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Home My WebLink AboutTR-7801A James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall Annex 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated WI q II ~ has been reviewed by this Board at the regular meeting of ~ lt~ ! I ~ 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) __ 1st Day of Construction ($50.00) __ ½ 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: BY: James F. King, President Board of Trustees James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, 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 ~ constructed JProject complete, compliance inspection James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino 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.: 7801A Date of Receipt of Application: May 4, 2012 Applicant: Jon Kerbs SCTM#: 143-5-9 Project Location: 430 Riley Ave., Mattituck Date of Resolution/Issuance: May 16, 2012 Date of Expiration: May 16, 2014 Reviewed by: Board of Trustees Project Description: To install a 4' high split-rail fence with wire mesh, and if necessary, across the south end of the property no closer than 10' landward of the marsh fringe. 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 survey received on May 4, 2012 and stamped approved on May 16, 2012. 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 .~King, Preside~ Board of Trustees P.O. Box 1179 Southold, NY 11971 Telephone (631 765-1892 Fax (63 I) 765-6641 Southold Town Board of Trustees Field Inspection/VVorksession Report Date/Time: JON KERBS requests an Administrative Permit to install a 4' high split-rail fence with wire mesh. Located: 430 Riley Ave., Mattituck. SCTM#143.5-9 Type of area to be impacted: ~r~ltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Pac,~haf Town Code proposed work falls under: pt.275 Chapt. 111 other Type of Application: i/Wetland Coastal Erosion __Administrative__Emergency Pre-Submission __Amendment Violation Info needed: Modifications: Pr~dntBrVVe~r~r~e ,~rJ. KJ/J.Jpg ~B. Ghosio · y J/ MiChael Domino //D. Bergen, D. Dzenkowski Form fille__d out~q tl)e field by -J , LJ'xcr em ~ e,'- Mailed/Faxed to: Date: other James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino 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 Office Use Only Coastal Erosion Permit Application Wetland Permit Application ~ Administrative Permit Amendmenffrransfer/Extension Received Application: Received Fee:$ 5"OOe ° f . /.,,'Completed Application ~1 q! I~- Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) ~7~LWRP Consistency Ayessment Form ~CAC Referral Sent: ~ I ~5ate of Inspection: ~ __Receipt of CAC Report: __Lead Agency Determination: Tectmical Review: --~ublic Hearing Held: Resolution: Name of Applicant & C Address ~, '~ t...~ ArC_ Phone Number:( Suffolk County Tax Map Number: Property Location: (/~tQ (provide LILCO po~:~c~s:eets~tion) AGENT: (If applicable) Address: Phone: of Trustees Application Land Area (in square feet):_ Area Zoning: ~ 5 Previous use of property: Intended use of property: GENERAL DATA Covenants and Restrictions: Yes _ ~<7 No If "Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals __Yes ~-- No If "Yes", please provide copy of decision. Will this project require any dfi, molition as per Town Code or as determined by the Building Dept.. Yes ~.,_N o Does the structure (s) on property have a valid Certificate of Occupancy y Yes Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspend, ed by a governmental agency? ~>< No Yes If yes, provide explanation: Project Description (use attachments if necess~ary): of Trustees Application 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? y 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 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): 617.20 PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only 3ART 1 - PROJECT INFORMATION ( To be completed by Applicant or Project Sponsor) 1, APPLICANT / SPONSOR 12. PROJECT NAME 3.PROJECTLOCAT,ON: I I County 4. PRECISE LOCATION:,.~tre#t ~dde,?~ and Road Intersections, Prominent landmarks etc -or provide mag t 5. IS PROPOSED ACTION: ~ New ~ ~pansion ~ Modificaaon / alteration SEQR DESCRIBE PROJECT BRIEFLY: 7 AMOUNT OF LAND AFFECTED: ~ ~ Initially acres Ultimately acres 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 asapply) ~Residential [] Industrla, []Commercial []Agriculture [] Park/Forest/Open Space []O,her (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) F'~]Yes '~71"No It yes, list agency name and permit / approval: T'r. OO~5 ANY ASPEUF OF-THE ACIIC)N HAVE A CURRENTLY VALID PERMIT OR APPROVAL? E~]Yes I~qNo If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? E~Yes o I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicanl / Sponsor~~Signature D~ateT"~/~ ou are a state agency, complete the Coastal Assessment Form before proceeding with this assessment Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M, ~ THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATEI~ GRADING~ DRAINAGE AND EROSION CONTROl. PLAN e/strict section atsck Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. sCOPE OF WORK - PROPOSED CONSTRUL;r~ON ft'l~I# / WORKASSF_,SSMENT ] Yc~ No a. What is the Total Area of the Pro'ject Parcels? I Will this Project Retain All Storm-Water Run-Off (Inctede Total Area of all Parcels located within Generated by a Two (2") Inch Rainfall on Site? the Scope of Work for Proposed Construction) (This item will include all run-off created by site r~ b. What is the Total Ama of Land Cleadng (S'F' ~Ac,es) clearing and/or construction activities as weft as all and/or Ground Disturbance for the proposed Site Improvements and the permanenI creation of construction activity? impen~ious surfaces.) (S.F., ~,) 2Does the Site Plan and/or Survey Show Ail Proposed PROVIDE BRIEF PROJECT DESCR]F~ON (P,~ ~ Pm - N.eed) Drainage Structures Indicating Size & Location? This Item shall include all Proposed Grade Changes and -- Slopes Contrulling Surface Water Flow. 3 Does the Site Plan andfor Survey descdhe the erosion and sediment control practices that will he used to control site erosion and storm water discharges. This -- item must be maintained throughout the Entire Construction Period. 4 Will this Project Require any Land Filling. Grading or Excavation where there is a change to the Natural Existing Grade Involving n~re than 200 Cubic Yards of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand U (5,000 S.F.) Square Feet of Ground Surface? 6 is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction U General DEC SWPPP Requirements: or within One Hundred (100') feet of a Wetland or Submission of a SWPPP is required for all Construction activitiss involving soil Beach? disturbances of one (il) c~ more acres; im:leding disturbances of less %hah one acre that 7 Will there be Site preparation on Existing Grade Slopes are part of a iorger comnm~ plan 11~3t will ultimately distsrb one or more ~cres of land; which Exceed Fifteen (15) feet of Vertical Rise to including Construction activities invc~ving soil disturbances of ~ than one (1) acre where One Hundred (100') of Horizontal Distance? the DEC has delermined thai a SPDES permit is reduimd for slorm water discharges. SWPPP'$ Shall meet the Minimum Requirements of the SPDES General Permit 8 Wi'il Driveways, Parking Areas or other Impen/ious for Storz3 Water Discharges from Construction activity. Permit No. GP-O.t0.O01 .) Surfaces be Sloped to Direct Storm-Water Run-Off 1.3~he SWPPP shall be prepared prior to the submittsl of the NOI. ~he NO[ shall be into and/or in the direction of a Town right-of-way? submitted {o the Department pdo¢ ts the commencement of construction activity. 2. The SWPPP shall describe Ibe erosion and sediment control practices end where 9Will this Project Require the Placement of Material, required, post-construct/off sloffn water management practices that will be used and/or Removal of Vegetation and/or the Construction of any I I constructed to reduce ~he p~lutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder STAq'E OF NEW YORK, COUN1T OF ........................................... SS 'lhat I ................................................................................. be/ng duly sworn, deposes and says that heJshe is the applicant for Permit, (Name of individual signing Document) And d~r hdsbe is the .................................................................................................................................................................... (Ovmer, Contr~or, Apaot, Cofporats Offlce~, ~c.) Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have perforated the said work and to make and file this application; that all statements contained in this applic, ttion are Ixue to the best of his knowledge and belief; and that the work will be performed in the maxmer set forth in the application fded herewith. Sworn to before me this; ............................................... dayof ............................................. ~0 ..... Nota~, Public: .......................................................................................... FORM - 06/10 of Trustees Application County of Suffolk State of New York DEPOSES AND AFFIRMS THAT H~,/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 WO~ WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TO~ BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TO~ OF SOUTHOLD AND THE TO~ TRUSTEES H~LESS AND FREE FROM ANY AND ALL DA~GES AND CLAIMS ARIS~G UNDER OR BY VIRTUE OF SAID PERMIT(S), IF G~NTED. ~ COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THE~ AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO ~SPECT THE PREMISES ~ CONJ~CTION WITH REVIEW OF THIS APPLICATION. SWORN TO BEFORE ME THIS DAY OF ,20 /1 Nota~ Public LAUREN M. STANDISH Notary Public Slat6 of New York r,o. 01ST6164008 O~a~!?d in Suffolk County Comm~ss~,.n Expires April 9, 20~ AUTHORIZATION (where the applicant is not the owner) (print owner of property) residing at. (mailing address) do hereby authorize. (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owners signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE. FORM The Town of Southold's Code of Ethics nrohibits conflicts of interest on the oart of town Officers and emolovees. The oumose of this form is to t~rovide information which can alert the town of ~ossible conflicts of interest and allow it to take whatever action is necessary to ~void same. ~ YOURNAME: ¢ ~1 iA ~ ~k.C~:~ ~) (Last n~,, first name, ~niddle initial unless you ~e applying in the name of someone else or other endty, 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 P]anning 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 Soutbeld? "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 NO lfyou answered "YES", complete the balance of thls 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 applicanUagenffrepresentative) and the town officer or employee. Either check the appropriate Iine 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 owner of greater than 5% oftbe shams 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-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 Town of Southold LWRP 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 Waterfi'ont 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 Waterfxont 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" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus~ each answer must be explained in detail~ listing both supporting and non- suooortine facts. 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 PROJECT NAME t~c: V'~ The Application has been submitted to (check appropriate response): TownBoard [~ Planning Board [--] Building Dept. [--~ BoardofTrustee,s/~ Category of Town of S outhold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) Co) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent ~f"a~rccfi°~_n: loc 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: (b) Mailing address: ~ ~0 ~--~ '~:P~ (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? No)~] ' If yes, which state or federal agency? Yes / C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. 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. Not 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 [x~ 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 Pages 8 through 16 for evaluation criteria Yes [] No t/N~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 [~Not/_ 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 IH - Policies; Pages 22 through 32 for evaluation criteria. Yes No ~Not App~ble 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 ~ 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 III - Policies; Pages 34 through 38 for evaluation criteria. Yes [~ No iN 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 POLICIEJ 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 L~J 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 7 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. No ~ Not Applicable Yes DATE 7'.dT O 0 ,~ . '-1' L J APPROV BY BOARD OF TRUSTEES T(~N~I OF SOUTHOLD ~,g~..,/y //, 7--o,'Z_ hdo~t '~01 ol IIt NIl Yldl IIIl ' MAY '4 2012