits. 1. Article Addressed to: 2. Adicle Number ('frans re,' horn sen,~-e labe0 Received If YES, enter delivery address baiow: [] No 3. Service Type [] Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 7002 2410 0001 6159 7603 Ps Form 381 1, August 2001 Domestic Return Receipt 102595-01-M~)381 817.21 Appendix C State Environmental Quatity Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only SEC 3ART I--PROJECT INFORMATION ~To be completed by Applicant or Project sponsor) 5. IS PROPOSED ACTION: ~ New ~"E~ban sion AMOUNT OF LAND AFFECTED: r, ili, ll., ac,e, WILL FROEOSED ACTION COMPLY WITH ~XiST[NG ZONING OR OTHER ~ISTING ~ND USE RESTRICTIONS? ~ Yas ~o If No. describe b¢iefly I "Agncudure -'~ParklFores[IOoen scace ~Other 10. OOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCALLY NO If '/es, llst agency(s) and permit/approvals DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUO PERMIT OR APPROVAL? [] Yes ~ If yes, list agency name and germit/aDproval I CERTIFY THAT THE INFORMATION PROVIDED AeOVE IS TRUE TO THE SEST OF MY KNOWLEDGE Appticant/,ponso* name:'-" / ~ ~'t ~-~ Date: Signature: w ~ -- ~ ~"""~ the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this a~s, essment OVER ! P~.RT ii_ENVIRO,'qMENTA' :SS~JENT ~To .~e ...... ~.e. s'/ Agenc ~ART IlI--0ETE2, MINATICN CF SiGNIFiCANCE ~To ~e comoleted ay Agency) NST~UCTION$; For each a~verse edect identified ~ove. determine wnettler it is SuDstantiai. ~arge, [mco~n~ or otherwise sigm Check ;his DOX f YOU h~ve identified one or more ootendalty large OF significant adverse impacts wnic,q ,~JA'¢ scour. -hen 3rocaed direc:l'/ ~o :~e FULL EAr ~nd/or preoare a positive' declaration. hecx f ~ave de[ermined, based on the information end analysis ~bove 8Rd any suooorfin[ you . '. ~d of Trustees Applicatio~ A~THORI ZATION (where the applicant is not the owner) ~~ ~-/~ residing at (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. net' s signature) 8 ~N 2 ? ~o3 Jl II