HomeMy WebLinkAboutTR-1140Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO, ..?!...4..,0. ....................
DATE: .... l~a~
ISSUED TO ............... Da.v, id...Ackex:man ................. :.~. ................................................
Aut'hnrizatian
Pursuant to the provisions of Chapter 615 of the Laws of
· the State of New York, 1893; and Chapter40~ of the Laws of the
State of New York 1952; and the Southold Town Ordinance en-
titled "REGULATING AND THE PLACING OF OBSTRUCTIONS~
IN AND ON TOWN WATERS AND PUBLIC LANDS and fha
'REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" and in accordance wlfh the
Resolution of The Board adopted at a meeting held on
19-/..6..: ...... and in consideration of the sum of $_!..i_5..,.Q.0....:... paid by
. Rochelle Place ,.,
ot ...~[at~..~c~ ........ ~ ............................................ .~' Y- and subject to the
Terms and Condlhons listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the following:
PermiSsion to add four (4) pilings to existing
dock at James Creek, Mattituck, N.Y., directly
in front of applicant's property at Rochelle
Place..
all in accordance with the c~taiJed specifications as presented in
the originating application.
IN WITNESS WHEREO'F, The said Board of Trustees h~re-
by causes its Corporate Seal to be affixed, and these presents
be subscribed by a majority of the said Board as of this date.
(./ I'rustees
TERMS and CONDITIONS
The Permlttee
residing at N.Y. aa
part of the consideration for the issuance of the Permit does understand and ptascribe to the fol-
lowing:
1. That the said Board of Trustees and the Town of Southold are released from any ami
aU d~mages, or el~im~ for damage$~ of glit$ ari~illg dit'~y or indir~;tly
ation performed pur~mnt to this permit,' and the said Permittee wiU, at hi~ ot her own e~peme,
defend any and all such suits initiated by third parties, and the said Petmlttee as$nm~
with respect thereto, to the complete exdnsinn of the Board of Trustees of the Town of 5outhold
2. That thi~ Permit is valid for a period of mos. which is comidered to be the
estimated time required t~ complete the woxk involved, but should dr~-,~r~ces warrant, request
for an extension may be made to the Board at a later date.
3. That thi, Permit should .be retained indefinitely, or as long as the said Permitme wish~
to maintain the structure or project involved, to provide evidence to anyone concerned that an~h-
orization was originally obtained.
4. That the work involved will be subject to the inspection and approval of the Board or
its agents, and non-compllance with the provisions of the origlmzting application, may be _~,,~ for
revocation of this Permit by resolution of the said Board.
5. That there will be nO ,,nreasonable interference with navigation as a result of the work
herein aUthorized.
6. That there shall be no interference with the right of the public to pass and repass along
the beach between high and low water marks.
7. That if future operations of the Town of Southold require the removal and/or alterations
in the location of the work herein authorized, or if, in the opinlon of the Board of Trustees, tim
work shall cause nnreasonable obstruoaon to free navigation, the said Permittee will be required,
upon due notice, to remove or alter thi~ work or project herein stated without expenses to the Town
of Southold.
8. That the said Board will be notified by the Permittee ot the completion of the work auth-
orlzed.
9. That the Permittee will obtain all other permits and consents that may be required suP'
plemental to this permit which may be subject to revoke upon failure to old-in same.
Rev. el?2
BOARD OF TOWN TRUSTEES
Town Of Southold
Main Road
Southold, New York 11971
APPLICATION FOR FIXED and/or FLOATING DOCKS
1.
Applicant's
an~
address:
n~e
2. Contractor's name and ~dress: ....... ~.~. ...... ~.~..~.~.~.~. ................................................
3. Briefly explain the purpose of this application: .............. ~ .................. ~¢ ....................................
................ DD 9-
................ ....... ................................................................................
........... ................................................................................................................................................
After issuance of a Permit, I expect to: (mark by an X~
(a) Commence work -- AT ONCF ............ ; ASAP ............ UNKNOWN .............
(b) Complete work in 1 DAY ............ ; 1 MO ............. ; 1 YR ............. ; FUTUR£ .............
Secure the correct Area Map from the Secretary of this Board, and by using an X WITHIN
A CIRCLE indicate as closely as possible the location of this dock. On the reverse side of this
map, provide a SCALE DRAWING which will show Ordinary High Water Mark, the shape
and size of the dock and any supplemental pilings which are needed to hold a floating dock
or tie-up a boat. Give all dimensions necessary to determine the area of the dock surface
which extends offshore from the O. H. W. M.
Will any portion of this construction extend offshore into Town Waters beyond c~n imaginary
line or boundary formed by other similar structures along the area's shoreline? YES or NO.
If it does extend beyond this so-called dock line indicate by how for, approximately,. ......... ft.
Provide the following docu,ments:
(a) A Licensed Engineer's Survey of the property involved.
(b) A copy of the Contractor's Plans and Specifications.
Will this construction require the Filling of any land offshore of the Ordinary High Water
Mark or the Dredging of any material from Town Lends under water? YES or NO. If it does,
Form A/4 (Application for Dredging/Filling) must be completed and attached as p~rt of this
application.
In requesting approval of this application, I submit that: the information presented herein
is true and correct to the best of my knowledge and belief; I am the person accountable for
the performance of the work in accordance with the plans and specifications attached; I have
read or am familiar with the provisions of any Southold Town Ordinance pertinent to the work
involved; and further, I intend to adhere to and abide by the Terms and Conditions of the
Permit, when and if issued to me.
.Accepted by: ~, ~'~.
Dated:
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GREA,T
PE¢ONI¢
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