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HomeMy WebLinkAboutTR-9419A Michael J. Domino, President �QF SO(/TTown Hall Annex John M.Bredemeyer III,Vice-President ,`O`� ��� 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Telephone(631) 765-1892 Greg WilliamsYO Fax(631) 765-6641 CUM BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1584C Date: July 8,2019 THIS CERTIFIES that the removal of the existing cottage includingexisting xistin sg anitary system and drainage structures; and remove invasive and dead trees; At 4760 Blue Horizon Bluffs, Peconic Suffolk County Tax Map#1000-74-1-35.55 Conforms to the application for a Trustees Permit heretofore filed in this office dated March 8, 2019 pursuant to which Trustees Administrative Permit#9419A Dated April 17, 2019,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 the existing cottage including existing sanitary system and drainage structures,• and remove invasive and dead trees), The certificate is issued to 4760 Blue Horizons Realty LLC owner of the aforesaid property. Authorized Signature of Sorry Town Hall Annex c'_ � Michael J. Dominsident �� O 54375 Route 25 John M. Bredemeyer III,Vice-President �� l0 P.O.Box 1179 Glenn Goldsmith Southold, New York 11971 A. Nicholas Krupski G � p Telephone(631) 765-1892 Greg Williams O yc4UNT1, Y Fax(631) 765-6641 � N� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 6 Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction '/ constructed Project complete, compliance inspection. INSPECTED BY: 6r�z,,5 COM ENTS: I CERTIFICATE OF COMPLIANCE: �Sz�e/ Michael J. Domino, President ` o�ps�FFO( G Town Hall Annex John M. Bredemeyer, III, Vice-President r � yam', 54375 Route 25 Glenn Goldsmith ' W ,?t P.O. Box 1179 A Nicholas Krupski yf�! Southold, NY 11971 Tele �o ap phone (631) 765-1892 Greg Williams �_ 1 ,� '�.6% 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 T� RGMot/Il� lAlSP�10/�l . . 1St day of construction %2 constructed When project complete, call for compliance inspection; Michael J.Domino,President �QF S0(�ry Town Hall Annex John M.Bredemeyer III,Vice-President Q� �� 54375 Route 25 O P.O.Box 1179 Glenn Goldsmith [ Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 oly��UMV,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9419A Date of Receipt of Application: March 8, 2019 Applicant: 4760 Blue Horizons Realty LLC SCTM#: 1000-74-1-35.55 Project Location: 4760 Blue Horizon Bluffs, Peconic Date of Resolution/issuance: April 17, 2019 Date of Expiration: April 17, 2021 Reviewed by: Board of Trustees Project Description: Remove the existing cottage, including existing sanitary system and drainage structures; and remove invasive and dead trees. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by Jenna Principi Design, dated July 14, 2017, and stamped approved on April 17, 2019. Special Conditions: No heavy equipment is to be used within 25'from top of bluff; dead trees are to be flagged and inspected by area Trustee prior to removal of same. Inspections: Tree Removal Inspection & Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be, required. This is not a determination from any other agency. Michael J. Domino, President Board of Trustees �TiyTTT r i 1 Y ' L ' y , d► ` } OL y ew 44 .� �waa. �Y 4 •spa gel, �,;� �• �� - _ 3 0.d r :!k.'� i n 41 I yl , 1 .'�.. i .d rte• - --- , / DESIGNER �- J E N N A / \ ` P R I N C I P I t ` D E S I G N MAR ! 8 2019 ! - PRINCIPI.J@GMAIL COM PHONE 631.291.7753 LOT 5 col r, .,. CONTRACTOR r x; rlu PRINCIPI BUILDERS RlZ, phone:(516)852-0651 BLUE NN r C",0 \% SUFFOLK 1 ` /�% `/ / l.r ,� { / TO OCs E OJ..I ENGINEER U " 1� %% / '. /' ',1,;: SUFFOLK COUP\ 7�� �Y,° ���Y�� �� % . ° � S.C,T.M, DIST. 1000 SFS 74 ! K 35 5� � P _. �.. 01 I�C.�� .�,�.� , JIM DEERKOSKI. 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T [ iI T -- I TIT -- -- - 7,11 i1:L:I i f T 1 I1C 11 I;.T I I F I -1 L- ------- ; ' I CW 0 WEST ELEVATION = U Q 00 W 'n m L - - --- LL z ZD ---- - - - z - 0 z - - -- -- _ II;I IiI ! C::I_Ir11L1 ! I:.rT:`T I. 0 C _ z W I ] O J w Ln ;I. 1_ _l__I . [ ; I ! T I _I.T.l .i.:I:..I,.1.r=I I,:' _�=I_ [, _I .t F� 0 SOUTH ELEVATION --� SCALE 1/,l"=1' 30 �. I.r[ l I I l- a l,[ I ! l,L 1. 1 i I. 1 1. i ( _I. 1 i,T [ 1 I [ T..1 I I I [ 1. ---- --- 1 1-!,I-,I i [ 1 [ ' I.l_ I.i 1_.I l.iI[lI `.1_ r I_ I 17; 1 ! r FD DRAWN BY: JD/JP -- - L_I 1_.I: l I'i' I11 ' 1 I. 1'` it [ I -I [ T ! 1 I ] 1 i.:T`1 ; I i SCALE: SEE PLAN SHEET N0: EAST ELEVATION SCALE. 1/4"=-,l' A - 1 DESIGNER J E N N A --- -- -- P R I N C I P D E S I G N - - - - - _ PRINCIPI.J@>GMAIL.COM PHONE 631 291.7753 I MAR 8 2019 I I CONTRACTOR :7 s PRINCIPI BUILDERS phone:(516)852-0651 ENGINEER 201-21,-2 0-e8 JIM DEERKOSKI, PE 2'-4'—{ -- 20-20 phone:(631)298-7116 I I I I J I V LIVING / DINING I LLJ KITCHEN �' O I © BATH " I 2 00 Ij 1 Q w L-------------riZ SO00 � I BEDROOM 1 BEDROOM 21 I I N O f14-3 O i ( = z n J (( W O ED— — — — — — — — — J w --3'-1'-----2'-9' -- �'-6' -j--2'-G'-- -3'-48'----` 20'-2e. 20'-21, FIRST FLOOR PLAN ROOF PLAN SCALE 1/4"=1` E 1/�a"=1` REVISED 14.07.17 JP DRAWN BY: JD/JP SCALE: SEE PLAN SHEET N0: A - 2 DESIGNER PRINCIPI.J@GMAILCOM PHONE 631 291.7753 MAR 8 2019 CONTRACTOR \ \\ ! , PRINCIPI BUILDERS\ \ \ \ \ \ \ \\ \\ �, phone:(516)852-0651 ENGINEER JIM DEERKOSKI PE phone:(631)298-7116 410 w NATURAL 4' SNOW FENCE FABRIC SILT FENCE _ BALES OF HAY \ \ \ EROSION PREVENTION DETAILS U I \ 0 C? I \ \ \ \ \ \ w00LO 3 TREES TO BE REMOVED 'I" > zLL Z f - mica r�i N O LU O � W c , m D 2 TREES TO BE R OVER Co r'Th�� J s - 1 ' r / F REVISED 14.07.17 JP r DRAWN BY: JD/JP SCALE: SEE PLAN SHEET N0: ROOF PLAN c ltj r OF SO Town v Town Hall Annex Michael J.Domino,President �� 54375 Route 25 John M.Bredemeyer III,Vice-President �� lQ P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A. Nicholas Krupski ' G • Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 �Cour>�,��' 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 Project complete, compliance inspection. INSPECTED BY: L '✓�� �'�Iv�` COI LAMENTS: CERTIFICATE OF COMPLIANCE: Blue Horizon Blfs Peconic 3'49 PEdit Uccember 18,2018 r.' L +` j - I 'r 4, 1, �i1r�S.t`. � a.3iiau.�+�.,-�..w.�.� ._�...d:�' ��It�E ti��c � �'�'+^a�r������1���►•r� Blue Horizon Blfs Peconic U �I� Edit December to 1018 3.49 PM ! r n 4� t 4� ' f r t .. 1 r f ° �r a 1 1 - L _ Zf' y '4 �� 1 1✓t ry t'1 (r �r� �� �M� ����.� .I�t�. �. ,. T y F .'j I Ir r � � � • n 1 -►'�`Wa. ?:- � - � _ ,yew y:�. .°._..fes-IEf� ���•�4�+--�`�X '--.�6.-�`'^is � , ::T -. � .. _. - .. Blue Horizon Blfs Peconic Edit January 20 336 PM 1 1� Icy � 1 — P. 14• f Jj r 77, 73 9`d�Q�� �s �. t t ,�jy�+9pT�ufrly •z,�5f4��:�c '� •,'�!y " +'y-�'rte, f� i •' - - 1r.. n ��r/1�.� .S�' +�.'Y � ^"h. i •♦ f ��/V�k A \ � 1, - Z . Blue Horizon Blfs Peconic Edit January 20 336 PM 1 ft HDA - - r JAI 4 o MTCM AMTLH UNE J - �— L:-------- --- — ----- NYSOv --�---_ 123 FOR PCL HQ PCL NO. .f y 12.1 51Ny SEE SEL.NO. SEE SEC.NO. i �R' �mlaln 1.7A 088-01+110 ]'3tsz` �• " " J ro u a aox C I" 4, i I zoN-) n ?' 6.3AIc) t�s>` " '� a ,t M «^ a t°t•` ♦ Al° N io " w7 dry ° r�`a ��� t ''•`'c, r'�a Iv 0At I 41 lze O 44 ��`) 3� a •B to sue) I II6 I m ro" ,� �� � ti � TOWN OF SOUIHOA� �y� n P1 212 �cIIVV� a a �4(�) - ms's)', str ,.. Pte. 'b TOWN OF 501ffHIXO � i I C'P• •41od �p I ��F4.FaA mom, ^� p �a • 1za I� '- 1 '` RaxNOFO I5.]Hc) moo* rya p FOR \ p PCL NO. ME I SEE SEL.NO. ILLI 50601-00.1.1 I S1.IA(y I cov - M1 POR PCL NO. SEE SEC.NO. 2.64 b1 M1 00601-00.13 1.a e 00 I /z] ° e 00.41 FOR PCL NO. FOR PCL NO 12.6 FOR PCL NO. SEE SEC.NO. SEE SEC.NO SEE SEC.NO. O yr��91 OBB01-015 FO 12.8 A 1 OB502-OIR —_—_- �x3H t4 LINE 22A(c) � ------ ——————— ——————— �-- --_-- ARIA MATCH S�Ec --�--- eE4xo.m5 IAATLH SEE SEC NO SE E SEC.N0.005 oI)m�t NOTICE COUNTY OF SUFFOLK © N SOUTHOLD SECTION NO E �� _ w.... � )e+) Real Property C—IRI ax Service NY11"1 gena v �1 � E a --- �� --`-- ��--^-- G unry Curter RlveNwx,NY11001 M in 8o �74 D w,. a r rtt MQw rzu "` F ae1 1mrh,�n,E PROPERTY AMP 211A -- -- OFFICE LOCATION: ®X®f S® �®l® MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) ua Southold, NY 11971 ® �pTelephone: 631 765-1938 ® Fax: 631 765-3136 c®Uf19T�,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: April 10, 2019 Re: LWRP Coastal Consistency Review for 4760 BLUE HORIZONS REALTY LLC SCTM# 1000-74-1-35.55 Richard J. Principi & Eric Martz on behalf of 4760 BLUE HORIZONS REALTY LLC request an Administrative Permit to remove the existing cottage, including existing sanitary system and drainage structures; and remove invasive and dead trees. Located: 4760 Blue Horizon Bluffs, Peconic. SCTM#: 1000-74-1-35.55 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 provided the Board considers the following recommendation: 1. Require the construction of a vegetated, non-turf buffer landward of the top of bluff and preservation of existing trees to the greatest extent practicable to further Policies 4 and 6. 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 J John M.Bredempyer III,President Town Hall Annex Michael J.Domino,Vice-President 54375 Main Road P.O.Box 1179 James F. King,Trustee Cn Southold, New York 11971-0959 Dave Bergen,Trustee Telephone(681) 765-1892 Quarles J.Sanders,Trustee Fax(631) 765-6641 ou"11 BOARD QF TO TRUSTEES D E-CE I V E nn TOWN OF SOUTHOLD F_ Office Use Only MAR - 8 2079 Coastal Erosion Permit Application Wetland Permit Application Southold Town Administrative Permit X _Amendment/Transfer/Extension "ived Application: d Received Fee:$ 106,-6-- Completed AppFicationT Uffsll ---,-Incomplete: SEQRA Classification* e I,Fy' p Type 11 Unlisted Coordination:(date sent):_ q,j q LWRP Consistency Assessment Form: Referral Sent: Data ' V— � e of Inspection: W , Receipt of CAC Report: Lead Agency Determination: 'Technical Review, TO 6i'P&-. 7. ;—/--Public Hearing Held: DID pur Resolution: � Narrie of Applicant: 4760 Blue Horizons Realty 4[,C Mailing Address: 12 Gilder Ct C006 Northport, NY 11768-3310 Phone Number: (631) 368-4818 Suffolk County Tax Map Number: 1000 , 74-1-35.55 Property Location: 4760 Blue Horizon Bluffs, Peconic, NY 11948 County Rd. 48 & Henry's Rd. (provide LILCO Pole#, distance to cross streets, and location) AGENT: Richard J. Principi Jr. & Eric Martz (If applicable) Address: PO Box 1248,Southold, NY 11971 Phone: (516) 852-0651 & (917) 916-�724 Board of Trustees App:.',- ation GENERAL DATA Land Area(in square feet): 49658 Ar,ea Zoning..R R/R40 Pxvidous use of property: Seasonal Residence Intended use of property: Year Round Residence Covenants and Restrictions on property? Yes X .— No If'"Yes",please providle a copy. Will this project require a Building Permit as per Town Code? X--Yes = No If"Yes", be advised this application will be reviewed by the Building Dept.prior to,a Board iol,Trkistee review and Elevation Plans will be required. boes this project require avariance from the Zoning Board of Appeals? Yes. X No If"I(es",please provide copy of decision. Will thisject require any demolition as per Town Code or as determined by the Building Dept. Pro) X.—Yes —,--,—No Does the structure(s)on property have a valid Certificate of Occupaticy9i Yes XNo Prior permits/approvals for site improvements: Agency Date X No prior permits/approvals for site improvements. Ffas any permit/approval ever been revoked,or suspended by a governmental agency?'_ X No Yes If yes,provide explanation: Project Description(use attachbients if necessary): Remove existing residence, sanitary and drainage structures, invasive and dead trees. Restore areas with natural vegetation and grass, Board of ftustees .Alpp}- ;at:io n WETLAND/TRUSTEE LANDS APPLICATION ION DA'II&,A Purpose of the proposed operations: Remove existing residence, sanitary and drainage structures, invasive and dead trees. Restore areas with natural vegetation and grass. Axea of wetlands on lot:' 4963 square feet Percent coverage of lot: 9.16 % Closest distance between nearest existing structure and,upland .,edge of wetlands: 2 P_ feet Closest distance between nearest proposed structure and upland edge of wetlands: ______ 125 _ feet Does the project involve excavation or filling? No X Yes If yes,how much material will be excavated? g --_,cubic yards How much material will be filled?,_ 250+/- .cubic yards (Fill in existing foundation.) Depth of which material will be removed or deposited: „ +./' feet Proposed slope throughout the area,of operations: _1 :4YMax Manner in which material will be removed or deposited: Material to be removed mmmm and deposited by an excavator and by hand, 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): i'110 negative impacts to the wetlands or tidal waters of the Town of Southold are anticipat(:d. 61 7.20 Appendix B S,h or l.Environmental rllssessrnent pori Instructions for Completing Pprt 1 -Project Information. The applicant or project sponsor is responsible for the completion of Psi rt 1, Responses bwome partof the application far approval or funding,are subiect to public review,and may be subject to further verification. Complete Part 1 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 additional pages as necessary to supplement any item. Part I -Project and Sponsor Inform atlon Marne of Action or Project: ____.._._-..,.. , ,_ •- .- -- . . .,. • ,, _.. ,..,..., '` 4760 Blue Horizon Bluffs. Project Location(describe,and attach a location map): �- 4760 Blue Horizon Bluffs, Peconic, NY 11948 Brief Description of Proposed Action, Remove existing residence, sanitary and drainage structures, invasive and dead trees. Restore areas with natural vegetation and grass. Name of Applicant or Sponsor: � 'Telephone: (631) 368,4818 4760 Blue Horizons Realty LLC E-Mail: Address: ....._... �......,._.,..,..,-.,,.._.�.�,�,_...,_....... _.,_.-..._._......._,�._._.......;. 12 Gilder Ct C006 City/PO: �___-�--.....� ,..._..... ., ._.,. State; .,�....,.�.�.,,._.,....-.�'� Zip Code:_......-•---, i! _ Northport _ _ _ NY_ 11768_ _ I.Does the proposed action only involve the legislative adoption oFa plan,local law,ordinaned;­ 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. 1f no,continue to question 2. ` 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO ! .MES_, If Yes,list agency(s)name and permit or approval: Southold Building_ Dept. __ _ _ ■ 3.a.Total acreage of the site of the proposed action? �- ,7 _acres b.Total acreage to be physically disturbed? —.25 acres c.'Total acreage(project site and any contiguous properties)owned or controlled;by the applicant or project sponsor? _1.47 acres i �. Check all llagd eines that occur on,adjoining'arid near the proposed action. ❑Urban .Rural(non-agriculture) E]Industrial []Commercial ❑✓Residential(suburban) i i ❑Forest DAgriculture El Aquatic 0Other(specify): ❑Parkland Page 1 of 4 ; s Eke proposed action„ . �'"'NO �1&1,S N/A a,A permitted use under the zoning regulations? „p _b.Cgnsislent with the adopted comprehensive plan? Ili 's 6. Is the pmol?osed action consistent with the predominant character of the existing built or natural [NO YES lapdscape? - "?.wls the'site'of the proposed action located in,or does it adjoin,a state listed Critical Environmer<tal Area? NO YES r , Il, a.Will the proposed�action result in a su stantial increase intraffic above present levels? ww . NYES lb,Are public transportation service(s)available at oe near the site of the proposed action? e.Are an,y pedestrian accommodations or bicycle routes available on or near site of the proposed action? - 9,'Does the proposed action meet or exceed the state 660 y code'requirements?^T 1Vt) !,i YES If the proposed action will exceed requirements,describe design features and technologies: Will the proposed action'conne-et to an existing public/private„water supply? .M . NO YES r If No,describe method for providing potable water: On-site sub-surface well_ _ private t lay a12 �v�� X Sta folly Coit Health Q 1 � ,__ ,�... _4 � �._ry_ TR T El 11.Will the proposed action connect to existing wastewater utilities? ; N61` 'YES If No,describe method for providing wastewater treatment! Private on-site wastewater 12. a.Does the site contain-a structure that is listed on either the State or Natianal Register of Historic !i I NO YES Places? " b.Is the proposed action located in an archeological sensitive area? F �13.a:noes 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? �r If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are 1lkee y to be found on the project site. Check all that apply: R]Shoreline []Forest ❑Agricultural/grasslands DEarly mid-successional D wetland El Urban []Suburban 15.goes the site of the proposed action contain any species of animal,or associated habitats,listed IV4ia YES by the State or Federal government as threatened or endangered? fpr 16.Is the project site located in the 100 year flood plain? � NOYE 17.Will the proposed action create storm water discharge,either from point or non-point sources? --� -, YES if Yes, . a,will storm water discharges flow to adjacent properties? NO YES � b,Will storm water discharges be directed to established conveyance systems(runoff and storm drains)'? If Yes,briefly describe: [3NO AYES Page 2 of 4 Y- Does the proposed action include construction or other activities that result in the impoundment of N® -'Y'S water or other liquids(e.g.retention pond,waste lagoon,dam)? if°,res,explain purpose and sine. 19.Has the site of the proposed action or an adjoining property been the location of an active or closed ' NO r YES soliid waste management facility? If Yes,describe: 20,Has the site of th'e'proposed action or an adjoining property been the subject of remediation(vri oing or NO ! YES' completed)for hazardous waste? I If Yes,describe:—_...__ i I AFFIRM THAT 1 HE INFORMATION PROVIDED D AB®YE IS TRUE AND ACCURATE'f'6 THE BEST OF MY , KNOWLEDGE ddii Applicant/sponsor name: 1 Bate;_ L iM � Signature; Part 2-Impact Assessment. The Lead Agency is responsible for the completion of fart 2. Answer all of the.following questionsin Part 2 using the information contained in Part I and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the n.-viewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" •-_ ....,.,._ -ry—.�....-.,,., - 'No,or (Vl<oder•ate small to large Impact impact may may occur occur —1Me w 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 establishment of a Critical Environmental Area(CCA)? � ,J 5, Will the proposed action result in an adveirse change in the existing level of traffic or A i affect existing infrastructure for mass transit,bilging or walkway? 0 El 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ; _ reasonably_available enemy conservation or renewable ener_�gy o�unities? M1� M7. Will the proposed action impaict existing: ^ T. a.public/private water supplies? b.public/private wastewater treatment utilities? 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,gnonndwater,air quality,flota and fauna)? 'Page 3 of 4 . b„�.<.,...:.,_ ...._.-____..,_........� ..__._.. `-".�._ No,or ', Moderate small to to rge Impact impact way 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? ; Fart 3-lDetermina¢ion 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. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included 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. Check this box if you'have determined,based on the information and analysis above,aiTdF;ny'su0portmg documentation;" that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. 1 El 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 impacts. 1 Town of Southold-Board of Trustees - 1 ]dame of Lead Agency. . _ I�atem President a Print or Type Frame of Responsible Officer in Lead Agency Title of Responsible Officer SignaturF;of Responsible Officer in Lead Agency _ Signature of Preparer(if different from Responsible Officer) j' PRINT �_. Page 4 of 4 i r APPLICANT/AGENT/REPRESENTATWE TRANSACTIONAL DISCLOSURE FORM ►i e Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of (his form is to provide information which can alert the town of possible conflicts of interest and allow it-to lake whatever action is necessaryto avoid shla�me, Ma YOUR NAME: 1—US�rt1 r)t� d �uS0 r6of l�XaI" (Last name,fust name,.tpiddle initial,unless you are applying to the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) a NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion _Z( 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 officcr or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"•means a business, including a partnership,do which the town officer or employer;has even a partial ownership of(or employment by)a corporation to which the town officer or employee owns more than 5%of the shares. YES NO X - 1 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 i 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 or tile applicltnt (when the applicant is a corporation); i B)the legal or'beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); ' C) all officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 4.3 day of WA%°W 20 Q Signature Print Name , icT 1. kr-vs a /-o Form TS 1 A /t,/ 9 �(w/tGCx_r �i/Sc•rd h , Board of Trustees Application AFFIDAVIT 1�usa-1-o 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 roperty Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF 320 Notary Public KEVIN S.MCQUADE KEVIN S.MCQUADE Notary Public,State of New York NotaryPublic,State of New York No.4926756 Commission Expires April i:, G u No.4926766 CommissiorrExpires April 19, Board of Truste®s Application I AUTHORIZATION (Where the applicant is not the owner) I/We,._M(-r t o T l— UScro v r owners of the property identified as SCTM# 1000- 74-1-35.54 in the town of Peconic ,New York,hereby authorizes Richard Principi & Eric Martz 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. roperty Own Signature Property wner's Signature SWORN TO BEFORE ME THIS DAY OF Y 1 ,20 Notary Public KEVIN S.McQUADE KEVIN S.McQUAI?E Notary Public,State of New York Notary Public,State of New York No.4926766 No.4926766 Commission Expires April 19, Commission Expires April ij,__ Board of Trustees ,app', ation AFFIDAVIT 4760 BLUE HORIZONS REALTY ILC BEING DULY SWOP14 TI; EP�SES AND AFF41RMS THAT HE/SHE'IS THE APPLICANT FOR THE ABOVE IDESC;RIBED PEIAIIT(S)AND THAT ALL STATEMENTS CONTAINED REREIN ARE TRUE TO THE BEST OF HISMER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE T6j[ANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOU T`HOLD TOWN BOARD OF TRUSTEES. THE AIPPLICANT AGREES TO HOLD THE TOWN OF SO TI HOLID 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 43NANIED. IN COMPLETING THIS APPLICATION,1IERETY AUTHORIZE THE, TRgST4ES9 THEIR AGENT(S) OR R,PRESENTAHI3ES9 INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY TPROPERYY TO INSPECT THE PREMISES IN CONJUNCTION wim TIEIIS APPLICATION, INCLUDING DING A FINAL INSPECTION. I :THERAUTHORIZE THE BOARDOF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COAST. 04 EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING TBA TERM OF THE PERMIT. 34144e,4roperty Owner 4 SWORN TO BEFORE ME THIS ,� _DAY OF ��� � _ ��,2® � Notary Public KEVIN S.McQUADE Notary Public,State of New York No.4926766 ��v ;'nmmission Expires April 19 ' l Fy..h } ♦ 1 APPLICANT/AGE,NURE PRESENTATIVE TRANSACTIONAL DISSCLOSURE�FORM " ,Tire f'�a rr. h�! tld°� gde of th10401' "s rhfl6cfs'cit interi�As-0-119,W-1 ,i '�r I.pCpi�tpY �S►�•l�i fv 1''a f`"Ai nti hi%+�a?ltiali�. ► �]f�t '�i f tim' F' o iii e' t llr¢ nPititeresl'�nci l i] (i o,�l a av}ate er gr c neossary to avold s in . 4760 Blue Horizons RealtyL L Q YOUR NAMRs (Last name,first mane,'piddle initial,unless you are applying in the name of someone else or otter 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 Change of Zone , Coastal Erosion 7 ' Approval of plat _ _ _._ Mooring Exemption from plat or official map -��„ - Planning b Other (If"Other'',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child),ll,'ve arselirtionship with any officer or employee of the Town of Southold? "Relationship"'includes by blood,rrlarriage,or bu5l, 'ss`hIcrieet.�`f3usIness interest"means a business, including a partnership,in which the town officer or employee has even a partial otivt4ct31iip;sa't'(9T employment by)a corporation in which the town officer or employee owns more than'5%of the shares. YES w NO X 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 applicont/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 ofi icer 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); II)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 6i'r4 ..r.a�,r.a....r..+r,•,nws.nnn+•+wrwwrwa�w�—ter w ' r•.d.,nnl,• a .....wy.�r.n-..w..n,.f rv�w n.� -r.•wwaurw.�r,•. _-_ -r.•w,�.w+w.,hw+vn�. Submitted d of 20b Signature t • _ , Print Name' t Form TS II ac� � Town of Southold ,LWRPCONSISTENCY 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 gather ministerial permits not located within the Coastal Erosion A azard 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 tnp�rn the coasts area(which includes 5,L)LgL5outhold 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. ' "liu ; each, ��tR�� tams cl tivaed im ile tiR' It tk! t�rla�i d sSUD o:rdne facts. If an action cannot be certified as consistent with the LWRF 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. 13. DESCRIPTION OF SITE AND PROPOSED ACTION SC,r1 !k 74 01 „, 35.55 'PROa{CT NAME 4760 Blue Horizon Buffs The Application has been submitted to(checl�appropriate response): Town Board F� Planning Board Building Dept. M 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: Remove existing residence, sanitary and drainage structures, invasive and dead trees. Restore areas with natural vegetation and grass. Location of action: 4760 Blue Horizon Bluffs, Peoonio, NY,11958 Site,aerpage: 1.47 Present land use: Seasonal Restdence Present zoning classification: RR/R40 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: 4760 Blue Horizons Realty LLC (b) Mailing address:.12 Gilder Ct C006 Northport. NY 11768 (c) Telephone number: Area Code( (d) Application number,if any:. Will the action be directly undertaken,require funding, or approval by a state or federal agency? YesEJ No If yes,which state or federal,ckgeacy? C, Eyaluate 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 foram be returned for completion. .DEVELOPED COAST POLICY Policy I. 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 LWRP Section III—Policies; Page 2 for evaluation criteria. Eyes ED No 1:1 Not Applicable Existft' structure 2 f6et from the bluff will be rernoved. � Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LAMP Section 11II Policies Pages 3 through 6 for evaluation criteria L .J Yes L_.l No❑ loot Applicable Area near bluff will,be to natural conditions. "Attach additional11 sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section 1111--Policies Pages 6 through 7 for evaluation criteria Z Yes,E]' No [:] Not Applicable �E ,Zjgti,pcljstruq6e 2 feet from the blWjf will be removed. Kt-ia7ladditional sheets if necessary NATURAL COAST POLICIES 'Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See Lvfftlp Section III—Policies Pages 8 through 16 for evaluation criteria Mr Yes ❑ No 11 Not Applicable _UX structuC 2 et 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 116 through 21 for evaluation criteria T:] Yes 0 No LJofApplicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including I Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages,22 through 32 for evaluation criteria, F] F1 O 'Ves Q No W.iilqui Applicable ,IE'�oKqt will have nonegative impacts to town ecosystems. eym.e—mn..nmrml+mmwiw..-.rrr�r r....r...r.� r - J y attach radditional sheets ifnecessary Policy 7. Protect and improve air quality in the 'Town of Southold. See I,WR P Section III — Policies Pages 32 through 34 for evaluation criteria. Yes :NoNot Applicable Project will have no�neclative impacts to—air quality. �ataah additional sheets if necessary z Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See L Section HI—Policies; Paage�34 through 38.for evaluatiop criteria. 1,.�.i yes 1:1 No ®Not Applicable 'ro ectvill have no negative impacts on the environment. 77 PUBLIC COAST POLICIES Policy 9. Provide for paalilic 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. YOO NOR]Not Applicable __Rrol t lNiil vP no_itYl la�t~Qn�t�a�blic_a ers �- rte – m-, .R� Attach additional sheets if necessary WORKING COAST PU.UICIES I Policy 10® Proiect Sounthold's water-dependent uses and promote siting of uuew water-dependent Lases in suitable locations. See LWRP Section. III—Policies; Pages 47 through 56 for evaluation criteria. i®Yes ❑ No Z Not Applicable Pro'ec�� t will have no ne ative impacts on water-rdependent uses. Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Log Island Sound, the Peconic Estuary and Town nn waters. See LWi.2P' Section III—Policies; Pages 57 through 62 for evaluation criteria. C]Yes ❑ NoL!J Not Applicable mProiect will have no negative im ots on,marine resources._ Attach additional sheets if necessay Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. [❑Yes ❑ No Z Not Applicable Project will have,no negative impacts Qn agricultural lands. _ ,Attach additional sheets if necessary Policy 13. Promote appropriate nese and development of energy and adneral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. DYes ❑',No 21 Not Applicable Project will have no negative impacts on marine resources. r� r 'PREPARED BY Eric Martz "IIiTI.I+1 , DATE 2/13/19