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HomeMy WebLinkAboutTR-3rev. 3/28/88· YOUR ORIGINAL PEP~MiT NUMBER / BOXRD T aUSZrE Town' of® Soufhol~ 5lMn Road Sou~old, 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 returned to you .within a week° l. ~pp. licant's Name & Address: . . .. . . . ?~..o.. · ...... ".~.<.{//~'¢2.I~2~.'. ~/-~ '~./~.~.' .~. Tel No: Z3U' 2. Contractor's Names. & Address:.~. .......................... Tel. No ......... 3: The purpose of this application: Redriving or replacing openwork dock or openwork pier piling, and mooring piles, 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 winter. SPECIAL CONDITIONS 1. No dredging or filling is permitted. :< 2. Repairs to existing structures shall be limited to replacement of timbers without 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 cir cuss ta nces. .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 permanttF 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 .~equired' on this project ._i.s clearly visible. · PERMIT ~J31BER ":::;'.-.". $iqned - Owner S~.~/_ ~J~.~ Board :O'f:'. Sour'hOld..-.::: Town soUTHOE:D, NEW YORK Trustees PERM.IT.' NO, ........ ~-.~.~':~ ......... DATE: ,..a...'9.c:,;J.-._..7.,........~,9 8.0 tsSUED"'TO" El. Wood HU~hes ' PumU'ant fo'th'e provisions of': Chapf.er 61'5 of. +he Laws of. fhe Sta+e of 'New' yOrl( '189'3; and Chapter .404.of. the. Lg~vs,:.of: State ,o,.f' New" York'i95.2;. and fhe' ~Soufho.ld:' Town Ord;hanCe .eh- tiffed '? 'REGULA'TI. NG.,:AN'D' THE PLACING 'OF':.OBsTRt~'CT[ONS IN AND' ON. TOWN-WATERS AND 'PUBLIC LANDS.. and 'the REMOVAL OF SAND', GRAVEL OR. OTHER MATER'IALS~.;FROM LANDS UNDER "' ' ' ' " TOWN WATERS; and in accorc{a.nce wlth".fhe Resorufion of The Boa~d.i'.adopfed 'al a'meefing he[.d on.'~.~c~.~.._.6., 19..~3.0..~, and ;n consideration, ot!..the, sum of $. .. . ~.~. .;.. .0..0 ..... paid. by:..~ ....................................... ~'~ .W....O.?d,. ~. ug.h..e_s . . of ........... .C.~.~.C.,~oqp.~.. ............................................ N. ¥. a~ct .s~biec+. fo fl~e Terms and C;o.ndifions "Ils.fed on ~th'e reverse side hereof, -"of S. oUfhoJ'd .TOwn Trusfees :authorizes and per.mils +he following:.. to. add .a' 3" x' '~0."' ramp and:"5'"' x 14' 'float. to existing dock off Private property' o~ applicant 'at' MUd. Creek subj. sCt .to.the removal .of ~hr.e~ feet fro~ the existing dock. aJJ Jn accordance wifli the de+ailed speCificafions as presenfed in +he orlg[nafing appJica+~on. IN WITNESS W'HEREOF, The .said. Board 'of Trusfees Eere- by causes 'ifs COrporate Seal fo be affixed, and .these presenfs to b~ Subscribed ..b'¥ a. 'maiorlty of .+he sard' BOa'rd as of ~h~s 1711Meadow':Lane East Meadowi~. Y. 11554 TERMS· and CONDITIONS Etwood."Hugh.eS r~idin§ ~ Skunk Lane, Cutchogue N. Y~ ~ paxt of the consideration for the issuance:of the. Permit does tmdersmnd and .pi~:xibe to.the fol- lowing: 1. That the said BOard of Trustees and the Town of Southold are released from. any and ail: damages, or clMms for damage% of suits arising directly or indirectly as a. result, of any 'opex- atlon perforated pursuant to this., permit, and the said Permi~ will, at his. ox her owa expeme, del'end:, any- and all such suits initiated by third parties,. 'and'the said' Pexmittee assumes full'liah~-. with respect .thereto, .to the complete exclusion of the Board. of Trastees of the Town of Southold 2. That this Permk is Valid for a period of 12 mo~ which' is considered to'be the estimated .time required to complete the work involved,, but should cixcumstances'.Waxxang request for an. extension may be made to the Board.'at a later date. 3. That: this. Permit should .be retained indefinitely, or as Ioog. as the said Permitter. wishes to maintain .the structure or project involved~ to provide evidence to' anyone concerned that auth, orization was originally obtained. '" 4. That. the work inVOlved will be subject to the 'fiaspec~ion and .approval of tim 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 woBr herein authorized. 6. That there shall be no interference .with .the'. right .of the .PUblic to. pas~..amt .re. pass :along the beach between high and tow water marks. 7. Th.ag if future operations of the TgW!l of SOu~td :.~,~lulre..:the.rem~al and/or alterations in the location:, of .the ~Ork'hereia.authorized, or if,. in the. opinlon,Of. L~he Boax'd.'of:'Tru-Steeg the work shali cause unreasonable obstmcuon to free navigation, the said..'Petmittee Will. be requlred~ upon due notice, to remove or alter this work or project herein Prated. without, expenses to the T°wn of Southold. 8.'. Tha~ -the said Board will be notified, by'the Permittee .or th~..COmlal~on, of the work' auth- or~zed~ That the Permitter Will obtain. all ~er permits and com~, e. hat.may :be required plemental to this permit which may be subject to' revoke upon failure, to obtaia same. BO/~ ;TEES Telephone 516-765'1938 11971 September 22, 1981 Due to a change in office personnel, we v/ould like to revise our re- cords. Therefore, we would appreciate it if you would complete the form belOw and return it to the Board of Trustees, Town Hall, Main Road, Southoldr N~. Y., 11971, as soon as possible. Have you received your notice of approval? Hav.e you received your permit? Were you issued a permit number? wa s If so, what is the permit number? Were you issued a mooring number? If so, what is th.e moor~ing number? Thank' you for your cooperation. HUGHES' MEADOW. LN ~AST :~EAD'OW NY I155~ Yours truly, Anna T. Hataier, President Southold Town Trustees BOARD O.F TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 CREEK STRUCTURES INVENTORY TELEPHONE (516) 765-1892 Current Owner' s Name: Address: Purchase Date: Telephone NS.: Previous Owners: Date of Field .Work: Applicant: Permit Permit NO. .: '$ ~.~ Permit Specifications: SpecificatiOns BOARD OF TOWN TRUSTEES Town Of Southold Main Road Southotd, New York 11971 APPLICATION FOR FIXED and/or FLOATING DOCKS 2, (~ontroctor's name eno address: ...1.~'.~/.~ ...... ~.:......~<,.../..~.~.~. ................................................... ....... ....... :...,.... ........... · ........................................ Briefly explain the .purpose of this application: ........................................................................ .............................~.~ 3 '. ......... .x../~..: .......................................... ~,~ ~ ,_c : .............. z / ~ '. ................................. ~.~.r.-.. ........... ~. ..... ~.~,.~.~ ....... ~.~.~ ....................................................................................... After issuance Of a Permit, expect to: (mark by an (a) Commence work-- AT ONCE J ' ASAP · UNKNOWN (b) Complete work in -- ] DAY V/' ' I MO ............. ; ] YR ............. ; FUTURE Secure the correct Area Map from the Secretary of this Board, and 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 a 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 all dimensions necessary to determine the area of the dock surface which extends offshore from the O. H. W. M 6. Will any portion, of this construction extend offshore i.nto Town Waters beyond an~jj~naginary line or boundary formed by other s m ar structures a ong the area's shoreline? /~j~!~ or NO. if it does extend beyond this so-called dock line indicate by how far, approximately,. ......... ft. Provide the fallowing documents: (e) A Licensed Engineer's Survey of the property involved. (b) A copy of me Contractor's Plans and Specifications. Will this construction require the Filling of any land ,offshpre of the Ordinary High Water Mark or the Dredging of any material from Town Lands under water? 'lll~or NO. If it does, Form Al4 (Application for Dredging/Filling) must be completed and attached as part of this application. .Accepted by: In requesting approval of this application, I submit that: the information presented herein ~s true and correct to the best of my knowledge and belief; I am the person accountable for t'he performance of the work in accordance with the plans and specifications attached; I have read or am familiar with the .provisions of .any Southold 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 and if issued to me. BOARD OF TOWN TRUSTEES Towa of Southold Main Road Southold, New York 11971 P/1 1~ev/6/5'2 1. Your application, dated .......... ,~.~/..~....~....7(.~ ........................................ has been reviewed by this Board. at a meeting of the Trustees held an .......... .~.~....~../..~. ............................................................... a,nd resulting in the action, as indicated below: ( ............ ) { ............ ) Application approved. Application denied. Application tab[ed. 2. .Comment~ a'nd remarks: 3. If your application is approved above, A Permit Fee is now due, and should be made payable to the order of the Board of South'old Town Trustees. This fee is computed below according to the Schedule of Rates os set forth in the Instructior Sheet (Form I/1). If the' Permit Fee is paid ix person to the Secretary of the Board, The Permit will be obtainable at the same time. If the 'fee is paid by mail, the permit will be mailed in reply. Com,putation of Permit Fee: Total Fee for this application ............................................................ $ ....... ../.....~7...'...~..~ ............. Chin. Board of Southold Town Trustees. Secr'~Sry. BOARD OF TOWN TRUSTEES Town of SoatbOld M~ala Road Sottthold, New York 11971 To: .......................................................... 1. Your application, doted .......... ~..~..~....?'.-/..a~..~ ........................................ hoe been reviewed by this Board, at o meeting of the Ti-ustees held on ........... ,.~.,~.~..~..?....~.?. ............................................................... a-nd. resulting in the action, as indica.ted below: (......X......) Application approved. (..: ......... ) Appli¢otiondenied. (. ........... ) Application tabled. 2, Comments and remarks: t3~ If your oppl'ication is-approved above, A Permit Fee is now due, and should b.e made payable the order of the Board of'Southold' Town Trustees. This fee is computed beiow according to the Schedule of Rates as set forth in the. Instruction Sheet (Form I/1). If' the Permit Eeo is paid ~n person to the Secretary. of the Board, The Permit will:be obtainable at the same time. If the fee is paid by mail; the permit will be mailed in reply. Computation of Permit Fee: Total Fee for this application .................................................. $ ..... /....~.........~..~ ............ Chin. Board of Southotd Town Trustees. .. Secretary.