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HomeMy WebLinkAboutTR-7127A 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 __ 1st day of construction ¼ constructed ~"'"'Project complete, compliance inspection. James F. King, President Jill M. Doherty, Vice-President Peggy- A. Dickerson Dave Bergen Bob Ghosio, Jr. Town HallAnnex 54375MainRoad P.O. Box 1179 Southold, New York 1197170959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7127A Date of Receipt of Application: July 16, 2009 Applicant: Matthew & Vera Cusumano SCTM#: 136-1-1 Project Location: 435 Briarwood Lane, Cutchogue Date of Resolution/Issuance: July 22, 2009 Date of Expiration: July 22, 2011 Reviewed by: Board of Trustees Project Description: To remove a tree which has recently leaned toward the bulkhead. 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 Matthew & Vera Cusumano, received on July 16, 2009. 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. JaYmes F.C~King, ~resident Board of Trustees JFK:eac 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: Please be advised that your application dated ~t~4 I~/o1C-,:O9 has been reviewed by this Board at the regular meeting of''J _.3~(,~[.~ ,:,~o2~ ~o_/ and your application has been approved pending the complebt~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) __ ~ 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 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: $. ,~-0 o~ BY: James F. King, President Board of Trustees James F. King. President Jill M. Doherty. Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: MATTHEW & VERA CUSUMANO request an Administrative Permit to remove a tree which has recently leaned toward the bulkhead. Located: 435 Briarwood Lane, Cutchogue. SCTM#136-1-1 Type of area to be impacted: __Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: __Chapt.275 Chapt. 111 other Type of Application: Wetland __Coastal Erosion ~Amendment __Administrative__Emergency Pre-Submission __Violation Info needed: Modifications: Conditions: Present Were: __J.King __J. Doherty __P. Dickerson __ D. Dzenkowski other Form filled out in the field by D. Bergen__ B.Ghosio, Mailed/Faxed to: Date: James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave B~rgen Bob ~nosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only __Coastal Erosion Permit Applicatio~ll __Wetland Permit Application ~ Administzative Permit Amendment/Transfer/Extension l~_Rece~vved Application: ,. c]~tl~,lOq ReceivedFee:$~'T~f ~ q~i~0[O~ ~C'~mpleted Application q [[~{(3q __Incomplete __SEQRA Classification: Type I Type II Unlisted __Coordination:(date sent)_ __LWRP Consistency Assessment Form DAC Referral Sent: ate of Inspection: '71rll©q. __Receipt of CAC Report: __Lead Agency Determination:__ Technical Review: _~hlblic Hearing Held: q [~.[kDq __Resolution: Name of Applicant Address ~L)~ h0( 117~ Suffolk County Tax Map Number: 1000 - Property Location: ~ /~ I~1 (provide LILCO Pole #, distance to cross streets, and location) Phone Number:(~ - _"7.as ¢- _~I~L ~ AGENT: (If applicable) Address: Phone: of Trustees Applicat' GENERAL DATA Land Area (in square feet): Area Zoning: 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 __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspende)il by a governmental agency? ~/No Yes If yes, provide explanation: Project Description (use attachments if necessary):. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: _.~00 0 ~ squTM feet Percent coverage of lot: ~ % Closest distance between nearest existing structure and upland edge of wetlands: 7° feet Closest distance between neprest proposed structure and upland edge of wetlands: ~//~ feet Does the project involve excavation or filling? X/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 tkroughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any~ 9_n [he weft_ands and tidal ?~t_ers_ 9f ~e town tha_t ~ax r_~s_ul[by reason of such proposed operations (use attachments if appropriate): PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 6t7.20 APPENDIX STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Ar 3[icant or Project Sponsor) 2. PROJECT NAME PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map SEQR 6, DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WIL ROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~Yos [] No If no. describe briefly: 9. W T IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~Res~iOential E~lnOustdal [~Commercial E~Agriculture E~Park/Forest/OpenSpace E]Other (describe) 10.' DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal~ State or Local) E]Yes yes, agency name permit approval: list and ANY A' b~;I OF THE ACIION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [~]Yes If list agency name and permit / approval: yes, 12. As A RESIST OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant , S~;r~or Na~ .D Dater/ /~"i If the action is a Costal Area, and you are a s~te agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead A~enc¥) IA. DOES ACTION EXCEED ANY TYPE THRESHOLDIN6NYCRR, PART6174'~ Ifyes, coordinate the review process and use the FULL EAF. r--] Yes r~No B, WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. [] Yes [] NO C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WiTH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or fioedthg problems? Explain bdefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain bdefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensiiy of use of lar)d or other natural resources? Explain briefly: C5. , i ':: ~ : subsequent development or related acbwtles likely to be reduced by the proposed action? Explain briefly C6. Long erin, short term cumulabve, or other effects not ~denbtied ~n C1 C57 Explain briefly D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEAI? {If yes, explain bdefl~,: []Yes E~No ......... E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If)/es explain: PART Ill - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwisesignificant. 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 (0 magnitude. If necessaw, 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 :.,es, the d~term!nztien cf eignil~cance must ev3fuctc th c pcteebal4mpcct of-thc prcpcc, cd action, on thc cavlronm,,c~,ta', charactar~$t~c~ of ~he CFA 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. C-heck thi~ D~-yo~l~-~J~"~rm~-~'d'i base~ ~'th~ ~nformation an(:[ ~aly~is ~bove and any ~upp0Hing docu~en~borll t-;~¥~e ~r0p-~- ~c~i~)' WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons suppoding thi determination. Name of Lead Agency Date Title of Responsible Officer Pdnt or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from responsible officer) Board of Trustees Appli~ion County of Suffolk State of New York .~..~ ~ ~ ~q Clt~Lt~tk.~ 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 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, THEiR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WIT~I REVIEW OF THIS APPLICATION Signature 5% ItO~I~IIE J. DOItOSKI Notary Public, State Of New York ~o. 0l D06095328, Suffoik~ Term Expires July 7, 20 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE. FORM The Town of Southold's Code of Ethics omhibits conflicts ofintesest on the oart of toWn Officers and emvlovees. The tmmose of this form is to orovide information which can alert the town oftmssible conflicts of interest and a ow t to take whatever action is necessary to avoid same. YOUR NAME: (Last name, first name, r~aiddle initial, unless you are applying-in th~-name of someone else or other entity, such as a company. If so, indicate, the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring 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 Southold? "Relationship" includes by blood, marriage, or buginess interesL "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 N~ lfyou answered ~'YES", complete the balance of this form and dat~ 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 appllcant]agenffrepresentative) and the town officer or employee. Either check the appropriate llne A) through D) and/or descdhe 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 o~vner of greater than 5% of the shares of the corporate stock of the applic0nt (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 1 Submitted this Signature Print Name day of 200 -il,~s:4 /._ 421.3`5 -- , WIDE -;~20 (kpoWl1 as r.o.w' _ CARGiGH & NIOIF FRED J' ,~NN SURVEY OF PR OPEN T Y A T CUTCHOGUE TOWN OF SOUTHOLD SUFFOLK COUNTY, IV. Y 1000 - 136 - 01- 01 Scale 1" = 20'