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HomeMy WebLinkAboutTR-9490 Glenn Goldsmith, President �QF S�(/Ty Town Hall Annex A. Nicholas Krupski,Vice President ,`O� Old 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III l Southold,New York 11971 Michael J.Domino G Q Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE 1819C Date: May 26, 2021 TRIS CERTIFIES that the existing 3,292sq.ft.two-story dwelling with screened porch;remove and replace existink windows and doors; remove existing 2440sq.ft. entry deck; construct new dormer additions on south roof-remove existing dormer and replace with 596sq.ft. dormer, on north roof-new 200sq.ft.dormer addition;new 68sq.ft.entry porch; remove existing 850sq.ft. rg avel parking area and. curbing;remove seven existingtrees,ees,plant-+18 new evergreen trees;remove existing stepping_stones. from porch to stair at bank, construct a 226sq.ft. terrace with stairs at east side of house; construct a 350sq.ft. poolhouse with 32sq.ft. covered entry and 10'x16' attached trellis; new 250sq.ft. stone walkway to entry; new 20'x40' gunite swimming pool, construct a 1220sq.ft. stone pool terrace;new 4' high pool enclosure fencin .andag tes(280 linear feet);new 4' high-gate at existing stair at bank, and for the two(2) }existing A/C condensing.units; At 4000 Great Peconic Bay Blvd.,Laurel Suffolk County Tax Map#1000-128-6-2 Conforms to the application for a Trustees Permit heretofore filed in this office Dated April 16, 2019 pursuant to which Trustees Wetland Permit#9490 Dated June 19,2019,was issued and Amended on July 15, 2020 and conforms to all of therequirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the existing 3,292sq.ft.two-story dwelling with screened porch;remove and replace existing windows and doors;remove existing240sq.ft. entry deck; construct new dormer additions,on south roof-remove existing dormer and replace with 596sq.ft.dormer, on north roof-new 200sq.ft. dormer addition,new 68sq.ft. engy porch; remove existing 850sq.ft. rgrayel parking area and curbing;remove seven existing trees;plant f 18 new,evergreen trees;remove existing stepping stones from porch to stair at bank; construct a 226sq.ft.terrace with stairs at east side of house; construct a 350sq.ft. poolhouse with 32sq.ft. covered entry and 10'x16' attached trellis;new 250sq.ft. stone walkway to entry; new 20'x40' gunite swimming pool; construct a 1220sq.ft. stone pool terrace, new 4' high pool enclosure fencing and gates 280 linear feet); new 4' high gate at existing stair at bank; and for the two(2)existing A/C condensing units. The certificate is issued to 4 00 GPBB LLC owner of the aforesaid property. 4 Authorized Signature \WJ A, Glenn Goldsmith, President so(/- Town Hall Annex A.Nicholas Krupski,Vice President ,`O �l0 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III Southold, New York 11971 Michael J.Domino c� G Q Telephone(631) 765-1892 Greg Williams �� �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 5�2d/2f J INSPECTED BY: C. ©1 dam s�� Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale"line/silt, boom/silt curtain 1 St day of construction % constructed Project complete, compliance inspection COMMENTS: CERTIFICATE OF COMPLIANCE: Glenn Goldsmith,President QF so(/ry Town Hall Annex Michael J.Domino,Vice-President ,`O� ��� 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 GregWilliams �� Fax(631)765-6641 C4UNTY,� BOARD OF TOWN TRUSTEES July 16, 2020 TOWN OF SOUTHOLD Samuels & Steelman Architects 25235 Main Road Cutchogue, NY 11935 Attn: Nancy Steelman RE: - 4000 GPB,B, LLC 4000 GREAT PECONIC BAY BLVD., LAUREL SCTM#: 1000-128-6-2 Dear Ms. Steelman: The following action was taken by-the;Southold Town Board of Trustees at their Regular Meeting held on Wednesday, July-15, 2020:. RESOLVED that the Southold Town Board of Trustees APPROVE the Administrative Amendment to Wetland Permit#9490 to construct a 1220sq.ft. stone pool terrace in lieu of the originally permitted 131-5sq.ft. terrace; construct a 350sq.ft. poolhouse with 32sq.ft. covered entry and 10'x16' attached trellis; construct a 226sq. ft. terrace with stairs at east side of house, in lieu of the originally proposed 658sq.ft. terrace and stepping stones on grade adjacent to dwelling; and as depicted on the site, plan prepared by Samuels & Steelman Architects last dated January 22, 2020, and stamped approved on July 15, 2020. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, AL 1 Glenn Goldsmith President, Board of Trustees GG/dd GENERAL STORMWATER POLLUTION PREVENTION NOTES DRAINAGE CALCULATIONS REVISED: PERMANENT STORM WATER RUNOFF CONTROL MEASURE GARAGE SLAB EL 24.8 FT CONTRACT 11/4/19 SITE DESCRIPTION & GENERAL SEQUENCE OF SITE ACTIVITIES FOR THE ENTIRE SITEILI GRADE LINE ELEVATION 23.9 FT. WIRE FENCE A/ AREA OF RESIDENCE (DW-A) � GLEAN OUT SCTM # 1000-128-06-02 Development activities for this project will consist of: FILTER CLOTH DRY WELL AREA x RAINFALL x RUNOFF FACTOR TRUSTEES 1. Installation of temporary erosion control measures (silt fence barriers), see detail 1 &2 (DW-A) 1,0015 SF x (2/12 FTa x I.O = 183 GU. FT. § GRADE LINE ELEVATION ±23.9 FT. GRADE LINE ELEVATION ±23.9 FT. PROPERTY: 4000 PECONIC BAY BLVD AMENDMENT 2. Clearing of brush, trees and Iandscaping in areas shown on Site Plan SURFACE U5E: (1) 8' DIAMETER x &' HIGH POOL ADDRESS LAUREL NY 11948 FILTER CLOTH MIN. 6 � I' MIN. 2' MAX. ' 1/22/2020 3. Demolition of existing structures and associated building components DRAINAGE (1) 6' X 6' STORM DRAIN RING = 253.4 GU. FT. OWNER: PUNIT & SARAH MEHTA BELOW GRADE PROVIDED REQUIRED 4. Excavation for the new foundations and swimming pool (+/-3 ft below finished grade) 14'/FT. 1000 al " 253.4 GU. FT. > 183 GU. FT. g 1/8 A TOP OF POOL 22.0 FT. SITE: 47,436 SQ. FT. - 1.089 ACRES 5. Construction of the new foundations, swimming pool and building structure \ SEPTIC 6. Construction of underground electric and utility lines from the utility pole to the buildings '�\�j\ �\�j�\/�\/� AREA OF RESIDENCE (DW-13) IE. +22.5ci' TANK LEACHING ZONING: R-40 7. Construction of a new underground water line from the existing residence to the garage �/ DRY WELL AREA x RAINFALL x RUNOFF FACTOR IF. +22.27' I7.-� 7' POOL FLOOD ZONE: X 8. Installation of the septic system (DW-B) 1,213 5F x (2/12 FT.) x 1.0 .= 216 GU. FT. BOT OF POOL 18.0 FT. TEMPORARY STORM WATER USE: (I) 8' DIAMETER x 6' HIGH POOL LOT COVERAGE: : 9. Installation of on site drainage structures (permanent storm water runoff control measures), see detail 1 IE. +21'67' EXISTING: 6.53% RUNOFF CONTROL MEASURE (1) 8' x 6' STORM DRAIN RING = 253.4 GU. FT. GROUND WATEF: 10. Installation of underground piping from gutters and downspouts to the drainage structures PROPOSED' 8.5% EROSION & SEDIMENT CONTROL DETAIL PROVIDED REQUIRED • 11. Filling and grading of soil above drainage structures 253.4 GU. FT. > 216 GU. FT. 3' MIN 12. Construction of new terraces 2 ) SEPTIC PROFILE SURVEYOR: PO BOX gOg SURVEYORS, PC ( 13. Construction of new driveway and parking areas including grading and driveway surfacing NO SCALE AREA OF POOL HOUSE DW-C 14. Installation of new landscaping plants, lawns as required DRY WELL AREA x RAINFALL x RUNOFF FACTOR SOUTHOLD, NY 11971 15. Removal of the temporary erosion control measures (DN-C) 310 5F x (2/12 FT.) x 1.0 = 65 CU. FT. (N.T.S.) LICENSE # 49618 USE: (1) 6' DIAMETER x 6' HIGH POOL DATED: FEBRUARY 6 2019 � (1) V X 6' STORM DRAIN RING = 134 CU. FT. ' SITE DATA PROVIDED REQUIRED ELEVATIONS ARE REFERENCED O Site Area: 47,436 SF= 1.089 AC 134 CU. FT. > 65 CU. FT. TOP OF EXISTING GRADE TO N.A.V.D. 1989 DATUM Receiving Waters: PECONIC BAY O �- AREA OF GARAGE (DW-D) CAST IRON FRAME AND COYER TO Contractor: N/A DRY WELL AREA x RAINFALL x RUNOFF FACTOR GRADE (AS REQUIRED) A% 11111111IIN" Oak 11111= (DW-D) 5-10 5F x (2/12 FT) x 1.0 = 15 GU. FT. AV M LOCAlk I ION MAV � UJW POLLUTION CONTROL MEASURES USE: (1) 8' DIAMETER x 4' HIGH POOL TRAFFIC SLAB (SEE - Z In accordance with the provisions of the Town of Southold, chapter 236, storm water management and erosion and sediment control measures including, but not limited (1) 8' X 4' STORM DRAIN RING = 168.01 CU. FT. PLANS FOR LOCATIONS) 10NORT to, the following shall be employed during construction: PROVIDED REQUIRED 168.9 CU. FT. > 45 CU. FT. A. Existing vegetation to remain shall be protected (by installation of construction fence or other approved means)and shall remain undisturbed. AREA OF DRIVEWAY (DW-El �y yetiti� B. Clearing and Grading shall be scheduled so as to minimize the extent of exposed areas and the length of time that areas are exposed.A maximum of 1 acre shall be DRY WELL AREA x RAINFALL x RUNOFF FACTOR F LAUREL LINKS COUNTRY CLUB disturbed at one time unless written permission is granted by the NYSDEC. Graded and stripped areas shall be kept stabilized through the use of temporary seeding (DIN-E) 1,0186 5F x (2/12 FT) x 0.7 = 232 GU. FT. _ - J ♦^ W as required. Seed mixtures shall be in accordance with the soil conversation service recommendations. USE: (1) 8' DIAMETER x 6 HIGH POOL C. Bare soils shall be seeded within 14 days of exposure, unless construction will begin within 21 days as sections are completed, or if construction on an area is (I) 8' X 6' STORM DRAIN RING = 253.3 GU. FT. ® ® ® ® ® ® ® ® ® VillDRAINAGE BASIN FOR A. Z PROVIDED REQUIRED Q 0 ® ® ® ® ® ® ® ® ® SIZES SEE SITE PLANS o °F mP O 1- suspended, the area shall be seeded immediately. Z p a. Seed preparation -scarify soil if compacted, remove debris and obstacles such as roots and stumps. 253.3 GU. FT. > 232 GU. FT. J y 3' min ® ® ® ® ® ® ® ® ® } �Q°P ��.p °� .� O ® ® ® ® ® ® ® ® ® BACKFILL MATERIAL P �� 'u`' b. Soil Amendments Z p- W �"' 1. Lime to ph 6.0 0 ® ® ® ® ® ® ® ® ® fL TO BE CLEAN SAND SITE Q 2. Fertilize with 6600 lbs of 5-10-10 or equivalent per acre(14 lbs/100 sq. ft.) ® ® ® ® ® ® ® ® ® AND GRAVEL T . > F= c. Seed Mixtures ® ® ® ® ® ® ® ® EH 4000 PECONIC BAY BLVD. 1. Temporary seedlings LAUREL,NY. 11948 o J a. Ryegrass (annual or perennial) @ 30 lbs. per acre (0.7 lbs per 1,000 sq. ft.) Z W b. Certified "Aroostook"winter rye (cereal rye) @ 100 lbs. per acre (2.5 lbs per 1,000 sq. ft.) use winter rye if seeding in October/November. GROUND WATER G'�F °cb, Great WLU 2. Permanent seedlings-See Landscaping plans �yy Peconic Bay Q D. The length and steepness of cleared slopes shall be minimized to reduce runoff velocities. Runoff shall be diverted away from cleared slopes. PERMANENT STORM WATER E. Sediment shall be trapped on the site and not permitted to enter adjacent properties or public roads or drainage systems. Sediment barriers shall be installed along J the limits of disturbance prior to the start of construction and shall be maintained until construction is complete. RUNOFF CONTROL MEASURE F. A stabilized construction entrance shall be maintained to prevent soil and loose debris from being tracked onto local roads. The construction entrance shall be STORM D RAI NAGE RING TYPICAL maintained until the site is permanently stabilized. Any sediment tracked onto public roads to be removed or cleaned on a daily basis. G. All runoff shall be retained on site in accordance with local regulations and approvals. Drainage inlets installed on site shall be protected from sediment buildup NC SCALE TEST HOLE through the use of appropriate inlet protection. NO SCALE JAN 3 0 2020 H. Appropriate means shall be used to control dust during construction. I. Following permanent stabilization, paved area shall be cleaned of soil and debris and drainage systems shall be cleaned and flushed as necessary. BY MARK McDONALD GEOSCIENCE J. The contractor is responsible for inspection and proper maintenance of erosion control measures. Inspections must be performed every seven calendar SOUTHOLD, NEW YORK 11971 days and immediately after periods of rainfall greater than one half inch. Maintenance measures are to include, but are not limited to, cleaning of recharge TEST HOLE DATA 4/16/19 1 PM ELEV. + 23.8 basins, sediment traps and drywelis, cleaning and repair of sediment barriers, repair of berms and runoff diverters, and cleaning and repair of inlet protection devices. K. During construction, the contractor will comply with all local regulations concerning the disposal of solid waste and debris and toxic and hazardous waste, as well as DARK BROWN LOAM OL sanitary sewer and septic system regulations. Temporary fencing shall be erected as shown on Site Plan along with the placement of dumpster's to control the buildup 1.0 FT. of debris. The contractor shall periodically clean up any debris accumulated along the temporary fence and empty the dumpster's regularly. O I The contractor will report any required modifications to the SWPPP necessitated by field conditions or construction activities to the Engineer/Architect for revision of the 4.0 FT. BROWN CLAYEY SAND SC SWPPP where appropriate. DESCRIPTION OF CONSTRUCTION AND WASTE MATERIALS STORED ON SITE 17 FT. PALE BROWN FINE SAND SP 08 Z- Construction materials shall include concrete wood forms, building lumber and associated metal attachments, precast concrete septic/drainage structures, prefabricated COMMENTS: NO WATER ENCOUNTERED Q• a building components (windows, doors, cabinets, flooring materials, finished roofing and siding materials, lighting fixtures, plumbing fixtures), gypsum wall board, batt and g -4 rigid insulation, piping for plumbing, outdoor paving materials. _J c �e Waste materials shall include demolition materials from the existing building structure, unused building materials and products, trash from construction workers meals ~ o r and drinks. Project site shall have a dumpster that all waste materials will be temporarily stored and dumpster shall be emptied weekly by a private carting company. W _J• W Z W � '= a z `u ..+ W• n ? c Q � O ; W• N = e GREAT ate• N/O/F NEW 4' HIGH FENCE EXISTING (2) PRIVET PECONIC BAY N N N/O/F ALAN FIDELLOW, BETH FIDELLOW SHRUBS TO BE REMOVED EXISTING STEPPING BUSHMAN STEVEN JUDITH FIDELLOW AND (POOL ENCLOSURE) STONES TO BE REMOVED NEW SEPTIC SYSTEM FOR A POOL HOUSE NEW EVERGREEN SCREEN PLANTINGS BUSHMAN ELLEN BARBARA VERCOLLONE EXISTING TREE TO 4025 GREAT PECONIC BAY BLVD 75 GRANITE SPRINGS RD - NEW 1000 GAL SEPTIC TANK (ST) POOL EQUIPMENT - EASTERN RED CEDAR 5" HT- NOT BE REMOVED EXISTING - CLEANOUT EXISTING DECK STRUCTURE LAUREL, NY 11948 YORK TOWN HEIGHTS, NY 10598 (2) 6x4 DRYWELLS FOR IN CONTRACT AD 1000-128.-3-13 4030 GREAT PECONIC BAY BLVD - (1) 5 FT x 4 FT NEW LEACHING POOL (new LP) POOL EQUIPMENT EXISTING TREES EXf5TIN6-TREE5 EXISTING BEACH STAIRS DWELLING 1000-128.-6-1 - (1) 8 FT x 4 FT FUTURE EXPANSION (EXP) LEACHING POOL TO BE REMOVED TO REMAIN SOF NE PUBLIC WATER DWELLING GLEAN OUT EL 7 1 551.64' PROPOSED NEW FENCE C:CP'C N STF YO S15*16'00"E SPLIT RAIL FENCE 24 PUBLIC WATER 24 _ AND GATE (POOL _ 10' 3 to •1-E , ENCLOSURE) �Q' -- -' _ -s EL 25.0' \ . ' min + 4.1 D D EXISTING s to LP x x- 11 \ BULKHEAD SIDE YARD SETBACK - ACCESSORYl--- _ / 3 q 23.9+ NEW POO ,i +25.5 5� 1 PROPOSED SILT XISTING DRIVEWAY W/ o, NEW 2 CAR 15'-0" HOUSE PROPOSED NEW �o �E S N,, s� FENCE DURING p N NEW TOP LAYER OF STONE EXISTING TR GARAGE 350 S 2b'x40';POOL O� T� ACE �O ] p CONSTRUCTION A•�'� TO BE REMOVE N ,� '�� o� �? s• SEE DETAIL OFF q� TEST HOLE 528 s +24.8 I� B�� y������z�,-, P 'R�JE(3"I` NO: 1902 RAW Y No APRON A ELECTRIC Ll +24. Q 9� DRAWN B . 8 _.- --__ EXTENT OF OIL/STONE x4 +24.7 24.6+ OO�J o +24.1 --'` - . - •-.- . -�ITL'E --- ------- ' F� .�� GATE EXI TING : � � 2�, UT ' BOLLARDS ' �'•�• -� - 2+ p 2 ST STORY -o : C�X15TING CHECKED BY: O - \ - •-- _ ___ - _ 23.5'+ DRIVEWAY �. - �,. `� HOU E BE � �G EXISTING NS / GAS - -,- •-' --•--• ---_. --___ __- _ _- _- _OIL 4 STONE .._. ,__ �� 4 BEDROO HOUSE l,� BULKHEAD DATE -•- - �� '�- ' w/ INTERI R F PANEL '-•- - r _240+ I RENOVATI \ 9° N52'21'53"W SEPT. 10, 2019 - -- w Ig �� VC11, 1.51' SCALE: ST ♦�y� \ $ FIRST PIN FL \ \ 1" = 20' - 0' SIDE YARD SETBACK - PRINCIPLE 8x6 23 K ELEV +27.3 \ �\ �, SHEET TITLE: METER �'� \ - 8x6 DRYWELL WITH INLET GRATE L0 FOR RAINWATER RUNOFF ROM C R-' j ♦ - IN LINK O DRIVEWAY PARKIN A 2 .-'�- =""t - ` ��+I•, NEW ELECTRIC, EL 25.2' -._ - _ _ _ _ _ _ _ _ _ _ _ _ _ ELECTRIC LINE _ GATE SITE METER PANEL N14'38'20"W ACTUAL - - ' N14'48'00"W DEED N/O/F 24 EXISTING EXISTING 543.0 24 22 16 10 EXISTING GARAGE UTILITY POLE HVAC, EQUIP 24 26 26 APPROVE PLAN EXISTING UTILITY POLE 'OG EXISTING UNDERGROUND MARY E NOLTE AND LAUREL COUNTRY EXISTING DRIVEWAY TO TO BE REMOVED D BY PUBLIC WATER LINE ESTATES PROPERTY OWNERS ASSOCIATION NEW ELECTRIC BE REMOVED NEW COVERED NEW 4 HIGH FENCE BOARD OF 1 RUSTEES C� 3850 GREAT PECONIC BAY BLVD METER fPANELEXISTING UNDERGROUND LOCATION OF EXISTING ENTRY PORCH (POOL ENCLOSURE) TOWN OF SOUTHOLD 1000-128.-6-3 PUBLIC, WATER LINE SANITARY SYSTEM TO EXISTING COVERED PORCH EXISTING FENGE TO BE F VACANT REMAIN TO BE RENOVATED _ REPLACED WITH NEW FENCE SHEET NO: N 0 F NEW UNDERGROUND WATER LOCATION OF EXISTING DRYWELL DAA / / LINE FROM RESIDENCE TO FOR 5TORMWATER ROOF RUNOFF f �F KELSEY ROBERT D POOL HOUSE EXISTING DECK REMOVED I Fj 2345 ROSE WALK EXISTING UNDERGROUND GAS LINE PROPOSED SILT FENCE DURING �` f ALPHARETTA, GA 3000 05 CONSTRUCTION SEE DETAIL -------� 3790 GREAT PECONIC BAY BLVDP 1000-128.-6-4L L S I T E L A lixm- DWELLING .0 V R AAR TRUSTEE AMENDMENT PUBLIC WATER SCALE: V = 20'-0" RFVISIoN nATF-1/22/2i(1 Glenn Goldsmith,President QF S0 Town Hall Annex Michael J. Domino,Vice-President ,`OOl0 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III 41 Southold,New York 11971 A.Nicholas Krupski G Telephone(631) 765-1892 Greg Williams �� �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: SOUTHOLD TOWN BUILDING DEPARTMENT RE: VERIFICATION OF BUILDING DEPARTMENT PERMIT REQUIREMENTS SCTM#: J 21— (O _Z ,l t; Property. Owner Name: Z 600 GP.i� Date Sent to Bldg. Dept: 2 12, 1 . , 1 2020 The Office of the Board of Trustees is forwarding the above referenced"applic-yita for2 verification of the Building Department's-permitting requirements stated below: YE.S/ NO W Will the proposed project require a Building Permit? Will the proposed project require a variance determination from the Zoning Board of Appeals? Will any part of this application be considered-a,Demolition as described under Town Code? - COMMENTS: a ure f ReAe er Date DiSalvo, Deane From: Nancy Steelman <nancy@samuelsandsteelman.com> Sent: Tuesday, February 11, 2020 4:04 PM To: DiSalvo, Diane Subject: Re:Amendment to 4000 GPBB, LLC - Hi Diane, I'm very sorry that I didn't get back to you sooner with your requested information. We were on vacation for a couple of weeks. See below to answer your questions: On 1/30/20201:46 PM, DiSalvo, Diane wrote: Receipt is acknowledged of your request to amend Permit#9490. Please advise if the permitted 1,315sq.ft. patio around the pool has changed in size. Yes,the terrace around the pool has become smaller. Total area is 1220 sf. There is a small entrance patio to the 350sq.ft. poolhouse—is this separate from the 350sq.ft.—please indicate and advise of sq.footage; Yes,the small covered entry is in addition to the 350 sf. That area is 32 sf. Where you are eliminating the 658sq.ft. east side terrace, are you also eliminating as permit states the "stepping stones on grade adjacent to dwelling" Yes,we are eliminating the east side terrace and the stepping stones. —and what is the square footage of the new terrace. Area of the neve terrace is 226 sf which also includes the stairs. Please get back to me if you have any additional questions. Clancy DLL we Di,Sp LVD SDuthoLc{ Towvu Trustees 54375 R-oute 25 SouthaL , NY z:L971 i S A M U E L S & S T E E L M A N January 22, 2020 Board of Trustees f Town of Southold P.O. Box 1179 lu ' } JAN 30 2020 Southold NY 11971 G Re: Mehta Residence—4000 GPBB,LLc ➢ €m___. - 4000 Peconic Bay Blvd. Laurel, NY Trustees Permit# 9490 SCTM #1000-128-6-2 Dear Trustees, We are requesting an amendment to a Trustees Permit that was approved on June 19, 2019. This original Permit was for Renovations and Additions to an existing residence, new Terraces, a new Swimming Pool, pool enclosure and tree removal, etc.. In addition, a Letter of Non Jurisdiction was issued on May 6, 2019 for construction of a new Garage and Pool House. Since our original application, we have made several changes to the Project and will require an amendment to the original approval. These changes are listed below: 1. The change in the Zoning Code for Pool Houses required that we separate the Pool House from the Garage and limit its size to 350 sf. Although the Pool House is still out of the Trustees jurisdiction the owners are now proposing a new 10'x 16' Trellis at the Pool House. As a result of the Trellis being attached to the Pool House, both the Trellis and the Pool House are now in the Trustee's Jurisdiction. 2. The original Permit approved a 685 sf Terrace at east side of the House. This Terrace has now change in size and configuration. ,ot We are submitting one copy of the Original Approved Site Planf and 4 copies of the Revised Site Plan. Please consider our request for our Amendment to the Trustee's Permit, Sincerel , Samue and Steel n Architects ARCHITECTS ancy S e man, R.A. 25235 MAIN ROAD CUTCHOGUE,NEW YORK 11935 (631)734-6405 FAX(631)734-6407 Michael J.Domino_ President �QF SO(/TyO Town Hall Annex John M.Bredemeyer II ie-President 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G • Telephone (631) 765-1892 Greg Williams Fax(631) 765-6641 OOUNT`1,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 10, 2019 Nancy Steelman Samuels & Steelman Architects 25235 Main Road Cutchogue, NY 11935 RE: 4000 GPBB, LLC 4000 GREAT PECONIC BAY BOULEVARD, LAUREL SCTM# 1000-128-6-2 Dear Ms. Steelman: As per your written request emailed to our office on October 23, 2019, the Administrative Amendment to Wetland Permit#9490 Application for the above- referenced property has been withdrawn. Enclosed is refund check #1187 in the amount of$50.00. If you have any questions, please do not hesitate to contact the office. Sincerely, Michael J. Domino, President i � G ; TOWN OF SOUTHOLD 1187 BOARD OF TOWN TRUSTEES P.O.BOX 1179 • . SOUTHOLD,NY 11971' 50-666.214 DM 12/10/2019 Samuels & Steelman Architects 1 $ 50.00 K PAYTDOTHEOR%DlROF Fifty Dollars and 00/100 ------------------------------------------------- DOUAIM 8 � ,av Bridgehampton National Bank 'liI'l, ltour117oto wNYRl 1071 —w dgenb— 4000 GPBB, LLC _ FORApplication Withdrawn; SCTM 1000-128-6-2 11000 1 &13 711'=1:0 2 140666 7 : 0500035 4112 DiSalvo, Diane From: DiSalvo, Diane Sent: Wednesday, October 23, 2019 2:37 PM To: Cantrell, Elizabeth Subject: FW:4000GPBB FYI—We need to refund Samuels&Steelman the$50.00 received from them (Check#17911) on behalf of 4000 GPBB on 10/1/19. From: Nancy Steelman [mailto:nancy@samuelsandsteelman.com] Sent: Wednesday, October 23, 2019 11:37 AM To: DiSalvo, Diane Subject: 4000GPBB ° Diane, Please withdraw the Administrative Amendment to the Mehta Residence (4000 GPBB) and refund the payment of$50. Thank you, Nancy Steelman Nancy Steelman R.A. Samuels and Steelman Architects Cutchogue, New York 631 734-6405 ATTENTION: This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. a i S A M U E L S & September 25, 2019 S T E E L M A NF� s — ,,7 Board of Trustees Town ofSouthold P.O. Box 1179 EP 2. 7 2019 Southold NY 11971 Re: Mehta Residence—4000 GPBB,LLc Bjl(o U, 4000 Peconic Bay Blvd. Laurel, NY -Trustees Permit#9490 SCTM #1000-128-6-2 Dear Trustees, We are requesting an amendment to a Trustees Permit that was approved on June 19, 2019. This original Permit was for Renovations and Additions to an existing residence, new Terraces, a new Swimming Pool, pool enclosure and tree removal, etc.. In addition, a Letter of Non Jurisdiction was issued on May 6, 2019 for construction of a new Garage and Pool House. Since our original application, we have made several changes to the Project and will require an amendment to the original approval. These changes are listed below: 1. The change in the Zoning Code for Pool Houses required that we separate the Pool House from the Garage and limit its size to 350 sf. Although the Pool House is still out of the Trustees jurisdiction the owners are now proposing a new 10'x 16'Trellis and a new 4'x 6'-6" Outdoor Shower at the Pool House. As a result of the Trellis being attached to the Pool House, both the Trellis, the Pool House and the Outdoor shower are now in the Trustee's Jurisdiction. 2. The original Permit approved a 685 sf Terrace at east side of the House. This Terrace has now change in size and configuration. The new Terrace is 394 sf with stepping stones to the Swimming Pool Area. We are submitting one copy of the Original Approved Site Plan and 4 copies of the Revised Site Plan. Please consider our request for ourAmendment to the Trustee's Permit. Sincerely Xancy nd SWR. . chitects ARCHITECTS a , 25235 MAIN ROAD CUTCHOGUE,NEW YORK 11935 (631)734-6405 FAX(631)734-6407 i Glenn Goldsmith, Pi lent Qg11FF0L� Town Hall Annex Off' �G Michael J. Domino, Vice-u-: dent ,�� �,, 'A 54375 Route 25 John M. Bredemeyer III o =` P.O. Box 1179 A. Nicholas Krupski o � Southold, NY 11971 Greg Williams Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: f�����c� 5:qS Completed in field by: Samuels & Steelman Architects on behalf of 4000 GPBB, LLC request an Administrative Amendment to Wetland Permit#9490 to construct a 1220sq.ft. stone pool terrace in lieu of the originally permitted 1315sq.ft. terrace; construct a 350sq.ft. poolhouse with 32sq.ft. covered entry and 10'x16' attached trellis; construct a 226sq. ft. terrace with stairs at east side of house, in lieu of the originally proposed 658sq.ft. terrace and stepping stones on grade adjacent to dwelling. Located: 4000 Peconic Bay Blvd., Laurel. SCTM#: 1000-128-6-2 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q 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 Noticeof 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 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: 4 1 �-kCacOl�I Tn�Wal4"�1 — ilri �aGl�eVc� �81V1CD(lMe�fl�a C 1 M9��iC l I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other i Michael J. Domino, President ��q o , Town Hall Annex John M.Bredemeyer III,Vice-President ! y 54375 Route 25 P.O. Box 1179 Glenn Goldsmith Southold, New York 11971 A.Nicholas Krupski Telephone (631) 765-1892 Greg Williams '" Fax(631) 765-6641 Coo � BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 10, 2019 Nancy Steelman Samuels & Steelman Architects 25235 Main Road Cutchogue, NY 11935 RE 4000 GPBB, LLC 4000 GREAT PECONIC BAY BOULEVARD, LAUREL SCTM# 1000-128-6-2 Dear Ms. Steelman: As per your written request emailed to our office on October 23, 2019, the Administrative Amendment to Wetland Permit#9490 Application for the above- referenced property has been withdrawn. Enclosed is refund check #1187 in the amount of$50.00. If you have any questions, please do not hesitate to contact the office. Sincerely, Michael J. Domino, President TOWN OF SOUTHOLD 1187 BOARD OF TOWN TRUSTEES P.O.BOX 1179 SOUTHOLD,NY 11971 CUTS 12/10/2019 50-665-214 _ .... Saiiwels & Steelman Architects 50.00. .__ PAT TO THE ORDER OF Fifty Dollars and 00/100 --------------------------------------- -_ DOLLARS' 8 _ , �- r . k� s.au,aw.aw arann .._ .m.— mwu ut4x o 1411 anh.wR ,4( 00 GPBB,. LLC QRApliation..WithdySCTM 1000-128-6-2 h '.. Mr ii"100 L L7ii' 1:0 2 L4066671: 0500035 11,111, Cantrell, Elizabeth From: DiSalvo, Diane Sent: Wednesday, October 23, 2019 2:37 PM To: Cantrell, Elizabeth Subject: FW:4000GPBB FYI—We need to refund Samuels &Steelman the $50.00 received from them (Check#17911) on behalf of 4000 GPBB on 10/1/19. From: Nancy Steelman [mailto:nancy@samuelsandsteelman.com] Sent: Wednesday, October 23, 2019 11:37 AM To: DiSalvo, Diane Subject: 4000GPBB Diane, Please withdraw the Administrative Amendment to the Mehta Residence (4000 GPBB) and refund the payment of$50. Thank you, Nancy Steelman Nancy Steelman R.A. Samuels and Steelman Architects Cutchogue, New York 631 734-6405 ATTENTION: This email came from an external source. Ido not open attachments or click on links from unknown senders or unexpected e ails. i r ` Michael J. Domino, Presidentcopy; Town Hall Annex John M. Bredemeyer, III, Vice-President 54375 Route 25 Glenn Goldsmith r ,?k P.O. Box 1179 A Nicholas Krupski y • r�7r Southold, NY 11971 Greg Williams -0, Telephone (631) 765-1892 Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction _ % constructed When project complete, call for compliance inspection; 21 BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD,NEW YORK PERMIT NO. 9490 DATE: JUNE 19,2019 ISSUED TO: 4000 GPBB,LLC PROPERTY ADDRESS: 4000 PECONIC BAY BOULEVARD,LAUREL SCTM# 1000-128-6-2 AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in zh accordance with the Resolution of the Board of Trustees adopted at the meeting held on June 19, 2019 and in consideration of application fee in the sum of$250.00 paid by 4000 GPBB, LLC and subject to the Terms and I Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Ik~' Wetland Permit for the existing 3,292sq.ft.two-story dwelling with screened porch; remove and replace existing windows and doors; remove existing 240sq.ft. entry deck; construct new dormer additions on south roof-remove existing dormer and replace with 596sq.ft. dormer,on north roof-new 200sq.ft. dormer addition; new 68sq.ft. entry porch; remove existing 850sq.ft. gravel parking area and curbing; remove seven existing trees; plant±18 new evergreen trees; remove existing stepping stones from porch to stair at bank; new 658sq.ft. stone terrace and V stepping stones on grade adjacent to dwelling; new 250sq.ft.stone walkway to entry; new 20'x40' gunite swimming pool; new 1,315sq.ft.stone pool terrace; new 41 high pool enclosure fencing and gates (280 linear feet); new 4' high gate at existing stair at bank; and for the two (2) existing A/C condensing units; and as depicted on the site plan prepared by Samuels & Steelman Architects,dated April 16,2019,and stamped approved on June 19,2019. 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 19`h day of June,2019. W 'M & A F F Ili J-1 COD :S TERMS AND CONDITIONS The Permittee 4000 GPBB LLC 4000 Peconic Bay Blvd.,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. S. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required, upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. 10. No right to trespass or interfere with riparian rights. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. Michael J. Domino,President oOF SO�jyoTown Hall Annex John M.Bredemeyer III,Vice-President l 54375 Route 25 h 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 com BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 19, 2019 Nancy Steelman Samuels & Steelman Architects 25235 Main Road Cutchogue, NY 11935 RE: 4000 GPBB, LLC 4000 PECONIC BAY BOULEVARD, LAUREL SCTM# 1000-128-6-2 Dear Ms. Steelman: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, June 19, 2019 regarding the above matter: WHEREAS, Samuels & Steelman Architects, on behalf of 4000 GPBB, LLC 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 April 16, 2019, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS; the LWRP Coordinator recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policy of the Local Waterfront Revitalization Program to the greatest'extent possible through the imposition of the following Best Management Practice requirements: the issuance of the permit; and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on June 19, 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, 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, and, 2 J 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 for the mitigating factors and based upon the Best Management Practice requirement imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, RESOLVED, that the Board of Trustees approve the application of 4000 GPBB, LLC for the existing 3,292sq.ft. two-story dwelling with screened porch; remove and replace existing windows and doors; remove existing 240sq.ft. entry deck; construct new dormer additions on south roof-remove existing dormer and replace with 596sq.ft. dormer, on north roof-new 200sq.ft. dormer addition; new 68sq.ft. entry porch; remove existing 850sq.ft. gravel parking area and curbing; remove seven existing trees; plant t18 new evergreen trees; remove existing stepping stones from porch to stair at bank; new 658sq.ft. stone terrace and stepping stones on grade adjacent to dwelling; new 250sq.ft. stone walkway to entry; new 20'x40' gunite swimming pool; new 1,315sq.ft. stone pool terrace; new 4' high pool enclosure fencing and gates (280 linear feet); new 4' high gate at existing stair at bank; and for the two (2) existing A/C condensing units; and as depicted on the site plan prepared by Samuels & Steelman Architects, dated April 16, 2019, and stamped approved on June 19, 2019. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, Michael J. Domino President, Board of Trustees MJD/dd a - Michael J Domino, President Town�Gti` Town Hall Annex John M. Bredemeyer, III, Vice-Presidenty `.< z 54375 Route 25 Glenn Goldsmith o `� P.O. Box 1179 A Nicholas Krupski Southold, NY 11971 Greg Williams ��V Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: - 4000 GPBB, LLC c/o SAMUELS & STEELMAN Please be advised that your application dated April 16, 2019 has been reviewed by this Board at the regular meeting of June 19, 2019 and your application has been approved pending the completion of the following items checked off below. 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) 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 7 g,�q r BY: Michael J. Domino, President qr Board of Trustees N SURVEY OF PROPERTY AT LAUREL TOWN OF SO UTHOL.D 0 SUFFOLK COUNTY, N Y. h� -n 1000-128-06-02 01 h� SCALE: 1 "=40 / 501 FEBRUARY 6, 2019 / 2 DWELLING PUBLIC WATER tArIPP 16 / 2019 -77 /LO EL 24.5' MON. FND. 1 EL 25.0' SRF END 1 Jv �J O 0.5'E O ~ lb 1 Al \ SRF END 1 0.7'E � Q EL 24.3' MON. FND. METER +24.1' O MON. FND. / �► EL 25.2' � Q 4" (JA BOLLARDS I \ Q coI SRF END 1 0 N GAS 0.3'E 1 0. PANEL N/O/F crl ti ALAN FIDELLOW, BETH FIDELLOW 1 p G / JUDITH FIDELLOW AND i• BARBARA VERCOLLONE / DWELLING DWELLING `I i +23 7' PUBLIC WATER \ PUBLIC WATER / \ n'�_r % Ll r I 1 I iT� 1 A _1 n }� I N r I I I ca I Z SRF END \ O.L. +23.5' IPA \4\ oft^ \ 9y BIAG• O 9� 1 1 �,c 1 4.S ` .01 88 5.4 OUT ,' Up SHOWER/ " 24 OAK /ry cp / I 20" OAK OF'G� O' ION. FND. /`V- / / I' ce 1y �11ti 16" PINED; / a F ' 2fi � �•talc. , JS � 2.3 25.5 i 1 AC Aa , / 1 LANDINGS 1 W OD STEPS TIFIED TO: ,/ PORCH ,�'—� /i i •' '^ 00 GPBB LLC ,•tib I / /ib o w IVOCATES ABSTRACT, INC. ooD 'STCOR LAND TITLE INSURANCE COMPANY FE.END 'MON. FND. �J' DECK �S BANK USA 0.4,E (51 = REBAR 01. i� ' P = WELL FE.EN /�/ 10/�00�� C.? 1.7'E = STAKE = TEST HOLE % N52'21'53"W VO = PIPE �\ 1.51' Q<C/ = MONUMENT _---_'S35'43'0�1"W 29.86 = WETLAND FLAG �� = UTILITY POLE O� A 77ONS REFERENCED TO NA VD 88 ALTERA77ON OR ADDI77ON TO THIS SURVEY IS A WOLA77ON OF N. Y.S. UC. NO. 49618 'ON 7209OF THE NEW YORK STATE EDUCA77ON LAW. EXCEPT AS AREAL 1. 089 ACRES PECONIC SURVEYORS, P.C. SEC770N 7209—SUBDIWSION 2. ALL CER77FICA77ONS HEREON ARE TO TIE LINE (s31) 765-5020 FAX (631) 765-1797 FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR S P.O. BOX 909 BEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE I TURE APPEARS HEREON. 1230 TRAVELER STREET SOUTHOLD, MY 11971 93-122 GENERAL STORMWATER POLLUTION PREVENTION NOTES PERMANENT STORM WATER RUNOFF CONTROL MEASURE DRAINAGE C LC U LATIONS GARAGE SLAB EL 24.6 FT SITE DATA SITE DESCRIPTION & GENERAL SEQUENCE OF SITE ACTIVITIES FOR THE ENTIRE SITE WIRE FENCE W/ AREA OF RESIDENCE (D'`N-A) w GRADE LINE ELEVATION 23.9 FT. SCTM # 1000-128-06-02 Development activities for this project will consist of: FILTER CLOTH DRY WELL AREA x RAINFALL x RUNOFF FACTOR � GLEAN OUT 1. Installation of temporary erosion control measures (silt fence barriers), see detail 1 &2 GRADE LINE ELEVATION ±23.9 FT. GRADE LINE ELEVATION ±23.9 FT. PROPERTY: 4000 EL, NYPECONIC BAY BLVD (DW-A) 1,095 5F x (2/12 �T) x I.O = 183 GU. FT. ADDRESS LAUREL NY 11948 2. Clearing of brush, trees and landscaping in areas shown on Site Plan �� SURFACE U5E: (1) 8' DIAMETER x 6' HIGH POOL I' MIN. 2' MAX. FILTER CLOTH MIN. 6 '� 3. Demolition of existing structures and associated building components BELOW GRADE DRAINAGE (1) VX 6' STORM DRAIN RING = 253.4 CU. FT. OWNER: SARAH BINDER MEHTA FLOW PROVIDED REQUIREDPUNIT MEHT�A 4. Excavation for the new foundations and swimming pool (+/- 3 ft below finished grade) 14"/FT. 5. Construction of the new foundations, swimming pool and building structure \ \ \ \ \ \ \ 253.4 GU. FT. > 183 GU. FT. 1000 gal I/8"/FT. T1 TOP OF POOL 22.0 FT. SITE: 47,436 SQ. FT. = 1.089 ACRES \ \ \/\ / AREA OF RESIDENCE (DW-B) SEPTIC LEACHING ZONING: R-40 6. Construction of underground electric and utility lines from the utility pole to the buildings � �j\ �j� IE. +22.5x' TANK 7. Construction of a new underground water line from the existing residence to the garage �/ DRY WELL AREA x RAINFALL x RUNOFF FACTOR POOL IF. +22.2'1 IE. +21.'1'1' FLOOD ZONE: X 8. Installation of the septic system TEMPORARY STORM WATER (DW-B) 1,293 Sr- x (2/12 FT) x 1.0 = 216 CU. FT. BOT OF POOL 18.0 FT. 9. Installation of on site drainage structures (permanent storm water runoff control measures), see detail 1 USE: (1) V DIAMETER x 6' HIGH POOL IE. +21.6'1' LOT COVERAGE: 10. Installation of underground piping from gutters and downspouts to the drainage structures RUNOFF CONTROL MEASURE (1) 8' X 6' STORM DRAIN RING = 253.4 CU. FT. GROUND WATER EXISTING: 6.53% 11. Filling and grading of soil above drainage structures EROSION & SEDIMENT CONTROL DETAIL 255.4PROVCU.PT. >216 GUS. FT. 16' PROPOSED: 8.4%10' 3' MIN 12. Construction of new terraces NO SCALE ®� SURVEYOR: PECONIC SURVEYORS, PC 13. Construction of new driveway and parking areas including grading and driveway surfacing AREA OF GARAGE POOL HOUSE (DW-C) SEPTICPO BOX 909 14. Installation of new landscaping plants, lawns as required DRY WELL AREA x RAINFALL x RUNOFF FACTOR 15. Removal of the temporary erosion control measures (DA-0) 919 5F x (2/12 FT) x 1.0 = 154 CU. FT. (N.T.S.) LICENSED, 11971 LICENSE # 4!9966 18 U5E: (2) 6' DIAMETER x 4' HIGH POOL (n UJ SITE DATA (2) 6 PROVIDED DED M DRAIN RING Q 115.6 UIRED CU. FT. DATED: FEBRUARY 6, 2019 Site Area: 47,436 SF = 1.089 AC 178.6 CU. FT. > 154 CU. FT. TOP OF EXI5TING GRADE Site ARE REFERENCED TO Receiving Waters: PECONIC BAY TO N.A.V.D. 1989 DATUM AREA OF DRIVEWAY (DW-D) CAST IRON FRAME AND COVER TO Q Contractor: N/A DRY WELL AREA x RAINFALL x RUNOFF FACTOR GRADE (AS REQUIRED) POLLUTION CONTROL MEASURES (DA-D) 1,986 SF x (2/12 FT) x 0.7 = 232 GU. FT. L 0 A I Imm M A�USE: (1) 8' DIAMETER x 6' HIGH POOL TRAFFIC, SLAB (SEE In accordance with the provisions of the Town of Southold, chapter 236, storm water management and erosion and sediment control measures including, but not limited (1) 8' X 6 STORM DRAIN RING = 253.5 CU. FT. PLANS FOR LOCATIONS) m NORT AVWbk to, the following shall be employed during construction: PROVIDED REQUIRED CREE 0Lill 253.3 GU. FT. > 232 CU. FT. A. Existing vegetation to remain shall be protected (by installation of construction fence or other approved means)and shall remain undisturbed. ry ' <y ° B. Clearing and Grading shall be scheduled so as to minimize the extent of exposed areas and the length of time that areas are exposed.A maximum of 1 acre shall be - ti� LAUREL LINKS COUNTRY CL0CLUBdisturbed at one time unless written permission is granted by the NYSDEC. Graded and stripped areas shall be kept stabilized through the use of temporary seeding i` W UJ as required. Seed mixtures shall be in accordance with the soil conversation service recommendations. 6 ® ® ® ® ® ® ® ® ® to C. Bare soils shall be seeded within 14 days of exposure, unless construction will begin within 21 days as sections are completed, or if construction on an area is DRAINAGE BASIN FOR ov i` Z suspended, the area shall be seeded immediately. Q Z � ® ® ® ® ® ® ® ® ® SIZES SEE SITE PLANS o °� Wm� a. Seed preparation -scarify soil if compacted, remove debris and obstacles such as roots and stumps. p J } 3' min ® ® ® ® ® ® ® � ® } ��°P ��.p ? f O o b. Soil Amendments Z 0- OC ® ® ® ® ® ® ® � ® BACKFILL MATERIAL P °? a��Q ;' �"' 1. Lime to ph 6.0 0 Z ® ® ® ® ® ® ® ® ® TO BE GLEAN 5AND / Q c4c 2. Fertilize with 6600 lbs of 5-10-10 or equivalent per acre(14 lbs/100 sq. ft.) 4 M ® ® ® ® ® ® ® ® ® .` AND GRAVEL ` SITE , \ c. Seed Mixtures ® ® ® ® ® ® ® ® ® 4000 PECONIC BAY BLVD. 1. Temporary seedlings - LAUREL,NY. 11948 a. Ryegrass (annual or perennial) @ 30 lbs. per acre(0.7 lbs per 1,000 sq. ft.) �.�o `;�` b. Certified "Aroostook"winter rye (cereal rye) @ 100 lbs. per acre (2.5 lbs per 1,000 sq. ft.) use winter rye if seeding in October/November. GROUND WATER - F oa Great WLU 2. Permanent seedlings-See Landscaping plans - - - - - Cy Peconic Bay D. The length and steepness of cleared slopes shall be minimized to reduce runoff velocities. Runoff shall be diverted away from cleared slopes. PERMANENT STORM WATER ` E. Sediment shall be trapped on the site and not permitted to enter adjacent properties or public roads or drainage systems. Sediment barriers shall be installed along APPROVED B the limits of disturbance prior to the start of construction and shall be maintained until construction is complete. RUNOFF CONTROL- MEASURE OF TRI 111,Tr- F. A stabilized construction entrance shall be maintained to prevent soil and loose debris from being tracked onto local roads.The construction entrance shall be BOA maintained until the site is permanently stabilized. Any sediment tracked onto public roads to be removed or cleaned on a daily basis. STORM D RAI NAGE RING TY�ILAL TOWN OF SOUTHOLD G. All runoff shall be retained on site in accordance with local regulations and approvals. Drainage inlets installed on site shall be protected from sediment buildup NO SCALE through the use of appropriate inlet protectioin, c Q H.Appropriate means shall be used to control dlust during construction. { DA�� �� ,�t �1 1 I. Following permanent stabilization, paved area shall be cleaned of soil and debris and drainage systems shall be cleaned and flushed as necessary. J. The contractor is responsible for inspection and proper maintenance of erosion control measures. Inspections must be performed every seven calendar days and immediately after periods of rainfall greater than one half inch. Maintenance measures are to Include, but are not limited to, cleaning of recharge -N basins, sediment traps and drywells, cleaning and repair of sediment barriers, repair of berms and runoff diverters, and cleaning and repair of inlet protection devices. K. During construction, the contractor will comply with all local regulations concerning the disposal of solid waste and debris and toxic and hazardous waste, as well as sanitary sewer and septic system regulations. Temporary fencing shall be erected as shown on Site Plan along with the placement of dumpster's to control the buildup of debris. The contractor shall periodically clean up any debris accumulated along the temporary fence and empty the dumpster's regularly. The contractor will report any required modifications to the SWPPP necessitated by field conditions or construction activities to the Engineer/Architect for revision of the SWPPP where appropriate. DESCRIPTION OF CONSTRUCTION AND WASTE MATERIALS STORED ON SITE o5 Z• Construction materials shall include concrete wood forms, building lumber and associated metal attachments, precast concrete septic/drainage structures, prefabricated building components (windows, doors, cabinets, flooring materials, finished roofing and siding materials, lighting fixtures, plumbing fixtures), gypsum wall board, batt and Q rigid insulation, piping for plumbing, outdoor paving materials. _J o Waste materials shall include demolition materials from the existing building structure, unused building materials and products, trash from construction workers meals y o and drinks. Project site shall have a dumpster that all waste materials will be temporarily stored and dumpster shall be emptied weekly by a private carting company. W J' W z � a � W• � � 5 Q N G W• N GREAT a I-• N/O/F PROPOSED NEW FENCE EXISTING (2) PRIVET PECONIC BAY cn cn- N/O/F ALAN FIDELLOW, BETH FIDELLOW (POOL ENCLOSURE) 5HRUB5 TO BE REMOVED EXISTING 5TEPPING BUSHMAN STEVEN JUDITH FIDELLOW AND STONES TO BE REMOVED EXISTING BULKHEAD BUSHMAN ELLEN BARBARA VERCOLLONE NEW EVERGREEN SCREEN PLANTINGS EXISTING TREE TO 4025 GREAT PECONIC BAY BLVD 75 GRANITE SPRINGS RD POOL EQUI NT - EA5TERN RED CEDAR 8" HT BE REMOVED EXISTING LAUREL, NY 11948 YORK TOWN HEIGHTS, NY 10598 (2) 6x4 DRYWELLS FOR POOL EQUIPMENT EXISTING TREES ADEXISTING DECK STRUCTURE 1000-128.-3-13 4030 GREAT PECONIC BAY BLVD EX+sTIN6-TIES TO REMAIN EXISTING BEACH STAIRS DWELLING 1000-128.-6-1 TO BE REMOVED � .�� <<., ✓y PUBLIC WATER DWELLING NEW SEPTIC SYSTEM FOR EL. 7.1 A GARAGE POOL HOUSE 05ED 4'X6' �` CO c �� 551.64 PROPOSED NEW FENCE SPLIT RAIL FENCE 2 PUBLIC WATER 24�_ _ °U�OORO AND c!�ATE (POOL ' r EN01-05URE) " r �� "" "7 EXISTING _ i 7EL5.0 GATE \ p; cn N x x x T. 11 \ \ BULKHEAD SIDE YARDSETBACK, ACCESSORY ® __= PINE\, 4 \ � - j 1 PROPOSED SILT SIDE YARD SETBACK - PRINCIPLE - OS�NEW 2 CAR G AGE / POOL HOUSE PROP05F-D NEW ToA \E 5'�N s� FENCE DURING a o B G ] O CONSTRUCTION \ LP sf 2�p x4011POOL G O�IR RADEI �Rp�'T 1 _ �6 ti j Q SFE DETAIL 2 '� PROJECT NO: FFG'9� EXISTING PROPOSED 4'X6' FI LEY+24 8R IGrI 4 ,� ��_. 9 ��� 'r'� P ✓ 1 \ DRIVEWAY OUTDOOR _ +24.7 .��i9� DRAWN BY: SHOWER O 0� +24.1' ice'-. •�..''..�.,�,, ---_._ - --- �o�v5 24.6+ EXI TING O i �'�' \ -`'"'''-•�•�•••r�.,..�.,, ------- 24.2 G F p'� �;. 2 ST RY xiSTING EXISTING CHECKED BY: ' BOLLARDS +23.5' �� G�`� 4 BEDHOU Roo EHOUSE \ E \ BULKHEAD •_. '�:GAS \ - -_ -- _'___.�._ =�- . -, -----_ _ ' -'--5 • =t- . ` \ DATE: PANEL \ -� DRIVEWAY 24._0+ _-- �° r %;" NTERI R p • _ RENOVATI 5 ��� A ri 116, 2 2 ��.f-� � 1�533 sf = \ \ \ \ N51.51 53 W SCALE: o g� SIDE YARD SETBACK - PRINCIPLE •�_ w �y - 8 `IRST,,FIN'FL � \ \ 1" = 20' 2 X 5. ELEV� +2�.3 \ \ SIDE YARD SETBACK -ACCESSORY •� 8x6 I 1 \ s SHEET TITLE: WATER 8x6 DRYWELL WITH INLET GRATE •� PARKI 2 + c \ \ \ \ N FOR RAINWATER RUNOFF FROM 2 3, _ I GATE � N DRIVEWAY PARKING AREA - - J �� \ 9�F`,Q EL 25.2' _ \ -•-•- - - - - - - - _ __ - ____ SITE N14'38'20"W ACTUAL 24 \ 543.0 ' 24 22 20 16 10 EXISTING PLAN N/O/F SN14'48'00"W DEED N/O/F EXISTING EXISTING GARAGE HVAC, EQUIP 24 26 26 ROBINSON SHERWOOD 'A�c. MARY E NOLTE AND LAUREL COUNTRY UTILITY POLE EXISTING DRIVEWAY TO TO BE REMOVED ROBINSON BARBARA J EXISTING UNDERGROUND ESTATES PROPERTY OWNERS ASSOCIATION BE REMOVED NEW COVERED PROPOSED NEW FENCE 3605 GREAT PECONIC BAY BLVD PUBLIC WATER LINE 3850 GREAT PECONIC BAY BLVD EXISTING UNDERGROUND LOCATION OF EXISTING ENTRY PORCH (POOL ENCLOSURE) EXISTING LAUREL, NY 11948 1000-128.-6-3 PUBLIC, WATER LINE SANITARY SYSTEM TO EXISTING COVERED PORCH EXISTING FENCE TO BE BULKHEAD 1000-128.-3-22 VACANT 8x4 DRYWELL FOR REMAIN TO BE RENOVATED _ REPLACED WITH NEW FENCE SHEET NO: DWELLING GREAT - - - - - - - NWATER RUNOFF FROM NEW UNDERGROUND CATION OF EXISTING DRYWELL PROPOSED NEW FENCE PUBLIC WATER N/O/F GARAGE / POOL HOUSE ELECTRIC UTILITY LINE FOR 5TORMWATER ROOF RUNOFF (POOL ENCLOSURE) PECONIC KELSEY ROBERT D EXISTING UNDERGROUND 6A5 LINE EXISTING DECK REMOVED `- 2345 ROSE WALK DR PROPOSED SILT FENCE DURING ALPHARETTA, GA 30005 CONSTRUCTION SEE DETAIL y BAY 3790 GREAT1000-128.-6-4 PECONIC CNIC BAY BLVD P i '�` ' 0 if L nA L L BOULEVARD I T E PLA N- DWELLING _..____._ PUBLIC WATER SCALE: 1 = 20'-O ;:I REVISIONS: LLJ Z 0 0 � 0 0 uj Z EXISTI G SIDE YARD LINE N (2) PRIVET SHRUBS TO BE REMOVED EXISTING WOOD BULKHEAD Q EXISTING TREE TO BE REMOVED 06 � W NEW EVERGREEN SCREEN EXISTING WOOD RETAINING WALL NEW SEPTIC SYSTEM FORA GARAGE PLANTI NGS POOL HOUSE EXISTING DECK STRUCTURE Z - EASTERN RED CEDAR 10' HT EXISTING TREES TO REMAIN O (2) 6x4 DRYWELL5 FOR POOL EQUIPMENT ---_ Q POOL EQUIPMENT PROPOSED NEW FENCE NEW SHRUB AND GROUND EXISTING BEACH STAIRS (POOL ENCLOSURE) COVER PLANTINC75 Q - HYDRANGEA V HT > EXI5TIN& TREES TO BE REMOVED - PACHYSANDRA 12" \ PROP05ED NEW FENCE AND 6ATE (POOLJ 3: PROPOSED 4'X6' OUTDOOR - ORNAMENTAL GRASSES 24" EL. 27.1 ENCLOSURE) Z W _ r2do R '- _ 1 W 12 J DW ir 6x4 6x4 �'P` DWG E STING EXISTING WOOD RET,4�INING WALL 6x4 - _ 5TG \ •GRASS _ • • I PINE - 4. EXISTING TREE 1. GREAT tII TO REMAIN ♦ . ' 1 P E C O N ' PROPOSED NEW 2 CAR --I 'J� GARAGE / OOL HOUSE PROPOENEW NRD>= -J BAY PSa ef - l0 POOL O �O FI T FIN FLR I- ® F ' EXIST � �\'. IN6 WOOD EXIS O TING - -- q N1 - _ ❑_r-- -- REMAIN PLANTS TO BULKHEAD F- _ 9 1 O Z F-Ir 2 1 • existing G� �. +24.7 4. -I 5 - --1 lawn O co Q• M ❑ I ❑ • 1 .8 24.6+ . . M I I 1 EXISTING wn `ry N ° ❑ la , F p o ° M BEACH �' I O W -J w z 3 x 24.2+ GATE I NATURALIZED SHRUB GA STAIRS .EXI5TIN a Z LAND GROUND COVER BE, LH � W. u N o PLANTI G 6RA5' : . a N o ' C W• N = a - - \ EXISTING - • �--- \ �/ � — — • : ••• ' • . . • :.2 STORY .. .. . . .. : Q H• HOUSE EXI5TI cn cn 4 BF_DkO M HOUSE PLANTS TO _ DRIVEWAY 24.0+— I �-A, NATURALIZED SHRUB Vim / N RIOR, REMAIN — AND GROUND COVER RENOV TIONS Nc" \ PLANTINGS 1,63 sf FIRST FIN FLR \ ELEV 27.3 0 • DW D PARKING W DG AREA 8x4 EXISTING \ 8x6 I + 3.3 - ® 3 GARS -� \ 2 '\ �- TREES TO . • - • existing REMAIN • '.° ° . •. ,. -.��. • I L ) f \ , X lawnc' + ` GATE 1 ---� 20 � PROJECT NO: 24 22 18 16 10 � 1902 EXISTING HVAC EQUIP 24 26 26 DRAWN BY: EXI5TIN6 DRIVEWAY TO BE EXISTING GARAGE TO BE REMOVED UT REMOVED CHECKED BY: NEW UNDERGROUND ELECTRIC UTILITY LINE NS 8x6 DRYWELL WITH INLET &RATE EXISTING DECK REMOVED NEW COVERED ENTRY PORCH PROP05ED NEW FENCE (POOL ENCLOSURE) DATE: FOR RAINWATER RUNOFF FROM DRIVEWAY PARKING AREA EXISTING COVERED PORCH TO BE RENOVATED EXI5TIN6 FENCE TO BE REPLACED WITH NEW FENCE April 16, 2019 SCALE: 8x4 DRYWELL FOR RAINWATER PROPOSED NEW FENCE (POOL ENCLOSURE) EXISTING WOOD' RETAINING WALL 1" = 101 - 01V RUNOFF FROM GARAGE / POOL HOUSE SHEET TITLE: EXISTING UNDERGROUND GAS LINE EXISTING UNDERGROUND PUBLIC, WATER LINE SITE PLAN ENLARGEMENT 77-7-7 SHEET NO: ENLARGEMENIm PLAN SCALE: 1 " = 10._0" /,PR 1 20,13 t •. Lu to I I � O ON — w D z - - -- - - - - - - -- - - - - -- -- -- - - - - - - - - - - - - - -- - - - - - - - p • GL. °6 w SUEST (/) _ ROOF BELOW BEDROOM ENTRY z 71 L _ O d --- - -- - _ UP - - - -- - - - - O OPEN �O .�...� .:.-- .__:- DORMER � MEDIA ROOMBELOI- I— AWVE I Q > QwDR O -� N BATH w ATTIC DN UJ w BEDROOM Oct SUE5T I BATH GL. SKYLIGHTS o O LINEN GL05ET LLL--- L- -JL —J — —— — —— — ——— HALL N ALK-IN CLOSET —— K I TGHEN I 0s z - - -- - - - - - - - ---- - - - - -- - - - - -- -- -- - - - - - - - - - - - - - -- - - ---- -- - - - - -- - - - - - - - - - o M Ski V/ Q �Y I Of r Y 00 a o i U1 M O � m IY W -J• wZ3X L INS/D I N I NS AREA _ = a Z LL a N q cm 00 W• N 2 ,y MA5TER BEDROOM — — — I I co co BEDROOM I II :- r �. ST r�1� n17J5 f• r i ✓' PROJECT NO: ROOD BLOW 1902 DRAWN BY: NS -- - - -- -- -- ------ - --- - - -- - - -- - - - CHECKED BY: DATE: APRIL 16, 2019 SCALE: 1/4" = 1'-0" SHEET TITLE: S PE C u" N D F L. L, SCALE: 1/4" = V -0-- SCALE: -0" FIRST SCALE: 1/4" = V -0-- FLOOR PLAN t,PR j 6 2019SHEET NO: 1 9 r i TOWN OF SOUTHOLD TRUSTEES Lu 0 0LMM_ U LU Z —ILL —11-11— . .l..-L -JIJI— UJ " O H - O H I O J a z W a W UJ a E A S E LE V A T I A 0"k lok", im %j K i . vi E L EVAn"I"I U00", N J SCALE: 1/4" = l' -O" SCALE: 1/4" = l' -O" o� z rl og � A c� a• M � F O W —j• w z 3 t a z w W• U N LL1 0 Q N Le) W• N2M H � cn cn PROJECT NO: 1902 DRAWN BY: NS CHECKED BY: DATE: APRIL 16, 2019 SCALE: 1/4" = 1'-0" SHEET TITLE: WIEST ELEVATIONN SCALE: 1/4" = l' -O" SCALE: 1/4" = l' -O" BUILDING ELEVATIONS ` 1 SHEET NO: APR 2019 TOWN OF SOUTHOLD TRUSTEES Michael J Do President �QSVFF©( c Town Hall Annex John M. Bredemeye -u ;Vice-President - �o 54375 Route 25 Glenn Goldsmith ` y a ' P.O Box 1179 A.Nicholas KrupskiMr Southold,NY 11971 Greg•Williams Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: /)9 2 'SS Completed in field by: 6. Co I SM`A Samuels & Steelman Architects on behalf of 4000 GPBB,LLC requests a Wetland Permit for the existing 3,292sq.ft. two-story dwelling with screened porch; remove and replace existing windows and 'doors; remove existing 240sq.ft. entry deck; construct new dormer additions on south roof-remove existing dormer and replace with 596sq.ft. dormer, on north roof-new 200sq.ft. dormer addition; new 68sq.ft. entry porch; remove existing 850sq.ft. gravel parking area and curbing; remove seven existing trees; plant ±18 new evergreen trees; remove existing stepping stones from porch to stair at bank;-new 658sq.ft. stone.terrace and stepping stones on grade adjacent to dwelling; new 250sq.ft. stone walkway to entry; new 20'x40' gunite swimming pool; new 1,315sq.ft. stone pool terrace; new 4' high pool enclosure fencing and gates (280 linear feet); new 4' high gate at existing stair at bank; and for the two (2) existing A/C condensing units. Located: 4000 Peconic By Boulevard, Laurel. SCTM# 1000-128-6-2 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 V Wetland Coastal `Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N, Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: /J. Bredemeyer M. Domino G. Goldsmith �N. Krupski `v G. Williams . Other y `" • �� I-I' ♦ ,tot 0-6 • ► r UO e• t' • SOOO . .�. . .112119 Aqo. 1'..-atm � �. •� ~ - , � F PV! Of JfI r i •. • ^— A� `- 6 / 12 / 2019 15 : 02 >> i • `i r , t_ v {, _ - ��I� �% , `.lir - y (� � s • �1� 6 / 12 /2019 4.15 . 0 2 .►` .111G P•B,LLC yv� _ 111 ' • • r '��" -1� . " •' fF t' • � 1000-128-6-2 •yam, - +� �l '. _ _ ., i /19 a .t ' ..4 J. ` �'. ; •,� `, ow r. W AL I ' AI ♦ ` is a` � I �«'• y+l� �� '�'I,�i . `� �. .' i t 'w. } I '• � f •1 `may .-New York State Department of Environmental Conservation Am Division of Environmental Permits, Raglan One Iloilo Building 40-SUNY,Stony Brook,Now York 11790-2356 MW Pna+mi(831)444-0403 a FAX:(631)444-0363 ' Website:www.decstate ny.us Erin M.Crafty Gicner hof N u&d1d2a.-Mdol l Miands im October 9,2003 M8. Barbera Kelsey P.O. Bose 405 3700 Pec—,mis Say%tilftasM. Wttitudc,NY 11952 Re: Kelsey Properly 4040 Peewic Bay Boulevard MattltucK NY 11952 DEC#1-4738-03200/00031 Dear ire.Kelsey. Bead on the infennatlon you have submitted, the New York State Department of Environmental Conservation has determined that: . The portion of your propertywhich is located landward ofa functional and substantial man-made structure (a burl) greater than 104' in length, constructed prior to $120177 as shown on Aerographles Photograph#65-1890, Is beyond the jurisdiction of Artlde 25{Tidal Wetlands). TherSfiirie.In 6c&rd ri*wi1h-ti7S 6xint Tidal`Wetlands Land Use Regulations(OWORR Part 861)no permit is required underthe TWaf Wedands Act, Please be advised,however,that no construction, sedimentation,or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary,as indicated above,without a permit. It is your responsibility to ensure that all necessary precat frions are takan to provent any sadmantaGon or odiher altaraUon or disturbenos to the ground surface,or vegetation within Tidal Wetlands jurisdiction which may result from your project. Such precautions meyindude maintaining adequateworkarea•bebrwn the tidal wetland jurisdictional boundary and your prujod(i.e.a 15'to 20'wide construction area)or er+eding a temporary fence.barrier.or hay bale berm. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. Sincerely, Gkorao W. Hera-mart Permit Administrator cc: SMHP William A. Kelsey file o ' , ,.. - r f t' . ,.. .... -.... ...._^ams... If zt Zt 41 K , Mehta — view looking north — March 2019 � ls Y j x x .t Mehta — view looking south — March 2019 a � x _ t n Mehta — view looking northeast — March 2019 may. ,f• d 1 U � _ F� _ *�' ,��.- K_-�}� k'• ?�`� � tet, �' ,� Mehta — view looking west — March 2019 �i y r v Mehta — view looking east — March 2019 less PROPERTY w—60 SEE SEC.NO.,se N, app I-TCH Z FOR PCL No. SEE SEC.NO. SEE WC.NO. 7 _WC 12x425 17A4.) 2 '0 FMPCL No 1Y 2 is IIA 14.3 13 11A U3 13 ".1 IA 4V 112152 5 lei 2 i 1A I a 17 .6 is 5 SCALE -100� 5 12 6 a9 2t 1A.) NOTICE COUNTY OF SUFFOLK C SOUTHOLO SECTION NO 1E E Real Property Tax Service Agen G Cy y In 1]a 128 EGoun,Gnw NYttWt m NA 1000 D P PROPERTY IMP OFFICE LOCATION: ��OF O �® 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 a® ®IyCOU 9� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To. Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: June 14, 2019 Re: LWRP Coastal Consistency Review for 4000 GPBB,LLC SCTM# 1000-128-6-2 - Samuels & Steelman Architects on behalf of 4000 GPBB, LLC requests a Wetland Permit for the existing 3,292sq.ft. two-story dwelling with screened porch; remove and replace existing windows and doors; remove existing 240sq.ft. entry deck; construct new dormer additions on south roof- remove existing dormer and replace with 596sq.ft. dormer, on north roof-new 200sq.ft. dormer addition; new 68sq.ft. entry porch; remove existing 850sq.ft. gravel parking area and curbing; remove seven existing trees; plant±18 new evergreen trees; remove existing stepping stones from porch to stair at bank; new 658sq.ft. stone terrace and stepping stones on grade adjacent to dwelling; new 250sq.ft. stone walkway to entry; new 20'x40' gunite swimming pool; new 1,315sq.ft. stone pool terrace; new 4' high pool enclosure fencing and gates (280 linear feet); new 4' high gate at existing stair at bank; and for the two (2) existing A/C condensing units. Located: 4000 Peconic By Boulevard, Laurel. SCTM# 1000-128-6-2 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 on the new submittal and my assessment, the proposed action is recommended as INCONSISTENT with Policy 6.3 of the LWRP. 1. Pursuant to § 275-3. Findings; purpose; jurisdiction; setbacks of the Southold Town-code, the Boards'jurisdiction and setback are incorrectly shown on the survey. The setback was measured from the bulkhead and not the top-of-bank. 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 y Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O.Box 1179 Southold,NY 11971 Telephone(631)765-1889 Fax(631)765-1823 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., June 12, 2019 the following recommendation was made: Moved by John Stein, seconded by James Abbott, it was RESOLVED to SUPPORT the application of 4000 GPBB, LLC for renovations and additions to an existing dwelling, new swimming pool and terraces. Located: 4000 Peconic Bay Blvd., Laurel. SCTM#128-6-2 Inspected by: James Abbott, John Stein Vote of Council: Ayes: All Motion Carried p S11FF`R,�_ Michael J. Domino, President �o�o c0el Town Hall Annex John M. Bredemeyer, III, Vice-President o 54375 Route 25 Glenn Goldsmith P.O. Box 1179 A Nicholas Krupski y Southold, NY 11971 Greg Williams mol , c � Telephone (631) 765-1892 Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUSTEES TO: SOUTHOLD TOWN BUILDING DEPARTMENT RE: VERIFICATION OF BUILDING DEPARTMENT PERMIT REQUIREMENTS - �-Z SCTM#: J28 Property Owner Name: 6f 8f Date Sent to Bldg. Dept: The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated below: YES NO Will the proposed project require a Building Permit? Will the proposed project require a variance determination from the Zoning Board of Appeals? Will any part of this application be considered a Demolition as described under Town Code? COMMENTS: Ngan4eoReviewer Date 'Z� SO°��. - - b Michael J.Domino,President Town Hall Annex S =� �-- ,��r- John M.Bredemeyer III,Vice-President ' }:} 54375 Route 25 rr P.O.Box 1179 Charles J.Sanders �„ Southold,New York 11971 Tenn Goldsmith �i` •� 4 1 G �` ,. ,� y { Telephone(63 ) 65-1892 7 Fax(631) 765-6641 A.Nicholas Krapski BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application Administrative Permit Amendment/Transfer/Extensi,�gRn ��JJ Received Application: T X/ Received Fee: $ 2S0e =Completed Application: , 6 Incomplete:• APA 2019 SEQRA Classification: Type I_ Type II_ ' Unlisted Lead Agency Determination: Coordination:(date sent): _7"_LWRP Consistency Assessment Fo CAC Referral Sent: 5, Date of Inspection: Receipt of CAC Report: Technical Review: Public Hearing Held—�: L�- Resolution: Legal Name of Property Owner(s): 4000 GPBB, LLC Mailing Address: 220 Riverside Blvd., Apt. 45a, New York, NY 10069 Phone Number: 917 846-6250 Suffolk County Tax Map Number: 1000-128-0r 0? Property Location: 4000 Peconic Bay Blvd, Laurel, NY (If necessary,provide LILCO Pole#,distance to cross streets, and location) AGENT(If applicable): Nancy Steelman, Samuels and Steelman Architects Mailing Address: 25235 Main Road, Cutchogue, NY 1'1935 Phone Number: 631 734-6405 • co- ��q Board of Trustees Application GENERAL DATA Land Area(in square feet): 47,436 sq. ft. Area Zoning: R-40 Previous use of property: Residence - Single Family Intended use of property: Residence - Single Family Covenants and Restrictions on property? Yes X No If"Yes",please provide 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 of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes X 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.? X Yes No Does the structure(s)on property have a valid Certificate of Occupancy? X Yes No Prior permits/approvals for site improvements: Agency Date -D.EC - KIJ Oct. 9 2003 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes,provide explanation: Project Description(use attachments if necessary): See Attached METRA RESIDENCE 4000 Peconic Bay Blvd., Laurel NY SCTM# 1000-128-06-02 PROJECT DESCRIPTION (within Trustees Jurisdiction) Renovation to an existing two story year round residence and screen porch (3292 sq.ft) Remove and replace existing windows and doors Remove existing entry deck (240 SF) New dormer additions south roof- remove existing dormer and replace with new dormer (596SF) north roof- new dormer addition (200 SF) New entry porch (68 SF) Site Improvements and Additions Remove existing gravel parking area,& curbing (850 SF) Remove seven existing trees Plant 18 +/- new evergreen trees Remove existing stepping stone from porch to stair at bank New stone terrace and stepping stones on grade adjacent to House (658 SF) New stone walkway to entry (250 SF) New 20'x40' gunite swimming pool New stone pool terrace (1315 SF) New 4' high pool enclosure fencing and gates (280 LF) New 4' high gate at existing stair at bank 2 Existing AC condensing units Hoard of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations; Renovations and addi ions tc an Pxisfing residence, new Swimming Pool and Terraces. Area of wetlands on lot: o square feet Percent coverage of lot: p Closest distance between nearest existing structure and upland edge of wetlands: 58' feet Closest distance between nearest proposed structure and upland edge of wetlands: 116' feet Does the project involve excavation or filling? No X Yes If yes,how much material will be excavated? 178 cubic yards Swimming Pool How much material will be filled? o cubic yards Depth of which material will be removed or deposited: 4'-8' feet @ Pool Proposed slope throughout the area of operations: 1% Manner in which material will be removed or deposited: backhoe 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): NONE 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -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 4000 GPBB, LLC Name of Action or Project: Mehta Residence Project Location(describe,and attach a location map): 4000 Peconic Bay Blvd., Laurel, NY 11948 Brief Description of Proposed Action: Renovations and additions to an existing residence, new Swimming Pool and Terraces. Name of Applicant or Sponsor: 4000 GPBB, LLC Telephone: 917 846-6250 E-Mail: SBINDER@GMAIL.COM Address: 220 Riverside Blvd.,Apt. 45a City/PO: State: Zip Code: New York NY 10069 J-- IDoes the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval- Southold Town Building Permit, New York State DEC, Suffolk County Dept. of Health, and Southold Board of Trustees 3.a.Total acreage of the site of the proposed action? ---1TQ89_acres b.Total acreage to be physically disturbed? —_0-06 acres c.Total acreage(project site and any contiguous properties)owned 1.089 or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. [I Urban ❑Rural(non-agriculture) []Industrial ❑Commercial Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland 'Page 1 of 4 Y 5. Is the proposed action, �^_ NOYER N/A a.A permitted use under the zoning regulations? ❑ _ _ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: ❑ rul 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 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: ❑ L__I 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ 11.Will the proposed action connect to existing wastewater utilities9 NO YES If No,describe method for providing wastewater treatment: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? b.Is the proposed action located in an archeological sensitive area? ❑ 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO Y 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. Id tify the typical habitat types that occur on,o�are likely to be found on the project site. Check all that apply: horeline ❑Forest guicultu.aal/grasslands ❑Early inid-successional Wetland ❑Urban Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State ou Peder al government as threatened or endangered? �j� [:]- 16. 16.Is the project site located in the 100 year flood plain? lNO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a. Will storm water discharges flow to adjacent properties? � El C'j NO []YES j b.Will storm water discharges be directed to established conveyance systems(runoff and st drains)? If Yes,briefly describe: ❑NO EYES ------------existing gutters/leaders to catch_basins__ Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: _ 1 19. 1 las the site of the proposed action or an adjoining property been the location of an active of closed NO YES solid waste management facility? If Yes,describe: 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/s�p r name: ane Steelman, Agent---,- Date:4A(,A-i SignatuVV r f_ Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? _ 3. Will the proposed action impair the character or quality of the existing community? E 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or p�} affect existing infrastructure for mass transit,biking or walkway? 9� 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 J private water supplies? b.public I 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, I`1i waterbodies,groundwater,air quality,flora and fauna)? �I 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 n/ ❑ problems? E0 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. 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 environrnenta7p;ts. Town of Southold-Board of Trustees t�[ Name of Lead Agency ==.M,�ww Date Michael J. �R�>IIgl1 _ President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer greRo �Ofiin Lead Agency Signature of Prepaier(if different from Responsible Officer) PRINT Page 4 of 4 Board of Trustees Application AFFIDAVIT Sarah Mehta (Member) 4000 GPBB, LLC BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR-REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF aiZ f i. , 20 ,030A M� 09boo�� Nota blic� _ �o1Y `y0 Notary P o Q � 0 O� r ® m co 6dti ��Q� God G�� KI"GS Board of Trustees Application AFFIDAVIT Punit Mehta (Member) 4000 GPBB, LLC BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND.ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF r>' I ,20 C 1 Notary Public AMANDA PARISI ALVAREZ Notary Public -State of Nev York N0 OIAL6349019 Qualified in New York County My Commission Expires Oct 11, 2020 Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) (Member) I/We, Sarah Mehta of 4000 GPBB, LLC , owners of the property identified as SCTM# 1000- 128-06-02 in the town of Laurel ,New York,hereby authorizes Nancy Steelman Samuels & Steelman Architects 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. jv� 441 Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS_�DAY OF /.���/� L ,20_1_T Notary Pu lic W30-0 09boo� y0 • m c r A 0 dbti O KINGS Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) (Member) I/We, Punit Mehta of 4000 GPBB, LLC , owners of the property identified as SCTM# 1000- 128-06-02 in the town of Laurel ,New York,hereby authorizes Nancy Steelman Samuels & Steelman Architects 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 41' SWORN TO BEFORE ME THIS `" DAY OF Apr/l , 20 C Notary Public AMANDA PAR ISI ALV AREZ Notary Public State of'New York NO. 01AL6349019 Qualified in New York County My Commission Expires Oct 11, 2.020 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold s Code of Ethics prohibits conflicts of interest on the part of totun officers and emnloyees.Tlic ntimose of this form is to Vrovide information which can alert the town of possible conflicts of interest and allow it to take whatever action is f iiecessary to avoid same. 4000 GPBB, LLC (Sarah Mehta) ! YOUR NAME: ; (Last name,first name,jpiddle 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 eniployee of the Town oi'Southold? "Relationship"includes by blood,nlarriage,or business interest."Business interest"means a business, including a partnership,in which Elie town officer or employee has even a partial ownership of(or employment by)a corporation in which the town of icer or employee owns more than 5%of the shares. NO X YES � 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 applicarit/agent/representative)and the town officer or employee.Either check E 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 or the corporate stock of the applicont (when the applicant is a corporation); B)the legal or beneficial owner of any interest in anon-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 f O day of �ti1 �— 20 9 Signature_�� Print Name Sarah Mehta Form TS 1 r APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide inforination which can alert the town of possible conflicts of interest and allow it to tale whatever action is necessary to avoid same. YOUR NAME: 4000 GPBB, LLC (Punit Mehta) (Last name,first name,4piddle 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 I 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'Gown of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a paitial ownership of(or employment by)a corporation in which the town otlicer or employee owns more than%of the shares. YES NO X I 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 youiseif(the applicaitdagent/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%o f the shares or the corporate stock of the applignt (when the applicmit 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 SubmittedAis, ID ay of ARIL 20A Signattu•e Print Name�PUni Mehta Form TS 1 I APPLICANUAGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of S uthold's Code of Ethics prohibits conflicts of interest on the part.oftown officers and cm1219yees.The PuKRose of this fqrqj is to provide information which can alert the town of nossible conflicts of interest and allow it to take whatever action is necessary to avoid same. ' Nancy Steelman YOURNAME: (Last name,first name,ipiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicatti the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of of Zone Coastal Erosion Approval of plat Mooring 1 Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,paredt,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, including a partuership,in which the town officer or employee has even a partial ownersitip of(or ertiploymeni by)a corporation in which the town officer or employee owns more than 5%ofilic shares. YES NO X i 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/agenUrepresentative)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): E A)the owner of greater than 5%orthe shares or the corporate stock of tite 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 Signature _ Print Nam _Seel.Cllag Form TS 1 0 ®e ® coIii } i 1 r - - s •- • o -e • '• i e • YDK�DSI? HSIH1 S3 •LA ssL:;N@ 1194 Iro epk . - x 1, ' IM Certified Mad Fee c ` O eta 1{�j• i e l M Certified Mad Fee t JU XPi �� e 1 Er $ C3 $ ! Extra Services&Fees(checkbox,add Qr Extra SBNices&Fees(check box,add tee te) �.. ❑Return Receipt(hardcopy)' []Rel Receipt(hardcopy) _ $ ( O ° tr E]Return Receipt(electronic) Q�•y�f,L� nen G. `po�tfila_rk, ❑Return Receipt(electronic) $ G osta � -t�1 I C3 ❑Certified Mall Restricted Delivery _r 1>J D c Her; 0 ❑Certified Mail Restricted Delivery $ ! ,,Hererd p ❑Adult Signature Required Atm--�` N,�. .00 []Adult Signature Required $ "� O ❑Adult Signature Restricted Delivery []Adult Signature Restricted DeliveryQ L-1 Postage 1 • G� • ., O Postage .,- _ $ —— ._.bili &�- $ `� Total Postage and Fees a Total Postage and Feesq 06/�16I2C�19 06�ti6� G19 $ 7 �� Sent To Ln Sent To �.� �w' "C 5:`° v 1 o8ti-Eidellow------------------------------- 3605_Great_Peconic_Bay-�Blv-d--------_ Street andApf.l1(o., ox o. Street and Apt.No.,orP -7-5,Gxante_5prings Road _v 3605-Great 31- -- ---------------------------------- I c ry sr�ra,'ziP+4� g --- z'P+41 - Laurel, NY 11948 York Town Heights, NY 10598 M. 1 1 0 111•I _ rt"I ®s ® I m_ ®. 0 ca 7. . ,,c rED Mn J�50- j+12 3 5 i'm Certified Mall Fee $3.50 Q� 1, d9 w i(cheek bax,add res ® Extra Services&Fees(checkbox,add tee as ) y to ❑Return Receipt(hardcopy) $` ❑Return Receipt(hardcopy) $ ( t/�G� trtlark CD zr ❑Return Receipt(electronic) $ /�f� Post( ' "� I ❑Return Receipt(electronic) $ �✓' O Qft,'hf1 �f Here, ® Certified Mali Restricted Delivery $ l ❑Certified Mail Restricted Delive $ �7� I ®y ED� []Adult Signature Required ry $— �(�I— (,r'f.v % r3 ❑Adult Signature Required $ G��y�Q v� ❑Adult Signature Restricted Delivery $ 'r J�'/'` j ❑Adultsignature Restricted Delivery$ J' �(� 9r, '� C3 Postage sl.Jl7 613/���y,Q, 9��f1 O Postage $1.Jia C°> ' ��' ii���lfifL�llq .0 $ C1fl� iij'1nita© Total Postage and Fg@� A I 0 Total Postage and F ` _ _ 0 /.btu .fl0'— - - v senrro aure Cntry�Est�Prop Owners+ Sent To- _ �= _ - -=' `----------- 3 ,a Steven &Ellen BushmaA- I N§treetandApENo.;ot $'OX 407 '� ' 7 Street andApLlVo.,oiPbB� S Great Peconic Bay_Blvd_ City State,ZIP+4®------ - - ------ City State,ZIP+4® -�,aLlrel; 1x948 Y aurel NY 11948 e 1 111•1 —J � - eB B 11 all• -_ i PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: rL- STATE OF NEW YORK COUNTY OF SUFFOLK residing at being duly sworn, deposes and says that on the day of , 20 , deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at , that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this Day of , 20 Notary Public I'l 4000 GPBB,LLC 1000-128-6-2 4000 Peconic Bay Boulevard Laurel, NY (certified mail, return receipt) 128-6-3 x*x**** xx*x**** (3850 Great Peconic Bay Blvd) Laurel Cntry Est Prop Owners PO Box 402 Laurel, NY 11948 128-6-1 *xxx***** ***** (4030 Great Peconic Bay Blvd) Munier Leon L Jr c/o Alan Fidellow 75 Granite Springs Rd York Town Heights, NY 10598 128,3-22 ********xx **** (3605 Great Peconic Bay Blvd) Robinson Sherwood Robinson Barbara J 3605 Great Peconic Bay Blvd PO Box 342 Laurel, NY 11948 128-3-13 *** xxxx*x*x**** (4025 Great Peconic Bay Blvd) Bushman Steven Bushman Ellen 4025 Great Peconic Bay Blvd Laurel, NY 11948 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL.RECEIPTS Name: Address: 4000 GPBB,LLC 220 Riverside Blvd. Apt . 45a New York, NY 10069 AGENT: Nancy Steelman Samuels & Steelman Architects 25235 Main Road Cutchogue, NY STATE OF NEW YORK COUNTY OF SUFFOLK Nancy Steelman , residing at 25235 Main Road, Cutchogue, New.. York ,being duly sworn,deposes and says that on the r., of ,Tune , 20_U_, 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 No-ces were mailed at the United States Post Office at Cut ehogue, NY , that said Noti s were mail to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this (o Day of ��/ , 20 t °LAUREN M MCI(ISSI M FLIAY P4JB- STATE OF I+�W YORK yo.011CA342308 Notary Public in Suffolk Coin* y mission Expires May 23,2020 r� o SOFFac�- Michael J. Domino,President �Q Co Town Hall Annex John M. Bredemeyer III,Vice-President �� s G�f 54375 Route 25 Glenn Goldsmith ro 0+ a P.O. Box 1179 A.Nicholas Krupski �p 'E Southold,NY 11971 Greg Williams 4,- p�• Telephone(631)765-1892 Grp Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of 4000 GPBB, LLC COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING THIS FORM IS TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR AT LEAST SEVEN DAYS PRIOR TO THE PUBLIC HEARING DATE A/ T Af it/ , residing at/dba S, ^ye,/ 4-S� era/.�i�✓ �i�7�U7� a-s�-3S Nl���� �dw Cu�ooyam, it/le being duly sworn, depose and say: That on the 1 l day of Tvy,�_ , 2011, I personally posted the property known as qO o-o E 1066, L- 4-C , ,5CT NI ti!'= /o o o - / z V — 6_ 2- by 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, June 19, 2019. Dated: /,7. e Sworn to before me this I V day of J u0✓e 201 LAUREN M MCKISSICK NOTARY-P,UBPOTATE OF NEW YORK No.01MC6342306 Notary Public Quali ed in Suffolk County My Commission Expires May 23, 2020 3•. COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ 'ar"plete items 1,2,and 3. A. Signat � r> ■ ,PPrint�your name and address on the reverse X '•_� �' so'that we can return the card to you. 7 re e ■ Attach this card to the back of the mailpiece, B• Received by(P ted Name) ¢ C. Dat et filV or on the front if space permits. WWW ii a l 1.Article Addressed to: D. Is delivery address different fro ? ❑Yes If YES,enter delivery address b W. `�ppp � •i c Q OZ;0. G. c c m E l� Steven &'Ellen Bushman ❑❑ ❑i 3 4025 Great Peconic Bay Blvd. • f (� r =H= c c y U Laurel, NY 11948 o a¢ g co co¢ l / � 0111313 ❑❑� o / II �I�lal ISII ISI III IIII II I IIII II IIII II II I I III 3. Service Type ❑Priority Mail Express® ❑ • -. �i ... Adult Signature 11RegisRegistered MaiITM+ � � �•O`p � '�••• ❑Adult Signature Restricted Delivery ❑R istered Mail Restricted • `O 2 ? 0 2 9590 9402 4651 8323 1389 78 10 Certified Mail® !E 02,1,s4ted �, o ❑Certified Mail Restricted Delivery ❑Retum R�elpt for ,> v m o .o n^ ❑Collect on Delivery Merchandise y,_ , I.-Article-Number_(fransfecfrom_service label) ❑Collect on Delivery Restricted Delivery ❑Signature Confinnation"M a v cc.• d ❑Insured Mail ❑Signature Confirmation v u Z it 7 015 0 6 4 0 0 0 0 4 9 0 3 8 8 8 3 4 ❑Insured Ma l Restricted Delivery Restricted Delivery __- — (over$500) aDi y m P eSoo- PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt v} `o`o • ass:! o Eft-_,❑�d d X m 6 8lv4co i ai❑ ❑[t1v 00 I SENDER: COMF;LETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY In C:) N m ■ Complefe mems 1,2,and 3.- ' '"' A Si ature �_ t Qrn „� ED o0 ■ Print your name and address on the reverse , ❑Agent I ar o E Co ® � a ❑ ddr ssee I �` ar o — CO iO o so that we can return the card to you. o � Z r Received by(Pr/nte Name) C. Dat of D livery c-0 '612 9 �'' ® � 2•m 6 r_3 - ■ Attach this card to the back of the mailpiece, N•° = � CV �.. F. or on the front if space permits. (� y m _" S Y 3 � ® cr) y..�' Z' N U U i 1. Article Addressed,to:— -- --- D. Is delivery address different from item 1? e v= CL ® � o .•.- n. If YES,enter delivery address below: ❑No m= L I a x ® Ln `': r Sherwood&Barbara J. Robinson N »� o b C° w o - c' o a (U -1 d y o a 3605 Great Peconic Bay Blvd. E "= o 9-.o O Box 342 - Laurel, NY 11948' I m o a -o Ln o M ='*o co ' a >. 5 F� L� i� ® � Z co L r)II I IIIIII IIII III I III IIII II I IIII II III III I III 3. Service Type ❑Priority Mail 13 ilTm @ U li ron ¢ o dT ¢ M LL ❑Adult Signature ❑Registered MaiIT"" I O ❑Adult Signature Restricted Delivery ❑Re$Istered Mail Restricted 111111 111111 _ ai r- p� 9590 9402 4651 8323 1389 85 0 certified Malla Delivery Cl Certified Mall Restricted Delivery ❑Return Receipt for I -- -- -- - - ❑Collect on Delivery Merchandise li 2. Article Number(Transfer from service label ❑Collect on Delivery Restricted Delivery ❑Signature Confirmation""+ ❑Insured Mail• 1:1Signature Confirmation 7 015 0640 0004 9038 81. ❑Insured Mail Restricted Delivery Restricted Delivery I (over$500) PS Form 3811,July 2015 PSN 7530-02-000-9053 _ Domestic Return Receipt ilOTICE HEARIiIG 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: 4000 GPBB, LLC SUBJECT OF PUBLIC HEARING : For a Wetland Permit for the existing 3,292sq.ft. two-story dwelling with screened porch; remove and replace existing windows and doors; remove existing 240sq.ft. entry deck; construct new dormer additions on south roof-remove existing dormer and replace with 596sq.ft. dormer, on north roof-new 200sq.ft. dormer addition; new 68sq.ft. entry porch; remove existing 850sq.ft. gravel parking area and curbing; remove seven existing trees; plant ±18 new evergreen trees; remove existing stepping stones from porch to stair at bank; new 658sq.ft. stone terrace and stepping stones on grade adjacent to dwelling; new 250sq.ft. stone walkway to entry; new 20'x40' gunite swimming pool; new 1 ,315sq.ft. stone pool terrace; new 4' high pool enclosure fencing and gates (280 linear feet); new 4' high gate at existing stair at bank; and for the two (2) existing A/C condensing units. Located: 4000 Peconic By Boulevard, Laurel. SCTM # 1000-128-6-2 TIME & DATE OF PUBLIC HEARING : Wednesday, June 19, 2019 ® at or about 5 :30P. M . If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours of 8 a.m. and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 Town of Southold LWRP CONSISTS,NCY 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 snaking 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 si ' �icant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supportim! 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# 128 - 06 _ 02 PROJECT NAME Mehta Residence The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 0 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: Renovations and additions to an existing residence, new Swimming Pool, and Terraces. Location of action: 4000 Peconic Bay Blvd., Laurel, NY 11948 Site acreage: 1.089 acres Present land use: single family residential Present zoning classification: R-40 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: 4000 GPBB, LLC (Sarah Mehta / Punit Mehta) (b) Mailing address: 220 Riverside Blvd., Apt. 45a, New York, NY 10069 (c) Telephone number: Area Code( ) 917 846- 6250 (d) Application number,if any: none Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No 1:1 If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure,makes beneficial use of a coastal location,and -minimizes adverse effects of development. See LWRP Section IH—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No E3Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria 7 Yes ❑ No 11 Not Applicable There is no historic or archeological structures on property. Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria 0 Yes ❑ No ❑ Not Applicable Building structure is in keeping in style and scale of neighboring stuctures. Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No ® Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No ©Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section HI—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ ❑ Not Applicable Yes No Not Applicable No development will take place in the "protected" or"natural indigenous environment Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages.32 through 34 for evaluation criteria. ❑ Yes [-] No[I Not Applicable The development will not add pollutants into the air. Attach additional sheets if necessary Policy. 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LVVRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No © Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. Yet No 0 Not Applicable No public land involved. Littoral access unimpeded. Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No D Not Applicable There are no public or commercial activities or uses on site. 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. ❑ Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No 0 Not Applicable Vere iso agricultural lands on site. Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No ❑ Not Applicable The construction will be using equipment approved by the Federal government for energy usage. The project will meet Federal standards for conserving energy "energy Star Program". PREPARED gy Nancy Steelman TITLE Architect DATE (o S A M U E L S & S T E E L M A N April 9, 2019 Board of Town Trustees Town of Southold P.O. Box 1179 6th9 t �� I Southold, NY 11971-0959 RE: Mehta Residence 4000 Peconic Bay Blvd., Laurel, NY TAX MAP # 1000-128-06-02 Dear Board of Trustees, We are requesting a WETLANDS PERMIT for the above reference property. For your review we are submitting the following documents (original and three(3) copies): 1. Completed application with project description 2. New York State DEC Letter of No Jurisdiction 3. Short Environmental Assessment Form 4. Owner Authorization Form 5. Agent Authorization Form 6. Agent & Owner Transactional Disclosure Forms 7. LWRP Consistency Assessment Form 8. Photographs of subject area 9. Survey of property in current state 10. Site Plan and Floor Plans and Elevations 11. Application Fee - check for$250 Please call us with any questions or concerns. Sincerely, SAMU S & ST MAN ARCHITECTS ncy Ste man, Principal Architect enclosures ARCHITECTS 25235 MAIN ROAD CUTCHOGUE,NEW YORK 11935 (631)734-6405 FAX(631)734-6407