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Home My WebLink AboutTR-7269AJill M. Doher~, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemcyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southotd, NY 11971 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. Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer 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.: 7269A Date of Receipt of Application: April 2, 2010 Applicant: Robert & Judy Finn SCTM#: 126-5-19 Project Location: 8908 Peconic Bay Blvd., Laurel Date of Resolution/Issuance: April 21, 2010 Date of Expiration: April 21, 2012 Reviewed by: Trustee James F. King Project Description: To cover bulkhead foundation with approximately 12 cubic yards clean fill. 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 in the application prepared by Robert & Judy Finn, received on April 2, 2010. 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. Board of Trustees JMD:eac Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghnsio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631 ) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD P ease be advised that your application dated has been reViewed by this Board at the regular, meeting of ~¢~' I ,~1, o~o/o and yOur application has been approved pending the completion of'the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ Ist Day of Construction ($50.00) ¼ Constructed ($50.00) l,~Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid Within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: BY: Jill M. Doherty, President Board of Trustees Jill M Doheny, President James F King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/VVorksession Report Date/Time: /'~,~¢' -z~ ..,? ROBERT & JUDY FINN request an Administrative Permit to cover bulkhead foundation with approx. 12 cy. of clean fill. Located: 8908 Peconic Bay Blvd., Laurel. SCTM#126-5-19 Type of area to be impacted: ~----SaltwaterWetland Freshwater Wetland ' Sound~"'Bay Distance of proposed work to edge of wetland P~of Town Code proposed work falls under: hapt.275 Chapt. 111 other ~f Application: Wetland __Coastal Erosion __Amendment inistrative__Emergency Pre-Submission __Violation Info needed: Modifications: Conditions: Present Were:~'~.King __J.Doherty __J. Bredemeyer__ B.Ghosio, D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: D. Bergen__ Jill M. Dohcrty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (63 l) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application/ Wetland Permit Application t~,Administrative Permit ._~Amendmenffrranffer~Eyension ~fiReceived Application: .t~[ ~ l0 ~.~R.eeeived Fee:$ ~- '~ _ ~ompleted Application~d~ Incomplete SEQRA Classification: Type I Type II Unlisted__ __Coordination:(date sent) LWRP Consistency Assessment Form CAC Referral Sent: -~ ~Dateoflnspecfion: 4[1~[~1} ~Receipt of CAC Report~: __Lead Agency Determination: Technical Review: ~,P~blie Hearing Held: c{ {02A~[~3 Resolution: Name of Applicant Address ~'~E) ~ AGENT: (If applicable) Address: Phone: ard of Trustees ApplicatJ GENERAL DATA Land Area (in square feet): Area Zoning: t~'/ Previous use of prope,y: ~tended use ofprope,y: Covenants and Restrictions: Yes ' [,,,/No If "Yes". please provide copy. Prior permits/approvals for site improvements: Agency Date fl,~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 ~ard of Trustees Applicati WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~ ft~.~ ~ I/q/t~ Area of wetlands on lot: .squTM 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 t/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 Statement ofJhe, e~eq_k !~'_ ~an_y, 0_n the wet!_agds an4.tid..M._ w.a__ters_ Pf~e town that._m_ay__ reason of such proposed operations (use attachments if appropriate): IPROJECT ID NUMBER ~ART 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 Applicar)t or Project Sponsor) NAME 2. PROJECT! ~/ County :~l~~--~/~'/ SEQR 3.PROJECT LQCATION: ~ i Municipa,ity Frq 4. PRECISE LOCATION: S~eet Addess and Road Intersections, Prominent landmarks etc -or provide map 5. IS PROPOSED ACTION: ~ New ~ ~pansion ~ Modifcation / afleratio. 6. DESCRIBE PROdECT ~RIEFLY: 7. AMOUNT OF ~ND AFFECTED: Initially ~ acres Ultimately acres 8. ~LL PROPOSED ACTION COMPLY WiTH EXISTING ZONING OR OTHER RESTRICTIONS? ~es ~ No If no, describe briefly: 9. WHAT IS PRESENT ~ND USE IN VIClNI~ OF PROJECT? (Ch~se as many as apply.) ~sidentia, ~,ndustda, ~Commercia, ~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, State or L~I) ~Yes ~No If yes, list agency name and permit / approval: 11, uuE~ ANY A~PE~I OP IH~ A~TION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ~Yes ~o If yes, list agency name and permit / approval; 12. AS A RESULT OF PROPOSED ACTION WILL ~ISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicanl /~~ Dat~ ~ Signature ~ 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? ff yes, ~onrdlnafa the reVmw pmonss and use the FULL EAF. I-I - 171.o B. WILl. ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNUSTED AC'RON8 IN 6 NYCRR, PART 617.67 If No, a negative declaration may be supemadad by another Invoivad agency. r-I - r71"0 C. COULD A~ RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FO{LOWING: (Answ~s may be haadwdifefl, If leglMe) I"° I C3. ;'~A.[;~, m' fauna, fish, ~ .F,;~'~, re'wildlIfe spe~s~, significant habitats, or ~reatened or endangered species? F_~in briefly:. I C4. A ...... anlty'a r..,;~;,,~ plans m' i~oals as off~elly adopted, or a cha~ge in use or intenstf~ of m of land or nthm. natural resources? ~= .~,Ta.,r~ ixielt/: I C5. Growth, s~,~,~ent development, or mtsted acthdfies flkeiy to be induced by the p~oposad ac~? F-x~ain briefly: I ~. o~r In~t~,lino~l~ ~r,~, In ~ offS- qua~ or t,~ of ~ ~ r,~n D. V~LL'I~IE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAl. CHARACTERISTICS THAT CAUSED THE ESTABUSHMENT OF A CRITICA ENWRONMERT~ AR~ [] ¥~ ITl"0 I (If~a~lain~ha"F I E. IS_....~ERE, ORIS THERE UKELY TO BE; CONTROVERSy RELATED TO*POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If ~ ~_~.-_~: UTM L~jNo I PAI~' III - DETERIIINA~ON OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadversee~e~tident~indab~ve'determinew~e~her~tis~ubs~antia~'~a~e~~n~ Each eflbct should be assessed in connection with its (a) setting (i.e. Urban ~' rural); (b) probability of occurring; (C) dum0on; (d) In~vers~llly; (e) geographic scope; and (f) magnitude. If neoessary, add attachments or reference supporting materials. Ensure that e,~planatlcms oonfaln mJfficlent deteff to show that all relevant adveme Impacts have been identified and adequately addremmd. If question d of part Il was checked yes. fie,determination of significance mustevaluate the potential impact oflhe proposed action off the environmental charactertstfl~ oftha CEA WILL NOT result In any significant adverse envimmental Impants AND pro,de, on offa~tents aa ne~ssa~,, the reasons suppoding th~ detennlnadon.. Board of Trustees Name of Lead Agency Date ,Jill M. Doherty President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer S~gnatum of Responsible Officer in Lead Agency Slgnslum of preparer (If riiffenmt m responsible officer) OBoard of Trustees Ap~ 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 IN THE MANNER SET FORTH 1N 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 TI-I~ TRUSTEES THEIR. AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONIUNCTION WITH REVIEW OF THIS APPLICATION. / c/ / Signature SWORN TO BEFORE ME THIS ~.~ tlc4 DAY OF t~4Jd ,20/0 'lxl~t [ry Public LAUREN M. STANDISH Notmy Public, State of New Yor)~ No, 01ST6164008 Qualified n Suffolk County COmmission Expires April 9, 20 j[ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE, FORM The Town of Southold's Code of Ethics orohibits conflicts of interest on the oart of town bfficers and emnlovees. The nurooSe of this form is to orov de information which can alert the town of oossible conflicts of interest and allow it to take whatever action is YOUR NAME: /"='Id/~ ! (Last na~e, first name,~iddle initial, un y pp y' g' som~ane else or other cnlity, such ss a company If so, indlcat~ thc other l~rSon'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 mlafioaship with any officer or employee oftbe Town of Southold? "Relationship" includes by blood, marriage, or business inte~es~ "Basin. ess interest" means a business, including a partnership, in which the town officer or employee has even ~. partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO ~ lfyou 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% oftbe 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, pm'trier, or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1