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HomeMy WebLinkAboutTR-9664A Glenn Goldsmith,President sorry Town Hall Annex A. Nicholas Krupski,Vice President �� Ol0 54375 Route 25P.O. Box 1179 John M. Bredemeyer III Southold,New York 11971 Michael J. Domino G • Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1891C Date: January 17, 2022 THIS CERTIFIES that the repair/replace stone paving at top surface of existing raised 45'x13'7.5"masonry patio and 8'x7x6' steps at rear, east side of patio; 9'3"x6'5" steps at south side of patio.with 4'9"x7'1 0" landing; one set of steps 4'9"x5'6" and one set of steps 459"x45155 removal and replacement of non-code compliant railings with code compliant railings. At 1155 Arshamomaque Avenue, Southold Suffolk County Tax Map #1000-66-3-6 Conforms to the application for a Trustees Permit heretofore filed inthis office Dated July 29, 2020 pursuant,to which Trustees Administrative Permit#9664A Dated-August-19, 2020, wase 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 repair/replace-st6ne paving at toy su`rface•of existing raised 45',x13'.7.5"masonry pati6_and_8'0"x6'_.steps'at rear;east_side_of-patio;9'3"x6'5' steps-at_south_side of patio with 4'9"x7'10" landing; one set of steps 4'9"x5'6" and one-set of steps 4'95'x4'1"; removal and replacement of non-code compliant railings with code compliant railings. ' "The certificate'is issued to Dominic & Patricia Grasso owners of the aforesaid property. Authorized Signature t Glenn Goldsmith,President �pE SOUTTown Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President h0 l0 P.O. Box 1179 John M. Bredemeyer III Southold, New York 11971 Michael J. Domino y G Q Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 ell- BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 1117 Zz INSPECTED BY: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale line/silt, boom/silt curtain 1St"day of construction % constructed complete,lete, com liance inspection J p . p p COMMENTS: 01W A CERTIFICATE OF COMPLIANCE: Glenn Goldsmith,President �QF S0(/jTown Hall Annex Michael J.Domino,Vice-President ,`O� ��� 54375 Route 25 III P.O.Box 1179 John M.Bredemeer Y � � Southold, New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 COUM`I,N BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD;Of TRUSTEES 7i HbU okid tl7 COMMENCEMENT OF THE ACTIVITIES Ci�E��(�D_OFF INSPECTION SCHEDULE Pre-construcfW;-ft I54e lMslftTT oc3 i t rtairi 1St day of(construction ; % constructed When project complete, call for compliance inspection; I Glenn Goldsmith,President �QF SO&J. Town Hall Annex Michael J. Domino,Vice-President ,`O� �0 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III 1�[ Southold,New York 11971 A.Nicholas Krupski y ,e G Q Telephone(631) 765-1892 Greg Williams �'0 �� Fax(631) 765-6641 COU BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9664A Date of Receipt of Application: July 29, 2020 Applicant: Dominic & Patricia Grasso SCTM#: 1000-66-3-6 Project"Location: 1155 Arshamomaque Avenue, Southold •,--Date-of-Resolution/Issuance: August 19, 2020 -Date of,.Expiration: August 19, 2022 Reviewed."by: Michael J. Domino, Trustee Project Description: Repair/replace stone paving at top surface of existing-raised 46x137.5" masonry patio and 8'x7"x6' steps at rear, east side of patio; 9'3"x6'5" steps at south side of patio with 4'9"x7'10" landing; one set of steps 4'9"x5'6" and.one set of steps 4'9"x4'1"; removal and replacement'of`non-code compliant railings with code compliant railings. 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 WSJS Architects dated{July 28, 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. t This is not a determination from any other agency. Glenn Goldsmith, President Board of Trustees i NOTE:ALL EXISTING GRADES&TOPOGRAPHY TO REMAIN i i I PETTYS POND S 05 46' 08" E 83.71 J U L 2 9 2020 ao 0 N EXISTING N Sn!tflald Town BULKHEAD Board of Trustees TO REMAIN �N hco c Z Z _~ rnX � � X W oW W W I SIN EXIS ING 0) AT EXISTING MASONRY PATIO&-\ LAW CN STEPS REMOVE EXISTING TOP SURFACE STONE PAVING MATERIALS. REMOVE ALL EXISTING WROUGHT IRON RAILINGS & BRICK POSTS. 8�-71� , INSTALL NEW BLUESTONE 0-0 26'-41/ " 9'-3" 4 9 PAVERS SET IN MORTAR ON N I EXISTING CONCRETE SLAB. o - INSTALL NEW TIMBERTECH RAILINGSAPERIMETER OF PATIO AND AT ALL SIDES OF STEPS. 10' r XIS I co x _ 45' - r` EXISTING MASONRY 3' BARBEQUE TO BE EXISTING REMOVED 2 STORY FRAME EXISTING 2ND STORY M HOUSE DECK 25' EXISTING COVERED r6' 50 _ FRONT PORCH (2ND STORY DECK ABOVE) EXISTING SLATE -WALKWAY XISTINGW N I w O > 0 ~ EXISTIN ? w GARAG Q °- o� < �' o Q ~ o N U) EXISTING 997.12' co w ASPHALT M DRIVEWA ti cn APPROVED BY S 06 22120" W 100.00' ="BOARD OF I RUSTEES -TOWN:OF,,SOUTHOLD ARSHAMOMAQUE AVENUE DATE ArvGusT !Q 2oZo s IN �p � V s" SITE PLAN ' ' 2 1"=30,_0,. PROJECT NAME: DRAWN BY: CP. DRAWING#: wsis PROPOSED ALTERATIONS TO THE CHECKED BY: WS WSJS ARCHITECTS G RAS S O RESIDENCE PROJECT#: 202006 755 NEW YORK AVENUE DATE: 07/28/20 spi ■ 0 HUNTINGTON,NEW YORK SCTM#1000-66-03-06 1155 ARSHAMOMAQUE AVE.,SOUTHOLD,NY SCALE: AS NOTED f Glenn Goldsmith,Pres a4 , Town Hall Annex Michael J. Domino,Vice-Pre;. -int " .+^` 54375 Route 25 John M. Bredemeyer IIIc" ce ° P.O.Box 1179 A. Nicholas Krupski "i,. �"J' Southold, NY 11971 Greg Williams ; Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/TimeCompleted in field by: William A. Scherer, R.A., on behalf of DOMINIC&PATRICIA GRASSO requests an Administrative Permit to repair/replace stone paving at top surface of existing raised 45'x13'7.5"masonry patio and 8'x7"x6'steps at rear, east side of patio; 9'3"x6'5"steps at south side of patio with 4'9"x7'10"landing; one set of steps 4'9"x5'6"and one set of steps 4'9"x4'1'; removal and replacement of non-code compliant railings with code compliant railings. Located: 1155 Arshamomaque Avenue, Southold, SCTM#: 1000-66-3-6 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 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: 41Lr I have read &acknowledged the foregoing Trustees€omme�ts'� � ._ ._ Agent/Owner: — --------- Present were: J. Bredemeyer M. Domino _ "G.Goldsmith N. Krupski G.Williams Other SURVEY OF LOT 15 N MAP OF _BE I XEDON ESTATES FILED MARCH 16, 1946 FILE No: 144 W E 51TUATE: SOUTHOLD - TOM: SOUTHOLD s SUFFOLK COUNTY, NY Lot SURVEYED 02-24-03 - 14 SUFFOLK COUNTY TAX a 1000-66-3-b O ^ O LO 71' W °o; W C TO: cr OOS BZAYAS Ngl v-r Q Do U� 1 -------- ---- - ---- -- °° o , --e;• o�g lOt i➢ M btumV�0U5 df--- _ £ r-ro B 4 Iii, 15 g r Houesg e 8 ---------- n---------------$ 00 W f� L-I Fr J U L 2 9 2020 �E ag 269-OG 8 2V I s Boat o (l';tees NEW NOTES. • MONUMENT FOUND �� •��,,,.,.� bye o PIPE FOUND AREA= 24bo1 SF OR 056 ACRES I JOHNC. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S.LIC NO.50202 GRAPHIC SCALE I"= 30' RIVERHEAD,N.Y.11901 369-8288 Fax 369-8287 REF.-UFIp secvm'APROS103-122-pro 16111 Yl f y t f � i A. . S •� i Grasso Residence 1155 Arshamomaque Avenue .7X7'1r t s View lookingin northwest direction y. * Southold, NY � � photo date.2-22-20 wWWL- `,AR OL • til (�,.• IONIC�� �� I � - ,� �.- , ��, '�• � ,j r.=_�_ tea� � � '.`+i►— - � 1S '�r� -; "� _ . _ :._ r� r--U Ob fit ,i Grasso Residence _ 1155 - Avenue •• • in southwestdirection .N..-' r .r.�_,_,_,,.+�.�-rte'--.•_ •••• j Grasso Residence 1155 Arshamomaque Avenue View looking in southeast direction Southold, NY photo date 3-2-20 SE E SEC NO 05 UNE t NA 4 a.As FOR PCA NO .. ; SEE SEC.NO„ �y '1 15 a a vs 4. ol pp;_ f ., �' a aw a� `y�A eM a 4 0{+ o•{ O �c.�� - \ �� \ {'..� e♦ a 'e. <" e`A\ ��, s \° 3m ri �,�" �" � a moo♦ l��//,,"�i°ef; S e�P,� \\ \�'�JY+P � ~ � � � +��a x . y a _ s7 a v. COUNTY OF SUFFOLK © N NOTICEE ,,,. ,� secnoN Nu —�— �.. a ru Real Property Tax Service Agency waNrux.�.n3Erurnra aKE aR v W E o�smiwraN 6 iM"PORl1DN Cf tRE SOUTHOLD 066 300 C{.-One R„h d NY II00I S.FFOUc CQMIY iw.t ANP s PROIBIEO A �. rrret PeMesol a ra mmnrt Mn .... ._ _ .wn.{wn __ __ �•• —__ "w�. (21) u�. .. S RFK moEetn Tax 513N�IGBLY. P -. °` OFFICE LOCATION: m'� m N MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 1`a Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 Telephone: 631 765-1938 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: August 4, 2020 Re: LWRP Coastal Consistency Review for DOMINIC & PATRICIA GRASSO SCTM# 1000-66-3-6 William A. Scherer, R.A., on behalf of DOMINIC & PATRICIA GRASSO requests an Administrative Permit to repair/replace stone paving at top surface of existing raised 45'x13'7.5" masonry patio and 8'x7"x6' steps at rear, east side of patio; 9'3"x6'5" steps at south side of patio with 4'9"x7'10" landing; one set of steps 4'9"x5'6" and one set of steps 4'9"x4'1"; removal and replacement of non- code compliant railings with code compliant railings. Located: 1155 Arshamomaque Avenue, Southold. SCTM#: 1000-66-3-6 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 INCONSISTENT with LWRP Policy 6.3 and therefore, INCONSISTENT with the LWRP. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. A Wetland Permit was not found for the as built masonry patio. 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 'IfV" 7 Glenn Goldsmith,President Town Hall Annex Michael J.Domino,Vice-President '0 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 This Section For Office Use Only —Coastal Erosion Permit Application /Wetland Permit Application E 07 EE �11 -7-Administrative Permit Amendment/Transfer/Extension DD r it! DD) 0714-Received Application: 7.Zq.,ZO JUL 2 9 2020] /Received Fee: $ 100,0U7 v/ Completed Application: 'n Southold To,�Vn incomplete: 0 f Trustees L Ive P SEQRA Classification: TypeI_ Type II Uniie,,,ative ec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): LWRP Consistency Assessment Form Sen . CAC Referral Sent: Date of Inspection: —Receipt of CAC Report: Tb[) GWO — Technical Review: Public Hearing Held: Resolution: I------------ Owner(s)Legal Name of Property (as shown on Deed): or^'l Ki C. 'Pq,4 KIC- Of & r-OAMO Mailing Address: ii * A 10 0144 Phone Number: 91'7- Suffolk County Tax Map Number: 1000- (p6 *3 Property Location: Lo m y k-, o, u pu4-tN (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Wifl;.A.M - � 4 ,r , K. A - A Mailing Address: Ncyj York Ay4- Hoy4inct4oin 0 )1743 V Phone Number: 403t - 3 �/- 19qj Board of Trustees Application GENERAL DATA Land Area(in square feet):- 2� („o-7 Area Zoning:.—&---D Previous use of property: ; e Intended use of property: iha,t. J�AM_J\r Re5idPk�,cP. Covenatlts and Restrictions on property? Yes ✓ No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? ✓ Yes No If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Pian 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 ✓ No Does the structure(s)on property have a valid Certificate of Occupancy? ✓ Yes No Prior permits/approvals for site improvements: Agency( Datte, r S.04at �a�_ ett{-. 2]1_ 20 o . O Ido. 4��L9� �10J n« BUZ-, Det L ��ZITZry � Cz aE O No. 410711) ti I No prior permits/approvals for site improvements. Has any permitlappioval ever been revoked or suspended by a governmental agency? ✓ No Yes If yes,provide explanation: Project Description(use attachments if necessary): K e e a,N I r t,n(a e c m e+ F o s4 cgn e_ ILI �.,r•i��{ -�(-o�, 'S�r aG� a.� exi 5-��,, �r rai sc.� t....a�on��l 1 ,Ir�cLJ �ir��-�en•4(, V_GYvtoya'� a�t� ren�4GeN+tyt/� o , n12 Co Go��in X'laclt(n'a �/� � Y.4V_1 40e1G ►+atli.�q S. �Xt57-tnq p4�-td QK� 54 eps J*tr-t e_"-6,or.y At,'CA Cori�i�Jr-4-�t0✓l GY-e, +v bc, t -Cin+ainea(. �l,+�se d�MGtnSLCv+$� a5 a��i c.�ec1 oh Side- 1'lar► dr,%u4snJ olln�-1s : o - 4-s' J S-4Gg 4�- rear j eat E S► �� o� p4��o - $�`1nx �'_o„ 44- sou opC440 . l ee-4 (J .r lq•-.d�no w+ ¢'-g" % /-'-to"I t sc-�' 5= �l��lt X �r.1tt Board of Trustees A,pp1i,.;iQ.,;ion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: R e�P a ;r .0tw,a i rL P v►a✓�G2 0� II -yN I ✓N o w,TIi CSZG - oto 3�Z o _ G�( c2� � I G o de, e �, S .q , Area of wetlands on lot: O square feet Percent coverage of lot: O % 9 z'-to%Z''+-, s4eps 11 Y2" -4,bt cp Closest distance between nearest existing structure and upland edge of wetlands: �q7 feet�.e {-:o Closest distance between nearest proposed structure and upland edge of wetlands: N A feet Does the project involve excavation or filling? '� 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): n T_Ine. rnro p �e�o ��a-�-�o�5 k[► �� kCkV v.o e{ �e�' nr� Wei- f -�� s APPLICANUAGENUREPRE'SENT"ATIVE TRANSACTIONAL DISCLOSURE FORINT The Town of Southold's Code orEthics prohibits conflicts of interest on the part of town b.21cers and emplaees.I lie purpose of this form is to Drovide infrrination which can alert the town of possible conflicts of interest and allose it to take whati'ver actinn is necessary to avoid.sztmc. A Sr, - YOUR NAME: W (,_�( A I� A• kw ee (Last name,first name,giiddle 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 ToNrn of Southold? "Relationship"includes by blood,rgarriage,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 Submitted this 2$ day of J .20B 2 o Z c Signature 4, Print Name e Form TS l Board of Trustees Application AFFIDAVIT Dominic & Patricia Grasso 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. S�� (��?cL� .............. Signature of P operty 0,,A4ier Signature of Prope y Owner SWORN TO BEFORE ME THIS 2D+k DAY OF �y . 20 KA Notary Public JOSEPH MURRAY Notary Public-State of New York No. 01 MU6184057 Qualified in Nassau County My Commission Expires on March 31, 2024 Board of Trustees Appli�aL.ion AUTHORIZATION (Where the applicant is not the owner) I/We, Dominic & Patricia Grasso , owners of the property identified as SCTM# 1000- 66-03-06 in the town of Southold New York,hereby authorizes William A. Scherer, RA 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. Prop rty Owner's Sign ure Property Owner's ignature SWORN TO BEFORE ME THIS 20-ti, DAY OF�� L , 20 Z a VIA Notary Public JOSEPH MURRAY Notary Public- State of New York No. 01 MU6184057 Qualified in Nassau County My Commission Expires on March 31, 2024 61 Z20 Appendix B Short Environmental Assessment Form Instructions for Cc)inplefing 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 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 1 -Project and Sponsor Information Name of Action or Project: of o ?-GSi Cv% tckv- io j4--Au, rc h;r Project Location(describe,and attach a location map): 1155 Ar5Lao om-R Je. Ave.. SoJAe,1 d f-�y Brief Description of Proposed Action: RL�Atr''�re��gGGihBv'(� o� ��-OhG UA�fth Af -�Vp �ul^,FQGP� 0'F I I t ey. 64:, (`o.lse.d MMoh rPCt?`l Q) 1►Nf, Gp6, Rem a vR I ah � rcp(At!ei+�6ln� o� hol(n Goca'G GornpllKh-�'JY'ai1lhgs view C04c Gorhpliaha- rayl� ki9 y. I J Name of Applicant or Sponsor. Telephone: 1- I A / L 11 r X31- 351 1q1/9 v�!tlttaM A JC�eeer, W SJ7 r'1rcInr-}e,C4`5 E-Mail: W5 w4_1 S �+re.4. Cvm Address: ` 'York / r 1 5S tJ e w T o r k Ave. H o i4l h +oh City/PO: State: Zip Code; HQr\ L O �� It*)+-) 1.Does the proposetPaction 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? acres b.Total acreage to be physically disturbed? O acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? .S(0 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban [►Rural(non-agriculture) ❑Industrial [:]Commercial Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, I 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? Fi;;t 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO J lYES If Yes,identify: El 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? Q ❑ E ❑ 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: ((;;;t 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ (�lj 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: (" (l;;;l 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? b.Is the proposed action located in an archeological sensitive area? D 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? -j b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? _tt� ❑ 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 ❑Early mid-successional PJ�Vetland El 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 0 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 YES ❑ b.W ill,storm,water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO []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: o 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: Ef 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:_ _ T� j ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponso name: tI I a vv� Date: O Signature: Q. 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 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 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 L: D(� L� reasonably available energy conservation or renewable energy opportunities? [.. ! 7. Will the proposed action impact existing: El � a.public/private water supplies? i.._.l b.public/private wastewater treatment utilities? ❑ Q 8. Will the proposed action impair the character or quality of important historic,archaeological, El or aesthetic resources? LQ! 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? EJ Page 3 of 4 a No,or Moderate small to large i impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? El 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 lai ge 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. QCheck 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 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 sienificant 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 sunportinand non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website(southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM#_(,_- 3 - �p PROJECTN (2rgSSo �es, d{hc2. Pa� io � engir The Application has been submitted to(check appropriate response): Town Board -❑ Planning Board❑ Building Dept. 9 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: C p A ck n rn Ain c e. a P-> l v� of i- 0V% a a:IL Al A.1 ;o v a. Tor Sctgf, -V ;n GOMI% II aanLe, U.t; 6Glrv[.` 3 11 D� k Res► AV%4-( aco e, o� New �olrk S�44kll Location of action:_)J�� /�r S�a,� o_w.ay2yC �ou-F old T Site acreage: J�(o Present land use: (2 e Present zoning classification:-4,0 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: Wi I�,i g�A , S, A ey-e r &A (b) Mailing address: w S,J 5 A r G L l 4 2 G16 -7<5 N-e'-44 y o r k A�ze , NJ (c) Telephone number: Area Code( ) (e'31, 1-19 q (d) Application number,if any: , Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No R 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 Pest Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy I. Poster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure,makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III–Policies; Page 2 for evaluation criteria. ❑Yes ❑ No gNot 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 2 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 HNot Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LNVRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No 15Not Applicable 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 ZNot 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 LVVRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑-Yes ❑ No ZNot Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LVV" Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No YNot 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 LVVRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ YeO No 2Not 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 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 wwaters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No U 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 2 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 Not Applicable PREPARED BY W , A . �G h e r e r 'TITLE_ A r G L 4 2 c,+ DATE '7/-Z-7/-z0