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Home My WebLink AboutTR-6044A . . 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.: 6044A Date of Receipt of Application: December 9, 2004 Applicant: William T. Childs SCTM#: 145-4-2.1 Project Location: 1780 Peconic Bay Blvd., Laurel Date of Resolution/Issuance: December 20, 2004 Date of Expiration: December 20, 2006 Reviewed by: Board of Trustees Project Description: To construct a second-story addition/deck onto 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 Stanley J. Isaksen, Jr. last dated June 2, 2004. 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. J!~.$ 0, J/. __1.. ~e Albert J. Krupsl6. jr.~~ Board of Trustees .EW YORK STATE DEPARTMENT OF gNVIRO. CONSERVATION . ~ DEC PERMIT NUMBER 1-4738-03403/00001 'FACILITYIPROGRAM NUMBER(S) . PERMIT Under the Environmental Conservation Law EFFECTIVE DATE October 29. 2004 EXPIRATION DATE(S) o Article 15. TiUe 5: Protection of Waters i TYPE OF PERMIT . New 0 Renewal 0 Modification 0 P~mlt to Construct 0 Permit to Operate I October 28, 2009 o Article IS, TIUe 15: Water Supply o BNYCRR 608: Water Quality CertificaUOn o Article 27, Tille 7: 6NYCRR 360: Solid Waste Management o Article 27, Tille 9: 6NYCRR 373: Hazardous Waste Management o Article 17, Titles 7, 8: SPDES o Article 15. Tille 15: Water Transport o ArticJe 19: Air Pollution Control o Article 34: Coastal Erosion Management o Article 15, Tille 15: Long Island Wells o Article 23, Tille 27: Mined Land Reclamation o Article 36: Floodplain Management o Article 15, Title 27: Wid, Scenic and Recreational Rivers o Article 24: Freshwater Wetlands . Article 25: Tidal Wetlands o Articles 1,3.17,19.27,37: 8NYCRR 360: Radiation Control PERMIT ISSUED TO TELEPHONE NUMBER William Thomas Childs n. I? 1 ) 298-9507 ADDRESS OF PERMITTEE 0 I!': l!!J [!; U \'I IS 1780 Peconic Bav Boulevard, Laurel NY 11948 ri .- . - :; CONTACT PERSON FOR PERMITTED WORK UL\.., J , 'liE EPHONE NUMBER T"wn NAME AND ADDRESS OF PROJECT/FACILITY Board of Trustees Childs Property, 1780 Peconlc Bav BouleYlird, Laurel NY LOCATION OF PROJECT/FACILITY SCTM # 1000-145-4-2.1 COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold Brushes Creek E:706.2 N:4536.8 Description of Authorized Activity Construct a second story addition/deck onto the existing single-family dwelling. All work shall be performed in accordance with tI1e survey stamped NYSDEC approved on 10129104. The proposed garage1storageibalcony, as shown on !he survey prepared by Stanley J. Isaksen, Jr. lasl revised on 6/2/04, are beyond the jurisdiction of Article 25 Tidal Wetlands, . . Brook, NY 11790-2356 DATE October29,2004 Page 1 of 4 . . . , 9&20-1 (8187}-9d New York State Department of Environmental Conservation o NOTICE '8 ...,. The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted at this site. For further information regarding the nature and extent of work approved and any Departmental conditions on it, contact the Regional Permit Administrator listed below. Please refer to the permit number shown when contacting th DEC. 0 I /-'f1J8. OJCl03 .,00 Regional Permit Admlnietrator Permit Number JOHN W. PAVACIC o Expiration Date NOTE: This notice is NOT a permit L_r.... E___ ~=:.'" , D-- -r- + + L_r.... E___ ~-"'''"' , ,- D-- . -...... . -.... __...(21) _.. . - -~ __ w......u.u-... __ 12.1...._... - --~ . (1) --- - ,-- --- --.-- . --~ -- --- -, m --- -, - ---..... - - "".....--- ----- - - - . - -. ..... :.- ~ =- (i ClUlTY OF SUFFOlX CD ~ Red~"","yT",Slr:vkel<1<<Y \ .Clu'rt1r..m:..~"YI1!ll .. ~ . .. - ~ --- -_...--.-- _...-..-- ., --... . .,,'" -...-............ ""-"""""""lfl1l' .......OIUITY'.._s_ ........__..l1I' ---.".--. U.-. -. - - - -. -......-...- SOUTHClD :;ll,;ll,lIIltU 144 1000 PROf'ERTYIUP .~ of~ ,~ &c~~ " ',. " . -r- __..121) (1) ':t"'..'::",':~";;; -~- - ~ - """ ... ..... =-- w =..... (i COt.NTY OF SUFHH @ Red~"",t,T",Slr:vkel<1<<Y lAmyc.rtor ~MYlaOI . ""'.IHI. .. . .. .. - --- - oom --...--.-- _...-..,-- -- --- --~ .-- -.........."""............ ...-..""....-.."" .......OIUITYl......S_ .,...".--"'''' _-.,.._l<8C'l. . -- -... ...._ lZ."....-U.\A-'" It.,..", _... '~ ~ ..... ~ ..... ... , - -. + o -N- J . . + SOUTHOLD SECTION NO_ 145 1000 PROPERTYIUP PECONIC BAY N 69'13'OO"E CONCRETE RETAINING WALL LOT' / Z / / / ( N / q I 0 "'/ "'-J 0 N I ~ 0 'V ~ 0 '<1/ '" > ::;: / I - ( ~ / Q / ---- -- BOULEVARD ~ \fU1! is'7i \fU1! o rn n 191.00' '" 0'" 00 -c g.- s.g ....c: 2;:;l ~,. ~= ~ I <.0 = LOT 2 :!?/ ~ '<1/ ;;/ ~ / "I I / :'! / '<1/ ( ~\[l ~ cg ~:.; \fU1! -===11 (~ 1"." C'--' CD END CONe. FENCE MON ~ '" PROPOSED 2ND LEVEL DECk THIS AREA 38.4 APPROX. HWL THIS DA T[ (2 JUL Y 04) 2-STORY RESIDENCE Z <e - CO o ~ !J) ~ ::s EARTH DRIVEWAY WITH \ & If"! '" ., { I" \ ~ ~ \'lj'l )/ 01. I ;. b <' /f (J1 <:: / I 'ii " ~ !i "i / ~ Lu Lu 0::: (j WASHED our BEHIND BULKHEAD 705.8' WALK N 65'14'20"E 38.00' C/) 75' ,lIL 35A "-.. 4605"W :)1-",,,2 R L FENCE GEN'LY 0 /' ~ N LINE "-.. "'~ " "'s ;'1 / I o ,:0;,., BLUESTONE ~",. EL 7.5 5G:i '" ~ o FOUND ~11l 37.74' ",(;,(0. o ' V) a<C; I, I o ,L...L.J 'qJ: f'lC/) ~ 0::: OJ ::',,',l.;;,.:;""EES ,:.:;,(;..1[[; hERE ON SHALL RUt.' ON,- ~- ~o ,...E PEF?SON FOR WHOM THE SURVEY -5 P,~EPAR[D. AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY, L[NDING !NSTlT!.mON, IF LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INsnTUTlON. GUARANTEES ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. NO TES.' ALL EL VA T10NS SHOWN ARE IN 7929 NGVD. UNAUTHORIZED ALTERAnON OR ADDlnON TO THIS SURVEY IS A VIOLA TION OF SECTION 7209 OF THE NEW rDRK STA TE EDUCA nON LA W. FLOOD ZONE LINES ARE FROM FiRM PANEL 483 OF 1026, MAP NUMBER 36703C483 G, EFFECTIVE DA TE MA Y 4, 1998 COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COpy SURVEYED: 2 FEBRUARY 1991 RE -SURVEYED: 20 MAY 2003 SCALE 1"~ 30' AREA = 30.03850 SF. (UPLAND) OR 0.689 ACRES SURVEY OF LOTS 1,2, & P /0 LOT .3 MAP OF PROPERTY OF ELIZABETH MESROBIAN AND FOREST HILLS IMPROVEMENT COMPANY, INC. SITUATE LAUREL, SUFFOLK TOWN OF SOUTHOLD COUNTY, N,Y, SURVEYED FOR: WI LLlAM T. HELEN H. CHILDS CHILDS -"-\~:i: 1 2CO- 145~04-002. 1 NYSDEC Al'l'ROVED AS PER TER~IS AND CO:"DlTIONS OF PEIUlIT NO. j-Y73ff. 03'103/0000/ DATE /0 /';;''1/0 tf I?fl'" //1 SURVEYED BY STANLEY J. ISAKSEN, JR. PO BOX 294 NEW SU FOLK. NY 6J1~7 -5835 ~c'~R~NTEED TO: ,V:LLW,I T. CHILDS f-JELEN H. CHILDS FiRST ~MIERICAN TITLE INSURANCE CO. 2. 2 JUNE 04 SHOW PROP. 2NO LEVEL DECK, HWL. DOCK. 1. MOVE & ROTATE PROP. GARAGE 26 MAY 04 l \. Albert J. Krupski, President James King, Vice-President Artie Foster .1 '. 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-~"'!o'l1 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application /Administrative Permit AmendmentfTransfer/Extension ~eceived Application: 1~/9/01( ""fl.eceived Fee:$~ ~ ~ ~ ~ ~ompleted Application IJ.J'IIOl( ~u _Incomplete _SEQRA Classification: i\ , Type I_Type II_Urtlisted_ DEe - 9 2C'J~ J~ _ Coordination:( date sent) CAC Referral Sent: Aate ofInspection:~/.3JOI/ Southold Town _Receipt of CAC Report: Board Q11rustees _Lead Agency Determination:_ Technical Review: ...t'I1blic Hearing Held: I.J JOIOI/ Resolution: Address Mil/AM /7??o fnor.l (~ .L.4 t/ Ref Alcl ((!L/~hone Number:<D'/) I , Name of Applicant -;-, . ~h !:JR c/ . (provide LILCO Pole #, distance to cross s reets, and location) Suffolk County Tax Map Number: 1000- Property Location: J '1?o f-e eo,) ( e.- 11;:- f.4. . L ~ ~ AGENT: (If applicable) Address: Phone: . . r Board of Trustees Application GENERAL DATA Land Area (in square feet) ,III It. 3~/~b() Area Zoning: f2E-<; id...eN Tt A 0 hd- .~ Intended use of property: RE5rdeiV?I 4<-- IE- 9'-/0/7/111...- Previous use of property: Prior permits/approvals for site improvements: Agency Date -L No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? -L No_ Yes If yes, provide explanation: Project Description (use attachments if necessary): ~A/ 7 T;< tJ e-Y'; #6- ,4 7)7 AOJ 5.e- f:-F;:;ee:J - c;:2~ FL, , wl1h ,.4- BIJ Lt!.~ ;.Iy - t?C/T Z;; C:/1511t/6- _>'7/2u~ IU(2L AJ() roo r/AI &_c; -- . . Board of --Trustees Application WETLAND/TRUSTEE LANDS APPLICA nON DATA Purpose of the proposed operations: t:{; -4-01;1 S.4?,/rLL &-tt!&f 70 AhtJ O&,yMU'>.e kk ?!dP FL, Area of wetlands on lot: square feet Percent coverage oflot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? vg 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, ifany, on the wetlands and tidal waters ofthe town that may result by reason of such proposed operations (use attachments if appropriate): Nt' ~ e . . Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: No Yes (cubic yards) Are wetlands present within 100 feet of the proposed activity? No Yes Does the project involve excavation or filling? If Yes, how much material will be excavated? How much material will be filled? Manner in which material will be removed or Describe the nature and extent of e environmental impacts reasonably anticipated resulting from implementation of the pr . ct as proposed. (Use attachments if necessary) . I . I PROJECT 10 NUMBER PART 1 . PROJECT INFORMATION 617.20 APPENOIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only (To be completed by Applicant or Project Sponsor) SEQR 2. PROJECT NAME -e '.€ )~ .t'orr 'A- Municipality 4. PRECISE LOCATION: Street ddess and Road /'7~~ f?ee~;'[/,:~ /S//{ ),,4 tVc County Intersections, Prominent 8'- vfI ( )u FFoL- ~7; e:;;:r~~ma~v>h~5 e,e ee g INcI &-e [~:rMOdification I alteration 6. DESCRIBE PROJECT BRIEFLY: 5/ /.e 6.> --r W4~T 70 t?h;t/ l'f /) t)& h 0 u 5'--e E/ /5"7/#6 71e ,4 N' "A " f 1l#r>1 iL ~ /.oaF (?# 7k- ~~fl, C,A5r 4 S/q/f/! !3ftt&~. #07 70 '!irllu(!.. tv R...e.. - cv~tJ !Jovs-e 15 ;:itt'- ?/t-$T U)t7'A. iT 7. AMOUNT OF LAND AFFECTED: 0 '2<!!,e?J Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [l2(ves D No If no, describe briefly: ;!:!:fAT IS PRESENT LAND USE IN VICINITY ~ Residential D Industrial D Commercial OF PROJECT? (Choose as many as apply.) DAQncu,ture D Park I Forest f Open Space D Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) D ' ,? -1 ~es DNO If yes, list agency name and~~pp~ Dc.<!- - /lr'P R t?V-sc..c.r ouJ. ee . (p 'rf\.. ~v-r. oc...- J .-,; LV r.J . 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY ID PERMIT O~PROVAV DYes D No If yes, list agency name and permit a prov 1) &2-- PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT T~E INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF Applicant I Sponsor Name W,I I Ii A^" --r: @ h f id > Si nature MY KNOWLEDGE Date /1/ ic if If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment . . ~ PART II - IMPACT ASSESSMENT (To be eomDleted bv Lead ADenevl A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. DYes DNo B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No. a negative declaration may be superseded by another involved agency. DYes DNo 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 pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: I I C2. Aesthetic, agricultural. archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: I I C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: I C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: I C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: I H_ __ ,--- C6. Long tenn, short tenn, cumulative, or other effects not identified In C1.C5? Explain briefly: I I C7. Other Imoacts lincludlna chances In use of either auantitv or tvoe of enerav? Exolain brieflv: I I D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? (If ves, explain brieflv: I DYes D No I E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: DYes DNo I I PART 11I- DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effecl should be assessed in conneclion with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials, Ensure that explanations contain sufficient detail to show that 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 CEA. Check this box jf you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL EAF andlor prepare a positive declaration. Check this box if you have determined, based on the information 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 thi determination. Name of Lead Agency Date Pnnt or Type Name of Responsible Officer In Lead Agency Title of Responsible Officer 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 w\.\\\~ '\ ~~\~ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HElSHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF IDS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN TIllS 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 TIllS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF TIDS APPLICATION. 4(6~L-~ . Signature SWORN TO BEFORE ME TIDS ~~ DAYOF l'\ tN- ,20~ ~ Notary Public D','JIHI'AAI(S IlUyPu~<.StaI..f_" /Io.01PAfiOII46t lkWiflOClilSoAfllikCllllllr 1 ~flpiwJalLlD'\ ~ . . APPLICANT/AGENTIREPRESENTA TlVE TRANSACTIONAL DISCLOSURE FORM The Town ofSouthoJd's Code of Ethics orohibits conflicts of interest on the Dart anow" officers and emoJovees. The nuroose of this form is to orovide information which can alert the town of nos sible conflicts of interest and allow it to take whatever action is necessarv to avoid same. . (! 11/ Lei 5 YOUR NAME: (,/("I/,A/n -r (Last name, ftrst name, J1liddle initial, unless you are applying in the name of someone else or other entity, such as a company. Ifse, 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.) Building Trustee Coastal Erosion Mooring Planning ./ Do you personally (or through your company, spouse. sibling, parent, or child) have a relationship with any officer or employee of the Town of Southald? "Relationship" includes by blood, marriage, or buSiness interest. "Business intere~ 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 halance 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 ynurself (the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) andlor describe in the space provided. The town officer or employee or his or her spouse, sibling, paren~ or child is (cbeck 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 s Form TS I