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HomeMy WebLinkAboutTR-9651A Glenn Goldsmith,President S 0 Town Hall Annex Michael J.Domino,Vice-President 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III Southold,New York 11971 A.Nicholas Krupski Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: IN8PEC-T5Dz'l3Y:j­Ar 54 Ch. 111 ----- CK,2-75-,w-� !1- "XJ;ia-fINSPECTION SCHEDULE Pre-corrstrt-torion�haybater-,Iin-e/silt,--b-.o-bM, '/--Sllt curtain 1t day of construction %-constructed Project complete, compliance inspection MMENTS' 0' &:2 77 7 ow, CERTIFICATE OF COMPLIANCE: Glenn Goldsmith,President S0!/rTown Hall Annex Michael J.Domino ,`O� Old 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III Southold,New York 11971 A.Nicholas Krupski G Telephone(631) 765-1892 Greg Williams �O �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1778C Date: December 2, 2020 TRIS CERTIFIES that the removal of two (2) existing wood stoops on seawgrd,side of house and construct a-1 6'x25"Wood framed deck with stairs down to grade; and a 7'x4'-deck accessible from existing 1 st floor bedroom; At 875 Gull Pond Lane, Greenp6rt Suffolk County Tax Map #1000-35-4-28.42: ------- -------- - -------- - --- - ------ - ---------- ---------- - -=--- - - -- --- - - ----=-- -- - Conforms to the application for a Trustees Permit heretofore filed in-this - - office Dated February 5, 2020 pursuant to which Trustees Administrative Permit#9651A Dated July 15, 2020,was issued and conforms to all the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the removal of two-(2) existing wood stoops on seaward side of house and construct a 16'x25' wood framed deck with stairs down to'grade,• and a 7'x4' deck accessible from ,existing 1st floor bedroom. The certificate is issued to Gull Pond Lane LLC bwrier of the afores 'd ropertY. Authorized Signature Glenn Goldsmith, President QF 50(/� Town Hall Annex Michael J.Domino,Vice-President ��� Ol0 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III Southold,New York 11971 A.Nicholas Krupski G Telephone(631) 765-1892 Greg Williams �� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 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-construdo''n,"11W ha4le line%silt'boorrvii{t curtain 1St day of construction 1/ constructed When project complete, call for compliance inspection; 1 Glenn Goldsmith,President '*0 SOUry Town Hall Annex Michael J.Domino,Vice-President ,`O ��� 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III 1 [ Southold,New York 11971 A.Nicholas Krupski cn G Q Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9651A Date of Receipt of Application: February 5, 2020 Applicant: Gull Pond Lane LLC SCTM#: 1000-35-4-28.42 -Project Location: 875 Gull Pond Lane, Greenport Date of Resolution/Issuance: July 15, 2020 Date of Expiration: July 15, 2022 Reviewed by: John M. Bredemeyer III Project Description: Remove two (2) existing wood stoops on seaward side of house and construct a 16'x25' wood framed deck with stairs down to grade; and a 7'x4' deck accessible from existing 1 st floor bedroom. 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 Press Start received on February 5, 2020 and stamped approved on July 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. t*' W'.0" - Glenn Goldsmith, President Board of Trustees SURVEY OF PROPERTY = A T GREENPORT TOWN OF SO UTHOLD - MAY 14 Nag SUFFOLK COUNTY, N. Y. 1000-35-04-28.42 SCALE: 1'=40' DEC. 3, 2002 SEPT. 14, 2004 (FOUNDATION) JUL15, 200 JAN•31 20065(MAL)) F DECEMBER 15, 2016 � SSMlSQN�NGINP HE p9R � ( 6p8q TODECEMBER 28, 2016 (REVSIONS) 'Zp RT JANUARY 24, 2017 (REVSONS) 6ERSooAUGUST 14, 2017 (CER7IFCA710NS) RO JANUARY 25, 2018 6/1, II I FEBRUARY 13, 2018 BpUNpRpN� N s TCP MARCH 17, 2020 (PROPOSED DECKS) NORTH RD. (SR• 25) L YJEpy EN'ppNs(3) � a ~~`'3 o�O ��`` . 6 LOT COVERAGE a PROPOSE n,1fBF� �R�~ , \` +OO + 0 � oh � 9' `� t , Foy � ~~ qoF . �� UPLAND AREA FROM MHWM 16,744 sq.ft. )) •p1 Z fENOE 6 % ' 2S o, ° F 4l plc yo �4"�C •h6 EXISnNG ,82 N66 s�cD 16ZONF cRq�2 �'~ ��O�C;�o2 h� �� tory o' 0 40. PROPOS HOUSE 1616 sq.ft. FRAMED 1 q�C ,a 2 S WOOD FR BLDG 200 SQ.ft. E�, 9 5 SHED N yo(/S,r�Ry F ? STOOP W/STEP SHED 112 SQ.ft. TO RFREMOVED .t0 f G 4 0 0 �O 9 9 8 TOP 1"04!6 DECKS 36 sq.ft. C��. c E< 9S, o' o¢s o \ o y� E� <4_ 41* STOOP 12 sq.ft oC,s STEPS 48 sq.ft. F cv ?4 O• l 13 3 w 10.0! 2 VC�N- A/ ST00 0 55�� c0 C 16 y. EL p Q 68y �"�F :c`n; � �' \� 165 O 9' j%` 2024/16744 = 12.IX F< a 00 s• � ��S 10F�9 US�E��P S oNE A� ----------------- PROPOSED 1p 7¢0 00, F< 98 aR ooBg� 566•p1+Zp N�O�SPMPN\5 HOUSE 1616 sq.ft. ?f c OR .r1E�. oft � NG - FR BLDG 200 SQ.ft. Awft DECKS 428 sq.ft. STOOP 12 sq.ft. STEPS 52 sq.ft. F< �VgcgNTJ 2308/16744 = 13.8% ----------------- '(ji�OF NtFt,✓Y KEY �a � 4 ■ = MONUMENT CERT IF I ED TO= GULL POND LANE LLC, = WETLAND FLAG F I R5T NATIONWIDE TITLE AGENCY, LLC AND `` AM TRUST TITLE INSURANCE COMPANY. e ELEVA77ONS REFERENCED TO NA VD 88 FLOOD ZONE FROM f7RM 361O3CO176H / Y. /C. NO. 49618 EFFEC77VE DATE SEPTEMBER 9, 2009 PECONIC SURVEYORS, P.C. ANY ALTERA710N OR ADDInON TO THIS SURVEY IS A WOLA77ON OF SEC77ON 7209 OF THE (631) 765-5020 FAX (631) 765-1797 NEW YORK STATE EDUCA77ON LAW. EXCEPT AS PER SEC77ON 7209—SUBDIVISION 2. ALL P.O. BOX 909 CER71FlCA77ONS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF SAID AREA = 23,777 S ft. MAP OR COPIES BEAR 7HE IMPRESSED SEAL OF 7HE SURVEYOR WHOSE SIGNA7URE ' q' 1230 TRAVELER STREET APPEARS HEREON SOUTHOLD, MY 11971 02-337 i C' SSIMOS RESIDENCE Lt i �f FEB 5 2020I'8751 GULL POND LAND EXISTING HOUSE C I Ell ST MARION N.Y. _,_."SCTI& 10-35-04-7 4 & 28 22 �I �OF NEvv)' ____ __ .___._ -_ _ _ _ EXSINGLE OISTING40P00.391S FAMILY RESIDENCE __ _- _ _ _ .___ _ _ _ _ _ _ 2x12 LEDGER FASTENED TO EXISTING HOUSE I N T /(�. ��� _ _ _ - __ WITH 1/2" STAGGERED LAG BOLTS @ 16" 0 C _- _ __ __ -- '_- _ '-_ _ --. ._ _ PROPOSED- REMOVE EXISTING WOOD STOOPS ON SEAWARD -------- _ - _ _ SIDE OF EXISTING HOUSE ANWOOD REPLACE WITH WITH STAIRS DOWNO DECKS A 16'x2TO GRADE-FRAMED AND A D7'xK4' °'• _ _ '- _ -_-_ _ = DECK ACCESIBLE FROM EXISTING 1ST FLOOR BEDROOM A - ----------' -- -- -------' - - ----- - - ---- -- -- - x - ---------------------- - I - �� �411 ---`--- -- ---- - - - —' - -- - -- - - - -- --- - EXISTING PROPOSED ______ -_-__--_-__-----______ Z DECK 1 0 SQ FT. 400 SO-FT. ______ -__ __ _ —__-.__- _____ -- __ _ _ x - __ _ x DECK 2 0 SD FT 28 SD FT �Op 75271 �C�� -- ----- --- - - - - do - - - --------- -- ---— - —- ROFESSIONP� --•---- -- - --- — _ - `g --_---:_ -- - - --- -- - ifLJVED BY GENERAL NOTES - - - 1 All worts shall mnlorm to the rep,uremenls of W Resulmul Cade al New Yoh Depanmenl ep urns. Y Cortgaary.,poste is men and _ s Siete,County and Tovm R el6 W61 _ O ---- — -- — -- -- --------- — — -- — —_ �0,4RD OF 'i►�USTEES best e ¢ee, 2 Before rammenung work Na Cmeacmr snail Ile all eaammu reau¢p IY gar Budding Department Pay ea fees mpuaee by meed agaves and onlen all m9uvee m 6x6 ACO POSTS ANCHORED TO P.- _ � 10' DIA POURED CONCRETE PIER= _ TOWNO F SO UTHO LD 3 The.choana,snap win wa vin rs°cloy as mmen,�and ue cl-. - ----- -- - -- --- ----- -- ---ON 18" DIA x 8" FTG TYP --- - - --- a the won lo mnswnm an aacrepennes wnxn woaw nleneres an a0.stalam. char y cry omp*ul on of the work ms¢nt, stud be reponea o the amnion or DnpeM oust Do not sten won urW1 sutll c¢Chrna have bee nee a.Is ala heansly gree,up. Fedure b candy nsebsmew-cane ion -11 be--ad as en.-Ma pedoan the req nnework - mrmMa the mawmgs and scen6¢tma of the amnnleu mance mlV DATE T '//�� of III toepmp V V�� 15 -20 to manus a P e rp q ale u plans m a Yi ) ®\ED �� --- ---- ----- - - - -- -- ---------' ------- --- -- ---------------------- --_----'---�- --- --- _ - 6 ..m at."'am e vol to ne s¢ledmuk langi t and t *nE! - 1x6 WOOD DECKING 7ba span w InaConvenors rKIsone ufirye .ad yeaadmda *I n of w to pmcams1FASTENED TO A_ND e m g.on a goo a� reman.aands` ora I non sn�G tl�sl Ieoues,Pmm )ng m_ M a e hours of ,mooed won oust,lona al.vena ub elenn. endOAR OSTEES D N RI - BEARING DIRECTLY ON POSTS e k le a caaremiands deMk mN oe s,„u Ma leastoIssma avaun mem mpbue.�/�� 8° XIM M ISE _ - -- ------- -- ----- --- - -- - - - - ------ ---------------------- _ - lampThe hnixtaMeconnaaae wnmi s eornmae,g ma.ferVem Isar togIdes and sare¢s T ♦1F _ ___ - - _ _ _ .. _.� - -- --' - - - _ -_--- --- __ -__.. -- - --- -- - '-- 0 Tn l-1 d bra g r a mg rucl lei�I —' �--- 9 The Conten-,anan p...ail Mr,mm o s end 4uh,for a mores ro, HOLD _— a m m m al PLAN , e Can r shalt cmwda Pmper chomp a la all m x 11,Plumem aammthati,VAC and shlb,ams,shall be B. pedormea by f nsed 1 , sa = s_O ss Persons who shall anange lar and coast all mWr2e nspMms The Gomm] IIII. Convenor anan as m,pw,,ble lar sMad.[Mg an other nspenms as regmrea L VLY ,g�j -7'-8" 7-8 7-8" L12 The emlrenor o coley raspons�bla for emswnwn safety and snap ode me 26'-0" and,.conn harmless Imre htganrn along out of the Coneanee,IaLre to movbe¢nsw¢on safety mars and methods 1 CONSTRUCTION NOTES 1All mebngs anan at an um¢ x tMead sed a1 a rmn m a1 36'below f gmde l - 2 Poured can a Met neve a mwmum on,of 2800.1 28 days unless nue 3 Sill melds shall to preserved,waled wood aha be mstaded above a 16 oz - ' copper leant,Shedd 4 Smngm Siang shalt¢ntarm to ASTM D 3679 and be mslanee n e®Herne the Naw York Sale B,sting Castle and nenufanarers spdiwvm acs 5 Pdags shall be-tailed by a n¢nsed nor to a depth arm bea eV agreed open aY an ergm¢r and¢micates shall issued suUg sahm fi Unless amerwse noted d d all Immvg rinswnaml wane weasels-shall ba EXISTING HOUSE a2 ler belle,D.aglas Fa Y All Immng ashh"mss and-..a dra Ie as p-.e eesgn leasee on AF&P Wood Forme Cons....Maaual for One aM nn Famdy Owenugs(WFCM) as apacled in R301 2 1.1 8 All Inland envelope complements shag¢may-In Chapmr 6 of Ne Enagy Consenaaon Code of the Sum of New Yoh, 9 Freblo.kmg snag be phMsd d m ell".Tremae®rsiruc mem ®astan¢ won NYS Cee,R 602 a to(ami an afmswe lm tamer IsN een slopes and baselon Me top sorry and ml spam HANDRAIL @ 36" to do panels snen Ile Imawded mr grazed opmmgs.n ac¢man¢win HANDRAIL @ 36" Nvs nee R3o1 z 1 z d lnaY am regam:a EXISTING HOUSE 11 All ponmsnal the new wham are Bsgned to comply stn local geognpluc and meas.¢m as a.,.u,the 1.1— lab* 4x4 POSTS THROUGH-BOLTED TO JOISTS 4x4 POSTS THROUGH-BOLTED TO JOISTS m o GEOGRAPHIC & CLIMATE DESIGN CRITERIA GROU 1x6 WOOD DECKING M WIND SPEED SNOW LOAD 1345 H 202 LEDGER FASTENED TO 1x6 WOOD DECKING SEISMIC DESIGN CATATGORY B 2x8 JOISTS @ 16" 0 C EXIST. HOUSE WITH 1/2" LAG-BOLTS WEATHERING2x12 LEDGER FASTENED TO FROT ENE DEPTH SEVERE @ 16" O C STAGGERED 2x8 JOISTS @ 16" O C EXIST HOUSE WITH 1/2" LAG-BOLTS TERMITE THREAT MODERATE TO HEAVY 2-2x10 GIRDER BEARING DIRECTLY ON JOISTS FASTENED TO DECAY SLIGHT TO MODERATE AND FASTENED TO POSTS JOISTS STRAPPED TO LEDGER BY TECO 2-2x10 GIRDER BEARING DIRECTLY ON @ 16" O C STAGGERED WINTER DESIGN TEMPERATURE ++ N GIRDER PER CODE AND FASTENED TO POSTS FEooO HAuaO As NOTED 6x6 ACO POSTS ANCHORED TO PIERS 6x6 ACO POSTS ANCHORED TO PIERS A-101 PL NAND SECTIONS [SFLOOR PLAN, FOUNDATION PLAN CALE AS NOTED AUGUST 17TH, 2018 10" POURED CONCETE PIERS 2" 0 10" POURED CONCETE PIERS 2" ABOVE GRADE ABOVE GRADE oress ' a SECTION 1 SECTION z TART � A � 1 ^.Af;f`115 I C7f.7ffmO yyDmd''f: 18" DIA x 8" POURED CONCRETE FTG 1/4" /^ss c 1'-0" 1_O+s �� 1/4" 11-011 _ � O F `t I 18" DIA x 8" POURED CONCRETE FTG �� Po 30x 4T J OAN CHAMBERS sorHonw„97' 631-294-Y241 I Glenn Goldsmif 'resident Town Hall Annex �:F Michael J. Domino, c�-President „�� lam, 54375 Route 25 John M. Bredemeyer III o '` P.O. Box 1.179 co A. Nicholas Krupski Southold, NY 11971 Greg Williams �� ply Telephone (631) 765-1892 Fax (631) 765-6641 rix BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: �' � '� 9 � v Completed in field by: ` GULL POND LANE LLC requests an Administrative Permit to remove two (2) existing wood stoops on seaward side of house and construct a 16'x25' wood framed deck with stairs down to grade; and a 7'x4' deck accessible from existing 1St floor bedroom. Located: 875 Gull Pond Lane, Greenport. SCTM#: 1000-35-4-28.42. CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual FootageorOK=q Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: �l 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice/of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Surveys 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: I L10 �_y z I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other IX r r Jti- i„ r ' ^mrd 1•, a +.. ���� ,., y1ilk At� - / JNX ,r ON AK Iry - .. tl'"",� t, • a� �` ... IaaW IAF. ? , X d ari , 111 R` ' �� ��'MN✓ .�� �." 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Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold, NY 11971 ® Q Telephone: 631 765-1938 9 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: July 7, 2020 Re: LWRP Coastal Consistency Review of GULL POND LANE LLC SCTM# 1000-35-4-28.42 GULL POND LANE LLC requests an Administrative Permit to remove two (2) existing wood stoops on seaward side of house and construct a 16'x25' wood framed deck with stairs down to grade; and a 7'x4' deck accessible from existing 1st floor bedroom. Located: 875 Gull Pond Lane, Greenport. SCTM#: 1000-35-4-28.42 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 CONSISTENT with the LWRP policies and therefore CONSISTENT with the LWRP 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 C Glenn Goldsmith, President �Q� so(/Ty Town Hall Annex Michael J. Domino,Vice-President ,`O� Ol0 54375 Route 25 P.O. Box 1179 John M.Bredemeyer III [ 1xi[ Southold,New York 11971 A. Nicholas Krupski cn ,c G Telephone(631) 765-1892 Greg Williams �� i0 Fax(631) 765-6641 ���4UNTY,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 1 TO: SOUTHOLD TOWN BUILDING DEPARTMENT FEB 7 2020 RE: VERIFICATION OF BUILDING DEPARTMENT PERMIT REQUIREMENTS SCTM#: Gvu �O�tlp [-,9- Property Owner Name: Date•Sent to Bldg. Dept: 2 11'20 The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated below: YES NO Will the proposed project require a Building Permit? Will the proposed project require a variance determination from the Zoning Board of Appeals? Will any part of this application be considered-a Demolition as described under Town Code? - COMMENTS: - Ya L&tre-4 FCS " ignature f eviewer Date Glenn Goldsmith,President �Q� SO(/rTown Hall Annex Michael J. Domino,Vice-President ,`O� ��� 54375 Route 25 P.O. Box 1179 John M.Bredemeyer III l Southold, New York 11971 A. Nicholas Krupski G Q Telephone (631) 765-1892 Greg Williams �� �� Fax(631) 765-6641 NT`1,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD - FEB 1 TO: SOUTHOLD TOWN BUILDING DEPARTMENT 1 2020 RE: VERIFICATION OF BUILDING DEPARTMENT PERMIT REQUIREMENTS SCTM#: 3 �{ z' �7i Property Owner Name:' 6A,(- 490N0 C.� 4 Date"Sent to Bldg-. Dept: # 2 11-20 The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated below: YES NO Will the proposed project require a Building Permit? Will the proposed project require a variance determination from the Zoning Board of Appeals? Will any part of this application be considered.a Demolition as described under Town Code? - COMMENTS: �JAYJ I b 1"?h ignature of eviewer Date n C Michael J.D ��rjf SOU�yo Town Hall Annex omino,President h0 l0 John M.Bredemeyer III,Vice-President 54375 Route 25 P.O. Box 1179 Glenn Goldsmith Southold, New York 11971 A.Nicholas Krupski Yp� Telephone(631) 765-1892 Greg Williams �yCOU ,� + Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application X Administrative Permit Amendment/Transfer/Extension t: - FEB , 5 2020 Received Application: 2-S-2-0 Received Fee: $ IDD 00 Completed Application: 2•(1.20 K s Incomplete: SEQRA Classification: TypeI Type II Unlisted Negative Dec. Lead Agency Determination Date: Coordination:(date sent): _/_LWRP Consistency Assessment Form Sent: ;.20 CAC Referral Sent: Date of Inspection: •1•20 i Receipt of CAC Report: Technical Review: Public Hearing Held: •ISZO Resolution: Owner(s) Legal Name of Property (as shown on Deed): CS LL �Oab LAW 07 L–c– Mailing Address: �� 20 rJELL �JLv 1�P �L Phone Number: 'IQ —(oq Q` Suffolk County Tax Map Number: 1000 - Property 000 -Property Location: LL 4 O b 7 (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: Board of Trustees Applica in 'TT-4— DATA Land Area(in square feet): TT—4` Area Zoning: Previous use of property: L 15 L A Intended use ofroe NO C- p p rtY� .�/ Covenants and Restrictions on property? Yes 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 _Z< No If"Yes", please provide copy of decision. Will this project re uire any demolition as per Town Code or as determined by the Building Dept.? Yes =No Does the structure (s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: �f pL�`3 Agency Date - — �a sir a�= s o�-rl�oL� w�-�c�a�S P i T _3q z M Pf-Q- 3 0 C) ODD 162- 1-�, Vi S Y No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?_>!�._No Yes If yes, provide explanation: Project Description (use attachments if necessary): - R1 0 �-.1✓ i STI r�C� wood i b S - 5 6 uA J& b --9 P f t'�4 S-t»u C� Wo"I wIfliT�� 'lA��0 bemS � �� rw v f bccy­ mce;sAia FP-o A ep STi0J& L00p_ b A . (Cr-ep Board of Trustees Appli4 -.ion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: O SV R8K F 94co l Area of wetlands on lot: — S® 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): 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part I -Project and Sponsor Information Name of Action or Project: 9--��5 G,&L' POW) L1vC_5' Ae6r, Project Location(describe,and attach a location map): 0.75(TUU- oND LAOS.," FOP- F So", 01, l 900i.� Coati►lyi Of) 15 LcccA—,&-b o 1 v*s7- stUta of Brief Description of Proposed Action: R00Qe Sk.5-r1A1(, WOOP 15-rCO .S 'ON S1AwPP-b Sf Ql: OF- e5"'C1sT'1k6- 400.0 fob RvPLAc:e w 6TH �_ DecKS . P ICY,' 25-' Woob-FkAmeb INEC'-k' ui iT-c sr' k4 bowo "® &A P&e- �%M> � -4',C Ll Rccu_';I&E 419_0 A ��IS�INCs� 14T rw®p— ?'Vt>P-00A • Name of Applicant or Sponsor: Telephone: ��O _ ® e� Q 1� � G� S�I �OS E-__JE90®,C'0 Address: D La PO K Cit /PO: State: Zip Code: Sd DL - I f G D 1.Does t e proposed action only involve the legislative adoption of a plan,local law,ordina ce, NO YES admini trative 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: ❑ V LP v `V� i blE 1 3.a.Total acreage of the site of the proposed action? acres SF b.Total acreage to be physically disturbed? 46o o acres S� c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? Q_';J91q-a cres s 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) [:]Industrial ❑Commercial Residential(suburban) ❑Forest ❑Agriculture quatic El Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ N ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 7. 1s the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: � ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation services)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: ❑ 0 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: �j ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: F;�_el ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? E F]b.Is the proposed action located in an archeological sensitive area? ❑ Rr 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: 1 r 14. ,Idd tify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: L1 Shoreline El Forest ❑Agricultural/grasslands ❑Early mid-successional Ea�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? ❑ M 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: ❑NO AYES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑ 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 /��p ��/�, Applicant/spo name: Cj 16�p Cfn��/ril/� Dater 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 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 orzoning 1:1regulations? [�r 2. Will the proposed action result in a change in the use or intensity of use of land? 9 ❑ 3. Will the proposed action impair the character or quality of the existing community? E ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the � F]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? ES(- 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage Elproblems? 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 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 '--Lrd of Trustees Applicatic AFFIDAVIT 6P-Ck► -j CA m io c- Wv > M ki A CA SA90 BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL, TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. i ature of operty Owner Signature of Property Owner C-s-R-f:&L,)P-y cASS)MOS M,4/LIR- CASS�9-%o SWORN TO BEFORE ME THIS J DAY OF 20 Notary Public NOSY ub11OA CA C'ertfff No.01648,a Of New York CoMrmFsssr on,,, !h Uf blk Expires 71iY APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: CA SS 1 NSC S G4�e&0(Z (Last name,first name,jpiddle initial,unlef you are applying in the name of someone else or other entity,such as a co pany.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,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 a 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 Submitted this day of 2049)-J,29 1 'O Signature y Print Nam' �(� GO�*/ Form TS 1 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. n YOUR NAME: CS20 (Last name,first name,ipiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,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 Of"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, 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 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. y The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of Signature Print Name -MAAf iq Gfl-sSAp=�q Form TS l Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used,by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be'explained in detail, listing both supporting and non- Moorting 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# - _- 'C 2— PROJECT PROJECT NAME L C A4U (E-7- n 6cA— 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: QRS ,wow CANMI . �soI> A 4' )C �' ��C�C ACcESA1L R-0A tf f Sze K)6- 1ST �UooP= Location of action: 97-5 (r o LL P aij b L'A M c% Site acreage: Present land use: hFca- Present zoning classification: g — L�,O 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: G V U, Fo N 19P—c-GO -S/4 0� (b) Mailing address: 2—'Y2-0 �G LL `��-y , Art :'V V/ (c) Telephone number:Area Code 0 —S-r f I (d) Application number,if any: 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. 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—Po ' ies Pages 3 through 6 for evaluation criteria El Yes 1:1No Not Applicable J Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Pol:Applicable Pages 6 through 7 for evaluation criteria F1Yes [:] No 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 P ges 8 through 16 for evaluation criteria F-1Yes F-1No 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 16thro gh 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 N Lpplicable _ l 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 Not Applicable Attach additional sheets,if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wast See LWRP Section III.—Policies; Pages 34 through 38 for evaluation criteria., ❑ Yes ❑ No Not Applicable PUBLIC COAST'POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. 1 F1 �Ye� No Not Applicable Attach additional sheets if necessary WORDING COAST POt___DIES r 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_5�Not Applicable Attach additional sheets if necessary Policy 11.. Promote sustainable use of living marine resources in Long Island Sound, the Pe conic Estuary and Town w ters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No Not Applicable ` Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No Not-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 15( Not Applicable PREPARED B TITLE A" � DATE 5