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TR-9407
Glenn Goldsmith,President '�XQF so�jy Town Hall Annex Michael J.Domino ,`O� ��� 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III Southold,New York 11971 A. Nicholas Krupski G Q Telephone(631)'765-1892 Greg Williams �O �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1768C Date: October 19, 2020 THIS CERTIFIES that the existing 28'4"x 187"one-story cottage; existing attached 4.6'x5.6' enclosed outdoor shower to be temporarily removed and replaced in-place, remove and replace existing locust and concrete footing with as per code minimum 3' deep +/-18-12" diameter concrete footings,• raise cottage up+/-2' to code compliant FEMA requirements; construct roof alteration with dormer; replace existing windows; and replace existing entrance steps with new 3'x8.4' enter platform with 4' wide steps to ground, At 65490 Route 25 Breezy Shores Cottage 924, Greenport Suffolk County Tax Map#1000-53-5-12.6 Conforms to the application for a Trustees Permit heretofore filed in this office Dated JanuM 10, 2019 pursuant to which Trustees Wetland Permit#9407 Dated March 20, 2019,was issued and conforms to all the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the existing 28'4"x 187" one-story cottage; existing attached 4.6'x5.6' enclosed outdoor shower to be temporarily removed and replaced in- place;remove and replace existing locust and concrete footing with as per code minimum 3' deep,+/ 18-12"diameter concrete footings; raise cottage up+/-2' to code compliant FEMA requirements* construct roof alteration with dormer; replace existing windows; and replace existing entrance steps with new 3'x8 4' entrxplatform with 4' wide steps to ground. The certificate is issued to David&Diane Nelson owners of the 1. aforesaid roperty, Authorized Signature Glenn Goldsmith, President �Q� sorry Town Hall Annex Michael J.Domino,Vice-President �Q� ��� 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III Jx[ i[ Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 oly0OUM,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION,: INSPECTED BY: `'��✓ e - 'Ch.-275 Ch. 111 INSPECTION SCHEDULE Pre-construction; haybale line/silt•boom/silt curtain 1 st day of construction % constructed Project complete, compliance inspection COMMENTS:� ::�2 CERTIFICATE OF COMPLIANCE. d�� r^'SUFFOL,� Michael J. Domino, President `�o�o Cooy Town Hall Annex John M. Bredemeyer, III, Vice-President �o <'. 54375 Route 25 Glenn Goldsmith N x P.O. Box 1179 A Nicholas Krupski y oy`f�� Southold, NY 11971 Greg Williams ` �1 , �� Telephone (631) 765-1892 Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction %2 constructed When project complete, call for compliance inspection; - .•01.11•-•}Ili i - • j1111 11'j�� ? �•`�110•'•1/1%. � .1,1.t.Ir•/%/r• _ . ..`1111 ill0i':. "- _,..•1011! 11'll'ey. ,�111••lll%�>;. - YSir _'ti��r�4u-r,,.�r�.:�n[m,�t.ai„nra�nEo�inl,rldY,r;;m.11"p,,C'",l^r},t„e,�;cy�?:E,.Ln`:7r�.rrrvrC!r,ymtqT�4'tv�m�:�:':it�.tp:xnrv,�vP.P'+rit.nS,•r„ar�rrn,rr,}4ti iva.�rr,,,rfi,:my,�5,rr,rn�Nlt•mh yrt,��rrrrcyY�ntrrn,yxn.Mvn q�,�„.yrfCl�?_�, =i^El i BOARD OF SOUTHOLD TOWN TRUSTEES r SOUTHOLD, NEW YORK - PERMIT NO. 9407 DATE: MARCH 20,2019 ISSUED TO: DAVID &DIANE NELSON A PROPERTY ADDRESS: 65490 ROUTE 25,BREEZY SHORES COTTAGE#24, GREENPORT ^ SCTM# 1000-53-5-12.6 <,Q�a AUTHORIZATION K Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in 3 , s,,l+ accordance with the Resolution of the Board of Trustees adopted at the meeting held on March 20,2019, and in consideration of application fee in the sum of$250.00 paid by David&Diane Nelson and subject to the Terms _ and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: t` Wetland Permit to for the existing 28'4"x 187" one-story cottage; existing attached 4.6'x5.6' �'- s t enclosed outdoor shower to be temporarily removed and replaced in-place; remove and replace 'sgA existing locust and concrete footing with as per code minimum 3' deep,+/-18-12"diameter ti? -_ concrete footings; raise cottage up+/-2' to code compliant FEMA requirements; construct roof - alteration with dormer; replace existing windows; and replace existing entrance steps with new rPlr 3'x8.4' entry platform with 4' wide steps to ground; and as depicted on the site plan prepared "r by Frank W.Uellendahl,Registered Architect received on January 10,2019,and stamped r f approved on March 20,2019. ? " IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, o� and these presents to be subscribed by a majority of the said Board as of the 20"'day of March,2019. �TS7s• '. _ �:� guFFO(,�- 1�'•�: lltiti7h7�}}'�2G?Z/ ��I'y _:1 Ca r ..t�.t%a,.ui6u�',.:15.vU;,,uwu,i;.t.•,,,,,.J:w,; ,.ua:�viZrx.:,l�ve:..,;,Sx;i�S w..a,..:•ltx,u;8>YwM:Gu y.uiw>,u uia.a�„i,Ya.✓;a a'lea;fi.,til'A,'a`a1uexL;.+��,:Lu;uiu.i xes k,ri rzv.1).io,wY„J„ :iSY•.iu,.ii.;.vsbu"iv,,.i,.i.".:vYHFG,ww',d =ti I t` Y\\`v�•' =3(. — \1�..�. : . — J,�/�! a i', JF� \`Jv,` --Mtl .:€'.i '�i'r � � 1 � _ .E� `�(- +�.'' f "fi"" .^`�.i ?..�qv,..I a.-9,�.•M i �<,i/. �.�,''i�.,^. .i =moi � � � i _-,,;,ae�,..� [[^�, _ �f:'S/.'�^, i lm "%Y 111•x" Tlcrtc�/V lli�'�Im9:mr"C,""..��1/ ,1���_�R. 11i:.` .s�/I` 11ie. ..i f l\�,r•_ „^/.+i,.ill �,1,;.. - •'�:i+S41i% _' - •.t.1,ii illi•;•. _ �.ii% (�'•• ..i%,ise ll) 1��••.^ _ •:;i:�,,�i.•..• TERMS AND CONDITIONS The Permittee David &Diane Nelson residing at Breezy Shores Cottage#24, Greenport, New York, as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 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 or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto,to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months,which is considered to be the estimated time required to complete the work involved,but should circumstances 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 authorization was originally obtained. 4. That the work involved 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. 6. That there shall be no interference with the right of the public to pass 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/or alterations in the location of the 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 required, upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit,which may be subject to revoke upon failure to obtain same. 10. No right to trespass or interfere with riparian rights. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. PROPOSED W E ALTERATIONS Z C-19 i JAN lQ J W Z COTTAGE w GREENPORT, NY c 24 BREEZY SHORES 65490 ROUTE 25 W C/-) g ARCHITECT FRANK UELLENDAHL z C-20 COTTAGE 24 TO BE RAISED 24" TO EL. 9.0 m 123 CENTRAL AVENUE m TO MEET FEMA FLOOD PLAIN REQUIREMENTS X 316 GRTEL: 631 NY718624 C-25 TEL: 631-477 8624 i i i i W o . ' OWNERS J DAVID AND DIANE NELSON 422 AVE. MAMARONECK,, NYYR115 3 W TEL: 914-282-5693 Q O.S. 3 o EL 5.5 DRYWELL � � 8'x3' � 02 CAMERA LOCATION FOR PHOTO VIEW #2 z PROPOSED C-21 RENOVATION & EXT'G FLOOR EL. 7.0 EXT,G FOOTPRINT OF COTTAGE 535 SF 13 SF ADDITION PROPOSED FOOTPRINT C-24 548 SF m O.S. c� INCREASED COVERAGE 2.42 % = 13 SF `+ EL 4.5 w — — — — — — — — — — .�.`. .�. ••:� • .'. •fir'•` • Imm PROPOSED 13 SF ADDITION r • • • . • • . • '•'•`•`-`•` FLOOD ZONE AE `•`•1•`"� .•:•.• •.•.•.•. .•.`.`.'.`.•+ ILE EXISTING STRUCTURES • .'.` '.`r'•`. . • . AS PER ELEVATION • .". .�•�.+. . . . . . . . . • a . • • • & . .' " `. " ` ' -'• CERTIFICATE, 12/16/13 '-`-;•`•` ••-, �- • r ` ' "-` ;" '•`-; RUN-OFF CALCULATION: . " • • BY PECONIC SURVEYORS'" o/ ` .•.•.• .•"+. " .' FOR 2° OF RAIN TO BE CONTAINED ON SITE 3 r `•" .• •'r•r"• • . "`.- . . .••.`.`•`•'•`r`r`r '.`.`. . . r . .`.• `r . . . . . 91.7 cu ft � o N N • ` ' ` ' ` ' ` ' ' ` LINE OF HAY BALES PROPOSED 8'x3' deep DRYWELL 126.7 Cu.Ft. s o "."-` "-`•`•`"`"`• •"•"•"•" - �`= — _ =`•`" `•�• -`-`• •"•`••-`•` ` AND SILT FENCE WITH GUTTER LEADERS FOR ROOF RUN-OFF •`r ••• ••. �' •�• ` " DATE: 06/14/2018 • • . , - • r.."•"..•"• • . — s �� SCALE: 1/16' - 1'-0" PROPOSED PEBBLE BEACH � , SCTM# = 1000-53-05-12.6 �� SITE PLAN TOWN OF SOUTHOLD DWG. NAME SHELTER ISLAND SOUND PHRAGMITIES SUFFOLK COUNTY, NEW YORK A-0 `� ®=J DWG. NO SITE PLAN f - f APPROVED BY BOARD OFIRUSTEESC-26 �' PROPOSI TOWN OF SOUTHOLD 0 i14 R 0 � ALTERATI01 wt, - Southold Town C-19 DATE �" r o Bard of Trustees COTTAGE '—'� 9 GREENPORT N' C-1 24 BREEZY SHORE 65490 ROUTE 2 O.S. Gn A CHITS( o C-20 LCOTrAGE 24 TO BE RAISED 24" TO EL, 9.0 12J3CENIR&AAet P.O.BOK 3' m ET FEMA FLOOD PLAIN REQUIREMENTS GREEhIT,Hr 19: o C-25 TEL 631-477 866; OWNER DAM AND DWRE NELSf 3 422 RUSHMORE A' WWRONECK,W 115 ' TEL 914-282-56, P= EL 5.5 DRYWELL O.S 11 --- >5 = PROPOSED C-24 ^1, 8k3;;i I!QCAMERA LOCATION FOR PHOTO MEW 2 m C-21 RENOVATION & EXT'G FLOOR EL 7.0 / EXT'G FOOTPRINT OF=C-24548 �, 13 SF ADDITION 0 S PROPOSED FOOTPRINx _ — — - 117_-1 _. � INCREASED COVERAGE 2,42 7 13 SF _ — _ -- — `+EL 4.5 — — — — : . ® PROPOSED 13 SF ADDITION FLOOD ZONE AE EL. 7 EXISTING STRUCTURES AS PER ELEVATION i CERTIFlCATE,Is Ts T3 RUN—OFF CALCULATION; BY PECONIC SU FOR 2'OF RAIN TO BE CONTAINED ON SITE J COTTAGE 548 SF;1007. run—off coefficient= 91.7 cu ft m UNE OF HAY BALES PROPOSED 8'x3' deep DRYWEl1 1267 Cu ft. i AND SILT FENCE WITH GUTTER LEADERS FOR ROOF RUN—OFF j !Il i l i R4TE: 08/14/201 PROPOSE( PEBBLE BEACH S �' SCTM = 1000-53-05-12.6 SITE PW � vlv• ti >� TOWN OF SOUTHOLD DWG.WE SHELTER ISLAND SOUND PHRAGMITIES SUFFOLK COUNTY, NEW YORK A—C TE effmammmArmi ! ©ate DN'C.NO Illll llllll } llUllllllll V' E � V E PROPOSI ALTERATIOI I JAN 1 0 LU1fj � Southold Town 28'_3 1/2° Board of Trustee `° (( [[ �� 15'-6' 3'-11 /2' N COTrAUL GAS M GREENPORT N' 90RTE2o 654ROUTE HEJGHT OF WALL 5'-11" ARCHITE( 123 CENIlk AVENI KITCHEN E `Po,�; ca — — GREENPORT,NY 119, BEDROOM 2 TEL:631-477 66. owl DAVID AND DIANE Not t� Zc, 422EU,W1A NECK, 8 115 . ^� -262-56' `� w 5 PROPOSED ADDITION 15'-11 9'-7" �HOW R ���� , " � al ENCLOSED PORCH BEDROOM 1 co �. 411f F 13 SF IF� III HEIGHT OF WALL: 5'-11° 535 SF 16 SF = 3% � m, Vele" — '� DATE: 06/14/201 SCALF: 1/4'-1'-C EXISTIN( FLOOR PLAI COTTAGE 24DWG.WE 15 EXISTING FLOOR PLAN DWG. A- SCALE: 1/4" = 1'-0' PROPOSED ALTERATIONS 28'-3 1/2' 14'-4 1/2° 4'-4" �F 8'-3" , GAS COITAGE AW 251 O AW 251 AN 251 WDH2O42 WDH2O42 GREENPORT NY 24 BREEZY SHORES smeg J o L — Q c L — — 65490 ROUTE 25 001 A CHIT C O N KITCHEN a 123 CUR�H GREENPORT,NY 11944 cnO TEL:631-477 8624 Epi , 6��IFKE DAVID AND DIANE NELSON 422 RUSHMORE AVE BR 2 MANARONECN,NY 11541 t o TEL 919-282-5643 `a I 7-0° CLG,HGT, m -co BR I Ca N �5' w UFA LIVING RM. c-.*, CATHEDRAL CLG. N L - 1 OUTDOOR SHOWER b = 1' STORAGE vii � (4) WDH2O42 N " KE WDH2O42 WDH2O42 Iwoo � mm �fr E �_ " n n n n DATE: 08/31/2018 D E C E `/ �; 14 4 1/2 ,>4, 3-0 1k1 9-7 Aim SCALE, 1/4•-1'-0 PROPOSED RR FLOOR PLAN O 21):d� DWG.NAME COTTAGE 24 A-2 PROPOSED FLOOR PLAN ®ii DWG.NO Southold Town SCALE: 1/4" = 1'-0' Board of Trustee 1. LLIM"LLIM" Ro'Box 340 GRENPORT,NY 119 TEL 631-477 86 0 NE ................... i M— ml HII Jul Jul ................. .......... ............. .............. ........ ........... PROPOSED ELEVATIONS DWG,MME I� PROPOS ALTERATIC JAN I O Southo Town f tees e I COITAGI �- GREENPORT P 24 BREEZY SHOR 65490 ROUTE ig RA CHITS FRANK UELLENO 123 CENTRAL AVE1 PA,BOK GREENPDRT,NY 11, TEL,631-477& 4WNE DAVE AND DM NEL' [Eli 422 RUSHMORE c WMONECK,NY 11 t TEL 914-282-5 WEST ELEVATION SOUTH EL P a�� 9 r 4 ElV 6 DATE: 06/14/2c SCALE: 3/16'0 1'- �' EZISTIP EAST ELEVATION NORTH ELEVATION ELEVATID DWG.NAME EXISTING ELEVATIONS � DWG.No A— SCALE: 3/16° = 1'-0" PROPOC aQ,Ya�1 1 0 ' t�i i-3 ALTERATIf Southold Town Board of Trustees (2)1.75x1.5'LVL RIDGE BEAM e RIDGE STRAPS EACH RAFTER PAIR COTfAGI 12 4 PROPOSED DORMER GREENPORT P �� 24 BREEZY SHOR 65490 ROUTE 2x6 ROOF RAFTERS SISTLRED TO N PROPOSED EXT'G 2x4 RAPIERS (2)DORMER WINDOWS AN 21 ARCHTTE 2z6 RAFTER RE i' LOFT 2z6 C,J,a 16'D.C. FRANK VEUEND 123 CENTRAL AM ®42'O.C. PA,BOK GREENPORT,W IIt TEL 631-477 8( -O BEAD BOARD — — — — OWNE owNE NEl! W 11 62-5 a BOOKCASE BOOKCASE o 4 1\ o ; s o KITCHEN lco %c N )1.75'x 11-7/8'NEW VL Pa IMETEf BEAM R Pm TO EACH WALL D El. 9' - PROPOSED FLOOR ELEVATION TO COMPLY WITH FEMA REGULATIONS N R NO � 2X12 F.J.®16'O.C.w/RAID INSULATION,EG.R-MAX R-MATTE PLUS-3,3'THICK;R-20.3 EL 7' - EXISTING FLOOR ELEVATION M 525'xRit- BTRPD CLUUIM BFFi1M STRAPPED TO EACH FIAOR JOIST COTTAGE LOCATED IN FLOOD ZONE AE-EL7 C8612 COLUMN BASE WRH CORROSION PROTECTION CEDAR LATTICE APRON SQUARE,SEE COTTAGE 25) o "• 12.4'DAL POURED CONC.FOOTING '•', RIGID PLASTIC FOOTING FORM , BIGFOOT SYSTEM,MODEL BF28,RING DIAMETER 06 DATE., 07l31/2L .E ' '+• � � SCALE. 3/6'=1'- :: .' PROPOSE CROSS SECTK 11000. 16'-5 1/2" a 18'-5 1/2" 2—2SoA- - - - CROSS SECTION i DING,NO Michael J.Domino,President SO Town Hall Annex John M.Bredemeyer III,Vice-President �� l0 54375 Route 25 P.O.Box 1 Glenn Goldsmith [ l [ Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg WilliamsO Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 20, 2019 Frank Uellendahl, R.A. P.O. Box 316 Greenport, NY 11944 RE: DAVID & DIANE NELSON 65490 ROUTE 25, BREEZY SHORES COTTAGE #24, GREENPORT SCTM# 1000-53-5-12.6 Dear Mr. Uellendahl: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, March 20, 2019 regarding the above matter: WHEREAS, Frank Uellendahl, R.A. on behalf of DAVID & DIANE NELSON applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the - Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated January 10, 2019, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held'by the Town Trustees with respect to said application on March 20, 2019, at which time all interested persons were given an opportunity to be heard, and, 2 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 275 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 have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of DAVID & DIANE NELSON for the existing 28'4" x 187' one-story cottage; existing attached 4.6'x5.6' enclosed outdoor shower to be temporarily removed and replaced in-place; remove and replace existing locust and concrete footing with as per code minimum 3' deep, +/-18- 12" diameter concrete footings; raise cottage up +/-2' to code compliant FEMA requirements; construct roof alteration with dormer; replace existing windows; and replace existing entrance steps with new 3'x8.4' entry platform with 4' wide steps to ground; and as depicted on the site plan prepared by Frank W. Uellendahl, Registered Architect, received on January 10, 2019, and stamped approved on March 20, 2019. 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$50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, Michael J. Domino President, Board of Trustees MJD/dd Michael J. Domino, President ,moo Gy Town Hall Annex John M. Bredemeyer, III, Vice-President _-D = 54375 Route 25 Glenn Goldsmith o .` 'ah P.O Box 1179 A Nicholas Krupski Southold, NY 11971 Greg Williams yy�rr Telephone (631) 765-1892 Fax (631) 765-6641 5, BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: DAVID & DIANE NELSON c/o FRANK UELLENDAHL Please be advised that your application dated January 10, 2019 has been reviewed by this Board at the regular meeting of March 20, 2019 and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) — (Silt boom) 1St Day of Construction ($50.00) % Constructed ($50.00) xx Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) 30- Year Maintenance Agreement (complete original form enclosed and submit to Board of Trustees Office) The Permittee is required to provide evidence that the non-turf buffer condition of the Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ 50.00 BY: Michael J. Domino, President ���� Board of Trustees Michael J. Domino, P, int o��SUFFO(,�coG Town Hall Annex John M. Bredemeyer III,Vice-President �� � 54375 Route 25 Glenn Goldsmith y z P.O.Box 1179 A.Nicholas Krupski P Southold,NY 11971 Greg Williams 4 dap! Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 3114 11 Completed in field by: Frank Uellendahl, RA on behalf of DAVID & DIANE NELSON requests a Wetland Permit for the existing 284" x 187' one-story cottage; existing attached 4.6'x5.6' enclosed outdoor shower to be temporarily removed and replaced in-place; remove and replace existing locust and concrete footing with as per code,minimum 3' deep, +/=18-12" diameter concrete footings; raise cottage up +/-2' to code compliant FEMA requirements; construct roof alteration with dormer; replace existing Windows; and replace existing entrance steps with new 3'x8.4' entry platform with 4' wide steps to ground. Located: 65490 Route 25, Breezy Shores Cottage #24, Greenport. SCTM# 1000-53-5-12.6 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted / N Ch. 275 Ch. 111 SEQRA Type: I II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey _< 5 years: Y/N Wetland Line by: C.E.H.A."Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: I have read & acknowledged the foregoing Trustees comments: Agent/Owner: _ Present were: J. Bredemeyer ---ZM. Domino /G. Goldsmith / N. Krupski G. Williams- Other 1 w_ David&Diane Nelson '0 Route 25,Breezy Shores Cottage#24,Greenport 111 3/12/19 V d Ala PWMIL ' 1 \k ; 3 / 12 /2019 10 . 20 Gmail-NELSON COTTAGE 24 @ BREEZY SHORES Page 1 of 1 Gmai..l Frank Uellendahl<frank.uellendahl@gmaII.com> NELSON COTTAGE 24 @ BREEZY SHORES Frank Uellendahl<frank@frankueliendahl.com> Thu,Aug 2, 2018 at 2:56 PM Draft �"�-',msµ+�n� fEv - ".�, � •�` F `"�.r- �, - -[ v_'*,.0 a•s> - zE "'"S�, :rr '•�5`M ti-ty;e -y+�.s_,..'i= s*._cr. c�+. sr- r�,r-g '=.�`,t�-`�'.a.��t.�a 'K.�f.-a��'�v�' .,�,,��, ,, r.,.i�<" ,5v. �t;._Y• .r�4�r-,�y,.:�i .'�-' �,-«�;s,�' „�_�'� s-. y 21-1 moi. -',_s...M4.; ��' �r.E�`a'�!i S',-i'. ,'�G`'`'` .•.�•=;�-' ��a'} - .br ..- 1"�'''v`- �r1K' ,• ter= �t :ri �:"� y'"^t•;` �c`;e "` i:. ;? ZBA APPLICATION BREEZY SHORES-COTTAGE#24 PHOTO#1 -NW DIRECTION-DATE: 05.07.2018-3:53PM https://mail.google.com/mail/?ui=2&i1--7d673c7l75&jsver--IgB KfC4wOS8.en.&cbl=gmail... 8/2/2018 Gmail-NELSON COTTAGE 24 @ BREEZY SHORES Page 1 of 2 Gmall Frank Uellendahl<frank.uellendahl@gmall.com> NELSON COTTAGE 24 @ BREEZY SHORES Frank Uellendahl<frank@frankuellendahl.com> Thu,Aug 2, 2018 at 3:02 PM Draft - ..;.`� .- _ _ -.,4•..-..i`i'a r+'.'r _ tiismer _ �.�`_�•`.,,SJr:�v51L;'`_`^�].'�`. ...`^n�'"�N�':iA"�..'.;u'3- s�3•i�`'.{+ (�.�,Th.-����,-�'}r�� _.��`{��'cv-�•-'"__+":��:.k�-.=,�ati4=,'r.:X+ '!^.t.x�: - 310 �€�" ;`#�.:.�$nc;,.: *'-�=i=� fi.'-�z� e max. •t..e. A ��=' a'i�a���.:'���uc�-�� _-_ '���_G'�'r 'J:E'i•�•. ��v....t-•'-ys*'._fie� _� n��2Ffa+. c{ ,3 �$, .'.. ''s'�� ti4.—.r - �,. �t 2 i - _ �s�`�`h'atiS'�i:o.Y•`•,.c''i {a.}' ,l�?.'p� "*� �`__ r ZBA APPLICATION BREEZY SHORES-COTTAGE#24 PHOTO#2-SE DIRECTION-DATE: 05.07.2018-3:54PM https://mail.google.com/mai l?ui=2&i1 ---7d673c7l75&jsvei=IgBKfC4wOS8.en.&cbl=gmail... 8/2/2018 Gmail-NELSON COTTAGE 24 @ BREEZY SHORES Page 1 of 2 Gmall Frank Uellendahl 4rankmellendahl@gmail.com> NELSON COTTAGE 24 @ BREEZY SHORES Frank Uellendahl<frank@frankueIIendahl.com> Thu, Aug 2, 2018 at 3:08 PM Draft ' _ _s"�,w-.. i'�°RX�;-'�''.�A --.��� z�"-t.�",._; i����✓r'sii. �ti.�. �.y���-Sl r� �,�:,_, -ter •�"- � `'---- teMil y^`, :,••�----�—,-,<�� .•.Tris �.;- .>; 46- ' ti �-3_0.2 � gyp-,. �.-r � '�5R '� - '�6• }='--eY'�+'s ZBA APPLICATION BREEZY SHORES-COTTAGE#24 PHOTO#3-NE DIRECTION -DATE:05.07.2018-3:55PM https://mail.google.com/mail/?ui=2&i1--7d673 c7l 75&j sver=IqB KfC4wOS 8.en.&cbl=gmail... 8/2/2018 V J ' V I ' I row � y ti T TTA6E 2� ' 1 �4�QO�poe. .•...� �o•,�,�moi,, 51TE MAP SOALEt I°_400' s T BCT ■d MONUMENT FOUND Q a BTAKE SET A= STAKE FOUND SEE SEC.No w MATCH... 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Iv, Of CO All, % 1 6 0 .10 7� IT C7- 9 N, 4811 SEE SEC NO -Z� _V, UNE OR SEE SEC NO 051 SEE SEC NO OSI SEEsec NO on IS. ♦ NOTICE COUNTY OF SUFFOLK K SOUTHOLD SECTION NO E Reroperty Tax Service Agency y 053 aIP —, - —w PROPERTY mi 1000 A MAP OFFICE LOCATION: �� i SO '`d(� MAILING ADDRESS: Town Hall Annex �� �� `��� P.O.Box 1179 54375 State Route 25 Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) C" Telephone: 631765-1938 Southold,NY 11971 p LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: March 7, 2019 Re: LWRP Coastal Consistency Review for DAVID & DIANE NELSON SCTM# 1000-53-5-12.6 Frank Uellendahl, RA on behalf of DAVID & DIANE NELSON requests a Wetland Permit for the existing 28'4" x 187' one-story cottage; existing attached 4.6'x5.6' enclosed outdoor shower to be temporarily removed and replaced in-place; remove and replace existing locust and concrete footing with as per code minimum 3' deep, +/-18-12" diameter concrete footings; raise cottage up +/-2' to code compliant FEMA requirements; construct roof alteration with dormer; replace existing windows; and replace existing entrance steps with new 3'x8.4' entry platform with 4' wide steps to ground. Located: 65490 Route 25, Breezy Shores Cottage#24, Greenport. SCTM# 1000-53-5- 12.6 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, the proposed action is recommended as CONSISTENT with the LWRP. The structure is located within Flood Zone AE EI 7 and will be raised to meet Chapter 148 Flood Damage Protection of the Southold Town Code. To further Policy 6 it is recommended that the Board assess the location and function of the sanitary system due to the proximity to surface waters. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Damon Hagan, Assistant Town Attorney ,(O,SOFFOt,��aG - Peter Young,Chairman o Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O.Box 1179 • ` Southold,NY 11971 Telephone(631)765-1889 Fax(631)765-1823 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., March 13, 2019 the following recommendation was made: Moved by Carol Brown, seconded by Peter Meeker, it was RESOLVED to SUPPORT the application of DAVID & DIANE NELSON to remove and replace existing locust and concrete footings with as per code min. 3' deep concrete footings, raise cottage up 2' to code compliant FEMA requirements; roof alteration with dormer; and replacement windows. Located: 65490 Route 25, Breezy Shores, Cottage #24, Southold. SCTM#53-5-12.6 Inspected by: Peter Meeker, Carol Brown,,John Stein Vote of Council: Ayes: All Motion Carried BOARD MEMBER U Southold Town Hall Leslie Kanes Weisman,Chairperson h0�%�F so ry�l0 53095 Main Road-P.O.Box 1179 Southold,NY 11971-0959 Patricia Acampora Office Location: Eric Dantes v, y� Town Annex/First Floor, Robert Lehner,Jr. � • �O� 54375 Main Road(at Youngs Avenue) Nicholas Planamento li`C�UIY f' Southold,NY 11971 RECEIVED httpJ/southoldtownny.gov pp �+ ZONING BOARD OF APPEALS Ol D 20 td. 2 3g TOWN OF SOUTHOLD DEC 2 4 1 Tel.(631)765-1809-Fax(631)765-9064 FINDINGS,DELIBERATIONS AND DETERMINATION Sou hold Town Clerk MEETING OF DECEMBER 20,2018 ZBA FILE:7223 NAME OF APPLICANT: David &Diane Nelson PROPERTY LOCATION:65490 Route 25,(Breezy Shores Cottage#24)Greenport,NY SCTM No. 1000-53-5-12.6. SEQRA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type II category of the State's List of Actions,without further steps under SEQRA. SUFFOLK COUNTY ADMMSTRATIVE CODE: This application was referred as required under the Suffolk County Administrative-Code Sections A 14-14 to 23, and the Suffolk County Department of Planning issued its reply dated August 24, 2018 stating that this application is considered a matter for local determination as there appears to be no significant county-wide or inter-community impact. LWRP DETERMINATION: This application was referred for review under Chapter 268,Waterfront Consistency review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. The LWRP Coordinator issued his recommendation dated November 26, 2018. Based upon the information provided bn the LWRP Consistency Assessment Form submitted,as well as the records available, it is recommended that the proposed action is CONSISTENT with LWRP policy standards and therefore is CONSISTENT with the LWRP. PROPERTY FACTS/DESCRIPTION: Subject parcel is located in the R-80 Zoning District and contains 82.6 acres. It is improved with three dwellings, a brick building, two garages, 28 seasonal cottages and 20 sheds. Access to the property is via Sage Boulevard, which is a private road,and the property is adjacent on the south to Shelter Island Sound. The Breezy Shores community is a unique property deeply rooted in the history of the Town. The multiple cottages on the property are pre-existing non-conforming use that was established prior"to zoning by the Sage family in the early 1900'x. The cottages previously housed employees of the Sage family brick factory, and after the brickyard closed, they were dented as seasonal cottages. In 2000, a real estate cooperative, Breezy Shores Community Inc. was established, and shares were offered as an ownership interest in the Cooperative. The cottage at issue in this application is known as Cottage# 24 and is owned by David & Diane Nelson. The cottage,with proposed improvements, is shown on the Survey of Breezy Shores, prepared by Frank Uellendahl,dated June 14,2018. Page 2,December 20,2018 47223,Nelson SCTM No. 1000-53-5-12.6 BASIS OF APPLICATION: Request for a Variance from Article XXIII, Section 280-123 and the Building Inspector's June 25, 2018,Notice of Disapproval based on an application for a building permit to make additions and alterations to an existing seasonal cottage,at; 1)a non-conforming building containing a non-conforming use shall not be enlarged,reconstructed, structurally altered or moved,unless such building is changed to a conforming use; at: 65490 Route 25, (aka Sage Boulevard, Breezy Shores Cottage #24, Adj. to Shelter Island Sound) Greenport,NY. SCTM#1000-53-5-12.6. RELIEF REQUESTED: The applicant requests a variance to construct additions and alterations to an existing nonconforming seasonal cottage by adding 13 sq. ft. addition, resulting in 2.4% increase in size, when such changes to a nonconforming structure containing a nonconforming use are not allowed by Town Code. ADDITIONAL INFORMATION: The file contains a memo submitted by the Board of Breezy Shores Inc., dated June'11, 2018, stating their approval of the applicants proposed cottage renovation. Included in the application packet, the applicant submitted eight prior decisions which granted variances for various cottages in the Breezy Shores Community. These decisions consisted of an interpretation and a use variance issued in 2011 and six decisions for area variances granting the applicants the ability to alter and construct less than 3.1% in increases to the size of their cottages. Email correspondence was received from a neighbor expressing support for the planned renovations. In addition to the proposed improvements, the cottage will be raised in order to comply with FEMA Flood Zone regulations. FINDINGS OF FACT/REASONS FOR BOARD ACTION: The Zoning Board of Appeals held a public hearing on this application on December 6,2018,at which time written and oral evidence were presented. Based upon all testimony,documentation,personal inspection of the property and Surrounding neighborhood,and other evidence,the Zoning Board finds the following facts to be true and relevant and makes the following findings: 1. Town Law §267-b(3)(b)(1). Grant of the variance will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. This unique property having been in existence since the early' 1900's represents its own neighborhood of 82.6 acres with substantial buffer of wetlands along the northern boundary of the property. Furthermore, the enclave of cottages is sufficiently removed from other adjacent neighborhood properties so that property owners will not be impacted by the proposal. 2. Town Law 4267-b(3)(b)(2). The benefit sought by the applicant cannot be achieved by some method, feasible for the applicant to pursue, other than an area variance. The existing seasonal cottage is a pre-existing non- conforming building with a pre-existing non-conforming use. As a consequence of the non-conforming status, any proposed additions and alterations will require relief from the code. 3. Town Law 4267-b(3)(b)(3). The variance(s) granted herein granted herein for the alterations and additions is mathematically substantial, representing 100% relief from the code because Section 280-123 prohibits the enlargement of non-conforming buildings with non-conforming uses. However,the proposed addition of 13 square feet to the existing structure represents 2.42% increase in the size of the pre-existing cottage footprint. The Board in prior decisions related to other Breezy Shore applications involving proposed increases of structure less than 3%, has deemed such increases, to be de minimus in nature. This applicants' proposed increase in structure size is minor and is just squaring off the building that is being lifted to conform to FEMA regulations. 4. Town Law $267-b(3)(b)(4). No evidence has been submitted to suggest that a variance in this residential community will have an adverse impact on the physical or environmental conditions in the neighborhood. The applicant must comply with Chapter 236 of the Town's Storm Water Management Code. The cottage will be also Page 3,December 20,2018 #7223,Nelson SCTM No. 1000-53-5-12.6 be raised to comply with current FEMA requirements to provide additional protection from potential storm surge flooding. 5. Town Law &267-b(3)(b)(Q. The difficulty has been self-created since the applicant purchased the parcel after the Zoning Code was in effect and it is presumed that the applicant had actual or constructive knowledge of the limitations on the use of the parcel under the Zoning Code in effect prior to or at the time of purchase. However,to the extent that a seasonal structure such as this that periodically requires some degree of reconstruction and/or alterations in order to continue the safe use of the structure, the need for variance relief is not self-created, but is created by Zoning Code that now prohibits an existing use and activities that at one time were not prohibited. 6. Tpwn Law 4267-b. Grant of the requested relief is the minimum action necessary and adequate to enable the applicant to enjoy the benefit of renovations and an addition to the cottage while preserving and protecting the character of the neighborhood and the health,safety and welfare of the community. RESOLUTION OF THE BOARD: In considering all of the above factors and applying the balancing test under New York Town Law 267-B, motion was offered by Member Lehnert, seconded by Member Dantes,,and duly carred,to GRANT the variance as applied for, and shown on the site plan of Breezy Shores, Cottage #24, prepared by Frank Uellendahl,R_A.dated June 14,2018. SUBJECT TO THE FOLLOWINGCONDITIONS: 1. The cottage use will continue in its current status as an unheated seasonally occupied dwelling. 2. No other alterations or additions may be undertaken without review by the ZBA, except for necessary minor repairs as determined by the Town Building Department. That the above conditions be written into the Building Inspector's Certificate of Occupancy, when issued. Any deviation from the survey, site plan and/or architectural drawings cited in this decision will result in delays and/or a possible denial by the Building Department of a building permit, and may require a new application and public hearing before the Zoning Board of Appeals. Any deviation from the variance(s)granted herein as shown on the architectural drawings, site plan andlor survey cited,above, such as alterations, extensions, or demolitions, are not authorized under this application when involving nonconformities under the zoning code. This action does not authorize or condone any current or future use, setback or other feature of the subject property that may violate the Zoning Code, other than such uses, setbacks and other features as are expressly addressed in this action. In the event that this is an approval subject to conditions, the approval shall not be deemed effective until such time that the foregoing conditions are met; and failure to comply therewith will render this approval null and void. The Board reserves the right to substitute a similar design that is de minimis in nature for an alteration that does not increase the degree of nonconformity. Pursuant to Chapter 250-146(.13) of the Code of the Town of Southold any variance granted by the Hoard of Appeals shall become null and void where a Certificate of Occupancy has not been procured, and/or a subdivision map has not been filed with the Suffolk County Clerk,within three Page 4,December 20,2018 #7223,Nelson SUM No. 1000-53-5-12.6 (3)years from the date such variance was granted. The Board of Appeals may,upon written request prior to the date of expiration, grant an extension not to exceed three(3) consecutive one (1)year terms. Vote of the Board: Ayes:Members Dantes(Vice Chair),Acampora,Planamento and Lehnert. This Resolution was duly adopted(4-0).(Chairperson Weisman absent) Eric L.Dantes Vice Chair Approved for filing I / 2 1 12018 �r� �.1�11 A f�•.�� -T'�t�T�.L OFFICE 1.QCA'D€N: ' ``::. b'-U ' ALAILING ADDRESS: 1-61 �p Town Hall Annex ;%i Y=y 'c ','. P.O-Box 1179 1 Y%W&�a5 State Route 25 Southold,NY 11971 car.Wrain Rd.8,Youngs Ave-) Telephonae:631765-5938 Southold,NY 11971 J46 �w w � TOWN OF SOU`pHOLD MEMORAMUM 1V U23 RECEIVED To: Leslie Weisman,Chair #M1, � .W-131 Members of the Zoning Board of Appeals ` ` Frown: Mark Terry, Assistant Town Planning Director ZONING BOARD OF APPEALS LWRP Coordinator Date November 26,2018 Re: LWRP Coastal Consistency Review for ZBA File Ref DAVID Aa'D DIANE NELSON 47223 SCTM# 1000-53-5-12.6. DA- AND D E NELSON#7223—Request for a Variance from Article XRffi,Section 280-123 and the Building Inspector's June 25,2018,Notice ofDisapproval based on an application for a building permit to make additions and alterations to an existing seasonal cottage,at; 1)a non-conforming building containing a non-conforming use shall not be enlarged,reconstructed,structurally altered or moved,unless such building is changed to a conforming use;at:65490 Route 25,(aka Sage Boulevard, Breezy Shores Cottage#24,Adj.to Shelter Island Sound)Greenport;NY. SCT#1000-53-5-12.6. The proposed action has been reviewed to Chapter 268,Waterlmnt Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program(LWRP)Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Foran submitted to this department,as well as the records available to me,the proposed action is recommended as CONSISTENT with the LWRP. The structure is located within Flood Zone AE El 7 and will be raised to meet Chapter 148 Flood Damage Protection of the Southold Town Code. To further Policy 6 it is recommended that the Board assess the location and function of the sanitary system due to the proximity to surface waters. Pursuant to Chapter 268,the Southold Town Zoning Board of Appeals shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: William Duffy,Town Attorney Michael J.Domino,President �� so�jiyo Town Hall Annex John M.Bredemeyer III,Vice-President ,`O l0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski Telephone(631) 765-1892 Greg Williams O!ycDUFax(631) 765-6641 NT`1,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application Administrative Permit Amen dm ent/Transfer/Extension Q Received Application: Received Fee: $ 250,00 Completed Application: .I Incomplete: SEQRA Classification: Type I Type II ZUnlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): PD `I ate of Inspection: 3. 2+l i ( E'er Receipt of CAC Report: JA'v"9 Technical Review: Public Hearing Held: S; Resolution: r,.Y______8naISLI of?r�_! ^s Owner(s) Legal Name of Property (as shown on Deed): '--A Vl0 � 1J//A t.-JE A)ELS D(4 Mailing Address: Phone Number: 014 - 292- - 5,6q3 Suffolk County Tax Map Number: 1000 - -50 - ,5 - 12s Property Location: 46!!�;74..90 120l.,,� 2,✓ , 6P��2_'�' �e�C 5S t/- /i3�5 ka407� of -T:1-),Q FoAv CW_ l 5z- of RI 2,�E5 (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT (If applicable): Mailing Address: Phone Number: J l 477 e� Board of Trustees Appl: tion GENERAL DATA Land Area(in square feet): a -7 ¢ Sl= Area Zoning: /< Previous use of property: Intended use of property: 12e!�✓1104V 19 L 6 ✓-T� L �'b�f'��� Covenants and Restrictions on property? Yes V/No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? /Yes No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? X/Yes No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? 1 Yes No Does the structure (s) on property have a valid Certificate of Occupancy? y Yes No - - ---- ---- -- Prior permits/approvals for site improvements: r Agency Date S'At c ,�o—r V No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency. VIINo Yes If yes,provide explanation: 2!:--: „ ,T Project Description (use attachments if necessary): ,� �L1�G� �kZ6 2- lug ,W I r74 4-,5 izi�E CODE- X 1AJ,, 3 Fr I06EP'�G�,yc /tel a� G� lam up -�-� 2 F1- -ro Ge7z0� L0�Z�L1�,�L ���- Board of Trustees Appl; Ltion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 7-0 Area of wetlands on lot:_ square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands:�(—�� feet 'Does the project involve excavation or filling? No -�,// Yes If yes, how much material will be excavated? O 222 cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: EAG 44&7,1, .�L 7:54fJP8-10 i24F"19,eQ �J�ff�aVb E(J 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): `7� r�12J ��low �IS Z LL k-V1-�LIE Board of Trustees Appl Ltion COASTAL EROSION APPLICATION DATA Purposes of proposed activity: F-V UeU0e*l 1 , Are wetlands resent within 100 feet of the proposed activity? No V Yes p p p tY Does the project involve excavation or filling? No ke"I Yes If Yes, how much material will be excavated? 0. 222 (cubic yards) How much material will be filled? S// (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts to the subject property or neighboring properties reasonably anticipated resulting from implementation of the project as proposed, including erosion increase or adverse effects on natural protective features. (Use attachments if necessary) 7-7-/e�- a r 1HE '-FVv J EC-T PS POS 451LL k107- -i4y�V� -/9P Y 4'�)� or A-t C E—5 1�e f e ULA P- Pv e-S TO 1/-)Fg(zt--1 q-ri0 L1 It5-14(C P 5TP7e _ -MPr7- 7WC 4,5 L04T-LD f k) &v00 22ME AF �z �' r ®rte ���-• 617.20 Appendix B Short Environmenta[Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attacH addiflonal pages as necessary` to supplement any irclif.— — — - Part 1 -Project and Sponsor Information Name of Action or Project: Project Location(describe,and attach a location map): �7r_-24,qo 2G DFEs�F 13LVDi Brief Description of Proposed Action: LiFt— GO tt �� 2 FT' 'IT ccc�' LY �Ol� /(1�LU r�DOre GY16- 6-M .2C00J-- �C, Z � L-J i Re 1C1CLe_1 TJ0 0�1; , ��r�11�CE�1�V T' &LFe'iV PO4-4j S, /13 0C= /f)ODJ770l__1( Name of Applicant or Sponsor: Telephone:10 6 1-2 7 2¢ X2141 k (��LLL= Et!C_ ��} � 6E/UJ' E-Mail: y4l. gell GIdabI � 1f�lil�c DlGt Address: 123 r� City/LStat Z'�1 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that ❑ may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: /2'21241-1.1e ❑ Y/3vlLD/,Ulm P��t'! 3.a.Total acreage of the site of the proposed action? 92, acres b.Total acreage to be physically disturbed? 0 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 02. acres 4 Check all land uses tha 'ccur on,adjoining and near the proposed ion. ❑Urban ral(non-agriculture) ❑Itldustrial Commercial Residential(suburban) ❑Forest Agriculture RAquatic EJ Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: 9 ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? -27 ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: [V I El 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑ b.Is the proposed action located in an archeological sensitive area? ❑ 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES ' wetlands or other waterbodies regulated by a federal,state or local agency? ❑ b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Ide'pgfy the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: Sh el ine e ❑Forest ❑Agri cultural/grasslands ❑Early mid-successional etland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? �❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? [NO DYES ❑ Nd b.Will storm water discharges be directed to established conveyance systems(runoff and sto drains)? If Yes,briefly describe: ❑NO S 7Z206c'(��U AJ 6L k.)6 tJ Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO I YES solid waste management facility? If Yes,describe: Nr ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDG Applicant/spon Date: Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ 3. Will the proposed action impair the character or quality of the existing community? ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the 1:1establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ affect existing infrastructure for mass transit,biking or walkway? Ed 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate 1 reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? El 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. -Par[.should,in gufficient detail],identify-the impact;-includm`g-any'measures or design elements that have been t`ncluded by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. ElCheck this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental imp cts. Town of Southold-Board of Trustees � //� Name of Lead Agency ate Michael J. Domino President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer �Ignature of Respo sible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 BREEZY SNORES COMMUNITY INC Sage Blvd. Greenport, NY 11944 June 11,2018 The Board of Directors of Breezy Shores Community Inc. (BSCI) 2017/2018, consisting of Dominle Mahl,President,Tom Charette,VP,Jimmy Costello,VP, Richard Wehrman,Treasurer, and Lena Beug,Secretary,hereby affirm that we have reviewed the.repair and renovation proposal sent by Diane and Dave Nelson. Plans were submitted on May 16th with an additional drawing sent on June 4th for cottage 24. Plans were prepared by: Frank Uellendaht P.O. Box 316 Greenport, NY 11944 (631) 477-8624 frank.ueliendahl@gmail.com The Board has no objections thereto. Thank you, 9Pv Dominie Mahl President, on behalf of the Board of Directors Board of Trustees Application AFFIDAVIT N V 1 k 1Ue f sm I wA y I V e f soy1 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 BOARD OF 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,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF V , 20 NOTARY PUBLIC STATE OF NEW YORK No.01FR6325118 QUALIFIED IN DUTCHESS C Notary Public MY COMMISSION EXP: Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, D AV I /y -P �S d�l ` — � 1 U fry`2 owners of the property identified as SCTM# 1000- 5 S 2• b in the town of S o u+E k o New York,hereby authorizes Fv-K vi on r/1 6j to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF �Ckr\ , 20 'NOTARY P BILK STATE OF NEW YORK NO.0 1 FR6325118 J QUALIFIED IN DUTCNES UN Notary Public 'fiy COMMISSION EXP: Gj APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The ToWn of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to rovide information which can alert the town of possible conflicts of interest and allow it to take whatever action is i necessary to avoid same. r YOUR NAME: GLS 1(1< Y IV Isfl1i1 V (Last name,first name,piddle initial,unless you are applying 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.) T grievance Building n -- Vaariaance Trustee Change of Zone Coastal Erosion — Approval of plat Mooring Exemption from plat or official map Planning Other (]f"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 _ If you answered"YES",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/agent/representative)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 5610 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 ks day of t;Ur 20 Signature A Print Name 00,VO kclS00 Form TS 1 APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics rohibits conflicts of interest on the part of town officers and employees.The puWse of this form is to provide information which can alert the town of Mss ble conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: �f �t�� � �CzilclK (Last name,fust name,rpiddle initial,unless you are applying 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 Building Variance Trustee �V— Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning 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 V/ Ifyou answered"YES",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/agent/representative)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 d y f �!� CaGL 20 Signature Print Name / rl Form TS 1 I /616 PROOF OF MAILING OF NOTICE ATTACK CERTIFIED MAIL RECEIPTS Name: Address: 422 Vu�)UJLO POE L-�L Vn4 STATE OF NEW YORK COUNTY OF SUFFO/L�K �ELz� L L 'C1 residing at 123 Caih-Oi( (e-V0 C �,d_ , being duly sworn, deposes and says that on the _RA L.L day of dA , 20 L,', 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 IQ Ort-- , that said N� were mailed to each of said persons by CERTIFLE MAIL TURN RECEIPT. 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[]Adult Signature Restricted Delivery$ � []Adult Signature Restricted Delivery$ 0 Postage C3 Postage $173.cc M Total Postage and Fees C13/071'2019 m Total Postage and Fees M "0°35 m $ $/6.85 rA Sent To /—Is 3/�� /,�_ (� Sent ToS�/.� ----------- -------------- --------------------------------------------- -- -v- p Street andApt No o O Box o p Street andApt.No.,or p ozx Nye �� __-____d. Crty, :•r r it 000-9047 See Reverse :rr ! C�J� ie •i,•r - Michael J.Domino, President ��00FF014.10 Town Hall Annex John M Bredemeyer III,Vice-President by,`�O GyJ 54375 Route 25 Glenn Goldsmith c P.O. Box 1179 A.Nicholas Krupski ® -Pry Southold,NY 11971 Greg Williams pr,� Telephone(631)765-1892 �lov Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of DAVID & DIANE NELSON COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING THIS FORMIS TO BE COMPLETED AFTER POSTING REMAINS INPLACE FOR AT LEAST SEVEN DA YS PRIOR TO THE PUBLIC HEARING DATE I, WLLV U6""I , residing at/dba 4 �- , o-c being duly swo n, depose and say: That on the 4&cday of rlif�l , 2019, I personally posted the property known as 6540 0 ft)u2 2f= Vt) -ZV &-(ULE7 CIS X(2 4- 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 of hearing noted thereon to be held W�dnesday, March 20 2019. J Dated: 03/vjI dC) TAture) Sworn to before me this 114day ofkdr* (,q CONN15 D.BIJNGFI Notary Public,State of New York No.01BU6165o60 Notary Public Quehfted is Suffolk County y Commission Ewes Apol M,�Z.o F7 PAI Servicid"m ' • CERTIFIED © RECEIPT Ln rO D, OWY M rXi HUMP 1CA 9 � .� �M. 717 GEE a LLLIII i M Certified Mall Fee _ _ i 1944 M CO Certified Mall Fee d°-� 0944 ca $ �._+I I - i ;?il $ . .-. ., �j I Extre Services&Fees(check bolt edd fee'3sep date) j L n Extra SeMCes&Fees(chedrbox add fee ate) ❑Return Receipt(hardwp7� $ ❑Return Receipt(hardcopy) $ ❑Return Receipt(electronic) $ j a(3I( Postmark $ Postmark 1-3 Certfied Mall Restricted Delivery $ rHere []Return Receipt o Certified Meal Restricted Delivery $ — Here C3I3 ❑ ❑Adult Signature Required $ C3 ❑Adult Signature Required $ []Adult Signature Restricted Delivery$ ❑Adult Signature Restricted Delivery$ Postage � 0 EDI I o cc Postage i l.55 M $ .J3/07/21.(19 $ ('✓rl Total Postage and Fees 03/07/2019 m 885 I MTotal Postage and Fees t15°v•.1 $ RI $ $6.v5 r- Sent To ` °s (,- Sent To / �c� ---�---Jf-----------—�®----------�--�-------------------- rqr---�� —J------------------------------------------- M Stieet andAPit ,or fQ Box No. (� O SfieefendApf.No.,or7'O ® a � d_ L -- crty ware,ziP+a LL --n------------- �� �� eta Ci ,state,ZIP+4�" :11 1 I I 111•1• - - Postal ServiceS. 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NUTILmL. U1 HL. AKINC NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 (\/lain Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: DAVID & DIANE NELSON SUBJECT OF PUBLIC HEARING: For a wetland Permit for the existing 26'4" x 167" one-story cottage; existing attached 4.6'x5.6' enclosed outdoor shower to be temporarily removed and replaced in-place; remove and replace existing locust and concrete footing with as per code minimum 3' deep, +/-16-12" diameter concrete footings; raise cottage up +/-2' to code compliant FEMA requirements; construct roof alteration with dormer; replace existing windows; and replace existing entrance steps with new 3'x6.4' entry platform with 4' wide steps to ground. Located: 65490 Route 25, Breezy Shores Cottage ##24, Greenport. SCTM## 1000-53-5- 12.6 TIME & DATE OF PUBLIC HEARING: Wednesday, March 20, 2019 — at or about 5:30P.M. If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours of 8 a.m. and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3: If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# - - /.26 tP PROJECT NAME A-16Z-- k) The Application has been submitted to (check appropriate response Town Board ElPlanningBoard❑ Building Dept. Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant, loan,subsidy) (c) Permit, approval, license,certification: Nature and extent of action: Location of action: Site acreage: 92- 6, /%/�.-�-CX/✓�27 MICS �J�sU _ �O�(J�Q.�-�11U� Present land use: Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: �� 1�l�l�lZC %z d/�� /��<<2'�12O�UL=Ct��•t'��' c Telephone number: Area Code (d) Application number,if any: 1 " / tq Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No 19/ If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LVVRP Section III-Policies; Page 2 for evaluation criteria. FlYes F] No ® Not Applicable � 7V 13E -/-Zg Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III-Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No 2 Not Applicable 20 14115 Esc �TfiJ2GY / �Jy©°S /::Z'22 4L&2e: /11�S I•(I SNE s��<�;:- Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Page S through 16 for evaluation criteria Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 throng 21 for evaluation criteria 1-1 Yes El No Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ EK Yes No N applicable Attach additional sheets if necessary - Policy 7--Pr-oteet andAm -ove-air- quality-in the Town-of Southold:--See-L-W-RP—Section-III—-Policies- - Pages 32 through 34 for alnation criteria. Yes 11No Not Applicable Attach additional sheets if necessary Policy 8. MinimizENot amental degradation in Town of Southold from solid waste and hazardous substances and wasLWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No pplicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Yep--1 No Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See WRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marme resources in Long Island Sound, the Peconic Estuary and Town wat {s. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. El Yes ❑ No Not Applicable ` Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for eval ation criteria. F-1YesQ No Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; P es 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable PREPARED BY 'EOXIL TITLE '-42Cql7FCl DATE o!koj /q