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HomeMy WebLinkAboutTR-6840A James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. ,~;~,pF SOpryo~yy ~`~ T • ~~0~~ ~~~OOUNTY,~."~'' n LJ Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1592 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 1 sc day of construction %2 constructed Project complete, compliance inspection. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. ,~~OF SO!/To,y~~ ~~`~ T G • ~~p~ ~~~~~OUNN,~,,,~' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6840A Date of Receipt of Application: April 9, 2008 Applicant: Joint Industry Board of Electrical Industries SCTM#: 83-2-1 Project Location: 3800 Duck Pond Road, Cutchogue Date of Resolutionllssuance: April 16, 2008 Date of Expiration: April 16, 2008 Reviewed by: Board of Trustees Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1592 Fax (631)765-6641 Project Description: Periodic beach maintenance; removal of debris from beach from 10' above mean high water to concrete seawall. Manual or rubber- tired tractor only - no treads, and no re-grading of the beach or stone relocation. 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 survey prepared by John C. Ehlers Land Surveyor, last dated February 25, 2008, and received on April 9, 2008. 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. v ~~ James F. King, President Board of Trustees JFK:eac James E King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. ,~'~OF SOpr~o~ ~~ • ~~0,~ ~1y00UNTV ,~"~'" BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: ~c~ir1~ Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631)765-1892 Fax (631)766-6641 Please be advised that your application dated q o20.'~Fj has been reviewed by this Board at the regular meeting of r' /6 o~g~ and your application has been approved pending the co pletion 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) _'~onstructed ($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: $ ,~y o, BY: James F. King, President Board of Trustees _ _._ moPee.vwe ~-_- se xo ~ i p p, 90 ,.sae, _~~. o. ~co. ns ~ k _ scxos co. zs .. , ~~ ~ ~ ti " ~ .5 ~ ~ ~ ~.vl a ~ ,..~ . m~~~n ~ ~ / _,: ,~ ate. `~., ~ J • h nl~ vn aino °v +. ~ 3 • d ~ O ~` _ c R 4 / ° ., Cp# . / ii ~. c n v e>' . %- i i ~4` y I ,Y ~O een ® n Q _ [ ' "~ v Q R+ ~ 'm J oz o~o~is ~ Q Voi a M ,oju ' .{~6` 'i ~ i n.ruc ~J i b an a~ ow.. o~ eoa ss ei eke .oi e~~ ~ ~ o ' g~~cx _ -__~ Z ~- u.~w ~ ~M a. ~ ~ '.> . ~s ssE ss.wo ~ [ss uc F ru.m `K ' f _ _ - _ ~~ O __ _ - ~ - .. _ _ ~*oe COIAJTY OF SUFFOLK © ~ fleal Property iox Service 4gency a ~„~,. ~~.,,~ r ~ SOUTxOLO seernx xo 083 ..~.~ v ~. a. ~.,,. -~ James F. King, President Jill M. Doherty, Wc~P'resident Peggy A. Dickerson Dave Bergen Bob tnosio, Jr. Y~o~,~oF soaryo~ T • ~O ~'fC~)IY~~1 N Town Hall 5311<J5 Route 25 P.O. Boa 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631)765-6641 BOARD OF TOWN TRU3TEE3 TOWN OF SOUTHOLD Office Use Only -Coastal Erosion Permit Applicati -Wetland Petmit Application ~ Adminishative Pemrit _AtrendmenVl'tansfer/Extcnsio -Received Application: Received Fee:$ -Completed Application -Incomplete _SEQRA Classification: Type I Type II_Unlisted _Coordination:(date smt) _LWRP Consistency Assessment Form -CAC Referral Senr. -Date of Inspection: _Receipt of CAC Report: _Lead Agency Determination: TechnicaiReview: -Public Hearing Held: Resolution: Name ofApplicant~~ l /L*~ I t~.V~`tYl~ ~pa.,rd Address ~rj8-11 ~-(avrt,~ UAV~ ~olal~e. Jr. ~'r~- 7l~ ~~/, Phone Number:( ) ~~~ ~nG{~~atr(~S ~~~-"~4 N y ~~ ~~ o x~iz3 Suffolk County Tax Map Number: 1000 - ~ ~ -~ _ Property (provide LILCO Pole #, distance AGENT: ~ l ~ I i UItM (If applicable) 50~ 1~ 1'4lA-r ~l1-oj(~dres5 a c~~,''~ Ny It9;~ oss streets, and location) ab ~TW ~N ~l~-L ~~L~ / 1 TL ,~~ t 3 >~ of Truataes Applicatio>~ GENERAL DATA Land Area (in square feet): ~~K Area Zoning: Previous use Intended use of property: ~~ U~' i~'r~ Q~ 1"C`- ~,~ ~ 1 V F, /TL C,~ ~j ~11/~E 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): Covenants and Restrictions:' Yes _~No If "Yes", please provide copy. ~d of Trnstaes Applicati~ WETLANII/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed ~~~N Area of wetlands on lot: square feet Percent coverage of lot: %~ Closest distance betwee Barest existing structure and upland edge of wetlands:~~P feet Closest distance betweep gearest proposed structure and upland edge of wetlands:-T~=i-~f1` 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: ~PR~a 25c.~ v~F delxK - • a51"e w~~~ be Yerr~red w'rFh Lar~Snar~l Statement of the effect, if any, on the wetlands and_tidal waters of the _tow_ n_th_a_t~result~ reason of such proposed operations (use attachments if appropriate): PROJECT ID NUMBER ~ 81710 ~ ~ SEAR APPENDIX c STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAbASSESSMENT FORM for UNLISTED ACTIONS Ony u PART 1 -PROJECT INFORMATION { To be completed by AQpikant ar Protect Sponsor) ~. APPLICANT/SPONSOR In ~~ 1NitlCam ?~Gt~ 2: PROJECT NAMEt - ~.~~.,.,~.A,. !~~' :(;~ "TIC1~//I'I i NtrctOh . t-+vF7fl-~y 3.PROJECT LOCATION: ~•IEJI~{1 •: , ~ d~ ~1 Munidpallty . ~ ( ~1 County ~V terseclions. Prominent landmarks etc -or provide mac 4. PRECIS E LOCATION: Street Adders and Road In _ ~ ` rt ~1/I OlKi • Srx.ntziri ~ 5. IS PROPOSED ACTION : ~ New ~ Expansan ~ Modgkadon /alteration 6. DESCRIBE PROJECT BRIEFLY: Y~1 ._ A ~ ~,~,N,',~/y / + ~~ ,^ ~,, 7. AMOUNT OF LAND AFFECTED: ~T 7 U) Ini6alty aces Ultrmalely aces ~' 8. WILL PROPOSEO ACTION COMPLY WITH IXISTING ZONING OR OTHER RESTRICTIONS? ~'.. l~lYes ^ No If no, desaibe lxiany: 9. AT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as appy.) '~, 'I 1 7V {2esidenfial ~ Industrial ~Commenaal ^P~gricullwe ~ Park! Forest! Open Space ~OCher (describe) - 10. ' DOES - ACT10N INVOLVE A PERMIT APPROVAL, fNi FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, Stale or tJKal) Yes IdINo % yes, tis[ ageray name and pem~ft !approval: 1~( P ? Yes ~No If yes. Est agency name arld permit / approvaC 12. AS A ULT OF PROPOSED ACTION WILL IXISTING PERMR/ APPROVAL REQUIRE MODIFICATION? ea No I CERTIFY THAT THE ORMATION PROVIDED ABOVE IS TRUE 70 THE BEST OF MY KNOWLEDGE AppNpnt ! pon Name Date: ~1 Si V v 1 U If the actlon is a Costal Area, and you are a state agency, complete the Coastal Assessment Form batons proceeding with this assessment M w- Board of Trustees Application County of Suffolk State of New York VVflliatrn ~~+a-bib °`~v r ~ ~~ L~N~S( DULY SWORN liBrUS1;S AND AFFIItMS 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/fiER 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 PROPE TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF APPt.ireTrntr W i~ Q'l~l! l/~' "' Signature SWORN TO BEFORE ME THIS__~_DAY OF 2p~ 1 .X,{.iri~i r ~ ~i ~ z- Notary Public Notary Public State of New York APR-10-2008 01:35 FROM: ~ T0:63~4 6643 P.1~1 Page 2 of 2 aoarG o3 lzuatelea t+ppl.lcaeton AUi,'NO&LL71E1'Qy ~ r L D Svhcte the applioaal: is aoc cho7oprpecl I GiCUC,~r~nrr~L'u~T!/!d__~~/~~jr,.;~eaidiIIq at JaQ~ U~~K~ ~~ ^Dr~nt per at Dr°paetY'}"Q` no- n4 sa T ,~, / Cu f ~O ~ N ~ do hazoby antharlsa i ~~ M J ~p 6 ~~ ~~ /~ ~ lf~4ant) ~61L1'..L2'L 'x'11 I' P to apply foc pernlt(61 fraw the sc itl~old 9oasd of Soya Tinctoaa oo my h¢Uatf, 0 /77~ et'a a gaatuzo) U Jos~Pt~ Doc~r~' 718-5qt-zaooxl~Z3 a ~ 31.- 7 3y- ~ 3ry 4/9/2008 __. APPLICANT/AGENT/12EPRESEN'1'ATI VF TRANSACTIONAL DISCLOSURE FDRM The.Town of Southold's Code of Ethics prohibits conflicts of intet~s! on the Hart of tnCVn n1Bms aa!t eambve~ The otnnose of this form is to provide infotination which can alwt the town of txtssibk txtnflitas of inmest atd bw it m take whapwet xxion 's ~. netxssarv to avoid same. ! YOUR NAME: Fy'7bv i N }~ (Last name, fast name, ~aitidte initial, unless you are applying is the name of someone else or other entity, such as a company. If so, indicate tlti.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 tether ,name the activity.) _ Do you personally (or through your company, spouse, sibling,. parepf, a child) have a relatiotavliip with any of6ar or employce of the Town of Southold? "Relationship' includes by blood, martiage, or business interest. "Busiticcs intuesl ~ means a business, including a partnership, in which the town ofTiar or employce bas turn a partial. ownership of (or employment by) a cotpomtion in which the town officer or employce owns more than 5°/a of the shares. YES NO __~ If you ansxron:d "YES", complete the balance of this forth end date and sign where indicated. Name of person employed by the Town of Southold Titlc or position of that ptrson - Describe the relationship between yourself (the applicanUagwUrtpresentative) and the town offar or employee. Either check the appropriate line A) through D) and/or destxibe in the spare provided. The town otfcer or employee or his or her spouse, sibling, patent, or child is (check all that apply): A) the owner of greater than S% of the shares of the corporate stock of the applcant (when the applicant is a corporation); _B) the kgat orbetteficial owner of any interest in a non-twrpotate entity (wh8n the applicant is not a corporation); _C) an officer, direclo ,pallet, or employee of the applicant; or _D) the actual applicant. DESCRIPTION OF 1LE[.ATIONSHiP spbmltted this -/ ay f ~ zoo' Signattue 4 Print Name Form TS 1 Building Trustee Coastal Erosion Mooring Planning