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HomeMy WebLinkAboutTR-300 TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES PERMIT NO. ....... ..~.....~.....~.. ............ Pursuant to the provisions of Chapter 615 of the Lows of 1893 of the State of New York; Chapter 404 of the Laws of 1952 of the S~ate of NeW York; .the.:pmvlsions of an ordinance entitled "$outhold Town Ordinance Regulating the Placing of Obstruc- tions in and on Town Waters and Public Lands, and the Removal of Sand, Gravel au ether Materials from Lands under Town Waters", anc in accordance with the .resolutibn of the Board of Trustees of the Town, of 5outhotd adopted at a meeting, of saJci B0ar8 on ., and in consideration~of the sum of , p~id by ........ ~.~.,~.~.~.t .............. : residing the said authorized and permits said ................... ~..~,~.~.~.~. ................................................... to ....... J~J~..~J~t~..J~ ....................... as part of the consideration for the issaanae of this permit does hereby release the said Board of Trustees and the Town of Southold ~r~m any and all damages claims for damages or suits that may arise or occur directly or ii,directly os a: result of any operation carried on under and pursuant to this per- mit, and w:i[I at his own expense, defend any end all suits which may be brought by third partie~, as a.result of any operation carried on pursuant to or in accordance .wlth the terms of this permit~, an~l assume full liability with respect thereto to the complete exclusion of said Board of Trustees and the Town of Southold. THI~ PERMIT is suDject to the following terms and con~iitions: 1. That there sha[I be no unreasonable interference with navigation as a result of the work herein authorized. 2. That there shall be no interference with the right of the public to pass and repass along thdt~portion of the beach between Iow and high water mark. 3. That the work shall be subject to the supervision and approval of the said Board of Trustees or its agents. 4. Th~at ff future operations of the Town of Southold require the removal and/or altera- tion in ~he location of the work herein authorized, or if, in the opinion of the Board of Trustees of the Town of Southold, such work shall cause unreasonable obstruction to free Oavigation, the said ....~t.,,..~..~3,~' .................... will be required upon due notr~ce, from the said Board of Trustees, to remove or alter the location of the work hereby authorized without expense to the Town of Southold, so as to render navigation reasonably free and unobstructed. Jo ~ Supervisor ~ ~~'~ T~vn~'~iall. 53095 Main Road P.O. Box 1179 /(~¢..F,~ ~ Southold, New York 11971 ID OF TOWN TRUSTEES Fax (516)765-1823 TOWN OF SOUTHOLD Telephone (516) 765-1800 APPLICATION FOR SPECIAL ICE DAMAGE PERMIT INSTRUCTIONS: Complete form below and return to above address. You should have this application approved and returned to you within a week. 1. Applicant's Name & Address: ~zC~ 2. Contractor's Name & Address: Tel.No. 3.The purpose of this application: Redrivincj or replacing openwork dock or openwork pier piling, and mooring piles, removal of damaged paling, repair, resetting or rep~aoement of floating docks, ramps, or decking, all necessitated by ice and storm damage resulting during 1989-1990 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 of tidal wetlands are to be disturbed under any eircumstances. 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) mus~ be displayed on project. 7. Groins and bulkheads are subject to inspection prior to issuance of permit. The authority conferred by this permit may be terminated by the Board of Trustees for a failure on the part of the said ........... ~,,..~t~.;~ ....................................... to comply with the terms and conditions herein imposed. In the ,event of such ,termination, this permit shall be deemed revoked five (5) days after the date when the Board' of Trustees shall mail to the said ............... ~.~..J~a~..M~ ...................................at the address given in his application, a certified copy of a resolution of the Board of TruStees directing such termination. IN WITNESS' WHEREOF; the said Board of Trustees of the Town of Southold has caused its corporate sec~J to be hereunto affixed and these presents to be subscribed by majority of the s~id Board ' ' a of Trustees, the day and year above w~'~tten, ...... /:L.-~,~.~.~.~,.~,/~.~ ..... (L. S.) ........ ~4 .~ .... ¢~ s.~ ........ ? STATE OF NEW YORK ) SS: COUN~ OF SUFFOLK ) O~ THIS ................... dog of ......... ~ ........................ 19..~.., bo{ore me ali personally ~own to me, who, being by me duly sworn, severally said that they each resided in the Town of Southold, County of Suffolk, State of New York, and were members of the Board of Trustees of said Town of Southold and constitu~d a majori~ of tbe same, that they knew the corporate seal of said Town of Southoid; that the seal affix~ to tbe foregoing instrument was such corporate seal; that it was so affixed thereunto by order of the Bcard of Trustees of said Town of ~uthold and that each one signed his name thereto as a Trustee and by like order. ~o~ ~, ~,~'.~ ~, .... ~o~o~,, P~ .................... ~ ...... TOWN OF SOUmOLD BOARD OF TOWN TRUSTEES TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....../' ~ . ~ ~ --' ,~/1~' ................... :. t9 ...... Application No .................. Approved ..... ~{.,~. · ~~'~../~,. ~.-~7~/~ ~g~- Permit No ...... .~.~..~. .............. ..................... /~/j,~Qfl~.~.f~Cf,~,&C/&(~~',-~.~ qT ........ chairman, Board of Trustees APPEICATiON FOR PERMIT INSTRUCTIONS A. This application to be completely filled in by typewriter or in ink and submitted ro the Town TrUstees in dup- licate. B. Plot plan showing location of lot and buildings on premises, relation ro adjoining premises, public streets, parks, etc., and giving detailed description of proI~)sed layout of project must be drawn on diagram which is part of this application. (~t~r~ OV~'J~-~J C. The work covered by this application may not be commenced before the issuance of a permit. D. Upon approval of this application. Town Trustees will issue a permit to applicant. Such permit shall be kept on the premises and available for inspection at all times. E. Applicant shall notify the Board of Trustees upon completion of the work covered by permit. APPLICATION IS HEREBY i~IADE to the Board of Trustees of the Town of Southold, Suffolk County, New York, for the issuance of a permit pursuant to the laws, Ordinances and regulations governing construction of: docks, piers, bulkheads, jettys and dredging in, under, and over the waters of Town of Southold. The applicant agrees ro comply ~vith all applicable laws, ordinances, regulations and conditions specified by said trustees, and to hold the Town of Southold. and all Town officials free {rom liability and damages of any kind. Name of owner of premises .. ]~l~.~ .*~,X .l~l'l Ol~. ............................................................ Street Address of Property ...~..a.1..f.~.~..l~.ok .R.oarl,. Bott%llol,d ~..N.o.~I~ ................................... Home address If Other Than Location J.~. 9..~.aS.%. ~Sgtl. ~%P.e~%,J.51~..~fol*k.~. 1~.~., .................... Creek, Bay or Harbor Fronting Property .~Q.lgll..Ol~.e~-.k~..3.OlZ~ll~l(1 ......................................... Permit Requested To: . .~!3, ilcj..blLlklle~,d. ~,r~. rlz, e~l~e ,..aDd..fl~ta:t, ir/~. ~loak ....................... Size of Proposed Work: Length .... .~..1 ~*. ........ Width....1.5.~ ....... Heighth Above High Water...5!.. ~i ..... Depth Below Low Water ..... ~.~. ........ Average False In Tide... 2/4'? ....... Yards to Be Excavated. J.5O.O ....... Width of Canal, Creek or Bay Fronting Property .... 2.~.0..~ ............. Depth at Low Tide .~.~. ................. Is This For Private or Business Use? ...... 2~.:l..v.a~kO ................. Area Zoning .~O~.l:te~%a. il ......... Complete plot plan ro be drawn on reverse side of this application. STATE OF NEW YORK ) )s.s. --~.. ~L~/fi ~ "~ju[ ] ~, ¢ ~ ~ being duly sworn deposes and says that he is the applicant for the above de- scribed permit, and that all statements contained herein are true ro the best of his knowledge and belief; that the work will be done in the manner set forth in the application and as approved by the Board of Trustees of the Town of Southold, and the applicant agrees to hold the Town of Southold and said trustees harmless and free from any and all damages and claims arising under or by vi~ue of said permit, r (app ca ) Sworn to before me thls..,t~,.,.~ ....... day of ....... ...[. ..... Notary public ......... ~ .... ~ .... county of../~J/~/t .........