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Home My WebLink AboutTR-6624A . 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 151 day of construction y" constructed ~ject 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.: 6624A Date of Receipt of Application: June 6, 2007 Applicant: Barbara A. Reiter SCTM#: 107 -8-33 Project Location: 165 Westview Drive, Mattituck Date of Resolutionllssuance: June 20, 2007 Date of Expiration: June 20, 2009 Reviewed by: James F. King, President Project Description: Install a post and rail fence along both sides of the property down to the seaward property corner marker on both sides. 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 application, received on June 6, 2007. Special Conditions: None. Inspections: Final inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. ;.,- o? ~ James F. King, President Board of Trustees JFK:eac . . 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: 13o.c1cnra.. f-1. 1<.e; +f'f Please be advised that your application dated Tu..(]e fo I ;?(j()7 has beenreVieweCfby this Board at tile I eyularmeetil.g of ~ L-v ,e. de i~C'" 7'----- -- and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1st Day of Construction ($50.00) _ .).9mstructed ($50.00) ~ Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: PAID: 1.5 .JUNE 2007 #6272 TOTAL FEES DUE: $ 5V~ BY: James F. King, President Board of Trustees . 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: ~6rR ~.'Ke;-l--f'f Please be advised that your application dated Tu..()e ro I ;l,0cJ7 has been reviewed by this Board at the regular meeting of J u.ne dO, dCiG) 7 and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1st Day of Construction ($50.00) -.y.onstructed ($50.00) -L Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ 50129-- BY: James F. King, President Board of Trustees . . 0""""","1"" ,I i.~1 )11 : I'I'P 1'1I1! , ' . , , ~ ~ I . 1\l . ~ p ~ -, If~ li'j I'I I :I'SI ill ! PiP I !Ill! ! fifjZJ I111I1 ~ ~ ; : . ~ !!!II, !I!ll liiif 1!111 iilll ,.1' , 11ffff ~: ~Hia~~ lilllH ','ill'l :~ I .~ ~ 01;' z ~r~~ -::: !1m" ~~I;; . , o ~[n ~=?~ -,J!" ;~:.'" H00 !~~ ::;~o !i:~ -~@ II PI rd ~ i(i ",y~, 1'\ t.// 1 I il ~<I"~ ~----_._---:l---,-------~ --~ ~",,\\\ll'T\ ;~..."'" #,0 'i:!!!i hI! ~~~ .. ! I . " I , , -- >-> " 0 . --J , I -~-- z ~=- I ,\ 'i I' I, I ,: I I Ii ,':1 'I: 'I i ,,~ I: I ,...~ ;;1 ~ I , ! J II L." Ii " I , n 1 I ,lSi I 111 ~ '" I OO-?+, , ~ , "''''.''''-1'' i . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob uhosio, 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 SOUTH OLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application V Administrative Permit / _Amendment/Transfer/ xtension ljeceived Application: ~ 01 -LReceived Fee:$(52J I l _Completed Application _Incomplete _SEQRA Classification: Type I_Type II_Unlisted~ _ Coordination:( date sent) _LWRP Consistency Assessment Form CAC Referral Sent: ~DateofInspection: \~ ~sret~ tp\19l\l1 _Receipt ofCAC Report: _Lead Agency Determination:_ Technical Review: ~ublic HearingHe~ Resolution: f5)~~~lw~rm lf1l JUN - 6 2007 lW ScllIlhbold Tawl Board of Truatees NameofAPPlicant---!5A({I3ItI?t1 A. ~EI'TEIf P. O. 84)( /fry. ~/;.JrTi'rtll-l( lV.y. 'JI ' , II'IJ'i-_ 0 toy 1 Phone Number: ( ) rZ,f- f.rtf3 Suffolk County Tax Map Number: 1000 - '173. Fir 107. - f - 3.3 f r,r WE srll "Ef,J DR" V E Address Property Location: (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: ~ard of Trustees APplicatJlt GENERAL DATA Land Area (in square feet): Area Zoning: t<..es ide,., I-r (AI ~@S;def\h'rA( Previous use of property: Intended use of property: Covenants and Restrictions: Yes If "Yes", please provide copy. V No 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 if necessary): ~S~\\ fOS~ ~ ("0.:,\ .Q(\Cil\~ on bo~ Sio.ec; o~ ~(+-t oOvJ\"'\ -b C\.'-:>('ju~ IS' frOM h ij h tvcJer Ii (I e 0" SJrl/fl/ I 4Ifard of Trustees APPlicat.., WETLANDITRUSTEE LANDS APPLICATION DATA Purpose ofthe proposed operations: POST ~ RA. Ii.... F~N~/iJG- 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? ~ No Yes rfyes, how much material will be excavated? o cubic yards How much material will be filled? o cubic yards Depth of which material will be removed or deposited: /fJ /fJr 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 andtidalwaters of the town that may result by reason of such proposed operations (use attachments itappropnate): .. . . - _un.. . jlJ(jN:.-.. . PROJECT ID 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) 2. PROJECT JibME I-eN SEQR ~. County 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks ete . or Drovide maD 5. IS PRDPOSED ACTION: ~ New 6. DESCRIBE PROJECT BRIEFLY: po S T' ~ fJLONG- PKOjOE D Expansion o Modification I alteration !<A,'L FEtJ(,'N6- E1tST (fI1I(T/At) sf WeST T J..../}l fs 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~ Yes D No If no, describe briefly: 9 WHAT IS PRESENT LAND USE IN VICINITY ~ Residential D Industrial o Commercial OF PROJECT? (Choose as many as apply.) DAgriculture 0 Park I Forest I 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) DYes ~ No If yes, list agency name and permit I approval: "IT.uut;.::i ANY A:;:il-'t:l;1 UI- IHI: ACIIQN HAV!: A CURRENllY VAllO PERMIT OFf APPROVAL? DYes ~NO If yes, list agency name and permit I approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT / APPROVAL REQUIRE MODIFICATION? Ges No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant I Sponsor Name Signature If the action is a Costal ~, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment . . PART II. IMPACT ASSESSMENT (To be comoleted bv Lead Aaencvl 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 han~written, 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 ~ 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 I C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: I . ~ ~-,- .... I C6. Long term, short term, cumulative, or other effects not identified in C1~C5? Explain briefly: L I C7. Other impacts (including changes in use of either uantitv or type of enernv? Explain briefly: r j 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 J 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 _m PART 111- 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 -----YeE:, the determination of s1goifk3nc8 ml:lst e'Ia.luate-the-peteA-tiaHmpact of the I3repo5cd aelief! Of! thE; CFlyiroflffiefttal-eharaeteristtesof-tho aCA. 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. Check fhlsuboxTf you havedetermTnea, basec!"o" 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 Print or Type Name of ResponsIble Officer In Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Pre parer (If different from responsible officer) . . Board of Trustees Application County of Suffolk State of New York t3A'RI3.1~1f A. Jf ,r~BEINGDULYSWORN DEPOSES AND AFFIRMS THAT HEfS IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HISIHER 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 RE OF THIS APPLICATION. ~ JUN~ ,20Q}- SWORN TO BEFORE ME THIS I rH (f DAY OF q,u~,V1 --rY1. ~~ olary Public ~ /(0 jD 7 LAUREN M. STANDISH Notary Public.. State of New lInk No.01<:>T6164008 Qualified In Suffolk CountY Commission Elcplm April 9, 20...J.L 4Ifoard of TrusteesAPplica~ AUTHORIZATION (where the applicant is not the owner) . .. I, (print owner of property) residing at (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) 8 . . APPLlCANT/AGENTIREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of South old's Code of Ethics nrohibits conflicts of interest on the Dart arroW" officers and emnlovees. The DUmose of this Conn 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: (Last name, first name, J;lliddle 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.) 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, IQarriage, or bus'iness 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. 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 applicantlagenVrepresentative) 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 applic~nt (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 Fonn TS I . . 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 OTHER POSSIBLE AGENCIES YOU MIGHT HAVE TO APPLY TO N.Y.S. Dept. of Environmental Conservation (DEC) SUNY, Bldg. 40 Stony Brook, NY 11790-2356 (631) 444-0355 Mon., Wed., Fri., 8:00 AM-3:00 PM Suffolk County Dept. of Health Services County Center Riverhead, NY 11901 852-2100 U.S. Army Corp. of Engineers New York District 26 Federal Plaza New York, NY 10278 212-264-3912 N.Y.S. Dept. of State Coastal Management 162 Washington Ave. .u_Albany,NY 1)),L 518-474-6000