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HomeMy WebLinkAboutTR-5850 i ALP jl�'MT` C�.` ?i •H� •!!�J - �,:�`. `S` �� � •�`�� �� �' ..��ii�. �` � �` -.,�.�t yr •.,`ems• Board Of Southold Town Trustees l �.• yt _\ SOUTHOLD, NEW YORK ib Dec. . 17, 2003 ...............DAT PERMIT NO. ... ......•• E: �• RAYMOND B. STRONG III • ,�. " ISSUED TO .....................a........................................................................................... . Pursuant to the provisions of Chapter 615 of, the Laws of. x `2. the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952, and the Southold Town Ordinance en- = titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDSand the FROM REMOVAL OF SAND, GRAVEL-OR OTHER MATERIALS LANDS UNDER TOWN•WATERS;'•--': and in accordance with the Resolution of The Board adopted at a meeting held on --Dec. 17, 200 00 aid b 2003" . and m consideration of the sum of ._.._.......�................ p y lF Raymond B. Strong III ...... ............... ..................................--•-- Southold . . . ............."-.•• N. Y. and. subject to the Terms and Conditions listed on the reverse side hereof, ' �- of Southold Town Trustees authorizes and permits the following: ermit to construct a TX 20'fixed timber dock beginning at ALW with a Wetland P ' TX la inshore ramp and 32"X 14'aluminum ramp to a new 6'X 20'float,and to 'float,and all in accordance with*the plans prepared remove the existing 12'X 16 �." by Costello Marine Contracting Corp.last revised 1/15/04. i, all in accordance with the detailed specifications as presented in y' -the originating application. IN WITN to be affixed, and these resents by causes its Corporate Seal ESS WHEREOF, The said Board of Trustees hiere- to p - � - be subscribed by a majority of the said Board as of this date. o !` Artie Foster. aJ Trusiees u �'/, ,'p,� Y� ""-►�.%ri�'�.��_'�-'� '� '' �`} 4--•^c�"�7 mar:ram ;t �' � TERMS and CONDITIONS P The Peraiittce 'Ra rriond B. Strop III 2205 B.ayview Ave. , Southo'ld -N. Y., as residing at presc ilie to:the fol- :parr of the cgoderation for-.the issuance of Abe:�etmit does.Understand and, lowing: i. That the-said Board of Trusttes and the Town-of Southold ate released 'from any and all dairi'ges, or claims•for:damages, �f suir¢s:arising:directly or iadireoy as'a.remk of an► oper- atioa performed pursuant ;to this permit, and -the said Pemuttee �, at his or her own-, defend any and 1T arch suits'iaitiated by-thhd-P and the said Fermia_assumes=fall hal�lity �p�:e cclusion;of the:Bayard of Tivstees of the Tawas of:Southold with respect thereto, to-.the 2. That this`Permit is valid for z ted(id of - : 24 mas. which is consideredto be the estimated time required 4o:complete the work-involved,:but'should; iraumsrances warrant,-request for an extension may be made to the Board at a later date. 3. That this 'Permit-should be 'retained indefinitely, or as long as the said Permittce wishes to maintain the_structure or .project -involved,-to,provide evidence to anyone concerned that-curb orizaton was originally-obtained. _ and approval of.the'Boat+d or 4. That the.work-involved will-be subject to *the inspection aPP _ its agents, and non-complianoe"with:the provisions of the:originating application, may be cause for - revocation of this,Permit by resolution of the said,Board. _ interference with navigation as a result of the wo 5. That there will be no unreasonable rk-herein authorized. 6. That there shall be no interference with the right of the public to pass and "repass al�g the beach between,high and low water marks. 7. That if future operations of the Town of Southold require the removal and/.or aluradons - 30. the location of the"work:herdn authorized, or,if;-in du--opinion-Of the Board:of Trusters,,the- wont shall cease unreasonable igation, the aid Permktee"will be 1O 'ed+ obstruction to free nav ;upon 4[ue notice, to remove or.alter this work or project herein stated without ezPcuses to the Town . Of Southold 8. That the said Board will be notified by the Permittee of the completion.of the wort =W@- .orized. :9. That the=Permittee will obtain all other permits and consents Ant may be required mp- .Plemetital to this-:permit which may be subject to revoke upon:failtue to obtain name. SUFFoc� Albert J.Krupski,President ��0 C� Town Hall James King,Vice-President h`Z` Gy 53095 Route 25 Artie Foster o P.O.Box 1179 Ken Poliwoda va Z Southold,New York 11971-0959 Peggy A.Dickerson *14-4 Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 17,2003 Mr. John Costello Costello Marine Contracting Corp. P.O.Box 2124 Greenport,NY 11944 RE: RAYMOND B. STRONG III 2205 BAYVIEW AVE., SOUTHOLD SCTM#52-5-2 Dear Mr. Costello: The Board of Town Trustees took the following action during its regular meeting held on Wednesday,December 17, 2003 regarding the above matter: WHEREAS, Costello Marine Contracting Corp. on behalf of RAYMOND B. STRONG III applied to the Southold Town Trustees for a permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated November 25, 2003, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on December 17, 2003, at which time all interested persons were given an opportunity.to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in - question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, 2 WHEREAS,the structure complies with the standards set forth in Chapter 97 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of RAYMOND B. STRONG III to construct a YX 20' fixed timber dock beginning at ALW with a YX 18' inshore ramp and 32"X 14' aluminum ramp to a new 6'X 20' float, and to remove the existing 12'X 16' float, and all in accordance with the plans prepared by Costello Marine Contracting Corp. last revised 1/15/04. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$5.00 per inspection. (See attached schedule.) Fees: None Very truly yours, A' C4 �'- Albert J. Krupski, Jr. President,Board of Trustees AJK/lms r. Town Hall Telephone 53095 Route 25 (631)765-1892 ® P.O.Box 1179 Southold,New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Monday, December 8, 2003, the following recommendation was made: RAYMOND B. STRONG I11 to construct a-3'X-30'-fixed timber dock beginning-at ALW with an 18' inshore ramp and 32"X 20' aluminum ramp to reach the existing float. t_ocated: 2205 Bayview Ave., Southold. SCTM#52-5-2 The CAC did not make an inspection, therefore no recommendation was made. 12/10/03 Field Inspection MOM 0 a; x, N H; W. - C) ITI \� cC\� '�!• "14dP i���l •ai�°n .�#I �1a�i.� �� it I" „i.�pi '"%" � i a w ,�.. "!',".��' � . i ii"ni i i dS ei i t I i 12/10/03 Field Inspection � E ' w s- pill', a, 12/10/03 Field Inspection e� w m;; 8.� F S �' Raymond Strong Agent: 2205 Bayview Avenue Costello Marine Contracting Corp. Southold, Box 2124 • rt' - W. 1 �-r• t �-.•�t:6 a}"Z.Is .'r" �, 1 Southern dock Fw di or j <Y OIL 1 is y, ,t Raymond Strong Agent: 2205 Bayview Avenue Costello Marine Contracting Corp. Southold, NY 11937 P.O. Box 2124 Photo taken 7/10/03 @ ALW (3:10pm - 3:20pm) Greenport, NY 11944 311w�NOWWAing flo w Raymond Strong Agent: 2205 Bayview Avenue Costello Marine Contracting Corp. Southold, NY 11937 P.O. Box 2124 Photo taken 7/10/03 @ ALW (3:10pm - 3:20pm) Greenport, NY 11944 l T Client: Raymond Strong Agent: C Mo Marine Contracting Corp. Inc. .'2205 Bayview Avenue F Box 2124 Southold, NY 11937 Greenport, NY 11944 October 19. 2003 I c• Client: Raymond Strong Agent: C Mo Marine Contracting Corp. Inc. .'2205 Bayview Avenue F Box 2124 Southold, NY 11937 Greenport, NY 11944 October 19. 2003 k .W ,G !.4 ■ .w�:A Client: Raymond Strong Agent: C fllo Marine Contracting Corp. Inc. 2205 Bayview Avenue F Box 2124 Southold, NY 11937 Greenport, NY 11944 October 19. 2003 L.` _ s l Y � .4 Client: Raymond Strong Agent: ( EIlo Marine Contracting Corp. Inc. 2205 Bayview Avenue F . _. Box 2124 Southold, NY 11937 Greenport, NY 11944 October 19. 2003 3 PF Southern neighbor's dock h E COUNTY OIFQXS�� S'E"No I SOUTHOLD ferry------- Red Prwty A 'I E, --- -, i,,t-; 25- 41 I/ Z A 2 =7 1W sz le sm T,==T Fir tx IN <OK I, K— �T N cli) IMP kl� S=Mm L E NOTICE COUNTY 0 SUFFOLK Q SOLD WL gmwav WS PIMI&A my Im 052 —2t: Ewry fle�Property-Tax Service A Canty Center D NEE 7— i a— A 1� i COSTELLO MARINE CONTRACTING CORPORATION DOCK BUILDING •JETTIES • BULKHEADING •STEEL&WOOD PILING • FLOATS 423 FIFTH STREET • P.O. BOX 2124 • GREENPORT, NEW YORK 11944 • (631)477-1199/477-1393/477-0682 • FAX(631)477-0005 January 29, 2004 L Southold Town Trustees D � � � � � P. O. Box 1179 Southold, NY 11971 Attn: Lauren FEB - 2 2004 RE: Raymond Strong, III Southold Town 2205 Bayview Avenue Board of Trustees Southold, NY 11971 Dear Lauren: Enclosed please find revised drawings for the above referenced property. Pursuant to the December 17, 2003 Public Hearing the following changes were made: 1.) The 3'x30'timber dock was shortened to 3'x20'. 2.) The 32"x20'aluminum ramp was shortened to 32"x14'. 3.) The existing 12'x16'float will be replaced with a 6'x20'float. If you have any questions regarding these changes, please do not hesitate to contact me. Yours truly, /Jaostello Walsh ermt Manager Enclosure v o v tony Sho LO :6 re rZq Qyl�je!'V �a\\U o ivy' N Colon RdIDA n9 :Ott Dr 22 Hashamomuck a Pond A Pond A Main Rd `QS Buddsoldtqu '7 O Fro o a m Q c Wil ow m of Dr arlin M Spar O A S VICINTY MAP LOCATION MAP 1" = 2500' 1" = 100' ADJACENT PROPERTY OWNERS 0 0 APPL I CANT 1000-52-5-1 1000-52-5-3 Thomas Byrne 8 c% Kevin Lyons Veronica Kaliski 1000-52-5-2 a Carol LI�ons 74 Roxen Road Ra mond B. 5trong, III 86 Birch Road Rockville Gentre, NY 11570 2205 Boy ow Avenue Molverne, NY 11565 (2345 Bayview Avenue) 5outh%v NY IIg71 ,(2085::Bayview Avenue)- E i 2 �n 2 E PROPOSED: D C E � U Gonstruct a 5' x 20' f ixed timber dock beginin at ALA with on 15' inshore ramp FEB - 2 2004 32 x R' aluminum ramp to new 6x 20 f loc t AGGE55: Southold Town Board of Trustees By water using crane a barge and by land using a 5 wide access path center of lot PREVIOUS PERMITS: Town of Southold Trustees Permit # 2178 issued July 51, Ig86 for a dock and f loot Prepared Amended p ` 0I-15-04 Costello Marine Contracting Corp. Prepared P.O. Box 2124 6reenport, NY IIG44 II-03-03 Ph. 631-47-7-119G sheet I of 3 PLAN VIElN APPLICANT 1000-52-5-2 Rayymond B. 5trong, III 2205 Bayyview Avenue I" = 40' 5ou%Id, NY IIG-7I Datum B a y v j M5L-N6VD'2G e W Avet7 � e 6 6 P N c� D2e m 9 � � # n ��� BQyvt e 05 W Axle 1` ca '0U -/elk ;Y ,0 k m \000 ,,a �ry� ju -0�o K ca 9 U Q •' •,WM e seocvo// stePs �[� `pat.,'��opQ�Y e,,,,'' '.�• ti q�lfi/t of iM`age �OncreWeE/qn 1.6 'Dq. -�` "�.• _ by R. to w ds v 1.6 L6 D..O.. '�- -�' FCx qll qs egefq . _ o 2.6 -Fyg_..aga5_:a_5 _on- aeo3gted 2.6 2.6 1.6 1.6 5.2.6 3.6 2.6 2.6 1.6 1 d' ,.`` " 3.6 2.6 1.6 bA - 3k- - - 4.2 3 3.6 25 2.5 w I. '•GLe._` --_-- y- t9A.,, 4.2 3.6 3.6 �' .4 1.31.3 '-6lb_-`-_______--� R.A 4.2 3.6 3.6 ti 2.4 1.3 •FiA _O-b 4.2 3.cy4�Q;yew .2 5.2 2.4 1.3 I ! '•-Q b"",0.Q 4.5 15 4.5 4.5 4.5 1` 5/0„ LL.9Qia3.9 3.9 3.2 3.2 3.3 s� x � f iber Dock 5.2 oM.WrJ �/�S 3.-1 3�mgg.4 above grade 2.22.2 2.6 E_o 5.2 5.5.5 5.5 5.5 4.5 �.�� 3.9 3.9 3 189 ramp2�n6 � r�.E�� a 6.2 6.2 6.2 5.5 55 5.2 5:5.2 " ry� 4.5 0 x�93;� rmp to 6' x 20' float m L 6.2 6.2 6.2 5.2 5.2 6.2 5.2 4.5 b.2 5.2 5 5.2 move existing.,19' x 16' float 1.1 6.2 6.2 4.9 4.9 4.9 4.9 5.65.6 ,.I ,.1 6.4 6.4 6.2 �6.2 4.9 4.5 4.5 4.5 4.2 3.6 3.61.6 ,.2 6.4 w�,'�'2 6.2 4.2 4.2 ,.2 6.4 'Y_Y7 b.2 b.2 6.2 APPROVED BY ,.2 6.4�Y ;fir -1.2 ,.2 7.2 N ,.5 ,.5 6.4 6.2 6.2 5.9 5.9 6.4 6.2 ,.4 ,A 7.2 ,.4 a 5 �5 ,.6 _.5 '15 ,.B 6.6 6.6 66 6.2 6. 6.2 6.2 BOARD OF TRUSTEES 7.6 a ,.B 6.2 5.9 5.9 7.5 T.5 -76 ,.6 ° f77 U c ,.B ,.B 7.5 ,.e 6.6 6.6 TOWN OF SOUTHOLD � I ,., ,B Tb ,.B ,.B ,.B T ° t7 ,.e ,.e DATE /� ,.B ,.B ,.B ,.B ,.B ,.e 7.6 ,.e ,.e ,. Prepared by: ,.e -1 e B /Ja Ame ded 9 Go5tello Marine Gontractin Corp. 6 ,.B ,.6 8.1 red d P.O. Box 2124 Greenport, 9Y IIcI44 II-O -03 Ph. (631-4711-IIGcl Sheet 2 of 3 SEGT I ON APPLICANT 1000-52-5-2 Raymond B. Strong, III 2205 Boyyview Avenue 1" = 20' 5outhold, NY Ilq'71 Proposed 3' x 20' Timber Dock 32" x 14' (4) new piles Proposed min- 4' abv. gr. Aluminum 8" dia. at new 3' x 18' ramps 1 ramp float comers 6' x 20' concrete -- -at - - -- ---- ----- -- ---- - --- ------ - ---- seawall --- ---- ----- --------- -- ------------------- I.M. ' Limit of Tidal Wetlands i Vegetation at concrete i remove bttm. seawall as delineated ' Existing by R. Fox on 10-I 1-03 FIOat 6„Dia.Piles 12' x 16' 10' on center All lumber - SYP sHW HW LW 34"above deck 10'Penetration GGA pressure treated All Hardware hot dipped galvanized DETAIL 1" = 4' 5/4" x 6" decking 311 x / II 9 ( 511 x b" stringers fl caps 6" Dio. Piles I All lumber - SYP 10' on center GGA pre55ure treated 54" above deck All Hardware 10' Penetration hot dipped galvanized bttm. Prepared by: Amended Costello Marine Contracting Gorp. Preppared 5-04 P.O. Box 2124 6reenport, RY IN44 II-03-03 Ph. 631-4 7 7-1 lgq Sheet 3 of 3 O�OSuFF�(�C Town Hall Albert J.Krupski, President �G 53095 Main Road James King,Vice-President c y� P.O.Box 1179 Henry Smith y 2 Southold, New York 11971 Artie Foster Oy �� Telephone(516) 765-18-92 Ken Poliwoda �f�l �a0 Fax(516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD ��`� ��-� � office Use Only 5 kx aDrt Coastal Erosion Permit Application j ' 01' C0--1W lK- /Fletland Permit Application Grandfather Permit Application Waiver/Amendment/Changes ��m /Deceived Applica ion: 1/1 0j ,%/Received Fee: $ 4RM E C E pleted Application. / d.3 Incomplete SEQRA Classification: Nov 2 5 9003 Type I Type II Unlisted �1 L! Coordination: (date sent) /<AC Referral Sent: / Southold Town mate of Inspection: ^ 03 Board d Trustees Receipt of CAC Report: Lead Agency Determination: Technical Review: ,P,ctblic Hearing Held: Resolution: Name of Applicant '_IIj lfl(hA -7) JtY�yIQ Address v� � Au yie_N ,Ayntup IIA i�i 0 iGt Y I I"I I J Phone Number: ( l (7) 0707 '26'ff Suffolk County Tax Map Number: 1000 - ate ' SP Property Location: O5 weoJ 4mul- , � � r`ty I jq7 (provide LILCO Pole #, distance to cross streets, and location) (' • AGENT: Ao,tv'le'(If appliCab e Ap ✓ Address s�� X ��a ��PP onf C Phone: 651 FAX# : (031-4} j 1 - Board of Trustees Applica _ )n GENERAL DATA Land Area (in square feet) : ��, 50 ft4 Area Zoning: 10 Glinplt - 1ilu Previous use of property: 6!IM& ffa_A&JC- Intended use of property: eAOA Prior permits/approvals for- site improvements: Agency Date Ulu No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes , provide explanation: Project Description (use attachments if necessary) : �-� Q 3`x s o - beotywo 0 a4- AL-V/ 2 B__ d of Trustees Applicatioi. WETLAND/TRUSTEE LANDS APPLICATION DATA / Purpose of the proposed operations: o ✓ r C/ Area of wetlands on lot: square feet Percent coverage of lot: /d % Closest distance between nearest existing structure and upland edge of wetlands: 80 feet . Closest distance between nearest proposed structure and upland edge of wetlands: �rj feet Does the project involve excavation or filling? x No Yes If yes , how much material' will be excavated? cubic yards How much material will be filled? .` / h cubic yards Depth of which material will be removed or deposited: Q feet Proposed slope throughout the area of operations : 1A, Manner in which material will be removed or deposited: pt Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate) : �ir►e. �r000sed ey c�a. �2 PAUAIM&I %AA f-71u nrr� o��tortslv� Kfo mor i on 4iy- weBa , will res -M My- 3 NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: Raymond B. Strong, III SCTM # 1000-52-5-2 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: ➢ Construct a 31x30' fixed dock - beginning at apparent low water (ALW) with an 18' inshore ramp and 32"x20' aluminum ramp to reach existing float. 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 2205 Bayview Avenue, Southold, NY 11971 3. That the project which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment. You may contact the Trustees Office at 765-1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold an does not reference any other agency that might have to review same proposal. G ri OWNERS NAME: Raymond B. Strong, III MAILING ADDRESS: 2205 Bayview Avenue Southold, NY 11971 Enc. : Copy of sketch or plan showing proposal for your convenience. PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name 7001 2510 0006 4064 939e7 '' ] dress. 7001 2510 0006 4064 9380 , Q� ° �' m m� m n� o cn: CO m m =�� �`m� �. o H a ■ O� d o� o� y� rnm O . xb�. 0 3& 3z N� 5 m m C n ro; o io m m aa. z, ° oZ� m '�" '�'m mom., c a, A mID N �, c� a y {T7, r c a f1� f`�1 CD D m m m C7_ 69 b7d l� ■ I� r �/ rD p C� 3 IN a; STATE OF NEW YORK COUNTY OF SUFFOLK 10 &k , residing at 10 Cheese_ $ , being duly sworn, deposes. and says tha on the _ 0 day of AbVIMke►e- _, deponent mailed a true copy of the Notice set fort - n the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective .names; that the addresses set opposite the names of said personss are the address of said persons as shown on the current assessment roll of the Town of Southold; that aid Notices re mailed at the United States Post Office at Pbqrf , that said Notices were mailed to each of said persons by (certified) ( registered) mail. Sworn to before me this c day of NlD0em be_k jX 5 C N 3 Notary Public REBECCA A.VILARDI NOTARY PUBLIC,STATE OF NEW YORK QUALIFIED IN SUFFOLK COUNTY NO:01 WO6039106 COMMISSION EXPIRES MARCH 27, 'aON 6 Board of Trustees Applica--on County of Suffolk State of New York Jaw, Q� BEING DULY SWORN DEPOSES AND AFFIRM8 THAT HE/SITE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY. AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S) , IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT( S) OR REPRESENTATIVES( S) , TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. S ' na ure SWORN TO BEFORE ME 'T'HIS DAY OF Notary Public REBECCA A.VILARDI NOTARY PUBLIC,STATE OF NEW YORK QUALIFIED IN SUFFOLK COUNTY NO:01WO6039106 COMMISSION EXPIRES MARCH 27x—�2-00& 7 PROJECT ID NUMBER 617.20 SEQR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT/SPONSOR 2.PROJECT NAME Costello Marine Contracting Corp. Raymond B. Strong, III 3.PROJECT LOCATION: Southold Suffolk Municipality County 4.PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map 2205 Bayview Avenue, Southold, NY 11971 SCTM# 1000-52-5-2 5. IS PROPOSED ACTION: 21 New ❑Expansion ❑Modification/alteration 6.DESCRIBE PROJECT BRIEFLY: Construct a 3'x30'fixed timber dock beginning at ALW with an 18'inshore ramp and 32"x20'aluminum ramp to reach existing float. 7.AMOUNT OF LAND AFFECTED: Initially - acres Ultimately - acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ❑✓ Yes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ❑� Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open Space ❑Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) Yes ❑No If yes, list agency name and permit / approval: ACOE, NYSDOS, NYSDEC, Southold Town 11.DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes a No If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? Yes ❑✓ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor a Jan o W Ash, Permit Manager @ CMCC Date: //�p/d 7j Signature If the action Is a Costal Area,and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF Yes ENo B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. 0 Yes 0No C COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten, if legible) C1 Existing air quality, surface or groundwater quality or quantity, noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly. C3. Vegetation or fauna,fish, shellfish or wildlife species, significant habitats,or threatened or endangered species?Explain briefly: C4. A community's existing plans or goals as officially adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly: C5. Growth, subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: C6. Long term, short term,cumulative,or other effects not identified in C1-05? Explain briefly: C7 Other impacts(including changes in use of either quantity or type of energy? Explain briefly: D WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA? If yes. explain briefly: El Yes No E. IS THERE,OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain El Yes No PART III -DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whetherit is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its (a)setting(i.e. urban or rural);(b)probability of occurring; (c)duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes,the determination ofsignificance must evaluatethe potential impact ofthe proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL I. EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation,that the proposed actin WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(If different from responsible officer) NowIT-2003 00:13pm From- T-825 P•002/002 F-810 PFWOi-" CASTEU-0 MARINE GUN 1. MUNC Oyu• aio •,t, a,uw irµt.'yl,}~^p.'c•. ,�'� s•.'.::+;; �!:�Yyr:.t1�ii•.;' ,+ + a CONTRACTING CORPO TION 00STELLO PILING•FLOATS CCNPK @UILGIN( o JlsMES!9u�F WING•gTM II<W� FIF>0�1 S'PkM-- PW 13CX t Z7 :*' N V11 YOB SS�44• (681)477-ii88147T 7$d3/q77-osBe • SAX(831)d77-000! '/.r S-(ro ow�erof •.•x.F Nj r�i�r t�i,a. ;.{It. :41S^.S?•+.�.•. •1 • , ••�{•' „ ..,�•.. . ' Bu$��""iir NOW. • � �-Ii�,�1 - ya 111 r•1 1 P•-Y ��L , IIA•• III n!m• v .---by8EV*CO"OlOeA§ Cap.the M&Wity to*a as qmt is nw pelfis emkofa,all of tt aec r pmnits fnr waffl�to be oompl�d at my above YIy •�i}p.S•- ��r,. •,a�-:��-..�_'"",h�-•�k�A�'v�.J� ,t1.-,v#{'���rr�$S,'f_�: .qr Nov-20-2003 12:34pm From- T-646 P-003/003 F-642 PHONE Na. 516 4 r( dtae� FROM COSTEU-0 MARINE CON 7. S ,4,ppLXC 'r/A(;EN'XY1 PRESENTATIVE TRANSACTIONAL AMCLOSUn]FO Co fEt ' a its Picts t ontown d tinwitiot tav'sat . f Cn thold LIL +ke of��'+',.,c►teTM� LY-0 dam,f;sht. ^� o Pre- ,tYu YptJitNAs1�A.13 ..,,-.-(T.estnatfiC,5rat r=cr dle initial,tsls V Y SDSA4`Or1E else or Othtr bdty,auch 0$a company,,,w,ttsdlGale ncc,, persasl'a or company's mar 1) NAME OF A11eL>iC TT')X. (Chock all&1 Apply-) Tax�avoaca - Chang o Of - ,4ppaov�:o`'!<I2t e9o1 Grp#oa fRemplat or offs � Chbar (i`•-0thee, my Officer or rarer 4 vlty) tlr,.�bl'your sp�,pany:,bfau3e, irl �U rn arinys�e9sieseessst." uhave a siucssintmest,,Monsabosi ao Do you persorraGy Cor u, irrehsdcs by blood,tr�ncie. by) caepot siiar+ of the,r"wn ofgaudtold vrhi h affioar or ensployee hAs oven a pares am=ship off(- nr intilrrdigg a 1%W'O p• , oo rrr:�n MA of the Amm is whim the u++va o#"sa.,or rm,.r,)., YES pro �;you a wrred —X- -f4ccsrpietc tho balauco of thus rdtm and date and sign where Indi�eed. 'Name o f perm.,mpb*by the Town of Southold y1tIc cs position of that parson Eitiw check a Iieartda 94Vrepresentnve)and the town officer or WwWas. ylcsyrltYs.:i•�•,,r,�u)�•Casrtrlp„�-Yfi@:1y�,►_9Salf{tLtOjyp r'.cc O,proMpte lint A)thtvuS4 D)andVar dciadbe in the spame+Prmnded. 'Ihe 1c,_7 ems.rer cr ear 1..byj%r:his or her BYieu9e,siblits8, t,or child is(chalk all that WPIY): _A)the owper of Qroater thers S'Y.of the shares of tr a orp g e sto&of the Oaplicant w(, yn the ears is a Corporotico)i it3 or ber--se>ta'.a+un Pw;)rnfoe etc ut a a4aa��,TJerL.IC 5?�+f lvi 4� ;�3 " appliCSttt is not 4 carooL'40031?i (�onoffices,director,pMcor,or=PloYee csf the applicant;er �)the®dual appiieszst DUSCpI2TION QV RELA'r►.ONSHIp Subrttitted this O h�— 200 3 Syg�tures • Ptintl�� � �•,.1 � r,� L �4 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The pMose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid sam . YOUR NAME: ( ast name,first name,midle initial,unless you a applyin in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO X If you answered"Y4 complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agentlrepresentative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this o2(7 a of 200� JOA4 Signature Tom' Print N /