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TR-9411
Michael J.Domino,President �QF S0(/r Town Hall Annex John M.Bredemeyer III,Vice-President ,`O� yOIO 54375 Route 25 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 lyCOU�fT`I BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE 1640C ------ ---— Date: October 6, 2019 THIS CERTIFI , Ld install 100 linear feet of rock revetment consistitr Cc C OF CUr'e,1o,,ct I course stone placed in an interlocking manner, landw (� C A perpetually maintain a 10' wide non n e-�� SS v� rti � ;evetment; Dnic Conforms to we filed in this office Dated Sente tland Permit#9411 Dated March 20, 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 block wall and install 100 linear feet of rock revetment consisting of 4-5 ton lower course stone and 2-3 ton upper course stone placed in an interlocking manner, landward of the Mean High Water line; and to install and perpetually maintain a 10' wide non-turf buffer along the landward edge of the rock revetment. The certificate is issued to Thomas V. Perillo,Jr. &Christopher Perillo owners of the aforesaid property. � - e m Authorized Signature •� �..,. .. - . . . . ... .,,,, .gip, Michael J. Domino, President ``�OF SO(/ryO 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 • Q Telephone(631) 765-1892 Greg Williams O Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: )016110) Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction '/2 constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: _ OK toy C o C. Rv'M w',1:k W_Krn;4 g411 0.,-,A glans amr,'IA 3/2v/)R CERTIFICATE OF COMPLIANCE: y=�` Town Hall Annex Michael J. Domino, President John M. Bredemeyer, III, Vice-President ��� 54375 Route 25 Glenn Goldsmith y ,? 4 P.O. Box 1179 A Nicholas-Krupski y ����� Southold, NY 11971 ,Greg Williams ol , �a Telephone (631) 765-1892 ii Yp�= 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 i INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain i, 1st day of construction %2 constructed xjl When project complete, call for compliance inspection; h - ,�!i 1/r o ira o - yj!Illj• -s ii{•'li'j'y.•.. -a lil r, '"- - ,;irr'11 Ilr•r ,.>-.•�N r1• -• _ •i�\� %lei• - n`�\1 %i�3n✓,�� +i�10 ls'.. +-�y:,q1 I,j,,y.�.� � `L\fit• OD�� YJJ'���:���"`0L. /I''• . qihw,,,.• �'�. � .q',.,p ,ung,.. i � � e `�- e . � � murAn,, + e r, -- � -tit� Yom: � ��5� l�• � �'�°�^„y, _ r.\, ,- �.;� <_ _€ + I�r�`1�' `. „n.pr...xr,;s9,:;nrn>E,rir,.,,,r,r,,m,�:rr�7nnxyo,rrm.p,r,,,g,,ar,�tA„x5°x+'7a2vR,.,±vwoti nn;,mM�MMrnrSdYrcnr r?,r!m:lfAr?r,t't<'ry)A1?.n,g57na,'�'n�ay�.5"'?`_mmr.,:,(11-VI ,.� ,rnvr�grn rc,me;a'�xr•�y1r”„p° /;' BOARD OF SOUTHOLD TOWN TRUSTEES =` SOUTHOLD, NEW YORK , a f. PERMIT NO. 9411 DATE: MARCH 20,2019 ISSUED TO: THOMAS V.PERILLO,JR. & CHRISTOPHER PERILLO PROPERTY ADDRESS: 1400 GREAT PECONIC BAY BOULEVARD,LAUREL 1'„ +o SCTM# 1000-145-2-17.4 AUTHORIZATION15 ({ _ Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in ,•; accordance with the'Resolution of the Board of Trustees adopted at the meeting held on March 20,2019, and in } v r consideration of application fee in the sum of$250.00 paid Thomas V. Perillo, Jr. & Christopher Perillo and ' subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to remove the existing block wall and install 100 linear feet of rock revetment consisting of 4-5 ton lower course stone and 2-3 ton upper course stone placed in an w interlocking manner,landward of the Mean High Water line; and to install and perpetually maintain a 101 wide non-turf buffer along the landward edge of the rock revetment; and as , ^ < depicted on the site plan prepared by Jeffrey Patanjo,dated August 7,2018,and stampedM approved on March 20,2019. r..t IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of the 20`x'day of March,2019. y _ r _ y,�V `•Ti":i���r � �1�11�i: ,•`�;v `ux,uLx••v;iY,.ww,w .ns>iu�vi,xvuv lv,u.,:r.uvww;.Ru•,y,x\u•�u6.eYS„>;.1v;.b,.$piunau�),J.;.zv�•,tixUY�•E•iU_wil«uiSi ut•5uuir��eadY,xr�,.z vo;,.•1 ti„ru t,..w'muuu Sn,l�.f;,'Xmwwxaiiv�,axuu.el;L,v;,Pttti,[cs'�., # l�+ ✓,fuw +- •..- � � \..,�•� — l�\`gyp _��. AFS `�t �•2. fg �Y_ 7` � �e a�: r'1 '-� '\'., �r'\ �i t ��l q�i"f t=.\:i _� a +��'a5i'x'• � '�%' �t ,iA^� i �:� � i \�%' + '�a*E i �'.1 tip. •.:li% .�.a~:. •.:V.�la,. _ ii iiia« _ •ori%.,:i:°�. •,1.,%ii.l�• �,1I.,rr�+�A� •.;r.� '�i°•• TERMS AND CONDITION- The Permittee Thomas V Perillo Jr &Christopher Perillo residing at 1400 Great Peconic Bay Boulevard Laurel, 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. The Permittee is required to provide evidence that a copy of this 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. 9. That the said Board will be notified by the Permittee of the completion of the work authorized. 10. 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. 11. 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. Michael J.Domino,President ��QF SO(/lyO Town Hall Annex John M.Bredemeyer III,Vice-President Q 54375 Route 25 O P.O.Box 1179 Glenn Goldsmith l�t Southold,New York 11971 A.'Nicholas Krupski G Q Telephone (631) 765-1892 Greg Williams �� Fax(631) 765-6641 olyCOU ,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 20, 2019 Jeffrey Patanja—_ _-- --- – -- - - P.O Box 582 Bohemia, NY 11716 RE:' THOMAS V. PERILLO, JR. & CHRISTOPHER PERILLO 1400 GREAT PECONIC BAY BOULEVARD, LAUREL SCTM# 1000-145-2-17.4 I,I Dear Mr. Patanjo: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, March 20, 2019 regarding the above matter: WHEREAS, Jeffrey Patanjo on behalf of THOMAS V. PERILLO, JR. & CHRISTOPHER PERILLO, 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 September 10, 2018, 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, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, I 2 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 THOMAS V. PERILLO, JR. & CHRISTOPHER PERILLO to remove the existing block wall and install 100 linear feet of rock revetment consisting of 4-5 ton lower course stone and 2-3 ton upper course stone placed in an interlocking manner, landward of the Mean High Water line; and to install and perpetually maintain a 10' wide non-turf buffer along the landward edge of the rock revetment; and as depicted on the site plan prepared by Jeffrey Patanjo, dated August 7, 2018, and stamped approved on March 20, 2019. Permifto 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.) I Fees:,$50.00 Very truly yours, T - Michael J. Domino President, Board of Trustees i MJD/dd i. i' I� 20% �Y AO Y� Y "L 1 � x �(FRAME m .SSE%r 1400 O O O 1 1 N 1 O N r pp5i1NG FENCE i� r ' 1 1 1 1 $B5 57'10"R 1 1 APPR®VE® BY ` ""BOARD OF TRUSTEES � TOWN-OF-SOUTHOLD DATE. /titA" 26, O I ' to � 1r N ' 1 r . 1 PROPOSED 10'WIDE PROPOSED 100 LF ROCK REVETMENT TO CONSIST OF NON-TURF BUFFER BOULDERS CONSISTING OF LOWER COURSE UMIIS OF STORM EROSION 4-5 TON AND UPPER COURSES 2-3 TON SIZES AND PLACED IN AN INTERLOCKING MANNER o=m=--- CONSISTENT WITH NVSDEC AND SOUTHOLD TOWN SPECIFICATIONS AND REQUIREMENTS. PROPERTY OWNER: M.N.W. — of EXISTING BLOCK WALL � TO BE REMOVED THOMAS V. PERILLO JR. _ _ CHRISTOPHER PERILLO 87 OLD COUNTRY ROAD _ —"'=W' .5799.98 MELVILLE, NY 11747 PREPARED BY: �, c !r E,i" LLn ��, GREAT PECONIC BAY JEFFREY PATANJO SEP 10 201�,� E P.O. BOX 582 BOHEMIA, NY 11716 631 -484-9332 @GM oarSoutofldTown ROCK REVETMENT PERMIT PLANS SCALE: JJPATANJO@GMAIL.COM � Boar o Trustees 1"=60' NOTES: PROPOSED PLAN DATE: 8-7-18 1 . PORTIONS OF SITE PLAN FROM SURVEY PREPARED BY: YOUNG AND YOUNG SURVEYING 1400 PECONIC BAY BOULEVARD 400 OSTRANDER AVENUE, RIVERHEAD NY LAUREL, TOWN OF SOUTHOLD DATE SURVEYED: SEPTEMBER 20, 1979 SUFFOLK COUNTY, NY SHEET: TAX MAP N0. 1000-145-02-17.4 1 of 2 Borders �' \L ,em „ rf` V, ` mil jt m i l CVS � �l'`4t'• ' IJ 4y pay finery �° °c°\ �t 14l)O'P econic Bay Boulevard,"' . l PROJECT LOCATION MAP N.T.S. EXIST. GRADE PROPOSED ROCK REYETMTM TO CONSIST OF //\//\ AND AN BOULDERS CONSISTING OF LOWER COURSE �\/\ 4-5 TON AND UPPER COURSES 2-3 TON SIZES ��\//\\/ CONSISTENTPLACED (WITH NYSDECLANDNSOUTH OLD TOWN SPECIFICATIONS AND REQUIREMENTS. HEIGHT OF ROCK TO VARY BETWEEN 4' & 6' ABOVE \ \\ \\ \ GRADE AT EXISTING BEACH. NOT TO EXCEED 6' LIMITS OF EXCAVATION IS LIMITED TO AREAREQ ANYIRED TO EXCESSLLT FILALL AND STACK ROCK. L WILL BE UTILIZED BETWEEN RO�FTOTE A TIGHT COMPACTED ENT SYSTEM. PROPOSED SILT FABRIC UNDER ALL / /\\%\\// / \\%\\//\// / APPROXIMATE M.H.W. TL 2.5t REVETMENT SYSTEM. \/\\/\\/\\/\\/ /\\/\\/\\/\\/\\/\\ \ APPROXIMATE M.LW EL 0.0t DISTANCE TO M.H.W VARIES FROM 10'TO 20' TO BASE OF ROCK TYPICAL SECTION A-A N.T.S. ROCK REVETMENT PERMIT PLANS 1��------ --= SCALE: i� ti IN.T.S. SEP 1 0 2018 TYPICAL SECTION �C DATE: _ I LOCATION MAP 8-7-18 Southold Tmvn j Board of Trustees 1400 PECONIC BAY BOULEVARD LAUREL, TOWN OF SOUTHOLD SUFFOLK COUNTY, NY SHEET: TAX MAP N0. 1000-145-02-17.4 2 of 2 Michael J. Domino, President �o�.. " �G� Town Hall Annex John M. Bredemeyer, III, Vice-President y ;r 54375 Route 25 Glenn Goldsmith o P.O. Box 1179 A Nicholas Krupski y�0 ao�S Southold, NY 11971 Greg Williams -� Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: THOMAS V. PERILLO, JR. & CHRISTOPHER PERILLO Please be advised that your application dated September 10, 2018 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) '/z 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) X 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, President1p��'" Board of Trustees Michael J. Domino, Pres ; Opp C'OG Ton Hall Annex John M. Bredemeyer III,Vice-rresident yam,, t" 54375 Route 25 Glenn Goldsmith N a P.O.Box 1179 A.Nicholas Krupski 0 Southold,NY 11971 Greg Williams ?' p! Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 11,olll L: `lU Completed in field by: 5 m) Jeffrey Patanjo on behalf of THOMAS V. PERILLO, JR. & CHRISTOPHER PERILLO requests a Wetland Permit to remove the existing block wall and install 100 linear feet of rock revetment consisting of 4-5 ton lower course stone and 2-3 ton upper course stone placed in an interlocking manner, landward of the Mean High Water line; and to install and perpetually maintain a 10' wide non-turf buffer along the landward edge of the rock revetment. Located: 1400 Great Peconic Bay Boulevard, Laurel. SCTM# 1000-145-2-17.4 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� 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: Y / N Ch. 275 ✓ Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: - Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Surveys 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: S��'C-.►moi►l� �U�ir.�L:�� ���lEr�tyl'r'?S-l� P�f? ��.L'l Te 'T1�. 1fl-l� 11�i�����.�j" �c e-c%5 ani ti./eS . L)O,mt I-have read & acknowledged the foregoing Trustees comments: Agent/Owner:, Present were: J. Bredemeyer M. Domino N/G. Goldsmith N. Krupski G. Williams Other { C � m CT\ ) VA R D 5.65°231 w, B91 �' 1, 91 1 00 130.00' °q2 50 0 tz�g 5.51 P OL E \ Ey Utt. 103. Y gA �� 0 Y Za �EoeE n 0 IA 6k O N E 04 52 O Cp I� CUpy9tP �j H�E�o PE P40_�y 4f z° 15x8 ®- U m ` C E Z � 1�•'`� d ti 2 i o ON ' N o N QZ' o ti o t � �22 2 •/ FR NOJ'r��^�•j C N 1 BYOR [ ' O N C Q ?P N � v � N Q Cz I � O O � p.457 o , O ' N 1 4i O Qui ti, Cb o � , cb l t..d 5 6 0.��0„w £L t& r f150 r „E 9850 BL`t60 �N 65057'10 - TEST HOLE= „ n Oo K T TOP SOIL 26348 s.f GRAVEL 1 Y to-o wA-rER £l-y 15� 1.0 N £La Ia0 � tV U1 x O 1 � , i L¢ V I � EL•°t� I N NOTE a = MONUMENT v Y I ' I1 MINOR SUBDIVISION PREPARED FOR: THOMAS V. PER/LLO 8 EDITH Al. PER/LLO 0_6 SEPT. 20, 1979 EL`II'x AT LAUREL DATE SEPT 5, /979 1IIs „W 9998 { TOWN OF SOUTHOLD SCALE / = 50� `56505710 SUFFOLK COUNTY, NEW YORK NO 79 -488 playground *UNAUTHORIZED ALTERATION OR ADDITION TO THIS GUARANTEED TO pork Y9 „ SURVEY IS A VICILATION OF SECTION 7209 OF THE AMER/CAN TITLE INSURANCE CD �$ $///.,OWn On mop of Lourelwood NEW YORK STATE EDUCATION LAW *COPIES OF THIS SURVEY NOT BEARING THE LAND C. File No. 5595 SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALLS• NOT BE CONSIDERED TO BE A VALID TRUE COPY Kti'Of NEW h0 ES1r7teS I, *GUARANTEES INDICATED HEREON SHALL RUN ONLY TO yqP EN W. yo Rf_ THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERN- �— MENTAL AGENCYAND LENDING INSTITUTION LISTED �r--- HEREON,AND TO THE ASSIGNEES OF THE LENDING z }_iL• Q �� n ia,1r :1V.••,: w INSTITUTION GUARANTEES ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. ^ Z co C DISTANCES SHOWN HEREON FROM PROPERTY LINES T / -ECO TO EXISTING STRUCTURES ARE FOR A SPECIFIC NIC LJA/ �=��'~ PURPOSE AND ARE NOT TO BE USED TO ESTABLISH °r �Pj �P� D L I(� PROPERTY LINES OR FOR THE ERECTION OF FENCES FJ3 1 NG a YOUNG � RI OS NR AVENUE �►� `- YOURIVERHEAD,NEW YORK SEP 10 2018 - j ALDEN W.YOUNG,PROFESSIONAL ENGINEER L AND LAND SURVEYOR NY.S LICENSE NO 12845 HOWARD W.YOUNG,LAND SURVEYOR NY.S.LICENSE NO 45893 -' A# J. s w y� s '�.•t r� ' t t r "� ie I �r.�-r' c.. h v v T -M � I d I a' 18 , 15 ' 32 , - - mas V.Perillo,Jr.&Christopher Perillo 1400 Great Peconic Bay Boulevard,Laurel SCTM#: 1000-145-2-17.4 *-,yr _ 12/5/18 we viOR - . � Rl.\k,�\ } 0,��fir y�,�'a•G ,;+ - - - 'moo._ r� v • - ! yy M / L 1 r , 'WA Ns O�*0 SUUr,ol Town Hall Annex Michael J.Domino,President 54375 Route 25 John M.Bredemeyer III,Vice-President ~ P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski Iti � Telephone(631) 765-1892 Greg Williams l�`,oU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD November 15, 2018 Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 RE: ENVIRONMENTAL DECLARATION OF SIGNIFICANCE PURSUANT TO NEW YORK STATE ENVIRONMENTAL QUALITY REVIEW ACT NYCCR PART 617 THOMAS V. PERILLO, JR. & CHRISTOPHER PERILLO 1400 GREAT PECONIC BAY BOULEVARD, LAUREL SCTM# 1000-145-2-17.4 Dear Mr. Patanjo: The Southold Town Board of Trustees adopted the following Resolution at a meeting held on Wednesday, November 14, 2018: DESCRIPTION OF ACTION: Jeffrey Patanjo on behalf of THOMAS V. PERILLO, JR. & CHRISTOPHER PERILLO requests a Wetland Permit to remove the existing block wall and install 100 linear feet of rock revetment consisting of 4-5 ton lower course stone and 2-3 ton upper course stone placed in an interlocking manner, landward of the Mean High Water line; and to install and perpetually maintain a 10' wide non-turf buffer along the landward edge of the rock revetment. Located: 1400 Great Peconic Bay Boulevard, Laurel. SCTM# 1000-145-2-17.4 S.E.Q.R.A. NEGATIVE DECLARATION OF ENVIRONMENTAL SIGNIFICANCE: WHEREAS, on November 9, 2018 the Southold Town Board of Trustees found the application of THOMAS V. PERILLO, JR. & CHRISTOPHER PERILLO to be an Unlisted Action Negative Decision pursuant to SEQRA Rules and Regulations. A Short Environmental Assessment Form and a field inspection have been completed by the Board of Trustees; and it is hereby determined that it will not have a significant effect on the environment, and; WHEREAS, the Southold Trustees are familiar with this project having visited the site on November 7, 2018 and having considered Jeffrey Patanjo plans for this project last dated August 7, 2018 showing the proposed revetment and bluff,stabilization, and a Alden W. Young, Land Surveyor survey last dated September 20, 1979, and; WHEREAS, in reviewing the project plans last dated August 7, 2018, it has been determined by the Southold Town Board of Trustees that all potentially significant environmental,concerns have been addressed as noted herein: • No existing rocks or boulders are to be utilized, moved, or relocated on the beach. • Access to the site for construction will be by land only. • Vegetative, non-structural measures are not capable of stabilizing the erosion of the bluff alone. • Protection of the toe of bluff using hardened structures including rock revetments is necessary. • As time progresses, continued-soil loss may lead to a complete loss of shoreline stability. • A site inspection by the Southold Town Board of Trustees recognized severe erosion on this property and requested an erosion control plan. THEREFORE, on account of the foregoing, the Southold Town Board of Trustees Approve and Authorize the preparation of a Notice of Negative Declaration pursuant to SEQRA for the aforementioned project. If you have any questions regarding the above, please contact this office. Very truly yours, Michael J. Do ino, President Board of Trustees rn, o��suFFoc�r Michael J.Domiosident Town Hall Annex John M.Bredemeyer IIf, vice-President �� y� 54375 Route 25 Glenn Goldsmith o = P.O.Box 1179 rn a A.Nicholas Krupski Southold,NY 11971 Greg Williams p! Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES / TOWN OF SOUTHOLD Date/Time: L'•3 45 Completed in field by: Jeffrey Patanjo on behalf of THOMAS V. PERILLO, JR. & CHRISTOPHER PERILLO requests a Wetland Permit to remove the existing block wall and install 100 linear feet of rock revetment consisting of 4-5 ton lower course stone and 2-3 ton upper course stone placed in an interlocking manner, landward of the Mean High Water line; and to install and perpetually maintain a 10' wide non-turf buffer along the landward edge of the rock revetment. Located: 1400 Great Peconic Bay Boulevard, Laurel. SCTM# 1000-145-2-17.4 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� 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: Y / N Ch. 275 V✓ Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey :5 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: ��co,:gh� �o=�✓ac� � i ` `` pp co�1�;nUa��®f1 0� �'c°�eG� a1cBo.cA�/ O.eC��o./to_o4 otl 5, SkA I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino v✓ G. Goldsmith N. Krupski G. Williams Other K 1400 Peconic Bay Blvd. Laurel, NY- Existing Conditions June 2018 a "4 .`�. .•� ,`� � ;;,, r • .. ��� - ..�' '! .,. < � 1• � ` � a / n P` a TA /// •.ti P yy� V / P 1 / / T G <o G�• �o 'P4� ai yo 1� CD O � ...•� ---- � —�— �� —— a nonce COUNTY OF SUFFOLK © E °`� �4$ RealProperty Tax Service Agency v d.�,... a �..ra...,. 77 tt ow K L ' r j LAW OFFICES CARMAN, CALLAHAN & INGHAM, LLP WILLIS B. CARMAN* CARMAN BUILDING 280 MAIN STREET MICHAEL F. INGHAM* HON.WILLIS CARMAN,SR. GREGORY W. CARMAN,JR. FARMINGDALE,NY 11735 (1901-1985) JAMES M. CARMAN** (516) 224-3514 WILLIS CARMAN,JR. (1931-2013) ROBERT M.CALLAHAN * Also admitted in FL DIRECT FAX: (516)224-3535 (1925-2017) **Also admitted in PA (- APR'2 1)4 20191 Apr;l 22,2019 �-_ Board of Trustees - Board of Town Trustees Southold Town Hall Annex 54375 Main Road,P.O.Box 1179 Southold,NY 11971 Re: 1400 Peconic Bay Blvd.,Laurel SCTM: 1000-145-2-17.4 Gentlemen: Enclosed you will find our firm's check payable to the Town in the amount of$50.00 as and for the payment of the Final Inspection Fee. Also enclosed is a copy of the Board's Notice for your reference. Ve truly yours, (� LIS B. CARMAN WBC/ddc Enclosures cc: Chris Perillo (w/enc.) Mr. Jeffrey Patanjo (w/enc.) (I is Email Upatanio@Mail.com) t. S OFFICE LOCATION: ��OF ryO MAILING ADDRESS: Town Hall Annex P.O.Box 1179 54375 State Route 25 Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) Southold,NY 11971 • Telephone: 631765-1938 olyC®U ,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, Assistant Town Planning Director LWRP Coordinator Date: November 9, 2018 Re: Local Waterfront Coastal Consistency Review for THOMAS V. PERILLO, JR. & CHRISTOPHER PERILLO SCTM# 1000-145-2-17.4 Jeffrey Patanjo on behalf of THOMAS V. PERILLO, JR. & CHRISTOPHER PERILLO requests a Wetland Permit to remove the existing block wall and install 100 linear feet of rock revetment consisting of 4-5 ton lower course stone and 2-3 ton upper course stone placed in an interlocking manner, landward of the Mean High Water line; and to install and perpetually maintain a 10' wide non-turf buffer along the landward edge of the rock revetment. Located: 1400 Great Peconic Bay Boulevard, Laurel. SCTM# 1000-145-2-17.4 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, it is my recommendation that the action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. It is recommended that existing vegetation landward of the existing structure is preserved. 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 Peter Young,Chairman 4 Town Hall,53095 Main Rd. Lauren Standish,Secret y ary � � 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., November 7, 2018 the following recommendation was made: THOMAS V. PERILLO JR & CHRISTOPHER PERILLO to remove existing block wall and install 100 If. rock revetment along with 10' wide non-turf buffer landward of the mean high water line. Located: 1400 Peconic Bay Blvd., Laurel. SCTM#145-2-17.4 The CAC did not make an inspection, however reviewed the plans and Supports the application with a 10' non-turf vegetated buffer. jY �o S�o��� Town Hall Annex Michael J.Domino,President ® , John M.Bredemeyer III,Vice-President 54375 Route 25P.O.Box 1179 Charles J.Sanders COO Southold,New York 11971 Glenn Goldsmith Telephone(631) 765-1892 A.Nicholas KrupskiDU�If'i,�, t {}' Fax(631) 765-6641 C ,�� ]BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application _j _ '_% it.' •� Wetland Permit Application Administrative Permit Amendment/T ransfer/Extens�n ® SEP 1 0 2018 Received Application: L`�®SCO Received Fee. $?�® �4 Southold Town Completed Application: l®,2 Roard Qf Trustees Incomplete: / SEQRA Classification: Type I_ Type 11 Unlisted Lead Agency Determination: Coordination:(date sent): �LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: Receipt of CAC Report: Technical Review: -�� — ,/ Public Hearing Held!a Resolution: Legal Name of Property Owner(s): oma 5y Pyr �� StZ C.I� ts�oP�erPer( 1 n Mailing Address: 97 61A Cok,,4rw (Z& Nle I y t I I e-, t 1 1_7" Phone Number: Suffolk County Tax Map Number: 1000- INS -a -/7•L Property Location: lam! oo P-ee."?ic- Q �I-9- - L4,K ( . See- /-P&4-f-/PA /Ncte - ✓a 'A 4 IQ i"A (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): '-J—e Fir 4+� �► o Mailing Address: 0 , R,x S-WP a- (�o 4e rn t Ay N`( It-7 / 4 Phone Number: �' 1' q q . .7 3 3.�_ 10� Board of Trustees AppL` tion GENERAL DATA Land Area(in square feet): al 3 q $ Area Zoning: Previous use of property: y a e Q-- T Intended use of property: 0,e- A-n Covenants and Restrictions on property? Yes ✓ 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? 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.? Yes ✓ No Does the structure(s)on property have a valid Certificate of Occupancy? Yes `.-� No Prior permits/approvals for site improvements: Agency Date N �R No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? NoT Yes If yes,provide explanation: Project Description(use attachments if necessary): ahep 4ASrAl/ Ivo zf- 2ocic- ad-12 wrtLt 10� w k A h o✓1 - -r'- p.(-- 4-A,- A,( H LJ -L f`w Board of Trustees App3 -- Ltion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: t rt 1/ o 0 c F iR.o e-K_ "%'e_+.1z c n t G.10.4 a 4� Area of wetlands on lot: ° square feet Percent coverage of lot: r'1'q % Closest distance between nearest existing structure and upland edge of wetlands: P ofl feet Closest distance between nearest proposed structure and upland edge of wetlands: a n a feet Does the project involve excavation or filling? '� No Yes If yes,how much material will be excavated? _ 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: 0 - 9 Manner in which material will be removed or deposited: 6- w'°AX- 6z X-6z P{r 4»/we_4 M y e,>.e.� vy�tea.` L k 1 cow.,,_A '9 F- --'LQ- AA. P.W. L-c.— 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): T Ae nC .)(t( AG A J +S I'rt.e 2 a4-e C-.'- o �t rlo(veecQ lrvvoA sAore- Ioste . Short Environmental Assessment Form Part 1 -Project Information 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 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 1-Project and Sponsor Information Name of Action or Project: 1400 Peconic Bay Blvd Rock Revetment Project Location(describe,and attach a location map): See location map-Vacant land south of 1400 Peconic Bay Blvd Brief Description of Proposed Action: Stabilize storm damaged bank with 100 LF of rock revetment landward of the MHW line Name of Applicant or Sponsor: Telephone: 516-224-3514 Thomas V,Perillo Jr &Christopher Perillo E-Mail: bill@carmanlawteam corn Address: 87 Old Country Road City/PO: State: Zip Code: Melville NY 11747 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 r Fv—/] ❑ 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: ❑ NYSDEC-Town of Southold Trustees 3.a.Total acreage of the site of the proposed action? 0 45 acres b.Total acreage to be physically disturbed? 0 01 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.45 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) [—]Industrial ❑Commercial m Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 3 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ r7l ❑ 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? ❑ W] 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:Name Brushs Creek,Name Peconic Bay and Environs,Reason Significant coastal fish&wildlife habitat, ❑ Reason Frotect public health,water,vegetation,&scenic beauty,Agency Southold, own o, 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES EL 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? ❑ ❑ 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: El r7l 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: 7 ❑ 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? 0 ❑ 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. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland ❑Urban m 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? Northem Long-eared Bat ❑ 16.Is the project site located in the 100 year flood plain? NO YES =71- 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, F-1a.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: ❑NO DYES Page 2 of 3 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: 7 ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: Z F] 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: W1 F I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF-MY KNOWLEDGE Applicant/sponsor e: Thomas V.Perillo Jr.&Christo her Perillo Date: $I I Signature: i PRINT FORM Page 3 of 3 otnerwise avauaoie to the reviewer. W nen answering Lnc LIUMLIUfIS u,c ICvlewer SnOuou On guwCu uy Uric WiwGpd nave my responses been reasonable considering the scale and context of the pro posed_action?" No,or Moderate small to large impact impact may may occur occur 1, 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 land9 El 3. Will the proposed action impair the character or quality of the existing community? L--J/ L 4. Will the proposed action have an impact on the environmental characteristics that caused the n establishment of a Critical Environmental Area(CEA)? El 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? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ 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? 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? ff El 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 Pant 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,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 impacts. Town of Southold-Board of Trustees Name ofLead Agency J L 5 tl[ate Michael J. ® �n President Print or Type Nan e of Responsible 3 icer in Lead Agency Title of Responsible Off+cet Signature of Respo tble Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) ---- PRINT Page 4 of 4 EAF Mapper Summary Report Tuesday, July 24, 2018 5:33 PM Disclaimer: The EAF Mapper is a screening tool intended to assist _-. . ;800 0` _ , . - _--_-_ - Project sponsors and reviewing agencies in preparing an env iro nm ental 12900=;100Qt5g_ '12900-i0`0"7Qassessment form(EAF).Not all questions asked m the EAF are 3 ®202 ; omanswered b the EAF Mapper Additional information on an EAF521;4 ® R°lp,�1-46= 12906= 0-100-600'0" { �� question can be obtained by consulting the EAF Workbooks Although -. ��r �$50E7'=3®0-30'0[ F r " " t i A, ,` the EAF Mapper provides the most up-to-date digital data available to 200-1, Q 5001 �: ,% F, .._ ,, ,gy p V` ��` 1'1&0-_400:,100 0 DEC,you may also need to contact local or other data sources in order 12,900'-1`0 ,5002 145 p_ppp_g7Q43 'q 45 00.36®_ °p to obtain data not provided by the Mapper Digital data is not a t `y ''" substitute for agency determinations •-1'1.5 00'-2056 i5 ' 14500200= 2060- � ;14506-300-5000- _ '094'aa Hari tregl i, ,/✓ ` r. - - .• l 1 C,"r-s N:.V-ai o '..- E:,;�aa(Arm.� ,,r'; Iv1:il1} G ' . w11'4500-'200-,. 004 f, ` (ut�l�Q.t] '145pti=2t76c t\7� , ,11.550®=200 1 1,000 •1'['4 ®�=2t t9=[ Tiarcra,ta M ('� .`` 1, , 'l ,?`'' ,� ( `, 4' r 'y mrd f�A•s.=fir+-^ questions in Part 2 using the information contained in Part I and other materials submitted by the project sponsor or otherwise available to, -,viewer, When answering the questions the revi( should be guided by the concept"Have my responses been reason :onsidering the scale and context of the proposed, )n?" No,or Moderate small to large impact impact may may occur occur 1, 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? El El 3. Will the proposed action impair the character or quality of the existing community? El LJ W4, Will the proposed action have an impact on the environmental characteristics that caused the ❑ f—I establishment of a Critical Environmental Area(CEA)? — J 5. Will the proposed action result in an adverse change in the existing level of traffic or (`�j ❑ affect existing infrastructure for mass transit,biking or walkway? u 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate �❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: El 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,groundwater,air quality,flora and fauna)? Page 3 of 4 f 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? F1 El 11. Will the proposed action create a hazard to environmental resources or human health? ❑ El Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part Z 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,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 suppoitmg documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees 1 Name of Lead Agency Date President Print or Type Name of Responsible Officer to Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 4 Board of Trustees I,' ,Iication AFFIDAVIT BEING DUILY SWORN DEPOSES AND AFFIRMS THAT ISE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF ITIS/HER KNOWLEDGE AND BELIED',AND THAT ALL WORD WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLID TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLID AND THE - BOARID 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 AIDVISOR'Y 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 ISSUEID BY THE BOARD OF TRUSTEES IDURING THE TERM OF THE PERMIT. r Signature of Property Owner Signat4 ;of Property Owner $WORN TO BEFORE ME THIS I � DAY OF , 20� .. IMAiifP�tle�dNew� Notary Public Board of Trustees 3' ,4cagion AUTHORIZATION (Where the applicant is not the owner) t I/We, ��o/Ncvs J, �eftilIe> �((� "k CMClsego cx— &tre 1/ 0 5 owners of the property identified as SCTM# 1000- 114 S- - 'ia 1'7• `� in the town of L a r c New York, hereby authorizes Pe, a 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 kkxaj 20 ` MAMEN mum Notary Public ' MMMOSM of Now York ASPIUACA i kg/tilGE Y!A'�1�+P cru u+.�yE A A 1!8 i�1L' TRANSACTIONAL]DISCLOSURE FORM Tile Townof Southold's Code of Cthics prohibits conflicts of interest on the part of town officers and employees.'17tc purpose oC this n f is to provide information which can alert the t4 and allow it to take whatever act ion is necessaa to avoid same. YOUR NAME: vet t I I o •T� 'eyi,�c S V • �2 (Last name,first name,4tiddle 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 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 or the Town of Southold? '`Relationship"includes by blood,marriage,or business interest."Business interest"means a business, inchiding a partnership,in which the town officer or employce bns 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 S1/4 oftbe shares of the corporate stock of the applicttnt (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 this /'7 day of CL- Submitted ..ZOX Signature __ �YG �" Print Name �;.,as Form TS 1 t � APPLICANWAGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Sot ithold's Code of Ethics Prohibits con 11iclso f interest on the. );I of town on icers--and 11i uuose of this form is to provide inrorination which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid,nnle. l/ YOURNAME: ���' < < d C� t r S-�� cA— (Last name,first 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 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 for through your company,spouse,sibling,parent,or child)have a relationship with any officer or cnnployee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."13usincss interest"means a business, including apurtnership,in which the town officer or employee has even a pautiat ownelShip of(or employment by)a coupmi alion in wilich file town oflicer of employee owns more dian 5%of the shares. YES NO lg,� 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 [lie 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 50.of the shares of the corporate:,look of the applicant (when the applicant is a corporation); B)the legal or benclicial owner of any interest in a non-corporate entity(when the applicant is nota corpon►(ion); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this l'1 day of_���2U,L2 Signature Print Name ('H R t, �e I ILA — Form TS 1 APP AICA-NT/A GENT/REPR ESRC+ISI'. TWE TRANSACTIONAL DISCLOSURE FORM � The Town of Southold's Code of Ethics,prohibits conflicts of interest on the Hart of town officers and endo yees._I7hepurLhosc or this form is to provide inforination which can alert the town of possible conflicts of interest and allow it to take whatever neti_on is i necessary to avoid same. YOUR NAME: �� �, �► �, ��-+ (Last name,first name,qfidle 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.) i Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) _ Do yon personally(or through your company,spouse,sibling,patent,or child)have it relationship with any officer or employee of the'rown ol'Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including apartnership,in which the town officer of employee has even a paitial ownership of(or employment by)a conhoration in whiclh the town oil icer or employee owns more than 5%ofthe 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 applictmt/agentlrepresentative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%orthe shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or bencricial owner of any interest in a nota-corporate entity(when the applicant is nota corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 9 d AZO 1 a Signature Print Name 0b Form TS 1 — Board of Txustees Application AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS T[IAT HE/SHE IS THE'APPLICANT FOR THE ABOVE (DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HE?!KNOWLEDGE.AND]BELIEF,AND THAT ALLWORK WILL BE DONE IN TH9.MANNER SET FORTH IN THIS APPLICATION. AND AS MAY BE APPROVED BY TAE SOUTHOLD TOWN BOARD OF TRUSTEES, THE APPLICANT AGREES TO HOLD THE TOWN OF SO.UTHOLgD AND TETE BOARD OF TRUSTEES,HARMLESS A_N D'FREE'FROM ANY AND ALL DAMAGES AND CLAIMS ARISING LNIDEl2"OR BY VIRTUE OF,SAIID PER.MITO,IF GRANTED. IN COMPLETING THIS A0PLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S)OR REPRESENTATIVF'S,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO 11-49PECT TIME PREMISES IN'CONJUNC`T'ION WITH THIS APPLI.CA'1CION, INCLUDING A MNAL,INSFECTION. (.FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY,PROPERTY AND AS REQUIRED TO INSURE COMPLLALNCEI NSUR E ®MPI.IANCE WIT U ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY°I HE]BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature Property 0wer Signature of Property Owner SWORN TO BEFORE ME-THIS 1'0 DAY OF t11er-`� a4- _ 20 l �,Elle ' = {Notary Pubk,state of Nevada ' IV "'J pU A1C ;'y—K": APaat^[men.No.10.3643.1 ( My Appt Expires Seo 10,2022 t Board of Trustees Applicat:a.on y �{ryr O (Where the applicant is not the owner) ' I T/We, owners of the property identified as SCTM#1000- 1 qS--2 -7, L#, in the town of New'York;,hereby authorizes to act as my agent and handle all t necessary work involved with the application process for permit(s)from the Southold Town Board of Triisteess for this property. Property Owner's Signature property Owner's Sig attire SWORN TO LVOOREME.THIS DAY OF� u C � ,20 � P t �s� t JLENDAY.ELIZALDE Notary Putq c,State of Nevada Not P1T C a J • Appointment Na, 10.3643.1 AV APPt,Expires Sep 10,2022 APPLICAN AIS.+GEN7E'MPRESENTA'Z'IV E TRANSACTIONAL DISCLOSURE FORM The TownofSoutiiold'sCode ofl;thicsMhibitsconflictsofJnicrestonttiepartoftownb'f57arsartdcmnlov6as.The vii mse,of• this form fsdo provide ihfornna_tion which•can Mort the town of possible conflicts of rota est anit allow it to take Vila revef action is necessary LQavoid sanie pCf 4„_.. Y013R NAME: ! (Last name,,first name,sp.iddle initial,ribless you ate applying in the name of someone else or other entity,such,as acompany.It so,indicate thk other person's or company's name.) NAME OF APPLICATION: (Chock all that apply.) Tax grlevarce i3uilding Variance, Trustee Change of'Zon6 Coastal•Erosion Approval ofplat Moorlag Exemption from,plat or offloial map Planning Other (Cf"Other'-`,narpe the activity.) Do you personally(or through your company,spouse,sitiIing;•parent,or child)have a roMonslup with any officer or employee of the Town of Sontbotd? "ReIntiprtsbip"includes by blood,tgarringe,or business ihtcresL`Businessiatcn st'r means a'busin�Ss hiclWding a partnership,in which(lie town officer or cm0loyce has Ivan a partial ownership of(or employment by)a corporation in which the town officer of employee owns more than 5%of the shares, YE$ NO t� If you answered"YES",complete the balance of this form and¢ate and sign where indicated, Name of person employed by the.Town of Southold Title or position of that person- Dcscribo the relationship ir'(ween yourself(the applicant/ageotlrcpresentetive)and the town ofticeror employee.Either check the appropriate line A)througli D)and/or descrlbc in the space provided. The:town officer or employee or his or her spbus-,sibling,parent,or child is(check alt:Hat apply): A)the owner ofgmater than S%of the shares of the corporate stock of the applfeant (whoa the applicant is a corporation); B)the legal or bencfcial owner of any interest in anon-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicaar or D)the actuat applicant, DESCRIPTION OF RELATIONSHIP Submitted•this ;T•0 •. �" +'"') �a�.L Signature �_ Print Name Form TS 1 February 14, 2019 0�, l»a_ � ' �-a -�:� fl V i Town of Southold Trustees Town Hall Annex Building s 1 FEB 2 1 201g - 54375 Rte. 25 P.O. Box 1179 Southold, New York 11971 Old '�`Y°� Boir or r,� jte RE: 1400 PECONIC BAY BLVD-LAUREL SCTM No. 1000-145-02-17.4 ADDITIONAL AUTHORIZATIONS Dear Trustees: Attached, please find original copies of property owner authorizations from Edith Perillo and Cynthia Moffit for the above referenced application. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours, 9 QQ Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 ., 41 \ Board of- Trustees Application AFFIDAVIT C'H'�-�-h► A `m��a� 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 BES l OF HIS/HER FOSOWLEDGE AND BELIEF,ATOM THAT _ ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION T-- 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. y So nature of Property Own Signature of Property Owner SWORN TO BEFORE ME THIS _DAY OF , 20 Notary Public w" Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, C M✓►+h�a. AAv Ffa-E , —r— owners of the property identified as SC 1 iv1# 1000- 17 ' u in the town of LA�tie,L .New York,hereby authorizes _ PA 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. Priberty Owner's Signature ,' Property Owner's Signature SWORN TO BEFORE ME THIS DAY ON , 2d -Notary Public " APPY.ICANT/AGENT/RFi-PRESENTATIVE TRANSACTIONAL DISCLOSURE,FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town 6fl5cem and employees.'1110 purpose of this form is to provide inforination which can alert the town ofpossiblc conflicts of interest and allow itio take whatever action is necessary-to avoid same. J� YOUR N AME: A. l o 7�tiA , (211 11 tP7 t (Last name,first name,jpiddle Enitial,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 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,ularriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial owncrslt_ip of(or employment by)a corporation in which the town officer or employee owns more than 5%of the nes. YES NO If you answered"YES",complete the balance of this form and¢ate 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/agenUrepresentative)and the town officer or employee.Either check the appropriate line A)through D)and/or descgbo 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 t ' �-�P y-of a a©t9 Signature ., _ Print Name Form TS I low CoedNwvmk UC'4m �2gt4— oZ Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, � t� PL Na owners of the property identified as SCTM# 1000- l q S' 2"1"7. 4 in the town of New York, hereby authorizes r)<f4� - - - Pot--`-i e�1:0 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 , 20_ I-9_,__ Notary Public Y1 PAft SM d NM yG* �/iolt0ad�l UL#M � Board of Trustees Application AFFIDAVIT 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 HNOWLEDGE ANIS BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION —_ - AND AS MAYBE APPROVER 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 ANIS 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. ie�'zs�—enc/ Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS Ll_DAY OF I' VkMAIIA-1 20 -- Notary Public tum ► tuba- "� f \ APPLTCANVAOEN T/REPRESENTATI E TRANSACTIONAT. DISCLOSURE FORM Tiro Town of Soutliold'c Codc of Ftltics prohibits cbnflicO bf intcrest on thand employees.The purpose of this form is:lo 'invidc ihforinalion which can alert the town of pgssibl6 conflicts of ihterost and allow itto take whdtever action is neccto'avoid same, l -• , YOUR NAME: per I I 1 I �i"t (Last name,Hist name,ipiddle initial,unless you are applying tri the name of someone else or other entity,such as a company.If so,indicate.thb other person's or company's name.) NAME OF APPLICATION: (Chock all that apply.) - Tax grievance Building - — - Variance Trustee 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,sililing;parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,aj=isge;or business intcrest"Business interest"moans a business, inclulding a partnership,in which the town officer or employee has even a partial ownctsttip oC(oremploymcnl by)n corporation in which the town officer or employee owns more than 5%oCthe shares. YES NO t� If you answered"YES",complete the balance of this form and date and sign where indicated. Name of perspn-employed by the Town of Southold Title br 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 orbeneFcial 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 Subted this day of 1 w. �d�� mit Signature Print Name JF-4�e'TH Form T5 1 February 27, 2019 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 P.O. Box 1179 Southold, New York 11971 RE: 1400 PECONIc BAY BLVD-LAUREL SCTM No. 1000-146-02-17.4 ADDITIONAL AUTHORIZATION Dear Trustees: Attached, please find original copies of property owner authorizations from Linda Perillo for the above referenced application. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours, Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 4' V , Board of Trustees Application. AUTHORIZATION (Where the applicant is not the owner) I/We, Lrrtr,Q6— P15r I'�jo owners of the property identified as SCTM#1000- J`q S-Z-1-7. L _in the town of New York,hereby authorizes 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 S-A-�,4 SWORN TO BEFORE ME THIS DAY OF v 20 1 EePublic- ENDA Y.ELIZALDE State of NevddaNOt y Pu C ntMent No. 10.3643.1t.Expires Sep 10,2022 API LICAN'�'/.A.CEitil' aRPRESENNATI'V'E TRANSACTIONAL DISCLOSURE FORME The'rownorSoutliold'sCode ofFthicsprohibitsconflictsofinterestonthe part oftowniilicarsand emplloym.'Me Dur --of This form is'to provide in forination which can alert the-town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same, ! ( A YOURNAME: pl-r I ()IP (Last name,Fist name,diddle initial,unless you are applying iii the name of f someone else or other entity,such as a company.If so,indicate;the other Person's or company's name.) NAME OF APPLICATION: (Chock all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat 6r official map Planning Other (IF"Other",name the activity.) Do you personally(or through your company,spouse,sibling•parent,or child)have a relationship witli any officer or employee of tlic Town of Southold? "Rclnt'ipnship"includes by blood,u;arriagc,or business intcresL"Business intenisfr means a businass, inducting a partnership,in which the town officeror employee has even u partial ownership of(oremployment by)a corporation in which the town officer or employee owns more than 5%of the shares, YES NO t� If you answered"YES",complete the balance of this form and¢ate and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Dcscribc the relationship between yourself(the applicant/agent/representative)and the town officeror employee.Either check the appropriate line A)through D)and/or describo in the space prosided, The town officer or employee or his or her spouse,sibling,paront,or child is(check all,that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applfc�tnt (when the applicant is a corporation); B)the legal orheneficiai 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 y'o 20e Signature— Print Name G e O Form TS 1 I L C• Board of Trustees Application AFFIDAVIT `/n A- Pe-rdl, BEING DULY SWORN DEPOSES AND AFFIRMS THAT ISE/SITE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE(BEST OF RIS/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 GRAN'T'ED. 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 EN'T'ER 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 .roperty Ow6 Signature of Property Owner , o-:r /VV c-Jc—_ wn.-/y o J!:2 �.L��-rc J SWORN TO// BEFORE ME THIS ���DAY OF �`�Y'UG i't� 20 I�I 1 ILENDA Y.ELIZAI,DE =-1 Notary public,Std:e of Nevada ary Pu 11C � rC?`i Appofntmen;No. 10-3643-1 !\\ Aly Appt.Expires Sep 10,2022 c��� P 0 November 9, 2018 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 P.O. Box 1179 Southold, New York 11971 RE: 1400 PECONIC BAY BLVD- LAUREL SCTM No. 1000-145-02-17.4 AFFIDAVITS Dear Trustees: Attached, please find original affidavits of posting and mailing for the above referenced project. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours, Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: r Address: SCTM#1000-145-3-5' SCTM#1000-145-3-9.1 Stumpf Living Trust SCTM#1000-145-3-10 410 S Oakwood Dr. Dicandia,Frank G Sanchez,Ronald J&Sanchez, Mary J • Spruce Park Laurel,NY 11948-0065 405 S Oakwood Drive 18 S P Laurel,NY 11948 Syosset,NY 11791 SCTM#1000-145-2-18 SCTM#1000-145-2-16 Laurel Ests POA McCarthy,Patricia F PO Box 505 1460 Peconic Bay Blvd. Laurel,NY 11948 Laurel,NY 11948 STATE OF NEW YORK COUNTY OF SUFFOLK Jeffrey Patanjo ,residing at P.O.Box 582,Bohemia,NY 11716 being duly sworn,deposes and says that on the IND day of �PE11.t�fL,20_18,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 at2o6 K ,that said Notices were mail each of said persons by CERTIFIED MAEURETURN RECEIPT. I SWaee Sworn to before me this Day of U�• ,2018 MARILYN S.HICKS I,. 0—S NOTARY PUBLIC,STATE OF NEW YORK j '4No Public Registration No.01 HI6365489 ; Qualified in Suffolk County Commission Expires October 10,2021 �s Postal p ■ CE) CERTIFIED fU Domestic Mail Only -a Certified Mall FeeIr ®n $ r1 Extra Services&Fees(checkbox,add fee as appropda O ElRetum Receipt(hardcopy) $ 1 C3 ❑Return Receipt(electronic) $- 7 �ostma 0 ❑Certified Mall Restricted Delivery $ I I u He''°1 C3 ❑Adult Signature Required $ 1 t []Adult Signature Restricted Delivery$ C3 Postage Total Postage ands — -- —-- — $ SCTM#1000-145-2-16 senrro - McCarthy, Patricia F N $ff'eei"w)vf-ffa; 1460 Peconic Bay Blvd. f fly sraie z'F ,3� Laurel, NY 11948 TM U • • � • CERTIFIEDstal Service Cal MAIL@ RECEIPTiCERTIFIED MAIV RECEIPT 117 Domestic Mail Only Domestic - Ln L m certified Mall Fe F• L U I m ce • " " U S IS ruffed Mail Fee Ir J Ir _ Extra Services&Fees check �� 'c� $ 7 7 mfbor4 add/ee es aPProPdete I Extra SBNiCes&Fees(checkbox,add fee as appropdate) � p `4 ❑Retum Races ❑Return Receipt(electron Copy) $ 1 � A ❑Return Receipt(hardcopy) $ 3 ) $ ( POstmerk C::i - I 1 O ❑Return Receipt(electronic) $ � PO f [3 ❑Adult Si Maui Restricted Delivery $ f 4 �4 Here 1-':1 p ❑Certified Mail Restricted Delivery $ r C3 ❑Adult Signature Required $ I f J t� C3 []Adult Signature Required $ ❑AdWt Signature Restricted Delivery1 / $ C ❑Adult Signature Restricted Delivery$ tt a O Postage /�—}�g• � O r=1 Total Postage and —--- E3 Total Postage and $ — $ SCTM#1000-145 3=5� ►ti sentroSCTM#1000-145-3-10 N. rq - Dicandia, Frank G a senrro Stumpf Living Trust O s; eeiandd i.No 5iieeien'2W-Flo:; 410 S Oakwood Dr. n 405 S Oakwood Drive i[y;stei`e,Zf�+d� lily SCefe;2T�+4e Laurel, NY 11948-0065 Laurel, NY 11948 I PostaPostal ceCERTIFIED o RECEIPT CERTIFIED MA,IL@ RECEIPT r=1 Domestic • j I. • .n For delivery information,visit, ur website at WWW.USPS.COM M Certified Mail Fee N, M Certified Mail Fee N Er $ i'� ~ "� Extra Services&Fees(checkbox,add fee as appropriate) Extra S0NIC09&Fees(check box,add fse as eppropdAte)' a� ❑ Return Receipt(hardcopy) $ d. �n= l O ❑Return Receipt(hardcoP» $ •,�`;�i +3 ,. ( j al'1k ❑Return Receipt(electronic) $f .r- ~�&ostrnark� ' ❑ Return Receipt(electronic) $ ,�Postm p Oi?' \ i ❑Certified Mall Restricted Delivery $ ��' ��' Here, ❑Certified Mail Restricted Delivery $ �g11•era ( O - Adult Signabse Required $ $[]Adult Signature Required []Adult Signature Restricted Delivery$ []Adult Signature Restricted Delivery$ N r 4\1 ` 0 Postage t �1 Postage O Em $ C3 $ Total Postage and Total Postager SCTM#1000-145-2-18 '� $ SCTM#100 45 3 9:1 $ Laurel Ests POA [� senrro `"'�-3- r_-q Sent To PO Box 505 1 ,a Sanchez, Ronald J&Sanchez, Mary J a " eiendApr R Siiee�andApt.ii(o.; 18 Spruce Park Laurel, NY 11948 r -,14e4r Syosset, NY 11791 art);Smte;zlP+ Michael J.Domino,President o�'1 SoffOtk.0oG Town Hall Annex John M.Bredemeyer 11I,Vice-President ya 54375 Route 25 Glenn Goldsmith y x P.O.Box 1179 A.Nicholas Krupski 0 • Southold,NY 11971 Greg Williams A p! Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of THOMAS V.PERILLO,JR. & CHRISTOPHER PERILLO COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING THIS FORM IS TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR AT LEAST SEVENDAYS PRIOR TO THE PUBLIC HEARING DATE I, Jeffrey Patanjo ,residing at/dba P.O. Box 582,Bohemia,NY 11716 being duly srr �N wttorn, depose and say: T1at on theme day.of Iy�d' , '2018 , I personally posted the property known as 1400 Great Peconic Bay Boulevard,Laurel. SCTM# 1000-145-2-17.4 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 Wednesday,November 14,2018. Dated: 1114 t (sin e) Sworn to before me this 10 day o au 2018 MARILYN S. HICKS NOTARY PUBLIC,STATE OF NEW YORK ANotaryC Registration No.01H16365489 Qual'fied in Suffolk County Commission Expires October 10,2021 ,NUTILt: Uim HL: AKING NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: THOMAS V. PERILLO & CHRISTOPHER PERILLO SUBJECT OF PUBLIC HEARING : For a Wetland Permit to remove the existing block wall and install 100 linear feet of rock revetment consisting of 4-5 ton lower course stone and 2-3 ton upper course stone placed in an interlocking manner, landward of the Mean High Water line; and to install and perpetually maintain a 10' wide non-turf buffer along the landward edge of the rock revetment. Located: 1400 Great Peconic Bay Boulevard, Laurel. SCTM## 1000-145-2-17.4 TIME & DATE OF PUBLIC HEARING : Wednesday, November 14, 2018 — 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 explainer➢ 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# `1 - 2- - 17 PROJECT NAME 1 oo pee-4 te—f3 !!1 9l v The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ 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: ,2o,ma.ye -eki s-ho$, (3(oc.y- we-d r+Nt9 /*aC- re va-r-,n-uhf �o✓�% wt-l-lt �o` w r,Qp I't -tu r �,•FrG/� G an cQ s✓«�eQ P r Location of action: 14 o o Pi�C'W' t t g (U CV a e,2 n-(- Site acreage: y• (0 0 Present land use: A✓ w e,rw h 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: s V• .per r, t S X16 f 4eA- P-e r, 1 p (b) Mailing address: 8 7 ,1 it 66Y..'A 4--rL1 (� /L"[vr (1 c t I -1K7 (c) Telephone number: Area Code( } S/( ` 9 a`{ 3 S I H (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency?, Yes �NoEl If yes, which state or federal agency? N`1 s OC—c- 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 LWRP Section III—Policies; Page 2 for evaluation criteria. DYes ❑ No ❑ Not Applicable - Plo�-� rS Lo�SrL{"a.tf w rk rltty ��i•:�rwy (�/lP�tr,� y-j.�tt Attach additional sheets if necessary , Policy 2. Protect and preserve historic and archaeological resources of the, Town of Southold. See LVW Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes 1:1 No D loTot Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Towns of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑" I Yes ❑ Ivo ❑ Not Applicable Qrsjwe4- s-"4'.1te-ea urea- fr-tee -gA Attach additional sheets if necessary NATURAL COAST POLItCIIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See I,WRP Section III—Policies Pages 8 through 16 for evaluation criteria 1 Yes ❑ Ivo ❑ Ivot Applicable TO GG� e(Oyppleees rL- S t . � lo� 164-ld— .tK&- Pnrtre4ya.4 rJ.✓� Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LMIRP Section III — Policies Pages 16 through 21 for evaluation criteria 19 Y s ❑ No ❑Not Applicable r®,i{G'- w(l( PiV4-'0a }' A4ea'n,5-E- �raS��� a� ��to��h -te axd SC';;�Ml Pi 4&—Fz.,J _s A- eJ-t' e't.l 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. ❑ ❑ IJ Yes No r.ut Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LW'RP Section III -- Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ leo[g--Not Applicable Attach additional sheets if necessary Policy S. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. �� ❑ Yes ❑ No Not Applicable PUBLIsC COAST POLItCIES 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. nn Er YeD No❑ Not Applicable 1 r®ICL4- ar'Ggf1aeeyLx-A-t oF' a+atL �irL A- atcr-rti otjmn AGZ -Cti Pv�o(ce Attach additional sheets if necessary W,GRIUNG COAST P __ICIES Policy 10. Protect Southold's water-dependent uses'and promote siting of new water-dependent uses in suitable locations. See LWRP Section III.—Policies; Pages 47 through 56 for evaluation criteria. ❑Yes ❑ Ido of Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and 'Town waters. See LWRP Section.III—Policies; Pages 57 through 62 for evaluation criteria. F]Yes F-1No 3--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 evaluation criteria. ❑ Yes ❑ No R/Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and minerai resources. See LVV P Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No D-lCot Applicable REPAIRED BY J TITLE A e,� DATE 9 September 5, 2018 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 ® E C EE P.O. Box 1179 Southold, New York 11971 - SEP 1 0 2018 RE: 1400 PECONIC BAY BLVD- LAUREL SCTM No. 1000-145-02-17.4 Southold Town APPLICATION FOR PERMIT r Tru e Dear Trustees: We hereby submit one (1) original and three (3) copies of the proposed plans, application and check for permit approval for the above referenced project. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours, r J ffrey Patanjo P.O. Box 582 Bohemia, NY 11716