The URL can be used to link to this page

Home My WebLink AboutTR-6690A 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 OFTOWNTRUSTEES TOWN OFSOUTHOLD CERTIFICATE OF COMPLIANCE # 0376C Date: October 24, 2008 THIS CERTIFIES that the demolition of existing storage shed and construct new beyond 100' from top of bluff At 4630 Blue Horizon Bluffs, Peconic, New York Suffolk County Tax Map # 74-1-35.51 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 8/08/07 pursuant to which Trustees Permit # 6690A Dated 8/22/07 and 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 demolition of existing storage shed and construct new beyond 100' from top of bluff The certificate is issued to CHARLOTTE DICKERSON owner of the aforesaid property. Authorized Signature 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 constructed roject 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.: 6690A Date of Receipt of Application: August 8, 2007 Applicant: Charlotte Dickerson SCTM#: 74-1-35.51 Project Location: 4630 Blue Horizon Bluffs, Peconic Date of Resolution/Issuance: August 22, 2007 Date of Expiration: August 22, 2009 Reviewed by: Board of Trustees Project Description: Demolish the existing storage shed and rebuild beyond 100' from the top of the bluff. 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 prepared by Charlotte Dickerson, received on August 8, 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. 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 Please be advised that your application dated /~cl,:~ ~>. o,qOO? has been reviewed by this Board at the regular meeting ~:~ /~,~ cz&-J-,-~,,-~. ~,?c30-~ 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) __ ½ Constructed ($50.00) V/Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: BY: James F. King, President Board of Trustees James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob ~nosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Applicatiot~ / Wetland Permit Application I/ Administrative Permit / Ame ndme nt/Tr a _ns~e_r!~xt ensio n V ..Rece~vved Application: ~-Received Fee:$ ~Completed Application __Incomplete __SEQRA Classification: Type I Type II Unlisted ~Coordination:(date sent) LWRP Consistency Assessment Form CAC Referral Sent: ~Date of Inspection: ~!! Receipt of CAC Report: Lead Agency Determination: Technical Review: ,.~'Public Hearing Held: Resolution: Name of Applicant Address Suffolk County T~ Map Number: 1000- Prope~y Location: Orovide LILCO Pole ~, dist~ce to cross streets, ~d location) (If applicable) Address: Phone: .rd of Trustees Applicati0 GENERAL DATA Land Area (in square feet): .-- I .oF /'~'C~'C Area Zoning: /~ ~t51C~t~A'~I~ [ Previous use of property: ~k'~6~ ~/ Intended use of property: %~,~, ~,01A (kI Covenants and Restrictions: Yes fi,. No If "Yes", please provide copy. Prior permits/approvals for site improvements: Ag ncy ,'o. __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspe~n~led by a governmental agency? ~ No Yes If yes, provide explanation: Project Description (use attachments if necessary): of Trustees Applicat~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: Percent coverage of lot: C) % Closest distance betwee~ n~arest existing structure, and uplatad edgeofwetlands: ,,g feet <~o ~0{~- Closest distance betwee, l~ nearest proposed structure and upland edge of ~vetlands: c~06 feet Does the project involve excavation or filling? ~tx No Yes If yes, how much material will be excavated? 0 cubic yards How much material wilt be filled? 0 cubic yards Depth of which material ~vill be removed or deposited: r0 feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the ~ffect, if any, on the wetlands and tidal waters of the town that ma), res.u, lt by reason of such proposed operations (use atth~hments if ~PproPriate}i 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 ~ME ~ SEQR 3.PROJECT LOCATION: ~.~ Municipality 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map 6.1, PROPOSED ACTION: [] New r-]Expansion ~MoOgication/altoration -- gO(_~l~lr~ 6. DESCRIBE PROJECT BRIEFLY: AMOUNT OF LAND AFFECTED: Initially ~) acres C) Ultimately O acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? r~Yes [] No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~'~ Residential [~ Industrial ~[ Commercial ~-']Agriculture [~ Park, Forest / Open Space ---]Other (describe) 10.' DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL ~Yes [] No If yes. list agency name and permit / approval: ~) 11.U(J[::5 ANY_~..~SF~ECT~F IHE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [~Yes L~JNo If yes, list agency name and permit / approval: 12, AS A R,R,R,R,R,R,R,R,R,R_~ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY T.AT TH~ ,NPO~ON PROV,DED ABOVE IS TRUE TO THE BEST O~ ~ ~.OW~O~ Applicant / Sponsor Na~ ~1 ~ [c~erS~ 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 Agency) A. DOES ACTION .~XCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. r~Yes [~No B, 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, C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, 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: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensib~ of use of land or other natural resources? Explain briefly: C5 Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, shorf term, cumulative, or other effects not identified in Cl-C57 Explain briefly: C7~ Other impacts (ineludia~ changes in use of either quanflb/or type of energy? Explain briefly: D WILL THE PROJECT HAVE AN IMPACT ON THE ENV~ONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONr E~Yes PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadversee~ectiden~~edab~ve'de~erminewhetheritissubstantia~'iarge'imp~rtant~r~therwises~gnificanI~ 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 :,,es, the determination of e[gn!fic~n6emust ovatua~thc pctuanfi~l ~mpcct cf thc propa3cd a 6q~k; F, On thc en, vlroa,, ' ' EA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur Then proceed direcfiy to the FULl EAF and/or prepare a positive declaration. Check th~s box if yo~ ha-va de~erm[ne~ based on ihe information and analysis above and any suppoding documen~ationl that the proposed acfi0i WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons suppoding th/ determination. Name of Lead Agency Date Title of Responsible Officer Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Signature of Preparer ([f different from responsible officer) of Trustees Application 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 HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE 1N THE MANNER SET FORTH 1N 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 IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS ~;/ DAY OF C"r'- ,2%07 ' lffotary PubJic~ ' ~r ~mi~n [xp~es May 3~, ~* of Trustees Ap~ AUTHORIZATION (where the applicant is not the owner) (print owner of property) (mailing address) 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 prohibits conflicts of interest on the vart of town officers and emnlovees. The oumose of this form is to orovide information which can alert the town of vosalble conflicts of interest and allow it to take whatever action is ~ec~ssary to avoid same. II . th (Last n~me, first name, ~niddle initial, u~less you are applying in the name of someone else or other entity, such as a company. If so, indicate~th¢ other person's or company's name,) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption~j[kom plat or official map Other ~" 1_ q ~o.~ (lf"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 Z NO If you answered "YES", complete the balance of this form anti__date and sign.._whey indicated. Name o f person employed by the Town of So~.~tholc~ r/NO 0~1~ q Tille 0r position o f that person ~] ~t.l~ ~ O~ ~ 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% oftbe shares 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, parmei', or employee of the applicant; or D) the actual applicant. DURVIE¥ Of= LOT I 5,UBDIVISION HAP Of= DLUE HORIZONS =ILE No. 7q~4 51TUATE: F~CONIC, FOlalN: 5()UTHOLD ~UFFOLK COUNT'f, NY' ~ROP HSE. 01-1~-02 APPROVED BY BOARD OF TRUSTEES ~o.,.., o~ ,ou~.o~0 AUG - 8 2007 $o,iBhold Tom~ Board of Trustees