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Home My WebLink AboutTR-6373A James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall Annex 54375Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0839C Date: February 19, 2013 THIS CERTIFIES that the construction of a second-story addition over part of the existing dwelling with the installation of dr/wells and gutters. At 860 Rabbit Lane, East Marion, New York Suffolk County Tax Map # 31-18-18 Conforms to the application for a Trustees Permit heretofore filed in this office Dated May 17, 2006 pursuant to which Trustees Administrative Permit #6373A Dated June 21, 2006, was 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 the construction of a second-story addition over part of the existing dwelling with the installation of drywells and gutters. The certificate is issued to VALERIE MICHELSEN owner of the aforesaid property. Authorized Sign "~ure Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE __ Pre-construction, hay bale line/silt boom/silt curtain __ Ist day of construction ~ constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: ~ ..Z/~//'~ James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen dohn Holzapfel Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 H~OURS 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 1st day of construction ½ constructed Project complete, compliance inspection. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapf¢l Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6373A Date of Receipt of Application: May 17, 2006 ;~plicant: Valerie Michelsen TM#: 31-'18-18 Project Location: 860 Rabbit Lane, East Marion Date of Resolution/Issuance: June 21, 2006 Date of Expiration: June 21, 2008 Reviewed by: Board of Trustees Project Description: To construct a second-story addition over part of the existing dwelling. Filndings: 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 an Administrative Permit allows for the operations as indicated on the survey prepared by Joseph A. Ingegno last dated May 22, 1998 and plans prepared by John Rabkevich dated March 14, 2006. Special Conditions: The installation of drywells and gutters to contain the roof ru n-off. 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. Jal sr~F. ~Ing, Pres'~ent BOard of Trustees James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated reviewed by this Board at the regular meeting of following action was taken: has been and the ( ,/'~'Application Approved (see below) ( ) Application Denied (see below) ( )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 Chapter 97 of the Southold Town Code. The following fee must be paid within 90 days or re-applicatior COMPUTATION OF PERMIT FEES: fees will be necessary. TOTAL FEES DUE: BY: James F. King, President Board of Trustees Jsznes F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel Town Hali 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Southold Town Board of Trustees Field InspectionfWorksession Report Date/Time: ~2/1¢ Name of Applicant: Name of Agent: PrOperty Location: SCTM# & Street Brief Description of proposed action: TYPe of area to be impacted: __$alt~vater Wetland Freshwater Wetland SoUnd Front Bay Front Di*tance of proposed work to edge of above: Part of Town Code proposed work falls under: __Chapt97 Chapt. 37 other Type of Application: C/Wetland __Coastal Erosion ~Arnendment __Administrative Info needed: __Emergency Mortifications: Conditions: Pre~ent Were: ~__J.King __J.DohertyCP.Dickerson ~//D. Bergen~J.Holzapfel __Other: MatIed/Faxed to:' Date: N Albert J. Krupsk~ 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) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only __Coastal Erosion Permit Application Wetland Permit Application ~-AdraJinstrative Permit __Amendment/Trans fer/Extensio~- -'~Received Application: ~ I'~ eted Application _~--/! ~ ] __Ingomplete __SEQRA Classification: Type I__Type II Unlisted __Caordination:(dat--~-sent)_ __LWRP Consistency Assessment Form __CAC Referral Sent: ,~Date of Inspect/on: ~ Il ~Re~eipt of CAC __Lead Agency Deterrmnation: TeChnical Review: -- 7Pul~lic Hearing Held: __Resolution: Name ° f Applicant-~ (~ / e--~r ~ ~. Phone Number:( ) oou , ,ap N.m er: 1000-g - MAY 1 7 2006 (prov/de LILCO Pole #,distance to cross streets, and location) AGENT: (If applicable) Address: Phone: ~oard of Trustees Applica~ GENERAL DATA Land Area (in square feet): Area Zoning: ~ Previous use of property: ~q' 2> ~t.~,-x)[ t~t~k Intended use ofproperty: ~ ~tc~ \,.~..k Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspe?5;led by a governmental agency? _. YNo Yes If yes, provide explanation: Project Description (use attachments ifnece~ssary):_ (d~. '~\O,.~,~ (~ ~ ~oard of Trustees Applica~ WETLAND/TRUSTEE LANDS APPLICATION DATA ~.~ Purpose ofthe proposed operations: ~rJkok%)[~-., %~ ~ .~(-~ 70 Area of wetlands on lot: square feet Percent coverage of lot: ~% Closest distance between nearest existing structure and upland edge o f wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet oes the project involve excavation or filling? . ~tff 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 ~tt~hments if apPr0priate~i PROJECT ID NUMBER T 617.20 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 II 2. PROJECT NAME 3.PROJECT LOCATION. Municipa,ity , co.nty 4. PRECISE LOCATION:~Str~I Addess and~,Road Intersections, Prominent landmarks etc-or Provide SEQR ! IS PROPOSED ACTION: [] New ~Expansion [---~ModificaUonlalterafion (~r'~ ~,~ ~ ~ ~ ,' Initially ~1 ,~ '~.~ f"'~ acre s Ultimately WI[~L PROPOSED ACTION COMPLy WITH EXISTING ZONING OR OTHER RESTR CTIONS? ' " Yes J[--~ No If no, describe briefly: 9. WHAT IS iF)RESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) [~]Residentlal g~lndustdaI E~]CommerciaI r-'-]Agriculture ['~ Park / Forest / Open Space ['--]Other (describe) 10. DOES A~TION INVOLVE A PERMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (~.~L~ral, State or Local) J~Yes ~JNo If yes. list agency name and permit / approval: 11.DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [-'--~Yes ii, No If yes. list agency name and permit / approval: I 12. AS A I~SULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICAT es No ION? CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Si nature ~-~ ~ Date:~],'~ )~) 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 completed by Lead A~enc¥) 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. ~] Yes [~No S. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. i---iVes r--INo C, COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, tt 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 bdefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly' C3 C4. C5 C6. I )n D~'~ILL THE ' HE ESTABLISHMENT OF A CRITIC~ ENVIRONMENTAL AREA (CEAI? /if yes' exp a n bdefl~/: [] Yes [] No ~S THERE, OR IS THERE LIKELY TO BEtsy RELATED TO POTENTIAL ADVERSE ENVIRONME · : PART III - DEaN OF SIGNIF CANCE (To be completed by Agency) INSTRUCTIONS: F~reachadverseeffectidenti~edab~ve~determinewhetheritissubstantia~'~arge~imp~rtant~r~therwises~gni~cant~ Each effect shodld be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographJq scope; and (t) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain ~.ufrc~r t ~ I ~o s he w that all relevant adverse impacts have been identified and adequately addressed, if question d of part ii was checked yes, the de~rmination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur Then proceed directly to the FUL~ EAF and/or prepare a positive destaration. Checl~ thi~ b~x i~ou t{~ve ~f~ern~'n~l~ b~se~ 0n th~nformation and a~alysis ~bove and any supportin~ documentation, that th~ ~r0p~d ~etie WILLi NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi deter~ination. Name of Lead Agency Pdnt or ~Type Name o~ Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Date Title of Responsible Officer Signature of Preparer (If different from responsible officer) Board of Trustees Applica~on County of Suffolk State of New York DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF H/S/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK Wii,L BE DONE IN THE MANNER SET FORTH IN TillS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AG tEES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HA :~MLESS AND FREE FROM ANy AND ALL DAMAGES AND CLAIMS ARISING UB )ER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS AP 'LICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR RE 'RESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PR[ MISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Sig~-ature SWORN TO BEFORE ME THIS I'~')'~ _DAYOF_ J~(IA~ ,20{)~, , MELANIE DOROSKI #OTARY PUBLIC, State of New Yofl{ No. 01D04634870 (~ualifled in Suffolk Count/~. ~/_ CommlS,~on F. xpi~ Septenmer ~0~ ~ ~oard of Trustees ApplicaOn AUTHORIZATION (where the applicant is not the owner) I,~~ residing (print owner of property) (mailing address) ~ck~~do hereby authorize (Agent) to apply for permit(s) from the SoUthold Board of Town Trustees on my behalf. (Owner's signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics orohibits conflicts of interest on the hart of town officers and emolovees. The ouroose .f this form is to orovide information which can ale~ the town of t~ossible conflicts of interest and allow it to take whatever action is necessary to avoid same. (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 thc other 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 Southold? "Relationship" includes by blood, nlarriage, 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 coq0oration in whidl the town officer or employee owns more t~V% of the shares. YES NO *~' If you a~swered "YES", complete the balance of this form and date and sign where indicated. Name df person employed by the Town of Southold Title 0r position of that person Describe the relationship between yourself (the applicant/agent/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 shams of the corporate stock of the applic0nt (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, partnei', or employee of the applicant; or ___D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 Submittedxthis Signature ~J~ Town of Southold LWRP CONSISTENCY ASSESSMENT FORM INSTRUCTIONS All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. _A proposed action will be evaluated as to its sigrdfica~t beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thns~ each answer must be explained in detail, listine both supportin~ and non ~. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM .Xg . .. \ % The Application has been submitted to (check appropriate response): TownBoardl ~-~ Planning Board [-~ BuildingDep,. ~-~ BoardofTrustees ~ Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency.(e.g, capital construction, planning activity, agency regulation, land transaction) (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: Location of action: c:6~ ~) Present land use: Present zoning classification: If an. application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name ofapplicant:~[Ck~ o..Z'\~L. ~C~b~ (c) Telephone number: AreaCode( ~'~)] .. ~-~'"~"~ ..el It ~t (d) Application number, if any: Willl the action be directly undertaken, require funding, or approval by a state or federal agency? Yes[] No [--] If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not suppor( the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. Yes ~[ No R Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria Yes [] Nol~ Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria [] Yes [--] No ~ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. l~linimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III- PoliC~ages 8 through 16 for evaluation criteria ~ Yes [] NoX-M Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of .Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria ~-] Yes [~ NoX~Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southoid ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. Yes No Not A~icable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. [-~ Yes [] No~ Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. [~ Yes Ct No~ Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources ofithe Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. ~-] Yes~i No ~Not Applicable Attach additionai ~ecessary ~ WORKING COAST POLIC$ Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent ases in suitable locations~ See LWRP Section III- Policies; Pages 47 through 56 for evaluation criteria. ~ Yes E-~ No~ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long 'Island Sound, the Peconic Estuary and Town waters. See LWRP Section Ill - Policies; Pages 57 through 62 for evaluation criteria. [] Yes Z] No ¢ Not Applicable Attach additiohal sheet~'~ if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 fo~aluation criteria. [] Yes [] NobLe, Not Applicable Attach additional ~ecessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Polieie~ Pages 65 through 68 for evalnation criteria. ~-~ Yes ~-~No ¢ Not Applicable SURVEY OF PROPERTY SITUA TED A T EAST MARION TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-31-17-19 1000-31-18-18 SCALE 1"=20' MAY 22, 1998 ELEV. MARCH 23, 1999 ADDED PROPOSED ADDITION & 1st FL. MAY 4, 1999 ADDED FLOOD ZONES JULY 9, 1999 LOCATED EDGE OF PHRAGMITES COMPANY, INC. CERTIFIED TO: RIDGE ABSTRACT CORPORATION BANK OF NEW YORK MORTGAGE TITLE No. L275144S HOWARD S. MICNELSEN VALARIE MICNELSEN LOT AREA DATA (AREA COMPUTED TO TIE LINES) S.C. TAX No. 18,957.03 sq. fl. 1000-31-17-19 0.435 oc, S.C. TAX No. 10,054.24 sq. fi. 1000-31-18-18 0.250 TOTAL 28.991.27 sq. fi. 0.665 oc. NOTE: FLOOD ZONE INFORMATION TAKEN FROM: FLOOD INSURANCE RATE MAP No. $6103C0177 G ZONE AE: BASE FLOOD ELEVATIONS DETERMINED ZONE VE' COASTAL FLOOD WITH VELOCITY HAZARD (WAVE ACTION); BASE FLOOD ELEVATIONS DETERMINED AGMITES~ $~, TAX No~ ~000-$~- MAY 1 7 2O06 q,Y.S, LiC. No, 49668 Ingegno Land Surveyor PHONE (516)727-2090 Fox (516)722-5093 APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTHOLD THE EXISTENCE OF RIGHTS OF WAY 98-297u