HomeMy WebLinkAboutTR-5803
TERMS and CONOmONS
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1he Permittee Beniamin & Jocelyn Sug1i~ '".""
raidiag lit 4639 Stillwater Avenue, Cutchogue. N. y~ as
put- of the coasiderauoo for the /too....." of the Permit does lIIldersIaod ..... ptescribe to the fol-
lowing:
1. That the said Boud of Trustees ..... the Town of Soulhold ate tdeased from my .....
all cJam.ges, or claims for: daaJaaes, of sula arWag cUrecd.y Of: faclirecd1 as . result of my opet'.
adoo petfotmed pinuaat to lhls permit, ..... the aid P. I J,"ec will, at Ids Of: bel: own esre-.
defead my ..... aIllUch lUlu -iaklm-l by tbl.td pudes. ..... the said ~ ,,~ ._ fa111Wll1ity
wich teSpect tbeteto, to the to"'pL1eexdasioa of the Iloud of Trusties of the T_ of ~
2. That lhls Permit is ..w foe a -period of 24 IDOS, wbld1 is coosld-r to be the
-.....tecJ u-'ftCJUired to~ the wod< ittwhed, butihoaIdcitcamstaDca wuraat, teqae$t
for an exteosioo ma1 be made to the Boud at a liter date.
3. That lhls Permit should be retalaed lndef'UJiIel,. or as l00g as the said Peaulttee wlsbCs
to - .....1_ln the structure or' project lnTOlved, to provide cvicIeo<e to anyoae (lllOCIOtDed that auth-
orizatioo was ori&ioal11 obtained.
4. That the ..odchm>lved will be subject to the ;,.spectlon ..... approva1 of the Jloard or
its ageots, ..... llOC1-<lOIDpllaoce with, the prcrrisions of the orlgl...flng .,pliadoo, may be cause for
rewcauoo of lhls Permit by resolution of the said Board.
5. That there will be no uareasooable lnterfereoce wich oa'rigadoa as a result of the wod<
- heI:eln aDcborized. - -
6. That there sba1l be DO ioterfereoce with the right of the public to pass ..... repas doog
the beach be_ blgh ..... low water maries. -
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7. That if future operadoos of the Town of Soulh91d reqalrc the removal U11d/or allalltloos
in the Iocatioo of the wod< heI:eln ...ll>- ...17M, or if, in the oplaioo of the Jloard of T.-, the,
wodl sba11 cause unreasoaable obsttualOo to free oa1'igotlO'\ the said J>-onl- will be requhecI,
apoo due.DOtice, to remove or allet' lhls wod< or project heI:eln stated wilhouc ~<lt.I(' to the Town
of Soulholcl.
8. That the said Board will be notified by tbe Permittee ot tbe COM1'~,<< the wodc 1IIlh.
orized.
9. That the Permittee wl11 obtain all other permia ..... _ dJat may be required sap;
p1ementa1 to dUs permit wblch may be subject to revoke upon failure to obaln -.
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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 SOUTH OLD
September 29, 2003
Mr. & Mrs. Benjamin Suglia
4639 Stillwater Avenue
Cutchogue, NY
RE: SCTM#137-3-7
4639 Stillwater Avenue
Cutchogue, NY
Dear Mr.& Mrs. Suglia:
The Board of Town Trustees took the following action during a Regular Meeting, held on
September 24th, 2003 regarding the above matter.
WHEREAS, Benjamin & Jocelyn Suglia applied to the Southold Town Trustees for a permit
under the provisions of the Wetland Ordinance ofthe Town of South old, application dated
August 29, 2003
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
September 24, 2003 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.ofthe Southold
Town Code.
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WHEREAS, the Board has determined that the project as proposed will not affect the health,
Safety and general welfare of the people ofthe town.
NOW, THEREFORE BE IT,
RESOLVED, that the Board of Trustees approved a Wetland Permit in an area landward of the
10 foot contour elevation - construct 14 'x3 7' wood deck attached to seaward side of existing
house, remove 8 'x 13' section on seaward side of existing house within existing footprint,
construct two additions to house, one 6'xI6' and one 8'x13' both on landward side of house and
both on concrete block foundation with the addition of drywells and gutters for roof run-off.
BE IT FURTHER RESOLVED that this determination should not be considered a determination
made for any other Department or Agency, which may also have an application pending for the
same or similar project.
Fee must be paid, if applicable and permit issued within six months of the date of this
notification.
Ifinspections are required, at a fee of$5.00 per inspection (See attached schedule).
FEES: None
Very truly yours,
~Jtl~s1<;d. -~~.~.
President, l;~do~
AJK/cjc
cc: DEe
Building Department
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Telephone
(631) 765-1892
Town Hall. 53095 Main Road
P.O. Box 1179
Southold. Ne.... York 11971
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
At the meeting of the Southold Town Conservation Advisory Council held Tuesday,
September 23, 2003, the following recommendation was made:
Moved by Donald Wilder, seconded by William Cook, it was
RESOLVED to TABLE the Wetland Permit application of BENJAMIN & JOCELYN
SUGLlA to construct a 14' X 37' wood deck attached to the seaward side of the existing
house, renovate 8X 13' section on seaward side of existing house within the existing
footprint, construct two additions to house, one 6X 16' and one 8X 13', both on the
landward side of the house and both on concrete block foundations.
Located: 4639 Stillwater Ave., Cutchogue. SCTM#137-3-7
The CAC Tables the application because the project was not staked.
Vote of Council: Ayes: All
Motion Carried
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Albert J. Krupski, President
James King, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
_Coastal Erosion Permit Applicatii'n
_Wetland Permit Application ~ Major
Waiver/ Amendm~chayges
_Received Application: ~ I 0 ~
_Received Fee:$ ;.IH....., I
_Completed Application <if"" lo..:j
_Incomplete
_ SEQRA Classification:
Type I_Type II_Unlisted_
_Coordination:(date sent
_ CAC Referral Sent: ;}- I)
_Date ofInspection: 1"iJ
_Receipt ofCAC Report:
_Lead Agency Determination:
Technical Review: ~
_Public Hearing Held:
Resolution:
Minor
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Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971.0959
Telephone (631) 765.1892
Fax (631) 765.1366
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Name of Applicant ~:~"-{;N .... ..Joc..t,,,, 'Su~.'"
Address tj('3"1 S\--; Ilw~" A-'Ie...
Luh:h"J''''-- N~ ,,~~ Phone Number:(b31) I "3y-f.r.{3c.J
Suffolk County Tax Map Number: 1000 - J~'1 -?:>-'1
Property Location: Yb~ 5\-.\\",:\",r" A,,~ ,
(provide LILCO Pole #, distance to cross streets, and location)
AGENT: '-.-.....
(If applicable)
Address:
~
Phone:
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Board of Trustees Application
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WETLANDffRUSTEE LANDS APPLICA nON DATA
Purpose of the proposed operations: D...cl.- ''''''~ i"".",<".. n ,~"~ : \-1 m<::
?'ol\rlls2. C\r~,hc~ ,^~,t(5
Area of wetlands on lot:
\ ,y\ 0 squarefeet
5.3 %
Percent coverage oflot:
Closest distance between nearest existing structure and upland
edge of wetlands: ~5 feet
') Closest distance between nearest proposed structure and upland
edge of wetlands: Sf feet
Does the project involve excavation or filling?
x
No
Yes
If yes, how much material will be excavated?~cubic yards
How much material will be filled?
NY..
cubic yards
Depth of which material will be removed or deposited: tI/IJ
Proposed slope throughout ~e area of operations:~-A
Manner in which material will be removed or deposited: AI IA
EiU ~
AUG 19 2003
Soulllold Town
808rd of Trustees
Statement of the effect, ifany, on the wetlands and tidal waters of the town that may result by
reason of such proposed operations (use attachments if appropriate):
:I* :s <"'f",\-ecQ -the.+ -\-\.,' fr"~-l'r+ .,,~\\ Ylc>.'''< (-l~ s6\f'CC"A-t
R-&/k: 0Yl -t\'\.i. "'Rt\cwA<;; Ocr-& +;.J)"" \ "..,t\1ers of +1-'-'. -r;>JN.
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Board of Trustees Application
GENERAL DATA
Land Area (in square feet): 'LIo J lOb
Area Zoning:
Q.-4Q
Previous use of property: ? Y",v",--k. P.o<;idl.~
Intended use of property: ? r; ve.-t<.- C....,\&-eNc.R....
Prior permits/approvals for site improvements:
Agency
l?::rn-nSl or;: \(">$\-=>
Nw ~o/"t'3l..~ ~t ,f- Env:/'t)Il.w3..Jl
c..u,.,x.rvc,-t "'"
L.
3 II../'!'!,
'\\w..s.....ft-(~\\-.s 'no-+< -O..f;{"-e~ G."c:\)
"'-.)<. "'.-re V-<c"~"-';~\ ~K, No wed::
w..s ~o.,.lfl. '->-'"-\\.-. ~ 'f'c<.-l;\l\):'
M:~ _
_ No prior permits/approvals for site improvements,
D~:::[~
Has any permit/approval ever been revoked or suspended by a govern
~No_Yes
If yes, provide explanation~
Soulhold Town
Board 01 Trustees
Project Description (use attachments if necessary):
-:I:N c;n ~r~ 1(,vxSi~"'''1?Q or- K.. lO\ (""'___\-"u, ~\<."'ttivV\lc,;yfihoc\: 1411-37' wood d...cl
co.>!t~ <fcS=.w<',-8 5\& cr--=:sh~.)""'v<;,a.,r..",.v..-';<.- '6' 1\.\3' xc\;"",,- ON ~<,,,,,.,<"<J Sic.... C~U;$-I-:~,
",,-~Sll- "",.'t\--.'N ",^'s\,,,. ~ec-\ ('j~' ('u a 1St . oNe b' )<,11,' o,,,,c} ctl't. .
~ \ l( \'3') I:x.~ co-' \Q~dl~r "",J..<.. ct;' .....0"...... Q>.~.0l ~'" c'" uY">c<<d'~_ 'D1oc-\:- ~c",.~.1",\,VV\S .
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NOTICE TO ADJACENT PROPERTY OWNER
BOARD OF TRUSTEES, TOWN OF SOUTHOLD
In the matter of applicant:
SCTM#lOOO-13,-~-7
YOU ARE HEREBY GIVEN NOTICE:
1. That it is the intention of the undersigned to request a
Permit from the Board of Trustees to:
-:LN 0...V'\ ~r<"," 6.~.....:>c,,& cr ~ \0' u~'-\ovr .rl~"'o..\"'rY"'l1 Lo-Yls..\.t...~~ l'-t' .,.?>, I W~(jl ckcl ~-\\^c:..~ t"
~ ~u...:.,,~,..JI Sdl.r... c.F. ~}l.\S.\-""\ "'~~ I ("~..:.c~~~ "is' ('30\ Srtc:...+tn1 ol\ Sc.4.~.....{.\ "3\~ c~ <..\\'\ir-, 'n(;\J~
""'........... -<'.>l,~'I\~~ ,.~.";,.c..,,..,;~~.. <>.~;.\{vY'>, .\-.. """"- ~,,"''''') 6~<<- (." )(Ib' C\~~ C"",,,- "" ><f?,l bokt-..
~.,., 'Q...,&...,.,'-& 5dA. cC '1-=""- ~ \oo~ "'''' G:--f)vc:k \:.Ioclc- ~c,-,,..,&..."",,,S?, '
2. That the property which is the subject of Environmental
Review.--is located adjacent to your property and is described as
follows:
Y""3'\ 5t,l\w...-\<r l\~ ,Cu-rc..~ve., N--j 11~3S
3. That the project which is subject to Environmental Review
under Chapters ~2, 37, or 97 of the Town Code is open to.public
comment on:jS~~~~~L~ryP'1YOU may contact the Trustees Off~ce at
765-1892 or Hi ...,~Hlny.
The above referenced proposal is under review of the Board of
Trustees of the Town of Southold and does not reference any
other agency that might have to review same proposal.
OWNERS NAME: ",,' ,,-;,.., 'S,'"
MAILING ADDRESS: ~
c.."rn;~~ N'I
PHONE #: (,..,0' - '13'-1 - WJ-"o
~IE C IE I W ~ ~'
lTo., 2 9 2003
Soulhold Town
Board of Trust..~
Ene.: Copy of sketch or plan showing proposal
convenience.
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PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
STATE OF NEW YORK
COUNTY OF SUFFOLK
~~}I\,~'N "Su~_t.. , residing at 1.{"3 5\-
C -A~t~ N't Iq ~5' , being duly sworn, deposes and sa
2- 'l ayof A;;pos+ ,2003 , deponent mailed a true cop
set forth in the Board 0 Trustees Apphcauon, drrected to each of the a
persons at the addresses set opposite there respective names; that the
opposite the names of said persons are the address of said pers as s
assessment roll of the Town In"Southold; that said Notices re maile
Office at c..~",<J(. /11'/ I/B\that said Notices w ;./ 'led to
(certified) ~o:!t8Fid) mail. !
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U.S. Postal Service,.,
CERTIFIED MAll,M RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
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Postage $
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o Certified Fee
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o Return Reciept Fee
(Endorsement Required)
o Restricted Delivery, Fee
o (Endorsement ReqUired)
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2.30
1.75
4.42
Total Postage & Fees $
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Sworn to before me this JR
Dayof Au..f,.-ll..i-J ,20~
fim ~ Q~
/ . Notary Public
Monica Cerise
~OTARY PUBLIC, State of New v-o.
ftO. 01 CE6059403 M~
()ualjfi~d .10_ Suffolk County
CommissIon Expires May ~9, 2O..fL.?
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CERTIFIED MAll,M RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
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Postage $ 0.37
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(Endorsement Required)
o Restricted Oeliv9fY Fee
D (Endorsement Required)
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1.75
4.42
Total Postage & Fees $
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CERTIFIED MAIL,., RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
Postage $
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0.37
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(Endorsement Required)
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Total Postage & Fees $
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,.,.. lliiOO'.Aj;fNip.......................................................................
0' PO Box No:' Lj.?eX) st, \ \ WAt:..- Ave.
CitY:.Si8i6:ziP+4---~----.~-------~~-.-l,;.d.--.-.~----.-~..-::::._~n_______..______~~~.
Cv~c.hu v"'- tv'! 1/'/ 3)
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Adjacent Property Owners
1000-\37-3-8.3
Bill and Sue Graff
4835 Stillwater Ave
Cutchogue, NY ]] 935
1000-\37-3-9
Eugene Annabel
1055 Ocean Ave
Bayshore, NY ]] 706
1000-\37-3-6
Vincent Annabel and others
4300 Stillwater Ave
Cutchogue, NY I] 935
IOl,H IU 'JJ IE ~
\~ lUG 29 2lllll \\:!J
southold low'
Board 0111ustees
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U-i6-4 (2187)- Text 12
I PROJECT I.D. NUMBER
SEQ
617.21
Appendix C
State Environmental Quality Review
SHORTEN~RONMENTALASSESSMENTFORM
For UNLISTED ACTIONS Only
PART I-PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. APPLICANT fSPON;!?R \ 2. PROJECT NAME I
':::'_10.\ "" S "'~ \; '" \r), vS</. d12cX:-
J. PROJECT LOCATION: r=::::::r
Municfpallty Cl,,)+~c~u-<. County S,,&\"-. .
4. PAEC:SE LOCATION (Street addrM and road intersections, prominent landmarks. etc., or proviae map)
'-l<.."?o, 'Slc'\\"-l& Me, C.u~u<:.. "^\ 1\'1~s
'-l
5. IS PROPOSED ACTION:
~ew 0 Expansion 0 Moditicatlonialteration
6. DESCRI8E PROJECT 8RIEFLY:-::r:.... "'"' Q.""'-'-' \"V">&w,,~ OF +>-.... IC'Cc-n\t>vr ..,_\<""~;,,,--, CG"s\:'''<-~ 141"3'1'
""",c<J, ~I<:. "'%\~~\ -to ""'c.~ os,,:.&... v~ c:...\~~;".:) 'hoHJl., "'<Nc~",'t<. 'i!' ~ 13' 5<.~~:,"'" <0'" ~"'u.:A".\I s.JJ.
o~ <!J<,''!'''''-,_''''"': "-"'",,",'N -ex..",,\,:":) "'<.o-t\" ",r\, Cu-Ils-\<uc.:-'l -\-we ".Q&'-\-\Irf)S -\0 Io"~ e...,'" (.,ll\lbl ..."
ON<.. g, ","3" , \:;,,-'\'1.-, "',., ~ \C\~"'o.<<,!l <;\(\U. 0(" y.,,,,-,,-"'<. "'~& \:,~ e~ U"T'1c.<<:I<<''ovLL ~c~<l'<i'''''3,
7. AMOUNT OF LAND AFi=eCTED:
Initially I () 2. 5" acres Ultimately rJ. /-1\ acres
a. WILL ,:::RO?I'JSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING '..AND USE RESTRIC71QNS?
~Yes 0 No If No. 'describe briefly
,.--..-- --~-'-
9. VJHAT IS PRESENT LAt~D llSe. IN VICINITY OF PROJECT?
~Flesldenlial O.!noustrial 0 CommerciaJ 0 Agricuiture
Describe: L
f'O\.,&, UK -5\ ~ ?"';""~<- "-""-'R<'f:'....0V\. t-- ,<
~'D'-",....0 " N,\S DEe:..
,-
Iher
10. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING, NOW OR ULTIMA I
5T ATE On LOCAL)?
I2S.Yes 0 No If yes. list agency(sl and permit/approvalS
OM A~YOT~E~. G~B~NME ENCY (FEDERAL,
AUu L'
soutbo1d Won
Boaro 0\ 1lUStees
'r
11.
DOES ANY ASPECT OF THE ACT'or~ HAVE A CURRENTLY VAllO PERMIT OR AP.
DYes' 0 No . If yas, list agency name and permit/approval,. I '
\0..... ~o.J) psu"t-\.\-t5 ~-\--4-f>\raSl ""....c.l! 'l<>.re.. ,...."-f>l'\1\~\.!'4'" ~"S1"",.vcJ,W'-
.pu fa ,...-u~ ~rb...... ~ D\& (5.<.Yr-<its. ..)
W(tS
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE .VlOOIFICATION?
DYes ~NO
Applicant/sponsor
INFORMATION PROVIDED AeovE IS TRUE 70 THE 3EST OF MY KNOWLE.DGE
'~
Dale:
~.. 2.<<(-03
Signature:
If the action is in the Co"stal Area, and 'Iou are a state agency, complete the
Coastal Assessment Form before proceeding with this a~~essment
OVER
PArtT il_::NV1RCNMEN7A'
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'SSES3MENI17o De Go~;::ieteC'J'1 ,j"genc
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'"". DOES ,,.l.,C7:C:-.l =.;':C2:.=;.:: :"'NY I,~= 7i-tr::.E3HOLJ!N -> ,'<':'C??. ~:..F,T o,7.~:"
i-.:y~s C,'to
3. 'NIL!.. ,K-;-:CN .=lE':::::VS ':::CRDINA 7'C.J ::j,E\/IEW ..:.5 ?RC'/IOEJ =':n U~IL;S7EO ,:..G7iCNS iN 3 .'t'(-::::::R.:l,~r;l 01 i_57
may be sUDersecec :y lnot"ef ;n'Jol'Jetl a~enc,!.
,/ '/as. .::ocrClnate :ne reVI~W :rocess ana 'JS6 ~t',e ;=:JL:.... ::'A;=-
;J .'~o. 1 rleqat:'/l) ::::ec:ar,,-
LYes
:..........: :-.10
C. C'::::ULD ACT.iON ~ESUl7 :N ,1.NY ,1,QVe::'SE :::=:==.-:,5 ASSCC:":' .E::J ',vIi:.! -,.,=. .='JU...CWING: ;Answers :nay :e ,'ancwrmen. ;/ ;e~rCleJ
C1_ ~:dsting lir ~ualit'l. ~uftace Of grOunawaler ::uality '~r :::uantlty, rlOlse ,e'/eis. :xls;:ing :.atfic ~atterns, selid ,vas;e :JrDct:c::~n ~r1fs;:c
oOtentlal fOf :r05.0n, ::::ralnage or :!ooc!inq Of obi ems? ':.::.ol.1ln :lrieily:
C2:_ Aestl'letlc, 19riC:JHufal. 3.rC:laeoloqic.al. his,onc, Of other ~atUral or cultural resources: Of communIty or iielgnbcrnood c;"larac:er? ::::':'olaH'l -'
C:J. \/egetatton or :auna. ~Isn. sr:ellfisn or 'Nllalife soec:es. slgmficant :-i.1citars, or :hre.3t<!f1ed or ~nC.1(H;efeO :;;::ec:es? Selaln ::Jrlarly:
c~. A c::mmunity's exist:ng ;llans O( goals as OWC:';lly adooted, Of a cnange in usa Of intensity at use ot land or other natural reSOUfCSS.? S"(plain :;r
CS, Growlh, suosecuent :::evelooment. O( rel.1teo ac:ivities likelY to oe induceooy the ::roooseo action? S"(olalO :Jfleily.
GS. '_c:ng :erm, ~nort :erm.::Jmuiati'Je. <Jr otner !!Ifec:s not icentifiea in C--:-C5? ::;0;01.110 :Jfleily.
.~,. Str:er :moac:s .incr~Cing -.::-:anges In 'Jse of ;!lher quantity Of :ype ot ~ne{gYJ? Solaln ::rietly.
'- ':'es
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'f ':'es, ~xctain Clrieily
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oJ. ,5 ; HE?;E,:::R ,5 -:"HE?E '_::<.:::..':' 70 3E. -::ONTi=l.QvE?SY r:l;E!....A.E0 70 ?OT2:'lTIAL A
Southold Town
PART III-OETE::iMINATION OJ;.SiGNIFICANC2 ITa oe comoleted oy A Board of Trustees
INSTRUCTIONS; For eaC:l adverse effect identified accve, determine wnettler It IS substantial. large, [mcortant or otherwise signific
::acn affect snouJd be assessed in connection witn its (a) setting (Le. urban or rural); (hI. ;JrobabiJity of occO?'1!1q; (Cl duration
irreversIbility: (el geograonic 3coce: ana (f) maqnitude. It necessary, add attachments or reference supporting materials. :.nsure
exclanaticns contain sufficient de.tail to snow tnat ail relevant adverse impacts have been identifieCl and adeqUateiy aCcressec:.
C:-:eck :his box if 'IOU ;,ave identified one or more ;Jotenrial/y larr;e or significant aC:'1ersa imo2c~s whic:1 MA ';
oc::::;r. Then Jrcceec airecrly to ~ne FUL!... ::AF 3.nd/cr preaare a positive- declaration.
_ C;;ec~< :his :JOX if 'IOU have de!ermined, based on the information and analysis above and any suooortjn~
coc:Jrr:enratlcn, :J1ar ~he :Jrocosed ac~icn l,'VILL ,'~OT result in.~(lY significant adverse environmental imcac::
AND ;::lrOI/ICe on 3.i:<.ac:1ments as necessary, (he reasons supcorting tnis deTerminarion:
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Board of Trustees Application
County of Suffolk
State of New York
~t-i~~'" ~. S~{>.. BEING DULY SWORN
DEPOSES AFFIRMS T HElSHE 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 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 TRUSTEES, THEIR AGENT(S) OR
REPRESENT ATIVES(S), TO ENTER ONTO MY/~OPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEviOF pUS APPLICATION
,(
t Signature
SWORN TO BEFORE ME THIS ,") I
c C - -
;(Vl~ 1~
. Notary Public
Monica Cerise
NOTARY PUBLIC. Slale 01 New York
No.01CE6059403
Qualified In Suffolk County 11 '1
Commission Expires May 29. 20 1L...i
DAY OF ,jl< L(
,20ti
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lI.rl't.t~lI.NT
TRANSACTIONAL DISCLOSURE FORN
.
The Town of S~u~hold"S Code of Bthics toh!bibs conflicts ot
nterest on the part of town off cere and employees. 'l'he
purpose Of this form is to provide information which can
alert the town of possible conflicts of interest and allow
it to take whatever action is necessary to avoid same.
TOUR NlI.HE'
l<';-i~ti~d~.-:~;~:;~
m dd.le
name of someone else or
~B a companf. If gO~ indicate
or company's name.)
<:~~~~t.::.:::.,'t~'.;~<!f}-;'~':i:.
NlI.TURH ot 1I.1'I'LI~TION. (Check all bhat applY.)
Tax grievance
Variance
change of zone
Ap'p~~al of plat ~
Exe~ption from plat or official map
other
(If "other," name the activity.)
..~
Do you perllona11y (or tht:"ough :rour coMpany, IIpbU8e, ltlbl1ng, __.
parent, 01:' child) have a relationshipvith any of ricer at'
employee of the Town of southoldl -Relo.tdonshlp. includes
by blood, .arriage, or business inter .
intereat" means a business, including
which the town officer or employee has
ownership of (or employment by) a c
the town of ricer or employee ovns More
sh'ares.
, i' IE
~
ation in which
5" 0' .the
d:, 29 2003
YES
NO 4.L
If you answerad .~BS,.. co.p18~e the ba
date aDd sign where indicated.
Name of person employed by the Town of Soubhold
Title or position of that person
Describe the relationship between yourself (bhe applicant)
Bnd ~he town officer er employee. Either check ~hG
appropriate line ~) through D) and/or describe 1n the space
prov~ed .
The town officer or employee or his or her epouaei e!bllng,
_C)
~D)
or child is (check all that apply)!
the ownat of greater than 5% of the ehares of the
corporate .tock of the applicant (when the applicant
is a corporation),
the legal or beneficial owner of any intereet in a
noncorporate'entl~y (when the appllcah~ is not a
corporat.ion),
an officer, director, partner, or employee ot the
applicant, or
the actual applicant.
parent,
_1\)
_9)
....
DESCRIPTION 011' RELATIONSIIIP
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ACCESS CONSENT FORM
FOR ACCESS
THROUGH PRIVATE PROPERTY
~";~P.K\"'" S..:>~.l'\.
(Name 0 Applica )
Office use
File #:
Permit #:
Only
Print or Type:
1)
4(,3'1 g:.\\w...-k
(Address)
Ai~
~0E' N~ IIq3
<..::J
2) ~
(Name & Address of Contractor Involved)
3)
4)
5)
1000- J 3'1 - "3 - '1
(s.c. T .1.1. #)
4/:'09 S\-,\\wtdu A.k.. c..,..k~~ N'l/l'1s(
(Project Location) 0
S+', \\WA-\:....- ~e..
(Name of Road or Private Property Involved)
: s.,v~o\c~
(Hamlet)
\<13$
~...,,'
( Name
N'l
Property Owner
6)
-::c;., "'''' Co.""=' \:...~....,.".d\ oF ~ u,' rnn+""r....\Nc.\.;\W1 lc"",s\-,...,d: ILl' )(31' ~ &<cl
(Brief Job Description) \ ,
o..-\\~'>I ~" 'X<\,,",-,,,,rc\) 'S,~ c..fr e.,...,.\-''':'S I,.,.,,-,~ l"-~..o~o..t< I!. x 13 Setho...., Or""l ~CI."""v<l ~"-c.,,
0\- -o..\';".~ """- \.>.)~. ~'.s\',~ ~c:J- ;o.)"T' ;-\, -to ho'~ J ow<.
~\1-11o'o.'" DNe. '6'l<I~','o~",.. .."'&b.~()"'(o-,\crd"'"
y,\bc.L ('"",,..&..-\,""5'
7 )
~ '4'('ro_9.
Starting Date:
Completion
8) Estimated Cost of Proposed Work:
9) Insurance Coverage:
A. The coverage required to be extended
Bodily injury & Property Damage;
$300,000/$500,000 Bodi ly Injury & $50
C I sou\hO!" 10wn
B. Insurance Company: t:N,rj4 . ,"fuel'"
C. Insurance Agent
Name & Tele:e.hone # .,IoS--:''C II
D. Policy # : ~/lry'2...S)
E. State whether policy or certif' ation
is on file with the Trustees ff' e:
(If no, Provide a copy wit Ap ication) (yes
ure of Applicant)
------------------------------------------------------------------
To be completed by the Property Owner:
I/We the undersigned, fully understa
Work referenced above and have n
Applicant to cross My/Our Property
the nature of the Proposed
objection to allowing the
the work.
(Si na ure of the Property Owner
or dul y authori zed represent at ive)
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4300 STILLWATER AVENUE
CUTCHOGUE. NEW YORK 11935
1Ro~m IJNE. 01' t
1 000- 1 37-3-6
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B~ AMIN SUGUA
463 STILLWATER AVENUE
CU HOGUE. NI;W YORK" 935
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4835 STILLWATER AVENUE
CUTCHOGUE. NEW YORK 11935
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WETLANDS VEGETATION DELINEATED
BY J.E. FlTZGERALD. JF ON 7/29/97
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~'1tb1O VIEW.AN8lE'5
PROJECT PLAN
Application regll!dinl! the Jl1'Operty of
Benjamin Sug1ia, SCTM #1000-13'7-3-7
CORPS OF ENGINEERS DATA
PURPOSE:
IN: Eugene's Creek
COUNTY: Suffolk
DATUM: MLW
AT: Cutchogue
STATE: New York