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Home My WebLink AboutTR-7170A 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 ¼ 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.: 7170A Date of Receipt of Application: September 2, 2009 Applicant: Ralph Vestbom SCTM#: 50-2-1 Project Location: 3500 Lighthouse Road, Southold Date of Resolution/Issuance: September 23, 2009 Date of Expiration: September 23, 2011 Reviewed by: Board of Trustees Project Description: To place two (2) cedar posts 6' high with 12"x12" signs above the high tide line. 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 Ralph Vestbom, last dated August 20, 2009, and received on September 2, 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. James F. King, President 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 Please be advised that your application dated ~o,?, c~:~ has been reviewed by this Board at the regular meeting' of ,~(~rc~?~,, o74:X:27 and your application has been approved pending the con~pletion of the following items checked off below. __ Revised Plans for proposed project __ Pm-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of Construction ($50.00) __ ¼ Constructed ($50.00) V'/' Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees am 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 m-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $. ~"~'-~) ~ BY: James F. King, President Board of Trustees James F. King. President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. P.O. Box 1179 Southold, NY 11971 Telephone(631) 765-1892 Fax (631)765-6641 Southold Town Board of Trustees Field Inspection/VVorksession Report Date/Time: RALPH VESTBOM requests an Administrative Permit to place two (2) cedar posts 6' high with 12"X 12" signs above the high tide line. Located: 3500 Lighthouse Rd., Southold. SCTM#50-2-1 Type of area to be impacted: __Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: __Chapt.275 Chapt. 111 other Type of Application: __ Wetland ~Administrative__Emergency Coastal Erosion Amendment Pre-Submission Violation Info needed: Modifications: Conditions: Present Were: __J.King __J. Doherty __P. Dickerson __ D. Dzenkowski other Form filled out in the field by D. Bergen__ B.Ghosio, Mailed/Faxed to: Date: James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob ~nosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (63i) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland Permit Application ~"Administrative Permit Amendmenffrra~.fer/Extension R~eceived Application: fi'Received Fee:$ ~--~ e~ , , · ,,..'Completed Application ~ _IIX[0 ~ Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) .~LWRP Consistency Assessment Form CAC Referral Sent'"-'-'- ...l~ate of Inspection: q [ q Receipt of CAC Report: Lead Agency Determination: Technical Review: _....P~lic Heating Held: q [~'~{0 ~ Resolution: Name of Applicant /~) ff4.~¢/q Address ~0 ~ ~rC ~, ~ff~[~ ~ ~ehoneNumber:(~ 765- / ~ / Suffolk County T~ Map Number: 1000 - 0~0,0 / 0~.00 /001. 000 / , Prope~yLocation:~OO ~0~S~ ~ad (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: ~rd of Trustees Applicati~ Land Area (in square feet): Area Zoning:. GENERAL DATA Previous use of property:. Intended use of property: Covenants and Restrictions: Yes No If "Yes", please provide copy. Prior permits/approvals for site improvements: Agency Date __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended 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 Purposeoftheproposedoperations:~'-O ~D ~/-~F ~ 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? t// 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 mater/al will be removed or deposited: cubic yards cubic yards feet .._Statement of_t.l~e' ~ff_e~t, _i[.~ny~ ?_n _th~ ~v_et_l_a_nds and tidal wa_ters 0fthe_ town that may res~ul_[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 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or orovide map 5. IS PROPOSED ACTION: [~d~ew n--]Expansion ~] Modification / alteration $EQR 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: InRially acres Ultimately acres 8~ 8. V~LL PROPOSED ACTION COMPLY WWH EXISTING ZONING OR OTHER RESTRICTIONS? Yes L-J No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ,~Residential r-~lndustdal [---]Commercial ~]Agriculture [~ Park / Forest / Open Space r~other (describe) 10.' DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal. State or Local) ~*Yes ~ No If yes. list agency name and permit / approval: 11, BUt:5 ANY, NY ~¢.t~'lzL;I OF IHE ACIION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? K--lYes J~o if list name and permit / approval: yes, agency 12. AS A R~:JLT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? · I CERTIFY T~H~NFORM~TION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Na~~ ~~~~. Date: Signa[ure If the action 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 617.4? If yes, coordinate the review process and use the FULL EAF. E~]Yes E~]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. [*'lYes ~'--~ No L COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, sudace or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain bdefly: C2. Aesthetic, agdcultural~ archaeological, historic, or other natural or cultura~ resources; or community or neighborhood character? Explain briefly: 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 intensity of use of land or other natural resoumes? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAl. ENVIRONMENTALAREA CEA? If es, ex lainbdefl: E. IS THERE OR IS THERE LIKELY TO BE, CONTROVERSY_ RELATED T0 ~OTENTIA_L ADVERSE EHVIRONM~NTAL IMPACTS? If}~e.~ explain: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadveraee~ectidenfl~edab~ve~deterroinewhetheritissubsb~nfla~~~arge~irop~rtant~r~therwisesigni~can~~ 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 necessary, add attachments or reference suppoding roatertals. 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 determ!n=~c.", cf s[[',n!fic3Rcc must eval~ctc thc Fctcnt!aPiropcct cf~,¢ prcpcc sdc, cfic;~en thc cnv~rcr, ro~ntal char~ct~ri~tics ofth~ C,~A. Check this box if you have identified one or more poten fialiy large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessaiy, the reasons supporting thi~ determination. Naroe of Lead Agency Date Titte of Responsibte Cfficer Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Signature of Preparer (If different froro responsible officer) of Trustees Applica~n County of Suffolk State of New York '/~-~tO~ ~t~ £ 7g~q J"~ 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, ! 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 '~ / DAYOF,'~IU _~ 7t. ,20 ~)q Rt~HNANAND PERSAUD NOTARy P!AJLIC, e. t,~,TE Ch= NEW YORK Board of Trustees Applicat~n AUTHORIZATION (where the applicant is not the owner) ~/~ ~/~ g~-~o//~ residing at (print owner of property) (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE. FORM The Town of Southold's Code of Ethics vrohibits conflicts of interest on the vart of town Officers and employees. The oureose of this form is to nrovide information which can alert the town of~ossible conflicls of interest and allow it to take whatever action is necessary to avoid same. (Last name, first name, ~idd/e initial, unless you are applying in the 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 alt that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (lf"Othef', 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- "Busines~ 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 thso 5~6f 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 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 ~hild is (check all that apply): A) the owner of greater than 5% of the shares of the corporate stock of the applic0ot (when the applicant is a corporation); B) the legal or'beneficial owner of any interest in a non-corporate entity (wh6a the applicant is not a corporation); ___C) an officer, director, pas~ei', or employee of the applicant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP S.bmi.e o' 200 Fo~ TS 1 Town of Southold LVOIP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits' and other ministerial permits' not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION The Application has been submitled to (check appropriate response): Town Board ~ Planning Dept. [] Building Dept. [] Board of Trustees ~ Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital [] construction, planning activity, agency regulation, land transaction) [] (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent Location of action: Site acreage:. Present land use: Present zoning classification: If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: ~5~/~.~ /~_/~./t~gf~ /~_t (c) Telephone number: Area Code ( ) (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [] No [~/ If yes, which state or federal agency?. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. [] Yes [] No ~N°t Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria ~ Yes ~ No [~Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria [] Yes [] No [~Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pa. ges 8 through 16 for evaluation criteria [] Yes [] No~lv'~ Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria ~ Yes ~-~ No[~2/i ~'lNot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. [] Yes [-~ No [~/Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. [] Yes [] No[~2~Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section Ill - Policies; Pages 34 through 38 for evaluation criteria. [] Yes [] No [--~Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. [] Yes~ No ~/Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. [] Yes [] No [~Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ~ Yes [~ No [~Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. ~-~ Yes [] No [~Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. [] Yes [] No 7- Not Applicable Created on 5/25/05 1 l.'20 ~4M Iz971 Beach Private Property Sign/Post Ralph and Dorothy Vestbom 3500 Lighthouse Road Southold, NY Aluminum Sign 18'x 24" Stainless steel bolts NO TRESPASSING ABOVE HIGH TIDE UNE VIOLATORS WILL BE PROSECUTED Cedar Post 6' Aluminum Sign 3.5'x 36" Beach Private Property Sign/Post Proposal Ralph and Dorothy Vestbom 3500 Lighthouse Road Southold, NY 8/20/0/9 Aluminum Sign 12'x 12" / Stainless steel bolts NO ABOVE HIGH TIDE UNE Cedar Post 6' $outhhold 1own Board of Trustees Sound AVENUE ~D/OR FHOM DATA O~T~NED FROM OTHERS APPROVED BY BOARD OF TRUSTEES TOWN OF $OUTHOLD DATE ~'~,~,~ ~- o ~