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HomeMy WebLinkAboutTR-88YOUR ORIGINAL PEt~MIT NUMBER Tows of Sbuthold 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: ...... ~W ......... .~-~. ~ ..... ......................... Tel No. 3. The purpose of this application: Redriving or replacing openwork dock or openwork pier piling, and mooring piles, removal of damaged pi~ing, repair, resetting or replacement of floating docks, ramps, or,decking, all necessitated by ice and storm damage resulting during 1981-82 winter. SPECIAL CONDITIONS i. 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 circumstances. ~5. A yellow permit sign provided by this office shall be displayed on thm project at all times while under replacement. 6. Original permit numbers (3'* high) must be permantl~ displayed on project. ALL 5tCC.~ii:C-S AiCD STA?LES :':US? DiS?,A¥ ViSiBLE :,:OG.qiiTG ALL DCCi~ A~:D BU~%HEADS ~IUST DzS=k:~ ViSiBLE PEFJdIT [ ~v:, '~:~; ~' ~h~- ~ r , ~ , .' ,.,,..,~ ~e .... ~ ~ ~ > ' SOU~HOLD NcWYORK ~., N/A PS~M17 NO... ~.~.!.~ ................ ~ D~I~: ...~.~.~ ...~3..q 198 D' TO Donald Shaw - , Pursuan~ fo }he prov[slons o~ C[epTer 815 o~ fhe Laws fhe Sra~ ~ New ~or~, 1893; an~ Cha~fer ~ ' 40-: o~ fne Laws oT ,ne 5ra,e o? ~ew Yor~' I%2 an~ the Soutno,~ Town Orcmance eh- {fled R:GULATNG AND THE PLACING OF OESTRUCTIONS -,>IN AND ON TOWN WATERS AND PUELIC LANDS and fhe REMOVAL OF SAND GRAVE~ OR OTHER MAT~'RIALS. FROM . LANDS UNDER TOWN WAtm.J; and In accordance w~Tn fhe , ~ , , , , ..?~%_~_~.e. ~.v Resoluflo~ of Tn~ Boarcla~oprea afa m~eflng he[: on , I~ ~. ~.:~9~. ' by ~ .. and ..... of fhe sum of $ ........ pa~d . m cons~eranon . of .._8~.~.~...~.~ ................................ N. Y. ~n~ ~ub[e,+ +o the Terms .end Condfflons ]is{e~ on ~he reverse side hereo{, o~ Sournel~ Town Trusfees aufnonzes ~nd permffs rne fo lowing: ~ppliaa~on approvod undor ~he Grandfather Clause -to ~cure a pom~t numBor for a dock Creek. ali in accordance wlfh ~he de~aile~ specifications as presenfe~ fhe orig;nafing app!lcaflan. IN WITNESS WHCR:~'~ The said Board of Trusfees here- · by causes lis Cor~orafe Seal fo be am×ecl, ano *hese presents fo be subscnoec: ~¥ a malomy o{ , e sa~a ~oara as oT fh~s da~.e. TERMS and CONDiTiONS Donald F. Shaw %'ne Permi~ · permit r~[d[sgat 12 Dickerson Dr. S.I., ~or prop. at Mattituck ~. ¥., ~ par~ of [he co~ideradon for ~e ~c~ of ~c P~: d~ ~de~d ~d ~ to ~ roi- '): ~ low~ng; 1. That the Southold Trus~aes Permit must be prominently displayed on the ~rem~ses effec%ed thereby during the period of 2. ~K~: ~e ~d B~ of T~s ~d ~ Towa of ~u~old ~ ~ed from ~y ~d work ~ damages, or da~ for d~ag~, of ~ z~ ~y oe ~r~dy ~ z r~ of ~y o~- ~nder a~on ~rfo~d p~t to ~s ~% ~d ~e ~d Pe~ will at ~ ~ her own ~ · . . the defend any ~d ~I su~ ~ ~t~ b7 ~d pa~, aaa ~e ~d Pe~ ~ ~ ~ .~ wi~ respect ~ere:o, ~o ~e ~mpl~ ~d~ion of m~ ~d of T~e~ of ~: Town of ~mdPe-'"z ;..- 3. That th~ Permit 1~ v~2d for a ~od of _Q~.~E ~AR w~ sufficient ~e r~ulred m ~mplere ~e work ~volv~ but should ~m~c~ w~ for ~ e~e~ion may be ~de to ~e B~d at ~ inter da~. 4. That tt:ffs Permit should be retaha~ indefkfftely, or as long a.s the smd Permkree wishm to maintain the structure or project involved, to provide evid~':ce to anyone concerned that orhat/on was originally obrMned. --: 5. That the work involved will be vabject to the inspection mad approval of frae Board or its agents, and non-comFHance Mth the prov~ion.s of the orig~rmH.-g appEmdon~ ~7 ~ m-~e foe revocaman of ~is Pe~it by r~oludon of ~e sa~d Bmrd. 6. That there will be no unreasonable interference with navigarioo ~ z result of the work= z heteln au[hot'zed. 7. That there shall be un interference with the Hghr of the public :o p~ss mad repass along the beach between high and low water maxks. 8.. That ~' furore opera, mas of the Town of Southold requLze the' Zemoval and/or in :he lo~tion of ~e work her~n au~o~ or fi, ~ the opi~ of ~e Bo~d of Tr~e~ work sh~ ~use u~onable obs~a~on to free navigation. ~e smd Pe~mee ~H ~ u~a due notice, m remove or alter ~is work er projecc here~n stated ~out ~ to of Sou~oi& 9. That the sa~d Board will be notified by the Permitsee m *.he completion of ~e work oHxed. (See tear off sheet.) 10. That the Permkree will obtain all other permits and coase=u that may be r~uirefl sup- plemeneM to [his permit which my ~ subj~ :o revoke upon failure-to obrMn same. BOARD OF TOWN TRUSTEES TOWN OF $OUTHOLD Town Hall, $3095 Main Road P.O. Box 728 Southold, New York 11971 September 27, 1983 TELEPHONE f5~)76~1892 M~. Donald Shaw P. O. Box 516 Shelter Island, Dear Mr. Shaw: New York 11964 Transmitted herewith is your permit which was granted under the Grandfather Clause, for your structure. Please post your permit number on your structure, so that it can be seen from the water. Thank you for your co-operation, in regard to this matter. Very truly yours, Board of Town Trustees Clerk to Trustees Attachment BOARD OF TO~;N TRUoToES Town Of $outhold B~a,:n Road APPLICATION FOR FLXED and/or FLOATI~'~G DOCKS .LA.. . ~. , ..... ~Lg.r ..lJf~. ...... ~.~i, .......... / 2. Controctor's name omd oddress: ...F':.~.%~.~L~ ............................................................... ............................................................................................................................... ~., ......................... 3. Briefly explain the purpose of this application: .,~ ..... ~ ....... 4. After issuance of a Permit, work must be completed within one Fear. LAKGE 5. Secure the correct Area Moo from the Clerk of this Board, and by using a/X WITHIN A ClJ~Ck[ indicate os closely as possible the location of this dock. On the reverse side of this map, provide a SCALE D~AWING which will show Ordinary High Wot~'~' Mark, the shape and s~ze o~ the dock and any suppJemantaJ piJ~ngs which ~re needed to hold a ~Jacring dock ~ or tie-oD ~ bo~f. ~]ve all d~mens~ons neces~o~ to d .... mln~ ~e cf the dock surtcce ~% ion EX_~:DS O= - S..O~ from the O. ~ '~. ~ ~= adjacent prope~y owners have d cks, specz~y location and length to scale. 6. Wi[~ any port~om of this construction extend offshore into Town Waters beyond on [moginc~ line or boumdo~ formed by other similar st~ctures along the a/ea's shoreline? Y~5 oF NO. [f i~ ao~s' ~ extend beyond *''toJ~ so-c~hed' deck line indicate by how fcc, approximately, .......... [~. 7. Provide the following documents: fa) A Licensed Engineer's Survey of the property' involved. (b) A copy of the Contractor's Plans and Specifications. ~i Short Environmenta! Assessment Form. Wetlands Apmlication _ _ 8. i this construction-require ~e t-illing of any land offshore of the Ordinopf High Water Mark or the Dredging of any material [rom Town Lands under water? Y[S or NO. Jf it does, Form A/4 (Appllcotioo for Dredging/Filling) must be completed and attached os port of this app:cation. 9. In requesting approval of this application, J sub,it that: the information presented herein is true end correct to the best of my know, ledge and belief; t om the person accountable for the performance of the work in accordance with the plans and specifications attached; J have read or om familiar with the provisions of any Sauthoid Town Ordinance pertinen.~ to the work im, eJved; and further, I intend to adhere to and ob~de by ~he Terms and C~nditions of the Permit, when and if issued ~o me. !0. To expedite findin~ specific location for inspection, indicate by using a temporary marker~ · ~ ~~ ~ ~. ._. '-:. U!:f~i.k: ::<::;:. ~- , ' . ':::'."::i:L'iA'i~:~e-~: ~/8~ ..' L ...... ,:. ' .... ... .. ' . ' Z