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HomeMy WebLinkAboutTR-9663A Glenn Goldsmith,President �QF SOUrTown Hall Annex Michael J.Domino OVA �� P.O. Route 25 � O P.O.Box 1179 John M.Bredemeyer III l Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams 0 �� Fax(631) 765-6641 � IDAUNT`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1775C 'Date:November 18,2020 THIS'CERTIFIES that the construction of a 32sq.ft.wrap around staircase to an existing 112sq.ft. existing porch-, and for a 648sq.ft. onr�ade paver patio with step; At 495 Elizabeth Lane, Southold Suffolk County Tax Map#1000-78-5-2 Conforms to the application for a Trustees Permit heretofore filed in this office Dated July 24, 2020 pursuant to which Trustees Administrative Permit#9663A Dated August 19, 2020, was issued and Amended on November 18, 2020 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 construction of a 32sq.ft.w1ap around staircase to an existing 112sa ft existing porch,• and for a 648sq.ft. on grade paver patio with step. The certificate is issued to Leslie Gazzola Revocable Trust owner of the aforesaid property. Authorized Signature Glenn Goldsmith,President *0 so(/ry Town Hall Annex Michael J.Domino ,`O� Ol0 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 �� �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD November 19, 2020 Michael Kimack P.O. Box 1047 Southold, NY 119.71 RE: ' LESLIE GAZZOLA REVOCABLE TRUST 495 ELIZABETH LANE, SOUTHOLD SCTM#: 1000-78-5-2 Dear Mr. Kimack: The following action was taken by the Southold Town Board of Trustees-at their Regular Meeting held on Wednesday,-November 18, 2020.. -RESOLVED-.-that-the-Southold T_own_Boarsl of Trustees.APPAOVtthe Administrative Amendment to Administrative Permit#9663A for a 32sq.ft.Wrap around staircase to an existing 112sq.ft. existing porch; and for a 648sq.ft. on grade paver patio with step.in lieu of-the originally proposed 455sq.ft; and as depicted on the survey prepared by Peconic Surveyors, P.C., last dated July 23, 2020, and stamped approved on November 18; 2020. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, Glenn Goldsmith President, Board of Trustees GG/dd SUS VE OF . T A T R YIV,-,, - - - 11 TONNOF` 0.�' SO UZ'.�O.ZDI I S- T,- O.L: CO,UIITT Y N. ! 1000-73-05-02 PIPE SCALE. 1"--30 SEPTEMBER 17, 1998 WATER' \ l METER SEPTEMBER 13, 2010 (FINAL) Ei �a 0 METER ' ;, \ JULY 23, 2020 (REDRAW, PROPOSED PA 711 POLE S N/O/Fs3 v_o MICHAEL FRANCIS - � e, �,�.' _ COLAVITO / _ �y0 '/ °" ' ° ♦ f 1 Ilk, f E j ., ` �� �� 0�`�' �• '/ ma �� TO:CT2020GTANKOIL 3.= y e5 °. /'w R 8.0 ' CMF APPROVED BY ,a '° i '.2' K I- WEE s7Y,` .a WOOD' '�' BOARD OF I RUSTEES " �P / STOOP WOOD �� NDUSE AC'UNITS A�._ / o, TOWN OF SOUTHOLD itil ;�ti) GARAGE CHIM. DATE AOmAg?,KEY /91 20?o 0 2ND-STYmLEv� - - - -= REBAR / cArR" -_ m =' " 40:5' '' J ® = WELL _ QST TIDAL WETLANDS BOUNDRY AS� q; v Step yy2ND Ff- - = STAKE DETERMINED BY PECONIC DECKS 9, - 'Y 1 I SURVEYORS ON SEPTEMBER proposea9Lgrade `-- 19' = TEST HOLE 15, 1998 OA "r�� � -= stone paver patio N I I _ 638 sq.,t. ' N/O/F • = PIPE , \_. ;Ny FLAG-^ ,�4 CHERYL L HANSEN o � POLE ■ = MONUMENT �¢Ps = WE77-AND FLAG 'PLAT. _ = U77LITY POLE ��yy PLAT' = HYDRANTOF 00 _ ��p-`a, NC- T. SFr FLOOD ZONE FROM FIRM 36103CO166 T=va 1 X11 Mop Effective Dote. MAY 4, 1998 COASTAL BARRIER IDENTIFIED AFTER 1990 {+�, ; s,4 BOTTOM OF OIL TANK = EL.&O , T GARAGE OFFSETS TO FOUNDA ADN ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW I YORK STATE EDUCATION LAW. EXCEPT AS PER SECTION 7209—SUBDIVISION 2. ALL CERTIFICATIONS Q --j LIC. NO. HEREON ARE VAUD FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR THE PE O l0,,j fC Y�J i S, P.C IMPRESSED SEAL OF THE SURVEYOR WHOSE SIGNATURE APPEARS HEREON. �v I AREA= 22,798 SQ. FT. (631) �785--solo', FAX (631) 765—i ADDITIONALLY TO COMPLY WITH SAID LAW THE TERM 'ALTERED BY' MUST BE USED BY ANY P.O. BOX 909 SOUTHOLD, N.Y. 11971 AND ALL SURVEYORS U77UZING A COPY OF AN07HER SURVEYORS MAP. TERMS SUCH AS 1230 TRAVELER STREET 'INSPECTED' AND 'BROUGHT—TO—DATE' ARE NOT IN COMPLIANCE WITH THE LAW. , ®'-1 _ _ a _ 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 [ Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 C4UNT`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION,: INSPECTED BY:` •/ • Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale line/silt boom/silt curtain 1St day of construction Y constructed Project complete, compliance inspection COMMENT CERTIFICATE OF COMPLIANCE: Glenn Goldsmith, Pre;' 'rnt �QSUEFUL,�Co Town Hall Annex Michael J. Domino - ,�� G� 1__ 54375 Route 25 John M. Bredemeyer III o '` P.O. Box 1179 A. Nicholas Krupski c Southold, NY 11971 Greg Williams ti ® p� Telephone (631) 765-1892 ��l Fax (631) 765-6641 BOARD OF TOWN TRUSTEES f TOWN OF SOUTHOLD Date/Time: /v o v '1�' Completed infield by: _�44 kA=nj,=�_ Michael A. Kimack on behalf of LESLIE GAZZOLA REVOCABLE TRUST requests an Administrative Amendment to Administrative Permit#9663A for a 32sq.ft.wrap around staircase to an existing 112sq.ft. existing porch; and for a 648sq.ft. on grade paver patio with step in lieu of the originally proposed 455sq.ft. Located: 495 Elizabeth Lane, Southold. SCTM#: 1000-78-5-2 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notic of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: U IV I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other DiSalvo, Diane From: mkimack2@verizon.net Sent: Sunday, October 25, 2020 5:33 PM To: DiSalvo, Diane Subject: RE: Gazzola -495 Elizabeth Lane Hi Diane: Consider this Email a formal request to amend the administrative permit for Gazzola with the following description: Add a wrap around staircase ( 1'x 32 ") 32 SF to an existing porch ( 8'x 14") 112SF; total of 144SF.Construct on grade paver patio surrounding existing deck and added wrap around stair at 40.5 Ft.x 16 Ft. (648 Sf—144 SF=504 SF. I'll drop off the$50.00 check tomorrow. Best From: DiSalvo, Diane<diane.disalvo@town.southold.ny.us> Sent: Friday,October 23, 20201:08 PM To: 'm ki mack2 @verizo n.net' <mkimack2@verizon.net> Subject:Gazzola-495 Elizabeth Lane Received your survey for Leslie Gazzola's amendment. Don't know if you are handling this for him? If so, I need a formal request to amend the Administrative Permit for the bigger patio (dimensions)and the steps to wooden deck(with dimensions)and a check for$50.00. D,W M D,L sR Wo 5outkoLo Towv- Trustees 54375 rzoL.te 2s P.D. -P:-.,OK 1179 SouthoW, N`( 11971 (�31) j 651892 1 Glenn Goldsmith,President r3F S0 - Town Hall Annex 54375 Route 25 Michael J.Domino,Vice-President h0 l0 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 Permit No.: 9663A Date of Receipt of Application: July 24, 2020 Applicant: Leslie Gazzola Revocable Trust SCTM#: 1000-78-5-2 , Project Location: 495 Elizabeth Lane, Southold Date,of Resolution/Issuance: August 19, 2020 Date of Expiration: August 19, 2022 Reviewed by: Michael J. Domino, Trustee Project Description: Construct a 455sq.ft. on grade paver patio surrounding existing 112sq.ft. porch. Findings: The project meet'sall the requifements=for,iss"uance 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 July 23, 2020 and stamped approved on August 19, 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. Glenn Goldsmith, President Board of Trustees SURVEY OF PROPERTY AT BA YVIEW TOWN OF SO UTHOLD SUFFOLK COUNTY, 10, 1000-78-05-02 / PIPE 01 SCALE: 1'-30 WATER \\ SEPTEMBER 17, 1998 / •p Off` METER SEPTEMBER 13, 2010 (FINAL) ,/ �e�O .y1• METER Ls, \ JULY 23, 2020 (REDRAW, PROPOSED PA 710) N/O/F O� 0 MICHAEL FRANCIS ./ 1 0 COLAVITO `�o yo \ - —e JUL 2 4 2020 ` . � 0GJ , G,p� CONCc� 00, 'Q 0 / OIL ��. �� ` , 19 ?� TANK ` +$0!I:;1G 171- / `?s �/ 323Y `T Bo rd(if .0 C,S `L�P� / w 80 �• ?,0, CMF tt /' WALK � h�V .0. 1 & 2 STONE ? ' G ' O ,sz HOUSE WOOD WOOD s3. BYSTOOP PAC UNITS 6 , 3 �o APO!/ ® KEY CHIM. .S m �,`�% GARAGE BOARD OF TRUSTEES TOWN OF SOUTHOLD ry '/ 2ND STY. 0 = REBAR \ CANTILEVER / DATE® = WELL _ \ . IST & �5' '� `�2a• A*fts7_ /Q� 2o2o TIDAL WDS BOUNDAS A = STAKE DETERMINED BY PECONI C ,y 2ND FL SURVEYORS ON SEPTEMBER , DECKS C = TEST HOLE 15. 1998 PROPOSED AT GRADE 0 , O \ STONE PAVER PATIO. -- • = PIPE SPS asp so.Fr. N/O/F 1� = MO ti OF\ MSM :yo POLE ��� CHERYL L HANSEN NUMENT sti F� �\ \ 0 0o L �p a = WETLAND FLAGWOOD b 91, = U77UTY POLE \ PLAT. = HYDRANT C \ rs°ooh c,OF NI MV�® fZ00D ZONE FROM f1RM 3610300166 ,� ET�>C, Map Effective Date: MAY 4, 1998 COASTAL BARRIER /DEN77RED AFTER 1990 CV BOTTOM OF OIL TANK = EL8.0 � � GARAGE OFFSETS TO FOUNDATION .' ANY AL7ERA77ON OR ADD17ION TO THIS SURVEY /S A VIOLATION OF SEC77ON 7209 OF THE NEW YORK STATE EDUCATION LAW. EXCEPT AS PER SECAON 7209—SUBDIVISION 2. ALL CER71ACA110NS L/C. N0. 49618 HEREON ARE VALID FOR 7N/S MAP AND COPIES 7HEREOF ONLY/F SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE SIGNATURE APPEARS HEREON. PEC II " 'd !��S,/P.C. ADD17IONALLY TO COMPLY WI7N SAID LAW THE TERM 'ALTERED BY MUST BE USED BY ANY AREA= 22,798 SO. FT. (631) 702 A'X (631) 765-1797 AND ALL SURVEYORS UTIUZ/NG A COPY OF ANOTHER SURVEYORS MAP. TERMS SUCH AS P.O. BOX 9D9' IINSPEC MIED' AND `BROUGH T 70—DA 7V APE NOT IN COMPLIANCE WITH THE LAI. 1230 TRAVELER STREET SOUTHOLD, MY 11971 0 195 Glenn Goldsmith, President Town Hall Annex 54375 Route 25 Michael J. Domino,Vice-President 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 ' ou V BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: SOUTHOLD TOWN BUILDINGEAT t 4G DEPT. RE: VERIFICATION OF BUILDINGl T7 SCTM#: Property Owner Name: Date Sent to Bldg. Dept: r 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? V;= Will any part of this application be considered-a Demolition as described under Town Code? COMMENTS: R Signature of reviewer Date d"" ff � Glenn Goldsmith, Pres it ,, Town Hall Annex Michael J. Domino, Vice-President 54375 Route 25 John M. Bredemeyer III P.O. Box 1179 A. Nicholas Krupski Southold, NY 11971 Greg Williams � - - Telephone Fax (636) 765-66431) 892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 7 /3/` Completed in field by: Michael A. Kimack on behalf of LESLIE GAZZOLA REVOCABLE TRUST requests an Administrative Permit to construct a 455sq.ft. on grade paver patio surrounding existing 112sq.ft. porch. Located: 495 Elizabeth Lane, Southold. SCTM#: 1000-78-5-2 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 r 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: I have read & acknowledged the foregoing Trustees comments: Agent/Owner- Present were: J. Bredemeyer . Domino G. Goldsmith N. Krupski G. Williams Other own NYSOEC •# 1-4738-2109100007 10 l tL� -� �i :i f �/" Do dk f�--J U L 2 4 2020 Southold Town Board of Trustees 0! NO OIL TANK/ 10 V� \ 0� 9` `° e.o• scot' ng 1 N� C UMTS ' to a� ��•` / ,� Z'M FLR. �V CZ / CANT. S DNFLOORL! iI `�f .44 ` , q1- 0cb� 4-1 TIDAL WETLANDS �'psy�� o��tyF lam° > �sx BOUNDARY AS DETERMINED BY E �A / ayj® �A' PECONIC SURVEYORS "� ON SEPT. l5, 1998 i ! 00 Sp Do, C3' �0 0 FLOOD ZONE AE (el, 8) FROM FIRM 361 03CO166 MAY 4,1998 COASTAL BARRIER IDENTIFIED AFTER 1990 .sri_..:a:ter i►N - r r` °� 1 1 • 1 1 1 � (1)Gazzola Residence Taken July 11,2020 Looking SSW +r br r t 1 1 1 1 i (2)Gazzola Residence Taken July 11 ,2020 Looking East .r r. 07 0P . ?0?0 01 . ?(. i w AIV Jr 07 . 09 . 2020 0121 I i :u - iF` � t A I I J .}►S i Y tt I m y SLEEPY HOLLOW ♦ A 10.15 \ �-� .tr '� Towx OF w20 "• / SO,rtIK]LD ' 1 ♦1�,1 90 ,3z ♦ n u 1s m r "" A A •. A ,e _---� n.......a �. a. D 16 \ 1 • en w A •Ae+A 'P 2% A SEE SEC.NO-011is. 20 O C x- 1. 21 41 11 ,R2 Tea ' _ -. ♦ �J ''-PAS tap,c •/ Qw'� LSO) ' •u s SEE 88r-NCL me V ^� ) J 153 =_ .. ,OM1 I1A 11 ZO Q .. a 76 Z+s ,a 18' m £ 51? � •x a e� 'b ] > �. � 4 zq„ Jo I ao 4 v _ m2 ' P • D, a� a 15m >! "' .,� �.\ „ oe a;� v' I I t,� o s,., �� e♦ ,i ,�{. .p1 ys A � �•b >\ I ,B axe � z or O 1 ~ .. .. >s _ ,°"K10 79 ^'as � •v ' N ss ..> Ct'p a� ,� a 'k9/N �zr� �a ' � s„ j � •e P „ 14 ys n Sos ® � M,2 f� I f2 ♦ to m eo p s ) as 'a+ n.l 11}y'_ +'y,K\ �.+ •.f' .+ ? p+ 4A(c)- I3A(-)4a '31. �� s•-O ^ as., xiM ♦'� o l f +.r © 1s g ' s i '-xM) of Q tb e ��:. 12.1 ^' .w O 11 ,63 ,s L , 'I w f0. 1f f �` w•'�- RD. n, U a 03 sEE SEc.1w.,1e1 a memo . NOTICE COUNTY OF SUFFOLK © N sn SOUTx,oLD SECT—NO E �a m� —iz— s,) O --•-- -- -- Ab ..tea a RealPropertyTaxServiceAgencY Y ae •s•aE N om- =µ___ awe a —_ n..�.. ----- o..�--•-- ro.,wnar� C—ft «+niawxw.,.xrnw, A 078 i•.wree�o a ...... n ..- —-.121A u —__ o...�.. --.-- trr -- macm.r aEavr• P o,e wm+cr xo 1000 PROPERTY MMP OFFICE LOCATION: MAILING ADDRESS: Telephone: 631 765-1938 Town Hall Annex µ" P.O. Box 1179 54375 State Route 25 �,'�� Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) N Southold, NY 11971 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: August 3, 2020 Re: LWRP Coastal Consistency Review of LESLIE GAZZOLA REVOCABLE TRUST SCTM# 1000-78-5-2 Michael A. Kimack on behalf of LESLIE GAZZOLA REVOCABLE TRUST requests an Administrative Permit to construct a 455sq.ft. on grade paver patio surrounding existing 112sq.ft. porch. Located: 495 Elizabeth Lane, Southold. SCTM#: 1000-78-5-2 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based 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 gy rtX'tt, Glenn Goldsmith,President (f�+ Town Hall Annex Michael J.Domino Vice-President �" �, ' Pt{ 54375 Route 25 . r 4mm5 P.O.Box 1179 John M.Bredemeyer III >• > ° Southold,New York 11971 A.Nicholas Kru ski p F Telephone(631) 765-1892 Greg Williams F� � Fax(631) 765-6641 �� 7 ••""n0' .ay� +Y BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD At 2 4 2020 This Section For Office Use Only Southold town Coastal Erosion Permit Application Bard of Trustees Wetland Permit Application _Administrative Permit fRece-ved Amendment/Transfer/Extensio•eceiveApplication: 7•Z 2D Fee: $ 160,Dompleted Application: •T-0 Incomplete: SEQRA Classification: Type I_ Type ll Unlisted Negative Dec, Positive Dec. Lead Agency Determination Date:_. Coordination:(date sent): LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: p Receipt of CAC Report: �'rechnical Review: ____ Public Hearing Held: ^Resolution: Owner(s) Legal Name of Property (as shown on Deed); 1,E 6AZZoC.4 RtV. ngt57- Mailing Address: , B, 6 0 X -7Z2 -5O LEAP61P Al,Y Phone Number: 2 -36 8962 Suffolk County Tax Map Number: 1000 - 4a e �Z Property Location: 4 a ZZ ,;EZ-4A1—,"-- (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): 11®C - !/� Mailing Address: O !� 97,1 Phone Number: Board of Trustees Appli, -:ion GENERAL DATA Land Area(in square feet): Area Zoning: !16 -Previous use of property: �MR12&/9/V,& 0AIE AA&/L Y Intended use of property: �d�. 77� 09�Afnle_ Covenants and Restrictions on property? Yes t'_"'No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes P'_�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 a 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: Arncy-_ _ - Date / ,. 4861 v o a /U Z46 2 aas wwvze No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? V No Yes If yes,provide explanation: Project Description(use attachments if necessary): C©WZrRC VW AA1 CzR4ZI5 V" BAM0 J' N Board of Trustees Appli,,=-kion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: M PP(�r/J,/.7•E je!!V. ® 1/�oe!)IE ARY-4 A=09 QUA' OD.P LQ1_ U, AZZ&A/ Area of wetlands on lot: 600 square feet Percent coverage of lot: 0,® % Closest distance between nearest existing structure and upland edge of wetlands: 44,9 ._feet Closest distance between nearest proposed structure and upland edge of wetlands: !Z�7" q feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? & ! cubic yards �s How much material will be filled? _ 6-- :Li cubic yards Depth of which material will be removed or deposited: A4 feet Proposed slope throughout the area of operations: L.4�_ _ 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): 41-1 AI - V 2= 49ZA —S W �L AW-l" av rlb4z 1 Board of Trustees App1iv--`,.ion AFFIDAVIT L ElZZ6r- 6A 9?j'O—CA d 7RIIS776 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. '2 At" 1, Signature of kWeyfy Owner Signature of Property Owner SWORN TO BEFORE ME THIS 1? DAY OF 7-(J4 . 20,f Notary Public MICHAEL A.IQMACK Nry public,State of New York No.02KI5056823 (Juafified in Nassau,County Commission Expires March 11,20' Board of Trustees Appli. -- -:ion AUTHORIZATION (Where the applicant is not the owner) owners of the property identified as SCTM# 1000- 7�&--0 -GZ in the town of New York, hereby authorizes /-1 X14,61 .4 k/JL A C< to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. Property OwnetojOture Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF y , 20 _ Notary Public MICNotary Pubt�ic, A. of New No.021asosa= Qualified in NassauCounty Commission Expires March 1 i,2022 APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSUR;' FORM The hwa ofSouthold's Code ofEthios prohibits conflicts of interest on the part of town officer,:and employees The�nimose of mos 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: �CYAZZEW44 1444 o ' (Last name,first name,piiddle 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.) N4ME 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 reladonsltip with any officer or employee of the Town of Southold? "Relationship"includes by blood,rnarriage,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 S%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 'ritle 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 S%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 t applicant is not a corporation); C)an officer,director,paftner,or employee of the applicant;or D)the actual applicant. DESCRIPTION Of RELATIONSHIP Submitted this ay of 20� Signature Print Name ' Form TS 1 APPLICANVAGENUREPRESENTATIVE TRANSACTIONAL DISCL®SUU FORM The Town of Sou hold's Cade o -Ethics prohibits conflicts of interest on the part of town Officeri and employees.The puroose of Ibis form is to provide information which can alert the town of possible conflicts of interest and allow it to take whale ver action is necessary to avoid same. YOUR NAME: ,"A !f4CA� RLC-ALA-4--,4-- (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 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 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 tine 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); I3)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_17_day of Signature i Print Name L Form TS 1 61Z20 Appendix B Short Environmental Assessment Form Instructions for 03ntpleting Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part l based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information Naane of Action or Project: L 4:�; P 4 VSB' Project Location(describe,and attach a location map): 4 04D Brief Description of Proposed Action. COW-r7R- tIC7 4)V 0A1 Name of Applicant or Sponsor: LF elephone _ ®� -Ma' Address: Bo x ®ate City/PO: State: Zip Code: IQZ1 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? —4-4acres b.Total acreage to be physically disturbed? _- QL—acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 4,0769_acres 4. Check all land uses that occur on,adjoining and near the proposed action. 0 Urban 0 Rural(non-agriculture) [:]Industrial 0 Commercial NrResidential(suburban) ❑Forest DAgriculture 0 Aquatic ❑Other(specify): ❑Parkland Page Y of 4 5. Is the proposed action, _ NO YES N/A a. A permitted use under the zoning regulations9 ❑ ❑ b_Consistent with the adopted comprehensive plan? 6. 1s the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: 9 ❑ S. a.Will the proposed action result in a substantial increase in traffic above present levels? NNOO( YES b.Are public transportation service(s)available at or near the site of the proposed action? EL � ❑ 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 technologierss 1L1 ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water:_ /� � ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: �( ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of I listoric NO YES Places? b.Is the proposed action located in an archeological sensitive area? ❑ 13.a.Does any portion of the site of the proposed action,of 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: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: %Shoreline ❑Forest ❑Agricultural/grasslands [3 Early mid-successional 19 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? Y_Ll 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 MYES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO F]YES 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 all active or closed NO NTF—S 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 f 01 F] I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Ja Date: Signature: Part 2-Impact Assessment. The Lend Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part I and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? El 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)? El 0 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? El 1:1 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 o portunities? El 7. Will the proposed action impact existing: a.public private water supplies? F] b.public private wastewater treatment utilities? El 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? F-1 R 9. Will the proposed action result in an adverse change to natural resources(e.g., wetlands, waterbodies,groundwater,air quality,flora and fauna)? F] F] Page 3 of 4 No,or Moderate small to large impact impact may may occur occur a 10. W ill the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? El 1 l. 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, t� that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. F-IU 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 Town of Southold J 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- -supportink 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#��Z � . PROJECT NAMEZO ,��,�V 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' Q construction,planning activity, agency regulation, land transaction) (b) Financial assistance(e.g. grant, loan, subsidy) (c) Permit, approval,license,certification: ZN Nature and extent of action: U C .4d 77 Q0 (� 6(tVA6 e._o&g 6aXFJ-0&r- 15(D..s-r:w: -A 441 � s Location of action; Site acreage:_ 01 42Y 9 _�-- Present land use: J -4XdZY 2, 4M Present zoning classification: R6'`� jl/ZIWI- 0/114' 9A1114Y 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: ir�ZZ®,� R.4e V. (b) Mailing address: (c) Telephone number: Area Code ( ) 6/6 2 i? - 9A (d) Application number, if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes F] 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. 1-1 Yes F] No Z 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 Yes ❑ No ONot Applicable Pat-I Cy ZA VA 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 JZ Not Applicable T1o r IAZ N&Y V4E1-JA1- -Ri4 ol�l1'�0� R' BAY 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 Z Not Applicable P6111CY " fV..'A6?VCA7%0A1 Attach additional sheets if necessary Policy S. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No YNot A plicable 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. ❑ ❑ 1,71Aj Yes No P l.pplicable UICy ti N/ 0 FIs' AMICAZ20AI 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 X Not Applicable .eQ /cyi &1A no ry& ,4f'-RL/c#71aw 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 X Not Applicable oLl cY 7b YWIS A&ovsl 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. 11Ye❑ No� Not Applicable 'PWC /al--, CALLew Attach additional sheets if necessary WORKING COAST PO; LIES 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 ❑ NoNot Applicable C L - Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III-Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No Not Applicable Poz I cx. /Z &,� 72 ��/s Ap?LzC4rl6y 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 j7zbe� A94 Ala 46 96JLS a& Ppllp,-E� -CRI , &.2.14"/ - :6ZA 'F_2.� 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,'n�7] Not Applicable PREPARED BY ./�, II� C�C TITLEDATE �!/