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Home My WebLink AboutTR-6737A 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 SOUTH OLD CERTIFICATE OF COMPLIANCE # 0295C Date February L 2008 THIS CERTIFIES that the partial removal of chain-link fence and removal of bomb shelter and debris At 5775 West Mill Rd.. Mattituck Suffolk County Tax Map # 106-6-3 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 10/5/07 pursuant to which Trustees Wetland Permit #6737 A Dated 10/17/07 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 partial removal of the chain-link fence and removal of bomb shelter and debris. The certificate is issued to GLEBE ASSOC. owner of the aforesaid property. rf/~ 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 TO: <'Olo({)P (J~-, Please be advised that your application dated 'O/S-.701 has been reviewed by this Board at the regular meeting of /(',.fIl/07 and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1st Day of Construction ($50.00) y, 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 South old 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: $ 5t),OD 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 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 1 st day of construction Y, constructed / Project complete, compliance inspection. ~ ~ \f) \J ~ N 'J ~ ~ .......... -...Sl ~ '-Sl ~ ~ ~ ~ J ~ fj II If ,--r .J--/'IN rYI' " ~/< < "". , " ." a't)tP 'jI.")' ~.~ 1- VA .A -::A c. <; , " ~ "". '.. "0 . \\-1 ,.0' ~. v \0\ .:b\~1:4 0' -<" o0{4 c,'+- (" ,~-.) ~o' /./ o. \" *"~\\ ~f,\ \~. \0\ el'- 0\ (;}.~ 0.... 'O-~ . ",. .",0(" ..." / 9.\'" c..:) v:f~~cl"o. 01 >(-.0 ". .... 1:'>0 .'!.~r:. ", ~,o . , < . ~ , \ \ \'~ ~ IE ~ J~ J_~_l::' ~\ \ \ ,\ r ;- \,\\ \ "L-su",,'I,,;; \ E~:',~~~'~~; \..- ATTlrUCK OF SOUT,..Ol.O OLI( COUNTY. ,..[W TOA!l; ''St.I 11[1 FO~ ~, LIAM S0SC:;LA .:R a. DOROTHY A.t30SCOLA " " TO . StJF /) ." \\ ,. ',' ~ -,F:::j- ~ ~ A O"t,l( SGAr..( 00 .,lAl'IU""" ), 19.~ I~. 40' ...107'1 .~... ,,,,,11_11.. "'1..'_~.1I.""''' 'II ...., 1....1 ,...'O\U'".,'UC"lI" .rn...... .too _...,.....cU.lI...... _<,... o)~ ..... h.."..o' ,....... __I ,a., ....<t Oil' '..".... )01.001110 M", I..~. 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Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6737A Date of Receipt of Application: October 5, 2007 Applicant: Glebe Assoc. SCTM#: 106-6-3 Project Location: 5775 West Mill Rd., Mattituck Date of Resolutionllssuance: October 17, 2007 Date of Expiration: October 17, 2009 Reviewed by: Board of Trustees Project Description: To partially remove the existing chain-link fence and to remove the bomb shelter and debris. 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 in the application received on October 5, 2007. Conditions: None 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. ~&7~ Jamet: ~ing, Presi~e? Board of Trustees '--- 12.1.." _... ..........,,". -.....,.. .. ,,"",," - - L"') -~ 10:> -. )~ .P,RllI'E/IU._-IUIi'~ ' L ......', .~,... E_.,,-_ ~ -'''"'''''~ N"'...'.... 0-- + 1211 o '::;,'" ",::'" ,.i'''"~~.o.:~ ""'" -----.l.-- ;E... ,.. " ,,""". ~:;" ~~';~ """"",., ~".c" W:~.Ntl."'" - ",,,,"__~__......i \ ...-SR...,.... ""Cl<----zz- ---L I I + . ......,t '" Ii II Ji-IV. ~" i' iid 1, U., "I 11 ' ''',5 1\ \' -N- --"" "j",,, l3.< "..,,'" ,., >S''''<' @ , ~i '-. " R", ~ I I 11 'I 1 I '..,.; o 1.~:,) " ""r<1 '" l.U,,, " J.,.,,) .., ,....,c> .., ""'" ''''T''''''''.Ol'ER>T''''.'''''''' O<T'""""""""""'."'H """'[(JuW T"..." "","",rm ~'",", -."'. "''''".>< '" ". _'''''''''''''''''''''',,[,,[,,:1 (i) COUNTY OF SUFFOLK @ Rea Property Tox Serv1ce Agency :~c.ntor~NYWOl " ,""".''''w SECTION NO 106 1000 PROF'!'RTYM.IP . . T6(p/'1oFSo....u.oIJ , James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghusio, Jr. Town Han 53095 Route 25 P.O. Box 1179 Southold, N ew York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application ...............Administrative Permit _Amendment/Transfer/Extension _Received Application: ~ceived Fee:$ !:P - p~ (b~ l-... la g 0 'J _ ...eDmpleted Application /1) ~/ 'OJ _Incomplete _SEQRA Classification: Type I_Type I1_Unlisted_ _ Coordination:( date sent) _ L WRP Consistency Assessment Form CAC Referral Sent: Aate of Inspection: If) /I 01 'tiC) _Receipt of CAC Report: ' _Lead Agency Determination:~ ~ Technical Review: ,. JJ ~ublic Hearing Held: I U //'1 J( . _Resolution: ~ rE ~ ..rE ..~ W ~ Jm I: G ;r1'''I7 ,; I.' I . ~/' --~-/ SCEti1Qld TO'iiJl Board of Trustees Name of Applicant 6 L.tl> 'i.. ~scr l ~\'i..s Address \D blLtPn- UiCLl:. en. St~ \~.Pi 1\'165 Phone Number:ct.3~ :.;.l tt~ -'Q)C(;D Suffolk County Tax Map Number: 1000 - /Oh - fI!J -:3 Property Location: SllS \..U. t'v\\\...L 'U> .\ U\\'v\-rrrroc.t ~l \ qs ~ ) (provide LILCO Pole #, distance to cross streets, and location) AGENT: N ~ ~ (If applicable) , Address: Phone: ~Board of Trustees APPlicAllbn . GENERAL DATA Land Area (in square feet): Area Zoning: Previous use of property: ~ ~.tA-J Intended use of property: "FIi.'t.uX:XD ~. 'Sl1"L ~ 'l'I"A-'ti1mu.L SAtJ ~~ uxY'IP~ I Covenants and Restrictions: If "Yes", please provide copy. Yes "- No Prior permits/approvals for site improvements: Agency Date ~ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or susp~ded by a governmental agency? No Yes If yes, provide explanation: Project Description (use attachments ifnecessary): ~\\I).L ~'t.N'OJA L ~~ ~l~\\J\Jb D-l.or q\) UN \L pt}.:L ~. V:t:JY\tN~ L Q)I;- ?Q..'t.\[\OQ~ OJ::t0"tt') SJ~, ~ S{'cCi"ie f'rtvD 4It Board of Trustees APPli~on WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose ofthe proposed operations: Ib <:'Lt.A/....) l P M'tSS ~ ~ W~lOU.s ~~ . Ib ~e.~'L St"T"L 'r-E:lc... \ , ~ll.~ 3rl.Q~ -r~-m\\X.1L s,.At-f~ cur.p~ Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance betw~n nearest proposed structure and upland edge of wetlands: '" ~ feet , Does the project involve excavation or filling? 'i. No Yes If yes, how much material will be excavated? 1i~~ , cubic yards How much material will be filled? H\-f! cubic yards Depth of which material will be removed or deposited: l4~A- feet Proposed slope throughout the area of operations: r L~ Manner in which material will be removed or deposited: \{ \~ Statement of tile effect, if any, on the wetlill1ds and tidal waters ofthe town that may res~Itby reason of such proposed operations (use attachments if appropriate): N.o~ \... PROJECT 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) SEQR PART 1 - PROJECT INFORMATION 1.Ab~;~SP~~\~~ 2. PROJECT NAME yux"tL~ \~I..\WCL 3PROJECT LOCATION: ,- SIlS w. fN.LL U> \~.N.I..\ County 'Su:foL-\.L Municipality 4. PRECiSE LOCATION: Street Addess and Road Intersections, Prominent landmarks elc - or provide map 5. is PROPOSED ACTION: D New D Expansion ~MOdifjCatjOn I alteration 6. DESCRIBE PROJECT BRIEFLY: ~-i\L U1nO\lAL cr t.l)(. \ So ",\1\.\-6 CMfhN ClNIL ~~'i , ~ 'r..i'I'COA-L ey;. ?e.. t.\f l ros ~U~ ~ '&\.'t.cnL + OlUA <; I 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~Yes o No If no, describe briefly: 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) o Residential D Industrial ~commerCial DAgricu,ture D Park I Forest I Open Space ~ther (describe) 10.' DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMA TEL Y FROM ANY OTHER GOVERNMENTAL AGENCY (]gral' State or Local) DYes No If yes, list agency name and permit I approval: . 11. UUtS AN' I ASPtC I Of IHE m.d IV," HAVE7\--cuRRENTLY VALlDPERMIT OR APPROVAL? .------ DYes fjiNO If yes, list agency name and permit I approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION? Ges DNo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant I Sponsor Name 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 comDleted bv Lead Aoencv) 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 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. DYes DNa C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, jf legible) C1. Existing air quality, suriace 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 . J 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 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: I I D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? (If yes, explain briefly: I DYes D No I E. IS THERE. OR IS THERE LIKELY TO BE. CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes ex~lain: I DYes 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 yes,tn&-Getefrniflation of siQniflGaHGe-mtJ8.t.evaluate-t/lef>eremiaHFfli*l6t-ef-tAe-proposed actieft-ef-l-tAe-eftiffiftffiefttal-eharacteristk,,s of tile CCA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL EAF and/or prepare a positive declaration. Check fhTsboxIfyoLd,ave-delermmed,basedon-OieInformation and analysis above and any supporting documentation, thaiihe-proposed' acilo-. 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 Pre parer (If different from responsible officer) . . Board of Trustees Application County of Suffolk State of New York ~ ?"t..?'L 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 HlSIHER 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 WITH REVIEW OF THIS APPLICATION. ~A \\.?"L Signature SWORN TO BEFORE ME THIS ~ DAY OF 0Mo6er ,20.fLL ~ ;? "177 " .LJ.u1lCtu t- o ary Public LAUREN M, STANDISH Notary Public, State of New \\)rk Nc.OlST6164008 Qualified in Suffolk County Commission Expires April 9, 20-/-1- . . APPLICANT/AGENTIREPRESENTATlVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics orohibits conflicts of interest on the Dart of town officers and emolovees. The Durnase of this fonn is to orovide information which can alert the town of oossibJe conflicts of interest and allow it to take whatever action is necessarY to avoid same. b\..'iJ.;,'t. YOUR NAME: ~S~\Pr~~ (Last name, first name, .qtiddle initial, unless you are applying in the name of someone else or other entity, such as a company. lfso, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If "Other", naJTIe 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 South old? "Relationship" includes by blood, marriage, or business interest "Business interesf~ 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 x 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/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) andlor 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 appliqmt (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, partner, or employee of the applicant; or _D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I SUbmitt~daY~ Si~nature . ~ ~ PrlOt Name t.. 200