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HomeMy WebLinkAboutTR-9576A Michael J. Domino, President Town Hall Annex John M. Bredemeyer, III, Vice-President 54375 Route 25 Glenn Goldsmith c N ,?k P_O. Box 1179 A Nicholas Krupski3 y Southold, NY 11971 Greg Williams �01 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 Y2 constructed When project complete, call for compliance inspection; Michael J.Domino,President soUry Town Hall Annex 54375 Route 25 John M.Bredemeyer III,Vice-President h0 l0 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 M� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9576A Date of Receipt of Application: September 30, 2019 Applicant: Sandra L. Fellman SCTM#: 1000-123-4-13 Project Location: 2850 Deep Hole Drive, Mattituck Date of Resolution/Issuance: November 13, 2019 Date of Expiration: November 13, 2021 Reviewed by: Glenn Goldsmith Project Description: Replacement of 266sq.ft of decking on existing deck. J Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by Donald G. Feiler, Architect, dated October 4, 2019 and stamped approved on November 13, 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. This is not a determination from any other agency. _ � 1, - Michael J. Domino, President Board of Trustees r w SUR VEY OF' PROPDR1 Y , AT' 11MATTIT , - iA,pP TO WN OF SO UTHOLD S s SUFFOLK COUNTY, NEW F , , 4; BEY �� `s� `�7o'o 4000- 133-04- 13 SCALE: 1 '=40' ° 6 sN ?'p,° .` SEPT. S, 1999 Q A_ s' ea, "tom-, � ,QO- ``,CgP'��p � � `� � � � ,�` • SEP 3 0 2019 e� soutllold.Totivn /ez Board of Trustees �(d / -A Certified to: Sandra L. Fellman Commonwealth Land Title' Insurance Company 70,99-2264 S, tot C7 '0 'r' rV AREA - 26,900 .sq. ft. �' s ox\N to tie lite N. Y.S. L,/,C, NO, 4.9618 ANY ALTERATION OR ADDITION TO THIS SURVEY 1S A VIOLATION , �f' 9 ORS, P C. OF SECTION, 7209 OF THE NEW YORK STATE EDUCATION LAW — 020 EXCEPT AS PER SECTION 7209—SUBDIVISION 2 ALL CERTIFICATIONS HEREON ARE VALID FOR THIS MAP AND' COPIES THEREOF ONLY•IF ' P. 0 C 909 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRA-VE-LER STREET- - WHOSE SIGNATURE APPEARS HEREON, SOUTHOL'D, X Y. 119.71 • •99-3+� APPROVED BY -BOARD OF I RPST�,ES TOW OE S&T061 n 0 Em B I IC DATE jvpv6m- w -1. IN, LJ OCT Southold Town �!,A__fOx2- 70 Boardof Trusses r5 r 4 "(C> ,4 T%- T f to ve p�Ctw ILI )EIC TPor_I T -Flet-i y� tRE D vra-cr,/pop,Cp 015856 tl� NE R C, �A T ell FO(A' r Michael J. Domino, Pr !nt Q CaG Town Hall Annex Off' . John M. Bredemeyer III,Vice-President �� y,4 54375 all 25 Glenn Goldsmith y P.O.Box 1179 ZLI A.Nicholas Krupski '" $° P17 Southold,NY 11971 Greg Williams 4141 Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD i Date/Time: 1 �� /I 1 z:3b Completed in field by: G. n SANDRA L. FELLMAN requests an Administrative Permit for the replacement of 266sq.ft of decking on existing deck. Located: 2850 Deep Hole Drive, Mattituck. SCTM#: 1000-123-4-13 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. eet 7. Placement of C&D materiaJ�400 feet TOP OF BLUFF: '✓ 1. Residence: 1 TO'feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 ✓ Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction 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: Seco,'a\„N_ �o� �a�d �Pc��ocec�nen� ;n k;�v)A ;c� glace . 14h- AA4-vw- I have read & acknowledged the foregoing Trustees comments: Agent/Owner: / Present were: J. Bredemeyer M. Domino '/ G. Goldsmith N. Krupski G. Williams Other 9/30/2019 Mail-Daly,Law' "utlook • .a t� - 3 i 3 i � t �a E . ,;Y vi Iq https://outlook.office365.com/mail/inbox/id/AAQkAGEyM W15ZmY5LThkM2YtNGQ3OC I iY WM3LTgxY WEOM2ZjM2YyNwAQAA%2FPJAv3%2Fn 1 AgmFjcV.. 1/l 9/30/2019 Mail-Daly,Lam —utlook 11 m"' i94 r �x ft- C4 Y https://outlook.office365.com/mail/inbox/id/AAQkAGEyM W15ZmY5LThkM2YtNGQ3OC l iY W M3LTgxY WEOM2ZjM2YyNwAQAPTdBc2T2bdMkKQZHU7K2S 9/30/2019 Mail-Daly,Lau-'- 7utlook r 1 4. ti^ �� ��, Aq 010,V, https://outlook.office365.com/mail/►nbox/id/AAQkAGEyM VA5ZmY5LThkM2YtNGQ3OC I iY VVWLTgxY WEOM2ZjM2YyNwAQAB V FzkuhBmZLg2gnLKv8UI... 1/1 OFFICE LOCATION: ®��®f S® MAILING ADDRESS: Town Hall Annex ® P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) CA 411C Southold, NY 11971 ;41% ® Telephone: 631 765-1938 Fax: 631765-3136 cou ,� 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: November 7, 2019 Re: LWRP Coastal Consistency Review for SANDRA L. FELLMAN SCTM# 1000-123-4-13 SANDRA L. FELLMAN requests an Administrative Permit for the replacement of 266sq.ft of decking on existing deck. Located: 2850 Deep Hole Drive, Mattituck. SCTM#: 1000-123-4-13 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 proposed action is EXEMPT from LWRP review pursuant to Chapter 268 Waterfront Consistency Review § 268-3. Definitions, B: B. Replacement, rehabilitation or reconstruction of a structure or facility, in kind, on the same site (inplace), including upgrading buildings to meet building or fire codes, except for structures in areas designated by the Coastal Erosion Hazard Area (CEHA) law where structures may not be replaced, rehabilitated or reconstructed without a permit and shoreline erosion control structures (including, but not limited to, groins,jetties, bulkheads, filled piers) located within Great Peconic Bay, Cutchogue Harbor, Little Peconic Bay, Hog Neck Bay, Noyack Bay, Southold Bay, Shelter Island Sound, Pipes Cove, Orient Harbor, Gardiners Bay, Long Island Sound, Fishers Island Sound and Block Island Sound(excluding all creeks); 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 If oVf 0tA-c Michael J. Domino, P dent ��o` ��y Town Hall Annex John M. Bredemeyer, iii, Vice-President __3 2 54375 Route 25 Glenn Goldsmith N � P.O. Box 1179 A Nicholas Krupski y Southold, NY 11971 Greg Williams �'0 , dao Telephone (631) 765-1892 Fax (631) 765-6641 S O UTRO LD TOWN BOARD OF TRUSTEES TO: SOUTHOLD TOWN BUILDING DEPARTMENT RE: VERIFICATION OF BUILDING DEPARTMENT PERMIT REQUIREMENTS ,.., -- la3 r SEp 3 0 2019 Property Owner Name: rE� �� i�"� q.10. O 1 -'•rt ^_'�'1S-, -^ `lam , nTr - Date Sent to Bldg. Dept: ? s,J 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 t" 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: .0; Agdna�ture4o Revi wer Date r' DiSalvo, Diane From: Charles Nafman <cnafmanl@gmail.com> Sent: Monday, October 07, 2019 9:47 AM To: DiSalvo, Diane Cc: Charles Nafman Subject: Fellman Project/Administrative Wetland Permit/2850 Deep Hole Drive, Mattituck Good morning, Diane: I dropped the application off at your office last Monday,September 30th. Don Feiler,the architect that has been assisting us, advised us to provide you with an amended project description. It is to be amended as follows: "Replacing 266 sq.ft. of decking." Kindly confirm receipt. Please advise should you require any further information. Many thanks, Charlie Nafman ATTENTION:This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. ig-sotl'o Michael J.Don Town Hall Annex Domino President firek. 54375 Route 25 John M.Bredemeyer III,Vice-President q, -1 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Ira skiTelephone(631) 765-1892 Greg Williamsj�,, Fax(631) 765-6641 OU BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only E t Ez Coastal Erosion Permit Application Wetland Permit Application -Administrative Permit LI 1 SEP 3 0 2019 Amendment/Transfer/Extensio Received Application:- - 4, 3d Q Received Fee: $ 106,00 - Completed Application: rLqf T:g,L�s Incomplete: SEQRA Classification: Type I Type H Unlisted Negative Dec. Positive Dec. -Lead Agency Determination Date: Coordination:(date sent):_ ­LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: Receipt of CAC Report: Technical Review: :ZPublic Hearing Held: Resolution: Owner(s)Legal Name of Property(as shown on Deed): sw\ Mailing Address: 3 M Phone Number: � \-v S� 19 1 Suffolk County Tax Map Number: 1000 - Property Location: 1OL4*1 , AC, NIN aU� (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT (If applicable): Mailing Address: Phone Number:- Board of Trustees Appli_ tion GENERAL DATA Land Area(in square feet): - Area Zoning: �� Previous use of property: Rtg 0(-e KA— Intended use of property: ern _ Covenants and Restrictions on property? Yes No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? A,YesNo If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes",please provide copy of decision. Will this project reqgey demolition as per Town Code or as determined by the Building Dept.? _Yes1. o Does the structure (s) on property have a valid Certificate of Occupancy? zyes .No Prior permits/approvals for site improvements: Agency Date SSS _ 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: . _ - - - S UCS D Project Description(use attachments if necessary): � � � Board of Trustees Appli tion WETLAND/TRUSTEE LANDS APPLICATI®N DATA Purpose of the proposed operations: 1�;*t1)j> D4xt,3eJ'JC. Area of wetlands on lot:_ ( 2 coo(--t) square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? X No Yes If yes, how much material will be excavated? — cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: — feet Proposed slope throughout the area of operations: — Manner in which material will be removed or deposited:,, Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): 61 Z20 Append&B Slzort Environmental Assessment Form JCnslrud ons for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Ns I -Tlon1 of_ t STi06 vf�-CK PO F-C H Name of Action or Project: Project Location(describe,and attach a location map): 28 5c) 1C)oa? �_Vo Vte_ 1010,L J M t , I� Brief Description of Proposed Action:, '(Z���tSC� Cn•r-,c�'� lS-T t 111z6Cs IN Co x v t-7-wt--wS C PPG'-T ►k�tcz,4 ) N IOd S�P Po�1' 1�)�5. Name of Applicant or Sponsor: Telephone: S 1 E-Mail: S 0 L • �-�nA to5GF 54A0, MaTH Address: ® 0 � 1�` -4�1-r I��- �ci City/PO: State: Zip Code: -N N ( l 1521 -I.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 © F] 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: ❑ 1 50 -1-►k<-"L-,o TO I ►,p I CJ 6 DV_-V4 - Mtw - bd ILo1d6 3.a.Total acreage of the site of the proposed action? ®. (o acres b.Total acreage to be physically disturbed? O acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? O (P acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑industrial ❑Commercial ,KResidential(suburban) El Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page I of 4 '5. Is the proposed action, : NO YES N/A a.A permitted use under the zoning regulations? ❑- ® ❑ ' b.Consistent with the adopted comprehensive plan? ❑ 6. is the proposed action consistent with the predominant character of the existing built or natural NO YES' landscape? rI❑= KJ 17. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: ® i,❑ 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? nn 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: 10. Will the proposed-action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: 11.Will the proposed action connect to existing wastewater utilities? NO YES- If No,describe method for providing wastewater treatment: 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic -NO YES Places? r , b.Is the proposed action located in an archeological sensitive area? '-❑' - ❑' 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: -❑ f f - - 14. Identify 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 ❑Early mid-successional ❑ Wetland El Urban XSuburban 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? '71 �❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create stone water discharge,either from point or non-point sources? NO YES If Yes, a.Will stone water discharges flow to adjacent properties? ❑NO DYES '� ❑ b.Will-'form water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: DNO DYES 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: 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: ( ❑ 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 t Applicant/spo e: ar L� c/l. Date: Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the,following questions in Part 2 using the information contained in Part l 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 regulations? ❑ '2. Will the proposed action result in a change in the use or intensity of use of land? 'El [3- 3. Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that caused the El of a Critical Environmental Area(CEA)? S. Will the proposed action result in an adverse change in the existing level of traffic or El 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? ED 7. Will the proposed action impact existing: ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? L M 8. Will the proposed action impair the character or quality of important historic,archaeological, El�i architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date it President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer ,f Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Board of Trustees Apply `tion AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS THAT 41EISHt 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. ?"ature of Prope Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF_ I�yvJ� ;20 o g' CHARLES N AN y,b Notary Public,S ata of New York No.31- 71 4444 �u�lified in i� w tori;County is Commission Expires APPLICANT/AGENT/RE PRE,SET�'�t TIVE TRANSACTIONAL DISCLOSURE.FORM lfie 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't jprovide information which cawalert the town of possible conflicts-of mterzst and allow tt-to take whatever action is necessary to avoid same. YOUR NAME: (Last name,first name,.r1tiddle 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 vti lth,any officer ore�iiployee of the Town of Southold? "Relationship"includes by blood,marriage,,or business:interest."Business interest"aiteans a busincss; including a partnership, in which the town`officer or.employee has,even a partiahotivnership of(or employment by);a corporation in which the town officer.or employed ownsmore tham5%,of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person . Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the,shares of the corporate stock oFthe;applicjtnt (when the applicant is a corporation); 8)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 Submitte�this4�1 � of 9 20// Signature Print Nam Form TS 1 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1: All applicants for permits* including Town of Southold agencies, shall complete this CCAF .for, proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed.action will be.evaluated as; to -its. sii .beiieficialariii,adverse-effects;upon tliecoastal3�area�wluch:includes'.alloFS'outliold'Towri). - 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, vaeh-,answer must-'b,e:_exnlained--in detail;-listing-botht`sunnortina.and'_non 5iitiportin�;'facts. If an action cannot be- certified as consistent with the LWRP policy standards and conditions,:it sh'alI-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# l-o o_o_ -_ ;,3 _ o - .13 PROJECT NAME �.Pa�r1�101 Y1�a I dg c CZ-- The-Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital construction,planning activity, agency regulation,land transaction) (b) Financial assistance(e.g. grant,loan, subsidy) (c) Permit,approval,license,certification: Nature and extent of action: V ' P � 1 l Location of action:- -L JO {�(� Oi E , N ATI ruy=' , - Site acreage: __ �•6 - __ _ _- 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,: Sly (Z� �..• t—M Q,� (b) Mailing address: 3 ) �Q.C., • �S �$t IVy N Y 10613 (c) Telephone number:Area Code O 11 s 6 6 . 919 1- (d) _(d) Application number,if any:. f Will the action be ' ectly undertaken,require funding,or approval by a state or federal agency? Yes '0 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. 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 LVV" Section III—Policies; Page 2 for evaluation criteria. 0 Yes Q No Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LVVW Section III—Policies Pages 3 through 6 for evaluation criteria Yes '� No Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWAP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No KNot Applicable Attach additional sheets if necessary NATURAL, COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria '0 Yes ,0 No of Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of,Southold. See LWRP Section ffi —Policies Pages 16 through 21 for evaluation criteria ,❑ Yes 0. No - of 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 eva ation criteria. F! ❑' Yes No 1' Applicable 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 fo evaluation criteria. a Yes O No Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wast s. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. .Yes .0 No of 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. j '(eo No of Applicable Attach additional-sheets if necessary 1 WORKING COAST PG_JES 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 Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ 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. Cl Yes Cl. No Dl,Xot Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; ages 65 through 68 for evaluation criteria. Yes ❑ No E&Not Applicable PREPARED BY TITLE 0 W n DATE