Loading...
HomeMy WebLinkAboutTR-9554A Michael J. Domino, President `,�o�s�fFO( .Town Hall Annex John M. Bredemeyer, III,,Vice-President ,f"_ 54375 Route 25 Glenn Goldsmith c w ,?A P.O. Box 1179 A Nicholas Krupskiy o�")' Southold, NY 11971 Greg Williams � 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 '/Z constructed When project complete, call for compliance inspection; r f Michael J.Domino,President S0 Town Hall Annex John M.Bredemeyer III,Vice-President ,`O� yOIO 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski cn G @ Telephone (631) 765-1892 Greg Williams �O �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9554A Date of Receipt of Application: August 13, 2019 Applicant: David & Carmelina Levy SCTM#: 1000-31-14-9 Project Location: 12860 Main Road, East Marion Date of Resolution/Issuance: October 16, 2019 Date of Expiration: October 16, 2021 Reviewed by: John M. Bredemeyer, III Vice-President Project Description: Reconstruct existing 12'x25' wood deck and a proposed at grade 35'7"x30'4" brick patio with 6'x6' outdoor shower. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the project plan prepared by Patricia C. Moore, Esq., received on August 13, 2019 and stamped approved on October 16, 2019. Special Conditions: None. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. L This is not a determination from any other agency. Michael J. Domino, President Board of Trustees LEVY RESIDENCE 25'-0" 12860 MAIN RD . EXIST. DECK EAST MARION NY EXISTING: SINGLE FAMILY RESIDENCE ,7 SCTM# 1000-31 - 14-09 . ....... ZONE R-40 .57 ACRES ......... ....... . 13 2019 AUG ---------------- --------------------------- PROPOSED: ----------- ------------------- ADD 696 SQ. FT. IN GRADE MASONRY PATIO ............................. ........... ......................... ............. ---------------------------- ADD OUTDOOR SHOWER ----------- ----------------------------------------- O LJ ------------ ---------------------------------- --- ------------------- LLI EkEXIT. FIREPLACE FRAMING ------------------- --------------- - ----- -----­------.......... ­­­- --------__--------------_------------- -­­------------------------------ ----------- ..........-----­----------­-------------------------- .................­­­............ ................ 41 I ............... 4 4 4 N-GRADE' ONC. PATIO 0 LINE OF ROOF.OVERHANG -- ----------- ------ ---------------------------- ------ -- -------- EXIST. DECK W/ ........... -- - ------------------- ROOF OVER --- R --- 13-61' ---------------- -- . ---------- _2------------------------------------------------------- GENERAL NOTES 4 1. All work shall conform to the requirements of the Residental Code of New York State, County and Town Department Regulations, Utility Company requirements and best trade practises. 2. Before commencing work the Contractor shall file all documents required by the Building Department, pay all fees required by local agencies and obtain all required permits. 3. The Contractor shall visit the site and verify all dimensions and the existing conditions affecting the work prior to construction. Any discrepancies which would interfere with the satisfactory completetion of the work described herein shall be reported to the architect or property owner. Do not start work until such conditions have been examined and a course of action mutually agreed upon. Failure to notify the owner or architect of unsatisfactory conditions will be construed as an acceptance of the conditions to properly perform the required work. 4. All work is to conform to the drawings and specifications of the architect and engineer consultants. 5. The Contractor is to maintain a complete and up to date set of plans on the job site at all times 6. The drawings are not to be scaled under any circumstances. Ll 7. It shall be the Contractor's responsibility to ascertain all prevailing procedures including storage and toilet facilities,protection of existing work to remain,access to EXISTING DECK & PATIO PLAN work area, hours of permitted work,availability of water and electric power and all other conditions and restrictions for this particular location in order to execute the work in a careful and orderly manner with the least possible disturbance to the public. 1 /4" 1 '-0 1 . 22 . 19 8. The Contractor shall make the neccesary arrangements to utilities and services temporarily disconnected while performing the work as required. 9. The Contractor shall provide all dimensions and cut-outs for other trades. '10. The Contractor shall provide proper shoring and bracing for all remaining structure prior to removal of existing structure. 11. Plumbinig, electrical, HVAC and similar work shall be performed by licensed persons who) shall arrange for and obtain all required inspections.The General EXIST. DECK Contractor shall be responsible for scheduling all other inspections as required. 12. The Contractor is solely responsible for construction safety and shall hold the owner and architect harmless from litigation arising out of the Contractor's failure to provide construction safety means and methods. r ti 0 L- _T_ I.- - -h._[_... _-.-:- . ..... . ...... ............. ........ U) I -T------7--1--- CONSTRUCTION NOTES e i i -- - T T ___T _1 T_-1 T----- ------F _1--- T_ __F -T- I- I- 11__ � - --A 7-- ----------- - T--- ----- ------- 1. All footinOs shall rest on undisturbed soil at a minimum of 36" below fin, grade. ------ ........--- --- 2. Poured Concrete shall have a minimum psi of 2800 at 28 days unless noted. X iLu L 7 -T-j 3. Sill plates shall be preserved, treated wood and be installed above a 16 oz. TIO copper termite sheild. NEW IN-GRADE BRICK PA F- T I . ........ J 4. Shingle siding shall conform to ASTM D 3679 and be installed in accordance -I- ------ --1-A------ ---------- --- .................. with the INew York State Building Code and manufacturers specifications. 5. Pilings shallbe installed by a licensed contractor to a depth and bearing agreed EXIST. WOOD FRAMED DECKi 1 ------------­ upon by an engineer and certificates shall be issued stating same. LT� ---------- NO CHANGES f 6. Unless otherwise noted all framing and structural wood components shall be -- -----._l__ T- ; I I #2 or better Douglas Fir. T -T T 7. All framing techniques and methods shall be as prescriptive design based on LU AF&P Wood Frame Construction Manual for One and two Family Dwellings (WFCM) T I --- -- ---------- _-F _7 __T_ specified in 8301.2.1.1 U) —-------------------- 8. All buildling envelope components shall comply with Chapter 6 of the Energy X _ --_7F 7 UJ EXIST. FIREPLACE FRAVING Conservation Code of the State of New York. . ....... 9. Fireblocking shall be provided in all wood framed construction in accordance -T- with NYS Code R 602.8 to form an effective fire barrier between stories and between the top story and roof space. 10. Protective panels shall be provided for glazed openings in accordance with NYS code 8301.2.1.2 if they are required. -- — — — — — — — — 0 ---------- - ------------F_ IF-- 11. All portions of the new structure are designed to comply with local geographic ­ -- -- -- -- --- --------------- ------ and climatic criteria as stated in the following table. F I -TIF T GEOGRAPHIC & CLIMATE DESIGN CRITERIA ---- -- ----- - ----- GROUND SNOW LOAD 45 psl L I 1-J, L_ ------- WIND SPEED 130 MPH ---------- ----- --------- r____ -r- -7 L -------------- SEISMIC DESIGN CATATGORY B FROST LINE DEPTH 36" _-L. TERMITE THREAT MODERATE TO HEAVY EXIST, WOOD FRAMED DECK DECAY SLIGHT TO MODERATE T WINTER DESIGN TEMPERATURE 11 L) NO CHANGES --T L-1 i FLOOD HAZARD AS NOTED L--- t L t. =[- I __ __ r -7 PATIO PLAN 6 ___LT1-Itvv ------------- I SCALE AS NOTED JANUARY 2019 r. ------ CUTDOOR�_! ---I. 0 NSW -_T I_ 5� .1 41 -,r SHOVER 0 A oress 5� Lu L TA OKa A 10 6 r permits I drafting I expediting I PROPOSED PATIO PLAN PO BOX 49 SOUTHOLD NY 1197 I �L L I L I =L�E _____7 T __T __F F- T T =7 T 1 /4" 11-011 1 . 2 2 . 19 JOAN CHAMBERS 631-294-4241 SURVEY OF PROPERTY '•,amu .* 'goo SITUATE g,0 �,� �`�� � ORIENT �1`� ' ''• .;;: •: ° sem. TOWN OF SOUTHOLD 1�Q' \ `� '`'• �� �, o I SUFFOLK COUNTY, NEW YORK Too t \ S.C. TAX No. 1000-31-14-09 SCALE 1"=20' • .P + SEPTEMBER 26, 2017 \ ' • FEBRUARY 15, 2018 ADD CZM LINE I t 1 / ,•,' N]°YF •.. ,�°.�• �Q, * �' I AREA = 23.266 aq. it. L , r / ,�;• •• •••• 9 A! fm Ta umo 0.534 ac. i I , AUG 1 3 2019 00•, `,•' , • y 1 •• "; t + i Scutho!d Town ;� DAVID I. LEVYCERT/FLIED To: B of Trustees 1'•' a.•, •+•.',''� N�' Q V. CARMELINA LEVY \ •: ,, �Y �a CHICAGO TITLE INSURANCE SERVICES, LLC . • ' !' APPROVED BY 6`QB®ARD OF !RUSTEES A* �ap . TOWN-OF SOUTHOLD DATE ' \ 1>+Hj / ��� rAfrJ9m W ACtdaWatwmlAS EVAMM TIIC Iw1.W1 Dry'01 1 ma nc law Tela aun V]la NYS U. No SN67 n YY yy,y�p„p AI.]WtON a IWItIOY l'7j 1,� '`(YV RC dl]�KaM MOI�YOfitt�TA1E lP mucAlm LWINathan Taft Corwin III TN9�ry rm rwwa Land Surveyor el]c IE A V Rha 0 (�(VT..'�'• I � M. mvwem N=00 Ntraw swu aw n My PO w Ism twv m Suenwa To Staahfr J YaWM1 J1.LS JorrGA A Inaegro LS 1� V nmOr ta TAM O�NOT]N.B ID" riff.9mry+—Aftki oln— Sb Plum— Cm Uvcbm lywf PIUME(631)727-2096 Fax(631)727-1727 TNT.WMN"or ROM to WAY OFFICES LOCATED AT Kuwc A6tWES5 jrurbom 15as Main PO B..to /NOT uE� M dmn Nn York 116.7 J...J..."14em mA �NYM 119+7 I �I 1 Michael J Domino, Pr( nt �QgOFFQ(k r "Town Hall Annex John M. Bredemeyer III, Vice-rresident ��� G�� `"" 54375'Route 25 Glenn Goldsmith P.O.Box 1179 co ze A.Nicholas Krupski Southold,NY 11971 Greg Williams ��®1 �p! Telephone(631)765-1892 Fax-(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: qAY /y:-`0 Completed in field by: V- Patricia C. Moore, Esq., on behalf of DAkQ CARMELINA LEVY requestsan Administrative Permit to reconstruct existing 12'x25' wood decposed at grad 135'7"x30'4" brick patio with 6'x6' outdoor shower. Located: 12860 Main East Marion. CTM#: 1000=31-14-9 Jn tL'r�' �41M 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 o earing 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 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:. An J � 101( I have read & acknowledged the foregoing Trustees comments: Agent/Owner. Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams 'Other tM" '��! �f may:..".+ii"��•.s:�' � 1 +1 r 111 • .5 LEVY k� r 12860 MAIN ROAD EAST f MARION SCTM- 1 000-31-14-9 Al- r-7c. C � n �wly� � - -UT-T .. Fw rs .i Ift ML 106 ..d '� f Yv .a t•S w LEVY 12860 MAIN ROAD EAST MARION SCTM. 1000-31-14-9 _T° 11 IV a W, m'. IF f - - x+ LEVY y, ary 12860 MAIN ROAD EAST MARION �ySCTM- 1000-31-14-9 X ! M Inbox(3,760)- betsy.moore765 X I M Gmail - Re:12860 main road e- X P 12850 Main Rd -Google Maps X P Southold, NY-Official Website rw.google.com,`maps/place/1286i3+Main+Rd,+East+Mai ion,T NY+-11939/(4=41.1303602,-72.32811S8,143m/data=!3rnl!le3!4m5!3m4!lsOx89e8ald680ca8a81:1 )orred From © Workspace Login ws. FedEx,S)Tracking rd Office Supplies,Offi... Southold, NY-CA... E Home @ Suffolk Count;_CHS... jo Town c �C;ose __. https://www.facebook.com/photo.php?fbid=1021901841099416'/&set=a.1020, t Marion, NY • 1 LEVY 12860 MAIN ROAD EAST / � 1 MARION SCTM' 1000-31-14-9 ► , RJ, i L' Ing FOW F 97 4. Board Of Southold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. 0.7, DATE: 14ay 26, 1999 ISSUED TO ..JOHN.. T.... SICA Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance en- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS-." and in accordance with the Resolution of The Board adopted at a meeting held on .Alay.. 26,. 1.999 19 99 and in consideration of the sum of $ 150..09 paid by JOHN T. SICA of East. N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Wetland Permit to construct a single family dwelling with deck, septic system and well with condit. that a non-turf buffer from top of bank towards the bulkhead be placed. all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. C= /. . ......... ................. Trustees Town Hall Albert J.Krupski, President �;'��C � 53095 Main Road James King,Vice-President P.O.Box 1179 Cz Henry Smith i; Southold,New York 11971 Artie Foster Ken Poliwoda y oN I Telephone(616)765-1892 Fax(516)765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 1, 1999 John T. Sica 1602 Clifton St. Baldwin NY 11510 Re: SCTM #31-14-9 Dear Mr. Sica, The following action was taken by the Board of Town Trustees during a Regular Meeting, held on May 26, 1999, regarding the above matter: WHEREAS, JOHN T. SICA, applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated April 27, 1999 and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on May 26, 1999, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standard set forth in Chapter 97-18 of the Southold Town, Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approves the application of JOHN T. SICA to construct a single family dwelling with deck, septic system and well, with condition that a non-turf buffer from top of bank towards the bulkhead be placed. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency which may also have an application pending for the same or similar project. Permit to construct and complete project will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. FEES: None Very truly yours, Albert J. upski, A. President, Board of Trustees AJK/djh cc. DEC Dept. of State Health Dept. 7--7---T- 7T- 4—e M SEE SEC.0 —C No 622 UNE MATCH LINE UNE 9 a4O1MATCH -Z-———— FOR PCL NO S SEE SEC NO S - - 'i! � 022L3-01812i ITA ola 1,112 8A(.) lm 32 sc�' IS i. MAIN �yw 6 1=4o3 4 iai Ti -"s: 23A gio2 I! j,i B0.0 VA 1111 td, y1Pl3 % 2A 44 % Cf su,'roIX cou- 45 MAU O- 1131 72 % 11A FOR PCL No SEE SEC No Ci- 19. If" MARION LAKE 66 dcW ' e Al 2— MARION LAKE R]R PCL NO m 14 .4 TOYIHOFSOIJTH SEE SEC N ni— W 2&3 I.]A FORIPCLN I IA SEE SEc No % % 136 3M s 2 UNE I —0 m K SOUTHOLD SECTION NO NOTICE COUNTY OF SUFFOLK E p Cy (21) Real roperty Tax Service Agen y 031 max muw ,s m I—E A O's—11 1000 P PROPERTYMAP Al 7' OFFICE LOCATION: ®��OF MAILING ADDRESS: Town Hall Annex ® P.O. Box 1179 54375 State Route 25 Southold,NY 11971 (cor. Main Rd. &Youngs Ave.) ems Southold, NY11971 ® Telephone: 631765-1938 ® Fax: 631765-3136 lyc®UNTY,� 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: October 10, 2019 Re: Local Waterfront Coastal Consistency Review for DAVID & CARMELINA LEVY SCTM# 1000-31-14-9 Patricia C. Moore, Esq., on behalf of DAVID & CARMELINA LEVY requests an Administrative Permit to reconstruct existing 12'x25' wood deck and a proposed at grade 35'7"x30'4" brick patio with 6'x6' outdoor shower. Located: 12860 Main Road, East Marion. SCTM#: 1000-31-14-9 The proposed action has been 'reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the action is INCONSISTENT with the below listed Policy Standard and therefore is INCONSISTENT with LWRP. 6.3. Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. According to Town records, the structures were constructed without obtaining Board of Trustee review or regulatory permits. 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 rj1 Town Hall Annex Michael J.Domino,President 54375 Route 25 John M.Bredemeyer III,Vice President �J P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas KrupskiCA � Telephone(631)765-1892 Greg Williams COU Mi' Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only _Coastal Erosion Permit Application Wetland Permit Application ewt!�rntl R005,z - _Administrative Permit — Amendment/Transfer/Extension ��' Received Application: Tgpq Received Fee: $ 100.00 Completed Application: •iq Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): ,,LL =LWRP Consistency Assessment Form Sent: ! CAC Referral Sent: D Date of Inspection: b- •/ 1 Receipt of CAC Report: AUG 13 2019 Technical Review: Public Hearing Held: /6• T Resolution: Seuthr,,d o�+n Boar afhusiee� Owner(s)Legal Name of Property(as shown on Deed): T eLI C'�rj ; , P 11 r1' �y Mailing Address: 2-0 IAU %+rjY► 'Gbpe Qt f 63-VEA 14e-nd Phone Number: 5 I to 6�` o — (o&s-3 Suffolk County Tax Map Number: 1000- 3 ( — 1 Ll — 7 Property Location: W l to Locjd r F'a S•t (If necessary,provide LILCO Pole#,distance to cross streets,and location) AGENT(If applicable): �C�-('1/ f U.�G+ Mailing Address: c� 1 0,2_0 11� 7� Phone Number: ` Board of Trustees Application GENERAL DATA Land Area(in square feet): Area Zoning: _ q0 Previous use of property: c, N c?VK �A-WjinA rfo o 0c- Intended use of property: Les de-NVC CUAA C(C" PC3t1(-) o-n Covenants and Restrictions on property? Yes ___2(_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.? Yes X No Does the structure (s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date _ AzG L9 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?__K No Yes If yes,provide explanation: Project Description(use attachments if necessary): LN(si\miA C)l o, Ic(�p,77Y(,� �;-Ob2-�t � - "ex-col*kwC�- ' x mss' wo a z-�dr Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: RQ pJCQ u _.QAC i sf 4 iq Q ,Aamd (-'"S hAvX�- h-OU0 hrt Cit i o wEn oymmr sba�rr, air Area of wetlands on lot: % 000 square feet Percent coverage of lot: / D % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: 5--D feet Does the project involve excavation or filling? X, No Yes If yes,how much material will be excavated? 0 cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: N A feet Proposed slope throughout the area of operations: c7—(G.t' Manner in which material will be removed or deposited: y1CVi'd curd 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): Novae (3c.1�Qn�rar� — fs+7�Ca4t _ fv�Fuf�e�'' i DAVID I.LEVY AND CARMELINA LEVY as owner of prenei.iN 33860 Main Road.East Marion.NY(sant: 1001W 31 14 94)restdin5at InrN im, I*!s 5A`Lr�6-"'� �� do hereby authorize our attorney. Patrwik C. Moore.to apply l'or peraut(s)and appear liefow the Southold Board of Town Trustees on guy behalf. ✓ torner's signature) David I. Levy i _esti (owner's Signature) Carutelina Levy Board of Trustees Application Count}Of Suffulk State of New York DAVID 1.LEVY AND CARMELINA LEVY, BEING DULY SWORN DEPOSES AND AFFIRMS TI IAT HEIST IE IS TI IE ?LPPLICAN7r FOR Tl lE ABOVE DESCRIBED PERA-f 1T{S)AND THAT AL L STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF IIISr'IIER 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 SOUTIIOLD TOWN BOARD OF TRUSTEES.THE APPLICANT AGREES TO HOLDTHE TOWN OF SOUTI[OLD AND THE TOWN TRUSTEES I[ARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S). IF GRANTED. IN COMPLETINGTHIIS APPLICATION,I HEREBY A(ITHORIZETHIE TRUSTEES. THEIR AGENT(S)OR REPRESENTATIVES(S).TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OFTHIS APPLICATION. AVID 1. LEVY CARMELINA LEVY Sworn ta)i1a a Ittc tlti, '`D davof` V 2019 ��``��g1ND�j�'%,; No07 3 t OO?20 kP T y Not Public %� e,:°� 23 eL I C ,'fill `Y OFA 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 l based on information currently available. if additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: - LN _ I ' U(.A'� T Lex C-vVlG..✓M e-l I nG LSU Project Location(describe,and attach a location map): Brief Description of Proposed Action: �z,4 w at- Name of Applicant or Sponsor. Telephone: Dl.v`ca' ( L Ov t «tACl CCLV ff, tW(J E-Mail: Address: 9-C) rI/I S )- City/PO: State: Zip Code: 1` y 1' S �� 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that Er F-1 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: 3.a.Total acreage of the site of the proposed action? r acres b.Total acreage to be physically disturbed? U S acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? s 5� acres 4. Check all land uses that occur on,adjoining and near the proposed action. F]Urban E3 Rural(non-agriculture) ❑Industrial ❑Commercial Residential(suburban) ❑Forest ❑Agriculture El Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 it 5.' Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ ❑ b.Consistent with the adopted comprehensive plan? El � El 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: F1 M 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES 010 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: Ntt� 0 ❑ 10. Will the proposed action connect to an existing public/private water supply? r NO YES If No,describe method for providing potable water: �V 0 ( ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: �J� ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? �,�//f M ❑ b.Is the proposed action located in an archeological sensitive area? [J ❑ 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ❑ b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? 1 E]If Yes,identify the wetland or waterrcJ_body and extent of alterations in square feet or acres: 1 P23 VJAJrtj 14. jqpdtify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: Shoreline El Forest ❑Agricultural/grasslands El Early mid-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 or Federal government as threatened or endangered? ET ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? [ZNO DYES U ❑ b.Will storm water discharges be directed to established conveyance systems(rano and storm drains)? If Yes,briefly describe: ([V ❑YES Page 2 of 4 I 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: 0 ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: [f ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsorname: Date:_ ✓ 'rz`( Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part I 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 1. Will the proposed action create a material conflict with an adopted land use plan or zoning El 1-1regulations? 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? Eld 4. Will the proposed action have an impact on the environmental characteristics that caused the Elestablishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ affect existing infrastructure for mass transit,biking or walkway? 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: ❑ I ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? El Page 3 of 4 -a I i 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 a problems? 11. Will the proposed action create a hazard to environmental resources or human health? EL Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 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. ElCheck this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. ❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Prepare (if different from Responsible Officer) PRINT Pase 4 of 4 r � i Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Z. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be mlaine,d in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website(southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# -�3 ( -I- 9 PROJECT NAME The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1=1 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: ce tlschyd- ne-i'i 91"1 a rnLLi,r) 6vt Gl CA c� a�,sr Lca-di- W't �„ (l�GQ1�Vtie (Y1i t; N Location of action: 1 Z C) 1 n Site acreage: QHS 0 Present land use: Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: >OVVI-d -T u Lj, a-Rd Oa v (b) Mailing address: 2-±s &A e yyl cviq �Iiq (c) Telephone number: Area Code la S °— 6 p (d) Application number,if any: r Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No 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. Poster a pattern of development in the Town of Southold that enhances community character, preserves open space,makes efficient use of infrastructure,makes beneficial use of a coastal location,and minimizes adverse effects of development. See LVVRP Section III—Policies;Page 2 for evaluation criteria. [O'Yes ❑ No ❑ Not Applicable LVW cvce Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Polic- s Pages 3 through 6 for evaluation criteria ❑ Yes F-1NoNot Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No [kNot Applicable Attach additional sheets if necessary 19ATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies PrMot through 16 for evaluation criteria F] Yes ❑ No Applicable r 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 u Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ D/ Yes No /Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the 'Town of Southold. See LNW Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ No Not Applicable 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 E 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 ffi—Policies;Pages 38 through 46 for evaluation criteria. ❑ YeA0 No Not Applicable Attach additional sheets if necessary 7 1 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 gNot Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town wat rs. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. El Yes El 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 MNot Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; P es 65 through 68 for evaluation criteria. ❑Yes ❑ No Not Applicable PREPARED BY �G — TITLE s, DATE �'��� LEVY RESIDENCE 12860 MAIN RD. EAST MARION N" EXISTING SINGLE FAMILY RESIDENCE SCTMA 1000-31-14-09 ZONE R-40 57 ACRES 7 = Z.- PROPOSED - ADD 696 SO FT IN GRACE MASONRY PATIO DD OUTDOOR SHOWER =671 -n T GENERAL NOTES EXISTING DECK&PATIO PLAN 1/4" 1'-0" 1 22.19 V CONSTRUCTION NOTES E D:C_ gfl_eITe= e b,-(Ck- P,50-11 A4- e-j _G.E=PHIC&CLIW.IE DESIGN CRITERIA iL PATIO PLAN )c 6, SCALE AS NOTED jANUARY 2019 PROPOSED PATIO PLAN 1/4" - l'-O" 1 22 19 JOAN CHAMBERS ••