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HomeMy WebLinkAboutTR-5687 Jill M.Doherty,President �QF S0(/ry Town Hall Annex James F.King,Vice-President 01 1 54375 Main Road P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 Bob Ghosio,Jr. G ,r John Bredemeyer �Q Telephone(631) 765-1892 . D�yCOU '� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0519C Date January 27, 2010 THIS CERTIFIES that the.removal.of.a dwelling on a block foundation and construction of a. dwelling on a poured concrete foundation and installation of gutters and d . ells At 1145 Fleetwood Rd., Cutchogue Suffolk County Tax Map #137-4-26 Conforms to the application for a Trustees Permit heretofore filed in this office dated 12/31/02 pursuant to which Trustees Wetland Permit#5687 dated 1/22/03 was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this-certificate is being issued is for the removal of a dwelling on block foundation and construction of a dwelling on a poured concrete foundation and installation of gutters and d , ells The certificate is issued to ALFRED.A. MAGILL owner of the aforesaid property. 0 Authorized Signatur NOTE: EXISTING HOUSE SURVEY OF ON S/TE DESCRIBED PROPER TY SI TUA TE sanitary system. ate existing artm,znt. CUTCHOGUE, TOWN OF SOUTHOLD' by HPt+h[�2p BULKHEADED SUFFOLK COUNTY, N. Y. to be BOAT SLIP EXISTING CESSPOOL TO EMPTIED, REMOVED, AND BACKFILLED. N/F RYBECKY SURVEYED FOR MAGILL RESIDENCE RESIDENCE WITH PUBLIC WATER PROPOSED SEPTIC TANK , „40 E NOTE: ELEV. LOWER DECK \ 264.05) F FD N 39 0 2/7 IVING AREA = l z 90 W W/RA S /I/ 6 C/ CM g/5` 1 110.87" °Nc \`� Z m 5 sod —2O 22 /vq CO 1 A m h FRAME �'n /i LIMIT 0_ �19 C� GARAGE Z. P 53.0 MBER ROPOS D ONC. 8E\\ LIMITS OF � FLOOD FLOOD i}• 2—STORY FIRST FLOOR WALL P \ F �1 28.0' v� 3 BEDROOM 3•78 1 14\ x \ ZONE AE-8 � N BLUESTONE 67.7p \ -A N EXIST. D DRIVEWAY RESIDENCE N \ 10 6 \ U, CA �e WOOD RAMP `o 7.0' LP � 48.5' BAY W1ND0 D R y ST I° N zo CHIMNEY TOP OF BA 7 O SUPiY �a�_ O + BLUESTONE \ \ 12 \8 \ 4 \ Cn —1 O FD TIMBER noeo S7Ers FD 16 -\ \ C r� CM S 40' 04' 00" W \ 22 o R A ° cm 2 / 320.36' —1 EXIS77Nc °SFo F��iSnN° // FOR S.C.D.H.S USE ONLY CESSPOOL O CFSSP K''ez O PROPOSED NEW CESSPOOL WELL(APPROX.) OOG N/F CAMPBELL (SEASONAL USE) NOTE: NEW SCWA WATER SERVICE �l ELEVATIONS IN 1929 Nv^VD TO BE SLEEVED AS REQUIRED DUE TO PROXIMITY OF NEW SURVEYED 03 APRIL, 2001 PIPE CESSPOOL. NEW WATERLINE SERVICE FD TO RUN JUST NORTH OF SOUTH PROP. LINE. a r at° 6 SCALE 1 30.' v TEST HOLE DATA p AREA= 15,O81.O65SF I n PERFORMED BY McDONALD GEOSCIENCE GUARANTEES INDICATED HERE ON SHALL RUN it ,'.+ , ' �} a� OR G (�" 0.346 ACRES FDONLY TO THE PERSON FOR WHOM THE SURVEY 24 FEBRUARY 2003 r Q v cM IS PREPARED, AND Old HIS BEHALF TO THE f 1�, FLOOD MAP DATA FROG zf-IRA YfAP 61O3CO164G — EXISTING GRADE TITLE COMPANY, GOVERNMENTAL AGENCY, t: . FFECTIVE DATE 4 MA9 LENDING INSTITUTION, IF LISTED HEREON, AND BROWN SILTY SAND SM TO THE ASSIGNEES Of- THE LENDING INSTITUTION. 2 GUARANTEES ARE NOT TRANSFERABLE TO " VTI ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. '"; ; , " - R T� N I d y max► e y UNAUTHORIZED AL TERA TION OR ADDI TION TO THIS PALE BROWN FINE TO SURVEYED MEDIUM SAND SP SURVEY IS A VIOLATION OF SECTION 7209 OFTHE NEW YORK .STATE: EDUCATION LAW. STANLErq. aoKSEN, JR. P.0. B(5 '294 CUPIL S Of IHIS SUI?VE Y MAP NOI BLARING rv, �. :;:� �' NEW SUFFOLK,. NY 11956 THE LAND SURVEYOR:; _EMBOSSED SEAL SHALL ems, �` �_ NOT BE CON_,IDERED TO BE A VALID TRUE 516 734-5835 TM lOOO-137-04-26 COPY. � � rV / . S F� L IvW • GUARANTEED TO � NYSNLI N0.N492 3VEYOR MAGILL 2. 27 FEBRUARY 2003 SHOW PROP. DWELLING NOTE: 1. 29 JUL Y, 2002 SHOW ADDITIONS - -- -- _.._ _ ..... -...__.. .- _ Jill M.Doherty,President 4 Town Hall,53095 Main Rd. James F. King,Vice-President H w � P.O.Box 1179 Dave Bergen Southold,NY 11971 Bob Ghosio,Jr. �JJQl �� Telephone(631)765-1892 John Bredemeyer �` Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction % constructed v Project complete, compliance inspection. INSPECTED BY: COMMENTS: C CERTIFICATE OF COMPLIANCE: Albert J. Krupski, President ' Town Hall James King,Vice-President �QSUFFQ��C 53095 Route 25 Artie Foster �0 OG P.O.Box 1179 Ken Poliwoda Q y� Southold, New York 11971-0959 Peggy A. Dickerson y 2 Telephone(631) 765-1892 O Fax(631) 765-1366 col � Sao BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 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 J°4 to 15� o v— Z�� 1st day of construction % constructed Project complete, compliance inspection. Alberti.Krupski, President James King;Vice-President Town Hall Artie Foster 53095 Route 25 Ken Poliwoda P.O.Box 1179 � � eyp Southold,New York 11971-0959 Peggy A. Dickerson Telephone(631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 19, 2005 Mr. Alfred Magill 700 Glen Court Cutchogue, NY 11935 RE: 1145 FLEETWOOD RD., CUTCHOGUE SCTM#137-4-26 Dear Mr. Magill: The following action was taken by the,Southold Town Board of Trustees at their Regular Meeting held on Wed., January 19, 2005: RESOLVED that the Southold Town Board of Trustees grants a One-Year Extension to Permit#5687, as issued on January 22, 2003. This is not an approval from 'any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:Ims osuFFo�;��, Albert J.Krupski,President Town Hall James King,Vice-President = G'y� 53095 Route 25 Artie Foster y - P.O.Box 1179 Ken Poliwoda Southold,New York 11971-0959 15 Peggy A.Dickerson y�� a��� Telephone(631) 765-1892 1 `�► Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Building Dept. FROM: Board of Trustees DATE: May 12, 2004 RE: Alfred Magill 1145 Fleetwood Rd., Cutchogue SCTM#137-4-26 The Southold Town Board of Trustees reviewed the survey prepared by Stanley J. Isaksen, Jr. last dated February 27, 2003 and determined the proposed new cesspool to be out of the Wetland jurisdiction under Chapter 97 of the Town Wetland Code and Chapter 37 of the Town Code. This is not a determination from any other agency. p,��• f-,```?�\ 4x?� �T`�'��„��i�� �� "yf�3'y � 'Q.:.y�y. ■y£�ry. � -a. �- 40, Board Of Southold Town Trustees. 1 SOUTHOLD, NEW YORK p- `•:: DATE: Jan.22,.209 g';` ' PERMIT NO. ... ?f LFRED A MAGILL bs 'x ISSUED TO ................................ . / a, Pursuant to the provisions of Chapter 615 of the Laws of. u.. the State of New York, 1893; and Chapter 404 of the Laws of the - • ,• ` ' State of New York I952; and the Southold Town Ordinance en- -�`� titled ."REGULATING AND THE PLACING OF OBSTRUCTIONSY f. y IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL-OR OTHER MATERIALS FROM LANDS UNDER TOWW WATERS;:'.' and in accordance with the t Januar - 22, Resolution of The Board adopted at a meeting held on ......................Y-.... 200-3........, and in consideration of the sum of $..........20.0...0.0.._ ,pai y Alfred...A......Magill........................................................................................... :........... ........ `< /- ti. Cutchogue, Iof .............................. . . .................................................. N. Y. and. subject to the 4 Terms and Conditions listed on the reverse side hereof, ` • � . of Southold Town Trustees authorizes and permits the following: _`- _ 1 Wetland Permit to remove "old" house/block foundation/ replacer - y 1. with poured concrete foundation - new home on same footprint - . ' r : �. W _ with drywells, gutters and haybales. all in accordance with the detailed specifications as presented in s ' the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- ' fixed and these resents to ) '' r� by causes its Corporate Seal to be of (� t : be subscribed by a majority of the said Board as of this date. M A Foster -(Absent) y, Trustees c Az .ni A TERMS and CONDITIONS The Permittee Alfred A. Magill 1145 Fleet `` N. Y' 0 residing at and presctiLe to the fol- part' of the consideration for the issuance of the Permit does understand a lowing: i. That the said Board of Trustees and the Town of Southold are released from nay and an damages, or claims for damages, of sues arising directly or indirectly as a result of any open. ation performed pursuant to this permit, and the said Permittee will, at his or her ow u expense, defend any and all' such suits-initiated by third per, and the said Permittee assumes full liabulity with respect thereto, to the Complete'exclusion of the Board of Trustees of the Town of Southold 2. That this Permit is valid fora period of 2 4 coos. which is Considered to be the estimated time-required to complete the work involved, but'should.cirdldztaoca warrant, request for an extension may be made to the Board at a later date. rmit should be retained indefinitely, or as long as the said Permittee wishes 3. That this Pe to maintain the structure or project involved, to provide evidence to anyone concerned that iauth- orization was originally Obtained- bat T the work involve 4. d will be subject to the inspection and approval of the Board or its agents, and non-compliance 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. G. That there shall be no interference with the tight of the public to pass and repass slong the beach between high and low water marks. 7. That if future operations of the Town of Southold require the.removal and/or alterations . is the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the. be required, work shall cause unreasonable obstruction to free navigation, the said Peunittee tie Upon due notice, to remove or alter this work or project herein stated without expenses : . of Southold 8. That the said Board will be notified by the Per n ttee or the Completion,of the work iuutln- orized. 9. That the Permittee will obtain all other permits and consents that may be required sup- plemental to this permit which may be subject to revoke upon failure to obtain same. Albert J.Krupski,President Town Hall James King,Vice-President O$VFFQ��C 53095 Route 25 0� P.O.Box 1179 Artie Foster C �� Gy Southold,New York 11971-0959 Ken Poliwoda O= Peggy A. Dickerson y Z Telephone(631) 765-1892 O Fax(631) 765-1366 y'�pl dap! BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 27, 2003 Alfred A Magill 700 Glen Court Cutchogue,NY 11935 RE: SCTM#137-04-26 1145 Fleetwood Road Cutchogue,NY Dear Mr. Magill: The Board of Town Trustees took the following action during a Regular Meeting, held on January 22, 2003 regarding the above matter. WHEREAS, Alfred A. Magill applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated December 31, 2002. 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 January 22, 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, WHEREAS,the structure complies with the standard set forth in Chapter 97-18 of the Southold Town Code. 2 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 approved the application of Alfred A.Magill For a Wetland Permit to remove"old"houseiblock foundation/replace with poured concrete foundation—new home on the same footprint with drywells, gutters and haybales. 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. Fee must be paid, if applicable and permit issued within six months of the date of this notification. If inspections are required, at a fee of$5.00 per inspection(See attached schedule). FEES: $10.00 Very truly yours, Albert J. Krupski, Jr. President,Board of Trustees AJK/cjc cc Building Department Cti R 3$ • :•1 R�' 4.4 Y i,fS}� 1'3F J 3.y.�•k' � 11�9Y�[��bP��4R��i ,•�tl f •' •f T ��`,�.� {dY•4 ,sly�.�- Si j +K h if izA •kr SY f ! e 7pp� 1 t'`F •R. . Sh4rM1 p�Y�'r, n • _ _ � • � . • _ • . . • •�ti ���76i '„'t"'1E �� t4H f�v'A' ♦ 1"�• 1 1 iml TO I 1 J[`?��d� 1 pt�r'� 3• ery.�.4 „��,T, . • — -�fit,t{��• � >< ry�,lpp�. • . • • • • � • • • �1Li�ry t5 �.`'4 ,3 l�a^c4���.7��,Ty �yd a« • • 4�tF ,� i�k S,R�rt 3�Ct�;Fv`fi Wxtl • • • • If r +� f a pig gl CA- AN a • 1 S .T� � r s ?�t t3 jVVY 13, Y-11 l tl` �� r "Tall® �/ .•I ', ' $, y+,1�i �RYta yt yS StY 3' M. ir3ri Pi HAw FM ZMA AGoutT ' t� . • ire!. � Y� � rqa S, • f �'��alj, - '4�lS,�L'' svF � Mai {t � "i 1S•y''€&e�r���jT�'X• '�9�L 6��f5}y`S ,�}y�p: Alberti.Krupski,President OSUFFO(/�C Town Hall Vice-President ��j 53095 Main Road James King, �� y� P.O.Box 1179 Henry Smith c Southold,New York 11971 Artie Foster W = Ken Poliwoda O Telephone(516) 765-1892 y Q� Fax(516)765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Please be advised that your application, dated�e� has been reviewed by this Board, at the regular meeting of 22, 2003 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 be necessary. COMPUTATION. OF PERMIT FEES: Two Inspections @$5.00 each TOTAL FEES DUE: $ 10.00 SIGNED: PRESIDENT, BOARD OF TRUSTEES BY: LERK, BOARD 0 TRU TEES \ 4/98 Alberti.Krupski,President Town Hall O�OSV fFOC�,CO 53095 Route 25 James King,Vice-President P.O.Box 1179 Artie Foster �� G$� Southold,New York 11971-0959 Ken Poliwoda Peggy A.Dickerson ti Telephone(631)765-1892 ® Fax(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD ALFRED A. MAGILL YOU ARE REQUIRED TO CONTACT THE OFFOF TICE OF THE BOARD OF HE WORK, TO MAKE ANRUSTEES 72 HOURS PRIOR TO COMMENCEMENT APPOINTMENT FOR A PRE-CONSTRUCTION EBLEOREVOC FAILURE ATION OF THE SHALL BE CONSIDERED A VIOLATION AND POSS PERMIT. INSPECTION SCHEDULE x Pre-construction, hay bale line 1st day of construction % constructed x Project complete, compliance inspection. 1/27/03 Albert J.Krupski,President Town Hall James King,Vice-President OS �C 53095 Route 25 Artie Foster P.O.Box 1179 Southold,New York 11971-0959 Ken Poliwoda o Peggy A.Dickerson H Z Telephone(631) 765-1892 py O�.F Fax(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 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 1st day of construction % constructed/ Project complete, compliance inspection. s o = Town Hall. 53095 Main Road CP T P.O. Box 1179 •Telephone Southold, New York 11971 ��• (631) 765-1892 �( SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Wednesday, January 15, 2003, the following recommendation was made: ALFRED A. MAGILL to Femove "old" house on a block foundation and replace with poured concrete foundation and new dwelling on basically the same footprint. Located: 1145 Fleetwood Rd., Cutchogue. SCTM#137-4-26 The CAC did not make an inspection, therefore no recommendation was made. r'. NeW York State Department of Environmental Co nservation Notice of Incomplete Application - This is NOT a Permit a.riort Id: 1-4738-03073/0000J Appli Batch Number: 911619 Facility: M/1OILL' PROJPERTY 1145 FLEETWOOD RD SCTM#1000-137-4-26 CUTCHOGUE, NY 11935 G Applicont: ALFRED ANDRIF' 'MAGILL Owner Ili: 1490007 700 GLEN CT CUTCHOG(JE, NY 11935 Permitfs)Applled for:'•:1 -Article 25 Tidal Wetlands Project Loc•atrr-It: irr ,SOU THOLD in SUFFOLK COUNTY ry Your application for Permit is incomplete. The following items are required: The jul isdictiociul cut-of f on )his property is the top of bank/concrete wall at approximately elevat:t)n 24 on the submitted survey (not the 10 foot elevation contour as stated iti your letter). Accoi .irtgiy, it appears from the rendered photograph which you submitted that part of your propc� i! ;;riles scluar-i3r ? •)ff the existing deck seaward of this line. The 7/29/02 legend on the survcN: idc:d!!:'ies Iclditiors with a particular cross-hatching pattern but does not label these additions 4r., l;ro,h;;,;eJ ano does not cross-hatch the deck extension/addition in the same manner. Please ,1, 7,ir ;rdetai!ed p!-,)ic*-ct description itemizing dimensions of all proposed additions and deck r .,;n .i�,us and high!iirt same on four copies of the survey. In additioi;, pieese siibn,it Iwo copies of the Chuck Thomas architect plans referenced on the subm' !.:1.: i,'rutcgraph. Upon .>.e t of all of the :r'.)ove information,-processing will resume. .srzbt►zi.tregraes#ed informa'hon•by _ 11'u rtrr ter r� wz can be taken until all of these nraterials are received. Sigturture: Date: August 27, 2002 :•'Y cr• STONE' ? OOK BUILDING 40 BROCY • i 1790 :r; rYrurtL:r: . 1). 44470365 >2, < • December 18, 2002 Alfred A. Magill 700 Glen Court Cutchogue NY 11935 (631) 734-6140 N.Y.S. Department of Environmental Conservation Stony Brook @Stony Brook University Bldg 40 Stony Brook,N.Y. 11790 Subject: Letter of non jurstication Application ID: 1-4738-03073/00001 E r Owner ID: 1490007 Date Received: August 15,2002 Applicant: Alfred Andrew Magill Facility: Magill Property-1145 Fleetwood Road, Cutchogue NY 11935 DEC Contact: Laura I Scovazzo z I would like to apply for a letter of non jurstication after consulting with Glen Just. The construction will be landward of the top of the bank/concrete wall at approximate 24' . elevation as required in your letter dated August 27, 2002.Enclosed you will find two copies of surveys indicating the elevation and contour lines. Thank you for your time and patience regarding this matter. Sincerely, Alfred A. Magill DEC 2 7 �''�� April 3, 2002 N.Y.S. Department of D. E. C. SUNY Bldg. 40 Stony Brook, New York 11790-2356 RE: Letter of Non-Jurisdiction from D.E.C: I plan to do an,addition/alteration to my property located at 1145 Fleetwood Road, Cutchogue, New York. The construction will take place landward of the 10Pfoot line as per Me enclosed survey. Thank you for your kind cooperation in the above matter. Sincerely, Alfred A. Magill 700 Glen Court <? Cutchogue, New York 11935 631-734-6140 DEC 2 7 2-- (fold#2) _ NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION = DIVISION OF ENVIRONMENTAL PERMITS NYSDEC REGION 1 HEADQUARTERS SUNY @ STONY BROOK BUILDING 40 STONY BROOK NY 11790 ALFRED ANDREW MAGILL 700 GLEN CT CUTCHOGUE,NY 11935 (fold#1)--staple here NOTICE OF RECEIPT OF APPLICATION The Division of Environmental Permits has received the application referenced below. The material submitted is being reviewed by staff,and you will be advised in writing regarding the department's findings. In all future communications,please refer to the Application ID number. Application ID: 1-4738-03073/00001 Date Received: August 15,2002 Applicant: ALFRED ANDREW MAGILL Facility: MAGILL PROPERTY Description: ji-const addns to existing sfd landward crest bluff>10'el DEC Contact: LAURA J SCOVAZZO BANNER BUSINESS FORM:;(518).182-8321 �I r — • gra77 JOINT APPLICATI ' - _ �� ,� , , New York State FOR PiE.RMIT: United States Army Corps of Engineers Applicable to agencies and permit categories listed,n Item 1 Please read all Instructions on back. Attach additional information as needed Please print legibly or type 1.Check permits applied for: #V4 2.Name of Applicant (Use full name) / Telephone Number (daytime) NYS Dept.of Environmental Conservation 4��� �ly 1LL 6-Tl- 7-7V ff0 Stream Disturbance(Bed and Banks) Mailing Address rCL c�1 Navigable Waters(Excavation and Fill) 700 Co alzr 0 Docks,Moorings or Platforms PostCuOffice State, Zip Code (Construct or Place) ` T«/—O .i,J C N/ I /l 9J Dams and Impoundment Structures 3.Taxpayer ID (if applicant is not an individual) (Construct,Reconstructor Repair) n Freshwater Wetlands .*idol Wellanas 4.Applicant is a/an: (check as many as apply) bCoastal Erosion Control Owner Operator 0 Lessee []Municipality I Governmental Agency Wild•,ScGnic,ifnq'Recieational Rivers 5.If applicant is not the owner,identify owner here- otherwise, you may provide Agent/Conlact Person information. -_ 461 Watir Quality Certification Owner or AgenUContact Person [:]Owner [] Agent/Contact Person I Telephone Number (daytime) r •.Qalling Address { Post Office State Zip Code 9 ✓ +� rn M " r -- � C7 R %o0project/Facility Location (mark location on map, see instruction Ia.) L,r O�•p p ' l - w 6 County: Town/CityNillage: Tax Map Section/Block /Lot Nurnber: Nr �. i..lt �. „s • r �' of STIiI!C T ado .. tJi-roic.lc uZlf-J7Qur ivc,v •3'Rvv o :oo ocation (inci,ufing Street or Road) kTelophone Number (rlaytimp) rri CYt/ ��"' •p• ` p f(aywairr ,��.� ���.� ��L7 G/� /`G�.,.:� E 3�!�f Y_F a�� J Cris Post office � q State zip Code 7.Name of stream or Waterbed} (on or near firojert aite)1 r lYar; �` !u;el-<o to C/ �/Y t�S3� ffU G �t--- 'Marne of USGS Quad Map: Location Coordinates: f NYTM-E NYTM-N 4 �_JI Description and Pu Purpose:(Category of Activity e. new coiist(tr lionlinstallalion.mainlenar•:e or ' r,urcHv6uE�':.. J ^ rp ( 9 fy lY 9.. :,.,a;.,;, ..• . . ;^»•'. .,. e placement; Type of Structure or Activity e.g.bulkhead,dredging,filling,rear,:,r!rck;larir,g of carte,; l'ypa o(Mate iais � )o Quanti!i,:c; Slruct'_�s and Work Area Dimensions,Need or Purpose lo Seed' t) "�-- A/.r t'r41r'' / � a' ,r•/o.�.r 4•.o .t:� !z� T'o /fw,4,4_rJ' /�'o mot_ s! swy-.#�3 .Sc9t �,• =Saloo' Oo= A/0,.! ./�arts p 77j C cor�G 7� �1 e�'i l7'.c•/s�-x.•..r.t`d .4/ a✓•c_e- �' �r7 �✓�,�p 11! )._1 zect,^n If';E',5 Ind I ir!:cr_''•.c+; i( 1—t ;uo:�v.ae 1'_•rn::l( ) 1� 41 re.p�r-,cy Use p^;y i r DEC APPUCAT11)I4 NUMBER ��'TT�7Z �Q/7�Z� ,oe- e ✓-C I— Z7' yp p Z ----�_ . _ _ '1 -po!., - In - US ARMY CORT•S 01:ENGINEERS r--r 11�11.Will Project Occuiiy Eloper>r d Start 13. Estimated Comr tio� a {A. _`_j �� -� State Land? ® ❑ate' —�U2to t r'LVFJ9 Pt.uLc :G•:.r5r': d" Yes FIG �/Q t•// a J - 14.Has Mork Begun ore Project? (If res, attach-- =5.List Preview Perm,"f Appirtat: n Numbers and Oates: (1'Pr/) -dRplF1:?all^,ior FAly wO:kwas il:?I':ed without p0rrT11:)-�. No 4. Will this Project Roquim Additional tf yeas. Federal.,State,or Local Permi a? 'tea � Ple3 a List: 17 It'applicant is not the owner,both must sign the application _ !_—'--_•'__'_-_'-•—'�-- �-_-�---�_ hr:reby atfirr•,that information;provided on this for.',and all attachments submitted herewith is true to the!cast of my kI> x! ge anr!belief False,;tatemet,C,n13de herein are punishable as a Class A misdemear---or pursuaril to Section 210 45 of the Penal Law. Fuither,the appkcan:accepts full respx)r,sit'li^r for all durragi:,direct or indircct. i of'whatever•nature.and by whomever suffered,arising out of the project desciiaed herein and mjreei to indernniN, and save hamiless the State from suits,actions. damages and costs of every name and description resulting from said project. In addition,Federal Law.td U S.0.Section 1001 provides!or a fine of not more than $10.000 or imprisonment for not more than 5 years,or both where an apolicant knowingly and willingly fa:sirfes,conceals.w covers up a material tact;or knowingly makes or uses a false,ficticious or fraudulent statemant r' Q/ ti _ +w �L�'/ / eY / s, es/ / p � W / // s / / 'w /, �O•f� ® P 4?�� a / 3 / j/ j Sa SEc.NO.173 41, Iv 3 O a � 7 4y \ L9Alc) RO�o L1Alc) � �YMN 20 �SOl1Y OA o YMN ff 50�� 'YPO �\ r9•7 i0 LOAIc) / / LOW - S r 24 -6 27 F4EfT a a °°`a a \ o \ rn ~� ° \ d 23 +� 4 vb s FT `J do ., flo. a V COUNTY OF SUFFOLK O E Service Agency NOTICE o RedProperty N Y 119D1 M massnw•N FOLLO N� PO �MTU ,ALMAT04SA�FR� D � �tY Center NIFEMim � uro -N— ED ARF tR�� NYORAN)-� DIS NY TAY, Ar 6 OF xr 40 -1W k, _SC) WbmT aou Ur --R i � VATO �- \,,jT tjRffTEK PER�AGENCY' --F ~ * u+ �T IYAR lgp��- sASYE.AYFR��� REAL PRl1MTY TAX { w Vtr ^ FT,o,+tk'U+ -- °ny..M lM _A-�- P...m�n A�J ..--_ ,�-...,,.e,qc•--,]af?r=N.-,.v -f.;Y� Albert J.Krupski,President D�dSVFFo(�CO Town Hall James King,Vice-President 53095 Route 25 P.O.Box 1179 Henry Smith o Southold,New York 11971-0959 Artie Foster coo Ken Poliwoda Telephone(631) 765-1892 'yij�Ol �aO� Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Applicati _Wetland Permit Application Major Minor _Waiver/Amendment/Changes _Received Applic on: 0 Received Fee:$ -� _Completed Application 0 _Incomplete _SEQRA Classification: Type I Type II Unlisted Coordination:(date Isent)1*CAC Referral Sent6 w _Date of Inspection: '`- Receipt of CAC Report: _Lead Agency Determination: °z : _Technical Review: l �GT _Public Hearing Held: Resolution: Name of Applicant. "2� Address 7 0 o 2 6-"J Co c/2T 7zA" 0 6v� A/. S 3.S Phone Number:( ) G 3/- 7 3 y G/ 1/o Suffolk County Tax Map Number: 1000 - /3 7- o y- Z G Property Location: /� `{s -L&--&-T 4 o O- leo.0-0 . (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: ' Board of Trustees Applic on GENERAL DATA Land Area(in square feet): /S� o / 0 6 S .•�F Area Zoning: Previous use of property: AE.S /.0 Intended use of property: iPES i® Prior permits/approvals for site`'improvements: Agency Date 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: - IT 20,E`_ Project Description(use attachments if necessary): /ate✓ s e d L OG/c 1--o o/^✓-b-,�i-a.✓ /7/L-�/ .E'&-p 4,7cE v/ZE-� moo•✓ c/Lc- v- 0,,9 v,J /��✓4 n/ 7,/ /.�o..-: mac- o�,/ �/�.S �o� c- L s %7,f�� r-.S'.�.•-c � ��o i wiz . -✓,— • Board of Trustees Applic;• on WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: //d16 «-�'/J'�E ►13�5�c Fo o T/��r i� T � So VO Area of wetlands on lot: 51, square feet Percent coverage of lot: 33 % Closest distance between nearest existing structure and upland edge of wetlands: 'G o '± feet R r.a E-c/c y s Lu T- o LJ /V6 ' To E u G E -7V S 2��/c //�G// �✓�i�iL L i..�t Closest distance between nearest proposed structure and upland edge of wetlands: to d f feet / SI fe FT ,SA Mr E 2 S �i o d E Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? -U® cubic yards How much material will be filled? /1/0 cubic yards Depth of which material will be removed or deposited:-5 - `� VAR. feet Proposed slope throughout the area of operations: yE5 Manner in which material will be removed or deposited: •�f �•q� "�c ,so�L L✓/G G QE .�L��-a t!L� /S � j 7Z c�G.IL I i_`��I l f��"-j4'rrv�~-t�---��-� _,_ ' Statement of the erect, if any, on the wetlands and tidal waters of the town that may-result by reason of such proposed operations(use attachments if appropriate): 410A E T 11W y iS5 7-e_&3 Gt//G. Z_ 13E- ys �� 7V /�2 -1Jc-y.J i /f-•v �/�6 G.6-2n S S o .1�.�2 y i✓�zL S its .,��3 •✓ /�.✓y /� ofl f2v.✓ 49 F'F" PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: a7 tlls-i 4 W/9y STATE OF NEW YORK COUNTY OF SUFFOLK b A rwlJ-CIZ-G residing at 700 G,ek,"'�f ey, l, - , AJ y ii9yS,being duly sworn, deposes and says that on the 4' day of ;%,9- , 2003, 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 Day of 'A'V—A C . 20 U Notary Public No. ;(cad in Strf N Cote'iiy ova 1 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: ell E7- '-) cVC STATE OF NEW YORK COUNTY OF SUFFOLK ,residing at 6f4 A.) ', ze s 3,being duly sworn, deposes and says that on the 6' day of �'a . ,200S , 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 Day of Ct V--.J , 20Ui Notary Public pdit SW of NewYOsit ►` Qe ;ed to Stfo"c CO" d vu� CanMIN',on Ems M=h 20, PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK ,/�z�/��-jJ !�, ,Y!/�-C,•t� ,residing at ?USG�.✓ �'2 AA !f 3s,being duly sworn, deposes and says that on the 6 day of s4--J , ,20cl�, 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 r ll of the Town of Southold; that said Notices were mailed at the United States Post Office at l .ez c ,that said Notices were mailed to each of said persons by (certified) (registered)mail. Sworn to before me this Day of 20D Notary Public IdFlDAA.TIlG3Af�'r No"Rub1h sate of tam,Yok tda,48486D$ gvansd h sdo8c Cmpt ' C61Td0I3ylOt1 3 tdlra�fi�Dea,.a. � Albert J.Krupski,President OSVFFO��►C Town Hall �G James King,Vice-President .1. .53095 Route 25 y� P.O.Box 1179 Henry Smith y x Southold,New York 11971-0959 Artie Foster Ken Poliwoda • `F Telephone(631) 765-1892 y�ol �aQ� Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ------ ---------------------------- In the Matter of the Application of C4 COU TY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING residing at 70-0 being duly sworn, depose and say: That on the /0 day of -Z4-4 , 2003, I personally posted the property known as 37- 0 y 2<-, 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 o the ublic hearing. ^Date of hearing noted thereon to be held -/ / a' d Dated: (signature) Sworn to before me this f(Z) day of jah,rctr j 200-3 JUREE,83AIMn fNawYp�Y Not y PublicW:r. JAN 3 y. Board of Trustees Applic on County of Suffolk State of New York 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 HISMR 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. Signature SWORN TO BEFORE ME THIS 3 ` DAY OF 0 7-- &VNE E.SAYR% y Pubb,Stats®f NOW yf'*f1 ib.4948505 mad k9 Sdolk Gaunt 3/2o�e3 otary Public 14-16•d(2/87)—Text 12 PROJECT I.D.NUMBER '.2l SEQ Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I—PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME 3. PROJECT LOCATION: + Municipality ` w 7--C.!/-0 G,J County s0 C"F'p L/.C-- 4. PRECISE LOCATION (Street address and road intersections,prominent landmarks, etc.,or proviae map) 5. IS PROPOSED ACTION: RNew ❑Expansion El Modification/alteration 6. DESCRIBE PROJECT BRIEFLY• T y,7"'! OO n� [7e /7/E OG.Q Io4v a s E IJ. 42 .✓s'77L[!GT 7 7/6 -S .-=� S TF c.a 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres Nam. 3. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes C No If No,describe briefly I _ 9. WHAT is PRESENT LAND USE?N VICINITY OF PROJECT? I a Residential E:,.'ndusirial Commercial 1 Agricuiture i!?arx/ForestlOoen scace _._`Other � Describe: I ' 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)? ®Yes U No If yes. list agency(s) and oermit/aoorovals W C-rL4-v 0 /7-A j.% 7Z--E- S'ov—f7fDL13 j D&JA.) No•✓ ..%cJ2S?,rCJ7 0'tJ o y 6Z ?Jiy-7 J n/ -/lL O A C/LErJ-E L✓/1 G L ll. DOES ANY ASPECT OF THE ACTIO14 HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes' ®No If yes. list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL rRE•OUIRE MODIFICATION? Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: L /L L Date: DEL 3�� ZOOZ� Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER APPLICANT TRANSACTIONAL DISCL RE PORN The Town of sou hold's code of Ethics prohibits conflicts of interest on the part of town officers and emplo ees. The purpose of this form is to provide information which can alert the town of possible confi cts of ntereet and allow it to take whatever action is necessary to avoid same. YOUR HAHRt Last name► first name, middle immiamnless you are applying in the name or someone else or other entity, such as a company. if no, indicate the other person's or company's name. ) NATURE OIP APPLICATION: (Check all that apply.') Tax grievance Variance Change of none Appip-Val of plat Exemption from plat or official map Other (if "other," name the activity. ) d0,ee-41-C /�C=��+re..a:. w�+��•�q� �[- �i Do you personally (or sthrough your cbtipany, 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. IRS NO _ if you answered OYES,", 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) 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 hin 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 noncorporabe entity (when the applicant is not a corporation)t c) an officer, director► parttter, or emplbyee. of the applicants or D) the actual applicant. DESCRIPTION OF RELATIONSHIPV. • .. . '. •`:.;err:�"`��7j='"`�,r:.i?d:;«r:s',•, ,+r�,•�, ��r Submitted this ;3,.� • signature �•• '�• -Print name, i i §58-1 NOTICE OF PUl HEARING §68-1 Chapter 68 1 NOTICE OF PUBLIC HEARING §68-1. Providing notice of public hearings. [HISTORY: Adopted by the Town Board of the Town of i Southold 12-27-1996 as L.L. No. 25-1996, Amendments noted where applicable.] §68-1. Providing notice of public hearings. t Whenever the Code calls for a public hearing, this section i shall apply. Upon determining that an application is complete, the board or commission reviewing the same shall fix a time and place for a public hearing thereon.The hoard or commission reviewing an application shall provide for the giving of notice: h A. By causing a notice giving the time, date, place and nature of the hearing to be published in the official newspaper within the period prescribed by law. sp B. By requiring the applicant to erect the sign provided by ; the town, which shall be prominently displayed on the premises facing each public or private street which the property involved in the application abuts, giving notice of the application, the nature of the approval sought thereby and the time and place of the public hearing i thereon. The sign shall be set back not more.than ten (10) feet from the property line. The sign shall be displayed for a period of not less than seven (7) days immediately peeceding the date of the public hearing. The applicant or his/her agent shall file an affidavit that s/he has complied with this provision. C. By requiring the applicant to send notice to the owners of record of every property which abuts and every I property which is across from any public or private street §58-1 SOUTHOLD CODE §68-1 I from the property included in the application. Such notice shall be made by certified mail, return ur receipt requested,posted at least seven(7)days prior to the date of the initial public hearing on the application and addressed to the owners at the addresses listed for them on the local assessment roll.The applicant nr agent shall file an affidavit that s/he has complied with this provision. i NOT: ELEV. LOWER � W�pp D£CK 2 7 `9-O E NNC AREA = 17.90 CCCVVm W/ RAIL N\ PIPE FRAME � 22 GARAGE PRo � ER �' 1 STOR Y FL OOD � zao' FRAME h j'� 14 ZONE X ol HOUSE . R,u°f 10 s � F. F. EL4 =25. 86 �TONF 24. 7' lMNEY p lVL'WA Y _ T P OF AN WBER �• � p UESTA+YE 8 j2 4 4 04 � 00 W � 22 cm2 16