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Home My WebLink AboutTR-6218AAlbert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson 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 Permit No.: 6218A Date of Receipt of Application: Oct.18, 2005 Applicant: Allan Goodman SCTM#: 52.5.'11.1 Project Location: 1555 Bayview Ave., Greenport Date of Resolution/Issuance: October 19, 2005 Date of Expiration: October 19, 2007 Reviewed by: Board of Trustees Project Description: Administrative Permit to remove the garage door and add a window, and replace the siding on the garage as per plans surveyed by John Metzger last dated Dec. 19, 2001. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 97 of the Southoid Town Code. Special Conditions: None. If the proposed activities do not meet the requirements for issuance of an Administrative Permit s~t forth in Chapter 97 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Albert J. Krupski, Jr., President Board of Trustees GREENi PIPE $ COVE I N LET PT ! EXISTING DECK ADO TILE FLOOR ~l 16' O.C. WALL FRAMING. ADO R-15 BATT INSUL. 1/2' SHE~' I t'~OCK, EXIST, 2 X8 NEW 11-718' TJI CEILING JOISTS Q 16'O.C. NEW CLOSET SHOWER = = _ ~EX~T.~N~H~J~F~_ _ _ = = EGRESS ~ PEL~ ~EMEN~ 2~ ~ ~1 ~ X 3'11 -~' R.O. GOODMAN SEIBERT RESIDENCE GARAGE CONVERSION 9.29.05 1/4" = 1'-0" ENVIRONMENT EAST INC. REVISED 10.15.05 EXISTING DECK EXISTING DOOR NO ~GES EXJSTING ~ NO CHANGES 1 i EXISTING ENTRY NO (TrlANC.-,ES EXISTING DECK Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson 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 ,~Administrative Permit Amendment?Transfer/Extension_. __~Rece~vved Application: / ~[1 ~eceived Fee:$ _~. ~ ~mpleted Application ~Incomplete __SEQRA Classification: Type I Type II Unlisted ~Coordination:(date sent) . .__LWRP ConsistencyAssnssment Form fl!Bt ~--aS~C Referral Sent: r} ___Date of Inspection: Receipt of CAC Report: Lead Agency Determination: Technical Review: ,-'P'fiblic Hearing Held: ]O//t~/O~' Resolution: Name of Applicant . A ~LAJXO C__m- 01~)~2) Phone Number:t, Suffolk County T~ Map N~ber: 1000- 0~ -- Property ~cation: i~ SOo OF Ro. ~rovide LILCO Pole ~, dist~ce to cross s~ee~, ~d location) (If ~plicable) Phone of Trustees Applicati¢ GENERAL DATA Land Area (in square feet): Area Zoning:_ 12- ~--SI D~cIOT{ A(-'' Previous use of property: Intended use of property: Prior permits/approvals for site improvements: A~ gency ~ouw/¢0co ~OUT~UO ~SOO'T~'OLO Date 6~0 CeW"c- ~O0u.: Iqqq ~' 0oqx-~c~o fi< ee, t t.. 9..00'2-. --(--~o~s. __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspens[ed by a govemmental agency? Yes If yes, provide explanation: Project Description (use attachments if necessary): ~d of Trustees Applicati~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose ofthe proposed operations: 1141'~SaOg. t~rc.~oh,,~'rto~ OF Area of wetlands on lot: 0 square feet Percent coverage of lot: ~) % Closest distance between nearest existing structure and upland edge of wetlands: ' feet Closest distance between nearest proposed struct~=.e and upland edge of wetlands: feet /MD Does the project involve excavation or filling? ~ No Yes If yes, how much material will be excavated? How much material will be filled? 0 l~) cubic yards cubic yards Depth of which material will be removed or deposited: O feet Proposed slope throughout the area ofoperations: 1~3P~ '~ ~.~(~ o ~- ~x:~6T. ~L.o~'~' 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 such Proposed operations (use attachments if appropriate): PROJECT ID NUMBER PART '1 - PROJECT INFORMATION 1. APPLICANT / SPONSOR 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2 PROJECT NAME co., y $0 SEQR 3.PROJECT LOCATION: Mu nicipality ,~ 0 L~'-[--~t,.~) '"[1)k)~ I~J 4. PRECISE LOCATION: S~eet Addess and Road Intersections. Prominent landmass etc -or provide mad 6. DESCRIBE PROJECT BRIEFLY: 7, AMOUNT OF LAND AFFECTED: ~ [ ~ ~)O~ ?.-~ '~- FT. Initially acres Ultimately acres ~)/~J' 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~Yes [] NO If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) [~esidential E-]Industrial r-~commercial [~]Agriculture ~--~ Park / Forest / Open Space [~Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, Stateor Local) J~Yes J--JNo If yes, list agency name and permit/approval: II.DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? r-]Yes ~'~0 If yes, list agency name and permit / approval: 12. AS A RE LT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? /~/~(~/0~" [~h'es ~No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name Date; If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment II - IMPACT ASSESSMENT (To be completed by Lead A~lenc¥) ;EED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. ;EIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative may be superseded by another involved agency. No C. COULD ACT Cl. RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) . /, surface or groundwater quality or quantity, noise levels, existing traffic pat[em, solid waste production or disposal drainage or flooding problems? Explain briefly: C2. Aesthetic, a archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or faun~ or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: C5. Growth, subse~ activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL AREA E. IS THERE ENVIRONMENTALIMPACTS? PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, ~gnificant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); ~ of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequat~y addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potential impact of the proposed actior~n the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts wh~h MAY occur. Then proceed directly to the FULl FAF and/or prepare a positive declaration. Check this box if you have determined, based on ihe i~fdrrnafion and analysis above and any ~uppo~t~qg doCUrne~fi0n, that the proposed acfi0r WILL NOT result in any significant adverse environmental impacts AND provide, on attachments ~ necessap~, the reasons supporting thi! determination. ~ Date Print or Type Name of Responsible Officer in Lead Agency Title Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from respo~ible officer) 9oard of Trustees Application County of Suffolk State of New York ~WI~'~ '~-VOO"~--__.t~ BO ~v~G ~- 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 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 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 WITH REVIEW OF THIS APPLICATION. SWORN TO BEFORE ME THIS [ ~wt.x_ DAY OF ~ ~ ,20 ~ Notary Public BARBARA ANN RUDDER NOtI~/I=ubll=, Btate of Now York No, 4855805 Qu,llflld tn Suffolk Count~.. ~/ 18/18/2885 08:5B 212-8~61875 NICKELODEON P~ 81/81 Alan Goodman 684 Bmaclway #11E New Yof*k, New York 10012 To whom it may concern; I authorize Environments East to file building plans in association with work to be done at my property in Southold at 1555 Bayview Avenue, Souttx)ld, 11971, Sincerely, Alan Goodman APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics orohibits conflicts of interest on the oart of town officers and emolovees. The nuraose o.f this form is to nrovidc information which can alert the town of oussible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: ~--.~ ~-'~,.~ (..) ~p,~ ~ .~f ~-l~'~{'~. (Last name, first nares, galddte initial, unless you are applying in the name of someone else or other emity, 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 business 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 L~ 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 Sou?o~ld ~ ~ ~"' Title Or position of that person ""~ r--, "'~O 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 o~vner of gl'eater than 5% of the shares of the corporate stock of the applicont (when the applicant is a corporation); __B) the legal or beneficial owner of any interest in a non-cerpomte entity (when the applicant is not a corporation); C) an officer, director, partner, or employee oftbe applicant; or __D) the actual applicant. DESCRIPTION OF KELATIONSHIP Form TS 1 SubmiRed this ___day of 200 Signature Print Name ~ ~C~---g, Environment East, Inc. 2885 Indian Neck Lane P.O. Box 197 Peconic, New York 11958-0197 631-734-7474 Fax: 631-734-5812 Southold Town Trustees October 18, 2005 Concerning our application on behalf of Allan Goodman of 1555 Bayview Ave.: We request that the Trustees grant us a waiver on the grounds that this project, being the replacement of a garage door with a window unit and the replacement of siding, has no potential for adverse impact on the site. Sincerely, OCT 1 8 2005 SURVEY OF PROPERTY A T ARSHAMOMA Q UE TOWN OF SOUTHOLD SUFFOLK COUNTY , N. Y. 1000-52-05-11.1 SCALE: 1"=20' 5£'30'00' LOT ,~ $ 5£°30'00, I rc B.,I3J7' LOT ~ ELEVATION$ ARE REFERENCED TO N.G.V.D. AREA - 30,2,24 sq. ft. TO TIE LINES ANY ALTERATION OR ADDITION TO THZS SURVEY IS A VIOLATZDN OF SECTION 7B09 DF THE NEW Y~RK STATE EDUCATION LAW, EXCEPT AS. PER SECTION 7BOB-SUBDIViSION B, ALL CERTIFICATIONS HERE~N ARE VALID FOR .THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BE~ THE IMPRESSED SEAL OF THE SURVEYOR ~HDSE SIGNATURE APPEARS HEREON, LDT NUMBERS REFER TD 'M~P ~F SUMMER HAVEN* FILED IN THE SUFFOLK COUNTY CLERK'S QFF$CE AS ~AP ND, ~33 IC, N~. 49618 (631) 761 (63D 765-I797 P, D, BI]X 1~30 TRAVELER STREET 0~'--~' ,_CEIUTH~LD, N,Y, 11971