HomeMy WebLinkAboutTR-6715AJames F. King, President QF ~~(/~~
Jill M. Doherty, Vice-President ,~0~~ y~10
Peggy A. Dickerson
Dave Bergen e/+ is
Bob Ghosio, Jr. %~` ~ ~~
o~y~0UNT1 N~
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
# 0346C
Date Augast 8, 2008
THIS CERTIFIES that the placement of mulch installation of a sprinkler svstem, removal of
select trees, new shed, and p-ropane tank
At 7617 Soundview Ave., Southold
Suffolk County Tax Map #59-6-14
Conforms to the application for a Trustees Permit heretofore filed in this office
Dated 9/7/07 pursuant to which Trustees Wetland Permit #6715A Dated 9/19/07 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 placement of mulch installation of a sprinkler svstem removal of select trees new
shed and propane tank.
The certificate is issued to PAMELA MAINO & RICHARD JOHNSON owners of the
foresaid property.
Authorized Signature
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
,~;~pF SO~lyo~yy
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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, Si~'e i nSPeC~i on
151 day of construction
_/ %2 constructed /
V Project complete, compliance inspection. g~~/~8 - C?~
.
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
~re-construction, Sif-e.. jnspoc.t;ol")
1 st day of construction
Y, constructed
/ 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.: 6715A
Date of Receipt of Application: September 7,2007
Applicant: Pamela Maino & Richard Johnson
SCTM#: 59-6-14
Project Location: 7617 Soundview Avenue, Southold
Date of Resolution/Issuance: September 19, 2007
Date of Expiration: September 19, 2009
Reviewed by: Board of Trustees
Project Description: Clean-up yard, place down mulch around house, install a
sprinkler system, remove select trees, prune lower branches of healthy trees,
replace metal shed with new shed, and install a propane tank on the south side
of the house, west of the chimney.
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
plans prepared by Pamela Maino & Richard Johnson, and received on
September 19, 2007.
Special Conditions: A pre-construction site inspection must be performed by a
Trustee prior to any activity beginning.
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.
ro<'~
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: PCW'\e\~ (Y1oJ(\O ~ ~tcJ,Ofd :JOhn <::on
Please be advised that your application dated
been reviewed by this Board at the regular meeting of
and your application has been approved pending the co
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, Constructed ($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:
TOTAL FEES DUE: $ ,')0 Q.9
BY: James F. King, President
Board of Trustees
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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
Southold Town Board of Trustees
Field InspectionlW orksession Report
Name of Agent:
Date/Time: 1. / J- 07
Name of Applicant: POrne. \~ jY\ C\ ir"\O J
~ I,V 'Re.ih'''j.e..r
110\ 1
r:chc.cA Joh"joN
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Property Location: SCTM# & Street
Brief Description of proposed action:
cbr 6~,^J, ~J) -f.,-,,,-, i-rew,
r t<"().., +0 f"" {
Type of area to be impactes}:
_Saltwater Wetland ~Freshwater Wetland _Sound Front _Bay Front
Distance of proposed work to edge of above:
Pqtt of Town Code proposed work falls under:
:LChapt.97 _Chapt. 37 _other
Type of Application: ,/ Wetland _Coastal Erosion _Amendment ~dministrative
_Emergency
Info needed: + ~
-..:r 0 (h6-n-./ + \II d ()
,
Modifications:
Conditions:
Present Were: _J.King ~herty .1ffDickerson vD: Bergen
Other:
~b
Ghosio, Jr.
MailedIFaxed to:
Date:
Comments of Environmental Technician:
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Red Property Tax , Service Agency
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James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob lTnosio, 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
r{BJ ~ (G ~ n WI ~ lRl
IITJI SEP - I 2JJOI ~
Office Use Only
_Coastal Erosion Permit APplication/"
i _Wetland Permit Application 7- Administrative Permit
AmendmentlTraflli rl xtension
Received Application: ...,? ~ '7
Received Fee:$ ,57)
_Completed Application
_Incomplete
_SEQRA Classification:
Type I_Type II_Unlisted_
_ Coordination:( date sent)
_ L WRP Consistency Assessment Form
CAC Referral Sent:
/Date ofInspection:~ Cl J
_Receipt ofCAC Report.
_Lead Agency Determination:~
Technical Review:
A"ublic Hearing He~
_Resolution:
Southho/d Town
Board of Trustees
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~ j)ute Gv..r +
Fa.r..." "~Vt lit' A.J..r 1/ 138
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N='"fA~liomtAm~'"D;; e~~
Address 1~f7 <:;, I~ ~ _ __rCL
Phone Numb~1) ) ~ I 0 (') &-(
Suffolk County Tax Map Number: 1000 - SCf - C)6, - I f C"-o~)
P-:W:::~ .U.., .d.~ } w 't ~""'1$ Rei
(provide LILCO Pole #, distance to cross streets, and location)
AGENT: 'R,6J Kejn;nqer
(If applicable) D
Address:
Phone: b~l g?J3 sS I ,
~d of Trustees APPlicatio~
GENERAL DATA
Land Area(insquarefeet): E"+,,,,~ 10+
Area Zoning:-1Z.e c;~J I <t- I
Previous use of property: Q~- ~ ~ ~ t I ~ I
Intended use of property: R..e--<? ,C';) ~ . ...1
Covenants and Restrictions: Yes
If "Yes", please provide copy.
/NO
Prior permits/approvals for site improvements:
Agency
Date
L No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or sus:~ by a governmental agency?
No Yes
If yes, provide explanation:
~
Project Description (use attachments if necessary): Ge\-\~A II~tY.) ma.,I'\+~Cq lei ~""vr
_, PLA.J--':)l'hA')<"\ V\'\.u.I(.kqm~ ~,,--.u /
'tr: I "\:- \~f" SJ );t~.....) C \eA", 0 ~ee.> +-~d- GU~
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+'r-t e s.
iY'Ie:t"tt I s,he &-( \tV ,t r, "euJ b ~ ') .
P('Dpq'I'1€. +c:lV\. L Sou..-tl1s.,de qj- h.otts.€, wes.+O:f-(~I~
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1I5rd of Trustees APPlicati1lt
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: ~.{'-P n """ ~ I .1 ) 1... <- r... Q s.~
~"I, j ld- ) f1/JY" o+~ hu \~ ~Qft\'\.tt' r1 ~
-h-les a..::J ve~M,~
Area of wetlands on lot:
square feet
Percent coverage oflot:
%
Closest distance between nearest existing structure and upland
edge ofwetlands:~feet
Closest distance between nearest proposed structure and upland
edge of wetlands: .,JJ... feet
I
Does the project involve excavation or filling?
J 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 ofthe town that may result by
. reason of such proposed operations (use attachments if appropnate):.. - - - . ..
YVul-r-e s.L.L'" I'jh.+ ....... h..e", '+1.,..11.... ve~~l~
-
SEQR
. FECT ID NUMBER
,_ 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 NAME
t\lja. I "\0 YCI I"'YlJC
3PRO~tT LOCATION: ') I J. So 0 ( L
Municipalif? 11 <::;0 oJ V\ ~'I/ I ~A tI ~ County t=-
4. 7E:~ ;CATs,s:e~~e~ :::d IJS:;' promin~:;; ~o, :Lide maN y
PART 1 - PROJECT INFORMATION
1. APPLICANT I SPONSOR
Atf I YJ 0
O~~'Y"\
5. IS PROPOSED ACTION: 0 New
D Expansion
odification I alteration
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..".......lc.f.../ S.\"'....,"'-l:::I~./ s\y;+~ "" f ~1-t..A",- <Aj'=>
+-t:_~ > +W ClV'<.. JL/ti \ ~ J~ J y e.~l>\le ~.( d -I-.{'e~
,>Q-Y ...." <. I ~ v .bv-a.n-..~ ~ ~ I +l.v.,
\Lt-lll s.kJ I... ."+,, II fYq ~ n-e +: ,,-L J +-r~e s ) l'.{ pC
) ~ 6vt s.o\J+~ s, ') ~ 6
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't
6. DESCRIBE PROJECT BRIEFLY:
J
1l....Se
7. AMOUNT OF LAND AFFECTED:
Initially acres Ultimately acres
8. WILL PROPOSEO ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
~es 0 No If no, describe briefly:
.
~T IS PRESENT LAND USE IN VICINITY
l.:Y1'Residential D Industrial Dcommercia'
OF PROJECT? (Choose as many as apply.)
DAgriculture 0 Park / Forest / Open Space
DOther (describe)
10'DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal, State or Local)
Dves ~ If yes, list agency name and permit I approval:
TTllOEoA~~CTTIFlRCACTIOI"lHAVE A CURREI'IT[Y VALID PERMIT OR APPROVAL?
D Ves ~o If yes, list agency name and permit I approval:
PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION?
ATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant
Signatur
q '1 07
Date:
If the action Is a Costal Area, and you are a state agency,
plete the Coastal Assessment Form before proceeding with this assessment
.
.
PART II - IMPACT ASSESSMENT (To be comDleted bv Lead Aaencvl
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NVCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF.
DVes DNa
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.
DVes DNa
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
CZ. Aesthetic, agricultural, archaeological, historic, Of 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 1
C5. Growth, subsequent development, or related activities likely 10 be induced by the proposed action? Explain briefly:
I
C6. Long term, short term, cumulative, or other effects not identified in C1~C5? Explain briefly:
I I
C7. Other impacts (including changes in use of either quantity or type of energy? Explain briefly:
[ l
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
ENVIRONMENTAL AREA (CEA)? (If yes, ex~lain briefly: I
D Ves D No I
E. IS THERE, OR IS THERE L1KEL V TO BE, CONTROVERSV RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: 1
Dves DNO 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
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
....:y.es,tRe-determinatign gfs;gniHc3nse ml:lst evahlate-the-potemtiaHmpaetof-tlleprol3oseE.l ae-tiofl Of! the enyironmental cfiaraGteristic.s oft! Ie CCA.
Check this box i(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.
Che6kthis-boxlfyou"flavedetermmecf, basei;t'on -the In-(ormation and analysis above and-any supporting- documentation, thaHheproposed 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 (rom responsible officer)
4Itoard of Trustees APPlicat~
County of Suffolk
State of New York
L- 1?1772'I c. /;CJ r~#()} i..J BEING DULY SWORN
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 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,
~ltJ" .QYnlL- "
Signature
SWORN TO BEFORE ME THIS
7
DAY OF de;rl- ,201)7
/ ~
&. C;/A~"
II' Notary Public
:..,:.....
wrd of Trustees. APplicatie
AUTHORIZATION
(where the applicant is not the owner)
f.
I, P-'Lh\,C\ a ),to,,, 0 JohhSOY\residing
(print owner of property)
at1(,17 C;Ol/:)v,e..u .jJ,c/~
(mailing address)
do hereby authorize
~w ~e\Y\ (~1J
(Agent)
to apply for permit(s) from the
Southold Board of Town Trustees on my behalf.
8
.
.
APPLICANT/AGENTIREPRESENTATIVE
TRANSACTIONAL DISCLOSURE. FORM
The Town of Southe.d's Code of Ethics orohibits conflicts ofinterest on the Dart of town officers and emolovees. The Durnose of
this form is to ofovide information which can alert the town ofoossibJe conflicts of interest and allow it to take whatever action is
~;::;:;~id ~ ~ \ Cj Mo. I "1 D .
(Last name, first name, -I1liddle initial, unless yo'u are applying in the name of
someone else or other entity, such as a company. Ifsa, indicate the other
person's or company's name.)
NAME OF APPLlCA nON: (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, marriage. 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 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 South old
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 of the applic~nt
(wheo the applicant is a corporation);
_8) the legal or "beneficial ownC?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
Form TS I
Submitted t~s ~ day of'S:e r+ 200L
Signature-f-!fg;/ . '.M..~
printNamu .... Q, ~ ~
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 Envirorunental Conservation (DEe)
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.
A1h,ny, l\[V P?31
518-474-6000
APPROVED BY
~~~ARD OF TRUSTEES
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