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HomeMy WebLinkAboutTR-9622A Glenn Goldsmith,President Qf SO!/jTown Hall Annex Michael J. Domino,Vice-President ,`O� Old 54375 Route 25 P.O.,Box 1179 John M.Bredemeyer III l [ Southold,New York 11971 r A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �� �� Fax(631) 765-6641 COUNT'1,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1685C Date: February 7, 2020 THIS CERTIFIES that the as-built construction of 6'x6' landing with.steps; 4'.x5' addition to existing deck; installation of open outdoor/exterior shower attached to existing house with plumbing lines connected to main house service with a 4'x4' base at grade with drainage connected to new drywell; remove the 11 2'xl8"high step adjacent to concrete patio and fill in at grade; and for the 2'l 0"x4.5' HVAC enclosure; ' At' 15 Stliifiarie,Srnithold= ' Suffolk County Tax Map#1000-76-1-1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated August 13, 2019 pursuant to which Trustees Administrative Permit#9622A Dated,January 15, 2020, was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the as-built construction of 6'x6' landing with steps; 4'x5' addition to existing deck; installation of open outdoor/exterior shower attached to existing house with plumbing lines connected to main house service with a 4'x4' base at grade with drainage connected to new dr_ywell• remove the 11.2'x 18"high step adjacent to concrete patio and fill in at grade; and for the 2'l 0"x4.5' HVAC enclosure. The certificate is issued to Fernando & Maria Villa owners of the aforesaid property. u o ' Glenn Goldsmith,President �q SU!/ry Town Hall Annex Michael J. Domino,Vice-President 01 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III l l Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 oC UNN I BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: INSPECTED BY:' t " Ch.,275 Ch. 111 INSPECTION SCHEDULE Pre-coristruction; haybale line/silt-boom/silt curtain 1St day of construction % constructed Project complete, compliance inspection COMMENTS: CERTIFICATE OF COMPLIANCE: Glenn Goldsmith,President *QF SU(/TTown Hall Annex Michael J.Domino,Vice-President ,`O ��� 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III J�[ Southold,New York 11971 A. Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �� i0 Fax(631) 765-6641 �y4OWN,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 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-construcilobh,"h�* baffle linelsiltbbo'm/silt curtain 1 st day of construction Y constructed When project complete, call for compliance inspection; Glenn Goldsmith,President ``�QF,SUUT�, _ 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 Greg Williams 0 �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9622A Date of Receipt of Application: August 13, 2019 Applicant: Fernando & Maria Villa SCTM#: 1000-76-1-1 Project Location: 15 Sun Lane, Southold Date of Resolution/Issuance: January 15, 2020 Date of Expiration: January 15, 2022 Reviewed by: Greg Williams, Trustee Project Description: For the as-built construction of 6'x6' landing with steps; 4'x5' addition to existing deck; installation of open outdoor/exterior shower attached to existing house with plumbing lines connected to main house service, with a 4'x4' base at grade with drainage connected to,new drywell; remove the 11.2'x18" high step adjacent to concrete patio and fill in at grade; and for the 2'10"x4.5' HVAC enclosure.. 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 survey prepared by Peconic Surveyors, P.C., last dated December 27, 2019 and stamped approved on January 15, 2020. 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. _�� 4" Glenn Goldsmith, President Board of Trustees SURVEY OF N LOTS- 1 & 2 , MAP OF WEST CREEK DEVELOPMENT' GREE FILED JULY 6, 1937 FILE NO. 1236 oos" G 50 55, AT BA YVIEW TOWN OF SOUTHOLD f WOOD SUFFOLK COUNTY, N. Y. W x -T%E ,�� WOODEN 1000-76-01-01 2.3'WI. /L 0 03°� 'ava�` "O LOT �u,�' LO ' AUGSCA. 23, 1990, , Or c`Oi ;a o „�w TM W 000� � 2'+ GONG.GOVER o� 0 DECEMBER 27, 2016 PAF LOT E h JANUARY 17, z� T ZONE AE co• 2019 (CER7IFICA T10NS) Z =l is 1 Oj PO (EL•6 FEET) MARCH 21, 2019 (REVISIONS) v: woo w LL2N coNc•cov� _ __ JULY 29, 2019 U& C 2 �6'.i �� A�Ls oN 4' RING o o,— SEPTEMBER 25, 2019 (WOOD DECK REVISED) Co�0a F •6 • ZawooD o WOOD �'SO X '� OCTOBER 18, O Q k v� A�� 2019 (WOOD DECK REVISED) •P �" N$a6 STOOP f 44 2 �/ DW. CONNECTED �+► DECEF_MBER 27, 2019 (DRYWELLS ADDED) DECK RY � ice'TO TO ROOF GUTTER O M. 4� DOWN SPOUTS. �[l►` a �--� 1—S wµµ M.H.W.M, DOT. i�c� 4 4' , FR- HOU5E /n 7° / OUT. m WOOw TOP DANK C\ !A i SHWR IM; 442' 3O V• U n WOOR D s- - - -- - - 0� DECK p RANTING 40, Opb ,yGRADE �- HEAT JAN 1 0 2020 �� 1 � STONE + TIM EDGE PUMP WOOD $� 1 GRAVEL � I O�iO '��/PIPE OVE,IZEp N7 .ARiING `WOOD ONE "x.. FENCE • C�w_,. - �m j RAG OOD 9 45 50 AT RA YE SO X 4' DEEP DLUESTONE DW. CONNECTED PAVERS ON TO ROOF GUTTER- GRAVEL 95.00' WAS, �p DOWN 'SPOUTS. ROW OF 4"X4" PLfWTINGS, M OO DUT SSHWR DRAINS WOO O.CO� TIMBER EDGE S79'45'S0»E ` LANA 45.00' � U.N / �6�A55��t'UNpd jl�iD ,:APPROVED BY • = PIPE :"-BOARD OF i RUSTEES OF L ■ = MONUMENT CERTIFIED TO= 'TOWN OF 'SOUTHOLD FERNANDO A VILLA ash Ia FLOOD ZONE5 FROM FIRM 36103G0166H MARIA VILLA DATE " 7 5EPTEM6ER 25, 2009 CONTINENTAL AE55TRACT LLG - TAu�A'R`� 15� Zp20 AM TRU5T TITLE I N5URANGE COMPANY PATRIOT ONE MORT&AC�E f5ANKEK5, Lf ANY AL7ER477ON OR ADDI77ON TO 774/S SURVEY IS A VIOLA770N . •4roAb . LIC. NO. 49618 OF SECTION 7209OF 7HE NEW YORK STATE EDUCA770N LAW. PECONI Int P.C. EXCEPT AS PER SEC77ON 7209—SUBDIVISION 2. ALL CF_RTIFICA7lONS (631) 765=5 FAX (631) 765-1797 HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF AREA-6,733 SQ. FT. " ' P.O. BOX 909 SAID MAP OR COPIES BEAR 7HE IMPRESSED SEAL OF 7HE SURVEYOR to TIE LINE 1230 TRAVELER STREET WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N.Y. 11971 190-267 BUILDING DEPARTMENT / SUBMISSION / 000000 000000 000000* /, EEK 0E51 Coll) Q C A300,00F / SEE DETAIL PAGE NORTH ELEVATION SK-01 07/01/19 A300 18-0 1 levisfon Date EXISTING WOOD No. PLATFORM WITH STEPS METAL DOORS ACCESS TO MECH• BASEMENT EXT. WOOD STOOP AND STAIRS DW B NEW WIND - - - - 1 $/8/201 1 0 UP A30D 9 TRUSTEES PERMIT SUBMISSION 4R NEW WOO - - - ...... 0 • -_ A LANDING -- - - Existing Wood --- °ZD � A3Q0 I'I Rear Deck to remain - --- - 003 - NEW SLIDING - - - NEW NEW SLIDING LASS / I; -GLASS DOOR u DOOR 12'X6' 4 -2g' -- - - -- " ... - 3 2X4 X4 WINDOW_ (3) 2X4 - o - 51" " i - (3) 2X4 POT „ POST_ POST - - - - -- POST • 4 tit-D 9- ' -- -- -- .. 12-D - - 2' 1" --- - ---6'-0" - 1'-10/ SO " 34'-2' co EADER o cu 1 3/4 X 5 j • W-1 .1 �, ;�, 1/2- LVL HEADER • NEW WINDOW LV LVL HEADER NEW BARN M / SD 6'-0"X5'-2° 104.3 (2)1 3/4"x5 1/2" -•� DOOR l �� Zo LVLH ADER RELOCATED Din1n room EXITING WOOD I � / E EXISTING WOOD 103 FLOOR TO BE I NEW BLUESTONE /E\ A300 (3) 2X4 POST STOVE REMAIN NEW POCKET I FLOOR OVER A300 Livin q Room �-► DOOR 24 X80" EXISTING • ARCHITECT: E-1-04-1 NEW WALL CONCRETE " _ Bedroom 1 �,, o FERNANDO VILLA �I �� �\ 101 r' 1_ o¢ T — T 26-39TH STREET • in �n +1 � � NEW EXITING WOOD I t t --J f, WALL Q UEENS, Y 11369 N ;PATIO ' FLOOR TO REMAIN $ 9 86 New Reconfiew L JL JL Igured pQ5 Kitchen d d d Bathroom ATGRADE villafernando5@gmaii.com 102 0 • / EXISTING WOOD103.2 A300 630 0 NEW WINDOW • RAMP p " 12'-1n"/ \ I 1 NEW ELECTRICAL • _ D • 6'-0 X5'-2" T _T_ I / \ I _Z_ T PANEL - (2) 1 3/4"x5 - - -- 2" LVL HEADED ® DW ® 1 L' S T C O / EW ENTRY DOOR REF O r _ BENCH .. r W-104. - 36"X8D" � Exis'ng - - - �" -- - - w-1o3. - -- ---- - w-1oz-- - w 101 / SEP 2 7 2.019 t Sh d - 3-4 6'-0' ENTRY l2 -„- - 4 3p - -45- - 006 -_ (3) 2X4 PO 71, / • - 10'-0' - NE FLOOR/STOOP '� -- - ----- NEW " WINDOW1/ �1 - -_ W BLUESTO �i ------• - NEW INDO ------- AT GODRADE ---- - 4'-3 X2-4 PLANTING AREA 2•-6" ,-2" / - - - EXISTING DECK A 0 4 -- ON GRADE A200 ' I ' II �I-.-- .--._.--- EXISTING WOOD- _ ---- - - • 2 OUTDOOR HVAC - - - --- DECK -10 - 1 AT GRADE -- - -._ WOOD ENCLOSURE - - GRAVEL ' • o rc o -- - - j A300 o EXISTING -___ :: _ PLANTING AREA SOUTH ELEVATION zi�' • -_ Front- o '1 - Yard Q� EXISTING STONE & __ _� 001 ' o GRAVEL PARKING B A200 -- - - I- W'o0D WALKWAY [-----AT G EProposeFloor Plan Renovation / Orie t and affixBIS ` 0 job number label hereK _ ' PROPERTY CINE Project: VILLA'S RESIDENCE _= RENOVATION o i - - o 15 SUN LANE Southold, NY 11971 SUN LANE Title: AS BUILT FLOOR PLAN SEI�IG\S� �DDATE: 03/07/19 q �G (tNAN '4C PROJECT No: % DRAWN BY: C, HK BY: FV NG No: ` r- L A-101.00 1� 14 NEW� CADO FILE No: Ot I MEMO0 DECEMBER •TH 2019 LANE,15 SUN • • / NY 11971 • 1• & MARIA PHOTOGRAPHS SHOWING INSTALLATION OF ADDITIONAL DRYWELL TO CONNECT GUTTERS AND LEADERS AT NORTH EAST LOCATION AS REQUESTED BY TRUSTEES/IVIR. WILLIAMS. c�- ,v 720191i r � - � �• �, :• - � -rte' pyx.;7, -. 4. - <rI•�`4X'" iia' ♦ ~�� c=• IF P lk; PHOTO • • • y. rati,• � `�' , � ,' •i rte'' r a r f4. t r ' • • �� �`�,r� 9•'• .moi{ � a.•�� ♦ �f`,, i• may. 1 t' y •i IL 'I DEC 2 3 20]19 ' NEW DRYWELL IN PLACE WITH ALL RAIN WATER CONNECTIONS FINAL ti f. '�. b 4i• � d. .10� J '' ¢moi�•.�1+ �S�� �� INSTALLATIONDRYWELL COVEREDSOIL. Michael,J. Domino,Pre' nt O��SUFFO(�COG Town Hall Annex John M. Bredemeyer III,Vice-_i-r6 sident �� ��, 54375'Route 25 Glenn Goldsmith N P.O.Box 1179 A.Nicholas Krupski � Southold,NY 11971 Greg Williams Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in field by: FERNANDO & MARIA VILLA requests an Administrative Permit for the as-built construction of 6'x6' landing with steps; 4'x5' addition to existing deck; installation of open outdoor/exterior shower attached to existing house with plumbing lines connected to main house service, with a 4'x4' base at grade with drainage connected to new drywell; remove the 11.2'x18" high step adjacent to concrete patio and fill in at grade; and for the 2'10"x4.5' HVAC enclosure. Located: 15 Sun Lane, Southold. SCTM#: 1000-76-1-1 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 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 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: I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Br demeyer M. Domino G. Goldsmith N. Krupski G. Williams Other DiSalvo, Diane From: Fernando Villa <fvilla@maparchitects.com> Sent: Thursday, November 21, 2019 9:03 AM To: DiSalvo, Diane Subject: Re: 15 Sun Lane Southold application postpone application for permit Hi Diane, Do you think this could work: Installation of an outdoor/exterior shower attached to the existing house. All plumbing lines are connected to the main house service.The shower is open and has a 4' x 4' base at grade with drainage connected to a new dry well . M . d t a s ♦ 2 c, • r Fernando Villa AIA LEED AP BD+C Principal Magnusson Architecture and Planning PC 42 West 39th Street 15th Floor New York NY 10018 212 253 7820 x5661 t 646 783 5661 d 212 253 1276 f I 40 so Addendum Description of scope of work trustees'application Fernando Villa&Maria Villa 15 Sun Lane,Southold NY In lieu of the originally proposed wood step at the north side of the existing at grade concrete patio, We are proposing to fill it with small stone gravel as necessary to make that portion at grade. See additional notes on attached revised survey. "Wood step to be removed and replaced with fill at grade" t � .E F+ k area to be filled at grade using stone gravel SURVEY OF LOTS 1 & 2 YAP Or 'HEST CREEK DEVELOPMENT' 0100 `/_ mw JULY a 107 F71X N0.12M AT BAYVIEW WO, ,wl".11 '� TOWN OF SOUTHOLD SUFFOLK COUNTY. N.Y. 1000-M-01-01 SCALE 1-M 27. .°" e« d _.,____ .SIr TA 201➢ �� ���, __ � gam- smmEeoE 2s mro(YIOOD tta irwYUJ • uvY Your (E)Eiil[D i0 FEtWIJO Y Y 1 w V]n0WIi YEYQ J.YIl1� ,• yaw•a+ s� GOv�!! N.IMTRKi LL[. . MI}RUS• TIRE MY.1[NC((,pPYur rn�lo,ne W[TmSE eur,:rs �... pIOueo.�4µp1q.'on•s.e•rrs�wnilul HCC•C SWKKN P[ • i >z�pu�Atq•l rt•1v1�tui[m,G.mr ua AFEM6.7W 80 FT P.0 P.0 xs-solo nl.Y(en1 ms-1m Nt+•ilea oar r BSA PD➢ p .4Z tAe rw a Iw snty to TE LM OV M y'00" savnxxc,kr rrm 80—ZB7 � /' • // ' 1A it � s q - � ..fir t `' .� �, „� ... � �+ yc - J a, •o• •' . z _fit. y' G Y S . R F a 4 7 a .F 7 i� • �r �yf ..rte• ', . tl,.. �.I _ 1 h � ��"• '!�"'� •t.!Y.` ���� •i.d� ':� _� � df ' - �`.'• ice. t•. r r r , ' 4i'��„� `. i �:rte �;• .3; Iy-n 4 t•' FrT 1e6� j 3�3 fi�r}:S k� �?� '1`�i#�f •ln J 3 _ �x- . x4 . yJ�'b �4nt Yw y,M � S�Y ♦K s , �7 oV AL. £�Xl�'. CaND 1715 NOV 1 8 2019 Michael J. Domino, Preside O�QSUFFD(� Town Hall Annex John M. Bredemeyer 111,Vice-Pr.. nt y�� ` 54375 Route 25 Glenn Goldsmith N P.O. Box 1179 A.Nicholas Krupski � Southold,NY 11971 Greg Williams � dap! Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 10Aoq Completed in field by: � N FERNANDO & MARIA VILLA requests an Administrative Permit for the as-built construction of 6'x6' landing with steps; 4'x5' addition to existing deck; remove the 11.2'x18" high step adjacent to concrete patio and fill in at grade; and for the 2'10"x4.5' HVAC enclosure. Located: 15 Sun Lane, Southold. SCTM#: 1000-76-1-1 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: I 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: 44u,'- re'l"ej (( che 4 r U 124��5 tit r G✓G1&1:—�i P"—/, A � AJ- I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino f3' Goldsmith <Krupski G. Williams Other C . J,s 4, �� 5' .4, 94 '09 �v"'-� SURVEY OF LOTS 1 & 2 MAP OF v ; 'WEST CREEK DEVELOPMENT' T, R�EK FILED JULY 6, 1937 FILE NO 1236 - OSE C E�� `-f\ --�" SEP 2 7 2019 j Cl0 ��E ,- 5, AT EA YVIEW 1 So.S SO UTHOLD Southold Town ��.••-�•'' •36'36 � + q1E LINE TOWN OF Board of Trustees _ .g"L� �81 n SUFFOLK CO UNT�; N. Y. _.ter—•- '" 1, J AD Wim,,° _ 1000-76-01-01 „E SWM x _ PQE WOODEN �wKHE j 23�N h .-- -' 5�� SCALE: 1=20' o 5'Oo D N LOT �6 LOT AUG. 23, 1990 N- ,A NX s2 5; 9TEP`� 0Dq► a ® ° DECEMBER 27, 2016 24 GONC=COVER t LA�F°�M W° LOT p a� O (E 6N } JANUARY 17, 2019 (CERTiFlCA710NS) AE � MARCH 21, 2019 (REVISIONS) FEET) JULY 29 2019 L •����� °� WOOD RET. if GONC.GOVER WOOD STEP TO ° i �• a0 n �JZ s WALLS ON '}'$ 'RING AN N c0 fl� REPLA'ED D�WITH D ,009= ® SEPTEMBER 25, 2019 (WOOD DECK REVISED) W i 5p. 0 18. FILL AT Gf'ADE i� LINE OA LA at E • 5 6X6 G o `r p�oD �' �q4 V� ``$�6� CK to 0 STOOOP 44.2 ;� 1► OEGK MAv112' �fij s M.H.W.M. BOA �iM 4.� � //® y FR. HOU E ^ o,, Lug Q� TOP BANK SON D N -1 zw U 11, — 4a x p HIM 44.2' m c°,�F 'L°U w a c� ��• -zi � c� WOOD � G �- ING RADE O O / HEAT J A STONE + TIM. EDGE PUMP $ �� �GURB GRAVEL l WOOD Z° a�1// PIPE 105 PARKING \ � WOOD ONE " INCE �lr t1-O � y IERED N� WALKWAY •� �Y PINE RACK OOD 9 45'500W AT GRADE F 1 - = BLUESTONE PGRAVE ON ROW OF 4"X4" 95.00' WATER G WOOD POSTS PLANTINGS, 6.3' O.C. TIMBER EDGE S79'45150,„E - - y A� � 45.0 0, . sZ V , �DIRTJ RD • = PIPE T. T i �� , ��`✓ Cit � 1. ■ = MONUMENT CERTIFIED TO= � � FERNANDO A VILLA FLOOD ZONE5 FROM FIRM 36103G0166H MARIA VILLA 5EPTEMf-')ER 25, 2009 CONTINENTAL AP5STRACT LLC, AM TRU5T TITLE �I N5URANGE COMPANY ` PATRIOT ONE MO��T&A&E P>ANKERS, LLG , ' IC. NO. 49618 ANY AL7ERA77ON OR ADDI77ON TO THIS SURVEY IS A WOLA77ON �% OF SECTION 7209OF THE NEW YORK STATE EDUCA77ON_LAW. P . EYOR , P.C. �� EXCEPT AS PER SECTION 7209—SUBDIVISION 2. ALL CER77FICA7IONS_ A (631) -5020 FAX (631 765-1797 HEREON ARE VAUD FOR THIS MAP AND COPIES THEREOF ONLY IF AREA®O 733 SO. FT. P.O. BOX 909 - SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR �p 1230 TRAVELER STREET Q WHOSE SIGNATURE APPEARS HEREON. to 1 E LINE SOUTHOLD, N.Y. 11971 v�—��� _ I - & �r F= MAP OF 'WEST CREEK DEVELOPME FILED JULY 6, 1937 FILE T -- ?� POSE G ��l --'i" AT BA YVIEW 50.55, + ,. t TOWN OF SO UTI3'OLD Kf ° SUFFOLK COUNTY., N. Y. '7A3' ` vi 2.3V° w000 1000-76-01-01 w �`� 2.3V "' SCALE: 1'-20' jA,7A5 0�YS we T LOT AUG. 23, 1990 x W AM ham' WHO+ °' j © I cowccov� moo, DECEMBER 27, 2016 LOT / JANUARY 17, 2019 CER71FlCA71ONS Zo Z ', Z(° 'O�*� Ql / �O (EL.S F ET, ��. WOOP RE'sWALLf, ON T=Vmt 09- 6p�'`�5 46 44.2 F1'STORY M.H.W.M. 0m. 4 R. HOU5E m `- l► TOr, d1PlC o 44.2' d 3 �f WOOD frORc� �Antr►t� I l .) 5AT I O ti rrlA( STONE � � �-AnrTIN&GRADE UK ' �� PIPE �'° rARKIWEP �� f r�Al ZONE „X„ �ry toy � , wood Fv°p° � � N7g•45,50-W T^ucW - Lv o� 95.00. WA - -- S'UNLAN s,9 45'50,.E- - � � �UPN �Q jl 4s.°p' (2 RA55/DART) .�;'D> • - PIPE ■ - MONUMENT C , CERT I F I ED TOS �of NEW FEKNANDO A VILLA y ee�'MEo FLOOD ZONES FROM FIRM 36103C,0166H MARIA VILLA 5EPTEMDEK 25, 2009 GONTINENTAL LG AI35TKAGT L AM TKU5T T I TLE I N5URANGE COMPANY PATRIOT ONE MORTGAGE 15ANKEK5, LLC, 'LIC_- NO. 1 ANY AL7ERA77ON OR ADDITION TO THIS SURVEY IS A VIOLATION OF SEC77ON 7209OF THE NEW YORK STA7E EDUCA77ON LAW. PEC ( ? .C. EXCEPT AS PER SEC77ON 7209—SUBDIVISION 2. ALL CER7IFICA7IONS (631) (6311— HEREON 31; -HEREON ARE VALID FOR 7HIS MAP AND COPIES 7HEREOF ONLY IF AREA=6,733 SQ. FT. P.O. Bo ""'' SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER STREET s WHOSE SIGNATURE APPEARS HEREON. to TIE LIFE 90—,� � SOUTNOLD, N.Y. 11971 i f /$ o r f _ h r- f 15 SUN LANE, SOUTHOLD NY FERNANDO : MARIA f PHOTOS OF EXISTING DECK AND LANDING ADDITION NECESSARY TO PROVIDE EGRESS FROM INTERIOR -C�A15T►NG &"Dt GoNr•,t�t PATI 0 VIeW FrtoM rub PHOTO OF EXTERIOR ENCLOSURE FOR NEW HEAT PUMP EQUIPMENT AND AT GRADE CONCRETE PATIO E j Y r-bP-M $TW44Vh.E IV OU- ca 4PIja L4 o W Ne2- rJo -ul�vl 6£1 wv £xISTIN 6 Woo D I�sCK EXISTING BEFORE AND AFTER WOOD AT GRADE ENTRANCE (No change on existing decks only removal of non-compliant porch) 15 SUN LANE,SOUTHOLD NY FERNANDO&MARIA VILLA RESIDENCE s� ' • W * t a E' `� ���}fit A O EXTERIOR •• INTERIOR • • • • • OF WOOD •• • EGRESS AS • , BY TOWN uj © f• • :r PHOTOS OF EXISTING DECK AND LANDING ADDITION NECESSARY TO PROVIDE EGRESS FROM INTERIOR R 'l PHOTO OF NEW SAFETY STEP/STAIR AT EXSTING CONCRETE PATIO L O PRC HIT&CT O VILLA O LL �t1 W OPHOTO OF EXTERIOR ENCLOSURE FOR NEW HEAT PUMP EQUIPMENT u y f O 15 SUN LANE,SOUTHOLD NY FERNANDO&MARIA VILLA RESIDENCE `STATE OF 6 J 1 w '. h � - v � `_ _ „„w � �'S• lit, 13.1 SUN h ♦`h` iy, �;_ � ♦ �� _ ?b iei '� h h ♦h 711 h h �' `�4` I•`�J�� y h `� `_� Q' 'h Jam. •B. � CT n� Nil 11A(c) h ,♦',', h A Rom ;3 'h A K 1or.1� SOUTHOLD SECTION NO Nonce d� COUNTY OF SUFFOLK © E ------ —_ _ __" _ Real Property Tax SernceAgency r M a 076 E Md..�o.� —YL— u.,..... (Zi) . Gwnry G.m.r Rl..mae.xYttfet on o70 E•.r+.uu. M-___ ww,."�' s iy, ns " P lmcr uo t000 PROPERTY MAP N r,r b w 1J1Ngv�l1. '� w.vr --•-- wewun--vx-- mwxww�alE avm.mw SuFFoc� Michael J. Domino, P dent �o�o IceTown Hall Annex John M_ Bredemeyer, ut, Vice-President 54375 Route 25 Glenn Goldsmith N ,;; P.O- Box 1179 A Nicholas Krupski y Southold, NY 11971 Greg Williams l , '�a� Telephone (631) 765-1892 Fax (631) 765-6641 UTFfOLD TOWN BOARD OF TRUSTEES AUG 2 6 2019 ,, TOWN BUILDING DEPARTMENT RE. VER(FCCAT(ON OF BU[LD(NG DEPARTMENT PERMIT REQUIREMENTS S CTM#: Ulc-l.A� Property Owner Name: 2&-lq Date Sent to Bldg. Dept: 8' 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 Dzrno(ition as described under Town Code? COMMENTS: Signature of Revie er Date DiSalvo, Diane From: Fernando Villa <fvilla@maparchitects.com> Sent: Wednesday, October 16, 2019 11:24 AM To: DiSalvo, Diane Subject: 15 Sun Lane Southold application postpone application-for permit Diane After speaking with Mr. Greg Williams this morning, I want like to postpone my application for a permit on my property located at 15 Sun Lane, Southold,NY until the recommended work by the inspection gets done. I will resubmit an updated survey showing the exterior shower and a description of the work next week to schedule a re-inspection. Thank you very much, Fernando Villa Owner 15 Sun Lane, Southold,NY 11971 Fernando Villa AIA LEED AP BD+C Principal Magnusson Architecture and Planning PC 42 West 39th Street 15th Floor New York NY 10018 212 253 7820 x5661 t 646 783 5661 d 212 253 1276 f fvilla@mqparchitects.com www.mqparchitects.com twitter I facebook I linkedin I instagram Sent from my iPhone ATTENTION: This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. 1 OFFICE LOCATION: S �®� MAILING ADDRESS: Town Hall Annex ® P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) �s Southold, NY 11971 Telephone: 631 765-1938 ® a Fax: 631765-3136 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 FERNANDO& MARIA VILLA SCTM# 1000-76-1-1 FERNANDO & MARIA VILLA requests an Administrative Permit for the as-built construction of 6'x6' landing with steps; 4'x5' addition to existing deck; remove the 11.2'x18" high step adjacent to concrete patio and fill in at grade; and for the 2'10"x4.5' HVAC enclosure. Located: 15 Sun Lane, Southold. SCTM#: 1000-76-1-1 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 junsdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions According to Town records, the structures were completed without obtaining Board of Trustee review or regulatory permits If the event the action is approved, it is recommended that a non-turf,vegetated buffer is required landward of the bulkhead. The removal of the step is recommended as CONSISTENT. 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 ��OF �jyo Michael J.Domino,President soTown Hall Annex�O l0 Vice-President 54375 Route 25 John M.Bredemeyer III, P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski :rlh �p� Telephone(631) 765-1892 l� Fax(631) 765-6641 Greg Williams z9 e, BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit ApplicationrFAUCG, E B Wetland Permit Application Administrative Permit ; ' Amendment/Transfer/Extension Q Received Application: F449 7 Received Fee: $ — Snd of T Town Completed Application: g B r of Tn�stees Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): _/__�WRP Consistency Assessment Form Sent: ��"T•�� CAC Referral Sent: Date of Inspection: Receipt of CAC Report: Technical Review: Public Hearing Held: Resolution: Owner(s) Legal Name of Property (as shown on Deed): FEKAI IVbP VELD B. M4K/h VILL?- Mailing Address: 26 31 9 5 T44 5'(TL.Ef I, EAS T F-LM 9 094%�NY 1136q Phone Number: 4 Z $G Suffolk County Tax Map Number: 1000 - 0iG . 0o BLOCK 01 .00 Lor 00 Property Location: 15 5QN LANE: 500TI40L-b NY 119-+1 GOTS / Z?- WF'sl" Caefdt Ie1�E bpM evl T BAYS��Y F-0yotD • 71E # �Z-3 (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: Board of Trustees App:L=_c�ation GENERAL DATA Land Area(in square feet): 61733 Area Zoning: F%- 40 t,4"1 ) DSI SIN r4e61 D EN n A L Previous use of property: /-FAM/L�, P_-FJ/Drz1V6t Intended use of property: / FAM1 Covenants and Restrictions on property? Yes _.-2(_—No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes Y _No If"Yes", be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes x No Does the structure (s) on property have a valid Certificate of Occupancy? ✓ Yes No Prior permits/approvals for site improvements: Agency Date 3/z 43 5eq sr• spa ACC. Swtt/N6 DePAtLrmeNr JDozALD IZ 2d'/90 Z� GZ�} e K 91 / o 8P 1 s Decyc AcoItloN But Inc emmootewr Sbd7hbU 926 C)qp Z-19390 Ccye O aul"IN6 . D"A&Tmair FVOW 0 I/z3/1163 46 z /z41 c•r o VIL4 In "At"CUT VTl!O13 6/6/i 96 o Pc�cMlr# l0�-02 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? A No Yes If yes, provide explanation: 'tea Ind 6�X6� Project Description(use attachments if necessary): I-oWSrrairnoN of WoeD STEPS oM►D WVb1NG Xcbk TWIN6 bobKs ylq-Fer� R6AE$S AS Aei)VaSrt4 BY TDWN OF Sb u Idol-4) Bu14IN6 bt*A1_rMC-Ar IN,(PfC3'De cN 4/112019 , hv1>1Tnoty 711c� EXISPN6 X 5 8 fi0L ENcIASULE CK girl, p S s of SU tg V 6 't*or- P-emoicF,L1, 6x.4bB >v��?H fI / X 4 o� s � -� Board of Trustees APP'> ation '>, ­ Board LANDS APPLICATION DATA Purpose of the proposed operations: ON 1+ fA M 1 LY k4OUSE Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: 2-c' feet Closest distance between nearest proposed structure and upland edge of wetlands: 161 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): 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 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: V I LLA XE4I D*V CIF, , ,Ik,s BV/Lr WOOD SToor f bpc&V GAIVOIN6 i 5MP AIV4 HI/AC MVdWVA$ TID CXCI2 Project Location(describe,and attach a location map): I'S SUN LANE 1'90UT40L-D . 1`11( 11°9-4I Brief Description of Proposed Action: E6 .IVJ_r"c,nW OF WOOD SIbop A haCf dJOIVD/N6 �� s+4 T'� fl,i✓SS oir INTP-gio12 ,rL1OIN6 DOoR.,t Ar A-SQU.UTED FDr -IbINM or -r°UTMOLb BUILD/IV 6 b"Ar-rA46N . 424VJr,1'VCn0 v Or wooD XMP Fes- 5""C_rY Aa.,.M ceewr ro r5XIONG coNcdpfe pA po & fleA r 'PVMP WOOD ON"03VA&I F"Ge . Name of Applicant or Sponsor: _F1✓A NAN DO VILLA-A- Telephone: °, _4 84Z 9-19 6 E-Mail:;FV 1 LLA(Z M,4PAJYJ�/IECT•COM Address: 2-63-1 q S T4$ -Tmesr City/PO: State: Zip Code: e.4 ELM 44 v1ZST' /V y //341 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 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? o•1545 acres b.Total acreage to be physically disturbed? 0.0019 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? O.M4T acres 4. Check all land uses that occur on,adjoining and near the proposed action. F-1 Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial ZResidential (suburban) ❑Forest ❑Agriculture ❑Aquatic •❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NOYES N/A a.A permitted use under the zoning regulations? 1:1 El b.Consistent with the adopted comprehensive plan? El ® El6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ Z 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: PF—Co(V I C Bao)' AA/0 CA1111R. NS �/Cu��P�� ❑ 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: ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ FYI 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? F%71 Elb.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? ❑ ❑d b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ® ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: [ff Shoreline ❑Forest ❑Agri cultural/grasslands ❑Early mid-successional ❑ Wetland ❑Urban 9 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? ® ❑ 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? ❑NO DYES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ONO DYES Page 2 of 4 1 � � 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: � F1 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: F] I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE q Applicant/sponsor name: -Fm A(A N Do V Ll/?1 Date: Signature: �--� -7 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 1. Will the proposed action create a material conflict with an adopted land use plan or zoning F] ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑ 3. Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ ❑ establishment of a Critical Environmental Area(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: El a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, 1-1 ❑ 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? 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. F] 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 President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency . Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 i 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 em to ees.The PuWe of this form is to provide information which can alert the town of pgssible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOURNAME: X11LLA- (Last name,first name,-middle 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 Trustee Variance Coastal Erosion Change of Zone Mooring Approval of plat planning Exemption from plat or official map Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest"Business interest"means a business, the town officer or employee has even a partial ownership of(or employment by)a corporation including a partnership,in which in which the town officer or employee owns more than 5%of the shares. YES NO If ydu 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 of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non corporate entity(when the' applicant is not a corporation); C)an officer,•director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Dated: $/(3�� Signature G � L Print Name Af-IA I Form TS 1 } Board of Trustees Application AFFIDAVIT M A-'r-1 A V 1 Ll� 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 FRED 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. Si ature of P perty Owner Signature of Property Owner SWORN TO BEFORE ME THIS 13 S DAY OF A1JbUd'� , 201 _ N4ftary Public DIANE DISALVO NOTARY PUBLIC-STATE OF NEW YORK No. 0't D1475593 Qualified In Suffolk County My Commission Expires April 30, 204y" Board of Trustees App.,-;6ation AFFIDAVIT F- 2/v A'N Da vi LLA- 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. It Signature of Property Own Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF 320 Notary Public LYNDA M.RUDDER {Votary Public,State of New York No.01 RU6020932 Qualified in Suffolk County commission Expires March 8,20 f ' APPLICANUAGENTIREPRESENTATIVE 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 information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessM to avoid same. YOUR NAME: V l a A— Ft!)ENANOO (Last name,first name,-}piddle 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",nape the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town ofSouthold? "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 partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP �0 Submitted this 8 y of 200 Signature y Print Na Form TS 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. 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 signiftant 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 supporting and non- sup]orting 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# 1000 _ 0:76 a 0 PROJECT NAME Vi LAA ge5'd a EiV CZ IS .rVA/ 4ANE /FvI1T N0W /W1 I/9:�I The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees I. 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: r - Location of action: 1 S V M WIF , TDLJ 1/4oLD NY 11 9 q I Site acreage: o. !G 4 Present land use: o 4 E PAM i Ly pill V A m puJ"a ey' Ge Present zoning classification: P- - 40 M eD 1 U M IeN s1 ry SCJ l aciv77A L. 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: T'eg N A N Da vi L (b) Mailing address: 7-6-3c) IS T4 Sf*e i EAfr &LM 14v"r A v/ ►1369 (c) Telephone number: Area Code( ) 9 1 842 '1 q- R6 (d) Application number,if any: A)/8� Will the action-be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ NoIf 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 III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No Not 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 0 Yes ❑ No LTJ Not 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 �Not 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 ❑ Yes ❑ No LN 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 1:1 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 III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ ❑ Yes No Not 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 for evaluation criteria. ❑ Yes ❑ No A 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 LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No K 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. ❑ YegNo❑ Not Applicable 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 RL 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 IN 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 XNot Applicable 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 L'22 Not Applicable PREPARED BY t-'NND AD V 111A OW/Vt$2'1 P 2-// TITLE_ AACU i irx r DATE