HomeMy WebLinkAboutTR-6037A
.
.
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.: 6037A
Date of Receipt of Application: December 7,2004
Applicant: Robert Lehnert
SCTM#: 137-4-23
Project Location: 945 Fleetwood Rd., Cutchogue
Date of Resolution/Issuance: December 20, 2004
Date of Expiration: December 20, 2006
Reviewed by: Trustee Peggy Dickerson
Project Description: To install new windows and siding on the existing 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 Roderick VanTuyl, P.C. dated October 24, 1994.
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.
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Albert J. Krup~i:J(,P~
Board of Trustees
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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
8zuthold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-_"'10111
1-;(\0..,
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BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
Coastal Erosion Permit Applica%
= Wetland Permit Application _ Administrative Permit
Amendmentffransfer/E!<tension
---Received Application: l:J.f 7 rJ-{
/Received Fee:$ d'y)-
_....eompleted Application 1i}(?/t1{ ~ ~ (C ~ n H!~
_Incomplete 0
_SEQRA Classification:
Type I_Type II_Unlisted_ r-\ ,
_ Coordination:( date sent) j DEe 7 LvA \b!;
CAC Referral Sent: ,
......-]Jate oflnspection: 1 a-j 131 IJI<f
_Receipt of CAC Report: Southold Town
_Lead Agency Detennination:_ Board of Trustees
Technical Review:
-Jt1blic Hearing Held: IJ-I JCj (j.f
Resolution: ,
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If),) Cvl-&j,07~e.IIV/J /J15S-
Phone Number:CS'~ 7 ~ if - 2 1//1
.
/37- 4-23
q 15' F/ ~e f/Nt:)od If (/41.
IV
MAIn
Name of Applicant R 0 6 e,.-f
Address 3.2. b 4- 5"
Suffolk County Tax Map Number: 1000-
&Ie
ole #, distance to cross streets, and location)
AGENT:~6// / -eVlfOt
(If applicable)
fj"'nnl/lJ.j ea'5 f
Address:
J211s-
Mtti /lit
11) I
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Cv/.-&t~ 1/& /p 7/110/35'"
Phone: 6J/, 731/- ~~I/
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.
Board of Trustees Application
GENERAL DATA
+/- 33_,/00
Land Area (in square feet): ~ _0' _
Area Zoning: R - 4 tJ
Previous use of property: ~ t:1J,j ~H rt!:
Intended use of property: f? e5/J. -etll C e.
SF.
Prior permits/approvals for site improvements:
Agew
f./!,
Date
---X- No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a governmental agency?
---KNo_ Yes
If yes, provide explanation:
Project Description (use attachments if necessary):
J " J-eYJ U
;J.1.)er~J.llm5 /I/t:-w lIV/H),()w5 j -S-,J"nf!!J'
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. .
Board of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: f< e~ J.,,/ ~VI f e.
Area of wetlands on lot: square feet
Percent coverage oflot: / 7 %
Closest distance between nearest existing structure and upland
edge of wetlands: 4-1-- ., ~ feet
Closest distance between nearest proposed structure and upland
edge of wetlands: +/.. J ~ 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?
cubic yards
Depth of which material will be removed or deposited:
Proposed slope throughout the area of operations: IV' / J}
Manner in which material will be removed or deposited: IV / A
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):
are
t?" 7
w'/ I /; ~ hI?
Chlf,YJ 5fn5
~lt-e~1- a ~ lNe
IN/VIA-ow, J- 5/~1t1,::J,
TI, .e".e.
.
.
Board of Trustees Application
COASTAL EROSION. APPLICATION DATA
Purposes of proposed activity: 111 JT:II'J In AI.J.erA fll", ~ 01-
/V.eov
W'V1J.,pWS
.;.
.
'5ltAln:J
Are wetlands present within 100 feet of the proposed activity?
No X Yes
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?
(cubic yards)
Manner in which material will be removed or deposited: IV / IJ
Describe the nature and extent of the environmental impacts reasonably anticipated resulting
from implementation of the project as proposed. (Use attachments if necessary)
Th.~r e WI / /
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n e. w /NmdlPlI""~
6e.
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SEQR
617.20
PROJECT ID NUMBER APPENDIX C
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Qnly
PART 1 - PROJECT INFORMATION ( To be completed by Applicant or Project Sponsor)
2. PROJECT NAME
t.~
~
3PROJECT LOCATION:
Municipality
~
County
4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks ate - or provide map
q45
F/~ef~(H/~
J<oa.,.),
5. IS PROPOSED ACTiON: D New
D Expansion ~ Modification I alteration
6. DESCRIBE PROJECT BRIEFLY:
Ih J-.et''IfIr IIlh".".f,PY1~ J /II~
f'rt () ,). , /, ~ ~ fum 5
fo
WIn;'P~ .J- !>{,lln.:J. }/o
~.frn.f"Y--e ~I f~~/P(eH~e.
7. AMOUNT OF LAND AFFECTED:
Initially I acres
8. WILL PROPOSED ACTION COMPLY
;&Tyes .
7,,-
Ultimately WI acres
WITH EXISTING ZONING OR OTHER RESTRICTIONS?
If no, describe briefly:
9. WHAT IS PRESENT LAND USE IN VICINITY
~ Residential D Industrial D Commercial
OF PROJECT? (Choose as many as apply.)
DAgriCUItUre D Park I Forest I Open Space
DOther (describe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal, State or Local)
~Yes 0 No If yes, list agency name and permit I approval:
5<'I/J-h
11. DOES
DYes
ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
~NO If yes, list agency name and permit I approval:
12. AS A RE
[]ves
L T OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION?
No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Signature
Date:
Applicant
~-l-P4-
the action is a Costal Area, and you are a state agency,
complete the Coastal Assessment Form before proceeding with this assessment
.
.
APPLICANT/AGENTIREPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics nrohibits conflicts of interest on the Dart of town officers and emolovees. The Duroose of
this form is to nrovide information which can alert the town of oossible conflicts of interest and allow it to take whatever action is
necessary to avoid same.
YOUR NAME: /(n6e...f L.e/,J1<rf
(Last name, first name, middle initial, unless you are applying in the name of
someone else or other entity, such as a company. If so, indicate the other
person's or company's name.)
NAME OF APPLICATION: (Check all that apply.)
Tax grievance
Variance
Change of Zone
Approval of plat
Exemption from plat or official map
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 South old? "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.
X
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 South old
Title or position of that person
Describe the relationship between yourself (the applicantJagentJrepresentative) 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);
_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
=~~- "'~
Pnnt N e '" /. I'" r