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Home My WebLink AboutTR-6481AJames F. King, President -``~QF S~Vry~ Jill M. Doherty, Vice-President ,`~ Peggy A. Dickerson ~ l~ Dave Bergen Bob Ghosio, Jr. H ~ %~ ~ ~y00UNT'i,~~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 CERTIFICATE OF COMPLIANCE # 0320C Date: June 12, 2008 THIS CERTIFIES that the construction of a second-floor dormer addition, deck and window replacements At 4000 Peconic Bay Boulevard, Laurel, New York Suffolk County Tax Map # 128-6-2 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 11/4/06 pursuant to which Trustees Permit # 6481A Dated 11/15/06. 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-floor dormer addition deck and window replacements The certificate is issued to BARBARA KELSEY owner of the aforesaid property. ~ ~~ Authorized Signature James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. ~o~~pF SOplyo~ ~G ~' ~O `~C~U~ N~ 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 APRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 15~ day of construction '/z constructed Project complete, compliance inspection. ~/~~/~S ~k- . . 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 1st day of construction Y, constructed V Project complete, compliance inspection. . . 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.: 6481A Date of Receipt of Application: November 4, 2006 Applicant: Barbara Kelsey SCTM#: 128-6-2 Project Location: 4000 Peconic Bay Blvd., Laurel Date of Resolution/Issuance: November 15, 2006 Date of Expiration: November 15, 2008 Reviewed by: Board of Trustees Project Description: To construct a second-floor dormer addition, deck, and window replacements. 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 Donald G. Feiler, Architect dated November 3, 2006. 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. ~07~ James I~~g,' Presid;nV' Board of Trustees U In - :J: ~ ~, ~ ~' I . :: ~ ~ i I ~ i ~ I g.~ ~ m i ! o - "" i) 3 ii Ji ~* . ~"-( . ( r ,'l?,~..';i .... .-c ~ ~ J .,.,~ ., o J-~~-- " ~\U 1?e.cD I ~\..J~ "C,." h if ' . ~t~ \ N,<& 12 "i) ~e;.\..\...l~6t );\N1.-({ P.~ .',<,,\11, rot'-' r'-".....;::O ;,~:," C" ~..~-- ~". ~...~ -,,/, / ",,~,; ~-~v / ::." tf" . ! ,"":"'" ~>'~'.'::':', lit'"~"~ . - ~ 1-\ \. (.I f.:P' '-< ~ . PloT PL~ I ".. --=To I c '- " I ~ / V!::OG . . 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 TO: lJ()J) OJJltL h Q. ( /)0 J I Please be advised that your application dated reviewed by this Board at the regular meeting of following action was taken: /l1l/101o /11/ $;:/ \:'k 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-application fees will be necessary. COMPU:ATION?F PERMIT FEES: (!:J 1LV\W t~c.tL.&I - ~SD,OO 'f2.11/Cl1 TOTAL FEES DUE: $ 5O,Dt:> BY: James F. fSLng, Pre."ic:I.QQt tloard otTrustees . ., -.. -.... ~ ~ A T LAUREL TOWN OF SOUTHOLD SUFFOLK COUNTY, N. y: 7000 - 128 - 06 - 0:2 Seals: 1" = 40' Jan. 13,1993 (,~) .- ~ "" ~- " ~- ;:.' AREA = l091 Acres to tie lines // ~ ~ . ~ l;)~~ . ....,,~ .. ,I ! fe-1- -- -- " lJ\ ~ <D '9. " ;.. '!' . 93:..122 - .... .0;0:: 1::-<> .. ,,-':'- .. - 15 \I) f: := ",,-- ~ ~ f~ - 0..... It_~ .~d u '" ,,<: ~~-,:,.. ... .. Iii,c: c>" K u..... t':' . ~ ~ v~~J ...-J - .S "'<i ,,~ ",:"i!g ..,,-J .. ... .c:.. " Is " g~ ~ '" oC: .. w 15- · ct ~~~~ . . \ , -~ ,.. LE~L. ~. · .~~' f"!'!.{ ..---:::;; f,.ce . N/OtF -d'IOl< ~LlssELL . rlJOIf ~~ >;,~. . .$'- ~/OtF ....'~_ ~~ 0,6 /", ~ / 0.'.1-'0 - '<' <9(;>. . // <2 ~~ ~ -0 . -f L It"",.~ ".~ oc1l ~. "" V~ Ov ~<>" I ~Z L ',(l ,&'. <of' ~ ;in>" fn"'. 4038'20' .,. N. I HARVE'f N/0/F -- ------------- " . . ~ I . " ~ """"1 +"" . ~ . co > c N "' ~ I c.>Z ~-- ;1 ~ I ~, 'I :-y:: ~- f'''''' Eli ~-:~' o.!:i>- !;.ij :~J~ 0:>-, : ~i...~;: ~~~ U<l& e ~. ~-~-- t< 0;,. __" .J;NQJ..;>o' ~~-...... -<'Y~&-",') .~^~~.~; ~., ",-"."..':/ ^' "'" ~ '" ~, " ,., ' =",- ~;.~ ~ ~ " ;.H; '" ~ ~; ~ g ~!i'~ ~ zHl! +"U !!jlll,1 i~ ~h~~ 1,111'1 ;;11',j) ~d~~~i lill! i ilii i ~ i H ~ ~ i . ~ lid! ,1111 i I U . " . ~ Iii i I ""& ~ J ! i "~Q "C>o HHH LdHl Ie!!! I Iii ..../>'.;>&.9 , " 'i .i ~- n ~ ",,, ; ~ ' ; ~ ~ .' , , :idOl. qHI; L.lH~ II" N,I', 'rl. - I I " ~ I" J I J . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen . Town Hall 53095 Route 25 P.O. Box 1179 Southold, N ew York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Coastal Erosion Pennit Application = Wetland Pennit Application .,/ Administrative Permit Amendment/Transfer/Extension ~eceived Application:~ll. .LReceived Fee:$ :p--- _--Completed Application 111410k> _Incomplete _ SEQRA Classification: Type I_Type II_Unlisted__ _ Coordination:( date sent) _LWRP Consistency Assessment Form CAC Referral Sent: ./Date ofInspection:-.llj I 0\ O~ _Receipt of CAC Report: _Lead Agency Detennination:_ Technical Review: A'ublic Hearing Held:-Ll[rnOr- Resolution: Office Use Only Nev .. ~ Name of Applicant ~~ ~LS8'i Address fe(uIJ \ U ~ \?w 0, LA; Pa- I Suffolk County Tax Map Number: 1000 - \ '2.8 . O~ . 0 '2. fh.nt"lIC ~ f?L\JO I ,De:t..{yy A(2. Q:l. (provide LILCO Pole #, distance to cross streets, and location) tbN P>vO Property Location: 4vto ~rn ~s AGENT: (If applicable) pO l?o l' yY)t><U 1"\DCf- Address: Phone Number:( ) 1,../).0 l'6- ~ U5l2- l" '1 '2.. I UJ1..S rn~ ~ P-<> ~ (Phone: ,z~ 6 . 5 'tS"? 4Itard of Trustees APPlicat~ ~ GENERAL DATA Land Area (in square feet): "'\-"1 ) '5 '2. ~ SF Area Zoning: ~ +0 Previous use ofproperty:~RE."51 ~ n f"rt.. Intended use of property: ~"51 O'P'l \1 A-v Prior pennits/approvals for site improvements: Agency SoIJ~ IOW(ll iPo':>~ N I.{? ()e..c.. \-J "1 '";:) Oe.c. ~. :r Date -fa'Wh iT i*- t ZR . b' '2 _P-tVWl1 IT ~ J II 1.<.\ 1.3 (. \o( "I/O'? 'iz. efcl's j,'I/'t? SO,",1'\.\OI4? It> N N \lW=.T!Se> ~ \ T ~ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a goverrunental agency? ~No_Yes If yes, provide explanation: Project Description (use attaclunents ifnecessary): WoPOt:>~ f)!O ~ ~-5\.. N)() 1110N ef ~- ~O wP{vO OF €p-"bllNE. U>N~~N I . VJ \ N QOW f€;? ~ tsl"l T -? 1J\tuOv-r. ~rd of Trustees APPlicat~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~~Sl'i)(" ~ I ()1PRo~~-tX'lTS ~ ~1'Z>T1r'6 ~B. Area of wetlands on lot: tl~ ~I>- square feet Percent coverage of lot: % 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? Y- 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: FtM- Manner in which material will be removed or deposited: fJ'" Statement of the effect, if any, on the wetlands and tidal waters of the town that may resllltby ui-eason of such proposed operations (use attachments if appropriate): .. .. - . n W:o(,l.J,::.. '1b ee. l.PrlO..vp.p.o OF ~.SnN6 CoN~:;l!?UCflON I PROJECT 10 NUMBER PART 1. PROJECT INFORMATION . 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) SEQR 1. APPLICANT/SPONSOR 2. PROJECT NAME DOf'4 P-1-O ~~ ke,.?a( ~5,.o~d;:i 3.PROJECT LOCATION: Municipality ~U\" f) TIJW N County ~T ~ v Vt::.. 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks ete - or provide map '100 ~lc.. ~ etNO lofR.LPVt2-f!Sl- p.cf20~ 'f"1U>m OfSI.(YI P(l.. 00-, ...r e. 5. IS PROPOSED ACTION: D New D Expansion ~ Modification I alteration 6. DESCRIBE PROJECT BRIEFLY: . pPopoe,ep 1')..('10 ~ O~~ . ?(2-OP~ ~"-~ . WIN Do v;:) f2e;P~~ ~ I...Pf<<) N t:>(p() of- ~...."N6 Q)~D~ 7. AMOUNT OF LAND AFFECTED: Initially I acres Ultimately I acres B. WILL PROPDSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? .2SJyes o No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~ Residential D Industrial D Commercial DAgricu,ture D Park I Forest I Open Space D Other (describe) 10.' DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMA TEL Y FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ~Yes DNO If yes, list agency name and permit I approval: -ptN N ~...~S ~ ""'0 c.Al '(bUN ~I \.Q IN" ()dlP<Vrr'VIldt'I T . 11. UUt~ AN' ur- TRCAt; liON HAVE A CURRENILY VALID PERMIT OR APPROVAL? [gIves D No If yes, list agency name and permit I approval: - N ~ . 0 e:C - N.:r _1.11/{J~ 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT / APPROVAL REQUIRE MODIFICATION? Oves ~No .,... I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant I sponso~ame /)/j I Date: . \\/~/()G Signature . \ If))" action is a Costal Area, and ou are a state agenc , y y complete the Coastal Assessment Form before proceeding with this assessment I . . PART II. IMPACT ASSESSMENT To be com leted b Lead A enc A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? /fyes, coordinate the review process and use the FULL EAF. o Yes No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negaliv, declaration may be superseded by another involved agency. c=J Yes No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be hanQwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattem, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: I tl 0 C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: 1-)0 C3. Vegetatjon or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: I ,",,0 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 ~ 0 . C51'0wth~S;bsequent development, or related activili,s likely to be induced by the proposed action? Explain briefly: Long term, short term, cumulative, or other effects not identified in C1-C5? Explain briefly: L lher i;:(;IUding changes in use of either quantity or type of energy? Explain briefly: I C4. C6. ~ C7. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA ~CEA)? (If yes, explain briefly: DVes ~NO I E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? DVes ~NO L I If ye.s explain : .. 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 jj was checked -., -------v-es-,thsd-etem:li-J:latioFH)f si€lnifiGanoo-must-evaluat&the-f*)teA-tial-impaetef-tA e proj21ose€l aetioA-eft-ttte-Ofl. ireflFf1e:f1ta~charactari.3lic.& of the OCA. 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. Che6k-thfs boxifyouhave-delermmed-, based-O:-il-thelnfor-rriation and-analysis above arid-any supporting documentatlon'-fhalthe-proposediictlo- 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 Print 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) I. ~ Board of Trustees APPli~ion County of Suffolk State of New York ~o ~ P-vo6 ~L~ . BEING DULY SWORN DEP ES 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 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 PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. YJ SWORN TO BEFORE ME THIS -.3 PATRICI& RICHERT Notary f'1!b/~A SJ!tIlof New '1brtl .'JO.4i~l54 ifledinlfaUl . .., O' . ?L~A~ Notary Public / DAY OF ~ ,2otJh ~ard of Trustees APPlicat~ .. AUTHORIZATION (where the applicant is not the owner) ~ I, (AJ I t... L J t'lf' 11-. K. (}...5q (print owner of property) residing at fo ~'1. 405 (mailing address) MCrtT)~ do hereby authorize ~PvO ~\..-~ (Agent) to apply for permit(s) from the Southald Board of Town Trustees on my behalf. 1f;2.9!~el 8 . . :' APPLICANT/AGENTIREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics orohibits conflicts of interest on the Dart of town officers and emolovees. The Durnase of this fonn is to orovide information which can alert the town of DOssible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: .Do l'\ PvO 1;s\ ~p... (Last name, first name, J11iddle initial, unless you are applying in the name of someone else or other entity, such as a company. Ifso, indicate the other person's or company's name.)' NAME OF APPLICATION: (Check all that apply.) Building Trustee Coastal Erosion Mooring Planning )c )c. 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 Southold? "Relationship" includes by blood, marriage, or business interest "Business interesC means a business, including a partnership, in which the town ofticer 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 balance 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 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 shares of the corporate stock oCthe applicl,lnt (when the applicant is a corporation); _B) the legal or beneficial own~r 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 Submitted this _day of Signature Print Name 200 Form TS I . . DONALD G. FEILER · ARCHITECT 11725 Main Rd . Box 1692 . Mattituck, NY 11952 . 631 '298-5453 . Fax 298, 1380 To \\/?/oro ~~ O'f'"" TowN ~~~~ Te CJ...:) N 0 =r- ~vn\t)vK) Date ~~b.lf ~lO~~ +000 ~LC~ ~Ol~ . Re Pages to follow For your review As requested Please call at your convenience Comments: ~m~N 1~\.J6 tet)m~l ~~t.l~'N t'lor 'P~ So{4J~ 1-> Bo. C\i~- NP". ~