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HomeMy WebLinkAboutTR-6807A James F. King, President ~~'oF SOUryo Town Hall Jill M. Doherty, Vice-President l~ 53095 Route 25 Peggy A. Dickerson P.O. Box 1179 Southold, New York 11971-0959 Dave Bergen G Q Bob Ghosio, Jr. ~ 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 1St day of construction Yz constructed Project complete, compliance inspection. James F. King, President ~~Of ~~UryO Town Hall Jill M. Doherty, Vice-President l~ 53095 Route 25 Peggy A. Dickerson P.O. Box 1179 Southold, New York 11971-0959 Dave Bergen G Q • ~O Telephone (631) 765-1892 Bob Ghosio, Jr. O~yCOU~ N~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6807A Date of Receipt of Application: January 16, 2008 Applicant: Debra Lachance SCTM#: 52-2-26 Project Location: 630 Ruch Lane, Greenport Date of Resolution/Issuance: January 23, 2008 Date of Expiration: January 23, 2010 Reviewed by: Board of Trustees Project Description: To construct a studio addition to the front of the dwelling. 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 Boulevard Planning P.C. dated 10/22/07. Conditions: Gutters and drywells are installed in accordance with Chapter 236- Stormwater Management, of the Town Code. 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'l Jame F. King, Presidfpf Board of Trustees • James F. King, President ~,oF SOUIy Town Hall Jill M. Doherty, Vice-President h0~ Ol0 53095 Route 25 Peggy A. Dickerson yy P.O. Box 1179 T Southold, New York 11971-0959 Dave Bergen G Q • ~O Telephone (631) 765-1892 Bob Ghosio, Jr. I~C~U~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 23, 2008 Mr. Robert Lehnert Peconic Permit Expediting 32645 Main Rd. Cutchogue, NY 11935 RE: DEBRA LACHANCE 630 RUCH LANE, GREENPORT SCTM#52-2-26 Dear Mr. Lehnert: The Board of Town Trustees took the following action during its regular meeting held on Wed., January 23, 2008 regarding the above matter: RESOLVED, that the Southold Town Board of Trustees RESCINDS Administrative Permit #6735A issued to DEBRA LACHANCE on October 17, 2007 to construct asingle-car garage on the landward side of the existing dwelling, and, BE IT FURHER RESOLVED, that the Board of Trustees APPROVES the Administrative Permit application to construct a studio addition to the front of the dwelling, with the condition gutters and drywells are installed in accordance with Chapter 236-Stormwater Management of the Town Code, and as depicted on the plans prepared by Boulevard Planning P.C. dated October 22, 2007. This is not a determination from any other agency. Very tr yours, Jame .King, Preside ' Board of Trustees JFK:Ims James F. King, Presid~ -``~OF $QVTyO • Town Hall Jill M. Doherty, Vice-President l~ 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson ~ ~ Southold, New York 11971-0959 Dave Bergen Bob Ghosio, Jr. ~ ~ Telephone (6311 765-1892 ~~,~-COU~ a~ Fa~c (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: Name of Applicant: .Ve~rGt ~ppC1, k,, c,t Name of Agent: ~2 (~wi ~ C ! Ps1m ~ E P~`h~ Property Location: SCTM# & Street ~ 3 0 ~ uriih Ln ~ ~P°~~ Brief Description of proposed action: ~o~-i-E•~+ ~f'o ~ ~`^A w*'.l S~cVt- b~ ~,swr Tve{e of area to be impacted: -Saltwater Wetland Freshwater Wetland -Sound Front -Bay Front Distance of proposed work to edge of above: Papf of Towu Code proposed work falls under: _Chapt.~ Chapt. 781-other a7s Type of Application: _ Wetland _Coastal Erosion -Amendment _Administrative -Emergency Info needed: Modifications: Conditions: Present Were: _J.King _J.Doherty_P.Dickerson_D. Bergen Bob Ghosio, Jr. Other: MailedlFaxed to: Date: Comments of Environmental Technician: u>ellS ~ run o~{ ~ hoo ~Iw{ cnee -(31" rn~~ James F. King, President ~~OF SO(/TyO Town Hall Jill M. Doherty, Vice-President ,~O l0 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson l~ ~ Southold, New York 11971-0959 Dave Bergen G Q Bob Ghosio, Jr. ~ ~O Telephone (631) 765-1592 Ol~•~,OU~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6735A ~ ~.l Date of Receipt of Application: July 13, 2007 I ~ 0 Applicant: Debra Lachance I SCTM#: 52-2-26 ~j Project Location: 630 Ruch Lane, Southold Date of Resolution/Issuance: October 17, 20 7 ~n `I Date of Expiration: October 17, 2009 ~ 1, Reviewed by: Board of Trustees Project Description: To construct asingle-car garage on the landward side of the existing dwelling. 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 site plan prepared by David Howell Design/Arcalhek Architects, P.C. last dated May 7, 2007. Conditions: Proper drainage is required, in accordance with Chapter 236 of the Town Code, Stormwater Management. 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'~ Jame .King, PresidE~gf Board of Trustees i r~ James F. King, President ~QF S~V j Town Hall Jill M. Doherty, Vice-President ,~0~ ~~0'' 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson l~f # Southold, New York 11971-0959 Dave Bergen G ~ Bob Ghosio, Jr. ~ ~ ~O Telephone (631) 765-1892 ~l~ ~ ~ Fax (631) 765-6641 ~OUNTV ~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: rn, ~ hrr t~ ~Q Please be advised that your application dated `~~I ~(o~ has been reviewed by this Board at the regular meeting of /~~D'] 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) '/2 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: $ 5~,~O BY: James F. King, President Board of Trustees i James F. Ping, president ~~QF $QU~y Jill M. Doherty, Vice-President ~Q Town Hall p 53095 Route 25 peggyA Dickerson ,~L P.O. Box 1179 Dave Bergen y ? Southold, New York 11971-0959 Bob Ghosio, Jr. ~ Telephone (631) 765-1892 yC~(I~ at~"_ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Southold Town Board of Trustees Field Inspection/Work session Report Date/Time: ~ $ 7 Antony Martin on behalf of DEBRA LACHANCE requests an Administrative Permit to construct asingle-car garage on the landward side of the existing dwelling. Located: 630 Ruch Lane, Southold. SCTM#52-2-26 Type of area to be impacted: _X_Saltwater Wetland Freshwater Wetland -Sound -Bay Distance of proposed work to edge of above: Part of Town Code proposed work falls under: 9 _X_Chapt.275 Chapt. 111-other Type of Application: Wetland -Coastal Erosion -Amendment _X_Administrative -Emergency Pre-Submission Violation Info needed: Modifications: Conditions: cJ W Present Were: _J.King _J.Doherty_P.Dickerson~B~Bergen_ B. Ghosio, Jr _H. Cusack- D. Dzenkowski -Mark Terry other Form filled out in the field by Mailed/Faxed to: Date: Enviro ental Technician Revie 1 i.Ocl(" h¢ o+~~jo4cc o°J~~ae?S{ ~u 'j T~c~ Sef•~tY~ sys4c.,,.? ~r.Q,. uJ~s r.,~•-~y (4st Ids 5rrd..~~ ~ts.ru~ ditl~a f`~.l• ~`2 P~,~-I- i,. ~:lr~. Aw1l~<~_ Cln~l~ T,o- n.., -h.+-~ VY~ q Irv ' - u~p _ - r\ _ ~ 30 ~ 1 Xn~" ~ p ~ p in $V gh. G a~ 3r I l` Ch r + R a y ~ ~ nnmru znm d 3 ~ ~ ~ t ~u _ ~ 2 O ~ PTO / m~ ~ - !,rF~~ l n ~os~a ~ ~ r p' ~.p`e ~ e a~ ~ j t ~o~R. ~ro~ a ~ run 'i' - / Y' m• o nmort.<. , d .oni.i \ rer¢i 1 ' +4 rnuu ~f ~ 4~ O~ f0 *I O ~ r I i t hn' Q- ~ rrA.. ~.r 3 © °O ~ ~ # ~r ~ ,n~. ~ ~ ~ ' ~i i ~o o-~ o OO ~ ~ 4o s+a 'o m. `o ~ ~ ~ ~ R; r,~, r , ' ~o a ~r ~ ~ 3~ ~ r. o~ , u 3 .O ~ r wrcr.io. ~ • rw rv u. ~ c - - - ~ ~ rvoT Ct COUNTY OF SUFFOLK © i a SOUTNOLO ¢Ci1q° H0 c ~ ~ zv ~ - ~ - • - - Ped Aoperty lm Service Igency @ - - _ ~„~,~~.,,..un i~ _ 052 r,i _ r..,. uy , :r - a 1000 vvovmrv ws 1 James F. King, President ~~oF soUryo Town Hall Jill M. Doherty, Vice-President ~O l~ 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson ~ ~ Southold, New York 11971-0959 Dave Bergen G Q • ~O Telephone (631) 765-1892 Bob Ghosio, Jr. ~~COU~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8807A Date of Receipt of Application: January 16, 2008 Applicant: Debra Lachance SCTM#: 52-2-26 Project Location: 630 Ruch Lane, Greenport Date of Resolution/Issuance: January 23, 2008 Date of Expiration: January 23, 2010 Reviewed by: Board of Trustees Project Description: To construct a studio addition to the front of the dwelling. 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 Boulevard Planning P.C. dated 10/22/07. Conditions: Gutters and drywells are installed in accordance with Chapter 236- Stormwater Management, of the Town Code. 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. Jame F. King, PresidepC Board of Trustees James F. King, President o~~oF soaryol Town Hall Jill M. Doherty, Vice-President ~ ~ 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson ~ T Southold, New York 11971-0959 Dave Bergen G Q Bob Ghosio, Jr. ~ Telephone (631) 765-1592 ~,YC,oU~'~~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 23, 2008 Mr. Robert Lehnert Peconic Permit Expediting 32645 Main Rd. Cutchogue, NY 11935 RE: DEBRALACHANCE 630 RUCH LANE, GREENPORT SCTM#52-2-26 Dear Mr. Lehnert: The Board of Town Trustees took the following action during its regular meeting held on Wed., January 23, 2008 regarding the above matter: RESOLVED, that the Southold Town Board of Trustees RESCINDS Administrative Permit #6735A issued to DEBRA LACHANCE on October 17, 2007 to construct asingle-car garage on the landward side of the existing dwelling, and, BE IT FURHER RESOLVED, that the Board of Trustees APPROVES the Administrative Permit application to construct a studio addition to the front of the dwelling, with the condition gutters and drywells are installed in accordance with Chapter 236-Stormwater Management of the Town Code, and as depicted on the plans prepared by Boulevard Planning P.C. dated October 22, 2007. This is not a determination from any other agency. Very tr yours,a, Jame .King, Preside , Board of Trustees JFK:Ims James F. King, President ~~~F SDUTyO Town Hall Jill M. Doherty, Vice-President ~0 ~ 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson ~ ~ Southold, New York 11971-0959 _ Dave Bergen John Holzapfel G ~ Telephone (631) 765-1892 ~'~'~,r7UNTY,~c~` Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only -Coastal Erosion Pemrit Application -Wetland Permit Applicafion _?Administrative Permit _Amendment/Transfer/Extension _ ~ceived A Iication.L,C W . / / i t ~ ~ ii _ ~ - ~ Received Fee:$ ~ ' ~ L !Completed Application 0 -Incomplete _SEQRA Classification: - ~A N ~ 6 2~l)B Type I_Type II_Uniisted _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 ~e D/'~ L~ G ~l stn G -e Address -~/9' ~'1/2Q~lt 5,1i'cc~~ncl Floor ,New xoi h l~/ / ~ / ~ 0 Phone Number:( ) Suffolk County Tax M/ap Number:p1000 - s2 2 '2 6 1 Property Location: O 3 t7 /1 ~G ~ ~ n e ~ ~,i/I ~ 6~ T (provide LILCO Pole distancne to crossLstreets, and loc/ati/on) AGENT: ~CG019/L /'uMiT ~'C,Dtdit~n5 (If applicable) / Address: 326~~ MG/N /P~ ,_~y~ch OS!/:Gy. /Vy Phone: 73 ~ - ~3 6~ ' • Board of Trustees App~ation GENNERAL DATA Land Area (in square fQeet): 7~ ~O ~ 5~ Area Zoning: /I - ~ ~n Previous use of property: lC-~Sl~/Gvt Intended useofproperty: /PGSlar'fnL~ Covenants and Restrictions: Yes ~No If "Yes", please provide copy. Prior permits/approvals for site improvements: Agency Date D nFTbYJN 'iIPtY~T~~ ~_?mr~' e-735A~/1?~~~j } ~bwruoFd 81dq Dept: perrn~t 3~ I ~D z to lab/o~- =~wN oF~ad"A'td p~d91,LPt' ~P,Ynut- ~ 31 ~ 5 I ~ r f No prior permits/approvals for site improvements. Has any pennit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: Project Description (us/e attachments/if necessary): ~Q17. $ ~l/~C/G 7 /'d OS~GGL Sfy~/O R~41i ~J,dr~. 1 ~ j' ~ ~ ' it 11~`l-t- - ' ~ Board of Trustees Applation WETLAND/TRUSTEE LANDS APPLICATION DATA. Purpose/ofth/e'proposedoperatio/Ins/ ~ ~ O O?~~~ 0 o ~ ' hovs~. Area of wetlands on lot: p Q square feet Percent coverage of lot: , s Closest distance between neazest existing structure and upland edge of wetlands: ~~~.5 feet Closest distance between neazest proposed structure and upland edge of wetlands: /V/g feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? N/l~ cubic yazds How much material will be filled? /~//A' cubic yazds Depth of which material will be removed or deposited: /V/f} feet Proposed slope throughout the area of operations: If/ / Manner in which material will be removed or deposited:__ /V~ Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): - ~IZ-~ wl % ~ ~ - - ~ ~~l'ttG 1~d iT 'ro w~'I y?A tit/5 t~ 5 ~~ie S'~to5 ~ ~G~~r Gyrrfn ~x is~, ~ r James F. King, President ~QF SOVjy Town Hall Jill M. Doherty, Vice-President ,~0~ 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson Southold, New York 11971-0959 Dave Bergen G C John Holzapfel ~ Telephone (631) 765-1892 IyCOU~'~ Fax (631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD APPLICATION FOR AN AMENDMENT TO A WETLAND PERMIT ~~i ~ ~ ~ C !P~ N ~ i; DATE c 20 0 t~~k?; D C 2 1 2C01 i So ' ~o ~ o~ti~. OWNER C /6 GA~h G PHONE Trustees ADDRESS S/g" W 2Q ¢ ~ S-(/cc 2 FG G.v ~ a ~ / 0 DI / AGENT ,°G ~ t/ ~ PHONE - g3 6~ ADDRESS 3Z ~ Sr M~ t G ~ G ~ o G iV PROPERTY LOCATION 63 O h L6e G 6 ~e a TAX MAP NO. I OOD - J`- - - 2 UWe ~o ~ ~ m ~ request an Am dment to Permit # '73S to /GAD I/vo v~i o ~t ~i -~a rn a t ~ 5~ Signed By: • Board of Trustees App~atioa AUTHORIZATION {/where the applicant is not the owner) I, ~ICOf/f. Gat `naC?JGG residing at Jrl~' Vet-4~h 3~ICO"~i (print" owner of property) (mailing address) Na.v Yor N,r do hereby authorize ,~1 L / / (Agent) YGGOn ~G Yt/m, T ~.tn r,®li fi~to apply for permit (s ) from the Southold Board of Town Trustees on my behalf. (Owner's signature) 8 James F. King, President ~~OF ~~(/jO Town Hall Jill M. Doherty, Vice-President y~ 53095 Route 25 Peggy A. Dickerson l~t ~ P.O. Box 1179 Southold, New York 11971-0959 Dave Bergen G Q Bob Ghosio, Jr.'nt ~ ~0 Telephone (631) 765-1892 ly~~U~,N~11 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 15t day of construction '/z constructed Project complete, compliance inspection. James F. King, President ~~QF S~(/JyO Town Hall Jill M. Doherty, Vice-President ,~O 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson Southold, New York 11971-0959 Dave Bergen G Q Bob Ghosio, Jr. ~ ~O Telephone (631) 765-1892 ~y~DUMY,~`~ Fax (631) 76b-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6735A Date of Receipt of Application: July 13, 2007 Applicant: Debra Lachance SCTM#: 52-2-26 Project Location: 630 Ruch Lane, Southold Date of Resolution/Issuance: October 17, 2007 Date of Expiration: October 17, 2009 Reviewed by: Board of Trustees Project Description: To construct asingle-car garage on the landward side of the existing dwelling. 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 site plan prepared by David Howell Design/Arcalhek Architects, P.C. last dated May 7, 2007. Conditions: Proper drainage is required, in accordance with Chapter 236 of the Town Code, Stormwater Management. 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. Jame .King, PresidE~r~t Board of Trustees James F. King, President O~~OF SO(f jyOl Town Hall Jill M. Doherty, Vice-President h ~ 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson ~ ~ Southold, New York 11971-0959 Dave Bergen • ~O Telephone (631) 765-1892 Bob Ghosio, Jr. Fax (631) 765-6641 ~1y00UNTV 0~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD To: brnl, l,r~t('hn.n~Q Please be advised that your application dated { I?~~ o~ has been reviewed by this Board at the regular meeting of _/(51 /107 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) '/z 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: BY: James F. King, President Board of Trustees i James F. King, president ~~OF $Q(~~y Town Hall Jill M. Doherty, Vice-President ~O 53095 Route 25 Peggy A Dickerson _ ,L P.O. Box 1179 Dave Bergen y 'f` Southold, New York 11971-0959 Bob Ghosio, Jr. ~ • ~O Telephone (631) 765-1892 lyC~(l~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Southold Town Board of Trustees Field Inspection/Work session Report Date/Time: ~ ~ Antony Martin on behalf of DEBRA LACHANCE requests an Administrative Permit to construct asingle-car garage on the landward side of the existing ..dwelling. Located: 630 Ruch Lane, Southold. SCTM#52-2-26 Type of area to be impacted: _X Saltwater Wetland -Freshwater Wetland -Sound -Bay Distance of proposed work to edge of above: Part of Town Code proposed work falls under: 9 _X Chapt.275 Chapt. 111-other Type of Application: Wetland -Coastal Erosion -Amendment _X_Administrative -Emergency Pre-Submission Violation Info needed: S-Fai~ Gja-~~ (oc.--1-tN./ Modifications: Conditions: N e c.> d Present Were: _J.King _J.Doherty _P.Dickerson ~Bergen_ B. Ghosio, Jr H. Cusack D. Dzenkowski -Mark Terry other Form filled out in the field by Mailed/Faxed to: Date: Enviro ental Technician n,~ „ Review~l 1,t7 tll e~h,e o...,~~1° G ~ °I ~~~e • ~U ~ r "fl.~„~ ~ S c S L4c....~_ ~/tio., vJns l.,n.+4y (ust ~c1~ ,Vl U dt1~.i -Eo {'~~1. (Z P,c,Mt+ i.. I Elrc„~~.re:Lfo~'~ C In n,-o-,,,n. j ~ non -tw f r/,l~ FIST - ~ a?Q o T 4 $ y'P •tl' +Spm~ T v ~ y JJ N _ ryV .d p y "'d .i i~ - ~V ® v..,,,, 3 . ; ' ~e ~ 9 a / 9 p O x~. ' ^ ty 5 y w.eomaa _ .f.,., O z..ui \ ? -1 2, as ~ , 4. ~ F aar~ nS ` ~ oa 5 ~ / 5. .~z~ ~ ~ - s ~ ~ ~ ~ ~ z A ~gi +q \ ~ v > i : 4'4'^ ~ aV / . i ~'OA ate. ~ a ma. ~ ~..o....~ y~ ~ a~, ~ s .o.,. ~a.,., .ou< ~iv,~ °'n as' ~ ~ ~ zy o n^~ aa.ao ' :b~ o .,c m ii, ° © o '~s e _ p~ ~~~a s a iB ~p'r 1\ ~ ~ a${ Y S C - soot ~ ~ ~ ,C ~p~ S~ ~ ~O ~ ° ` l ~j 5~ pk0 \p O J a FO I n, N eve Y 2B I (~\Q~ xtd usa aun, ~ S rv iw.T b~. C 3 \ s xL ~ o~ 3 Oy ~~:n: va sp.w. a.~°v"<: w. ~ °sa u¢w.~ ~ • vy ...e,,.,,. wm m~.v IT,m 6 ~ r c p - - xprmE COUNTY OF SUFFOLK © i ' SWiHOLO scamx xp E rz1i _ Q ~ _ fled Property iax Service Agency _ X52 E u. . [uMY ftir~ %wfeL,X v 11901 X pm. ae o.....,..-..-_ u.. ..:.e..w F IOe~ FRpFERix MM - _ - _ ei 5UR1~EY OF PROPERTY SITUATE: ARSHAMOMAQUF ~ 0 Is N TOWN: SOUTHOLD SUFFOLK COUNTY, NY { ` J a s SURVEY OI-26-2006 ~ ~ fU W ~ E UPDATE 09-OS-2006 DIM. W.M. 10-18-2006 Towa S SUFFOLK COUNTY TAX ~ Board of TroSteas 1000-52-2-26 ~TIF)®TO: Debra I.aChance ,~oaA s, ~'°,~,GS 'boy ~ ~ ,~J e~ e e ~ ~ •~J ~ ~ o bq'~ ~ ~ ~°~~`°J ,a. ~ ~~o o` o~ ~ too" ~ Uj,~pa~0 ~ b s 4~ ~ Q~ ry~ ~ "yam e~ ti h^. o o q F~ qe~e O ~ 4 O~. \ ~ \ \ ~ 44 c~~0 \ \ \ 7 ~o~Q ~ \ \ r ~ oti~°oo ~ ~ ~ ~ \ - ~ ooh ~a ~ ~ F~~ti~+ ~ ~~p~ ~ ~ ~ ~ ~ ` \ (2 ~ ~ _ ~ 1 1_ - ~ \ l ~'@ \ ~ \ / / ~ ~70~~ '~'s0,2' g~'e 0 ~q ~~~~ea~ NOTES: ~v ~w» ~ °"5:• a ~ImpW rd Yallb w~NwCbb ¦ MONUMENT FOUND a PIPE FOUND ,r` 7f q ~K` ~'~,,,°m"..~°, ELEVATIONS REFERENCE NGVD'29 ` ~ ~,v - m.v-..> a. ~ ~ ZONED R-40 `'--ctz._~Xr='.• AREA = 7,983 sf or 0.18 acres JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 GRAPHIC SCALE I = 20 RIVERHEAD, N.Y. 11901 369-8288 Fax 369-8287 REF.\\Compagserver\pros\03\03-238.pro James F. King, President O~~Of SO(/lyol Town Hall 53095 Route 25 Jill M. Doherty, Vice-President ~ ~ P.O. Box 1179 Peggy A. Dickerson ~ ~ Southold, New York 11971-0959 Dave Bergen G Q Bob enusio, Sr. ~ y0 Telephone (631) 765-1892 Fax (631)765-6641 ~'~OOUNTV p~~~ BOARD OF TOWN TRUSTEES D TOWN OF SOUTHOLD JUL 1 32001 Office Use Only Saothhold Town Coastal Erosion Permit Applicatio Beall of Tmstee~ Wetland Permit Application _ Administrative Permit _Amendment/Trans fer/Extension !Received Applicat(i'onl~7 ReceivedFee:$_~, _.3_~ 1Q~r S'~ ~ompleted Application ~ I 1 y1 D~ yp (~t(~ ~ ~ 1(~I -Incomplete P ~ P _SEQRA Classification: ~ l u h Type I_Type II_Unlisted_ ~rpfl~' Coordination:(date sent) _LWRP Consistency Assessment Form CAC Referral Sent mate of Inspection: ! O -Receipt of CAC Report: -Lead Agency Determination: -Technical Review: Public Hearing Held: C7 Resolution: Name of Applicant {7EgiQ~ L~~Y.NP~NG~i Address 630 ~vGH I~.~tv~ T Sov~t-ktt~t,~ Phone Number:( ) °~~1.6q~'3~24'" Suffolk County Tax Map Number: 1000 - ~2 ' 2 ' 2 6 Property Location: rte' 00 r T~ Q ~ y ~ ~ 4' 8 (provide LILCO Pole distance to cross streets, and location) AGENT: A~'~'~o~`^ Y`n~~t~ (If applicable) Address: 2~ PP~'LtG c~~U't'~ / ~Vt'f lei ~S ~8 N ~ 03 Phone: ~ l'y - ~'11 • ~ ~ C3 D F~d of Trustees Applicatioz~ GENERAL DATA Land Area (in square feet): 1°I gj 3 SF Area Zoning: '(Z, - 4- ~ Previous use of property: Q>r S t q G~~G ~i Intended use of property: t~~'oE W t-l-}r C~~fLSti<~~ Covenants and Restrictions: Yes ~ No If "Yes", please provide copy. Prior permits/approvals for site improvements: Agency Date 8c~~e,o of PmP~AvS r~ 2 "T ~ 200 R/f~Q o~F TZvs}~.5 ~~Q 22 , 20 OCR 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 attaclunents ifuecessary): SfJ~ f~k-tom-~ 'P~h~l G ©?~-t~yc-E-~c~N ~ ~ zING~ GPe2_ G A'~2 A ~rd of Trustees Applicati~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: G-t~2 Area of wetlands on lot: ~ g ~ square feet Percent coverage of lot: ~ Closest distance between nearest existing structure and upland edge of wetlands: (02 feet Closest distance between nearest proposed structure and upland edge of wetlands: ~ ~ ~ ~ - O" feet Does the project involve excavation or filling? No ? Yes If yes, how much material will be excavated? ~ ~ 5 cubic yards How much material will be filled? 3 • S 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 of the town that may result by reason of such proposed operations (use attachments if appropriate): NIP sn.2o • SEAR 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) 1. APPLICANT/SPONSOR 2. PROJECT NAME Q~ liAtii-1~c6JG:F~ ~O'ZJ~ 2UG1-t V~r~1~i 3.?ROJECT LOCATION: y~F~- Municipality ~U V 1 r ~V~ County ~V t"' 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent) ~laynd~m~arksr etc -or orovide map 5. IS PROPOSED ACTION : ~ New ~ Expansion {-~rlodification 1 alteration 6. DESCR4BE PROJECT BRIEFLY: I - ~ ~o,~~_~~J i Q...~~~oj~~ /~~yO/~F N~^~ s I rvG-L~ 7. AMOUNT OF LAND AFFECTED: Initially cres Ultimately L"J acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ?Yes ~ No If no, describe brieFly: ~ Pk~-A~~•~ Z or-' t ~ ~~0 oY ~PPG~LS t~~~•G^ev~^r~or-~ 9. W T IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential ~ Industrial ~ Commercial ?Agriculture ~ Park / Foresl /Open Space ~ Other (describe) 10.~DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) Yes ? No If yes, list agency name and permit /approval: 1~v1v'~1^~G i~~-t~~1 CUR Y ALI PERMIT OR APPROVAL? Yes ~No If yes, list agency name and permit /approval: 1(2~A'S A RESU T OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? tJres No I CERTIFY THAT THE INF RMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant I S o or ame Date: Signature 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 com feted b Lead Agenc ) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL FAF. Yes ~ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? I(No, a negative declaration may be superseded by another involved agency. Yes ~ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be hantlwritten, if legible) Ci. Existing air quality, surtace or groundwater quality or quantity, noise levels, existing traffc 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, fsh shellfish or wildlife species, signifcant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in ose or intensity of use of land or other natural resources? Explain bneFly: C6. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in C1-C6? Explain briefly C7. Other impacts (including changes in use of either quantity or type of energy? Explain briefly: 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 Yes ~ No E. IS THERE, OR IS THERE LIKELY TO 8E, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es ex lain: Yes ~ No _ PART III -DETERMINATION OF SIGNIFICANCE (TO be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whetherit 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 identifed and adequately addressed. If question d of part ii was checked des, tl~delerminatienet-significaneeinust-evaluatethe{3eteatial impaetef-the~prepese9aeEieR e- •'~~;renmen691 eharaeteristies of the EEA. Check this box if you have identifed one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL EAF andlor prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentatiogthal the proposed actin WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons suppoding thi determination. Name of Lead Agency Date Print or ype Name of Responsible Icer In Lead Agency Title of Responsible Offcer Signature of Responsible Officer in Lead Agency Signature of Preparer (I different from responsible officer) 10/23/2007 15:29 63368395 • PAGE 02/02 A~t.13. 2001 1:43PM,,, No, 2456 P, 1 aoaYd o£ Trustees Application AORSORIZATION (where the applicant is aot Ehe aW13er) y} I, T~~JfA. ~..A_l„~_1764__Yi/~ residing at - ~ IGI ~04~~_ ` (print owner o£ paopertY) Tma~l ngJ1actdres'~) ~roo~.iyn~, ~~~ao~ do hereby autlwri$e Rnkxeri° ~lrl~' p,,~ .L. 1 ~ (AgElit ) ~~r~i r~/r/1'It e ~,i T1~ ~ to ayyly !or permiC (s) from the Southold Hoard of Town Trustees oti my heLalE. , e~ai4nature) R~~ (e3D R~cl~l 1-O~v~~ j s 10/23/2007 15:29 3368395 • PAGE 01/02 ~~r~o~c~n wrcvran group re~af 8stdte 490 BROADWAY, NEW YORK, NY 10012 (212)941-2500 FAR TRANSMISSION 10/23/2007 To: Lauren Standish coMPANY: PAX NUMSER: 631.765.6641 TOTAL PAGES WITH COVER: 2 FROM: Debra Lachance DIRECT: 917-699-3724 PAX: E MAIL: dla aQCORCORAN.COM MESSAGE: Lauren, Attached is the Board of Trustees Application. Best, Debra Lachance ~rd of Trustees Applicati• AUTfiORI2ATION (,whQere t~Ihe applicant is not the yowner~) I, ~CrJJK-TL CHfI^~c,~ residing at t~ - _ `~J ~ ~r (print owner of property) (mailing address) ~Od ~ }L ti ~ ~ ( do hereby authorize ~N-~7N`~ Y~YI~}rr~1 ~~o b~~~ ~a,aCv~ ~7GS~c-~~ Zara P~-~ A-J~ S~'f'1t (Agent) S`~~'t~ 15~a to apply for permit(s) from the N~ ~ti1~ ~OpO?j Southold Soard of Town Trustees on my behalf. (Owner's ign ure) 8 Board of Trustees Application County of Sle• /U State of New York `'~r~ ~L ~ y 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 REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY INSPECT THE PREMISES IN CONJUNCTION WITH RE W OF THIS AP L CATION. 4'~-'~~ Signature SWORN TO BEFORE ME THIS ~O DAY OF ~U~ ~ ,2007 az_ No. o+ ota ubli 6,4rwuo.•+o APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE, FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the Dart of town officers and employees The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. _ YOUR NAME: b~.~QA tiPrG~>`~^y~~ (Last name, first name, rlaiddle initial, unless you aze applying id 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 Building - Variance Trustee Change ofZone Coastal Erosion _ Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other", name the activiTyJ Do you personally (or through your company, spouse, sibling, parent, or child) have a relatonship 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 Southold Title or position of that person Describe the relationship between yourself (the applicant/agentlrepresentative) and the town officer or employee. Either check [he 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 applicant (when the applicant is a corporation); B) the legal or beneficial owner of any interest in anon-corporate entity (when [he applicant is not a corporation); C) an officer, director, partner, or employee of the applicant; or D) the actual applicant. - DESCRIPTION OP RELATIONSHIP Submitted this r~ day of 200 ~ ~ „ 5(h~ Signature Gam. C ~G~ _ Print Name tL fvric.<i Form TS ] p ~~[~Od~ D J U L 1 7 2007 Soothhold Town Board of Trustees David Howell Design 200 Park Avenue South, Suite 1518 New York, NY 10003 July 16, 2007 To: Trustess Town of Southold Reference: Debra Lachance property 630 Ruch Lane, Section 52 Block 2 Lot 26 Dear Sir or Madam, Please find enclosed application fee for the administrafive permit for the above referenced property. Please note package was forwarded and received by your office July 13. If you have any question please call me at 212.477.7700. Regards, Antony P. Martin