HomeMy WebLinkAboutTR-6480A
.
.
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
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 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
1 st day of construction
Y, constructed
,/ Project complete, compliance inspection.
fol.bl~ ~~YlW
.
.
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
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.: 6480A
Date of Receipt of Application: October 27, 2006
Applicant: James & Dawn Deerkoski
SCTM#: 114-10-2
Project Location: 260 Deer Dr., Mattituck
Date of Resolutionllssuance: November 15, 2006
Date of Expiration: November 15, 2008
Reviewed by: Board of Trustees
Project Description: To construct a dormer over the existing garage.
Findings: The project meets all the requirements for issuance of an
Administrative Permit set forth in Chapter 275 of the Southold Town Code. The
issuance of an Administrative Permit allows for the operations as indicated on the
plan prepared by James Deerkoski dated December 27,2005 and survey
prepared by Roderick VanTuyl dated March 13, 1996.
Special Conditions: Final inspection.
If the proposed activities do not meet the requirements for issuance of an
Administrative Permit set forth in Chapter 275 of the South old Town Code, a
Wetland Permit will be required.
This is not a determination from any other agency.
Jam~g,C;:s~
Board of Trustees
.
.
Jaml?S F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
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
TO: rjQ rY1..U)"j- ACh ill'!") ,000 ~ Il M-k. .
Please be advised that your application dated
reviewed by this Board at the regular meeting of
following action was taken:
10 /ri-r"J lOt.,
II/ISTD('
has been
and the
./
( ./) Application Approved (see below)
L-) Application Denied (see below)
L-) 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-application fees will be necessary.
COMPUTATION OF PERMIT FEES:
'1L naJ l ~~ ji:SO, ()')
TOTAL FEES DUE: $ SlJ,OD
BY: . James F,,-King,Pre~ident.
Board of Trustees
.
.
.fames F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
ToV'm. 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
Southold Town Board of Trustees
Field InspectionlW orksession Report
Date/Time:
Name of Applicant:
Name of Agent:
Property Location: SCTM# & Street
Brief Description of pro posed action:
Type of area to be impacted:
Saltwater Wetland Freshwater Wetland _Sound Front _Bay Front
Distance of proposed work to edge of above:
Part of Town Code proposed work falls under:
__Chapt.97 _Chapt. 37 _other
Type of Application: _ Wetland _Coastal Erosion _Amendment _Administrative
_Emergency
Info needed:
Modifications:
Conditions:
Present Were: _J.King _J.Doherty _P.Dickerson _D. Bergen
Other:
MailedIFaxed to:
Date:
Comments of Environmental Technician:
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.
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
.
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
_Coastal Erosion Pennit Application
_ _ wetland Pennit Application V Administrative Permit
Amendment/Transfer/Extension
LReceived Application: /0 IJ'1 /04
--=:::Received Fee:$ S\)
~ompleted Application 10 1.}'11 ClI.a
_Incomplete
_SEQRA Classification:
Type I_Type II_Unlisted_
_ Coordination:( date sent)
~ L WRP Consistency Assessment Form
CAC Referral Sent:
~ate of Inspection: 1111010ft,
_Receipt of CAC Report:
_Lead Agency Determination:_
_Technical Review:
-.J'ublic Hearing Held: //1/ ~1 D'-
_Resolution:
Office Use Only
2 7
~'
Name of Applicant J p,~S
Address
Zf.c,t!)
D€:.E.tL
DE.62'\losW'S.. (VPlWN
/Y)-A 11' J'I U (,,,,
~IY 13 s~.-,
10 L
i)eE.Q D'Z-'/E..- (Y/flTfI..vC"..k-
DE. Ee...\(QS IIV:::L
DQ.,-.Jt
NJ
031
Phone Number:( )
Suffolk County Tax Map Number: 1000-
\14
Property Location: Z <0 0
r
200 vJ €:.s--r of W~Srf}-1Il>L-)4
(provide LILCO Pole #, distance to cross streets, and location)
AGENT:
(If applicable)
Address:
Phone:
~ Board of Trustees APPlilllfon
GENERAL DATA
Land Area (in square feet):
'20 000
.
.
Area Zoning:
(2"S~l o<::..--}') 14 ~
Previous use ofproperty:~,,::> 1 DE. TV"') A '--
Intended use of property:
~ 1 0 Sr,r~, I'VL--
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?
~No_Yes
If yes, provide explanation:
Project Description (use attachments ifnecessary):----1)oe.yY)~
- ---_.~-_.._-,._-
CJ.r~f2.-- <S. x. 1 S 'fJ1J~'
G~~L
FOn-.
SJ~"'IE.-
... Board of Trustees APPlictlron
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:
S 1b~GE-
SPPlcL-
Area of wetlands on lot:
C)
square feet
Percent coverage oflot:
o
%
Closest distance between nearest existing structure and upland
edge of wetlands; 10'2- feet
Closest distance between nearest proposed structure and upland
edge of wetlands: 107_ feet
Does the project involve excavation or filling?
x
No
Yes
If yes, how much material will be excavated? C'9
cubic yards
How much material will be filled?
C)
cubic yards
Depth of which material will be removed or deposited: <::;> feet
Proposed slope throughout the area of operations: €)( I m 'f\k:;,
Manner in which material will be removed or deposited:
----.- -- -------------..-----.------ ----....-
Statement of the effect, if any, on the wetlands and tidal waters ofti1e town that may result by
reason ofsudiproposed operations (use attachments if appropriate): . ... - -. u_
617.20.
PROJECT ID NUMBER 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)
APPLICANT I SPONSOR 2. PROJECT NAME
SEQR
4R1l"t\t:. ":::>
3PROJECT LOCATION
::vt>5l1\.;~
Municipality
ru l\'UCJ x...--
County
S~(~)(-K--
4. PRECISE LOCATION' Street Addess and Road Intersections. Prominent landmarks ate _ or provide map
200 D<=-~
5, IS PROPOSED ACTION: 0 New
Oz,~
o Expansion ~ Modification / alteration
6 DESCRIBE PROJECT BRIEFLY:
Qo(9-F
[)(),i~
7, AMOUNT OF LAND AFFECTED:
Initially acres
B. WILL PROPOSED ACTION COMPLY
~Yes 0 No
Ultimately acres
WITH EXISTING ZONING OR OTHER RESTRICTIONS?
If no, describe briefly:
9_ WHAT IS PRESENT LAND USE IN VICINITY
~Residential 0 Industrial 0 Commercial
OF PROJECT? (Choose as many as apply.)
DAgricunure D Park f Forest I Open Space
o Other (describe)
10 DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal, State or Local)
DYes AJ No If yes, Ijst agency name and permit I approval:
II.UUl:;::)
DYes
Am -A::iI-'l:.C r Ut- THE AC lION HAVI::. A CURRENfL Y VALID PERMIT 1:JF{-ApPROVAL?
~ No If yes, list agency name and permit I approval:
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION?
Oves No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Date:
Applicant
Signature
z.c..~o
e action is a Costal Area, and you are a state agency,
e Coastal Assessment Form before proceeding with this assessment
.
.
PART II. IMPACT ASSESSMENT 0 be com leled b Lead A enc
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.41 If yes. coordinate the review process and use the FULL EAF.
c=J Yes 0
B. WILL ACTION R CEIVE 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.
o Yes No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, jf 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:
NO
C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly:
N()
C3 Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly:
rJiJ
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:
rJ.J
C5. Gro\lVth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly:
NV
C6. Long term, short term, cumulative, or other effects not identified in Cl-C5? Explain briefly:
NO
C7. Other impacts (including chan es in use of either quanti or ty e of energy? Explain briefly:
NO
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
ENVIRONMENTAL AREA CEA? If es, ex lain briefl
DYes !iO No
, '" m~" ,< '" m~ """ m 'C, '~mo_", ",wo, "e"'''H^, m~"", '~,""~'m^, 'w~, "~ .~'".
o Yes ~ No f ..... ...... .. . . ... ... I
PART III- 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
effect should be assessed in connection 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
- n---.y.es,the4etarmiRatiGA Gf SiQAifit:aAse FAblst C"aluate-the-petefltiaHmf*!stef-tAe-Pf~aeOOf't-6ft-ttle-em iffiflmc.1 ,tal GI181 actc.ri.stiG... of the CCA.
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 declaration.
Ctiec-kffifs'i)oidfyou-fiave.deiermTried',basea-on -the 'ii'formalion and analysis above and any supportin~.i documentation,' tha-fthe-proposed a'ell'C);
WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi
determination.
Name of Lead Agency
Dale
Pnnt or ] ype Name of ResponSIble OffIcer rn Lead Agency
Title of Responsible Officer
Signature of Responsible Officer rn Lead Agency
Signature of Preparer (If different from responsible officer)
.
.
Board of Trustees Application
County of Suffolk
State of New York
~ ~1.W'Sv{:Y'_ BEING DUL Y SWORN
DEPOSES AND AFFIRM THAT HE/SHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONT AlNED 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
REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES TN CONJUNCTION WITH REVIEW OF THIS APPLICATION
nature
SWORN TO BEFORE ME THIS 0( 6- ~ DA Y OF~ ,209 ?
JOSEPH A. DEER KOSKI
NOTARY PUBLIC, State of New York
No. 01DE5958125
Qualified in Suffolk COU~ 7
Commission Expires Jan. 31
Notary Public
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SUFFOL.K CO. HEALtH Otf!T. APPROVAl.
H.S. NO.
STATEMENT OF INTENT
, THE WATER SUPPLY AND SEWAGE DISPOSAL
SYS:rEMS FOR THIS RESIDENCE WILL
CONFORM TO THE STANDARDS OF THE
SUFFOLK CO. DEPT OF HEALTH SER VICES-:
(51
APPLICANT
DEPT OF HEALTH
APPROVAL FOIt
I SUFFOLK COUNTY
'SERVICES - FOR
I CONSTRUCTION ONLY
I DATE
I H. S. REF NO.:
,
I APPROVED:
SUFFOL.K CO. TAX MAP DESIGNATIoN:
,DIST. SECT BL.OCK PCL.
I l.lXlO (14 /0 2
\. OWNERS AOP"C:SS .
, 3i? pt;~ l.^t~;~
I fZ:lVi~Mi;":i) ;~y 1190\
I ........;.<,__,_.'"~, ."'=-,~. ......,_...t--._______.._ '.-- ~ ,,-,-
I
i -rfil... 7i:7 - ,~78
'-', --............-
DEED: L. ""fA P.
TEst HOL
STAMP
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... "*~>(o"""ry"'''-'''- '"':---
:a .,15 suf\IfW i<; 110 ~tiOn nf
3etl""" 1208 of IhfI New yQltt a.
f";ClucU\ionLaw.
CQpi~ ~ j)issUlYtY map not beaM:!I
fle\W1dsurveyor'alnkedsealo(
~sed _ shdnolbllc0nsidn4
to be a yaJdtNt copy.
Gua;1lll!ees 1ndIcdtd....., .".. n'1o
l'Jrljlothe personloc'whomfleltWSf
ili-VflPa-ted. and (l(Ihisbohalfto"'"
t'lie ('om;>any, govemmental ~_V'JAll
1efld~'l11ns1ii'I,;cm lIsted he~on and
lClh&c.s~lg11D-(1'll;i!the>\erl(iingFl~
lll\\c'Il. G.~<:,a:l:"'~'~ ;lre not uanslarable
to zd1\tiontJ in:.,';""KlilS 01' subS8Clue:C
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