HomeMy WebLinkAboutTR-6736A
.
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.
L
INSPECTION SCHEDULE
Pre-construction, hay bale line
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.: 6736A
Date of Receipt of Application: September 19, 2007
Applicant: Mark Melillo
SCTM#: 90-4-21
Project Location: 685 Oakwood Court, South old
Date of Resolution/Issuance: October 17, 2007
Date of Expiration: October 17, 2009
Reviewed by: Trustee Dave Bergen
Project Description: Trim the phragmites to 3' from the ground.
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 Mark Melillo, and received on September 19, 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 South old Town Code, a
Wetland Permit will be required.
This is not a determination from any other agency.
~5?'~
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
October 17, 2007
Mr. Mark Melillo
100 Indian Hill Road
Wilton, CT 06897
RE: 685 OAKWOOD COURT, SOUTH OLD
SCTM# 90-4-21
Dear Mr. Melillo:
The following action was taken at the Southold Town Board of Trustees regular meeting
held on Wednesday, October 17, 2007:
RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a
Transfer of Permit #8-88-90-4-21 from Robert E. Mitchell to Mark Melillo, as issued on
December 2,1988.
If you have any questions, please contact our office at (631) 765-1892.
Sincerely,
~~~
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: (()ez. k:. !Vle_l;JI,o
Please be advised that your application dated So~be. I ~ d2oo; has
been reviewed by this Board at the regular meetinFof ......Gt.-k)lc,~ 17 ::X07
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)
~ Constructed ($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:
c-.o ~
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 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 Inspection/Work session Report
Date/Time: I c3(1 ~ (0 7 ? r""
MARK MELILLO requests an Administrative Permit to trim the phragmites to
3' from the ground, and to Transfer Permit #8-88-90-4-21 from Robert E.
Mitchell to Mark Melillo, as issued on December 2,1988. Located: 685
Oakwood Court, Southold. SCTM#90-4-21
Tv.oe of area to be impacted:
~Saltwater Wetland _Freshwater Wetland _Sound _Bay
Distance of proposed work to edge of above:
PavofTown Code proposed work falls under:
jfChapt.275 _ Chapt. III _other
Type of Application: _ W etland _Coastal Erosion _Amendment VAdministrative
_Emergency _Pre-Submission _Violation _Planning
Info needed:
Modifications:
Conditions: C..,-t- ~ i.e.,! -/-"" -3~ d~.....+ c.~.f 6...e<~...,..,<,
Present Were: _J.King _J.Doherty _P.Dickerson h. Bergen_ B. Ghosio, Jr
_H. Cusack_ D. Dzenkowski _Mark Terry_other
Form filled out in the field by
Mailed/Faxed to:
Date:
Environmental Technician
Review Curt <rn.~ j>~al"J"""ckJ) ooi E4((J,.,anJ
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A-4831
Town of Southold
Suffolk County, NY
lAST NAME (DEFENDANT}
V'Yl ~ l-I L.LO
STREET ADDRESS
I ()O ItJD/.4tJ
e,1Y,., 1i
iN / {;. ON
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The People of the State of New York vs.
FIRSTNAIvIE
VIA jQ IZll
H/LC to.
STATE
c..r
LICENSE OR REGISTRATION NUMBER
MIODI..EINITlAL
5
APT. NO.
O(xt17
THE OPERATOR OR REGISTERED OWNER OF VEHICLE DESCRIBED BE[
PLATE NO.
DATE EXPIRES
STATE
o N.Y. 0 N.J, 0 N.Y, 0 N.J. 0
PLATETVPE
o PASS OCOMM D
D CADILLAC
D PLYM
D
D OUS D Me,
D VAN D
D BUICK D CHEV
D FORD D OLDS
D TOYOTA D YOlKS
BODY D ,oe D ADe
1Y" D TRUCK D TRAILER
VlNNUM8ER
D
D
DODGE
PONTIAC
VEHICLE MAKE
o s.w.
~
<; +- rhfz. , /or ''''5
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TMJI;~~ra~~i=r. r'
PARKING SCHEDULED FINE $
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;-rll~1~h
CONTACT COURT 0
daled
THE PERSON OESCRIBEO ABOVE IS SUMMONED TO APPEAR AT
SOUTHOLO TOWN JUSTICE COURT, 53095 ROUTE 25, SOUTHOLD, NY 11911
ON
dg ':Tt5':~cr:~r
AT
~"'O
CJe.
FALSE 5T'" TEMENTS HEREIN ARE PUNISHABLE AS A CLASS A MISDEMEANOR PURSUANT TO SECTION 21 0,45 OF THE Pol, N,Y.S
eOMJl !L ~
DATE
07.
BADGE!/Y1
11'(-'
,..,....TTT"llr'T1
,,^T1V
.
SUPPLEMENTARY
INCIDENT REPORT
I Of I
o
Southold Town Police Department
Route 25
Pecan ie, New York 11958
631-765-2600
Incident Report No.'s
Cll- (;'1:[3
Page
Pages
Narrative: (Print or Type Only)
UPOIJ
f"-19 T1fN
\.(. rr1EL/ /.LO
7~5- "831:
j,C() \.JtCTCtS C\ 11,
~A 1.{8?J1 ,
S\.ivYl M/i>tJ ON
i IV &- fffv 1l.l.C - ~ wn-~ fl. /.Jf..)(-
AIG OM .,.- o<F- ,~ t;
Sign
2 First
N
/ ~~
3 Rank: B.
4DatetJ7 1)5" 10
5 T;melDlf5""
1 Name: last
"
R FOR OFFICE USE ONLY K - Report to be Resubmitted
~ E INCIDENT A - Under Inv: F - Ref. to Chiefs Office:
p B - Cleared by Inv: G - Ref. to Chief of Operations Reason:
0 STATUS
R CODe C - Cleared by Arrest H - Ref. to Traffic Div.
e - File L - Other
T I - Ref. to Det. Div
E. Incident Unfounded J - Ref. to Youth Div.
s
T Date: _1_1- Forward Copy to:
A Status Code Reviewing Officer
T 1 2 3 4
U - -
s Signature Rank Time Hrs.
PDTS-2A
.
James F. King, President
Jill M. Doherty, Vice~PTesident
Peggy A. Dickerson
Dave Bergen
Bob Ghos io, Jr.
.
~~'Ur SOd~~-' .
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?',fCOUNTi.,'I<-&
Town Hall
53095 Rout~ 25
P.O. Box 1179
Southold, New York 1197HJ959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Southold Town Board of Trustees
Field InspectionlW orksession Report
llll(01
Date/Time:
Name of Applicant -1'1tff k- Vlte I. II 0
Name of Agent:
Property Location: SCTM# & Street
Brief Description of proposed action:
Type of area to be impacted:
_Saltwater Wetland _Freshwater Wetland _Sound Front _Bay Front
Distance of proposed work to edge of above:
Part of Town Code proposed work falls under:
_ChaptW _ Chapt ~ _other
;ns )J )
Type of Application: _ Wetland _Coastal Erosion _ Amendment _Administrative
_Emergency
Info needed:
Modifications:
q::::[o",+ \.5
::r~+ S~i
b'l- 2.D
F>lo..+ -
re.~
Conditions:
~+C(A
~ <L<>>..- i, IS -
Present Were: 0King v{Doherty _~ickerson ~Bergen
Other: /
,
/
L,/Bob Ghosio, Jr.
MailedJFaxed to
Date:
Comments of Environmental Technician:
I .
THIS PERMIT IS CQrjDt
PAINTS EXCEPT WHE
~.
,
,
.
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--
COSTELLO MARINE CONTKACIlNG COIlPORATION
DOCK BUILDING · JElTIES · BULKHEADlNG · STEELlrWOOO PIUNG . FOUNDATIONS
BOX AI( . GREENPORT.IIIEW YORK 11944 . 151. 477-1118 . 151. 477-1383
January 6, 1989
Frank Kujawski, Jr., President
Board of Trustees
Town of Southold
Main Road
Southold, NY 11971
Re: Robert E. Mitchell
Application 1646
Dear Mr. Kujawski:
In accordance with the conditions of the permit for the above ref-
erenced, we would 1 ike to notify you that the construction of the
project has been COIIpleted.
If you have any questions, please feel free to call our office.
Very truly yours,
~ t:.~_
Susan E. Long ~
Permit Manager
cc: Robert J. Mitchell~
.
-
. New York State Detment of Environmental conselion
15:;~:'~79:"'..... -- -7 ,,,..
CF.J:i:ito j'J'ku.-M-.-
l () (?;v/f K
.J;i-':~~( 'f II 'ivy
AMENDMENT TO PERMIT
~
......
~
Former Permit' (if "oy):
Thomas C. JorIlr
Commissioner
~/91/J;:~
..-
RE: permit- NO,u;&-J.Qcatioo: /0 -S>9'~/'IOb
~(kd:- 11tCIck.d/
~~~7'1010
--. Your recent request to extend the above permit has (feen reviewed
pursuant to 6NYCRR. Part 621. It has been determined thaij there has not
been a material change in environmental conditions. relevqnt technology or
appUcable law or regulations since the issuance of the e:Usting permit;
the:efore. the expiration date is extended to
~~5'" Your recent request to modify the above permit has (leen reviewed
pursuant to 6NYCRR. Part 621. It has been determined tha~ the proposed
modifications will not substantially change the scope of ~he permitted
ac:ibns or the existing permit conditions.
The:efore. the permit is amended to authorize:
'.j),,-~ . ()- ~ ~r"-rL __
{C'Y/b ')%t;~.f' --~ ~ ~ ''Y'()!3-Q.
a'1~/J~<;~.b-'(j;J-~ddc cg-.. J~1J'Y
Thi3 letter is an amendment to the original permit and assllch. shall be
pos:ed at the job site.
All other teras and conditions reJllain as written in the 0'\191na1 permit.
Very truly yours.
C.l~~ d' c---'-ta~r~
Deputy Regional Perm;t Administrator
Sent to:
f1fI1J1P
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24CHi1 IEI'9I A\'DIE
trI Q 'ISI'ClN, NY U3ll3
CORPS OF ENGINEERS DATA
:::
PVJ\I'OIII: (;outruct Ibed 0"0 ".l_y, hinged
"..p, .nd UoeUIllI dock ......red by two t-.oU.
dolphJ.... tor prJv.t. .....,...U_l JIIU_. "
1I&7WI: _
.: SANDPIPtR BASIN. CJDAa BEACR CR&IK
T: CaD.u, ar...::JI. 'I'-. .. .............
0CIIIft ., Mnot.K ftAft, ....._
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of. 4f-O",
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BV I'fll5lIW. '., ' .................
?/11ta - ?~. llIIUUNl11l POl/a>
J. E. PJPUuo. .It.
PROJECT lP~4I'olN'
i(
AppUeaUon Ro.
,--rdllll1 the pr_';lY lot
ROBERT E. MI~~".LL
SlIllolk County tax Map 10. tOOO~Bo-.~21
i
"pr._t.. .., .. '
Prop_~-r .-."t,f'~.s,c:",_
P.o. .... In. Cute......... oj'''' UUI
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CORPS OF ENGZHEERS DATA
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PLAN AND .ECT~ON VZENa
l'VIlPOU: ~tJ'llCt 1.1....., _ ....u...y. Ia1IIg.d
rup, elld tJOIlUIIlI 40cll "CIU'ec1 by two t_pUe
401pIl1.... for privete recr"U_l ""'-. '. .
IIA'I'UII: HIM
': SANDPIPER BASIN, CEIIAII BEACH CIlUIt
.: CtDAR BUCH. TOIlII Or SCIUTIIDU
lIIIn or, surFOLK BTAn: NEIf YOU
Appl1caU_ 110.
hvard111g tile property of
ROBERT E. MZTCHELL
sult01ll: County 1'... llep 110. Jooo-8O-.-21
..pr.....ted by
ProP_r_r ._rv~c__
P.O. - In. Clatc:hog... NY unl
~...~E. rl~&g.r.ld, ~r. 811-73..1.00
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(211
^KJTlCE
(i COUNTY OF SUFFOLK @
Red Property ToxServlce Agency
,...,1yl:ool...- Rtv"'~NYm.1l
. '.. ,''"''" rE"", '"
!1-tTI,:. SOUTHOlO
'I ""'_olI 1000
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stemm NO
090
PROP(RTYr.w>
----l
.'
.
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob fjnosio, 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
_Coastal Erosion Permit Application
_ We!land Permit Application ~ Administrative Permit
AmendmentJTra~fp?(E(')tl(ltsion
"""Received Application:~
~eceivedFee:$~
~ompletedApplication~
_Incomplete
_SEQRA Classification:
Type I_Type II_Unlisted_
_ Coordination:( date sent)
_LWRP Consistency Assessment Form
CAC Referral Sent:
-Bate ofInspection:~
_Receipt ofCAC Report:
_Lead Agency Determination:_
Technical Review:
/'Public Hearing Heid:~l:JJ I )f'(fJ
Resolution:
Office Use Only
R:~\,',
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Address 6 ff:' ()t7 J-hJ, VlL"~ fluu-z.r
""''''~: lao X~,";'.J I-/,LLR."V.
w . '-Tlr'<\ . C r 01" F-17 Phone Number:(b3I)
,
Name of Applicant~
.flu ~ -.1:) IVV
I J
II 'f} I
'Ur-R~;;L7
u e,sL'- i'".j-Z"j'U-7L
Suffolk County Tax Map Number: 1000 - 10. 0 <I ,
Property Location: b 8 s ()a k: ,-,), 'i> 0. e. <v<-:.-
.
02-(
J],Jt:.." '" if? 7 (
CC.fLr g<"~LJ. ~'e& a..",( P....h 11"-'(/11....;;.0.
(provide LILCO Pole #, distance to cross streets, and location)
AGENT:. .
(If applicable)
Address:
Phone:
. Board of Trustees APPliCeon
GENERAL DATA
Land Area (in square feet): ~/q, <UN' I~ ~,. PI.
Area Zoning: ~~'divh~
Previous use of property: Z >"f.-A-,.--/
il, <fltf <;:) 4.
Intended use of property: I<. ~s ,<h~ ,c12
Covenants and Restrictions:
If "Yes", please provide copy.
Yes
./
No
Prior permits/approvals for site improvements:
Agency
,Jay Inw.-. .l( ~
\
- ~ct.-~ ,t\tl
Date
- B'h' {" 4-
O/JJ~ckf
~ 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):
I (L~..;'"it .~ [he", ",ks
V ' J
-k 3,~.ko..... 5" ""f) .
~ Board of Trustees APPli1ltion
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: --r4",,.,,'-y ~ S~r,d;h.<- PA/h.JMrkr::.
lL~\I'l(f p\-n,.J":'~-f /JifHuw ')..Cil,J,~J 'fl.... IZ.,,,I-,tr
Jol/t..- I< J:, F'Nn~-k N. r.,~Q (jru..HL fLv.IL (.<--\u;V-M<'...;7 --f~~.!;;.
Area of wetlands on lot: V\. o/.J.
square feet
Percent coverage oflot: ,03
%
Closest distance between nearest existing structure and upland
edge of wetlands: .r'~ lot feet
Closest distance between nearest proposed structure and upland
edge of wetlands: tJl4- feet
Does the project involve excavation or filling?
,/
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:
IL.;'''' M,.VCj.. -h.
U
o.Pf('o""~ ~ 4~ JJ.-.. J""""'''\)'
Statement of the effect, if any, on the wetlands and tidal waters of ti1c town thatfilaj' re_s\llt by
reason of such proposed operations (use attachments if appropriate):
NO 6ffte,r .;., IMli"~ ~i:h-...r/''AL4.rc"R, trllVl-'1;!) <1 pl"rc'j.-',h
e.,.p.:(,;k.l ~ I.u- p<>s>ArE,; (1,,-,,,.:'1 t',t.JI-Cf'cI j'r~. --;r~'(j
.\-" C\ff.-"":""'~+I. ,", J:zl! L~)
PROJECT ID NUMBER
617.2_
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
SEQR
PART 1. PROJECT INFORMATION
1. APPLICANT I SPONSOR
lY\..rk M eI i\ ~
3.PROJECT LOCATION:
'-r~I,..v...,
Municipality 5i)~~
4. PRECISE LOCATION: Street Addess and Road
/of:)" o".J<; >,,''''.0 ~"Ii
S'~~'ccQ Iv
/
S,.. ).
County .........
(I::'
5. IS PROPOSED ACTION:
"e, 7 (
o New
Intersections. Prominent
(C.'('T "E.-_.L ~
landmarks ete - or provide map
D Expansion
IZ.l Modification I alteration
6. OESCRIBE PROJECT BRIEFLY:
Tf,...,,.J(j 1 sk,...l.1Ml ?kc'dU.:hc< ~~""\J '-iL<.- 8rz,":'~ O'I~.
Q v,,)L 1<;., k e... L.-"",,- <.!'<>~- IhJl- r.,A."".."",...... .f u<Jk.h.
(). Q
O-ff,"'6'....~ 6.(;J. ..t?""'-~rc"""J) i.81ki..
Pr,\-u,<(j-
T..-,'>v-t:'(J
7. AMOUNT OF LAND AFFECTED:
Initially f" Ok)l. acres Ultimately iJl acres
6. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
~Yes 0 No !f no, describe briefly:
9 WHAT IS PRESENT LAND USE IN VICINITY
~ Residential D Industrial D Commercial
OF PROJECT? (Choose as many as apply.)
DAgriculture 0 Park / Forest I Open Space
o Other (describe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal, State or Local)
~ Yes D No If yes, list agency name and permit I approval:
Sc",dL,uQ '&x.rcP //t.UJrk.<S
TT.-uut:.::s
DYes
ANY ASPECI Ul- lHE ACTION HAVe A CURREN1LY VALID PERMit-OR APPROVAL?"-
~o If yes, list agency name and permit I approval:
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION?
[]v es No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Signature
Date:
Applicant
13/ J,c'C7
Ifthe 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 eomDleted bv Lead Aoenev\
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 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:
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 tenn, short term, cumulative, or other effects not identified in C1-C5? Explain briefly:
I I
C7. Other imoacts (including changes in use of either quantity or tyoe of energy? Explain briefly:
r I
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT DF A CRITICAL
ENVIRONMENTAL AREA (CEA)? (If yes, explain briefly: I
DYes 0 No I
E. IS THERE, OR IS THERE LIKELY TO BE, CONTRDVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain I
DYes ONO 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
)'e!i, the determinatien efE:ignifiGanss must-evak:late-the-polential-impaet-oftho [3fO[3osed actiefloR tRe cfI\ifenmental cnaraetertsties-ofthe6CA.
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.
Chec-kTfils-boXTfyoiThave-determTneif, bisea-on-flielnformation and-analysis above and- any suPportinfi documentation, ihifthe-proposed ac"Uo
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 Onlcer In Lead Agency
Title of Responsible Officer
Signature of Responsible Officer In Lead Agency
Signature of Preparer (If different from responsible officer)
.
.
Board of Trustees Application
County of Suffolk
State of New York
~ (\\.\;\\0 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 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
REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION TH REVIEW OF THIS APPLICATION.
SWORN TO BEFORE ME THIS /7 tjj;. DAY OF C;~,20{J+
tl::::!- ~
FLORENCE R CARBONE
Notary Public, Connecticut
County of Fairfield
Ion 1. 12
:
.
.
APPLICANT/AGENTntEPRESENTATlVE
TRANSACTIONAL DISCLOSURE FORM
The Town of South old's Code of Ethics orohibits conflicts of interest on the Dart of town officers and emolovees. The Duroose of
this form is to orovide information which can alert the town ofoossible conflicts of interest and allow it to take whatever action is
necessarv to avoid same. .
YOUR NAME:
Mk.. S:.
(Last nam . first name.l1liddle initial, unless you are applying in the name of
someone else or other entity, such as a company. If sa, 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 II. L_ r? . ;)_
(If "Other'" name the activity.) ~~~I\,l';-;I~L ~.....--.1\ - Sk..n0~ 4--r,~~
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, 11larriage, 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,
Building
Trustee
Coastal Erosion
Mooring
Planning
YES
NO
./
If you answered "YES", complete the balance ofthis 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 yoursetf(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<;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
. b'ifu:-
S~bmitte~s ~a~ Iho. 1<6"'" 200 L
S 'gnature. 0
Print Name \1'\..<1<' r<I~l\\\"
Fonn TS I
.
.
June 23,2007
Mark S. Melillo
685 Oakwood Court
Southold, NY 11971
631-765-8329
~\~ J~N ~: :nJ~ ~
Southold Town
BNlrd of Trustees
Board of Southold Town Trustees
Southold, NY 11971
Town Trustees,
On May 11,2007, I purchased a home at the above address. I found at the closing, that
the Dock was not transferred over to my name. Attached is Dock Permit Certificate with
a prior owner's name of Robert Mitchell. I would appreciate this dock being changed
over to myself, Mark S. Melillo.
Attached is the $50. Processing fee.
.T~~
,j~J
Mark S. Melillo