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Home My WebLink AboutTR-7031A James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hail Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0475C Date: October 2, 2009 THIS CERTIFIES that the repair in-kind of a portion of the waterside wall of the existing gunite swimming pool At 1445 Bayshore Road, Greenport, New York Suffolk County Tax Map # 53-4-4 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated 1/30/09 pursuant to which Trustees Administrative Permit # 7031A Dated 2/18/09 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 repair in-kind of a portion of the waterside wall of the existing gunite swimming pool The certificate is issued to ANNETTE GOLDEN owner of the aforesaid property. Authorized Signature James F. King, President Jill M. Dohe.~y, Vice-P~sident Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town HalL, 53095 Main Rd P.O. Box I 179 Southol& NY 11971 Telephone (63 l) 765-1892 Fax (631} 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE O..E INSPECTION: / Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction ..~ constructed ~//Project complete, compliance inspection. INSPECTED BY: COMMENTS: James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Gho$io, 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 1st day of construction % constructed Project complete, compliance inspection, James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall Annex 54375 Main Road 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.: 7031A Date of Receipt of Application: January 30, 2009 Applicant: Annette Golden SCTM#: 53-4-4 Project Location: 1445 Bayshore Rd., Greenport Date of Resolution/Issuance: February 18, 2009 Date of Expiration: February 18, 2011 Reviewed by: Trustee Bob Ghosio Project Description: To repair in-kind a portion of the waterside wall of the existing gunite swimming pool. 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 received on January 30, 2009. 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. Jame , Presid~ Board of Trustees 053 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 Main Rd. & Youngs Ave. Southold, NY 11971 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MAIL1NG ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 Tol Jim King, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Scott A. Hilary, LWRP Coordinator Date: Re: February 10, 2009 Chapter 268, WATERFRONT CONSISTENCY REVIEW Administrative Permit for ANNETTE GOLDEN SCTM#53-4-4 Joanne Liguori on behalf of ANNETTE GOLDEN requests an Administrative Permit to repair in-kind a portion of the waterside wall of the existing gunite swimming pool. Located: 1445 Bayshore Rd., Greenport. SCTM#53-4-4 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to us, it is our recommendation that the proposed action is EXEMPT pursuant to § 268-3. § 268-3. Definitions. MINOR ACTIONS -- Include the following actions, which are not subject to review under this chapter: A. Maintenance or repair involving no substantial changes in an existing structure or facility; Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Admini GOLDEN SCTM#53-4-4 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob ~nosio, 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 Office Use Only Coastal Erosion Permit Application,, Wetland Permit Application s/ Administrative Permit ~ec AmendmenffTr ans fer_/l~xt ensiGn ~-iT~d App~cation: ~ t _~eceived Fcc:$ ~J-' ! ' _ _~9~leted Application !! ...__~complete __SEQRA Classification: Type I Type H Unlisted __Coordination:(date sent) __LWRP Consistency Assessment Form CAC Kefenal Sent: ~ o. _~ate of Inspection: __Receipt of CAC Report: __Lead Agency Determination: Technical Review: --..~blic Hearing Ileld: ~'9-!! __Resolution: Suffolk County Tax Map Number: 1000 Property Location:/Q, (proVide LILCO Pole #, distance to cross streets, and location) AGENT: ~-~ ''~/ld Z'~ (If applicablc) Address: Board of Trustees Appli~ion Land Area (in square feet): Area Zoning:. Previous use of property: Intended use of property: GENERAL DATA Covenants and Restrictions: If "Yes", please provide copy. Yes No Prior permits/approvals for site improvements: _ Agency . __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a gov~.ernmental agency? Not-"~ ¥ Yes If yes, provide explanation: Project Description (use attachments if necessary): _A Board of Trustees Appll tion WETLAND]TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 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 the project involve excavation or filling? No Yes If yes, how much material will be excavated? How much material will be filled? Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: cubic yards cubic yards feet reason of such proposed operations (use attachments if appropriate): pF~OJECT ~D NUMBER ] 617.20 : APPENDIX C II STATE ENVIRONMENTAL QUALITY REVIEW ' ~ SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART '1 - PROJECT INFORMATION ( To be completed by Applicant or Project Sponsor) 1. APPLICANT I SPONSOR 2. PROJECT NAME 3. PROJECT LOCATION: 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks eta-or D~ide 6. DESCRIBE PROJECT BRIEFLY: ?,AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres B. 'v~Lk PROPOSED ACTION COMPLY W1TH EXISTING ZONING OR OTHER RESTRICTIONS? r~Yes [] No If ~0, describe briefly: Res ~ IS PRESENT LAND USE IN VICINITY OF PROJECT? (Chooseasmaeyasapply.) identia, r-]Industrial r~Commercial r--]Agricutiure E~ParklForestlOpenSpace []Other (de$cdbe) 10.' DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDINg. NOW OR ULTIMATELY FROM ANY OTHER OOVERNMENT^L AGENCy (Federal. Slate or Local) ~'es r--'J No R yes, list agency name and permit / approval: tl.L,'tJI:5 ANY A3FI::UI UP IHE A~IlON HAVI:: A CURRENTLY VALID PERMIT OR APPROVAL? ]Yes C]No ti' yes, list agency ~arne and permit I approval: '[~3.~8 A RESULT OF PROPOSED ACTION WILL EXISTINO PERMIT/ APPROVAL REQUIRE MODIFICATION? es [] No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /:Spofisor Name ~ Date: If t etlon 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 completed by' Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 ~f yes, coordinate the review process end use [he FULL EAFt B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be super~eqeq by another involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be han~wiften, if legible) C1. ExisUng air quality, sudace or gmurldwater quality at- quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C5 Growth subsequent development or ,=l,=t=d actlmt~es likely to be induced by the proposed action? Explain bdefly: C~. Long t~nn, ~od tsrm, somulat~ve, or otbar aff*ct~ not identifind in Cl-C§? Explain b~fl¥: C7. Other mpacts (nc ud ng ~',a.0~ n use of ether c[uantJty o~- type of enemy? Ex,Iain bdefl}c - D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITIC ~L ENVIRONMENTAL AREA (CEA~? f es ex lain bde ' E. IS THERE, OR IS THERE LIKELY TO BE, GONTROVERSY RELATED TO POTENTIAL ADVERSE ENV RONMENTAL IMPACTS? ff~'es ex~Jain: PART III - b~= I ~.~MINATtON OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or othec~ise signiticant. effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) geographic scope; and (~ magnitude. If necessary, add attachments o~ reference supporting materials. Ensure that sufficient detail to show that all retsvant adverse impacts have been identified and adequately addressed. Check this box if you have identified one or more poten0aBy la~ or signir~ant adverse impacts which MAY occur. Then proceed directly to Ihe F EAF andlor pmpara a positive declaration. (~he~ ~h~ '~,'~E ~v~-~-~d~ ~)~a'i)~ :l~f~rm~tio-n an~l ~r~aly~s ,~b~,e a~d-a~ ~u~po~ng d~mentation, that ~e WILL NOT result in any significant adverse environmental impacts AND provide, on altachments as necesoaP/, the reasons suppoding determination. Name oi' Lea~ Agency Date Print or Type Name of Responsible Officer 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 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 1N 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 PERMTr(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. SWORN TO BEFORE ME THIS S~gnature /_7 DA¥OF ,20 O~ Notary Public WILLIAM M FAULK JR NOTARY PUBLIC-STATE OF NEW YORK No. 01FA6167S66 Qualified In Suffolk County Board of Trustees,App~ion AUTHORIZATION (where the apP~cant is not the owner) ~W~~ ~o~J/ residing atl (print owner of property) (mailing address) do hereby authorize~//v~ (Agent) p~ /~-- ~//O/~ &~/~ '~o apply for permit( s ) from the Southold Board of Town Trustees on my behalf. /(Owner ' s sign~ =~ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE. FORM ~ of Sou I ' d t ' h'bi c tow ~ ¢ of · ' v' ' fo 'onwhic o ibc ' ' I wit e ' ' (L~t name, fi~ n~e,~iddl~ ~ifial, ~1~ you ~ a~ly ~ n ~e ~..- of ~onc el~ or o~r ~nfiW, ~ch ~ a ~mp~y. If ~, indica~.~ o~r ~oo's or com~y's NAME OF APPLICA~ON: (Check all that apply.) Tax grievance Building Variance Trustee Coastal Erosion Change of Zone Mooring Approval of plat Exemption from plat or official map Planning 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 Southold9 "Relat onship" 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 Southold Title Or position of that person Describe the relationship between yourself (the applicant/agent/representative) and thc town officer or employee· Either check the appropriate llne A} through D) and/or describe in the space pro4ided. 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% oftbe shares of the corporate stock oftbe applic0n~ (when the applicant is a corporation); __B) the lega or beneficial owner of any interest in a non-corPorate entity (wbea the applicant is not a corporation); C) an officer, directOr, pm'mcr, or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 Submittedthis~ Y dayor ? aa~"'~ Print Hame fr/o/v~ ~ ~7-c~ ~,; SURVEY OF PROPERTY A T ARSHAMOMAOUE TOWN OF SOUTHOLD ~OAD AS ~ NO. 1124