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HomeMy WebLinkAboutTR-8182E James F. King, President O~~ffQ(KCO Town Hall, 53095 Main Rd. Bob Ghosio, Jr., Vice-President ti~ P.O. Box 1179 Dave Bergen ~ ~ Southold, NY 1 1971 at John Bredemeyer O Telephone (631)765-1892 Michael J. Domino y~O! ~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE QF INSPECTION: w~P ~r / Ch. 275 Ch. 111 EIY) wq e n C~ ~e rm i C Nrwrl Cane Sandy J INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction /YZ constructed v Project complete, compliance inspection. ~ I gZ -E INSPECTED BY: ~ COMMENTS: CE(R/TIFICATE OF COMPLIANCE: No. 9~ ~ 8 2 E ~rri c ar? ~ Spun dy . Lmergcnc~ Ptrnr~- • Issued To~rowht~l. C~u~ Proa. Date 2 h ~SSoc ec ~'c Address 2 15 ~4rrow ta.l l.ant. ~ P on S~tM ~ 4g~ 2~Zb ~ THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE.TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765.1892 .~,4 ~ ' ~~~_5: w~ :1; ~ 1' 94Y ~ ~ . 7 { r N ~ a~1~~ 1 ~ '~,~'-~}1~ j ~ ~ ~I ~P" ~ r ~ x`~' t ~ ctrl r, ~ A T° T ' ~ r r ~ - I g r ~s ~ i.~ ° } Y} r Yt S~ .~Yb ' c F_„r ~ n~; E rte. ~y~' yAa s I<0 1: t~ ~~.t .u.:. t ~ '}i n i, 1 1dt h~ ti „ ,;~I~ ~ tip r 1 pl t~ ~ I 1 y. t 1- a ~-~t { ~ / ~ iii . t d~ t ffyy a 't ~A 7 ~ ~ }~1 ~ , 1 ~ + ~ ~ ~ ~ - - - _ v~ Y ~ - r------ ` I. ~ C_ 2 • ~ ~ A t ~ ~ ~ ~ n ~ ~ w ~ n o ~ ~ ~ o n ~ rv " ,1 w - ` ~ ~i ~v i • n V 4 y / 1 t art ~ '1 ~ G,T~ +iie , ~ . ~ ~ - '+~,.1. ~ ` Tin ~ l~ P!' r - - - T 4 _ !k_ v'1hA7~ L1,~ ~ l~~ ~ '4 Y k ~ # ~ % - ~7k~. " t- Google Maps ~ ~ 5/30/13 11.52 AM To see all the details that are visible on the screen, use the "Print" link next to the map. t. . ~ ..w... ~ ~ d' = - ~r.. lgyy ~ A ~ ~ ti N ~;G ~y ~ R~' rn ~R~ ~ = • ~ 4- f. ~ may a M ~ ! ~~rk* ,.~A ~ x ,~ti i ~ ? L ` _ ~ ~ a ~ M1 N m~•~ r ICY fi4 ~ • '3' A L , ~ M., A Y' .L. ,,,4 Y V^` ~~~,o +d ~ K w. ~ ' N'~,, W I key - ~ iQ - p e ~ ~ a ~s..y v . .w... d, t' ~ r P` s n;M ~ ~t a ~ *A s. ~ . an 9 ~ +.y~,. 1 e~ y~M . , Ya1 4 ~ -4 i r'' > ~ " z Imagery ©2013 New York GIS, Map data ©2013 Google - https~;maps.google_mmJ Page 1 of 1 o~~~~~~~ fr1AY 3 0 ?~13 Southold Tc,~ r ;i~ss TROPICAL STORM SANDY EMERGENCY APPLICATION Valid th/~ru June 1, 2013 Property Owner Name: ~t~.BC~o^~~n,~-oqp'~ ~w"'~V ~~CF}~ Permanent Mailing Address: ~o ~~X Y gS N r j 14 Phone Number(s): ~ 3 j ` 7 ~ `f ' ~O~ Property Address: f~~?~W l~'fAID ~l4Ne i- ~'Ar»QF/~'~C ~?,IN-Q Suffolk County Tax Map Number. 1000 - Q,~r- ~a C~ Agent (if applicable) ,To ~ ?o IJ~DO ~ S , nQ~ S f d -e niZ ~i4 eA~ Address: i ~ ~S ~ 22oW E~F4RD (1A~v-Q n..2FOA1 iC ,tl~/' Phone Number(s): ~ ~ ~ ` ~ 3 Y ' ~ a Board of Trustee Permit Number(s): Will any part of this project require a Building Permit? N a How much fill will be required? tUo N-Q Project Descriptionl: ,da q„.c-~vu:~ ~T~. Sa~u~/ ,?1~ /¢~fl .a.~n~tct~,eQ 'ln t~~~b-~(U'~v,(Lt' lK.~" Z~nl -da..,~.1~.--e.~n.ol e~Ca^ti4~u.~( ~cw~.e+,e1+4..~.~P~+' u~Nl cJ~,~( ,d cu~.o~ ~ 7 - ll dy- ...~~-~~cuu..rkw~n.l~-¢.~.a o~c'W cp,~-pia wa-~--~.a~(.ua.~cGc~u.~i eQ.c.~~-~ ~9-ul/l ~(,,Q~ o''~~-~G.-~.o~P,;,.~t~y~+~EC t~o-E~v.E'.~..P.w~g..~.n.Qo~~~(t1nv~~-B'`d^"~ ~ ..Z-ec~.el~ _e.~~i'e~u-eQ ~.~n-7___a,>=,~.,~ 'v~ 0.~-1~.~ ..~.ea,~-~ ~ ~o ~2-ea_.P,(1 c~uaacQ C~ ~~t U County of Suffolk State of New York fo Al F, w 0 0 d 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 WITH REVIEW OF THIS APPLICATION. ~ ~ Signature of Property Owner SWORN TO BEFORE ME THIS ~ DAY OF ,20 / 3 , ° .Q~' R_ Notary Public Peary PYlilk''S~ New YbrM No.O1BE6099317 Qualified in SuffotM ~ormty Commission Expues Sept. 29, I r , • AUTHORIZATION (where the applicant is not the owner) I, ~/Yl~a+~v--~.P0.d( la}y„( ~ . residing at q'U 1~1C y g.~ /-e-C.B~.~ N y (print owner of property) (mailing address) do hereby authorize Ta /~ti F. Gu ro AS's (Agent) `~-"r-'-Clun.r /~r{~} to apply for permit(s) from the i Southold Boazd of Town Trustees on my behalf. (Owner's signature)