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HomeMy WebLinkAboutTR-9853A Glenn Goldsmith,President *QF SO(/jy Town Hall Annex A. Nicholas Krupski,Vice PresidentOl0 54375 Route 25 P.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 COUM,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1827C Date: June 26, 2021 THIS CERTIFIES that the as-built decks measuring 12'x8'11" (107.04sq.ft)and 12'x15'3.5" (183.46sq.ft.)respectively, for a total of 290.5sq.ft; At 435 Mockingbird Lane, Southold Suffolk County Tax Map 41000-55-6-15.57 Conforms to the application for a Trustees Permit heretofore filed in this office Dated March 18, 2021 pursuant to which Trustees Administrative Permit#9853A Dated April 14, 2021,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 as-built decks measuring 12'x8'1 I" (107.04sq.ft) and 12'x15'3`.5" (183.46sq.ft.) respectively, for a total of 290.5sq.ft. The certificate is issued to Peter& Gillian Cowan owners of the aforesaid property. Authorized Signature r"1 Glenn Goldsmith, President '�'QF so(/ryo Town Hall Annex A. Nicholas Krupski,Vice President ,`O �� 54375 Route 25 John M. Bredemeyer III P.O. Box 1179Southold,New York 11971 Michael J. Domino • Telephone(631) 765-1892 Greg Williams �� Y Fax(631) 765-6641 �y�4UNT`I,N� 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 constructed Project complete, compliance inspection COMMENTS: CERTIFICATE OF COMPLIANCE: Glenn Goldsmith,President �QF so(/ry Town Hall Annex A. Nicholas Krupski,Vice President �Q� �p 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III JxiL Southold,New York 11971 Michael J.Domino G Q Telephone(631) 765-1892 Greg Williams YQ 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 - BEL-OW INSPECTION SCHEDULE Pre-construction, hay-bale line/silt-boom/silt curtain 1St day of construction- % constructed k When project complete, call for compliance inspection; Glenn Goldsmith, President QF sv�lyo Town Hall Annex A.Nicholas Krupski,Vice President O �� 54375 Route 25 John M. Bredemeyer III l l P.O. Box 1179 Southold,New York 11971 Michael J.Domino cn G • Q Telephone(631) 765-1892 Greg Williams �'0 Fax(631) 765-6641 �yC0UNT1,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9853A Date of Receipt of Application: March 18, 2021 Applicant: Peter & Gillian Cowan SCTM#: 1000-55-6-15.57 Project Location: 435 Mockingbird Lane, Southold Date of Resolution/Issuance: April 14, 2021 Date of Expiration: April 14, 2023 Reviewed by: Michael J. Domino, Trustee Project Description: As-built decks measuring 12'x8'11" (107.04sq.ft) and 12'x15'3.5" (183.46sq.ft.) respectively, for a total of 290.5sq.ft. . 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 mch design services, dated February 12, 2021 and stamped approved on April 14, 2021. 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. 49—4aw/_� Glenn Goldsmith, President Board of Trustees • it APPROVED '-B. BOARD OF -I RUSTS SCTM 1000-55-6-15.57 - ,A, LOCATION AREA LOTCOVERAGE �O Ytl ®F SOUTH PROPERTY 29,352 SF 0 6738 ACRES ATE / Pee.!L !q,2nd( � (BUILDABLE PROPERTY) 18,899 SF EX.HOUSE 1,498 3 SF 7.92% EX.2ND.FL CANTILEVERS 53.5 SF (OVER DECKS BELOW) I fO(,po EX PORCH 263.4 SF 1.39% EX.DECK 218.5 5F 1.15% �/�NO AS BUILT DECK 290.5 SF 153% ) /41ti EX.POOL 711.0 SF 3.76% cpm Vol -Pht TOT3,05.2 SF TOTAL 3,035.2 METES AND BOUNDS BY ; � �Fw SFR�gT/�� � ® W .JOHN EHLERS LAND SURVEYOR M o �/ SURVEY DATE: 03-10-2009 ? �/ jj// �� r / Z O /Mpw �� ./ F14 Z� //� z PQz %F� j`` _ . il O 00, in !Z 2 Q f o POOL O. GN FENCE O V o o t,l1 ' 0S ' o � ,• 2ND FLOOR CANTILEVER 2113 W XX �. L 0, ��NG E C E 0 V E N ® DRAWN BY:JD SNF MAR 18 2021 2/12/2021 SITE PLAN SCALE.f'=20'-0" SCALE: SEE PLAN Southold Town Board of Trustees SHEET NO: j urz%ueo AS BUILT DECK 1 EXISTING DECK AS BUILT DECK • � al � EXISTING OO ! BREAKFAST r FSI EXISTING KITCHEN EXISTING GARAGE .. . ,. _ 1 • I 1 � -------- I rx.' °' r5��'�, wf , •a_3 rvi EXISTING 10 LIVING ROOM-------------- EXISTING DINING-ROOM HALFA1 0�1W1 • , i I1 EXISTINGENTRYJ W , i ! i EXISTING COVERED PORCH DRAWN BY:7D 1 ® ® ® ® ® ® 2/9/2021 ' pr c VSCALE: SEE PLAN1ST FLOOR PIAN ' MAR , 1 8 2021 SHEET NO • SCALE:1/,r=1'-O" i Southold Town Board,Elf Trustees A-2 ; ly Glenn Goldsmitr'� esident �0S11FFQ(,�� y Town Hall Annex A. Nicholas K�'� . ;ski, Vice-President ��� �',-�' 54375 Route 25 John M. Bredemeyer, III y z P.O. Box 1179 Michael J. Domino o Southold, NY 11971 Greg Williams ®! Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 2-62,( Completed in field by: ` Michael A. Kimack on behalf of PETER & GILLIAN COWAN requests an Administrative Permit for as-built decks measuring 12'x8'11" (107.04sq.ft) and 12'x15'3.5" (183.46sq.ft.) respectively, for a total of 290.5sq.ft. Located: 435 Mockingbird Lane, Southold. SCTM#: 1000-55-6-15.57 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 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: A4"- I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other SCTM 1000-55-6-15.57 ; LOCATION AREA LOT COVERAGE PROPERTY 29,352 SF 0.6738 ACRES (BUILDABLE PROPERTY) 18,899 SF j EX.HOUSE 1,498 3 SF 7.92% ( ` EX.2ND.FL.CANTILEVERS 53.5 SF (OVER DECKS BELOW) Foci ��o EX.PORCH 263 4 SF 1.39% \` oFw�TGgHo HiQ EX.DECK 218.5 SF 1.15% ;, ; „!y �S,�No o O—� ; AS BUILT DECK 290.5 SF 1.53% EX.POOL 711.0 SF 3.76% , F TOTAL 3,035.2 SF 15.75% METES AND BOUNDS BYj�/ F�/t)? /� O JOHN FREERS, LAND SURVEYOR �j /' ,/,;,l/%s FM v / ATlo L® w W SURVEY DATE: 03-10-2009 i �/ FNT �� - –.a V M %` — z o ow w oe- L POOL 2G� E FENCE O , P f c9��sy otic — G ' O 2ND FLOOR A CANnLEVER ,LC�7.• 1 • 1 , S till DRAWN BY:JD , D 2,12,2021 SITE PLAN j SCALE:1"=20'-0^ SCALE: SEE PLAN ; ' ! 4 MAR , 1 8 2021 ! SHEET NO: Southold Town ' I Board of Trustees k Vill AS BUILT DECK EXISTING DECK ;, AS BUILT DECK — — — — — — — — — — — i EXISTING O BREAKFAST ; ' ------t`--r-_ • .1•,.O EXISTING Irk�IaNG KTCHEN EXISTING GARAGE i0i •`K`•',s i g .rr. ;:T . EXISTING L ------------------------_____-_-_-- LVINGROO MQ^ cVZn Oz EXISTING DINING ROOM EXISTING ENTRY.-I i i i� i U ! EXISTING COVERED PORCH ; DRAWN BY:]D ' ® ® a ® ® NJ 2/9/2021 D LS' : SEE PLAN , 1ST. FLOOR KLAN MAR 9 8 2021 SHEET NO: SCALE:1/4"=1'-0' ' Southold Town Board of ThusteesA-2 ; i -- is, LAND SURVEYOR )ATE: 03-10-2009cb _ c cb f J, ��\ �6' \ O f t Ac � \ - =o� c� ,A Irk" - \t POOL ti ZC O� � \ FENCE 2c t 04 �O ' 2ND.FLOOR O� CANTILEVER Y Y �y `Z S u . rn S- SITE PLAN t )4— SCALE. 1 - 20 0 1�IIIIiillll 'I'" u 74 (1)Cowan Residence Taken:March 15, 2021 Looking SSE - - r {2 ) Cowan Residence Taken March 15,2021 Looking Nw f 1 t . All � ij, �j[epnnn�Att rar�n*gn i�1i�E11� � ii , 1'i i Mil .��.�.....: �:�rsuli�' iii► . _ - •ti . .1 ... � 1.: ; 03 - 15 - 2021 22 : 40 em WA F '"" Mm�l!il�f� ' l0fl� t#,t c�"�. 'fir.""^" � ",i'r� F,r"�° ]�a r �-` ro �.�-•�.ar� � '�t� � � � x; '': ^3«>�' k x Cowan Residence ' � ` ` Legend � `` � ,: r h a p y ter¢ e Write a description for your map. - , ' ��~ �¢ ' 435 Mockingbird Ln _ �-'*%, exa >< :�- "" �_—�.:w7`. .., .,+der t�..�#� x». ,-. �••` �� �?� +a`�^ ��� �� .� ' ``. ��.� z'- .^ ''• �*.:" _�K y'�r �, :"#:,qa '?� �''Y, .� <z'*�` � �'"�.f`,l;.a":��".�,.a a JI :a.�r:' � ��`-� � `� •�.'` ��... .. da,L,., 8"".:`�� .�K r ,,e 2g ami W �.� ,� .- ,.. `� E� � .. i• !, '�'n`� °` n� ��` �F r & j+a ` ra , y q �� .�e�" «� 'a'��' � 4 "'•• 9� �` '� `tom � Y y 1, x= f a z 2 e. to yY �35 a _ .. �. • n Os.N.M 8EE BEC.NO.OS, a¢eEc ra a W1CN ,111E w0a OIL69e i 47 01 2�01wave / ,.Wq \ FOR PCL 6 Ij NORiN °5 \ 053E-0600M0 N t00Nc1 4.43]Ncl e ,0.3605 1 3.aye1 Iol 4 Std 5a 2 LiNq t.s _\��/ � O'✓h osxiae aq .+ E i Y e� n a.orae 33 Ol.p1ot s man tANO anawr >` m.tb, B.sVq mai i 2-m 04 Wi4 i 13 >A y e.,s E P,v4LPMaxr 5 ^.,p1 �O 354 r PF.Tro.Ixrwa.N va O LBn y A.SM1 1.2 � '{ rv.f�rgxxr..m.ra e 9\ '3 �sy Iv ++ la � Y yENNECA T ^n 6 B ]5 w T.µcl a ] 15� 3B.ONc) , • oeKao�r � ti 1011e1 a w w .� ,55h +.INd O IONeI a.0 O \ rrvFro^ve'xT NOxry p ,` 3 41 ♦ 1.51a`°„ *.t0, 1y1 `al 10 5hT 1 h� .p 515e"� 9 L1 \ A T.ycl � u.a IhM o awB m1 O r r � Isse a „1]E.P�,xx.,.�,r>, \ `:hoc ° 1° EEE IaL wl • ,se �^. � gY ,$, o- .. \Y`> Y 5e 3j°LL 1> Ye.1°� 15Y+i,5.3115 J]]5>a♦5>. fD'tra Y`Ya .� dtiar Y ,+ I,Y 4+ iwb°� 5'r !t a h �. 1141 IS.aE ,sae IbA- 1 ,5.0i 15.]1 a w 'n tp 3.MIc) laa4.) M,,•.;,. w.t ) r ,• " FOR PCL.No. y� 4 z12] a p 11 Y w 3p 6 n Y xe Y 3v s]0 y,.1 5s.T' 6EE sEC.N0. 1>� 9 Y Y a� 25 �. � 4a1� InJosori / nuo -1MTCN - z. / aWExTeNNrq BEE SEC.1q.0O '.E ♦ J' l .«.+ r. •• .� __ r.u. __cP,__ u. __.__ NOTICE 4 COUNTY OF SUFFOLK © R v]^ sourNo�p SECTION NO d...� —�-- R+) -- -- a Real Property mx...S Service Agency v 055 p wr n ~FrNn.�]u 0 N p W m,c ra 1600 PROPERTY AUP 3,NN OFFICE LOCATION: � �' ��;, MAILING ADDRESS: Town Hall Annex ° �� �� �4 P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold NY 11971G aW Telephone: 631 765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Heather Lanza, AICP, Town Planning Director on behalf of Mark Terry, LWRP Coordinator&Assistant Town Planning Director Date: April 12, 2021 Re: Local Waterfront Coastal Consistency Review Cowen SCTM# 1000-55-6-15.57 The application referenced above is for a Wetland Permit for the installation of deck additions on either side of an existing deck. 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. 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 00 Glenn Goldsmith,President Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President John M.BSouth redemeyer III P.O. Box 1179 Southold,New York 11971 Michael J.Domino Ilk' -1892 Telephone(631) 765 Greg Williams Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application V/ Wetland Permit Application V' —Administrative Permit / Amendment/Transfer/Extension 17,-,—Received Application: f I If.2-1 —�'--Received Fee: $ ZOO-OV &A &W kl Completed Application: 3.31'24 Incomplete: -----SEORA Classification: Type I_ Type 11 Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: oordination:(date sent): n E C E V E LWRP Consistency Assessment Form Sent: L) I CAC Referral Sent: /—Date of Inspection: 'It.I.z/ I MAR 18 2021 Receipt of CAC Report: Technical Review: -7'-Public Hearing Held: Southold Town Resolution: Board of Trustees____j Owner(s) Legal Name of Property(as shown on Deed): BE22!5e &-&ZYAAI C WAN Mailing Address: -9-4 QC1 - Phone Number: -646�? Suffolk County Tax Map Number: 1000 - Property Location: 4957, HQCL- _C7_ 3AMEI fQQgAY, I197J (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): HIC HAEZ A. k-11HA CK Mailing Address: Jrn 1-17N 101D /Y—,Vl /'/!�l Phone Number: Board of Trustees Applicauion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ZV� �CpiyD�/� l acv S' jeEKAEV- 0112 12AIWPa R-r-CRE-41701V ENMeZ_X1hV",,r_-N Area of wetlands on lot: /0 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? AIA cubic yards Depth of which material will be removed or deposited: ,V feet Proposed slope throughout the area of operations: JqL447J Manner in which material will be removed or deposited: /1//A 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): .W_2!RZ-: "S f3nS/i/ NO 6� cr oil/ X1.0! LMI O S s'U 3 �U 1� G D_,GM/ CrID^/12 ' AM 6662ZZT65 /SMIIG C. Board of Trustees Application GENERAL DATA Land Area(in square feet): 2 Area Zoning: — �Q Previous use of property: , kFJ D ,6W 7Tl,4L 0&E F14/-/)Z Intended use of property: 9EVAEA17-1,4/ 41iU25 "HI-6—V Covenants and Restrictions on property? Yes No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? _XYes 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 __X 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: TP1�. �7—R"6/65—ency Date6 9) 200 9 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): L �_AG/ZE ��L� AF-49/L27 ,4,W776415 0 Z (z 9 0, gym. o45',ot> /SND 1210"x 617.20 Appendix B Short Environmental Assessment Form Instructions for Completin 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: CC WAUI aECk4=96&S Project Location(describe,and attach a location map): " LG0V /V•)1 / Brief Description of Proposed Action: X/s iVG ,Q C11- 12 9 0. Dr)/ 7hM� CL O.l';�T P L)W NI' ,D,EcIe /.i W10 0.44S R,64510 Name of Applicant or Sponsor: Telephone 96, Address: City/PO: State: Zip Code. 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 F may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES_ If Yes,list agency(s)name and permit or approval: ❑ 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? O. O acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0, 6y 7� acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban []Rural(non-agriculture) [:]Industrial ❑Commercial ZResidential(suburban) ❑Forest ❑Agriculture F-1 Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ Elb.Consistent with the adopted comprehensive plan? ❑ LT 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 9 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 ❑ 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? ❑ e.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 tec���ies: � El 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: IV1A 157J ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment:__­­ w_._N1-1 M 1112. 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? ❑ 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: 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 X Wetland ❑Urban XSuburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? 1K—/r [:] 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 properties9 ❑NO [—]YES ❑ b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)) If Yes,briefly describe: ❑NO DYES Page 2 of 4 18. Does the proposed action include construction of 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: �� W 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: ®; a 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 ////�� Applicant/sponsor name: _/.��OmleG Date: L Signature:____ ar 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 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"}-lave my responses been reasonable considering the scale and context of the pioposcd 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 1:1 ❑ 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? o ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the El F-1establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or 1:1affect existing infrastructure for mass transit,biking or walkway? El 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate 1:1 1:1reasonably 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? El 8. Will the proposed action impair the character or quality of important historic,archaeological, F]architectural or aesthetic resources`? El 9. Will the proposed action result in an adverse change to natural resources (e.g.,wetlands, n waterbodies,groundwater,air quality, flora and fauna)? I_1 Pane 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage (� problems? u 11. Will the proposed action create a hazard to environmental resources or human health? 7 0 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-tern,long-term and cumulative impacts. E:1Check 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 Pr int 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 I Page 4 of 4 Board of Trustees Application AFFIDAVIT Peter & Gillian Cowan � BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT($),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. ; s THE APPLICANT AGREES TO HOLD TILE,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 REPRE'SENTATIVES;-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' na eyof Property,Owner Signature of Property Owner Peter Cowan Gillian Cowan SWORN TO BEFOREME THIS, ____�Z_ -DAY"OF. ,.20 `SSSpTEpNz Dawn Johnson NOTARY =Notary Public,State of New York H AL _ PUBLIC ,"€No OIJ06349053 trojf Qualified in Suffolk County NOt PUb11C "411111n lmo Commission Expires 10/11/20AA f� 3 i f { Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) E I/We, Peter Cowan ,and Gillian Cowan owners of the property identified as SCTM# 1000- 55-6-1557 in the town of Southold .New York,hereby authorizes Michael A Ki m ack _ 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. i /P Property Owner's Signature Property Owner's Signature Peter Cowan Gillian Cowan SWORN TO BEFORE ME THIS 12-- ., _ DAY OF20 Dawn Johnson noraav =Notary Public,State of New York No oIJ06349053 Public .,Nati�� Qualified in Suffo Notlk County "nmimm�o commission Expires 10/11/202-4 i 1 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. YOURNAME: Cowan Gillian (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.) TYPE OF APPLICATION:(Check all that apply) Tax grievance Building Permit Variance Trustee Permit Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) Planning 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 applicantlagentlrepresentative)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 that 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 Submittedt day of Signature Print Name Gillian Cowan AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the wart 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: Cowan Peter (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.) TYPE OF APPLICATION:(Check all that apply) Tax grievance Building Permit Variance Trustee Permit Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) Planning 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 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 that 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 12, da of C/ ,202,1 Signature_ ,WAI Print Name /Peter Cowan 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 emoio'vices The nttruose of this form is to provide infomaation which can alert the town of possjbla conflicts of interest and allow it totake whatever action is necessary,to avoid same. YOUR NAME: 9�f LfA cl M/C94541 (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 oil'icer or employee owns more than 5%of the shares. YES NOy 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 sponse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of dwshares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or 6neficial'owner of any interest in a non-corporate entity(when the applicant is nota corporation); C)an officer,director,partner,or-employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this /ZLkda of��a 0� Signature Print Name Form TS I Town of Southold LW,RP 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 sigiuricant 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. Thins, each anmver must be explained in detail, listing both sunportintg and 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# �_ 6 -, IS, EI PROJECT NAME CDS[4 2,,0177'0A/S 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: And Nature and extent of action: 416614-41Z46 ji5xL�T;lel C7 DE GV- a- o. s Il=, z` Z: Cl 01S71- 14W/7— `/07. 04 ANO /2 'o'vY, 16-"if©zY-'//83-46 ��> '1 Location of action: 5 HOC AJ69/RIP IA NS. -GOOM 66D Site acreage,: Present land use: ��'/� �/77,C�L C)N-4 F—A)V II—V Present zoning classification EMIAAAENTW L ON,E AW 1 f/L y 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: PIETE R $i CSI L iA&__ C O WAM (b) Mailing address: 4:6,C TOvZVQ1-D, (c) Telephone number: Area Code (d) Application number,if any: #� r = 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 LMW Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No>0 Not Applicable 14CA-- /O 5- D0,55 itl — A N CAI A- C Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWR,P Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No 0 Not Applicable 1 O ALAtto ,-OLdG CAL— Attach ach 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 V Not Applicable Zy � .Sr V,11--7- D1504 Aj?"J tis GUlLL � �- N Y L A/0 I'C & C ���D U2 CE S QV AAE49 4WI�5 /W 08.E9ty Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRI' Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No Not Applic ble I'r�Gl c y 14 no rm/s APDL . Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No ONot Applic ble POLI cy r N 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 8011 C 6 Al, 7-6 W C ,48�- 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 Er Not Applicable P o6/ Cy 7 AW/A 776 Zti15 Ae? . Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWIdP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No JrSJ1 Not Applicabl BGG/c y Ay_.4 7-o1 S 4ppG 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. ❑ YeD No X1 Not Applicable POLICY 9 I-VIA ro ZVis AP�z- . 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 PQI/Cy / 0 A)IM 7-6 Y-hV5 A6PL- 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 1�1 Not Applicable 11 po 11CY 11 iv A 7'6 X7411 A?PZ- 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 1K Not Applicable ZYj6?� .4R" Al a 46 SO!G S ON Ort W/ /rV Soo r- 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 Er Not Applicab PREPARED BY wlIC'i EL .4. / Ae/ TITLE 6kiV7— DATEj&6j,*)