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HomeMy WebLinkAboutTR-6922A . . 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 L Project complete, compliance inspection. . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Han 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.: 6922A Date of Receipt of Application: July 2, 2008 Applicant: John & Marianne Clarke SCTM#: 44-1-25 Project Location: 56525 North Road, Southold Date of Resolution/Issuance: July 23, 2008 Date of Expiration: July 23,2010 Reviewed by: Board of Trustees Project Description: Replace the existing deck over the garage. 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 Bob Bohn, last dated August 18, 1998, and received on July 23, 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. ~~~ James F. King, President Board of Trustees JFK:eac T- . . 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: JOh~ ~ fflM,'afI()r: ~/a.rke.. Please be advised that your application dated ;:Tu..lp d, ~1J" has been reviewed by this Board at the regular meeting 0 Su~01~. dC02r and your application has been approved pending the com pie . n 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) 'h Constructed ($50.00) (~inallnspection 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: - co TOTAL FEES DUE: $ 50--- BY: James F. King, President Board of Trustees ~ II + // (\ I " 0 -N- o" ~ 1 1 I 1 , ~ fMP<....... 1 ..,..0..... ..s-.,-.., I I, ,-- ""'0 + ':::, ,! ,- o , / / ~, l ;;QTIC[ (i) COUNTY OF SUFFOLK @ :s"ReolprOpertyrOx.ServiceAgency ~ Coltl'j !:onl.,. m....tlo<kJ,N I 11!1ll1 .. .."" ~F[[T '" . '" ~ "'-m ",,'" """~L ". '" ."",,, '.. "'<COT""- """",, """'----"-'---- 'A"o m ::::, '" ::~::"- 0_ .."" --'""~.~ .."'..".~ [211 o "'~"""cE,'''[''T"",,,,,-, '" [,,,-,.,.,, ,'" """'''" " ,'" ......'-'''''''','"....'" ",".,,,,, """'H.~m"P<,.,"..'><"'.. "''',,"()P['''''' """C,.,,,,,,, I ,1 "'" I SOUTKOlD SrCTlONIlD O~~ 1000 P~OF't:RTY 1lAF' -l '.... . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob lfnosio; Jr. BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD . Town Han 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 Office Use Only ..-, \\.~ ~ ~ ~ ~ \;~ Ir, Ji'',',\ \~~\- . ii \ru JUl - 2 20GB,."::""- \ -~ - scutl10ld 10wn Board 011ms1ees _Coastal Erosion Permit Applicatioy _Wetland Permit Application L Administrative Permit ;:: _AmendmentlTrans7,r/Ext!!lSiOn -'0(eceived Application: 7 d./o ~ LReceivedFee:$ 9)C!;:t-' . --Completed Application -'1J 1 /W _Incomplete _SEQRA Classification: Type I_Type II_Unlisted_ _Coordination:(date sent) _ L WRP Consistency Assessment Form CAC Referral Sent: Vbate ofInspection:.='1111o (08 _Receipt of CAC Report: _Lead Agency Determination:_ T eclmical Review: -rublic Hearing He~ _Resolution: 'y11 Name of Applicant j" H /V r. .,; /'1 A 72 / A.I1/,-1/ L-' .i. ['? A J? Ie t3 j/.i II JJf ..>5 11' l> 9/1 C,v4~-r Ave ,/ Address S t' S' ,,23- /II' '" ~ J'H 'i!.J) I\r 6 w ;I 'f:D E 1'.4 RI:: Y II (J '7'0 So v THe L<< IVY Phone Number:(6J! '7 G .:j- - .:2 J Suffolk County Tax Map Number: 1000 - tJ if "/- 1- ..2 .J.-' Property Location: (' R if i' (<.// ~ -;,~ abf'~-7Z.-, ~ ~ '!1~~. L.iP/! (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) J') 77.5- S""1,g.~ ~ -Y_A-T7' p .'7" '- e';iT !:? p- 3 8' ;;. -'10 Address: Phone: ~rd of Trustees APPlicati~ GENERAL DATA Land Area (in square feet): Area Zoning: 1~A~~ Previous use of property: Intended use of property: Covenants and Restrictions: If "Yes", please provide copy. Yes ./ No Prior permits/approvals for site improvements: Agency . Date A<-.~ ~ IF .Jjll.s- z ill9lr,y' _ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? LNo_ Yes If yes, provide explanation: Project Description (use attachments ifnecessary): ,~.-/ ~ -Pd-L.r~ ~ ~~ old')! ~'" ~ de..! ~u ;2.5- //.5- ~ .fit ~/f'.Y I tlrrd of Trustees APPlicati~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~'-nJ _<--.- 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 between nearest proposed structure and upland edge of wetlands: feet Does 7roject 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: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of suchproposed operations (use attachments if'appropnate): ..- -- ... . - . fl_~ 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 ,. APPLICANT l.rOtI6El~ J,.J,,, J fiari"""~ C%,-ke 3.PROJECT LOCATION: 2. PROJECT NAME /?ej ";ld; n ex /5 -fIn Municipality cI County 5~ ,I..t, 11<. (/ /J Addess and Road Intersections, Prominent landmarks ete ~ or provide map ,Rd. ~P<i .,t-.A~/d f('p,p,..~><, Joe -I'f- weST f>.f' AJ.d"r~S"'JJLa. oj! .>-f-,-ee7 5. IS PROPOSED ACTION: 0 New D Expansion D MOdification / alteration 6. DESCRIBE PROJECT BRIEFLY: 1?e /! h c e m (-1 -f ,.f <l ;fJ r u- rex I S .7'- , '?Ji ja,...'Y C .:/c. c -f t' n Fa,'.j! a j2 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? OOves 0 No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY C8r Residential D Industrial 0 Commercial OF PROJECT? (Choose as many as apply,) DAgricu,ture D Park / Forest I Open Space OOther (describe) 10.' DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) DYes C8J No If yes, list agency name and permit I approval: NY A::it-'l:.l.;1 VI- IHI:: ACIIVN HAVE A--CDKKENILY VAllO PERMIT OR APPROVAL? DYes DNO If yes, list agency name and permit I approval: 12, AS A ESULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION? Ges No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Date: /~ 7/.t J'd' If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment _oard of . Trustees Application County of Suffolk State of New York I C'L.A'1H:E JtI)I/V /; f!L.4~Jre.J /14~/nlY"".c L BEINGDULYSWORN 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, THEIRAGENT(S) OR REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. ~.L ~<:_~..,:/t%L ~ ' ~~gnature d-no\ DAY OF ~~__,200d' SWORN TO BEFORE ME THIS ~~ h Al}J\~ Notary Public CONNIE D. BUNCH Notary PubHc~~\e 01 New Yorll No.01llU6185050 Qualified in Suffolk Countv Commission Expires April 14. to J~ . . APPLlCANT/AGENTIREPRESENTATlVE TRANSACTIONAL DISCLOSURE FORM The Town of South old's Code of Ethics orohibits conflicts of interest on the Dart of town officers and emDlovees. The nurnose of this fonn is to orovide information which can alert the town ofoossible conflicts of interest and anow it to take whatever action is necessary to avoid same. ' YOUR NAME: CIAA?Jc'C, J,#-l/ r-. 01 /'1/J''RIAAlNE L. (Last name, first name, -I11iddle initial. unless you are applying in the name of someone else or other entity, such as a company. Ifso, indicate the other person's or company's name,) , NAME OF APPLICATION: (Check all that apply,) Building Trustee Coastal Erosion Mooring Planning Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If "Other", name the activity,) 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, marriage, 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. 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 South old 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) 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~nt (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 SUbmitte~day~ J" J; 2008' Si?nature .' {? '4';' - ./ C"..t.~ PnntNa J,.A" ~ C/,:i:-e ':#~:i"",,'~i Cluke. 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