HomeMy WebLinkAboutTR-79 BOARD OF TOWN TRUSTEES
CaEEK ~~ Town of Southold
Ma~n Road
YOUR ORIGINAL PE~IT NUMBER 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 returned to you within a week°
1. Applicant's Name & Address:.
........... . ...... .......
2 Contractor Nam Addr .~,.~. '
's es & ess: ..............................
................ 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
1984-t985:-~nter.
SPECIAL CONDITIONS
1. No dredging or filling is permitted.
2. Repairs to existing structures shall be limited to replacement of
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 pro]ect at all times while under replacement.
6. Original permit numbers (3'~ high) must be permantlz displayed on
project.
Y, ~ ~/ST~AJ~,~/~// , certify that the work as authorized in
this permit ha~ been completed and zs now ready for your inspection.
Also, the permit number required on this project is clearly visible.
BOARD OF TOW~ TRUS%. gS
Town of Southold
Southold. New York 11971
5
2
d=ted ........ ~d.Z~d.~O ............................................... h~s beem reviewed by this
~une 7~ 1983
the T~stees h~ld om ............................................................................................
oho resulting in the action, os indicated below:
( ............
( ............
Appllcat[on approved.
Application denied.
Application tabled.
Comments and -emcrks:
Your application has been approved at Lhe June 7, 1983 Trustee
meeting. ':
A PEZ~qIT FEE
3. If ~_.~._r cgDlicotlon is cggroved above. ,,~' ,-"~'~ mff ,-t~:~ is now due~an~ should be mode payable
to t~ order of the Board of Southo~c Town Trustees. This fee is computed below accordina to
the Schedule of R~tesgs set forth in the ,instruction ~heeL~EQrm I/1~. ~his fee muse %e
paid wztnzn ~o ~ays or re-appz~zng an~ a~az~onax zee WZ&A De necessaz~
~ If the Permit Fee s ~a d n person to tn-e Secretar~ of the Soard, -he Permit will be obtainable
or the same time. if the. fee is paid by mail, the permit will be mailed in reglz.
Comoutationof Petmlt Pee:
FEES DUE ON YOUR STRUCTURE, BEFORE PERMIT CAN BE ISSUED.
3' x 35' float = 105 sq. ft. @ .25 sq. ft. ~ $26.25
3' x 30'dock = 90 sq. ft. @ .25 sq. ft. = 22.50
3' x 10' ramp = 20 sq. ft. @ .25 sq. ft.. = 7.50
Late filing charge ( placed on all structures newer~t~an-10 years)
5;00
$ 61.25 Due
Total Fee for this oppllcation ............................. ; .............................. $ ........................................
SIgne~r~ . Board o, Southolo Tcwn Trustees.
by
Clerk '"~/ ~5'~ /~ ........
ALL ~'-iOO.qI::GS _~ D S~.~l<~o ~-?GS%rDicPL~'~Y Vi..~LE ~'.OO~.z~G NU~-~BEF. S
ALL DCC2~ AND B~u~qEADS MUST DiSP~%Y VISIBLE PEPS'kIT
o ,d Of Southold_ Town Trustees
SOU~HO~D, NEW YORK
~OO~ Z~G ~O. N/A
PERMIT NO ..... 16.2.3 .............. DATE: _~q__~..c....~?83
- SSUED TO ............ ....................................................
V'
Pursuanf fo fhe pro ~s~ons of Chaplet 615 of fhe Laws of
fhe Sfafe of New York, 1893: ar,~ Ch~=fer 40~ of the Lawsof ~',ne
Sfafe o~ New York 1~2: ~nd fhe Sou~no,d Town OrdMance eh-
ffflea "REGULATffqG AND THE PLACING OF OESTRUCTIONS
IN AND ON TOWN WATERS AND PU~L,O LANDS ~nd fhe
REMOVAL OF SAND. GRAV~. OR OTH[R MATERIALS FROM -.
LANDS UNDER TOWN WAT[RS~"
Resolution of The Boera ~do=fed afa m~ef[n~ held on ....~.q....~.~
of ........... ~.~ ............................................. N. Y. ~nd sub~ecf +o fhe
Terms ~ndCcnemcns"" t[sfed o~ fhe reverse s~ae hereof,
of Souzno~d Town Trusfees aufnonzes and permffs fhe fo[owing:
Application approved to secure a permit n~ber
'for a' float, dock and ramp in Mattituck Creek,
Mattituck.
al~ m accordance wffh ~ ........
' ~,.e deTaz[e~ . Dresenfed
~pec~t~ca~l~ns as
~he original{rig apu~ca~cn.
IN WIiN:~S '-HH..R,.OF, The said Board of Trusfees here-
'Dy causes frs Corporafe Seal fo be at*i×ed, and *hese presen'rs fo
be s.,.s¢,loec= by a re=lot ,y of fhe sclc ~oaro..~.~oz, f,,ls .dar.e.
Board Of 5ou hold Town
SOUTHOLD, NEW YORK
MOO..~;~G NO. N/A
TFU '
PERMIT NO. ..1.6.~3 DATE: .... June 7.~(...:1983
ISSUED TO Walter R. Silleck
, cer~if,, una~ the work as authorlzed
~h-s permzn has been complened and =s no%¢ r~adv for your inspec-
t-ion. Also, the n'um%er recuired on this pro~ect ls clearly visible.
~ I further understand this permit is ncc valid unuzl this tear sneer
· s returned to ~he Trustees. - _
~.~ OF CP~EK .~. -DISPL/~, ~'qSlB~,~ ~RMiT NUMBERS
BOARD OF TOW~N TRUSTEES
Town Of Southold
Ms~n Road
Southold. New York 11971
APPLICATION FOR FIXED and/or FLOATING DOCKS
" I. Applicant's nome and addr
.......... ....... ..........
2. Contractor's name and add ess .....
3. Briefly explo[n the p. urpase of this app[icatian: ........................................................................
4. After issuance of a Permit, work mus~ be completed within one year.
LARGE
5. Secure the correct Area I%Aao ~rom ~he Clerk of this ~cord. and by using a/X V(~THIN
~ 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 Wat~ Mark, the Shape
~G~ and size o~ the dock end any supplemental pilings which ~re needed to hoed ~ floating ~eck
~7 or tie-ua ~ b~t. ~;ve ~~a~ to detenmin~ th~rea ~f the dock surz~ce
~CH_ ~XTENDS~FFSHO~ f[~m th~ O. H.W.. jMz If adjacent prope~y ~ ~
docks, specify location and length to scale. -
6. W,, any p~r,,on of ~nls cons,ru~t~on ex,~sd offshore Info To%n Wa,er~ beyond mn ~mag]~
line or bounda~ ~ormed by other similar s~,~dctures along the area's shoreJ~ne~ Y~S O~
if [t do~s extend beyond this so-called d~ line ~nd[cate by how far, approximately,. ........ ~
7. Provide the fo;Jawing documents;
(o) A Licensed Engineer's Survey of the property involved. ~
(bi A copy of the Contractor's Plans and Specifications. /
(c) S.,or~ Environmental Assessment Fo~m.
.[d) ~etlands npglicat~on.,, ~ ........
8. ~hl ~h[s cons~ruc~i(n-~equ~re ~ne VJl,Jag. ot any lana OTTSnore Or t~e gra~n~[gn ~a~6~
~ark or the ~redg~ng of any mater[a] ?rom Town ~ands under water? Y55 or. if it does.
~rm A/4 (AppJJcatJon {0r g~edging/FJJJ[ng) must be compJeted and stitched a5 part of this
cppiicat[on.
9. Ir~ requesting approval of this application, J submit' that: the information presented herein
is true end correct to the best of my know, ledge and Belief; t am the person accountable for
/ the performance of the work in accordance with theplons and speci¢]cationsattached; J have
r~ad or om famiiiar with the provisions of any Southoid Town Ordinance pertinent to the work
~'2_%* impaired; and further, I intend to adhere to end ~bide by the Terms and Conditions of the
i0. To expedite finding specific lo ' dicate
by ~sing a temporary marker~ .. i ! .! ! ~ ii}
...... :' [.il i '
A/2'Re~:,; 2/82 '-.:~. ...... L. ~; .... , ....................... : ................