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HomeMy WebLinkAboutTR-5492 Albert J.Krupski,President Town Hall James King,Vice-President O%Uv I/i'� 53095 Route 25 i. Artie Foster P.O.Box 1179 Southold,New York 11971-0959 Ken Poliwoda C Peggy A. Dickerson Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES i TOWN OF SOUTHOLD , I YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line .I St day of construction % constructed Project complete; compliance inspection. Albert J.Krupskii Pl ieside"ht Town Hall James King,Vice-President �OSVFF011r ® 53095 Route 25 Artie Foster P.O.Box 1179 Southold,New York 11971-0959 Ken Poliwocla Q Peggy A. Dickerson CA �? Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 22, 2002 Mr. &Mrs. Joseph Brittman 23 Jerome Street Smithtown,NY 11787 RE: 80 Gleiiit Rd.; Southold SCTM#78-2=10 Dear Mr. &Mrs. Brittmdu: The following action Was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, August 21, 2002: RESOLVED, that th6 Southold Town Board of Trustees APPROVE the Amendment to Permit #5492 to accommodate a 4'X 13' landing with same size balcony above. This is riot a determination from any other agency. If you have any questions, please call our office at(631) 765-1892. Fees: $10.00 Inspection Fees Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:has Albert J.Krupski,President SVFF00- Town Hall ,Vice-President 53095 Main Road James King, P.O.Box 1179 L Henry Smith Co ? Southold,New York 11971 Artie Foster . Ken Poliwoda, Oy Telephone(516)765-1892 Fax(516)765-1823 BOARD OF TOWN TRUSTEES r: TOWN OF SOUTHOLD f� 1 , To:T if n kot- h nn u rnatz , Please be advised. that your application, dated has been reviewed by this Board, at the regular meeting of R)a1 and the following action was taken: ( Application Approved (see below) ( ) Application Denied (see below) ( ) Application Tabled (see below) If your application is approved as noted above, a permit fee is now due, Make check or money order payable to the Southold Town Trustees. The fee is 'computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will he necessary. COMPUTATIO_N: OF PERMIT FEES: TOTAL FEES' DUE s SIGNED. PRESIDENT."; BOARD OF TRUSTEES LE K; BOARD OF TRUSTEES 4/98 AUG-22-2002 01 :28 PM BRITTMAN&SON 631 fL4 9270 P. 01 New York State Department of Environmental Conservation Division of Environmental Permits Rm 121, Building 40 -SUNY Stony Brook, New York 11790-2366 Telephone (631) 444-0366 .Facsimile (631)444.0360 Erin Crotty Commissioner July 29, 2002 Joseph and Elizabeth Brittman 23 Jerome Street Smithtown, NY 11787 Re: Brittman property Rn Clenn Road.Southold - . ..... - - j AUG-22-2002 01 :28 PM BRITTMAN&SON 631 724 9270 P. 02 Dear Mr. and Mrs, Brittman; 1A Your recent request to extend the above permit has been reviewed pursuant to 6NYCRR, Part 621. The expiration date is extended to X Your recent request to modify the above permit has been reviewed pursuant to 6NYCRR, Part 621, It has been determined that the proposed modifications will not substantially change the scope of the permitted actions or the existing permit conditions. Therefore, the permit is amended to additionally authorize: Construction of a 4'x 13'landing with same size balcony above.All work to be done In accordance with attached NYSDEC stamped approved plan last modified 7/16/02 by Joseph Brittman. All other plans,terms, and conditions remain as written In nal permit. This letter is an amendment to the original permit a , as such, s all be available at the job site whenever authorized work is In progress. ry truly your . hn Wlelan Deputy Regional Permit Administrator �Oc�UFf O�COIi = Town Hall. 53095 Main Road T P.O. Box 1179 Telephone O Southold. New York 11971 (631) 765-1892 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Tuesday, August 20, 2002, the following recommendation was made: Moved by Drew Dillingham, seconded by Bill McDermott, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Amendment Request of JOSEPH & ELIZABETH BRITTMAN to Amend Permit#5492 to accommodate a 4'X 13' landing with same size balcony above. Located: 80 Glenn Rd., Southold. SCTM#78-2-10 Vote of Council: Ayes: All Motion Carried ` . �~ �.G -�i ✓ ��• •'T�aa��`,..����•�J!=r_�.�.:�-ems;-_7F. i� .P':�+1. _/�..� - h 'i�. and Of Southold Town Trustees Bo X. SOUTHOLD, NEW YORK Feb. 21,. 2002 DATE: PERMIT NO. ... .................. ........ I. JOSEPH & ELIZABETH BRITTMAN } ........................................... .� ISSUEDTO .......................................................................................... Y Pursuant to the provisions of Chapter 615 of the Laws e the State of New York, 1893; and Chapter 404 of the Laws of the ti« �' State of New York 1952, and the Southold Town Ordinance en- .t rr titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS �. IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL-OR OTHER MATERIALS FROM REMO LANDS UNDER TOWN'WATERS;'`: and in accordance with the Feb. 20, y =•� , Resolution of The Board adopted at a meeting held on ........................... • }: 200 00 aid b 2002 I �f and in consideration of the sum of .. p Y JO5EPH & ELIZABETH BRITTMAN.............................................. ...... f, ,' w A ♦ ................................................... N. Y. and, subject to the Southold ;:, of ............................................ '; Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Wetland Permit to construct a 251.X 35, addition to the existing k'. 1 dwelling, with the condition that drywells and gutters are '=a _ installed to contain the roof run-off and that there be a staked row of haybales placed do wr� be ore con�triaction be n all in accordance with the detailed specifications as pr n ed in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to • b a ma'ori of the said Board as of this date. be subscribed Y I ty .- a a • K h Poliwoda (Absentl r. Trustees •77 � _ F� —L �L�t i�4* �i7I.V'Y�'IT�V+��'f LT.rR°C•"���—��'�� � ^.�a�'.' � � 1h: `�' �-i't' y..I'•�•X��L�Rx•J�.ff:}�a.r+Yc'M1`1��+J �' tl Y•t . 4' `''t lx. �, .�7G. .' G '" tS. yr` ♦ A .: ... •s. �f'%y. ,Q`!Y=;1 '"7'��. mum TERMS and CONDITIONS The Permittee Joseph & Elizabeth Brittman 23 Jerome St. , Smithtown, NY 11787 N. Y, as residing at part-of the consideration for the issuance of the Permit does.understand and prescribe to the fol- lowing: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly of indirectly as a result of my oper- ation performed pursuant to this permit, and the said Permittee will, at his or her awn expenses defend any and all-such mits-initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the eomplete'e:dusion of the Board of Trustees of the Town of Southold 2. That this Permit is'valid for s-period of : 24 mos. which is considered to be the estimated time'required to complete the work involved, but'should.cirduziistances 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 Permittee 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 inspection and approval of the Board or its agents, and non-romplianee-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 work herein authorized. 6. That there shall be.no interference with the right of the public to pus and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the.removal and/of alterations in the location of dle work herein authorized, or if{ in the opinion of the Board of Trustees, the. work shall cause unreasonable obstruction to free navigation, the said Permittee will be rcquh vd, upon due notice, to remove or alter this work or project herein stated without expenses to the Town of Southold 8. That the said Board will be notified by the Permittee of the compledon.of the work au& orized. 9. That the Permittee will obtain all other permits and consents that may be required sap' sa plemental to this permit which may be subject to revoke upon failure to obtain me. Albert J.Krupski,President Town Hall James King,Vice-President OSQFF�(�C 53095 Route 25 Artie Foster �O ��j P.O.Box 1179 ti y Southold,New York 11971-0959 Ken Poliwoda cz Peggy A.Dickerson ti Z Telephone(631) 765-1892 Oy �� Fax(631) 765-1366 �01 � Sao BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD February 21,2002 Mr. &Mrs. Joseph Brittman 23 Jerome Street Smithtown,NY 11787 RE: 80 Glenn Rd., Southold SCTM#78-2-10 Dear Mr. &Mrs. Brittman: The Board of Town Trustees took the following action during its regular meeting held on Wednesday,February 20,2002 regarding the above matter: WHEREAS, JOSEPH &ELIZABETH BRITTMAN applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated January 23, 2002, 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 February 20,2002, 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, 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, 2 NOW THEREFORE BE IT, RESOLVED,that the Board of Trustees approve the application of JOSEPH &ELIZABETH BRITTMAN to construct a 25'X 35' addition to the existing dwelling,with the condition that drywells and gutters are installed to contain the roof run-off and that there be a staked line of hay bales placed down before construction begins. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency,which may also have an application pending for the same or similar project. Permit to construct and complete project will expire two years from the date it is signed. Fees must be paid,if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. Fees:None Very truly yours, i Albert J. Krupski, Jr. President,Board of Trustees AJK/lms DEC Bldg. Dept. oS�F�o�co Tower Hall; 53095 Main Road ca 'T P.O..Box 1179 Telephone O Southold:New York 11971 (631) 765-1892. SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Tuesday, February 12, 2002, the following recommendation was made: Moved by Scott Hilary, seconded by Bob Ghosio, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Permit Application of JOSEPH & ELIZABETH ,BRITTMAN to construct a 25'X 35' addition to the existing dwelling. Located: 80 Glenn Rd., Southold. SCTM#78-2-10 Vote of Council: Ayes: All Motion Carried n o ER tom' I L-YT�:. .N Siding lines indicate the extent of added . construction'but not the extent of work' required - to eomOlete Oro iect ANY AL TERA TION OR ADDITION TO THIS SURVEY IS A "VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICAbONS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY /F SAID MAP OR COPIES BEAR THE kWRESSED SEAL OF THE SURVEYOR WHOSE SIGNATURE APPEARS HEREON. ADDITIONALLY T0,COMPLY WITH SAID LAW M TERM 'AL TERED 8Y' MUST BE USED BY ANY AND ALL SURVEYORS UTILIMS A COPY OF ANOTHER SURVEYOR'S.MAP. TERMS SUCH AS WSPECTED'AND TROUGHr TO-DATE'ARE NOT/N COMPLIANCE WITH THE LAW. Q. S E9 7y%. RQ Q 4' �� F '90 *110 Qa �If �P C. Z�� : JAN 2 3 �Q o\ - 1 �/ _ SURVEY OF trb a1PgF. i e! 5.3 QLOT 1 'ems Q "MAP OF WEST CREEK ESTATES" o�Q FILED AUG 19, � ss4e o. A SOUTHOLD TOWN OF SOUTHOLD - — - SUFFOLK COUNTY, N. Y. x x xvx 0 1000 - 78 - 02 - 10 rOP OF BAW SCALE: 1" = 30' MAR. 23, 1998 `OT 1 ` — `_ DEC. l7, 2001 ( update 1 �AN � 20� ADED .q g D ) ELEVA TIONS d CONTOURS ARE REFERENCED TO N.G.V.D. 1� ' N.Y. C. N0. 49618 e PtC AREA 23,375 SQ. ff. (63/O765 P 0 A " 11 765 - 1797 OXFLood 2pI/� A E . 0 TRA VELER STREET SOUTHOLD, N.Y. 11971 98 161 l -TO C.AAA-ovv�,- I N p AUG 2 8 2002 U �OSUFFO(�CO Towri Hall Albert J.Krupski;President h.1.� Gy 53095 Main Road. James King,Vice-Piesident o= t - -P.O.Box 1179 Henry Smith COD2 Southold,New York 11971 Artie Foster 4 Ken Poliwoda Telephone(516)765-1892 y �� ��l . Fax(516)765-1823. BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD LETTER OF REQUEST FOR AN AMENDMENT DATE OWNER . . .*ec,iz. tt PHO ' I -7 S aDDRss - 2. ,M I:ST . �'� w�1 I g7 AGENT OW PHONEI . ADDRESS S PROPERTY LOCATION ®^(-r1��1�U� (� O'i�7`�plc��� y• 7 TAX MAP NO. I/We �t� i request an Amendment to Permit# S �. Signed By: cS JUL 1 7 M ' PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: �Cw�lcXt�< <`s2si..�y,C►�4.L. l coc�cJ l 56uaa-S LUA-(Z/ -)J �v c3 c31- Z3-\ �UtJ UL�iuxY]-� Sc STATE OF NEW YORK COUNTY OF SUFFOLK -�ie��tta`�,�r3e5-Ct 6rL,ztr residing at \\1��l ,being duly sworn, deposes and says that on the i O day of hog, s ,20c�, deponent mailed a true copy of the Notice u set forth.in 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 persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at that said Notices were mailed to each of said persons by (certified) (registered)mail. Sworn to b ore me this Day of 20 D y Iff Notary Pu c WR1CIA CORMN NobiyNo.OIC05017851 Qualified in Suffolk CotiO Commission Expires Sept.11,_— v�+ NOTICE TO ADJACENT PROPERTY OWNER - a- BOARD OF TRUSTEES TOWN -OF.SOUTHOLD In the matter of applicant: CTMx 10 0 0- 102-1 U YOU ARE HEREBY GIVEN NOTICE: 1. That it is the Board intention Trustees the to;undersigned to request a pey_m;t from th /�J✓1,c'(\10 (�5'�11��r �Lsa'Lv�IT "� �t-�✓hC�� �-l 'K.1�1 L}�'iV'Ol(V(z- . 2. That the prop erty which is the subject of Environmental :h Review is located adjacent to your property end is described as follows : t (�..cys� oEM -. 3, That the project which is subject to Environmental Rev�i�ewt! +, +e-� 2, 37 , or 9-7 of the Town Code is open to pug.l i c -an-der ChaptersYou may contact the Trustees Office at Lnmme:nt on: ro-- 1892 or in c:•ri}ing. The above referenced proposal -is under rev iew °eferencef the aan ,of Trtiste2s of the Town of Southold and does not y other agency, that might have to review same proposal. OWNERS NAND': s � MAILING. ADDRESS: 23 PHONE Enc. : Copy of sketch or plan showing proposal for your convenience. OSUFfO(�C Albert J.Krupski,President Town Hall � OG .53095 Route 25 James King,Vice-President h y P.O.Box 1179 Henry Smith o= Southold,New York 11971-0959 Artie Foster y Ken Poliwoda ; • Telephone(631) 765-1892 d Q� Fax(631) 765-1366 . �01 � �a BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ------------------------------- In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING � r I, IDS residing at being duly sworn, depose and say: That on the 9 day of 20Q' 0 I ersonally posted the property known as &O ( q �-�^"� �`� � by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date o hearing noted thereon to be held l� od,, dal •aN,a0L or o�a�ouf- '�m, Dated: Sworn to before me this 7 day of jgu 20OZ No ary Public JVANNE QUOR7RUP NOTARY PUE!I!G,' ;',1 York Cd 3a!itttj ;,Suffolk Count 2 Commission Expires May 27,_ �. eat Fot,r Town Hall Albert J.Krupski,President C Off'James King,Vice-President 53095 Route 25 =y. l/,j� Henry Smith P.O.Box 1179 o Southold,New York 11971-0959 Artie Foster y Ken Poliwoda • `F Telephone(631)765-1892 y�01 �a0� Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only � �ellS Coastal Erosion Permit Application r� bPkc /Wetland Permit Application i Major Minor S o m _Waiver/Amendment/Changes Received Application: �L"W Received Fee:$ Completed Application 1 a3 OV, Incomplete SEQRA Classification: JAN 2 3 Type I Type II Unlisted Coordination:(date sent) RAC Referral Sent: Date of Inspection: cxI 1310 0-J . Receipt of CAC Report: Lead Agency Determination: Technical Review: . Public Hearing Held: al a0)0%d Resolution: Name of Applicant o s ao--f �*' �C_f 2 ��'T'r-f �21 T ?Mfi Address )m ► 7-H T��•ye.� Y .-� l 7 �1'7 Phone Number:(43)I 7 �� Suffolk County Tax Map Number: 1000- L/-23 gk9-7 R -' DI Property Location: �(� C E_-7 A-)� �(av'T? l L Cc� & Ufa✓ �- GL „ (provide LILCO Pole#, distance to cross streets, and location) AGENT: \� (If applicable) Address: Phone: 4MW Board of Trustees Application GENERAL DATA Land Area(in square feet): c�s3 j 37 TwF61, ?(D12g117, Area Zoning: CS 1 oki n }L-- Previous use of property: /D C c_ Intended use of property: i�/y Prior permits/approvals for site improvements: Agen y Date b . E,G> y 9� h x—Aw s ree-S /saves i�hsv` 3 LO.( No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspe�oed by a governmental agency? No Yes If yes, provide explanation: Project Description(use attachments if necessary): Fly A-) OA-) LAS 7_1 _!�7?11 L, Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: X j L -T Area of wetlands on lot: S square feet Percent coverage of lot: 2 % Closest distance between nearest existing structure and upland edge of wetlands: o feet Closest distance between nearest proposed structure and upland edge of wetlands: ° feet Does the project involve excavation or filling? No B/ Yes If yes, how much material will be excavated?S cubic yards 1 How much material will be filled? cubic yards Depth of which material will be emove r deposited: 3 feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: 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): 14-16•4(2/87)—Text 12 PROJECT I.D. NUMBER 617.21 SEO Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I—PROJECT INFORMATION (•o be completed by Applicant or Project sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME 5'&seyn - L12-43M 13a17"7Yb&o 1ADD)-E/0 MA )�iov&L fl"ILlT)weLC.iAJlt.r 3. PROJECT LOCATION: Municipality ?0 , 6'r* //77 County gurF d. PRECISE LOC T10N (Street address and road intersections, promin t landmarks, etc., or provide map) ® CCvu*j P, 'g�c �a�-� Iv - 11�7.1 � L I► r ►�`-'� Vey �D `� �L� a - 5. IS PROPOSED ACTION• ❑Ne, YExpansion ❑Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: PDD 7. AMOUNT OF LAND AFFECTED: Initially. j° Q acres Ultimately I_/ acres 3. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? as ❑No If,No,describe briefly I 9. WHA1,1S PRESENT LAND USE IN VICINITY OF PROJECT? f Residential Elridustrial ❑Commercial t_i Agriculture Park/ForestlOpen space LI Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE 0R LOCAL)? LJ Yes ❑No If yes, list agency(s)and permitlapprov s SO L.'TW c�,Bvr LD lNry DAN-# 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? vYes' ❑No It yes,list agency name and permit/approval -®1�7_V006®57 o07-C- 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE M001FICATION? ❑Yes 27No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNCWLEDGE Applicant/5 ame: 'J D en q24 q' lLi IM17rq R/?-* `77MA-k-2. Date: a Signature If the action is in the Constal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER t PART II—=NVIRONMENT S 3MEN T i;o be completed by :Agenc- A. •JCES ACT:CN EXCEED ANY ?E i TH"ESHG D IN a NYCPR. ?ART 517.:Z? It yes, coordinate the review :rocess and use the F41L_ -7,A. C]Yas I`No B. WILL ACTION RECEIVE CCCRDINATED REVIE'N AS PROVIDED =7R UNUSTED AC ICNS iN o NYCPR. PART 517.57 if No, a negative dec:ara may be superseded ny another:nvolvea agency. Yes _'No C. COULD ACTION RESULT iN ANY ADVERSE EFr=CTS ASSCC:AT=_0 WITH 'HE FOLLOWING:(Answers may ce nanawratten. it :egrble) C1. Existing air quality,,surface ar'grounawater duality at cuantity, noise levels, existing :raffic :atterns, solid waste prccuc:ion or disco potential for erosion, drainage or;loading problems?E;plain brieily C2. Aesthetic, agricultural, arc:taeological,historic,or other natural or cultural resources:or community or neignbarnood character? =xolain �r C3. Vegetation or fauna. .'Isn. snellfish or wildlife sbecfes, significant habitats, or threatened or endangered sbec:es? Exclatn drlarly: C;. A community's existing plans or goals as offic:ally adooted,or a cnange in use or intensity of use of land or other natural resources?Explain cr C5. Growth. subseduent 7evelooment,or related activities likely to be induced by the crobosed action? Explain oriefly. iC3. Long :arm.snort ,erm,cumulative,or other effects not identified in C:CS? Exorarn briefly. I f r : Other impacts iinc:dcing changes in use of dither quantity or ;ype of energy)? =:plain orfetly. i t I I I '-D. IS 7HERE.-,R iS THERE_!K-=•.'70 3E.CONTROVERSY RELATED TO POTENTIAL ACVERSE ENVIRONMENTr L i.IAP.AC' _ Yas i_.to If Yes, exclain brietly I PART I11—DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large, imcortant or otherwise signifiC Each effect should be assessed in connection 'xith its (a) setting (i.e. urban or rural); (b).probability of occayng; (c) duration irreversibility;(e) geograonic scope; and (f) magnitude. If necessary, add attachments or reference supporting tnateriais. ensure explanations c--ntain sufficient detail to snow that all relevant adverse impacts have been identified and adequately addressee. Check this box ff you have identified one or more potentially large or significant adverse impacts which iMA': occur. Then proceed directly to the FULL E.-\F andlor prepare a positive-declaration. I Check this box if you have determined, based on the information and analysis above and any supoortlnc documentation, :hat the prcoosea action '°,/ILL NOT result in�riy significant adverse environmental impact: i AND provide on attac invents as necessarv, the reasons supporting this determination: j • N—ne or :.Call Agency I t i 'nnt w ;vt.'e Maine or (enoonstare%.:ttrcer:n Ledo.•tgenCv ;rite or :<—oons,cie i)rrrcer j i jrgnature or lescans,Ore•_r:der in :eaa Agency i,gndture or r'retwier tit t.rr:e.'ent :ram re5consrale otricerl i i Date Albert J.Krupski,President O�OSUFFO(�CO Town Hall James King,Vice-President .53095 Route 25 P.O.Box 1179 Henry Smith c Southold,New York 11971-0959 Artie Foster y = Ken Poliwoda • `F Telephone(631) 765-1892 'fijJ�l �aO� Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING ` I,�aS r4�2 cr-rv�►4t� residing at g® Cam_& <;�o07-RV -� f1`h � I being duly sworn, depose and say: That on the day of en , 20 Z, I personally po ted the property known as O `ate S'ca� ���� o_�' by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the ublic hearing Date of hearing noted thereon to be held U F2b.o�i°t�`�" Vn or at" 7 .OD PM Dated: $( g ature) Sworn to before me this 13 day of Feb 200, - �M,Qt katrdry Pub is JEANNE QUORTRUP NOTARY PUBLIC,Sate of New York 527 Qualified in Suffolk County c2063 Commission Eypires May 27, i 1'�k 02 ca G r 0111A PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address : 34l 77 22., � Su L-WSJ , iJ LAJ y C32kC \\C\:1\ i.o X-j N C- tA\L_0 L`Y e alk-N0-r- \ -31 o i 2:�6-7'S . ("i tJ 3. elv Q AO S c J1"c t'j& J ur,'<- U�'� STATE OF NEW YORK COUNTY OF SUFFOLK `Jclj�(J�1 I-E�-i?�bc��s'R�• d,�i cT� y , residing at 20 �" r_^ being duly sworn, deposes and says that on the `,5 t day of deponent mailed a true copy of the Notice set forth in 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 persons are the address of said -persons as shown on- the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at that said Notices were mailed to each of said persons by (certified) (registered) mail. Sworn to before me this- is day of J- o _ ,'3 2-CXyZ Notaryy 'Public JEANNE QUORTRUP NOTARY PUBLIC,Sate of New York No.09 QU5078527 Qualimd in Suffolk County��D 3 Comn"ssion Expires May 27, NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of .applicant: �S�rt +�C t 2 r4�ET�E V/C i T`T Y✓k4� S C TM#10 0 0— 7 � YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: I LD fi D D 1 l o 2 . That the property which is the subject of Environmental Review- is located adjacent to your property and is: described as follows : l �'2 90 639U,4-) 12� ov;-yr o� �A ' 1 0 7 I 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 on: 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 .and does not reference any other agency that might have to review same proposal. OWNERS NAME : MAILING ADDRESS: 23 .3"e1Lcx�C S� PHONE #: Enc. : Copy of sketch or plan showing proposal for your convenience. s Board of Trustees Application County of Suffolk State of New York J0SCP h"—Brl O'n . BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE 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. 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