HomeMy WebLinkAboutTR-12 rev. 3/Z8t88,
YOUR ORIGINAL PEP=~IT NUMBER
BOARD OF TO~N '~?RUSTEES
Town of Southold
l%~ain Road
Southold, New York 11971
APPLICATION FOR SPECIAL ICE DAMAGE PERMIT
INSTRUCTIONS: Fill out form below and return to above address. You
should have this application approved and retu~ned~ to you. w~thi~ a Week~
~ ..~.'.'....'.........-. ~., ~ ...........~ ~~
2. Contractor's Names & AddresS: ........... ' .... , .... ~.... .......... ,...'.
Tel No
3'. The purpose of this application: Redriving or repla~ing openwork
dock or openwork pier piling,~, and~
removal
of
damaged
piling, repair, resetting or replacement-of floating docks, ramps,
'or decking, all necessitated by ice and storm damage resulting during
1987-1988 %4nter.
SPECIAL CONDITIONS
1. No dredging or filling is permitted.
2. Repairs to existing structures shall be limited to replacement o'f
timbers withoht change in design or dimension.
3. No repair or replacement of bulkheads is permitted under this permit'.
4. No freshwater or tidal wetlands are to be disturbed under any
circumstances.
~5. A yellow permit sign provided by this office shall be displayed on
the project at all times while under replacement.
6. Original permit numbers (3'~ high) must be permantlg displayed on
project.
(Tear off and return)
'I, , certify that the work as authorized in
this permit has been completed and is now ready for your inspection.
Also, the permit number required on this project .~s clearly visible.
PERMIT NU~ER
:::"::"':--_-' .....'....... ~ Signed- Owner Si~ned - Contraotor
Board
'Of $o"uthotd Town
SOUTHOLD, NEW YORK
Trustees
DATE: ~q.YP.mber -,.Z1, 1
PERMIT NO: :bO50
Pursuant fo the provisions of. Chapter 615 of' the Laws of
~he State o~ New york, 1893; and Chapter 404 of the Laws of.~he
Sfa+e of New York 19521 and the SoufhoJd Town Ord[nance.en~
rifled "REGULATING AND THE PLACING OF OBSTRUCTIONS
iN AND 'ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, ~RAVEL OR OTHER MATERIALS FROM'
LANDS UNDER TOWN WATERS;" and in accordance wffh the
ResolUfion of The Board adopted a+ a meefbg held on ..No.~.p~.~
19...2.4.., and in cons~derafbn of the sum of $.3.0.,..5.9 ...... paid by
Preder~ck ~atconer
Terms and CondffJons lis+ed on the reverse side hereof,
of SoufhoJd Town Trustees aufhorlzes and permffs +he following:
[0 ft.., float 6 ~t. b~ 20 ~., w~th two moo~zng
pk[es and ~edredge an area 30 ~t. b~ 30 ft., ~emov~
'pza~ea on one apR&zcant s.up&an~ p~ope~c~ at PZe'e~woo,
all in accordance wl+h the detailed specificitions as pre, need [n
'the o~gJ~a~bg aBpJica}To~ . ,
Road, ¢~:cnogue, a~ ~a~ Creek, e~ecCkve Oct.[.2,Z974
)N WITNESS WHEREOF, The s~ld Board of Trustees h~re-
by causes frs Corporate Seal fo be aft)xed, and these presents fo
be subscr]bed by a majority of +he sa)d Board as of +his
TERMS and CONDITIONS
The Permittee
Frederick Falconer
..r~iding a't Boxy' 1OD, F_l~eetwood Road, Cutcho~ue 11935 N.Y., x~
part of the consideration for the issuance of the Permit doe~ understand ami prescribe to the fol-
lowing:
1. That the said Board of Trustees and the Town of Southold are released from a~y and
all damages, or daims for damage, of suits arising directly or indirectly as a result Of any oper-
ation performed pursuant to this permit, and the said Permittee wi~ at his or her' own expense,
defend any and ali such suits initiated by third parties, and the said Permittee mqsumes fidl liability
with respect thereto, m. the complete exclusion of the Board of Tmees of the Town of Southold
2. That tiffs Permit /s' valid for a period of 12 mos. which is considered to be the
'estimated time required" to complete the work involved, but should drcamatances warrant, request
for an extension may be made to the Boaxd at a later date.
3. That this Permit should be retained indefinitely, or as long as the said Permittee w/shes
to.. maintain the structure or project involved, to provide evidence to anyone conCemed.,that auth-
Orization was origimlly obtained.
..... 4: That. ~the work involved will be s-abject to the inspection and approval of the Board or
its agents, and non-compliance with the provisions of the originating application, may. be cause for
revocation of this Permit by resolution of the said Board.
5; That there will be no unreasonable interference with navigation as a result of the work
he?ein attthorized~
6. That there shall be' no interference with the right of the public to pass and repass ~long
the beach between high and low water marks.
7. That if future operations of the Town of Southold require the removal and/or alterations
in the location of the. work .herein authorJged, or if, in the opinlon of the Board o£ Trustee% tJae
..... .work shall muse unreasonable obstmmon to free navigation, the said Permlttee will be required,
· upon .due notice, to remove or alter this work or project herein stated without expen.~ tO the Town
"of. Southold.
'%'.'.. ,: 8. That the said Board will be notified by the Permittee or the completi°n of the work auth-
~ ... . 9. That the Permittee will obtain vSI other permit~ and consents ,hat may be rorluired mi>
7!i5~' .' ""75 ~"...plementvfl 't0 this permit which may be subject to revoke _.upon failure to obtain same.
BOARD OF TOWN TRU$TEES
Town of Southold
Main Road
Southoh], New York ]197]
P/1 Igev/6/~2
Frederick Falconer, Box 10D, Fleetwood Road, Cutchogue~ N.Y. 11935
]. Your application, dated ...... ~..e.?.,k.~,b,~.~',...,k..9..:,..~.?.7-.4. ...................... hqs been reviewed bY This
Board, at a meeting of the Trustees held on ....0.C.tZ.Q~.~...7 ..... ~-.9,.7~....~.~.ci..~,O..v..C.~b..~.~.,.~,l.,.....k. 9..7..4.
and resulting in the action, as [ndicoted be[ow:
(._.~...) Application approved.
( ............ ) Application denied.
( ............ , Application tabled.
2. Comments and remarks:
3. if your apphcat]on s approved aDove, A Permit Fee ~s now due, aha snou~c ae m~de p~y~b!e
to the order of the Board of Southold Town Trustees. This fee is computed beiow ~ccording
?he Schedule of Ra%'es as set forth in the Instruction Sheet (Form
If the Permit Fee is paid in person to t~,e Secretary of the Board. The Permit wi]! b( ob'r~inoDic
a~ the same time. if ~he fee is paid by mai], the permit will De mailed in rep~y
Computation of Permit
Catwalk - ~ ft. by 10 ft. - l0 sq. ft. -~ 10¢ sq. ft. - ........... S 4.00
Ramp - 2~ ft. by 10 ft. - 25 sq. ft. - ~ 10¢ sq. ft.
Float - 6 ft. by 20 ft. - 120 sq. ft. - ~ t0g sq. ft.
2 Mooring piles ~ $1.00 each
100 cu. yds. fill dredged - ~ 10g cu. yd.
Less filing fee
2.50
12.00
2.00
10.00
$30.50
5.00
$25.50 DUE
Total Fee for this application ............................................................ $ ....2.,.5..~.,.5, Q .......................
Chin. Boord of 5outhold Town Trustees.
Secretary.
BOAiqD OF TO~N TRUSTEES
Town of Southold
~a;~n Road
Southold. ~ew _York 11971
P/!
Lawren2e M. Tuthill 1215 Inlet Lane. Green~rort, N.Y. 11944
To: a/Cprederick Falconer. Box 10D, Fleetwood Road, Cutchogue, N.Y.
~ Your application, dated ............ .~,.e.e..tz. 9..~.~.e...~ ..L..9.., L97~' ............ has ~een reviewed by this
Board, ar a meeting ef the Trustees hetd on qC~o~Dr 7, 1974
cna resuiting in rrm action, as indicatedbe,ow.' ' '
Appl;cation aaprovea.
Application denieo
and make
Appiication tabled The Board will investiga:e the
e deciszen ae hheir nex~ meetLn~ OR Nosemb~r
2 Comments end remarks:
3. if your application is approved above, A Permit Fee is nc~ aue, and should se mede savqb[e
;o me order of the Board of Southold Town Trustees. This fee is computed
?he Schedule of Rotes as set form in rne nsrruction 5hee~ (Form
!f the Permit Fee ~s paid n person ~o rne Secretary of the Board, The Pa:mit wil~ ~e ~bt-oincbic
et the Some t~me. If the fee is paid by mail, the permit w~ll be mailed in redly.
Computation of Permit Fee:
Total Fee far this eDolicatien
Signea ALVAH B. GOLDSMITH
Chin. Boaro of 5outnold Town Trustees
Secretory.
BOARD OF TOWel TRUSTEES
Town Of Southold
Main Road
Southold, New York 11971
Rev.
APPLICATION FOR FIXED and/or FLOATING DOCKS
...... ..... g.,...z -
2. Contractor's name and address: A..~.,.~...~..~....~.,...~....~..,.~.../'..V~..:....Z..~....~,..~.~L..!.~. .....................
.......
3. Briefly explain the purpose o~ this application: ......
....... .............................................
4. After issuance of a Permit, I expect to: (mark by on X)
(a') Com,mence work ~ AT ONCE ............ ; ASAP ..~ ..... ; UNKNOWN .............
(b) Complete work in ~ 1 DAY ............ ; 1 MO ............. ; 1 YR.~ ...... ; FUTURE .............
5. Secure the correct Areo Map from the Secretary of this Board, ,~nd by using an X WITHIN
A CIRCLE indicate as closely as possible the location, of this dock. On the reverse side of this
map, provide ~ SCALE DRAWING which will show Ordinary High Water Mark, the shape
and size of the dock and any supplemental pilings which are needed to hold a floating dock
or tie-up a boat. Give ali dimensions necessary to determine the area of the dock surface
which extends offshore from the O. H. W.M. ;~/~ "b~ & ~ ~-~ ~ ~
6. Will any portion of this construction extend offshore into Town Waters beyond an, imaginary
line or boundary formed by other similar structures along the area's shoreline? YES
If it does extend beyond this so-called dock line indicate by how far, approximate[y,~'-~...ft,
Provide the following docu:ments:
(a) A Licensed Engineer's Survey of the property involved.
(b) A copy of t'he Contractor's Plans and Specifications.
8. Will this construction require the Filling of any land offshore of the Ord_4nary High Water
Mark or the Dredging of any material from Town Lands under water?~J~'or'¢~l~. If it
Form A/4 (ApBlication for Dredging/Filling) .must be completed and qttached as part of this
9. In requesting approval of this application, I submit that: the information presented herein
is true and correct to the best of my knowledge and belief; I am the person accountable for
the performance of the work in accordance with the plans and specifications attached; I have
read .or am familiar with the provisions of any Southoid Town Ordinance pertinent to the work
involved; and further, I intend to adhere to and abide by the Terms and Conditions of the
Permit, when a,nd if issued to me.
.~ccepted [:]Y;..,2/'~, ~/y!