Loading...
HomeMy WebLinkAboutTR-9934A Glenn Goldsmith, President *QF SO Town Hall Annex A. Nicholas Krupski,Vice President ,`O� ��� 54375 Route 25 P.O. Box 1179 Eric Sepenoski J ?s . Southold,New York 11971 Liz Gillooly G Telephone(631) 765-1892 Elizabeth Peeples • �� Fax(631) 765-6641 oou�m,��' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1896C Date: January 26; 2022 'THIS CERTIFIES that the construction of a second story staircase°from reaubalcgjY to, rg ade at east)'garage corner: ,4'6" in width: 12'6"high with 2"x12" ACQ stair stringers with 2"x4 At 885 Petty's Drive, Orient -Suffolk County Tax Map #1000-14-2-24. Conforms to the application for a Trustees Permit heretofore fledyiri'this office Dated'June 4,.2021.pursuant to which;Trustees Administrative Permit#9934A: - .-Dated JulY: 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 construction-of a second story staircase from rear,balcony to grade at(east) grave corner: ' 4'6" in width; .12'6" high with 2"x12"AQQ stair stringers with 2'.'x4"treads; The certificate is issued to MC Droege Fam. Rev. Tr. c/o-1Vladeline_Droege owner of , the aforesaid property. ; Authorized Signature Glenn Goldsmith,President �QF f s®G�j� �� Town Hall Annex A. Nicholas Krupski,Vice President ,`O� ��® 54375 Route 25 _. P.O. Box 1179 John M. Bredemeyer III Southold,New York 11971 Michael J. Domino G Q Telephone(631) 765-1892 Greg Williams 0 Fax(631) 765-6641 �y00UNT`1,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: „222 INSPECTED BY: d� Ch. 275 Ch. 111 INSPECTION,SCHEDULE Pre-construction, haybale line/silt, boom/silt curtain 11st day of construction '/wnstructeo` . _ . Project complete, compliance inspection COMMENTS: CERTIFICATE OF COMPLIANCE: �iL� � Glenn Goldsmith, President " �i �� ��, Town Hall Annex µ . A. Nicholas Krupski,Vice President 54375 Route 25� �»„ � "�'�� P.O. Box 1179 John M. Bredemeyer III Southold,New York 11971 Michael J. Domino �, "m"",� Telephone(631) 765-1892 Greg Williams � '°"� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9934A Date of Receipt of Application: June 4, 2021 Applicant: MC Droege Fam. Rev. Tr. c/o Madeline Droege SCTM#: 1000-14-2-24 Project Location: 885 Petty's Drive, Orient Date of Resolution/Issuance: July 14, 2021 Date of Expiration: July 14, 2023 Reviewed by: John M. Bredemeyer, III, Trustee Project Description: Construct a second story staircase from rear balcony to grade at (east) garage corner: 4'6" in width; 12'6" high with 2"x12" ACQ stair stringers with 2"x4" treads. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the survey prepared by Jeffrey W. Haderer, Licensed Land Surveyor, last dated February 2, 2021 and stamped approved on July 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. Glenn Goldsmith, President Board of Trustees Glenn Goldsmith, President /i Town Hall Annex A. Nicholas Krupski,Vice President V, 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III Southold, New York 11971 Michael J. Domino . ' Telephone(631) 765-1892 Greg Williams ` Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction Y2 constructed When project complete, call for compliance inspection; CERTIFIED TO:MADI DROEGE - - JOB NO. 2015-280 MAP NO. 5859 - C FILED:JANUARY 26,1973 REVISIONS: En UPDATE SURVEY 1/8/2021 REV. PROP. PARKING 2/2/2021 OF NES 4ou t h old Town r of Trurfes Vr- NAND <006 c' JEFFREY W. HADERER L.S. n� _ I NYS LIC. NO.:050538 G) O TWjWFOW RRVEYM '90 ox 189W.MffrAUK fl}CUM}3;1_7h TE.T �' 0, 0-7 631-369431. -(F)6-21-36"-313 MMES OF SURVEY P MWER PAP R OR E1. 'TRL1Nt 0oT BEARING f 1 �P Th*L"D SURMIE`0 SEAL OR�.S�n SF,I�L S1dALL NOTUE CONSIDEREDSEA VAMCOPYANOSHALL NOT REUSED MRAWPURPOSE LOT AREA:44,214 SQ.FT. = 1.015 ACRES LOT COVERAGE.5,720 SQ.FT. = 12.9% DWELLING:2,932SQ.FT. N1 \ 2nd FLOOR OVERHANGS:94 SQ.FT. STAKE \ SHED: 107 SQ.FT 'VO TAl;?U- \ \ DECK. 1,370 SQ.FT. \ POOL:510 SQ.FT. \ 1 RZVC POOL PATIO: 707 SQ.FT. \ 1 O \ - \ \ c1 \ 3 \ \ O W J F I _ FRAME \ \SAUNA 1.1.2'W LLV std RNOTE (X Q E �w 19.0' z - � y _" 31.0' g 40, F a £^�. _ W - ' y'ub. N tacn �_ 1_t APP VED BY ziURVEY Op"F LOT 6 BOAR OF 1 RUSTEES oft 0% TOWN F SOUTHOLD MAv vF PETTYS BIGHT DATE ( ! Zo s' mmEASEUEI/T RECGRU05L'pFALE 6T/ImvmI /YL' rGtvj tvn EMD i�M�—�Y EYlpEIIT A7 THE ORIENT f 4+ie TOWN OF SOUTHOLD - SUFFOLK COUNTY, NEW YORK S.C.T M. 1000 SEC. 14 B[.K. 02 LOT 24 " ' 20 10 0 20 40 60 80 100 120 140 160 180 SCALE. 1"=40' DATE:OCTOBER 9, 2015 , � x Glenn Gc{ nith, President ��\OS�F� ;cpG Town Hall Annex A. Nicnoibs Krupski, Vice-President ,� P �� 54375 Route 25 John M. Bredemeyer, III o '` P.O. Box 1179 Michael J..Domino o Southold, NY 11971 Greg Williams �'j1p� �ao� TFa p -1892 (631) 765 6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time:G ?A, � Completed infield by: MC DROEGE FAM. REV. TR. c/o MADELINE DROEGE requests an Administrative Permit to construct a second story staircase from rear balcony to grade at (east) garage corner: 4'6" in width; 12'6" high with 2"x12" ACQ stair stringers with 2"x4" treads. Located: 885 Petty's Drive, Orient. SCTM#: 1000-14-2-24 CH. 275-3 - SETBACKS j 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: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Surveys 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: it 04-�( I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: �J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other CERTIFIED TO:MADI DROEGE JOB N0. 2015-280 r MAP NO. 5859 5 FILED:JANUARY 26,19 73 REVISIONS: UPDATE SURVEY 1/8/2021 REV. PROP. PARKING 2IV2021 ��OF NEW� JUN ® 4 2021 C� W O,Q Southold Town I Board of Trustees .05 S�a�1D O JEFFREY W.HADERER L.S. v NYS LIC. NO.:050538 9 0% 10 F I WINFORKS s PIN, g2 O LAND SURVEYING Ir.9 , ,y y . (� SUCCWOR 7t7NANWONSURVEW,,"7ND,'"LS J O / v 188 W.MOATAUKIHGHWAY,UMTE3 SY�,� C�JO.S•� O HAMPTONBAH,,NEW YORK 11946 (V)631369-8311-(F)631369-8313 y 4�'9, Eg..'twlnfork-d-dsu-ey@yah-.c— I COP/ES OF THIS SURVEYMAP,EITHER PAPER OR ELECTRONIC,NOT BEARING ,��0���� THE LAND SURVEYORS INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BEA VAUD COPYAND SHALL NOT BE USED FOR ANY PURPOSE. LOTAREA:44,214 SQ.FT. = 1.015ACRES M LOT COVERAGE. 5,720 SQ.FT. = 12.9% DWELLING:2,932 SQ.FT, \ 2nd FLOOR OVERHANGS:94 SQ.FT. HUND \ \ \ SHED: 107 SQ.FT. \ \ DECK. 1,370 SQ.FT. \ POOL:510 SQ.FT. z POOL PATIO:707 SQ.FT. �A\ D aV sTgKE Q FOUND 8ZACK Arx 10• cFrEeNNF�""�USE 2 +m ,N�SQA Jy J U AND PL4 rPOa' L) 4i 0 PRp ANK y ) \ FRAME 25'W W STA \SAUNA 12'W LL.U No TAND 344 ,'------off` FON OON�FNOTE 0 Z ti a DRi YN \ 0 E �y LU .7 a SNC sTPRO\'�s O m 2RwE 19,0, z F s z 2p, a COR RO \ I �O 31.0' G4,.4TOR - •4A,/fS��"L1 � a b "2 9'OFFD LL o 47. O jy O'YO s �'ioy c\I ep UN�c Q p) CON 0ST MON� FOUND OS'E F q grN a `V SURVEY OF LOT 6 MAP OF PETTrS BIGHT SITUA TE A T 64SFMEArANDOREDFSNRFADE STRUCTURES RECORDED OR 'U., UnARENOT DDARANIEED NlFSS RIYSICALLY EV/DFM Ai 771E - ORIENT >,�E��p�,DNS� HEREON FROM INES7AUCIURES roniE RAOPER1YIlNES AREfORASFEppC TOWN OF SOUTHOLD R"° ^^m ARENOi/NI FeO GU/DEINE SUFFOLK COUNTY NEW YORK WAUS,NOFFENTIO RETAINING A WAUS,PoOL$PATIOS FLaNnND + AREAS,aopnoxs ro BmIpNGs S.C.T.M. 1000 SEC. 14 BLK 02 LOT 24 AM1DANYWHERCONS7RUCnON. uNAVINORIZEDALTERAnONORAC&ON ro SECnON 770AI 7t09veraAnaATron S 0F iNENEW YORKSigTE EDucanaNuw 0 10 0 20 40 60 80 100 120 140 160 180 COWES OF 7185 SURVEYNMN07BEAR NO SCALE: 1"=40' DATE:OCTOBER 9 2015 INEW DSURVEYORS INKED SEAL OR EMBOSSED SELL SHALLNOTBE CONSIDERED + ro FEA VALID D7IECOPY CFA IlWCATfONS INp017ED HERON SNALL RUN O+d.Y ro TNEPFRSON(S)FOR IM1SIOM INFSURVEY IS PREPARID ANDON NIS BENAlF 70 illE T11lECDMRANY.GOVERNMFN7AL AGFNCYANO LEND/NGUAnMIONMSrEOHFREON AI/D ro rNEacvorrEEs oFTNEIENpmTINaT� runox CERnF�GnoNS ARE NOr TRANSFERABLE rpo�am�noNat LNsnrunoNs oRsusssauENr i DEMO EXIST'G. BRICK SLAB AREA FOR NEW 14" DIA. P.G. SONOTUBE ON 24"x24"x12" POURED CONC. FTG. TO BE INSTALLED A MIN. 36" BELOW GRADE EX. BSMT. EX. BSMT. EX. BSMT. WINDOW WINDOW WINDOW 71 , 114 - EX. BRICK --J SLAB EX. BSMT. EX. BSMT. EX. BSMT. EX. BSMT. WINDOW WINDOW WINDOW WINDOW EXIST'G. BASEMENT Ex IST GARAGE N z ----- - B -- — — —Q— — — — --$— — — — Lj—0 — — — $--- — — — s~ 0 U U T�� BOSLER Q «S EXIST'G / MSCI-IANICAL SUMP PUMP EXIST'G BATH b o IF— ----II o II- --- ----II N — —UP— — — — � N (� 00 �Z �Z M 7 7E Z 6 co 3 3 Seal / Signature laz xm ���G ��4�,� FLOOR AREAS : BASE1 1 EN7 : ± 1625 SF Project: SOU N DST I ON FLAN B A T�4 R 0 01"I : ±45 S F DROEGE FAMILY 1"f ECS . ROOM : ±•42'�l SF REVOCABLE TRUST 885 Petty's Drive Orient,NY 11957 Town of Southold,Suffolk County,NY S.C.T.M#: 1000-14-2-24 Architect of Record Nicholas A. Vero, Architect, PC 120 Mill Road Westhampton Beach,NY 11978 T:631-288-1404 F:631-288-0549 E:nveroarch@aol.com ;---_ Date ScaleW1 E 3-18-21 j411_1t- 011 JUN 4 2021 Drawing Title - FOUNDATION Southold Town PLAN Ro�rd__ of fTrustees Drawing No.: O i EXIST'G POOL EXIST'G DECK EXIST'G. POOL DECK — - - - - - - - - - - - - - - - - 2)2°x10" ACQ HDR. 2"x12" ACQ STAIR STRINGERS W/(2) 9b" THRU 0 ENDS AND MIDDLE BOLTS 0 EACH POST 6"x6" ACQ POST ON 14" DIA. CABLE RAILING W/ ALUMINUM P.G. SONOTUBE ON POSTS AND TOP RAIL 24"x24"x12" POURED CONC. INSTALLED AS PER FTG. MIN. 36" BELOW GRADE MANUFACTURER SPECS. 2"x10" ACQ D.J. 0 16" O.G. 2"x4" ACQ TREADS EXIST'G. — — —_ -r— --1--I— —r—T—T— POSTEX I I I I ( I bQ.1 I K ( I I I I 2"x10" NAILER SECURE L _ I I I I I 0. 's W/ VDIA. x 3" LAG I LA I I I I 1 SCREWS 0 16"O.C. I I I I I — — — — — — — — — — — — — — — — — — I 5 Ko I O a IU 2PSGREAT RM. IROCEK T " N BEDROOM U EXIST'G OWNER'S USE DINING RM. (BEDROOM *174 SF BATH *40 SF) s., O I I .� I Q b GAIRAGE I � EX. ----- d 00 -- POOL 3 O ( sa Ell ( Q o0 ROOM N EX. I cn — — — I — ¢ — — CL. EXIST'G o o EX I ST'G BAT" z Z BATS-! sa i LIN. I co 0 I Seal / Signature EX GL. we]I �,, • - >.,, co y 3 'F' EXIST'G uP DN ProJ ect: LNDRY TBS AGE DROEGE FAMILY REVOCABLE TRUST SINK 885 Petty's Drive O EX I ST'G IOrient,NY 11957 FOYER — — — — Town of Southold,Suffolk County,NY EXIT S.C.T.M#: EX. EX. 1000-14-2-24 CL. GL. Architect of Record Nicholas A. Vero, Architect, PC FLOOR AREAS : 120 Mill Road EXIST'GPORC" FIRST FLOOR : ±2391 S F T:631-288-1404 on Beach,NY 11978 GARAGE : .+506 SF F:631-288-0549 E:nveroarch@aol.com F I RST FLOOR PLAN - 1"1 S I N D E C K : ± 1237 S F Date Scale SGALE: Ii4"=I'—o" POOL DECK : ±508 SF 3-18-21 %4"=1'-011 POOL : ±440 S FDrawing Title FIRST i FLOOR PLAN JUNI 4 2021 Drawing No.: So ri r% Town Q (B2= Board pf Trilstees PROPOSED STAIRCASE _ _ _ _ _ _ _ ROOF DECK (— ROOF DECK EX. I Z z i i x. '" CL. a a ———————————————— ----------------- i / /�.• ;,/' _____ __ _— _— _— _— _— _ -- f 'EX./ EX. EXIST'G %' EXIST'G II ( 1 1EDROOM ''/ f BEDROOM II OWNER'S USE II (BEDROOM *259 SF ffll BATH *70 SF) II EXfS'i`' i EXIST'G II II BEoRgoM/ %j` j` % BEDROOM II EX. X. OWNER'S USE II (BEDROOM *276 5F BATH *59 SF) 8 j r /, ❑ ❑ Xi f I $ATNG EBATNG CL. u Ir CI L= 7 ® u IT 8 ---------------- --------------- II QCIST'G /. jE XIST'G II -------------- ----------------J / n 1 I BATH —I— u BATH ,. / / i � EX. c:TU531TUBII LIN. ( LIN. OII f II i ii — DN II II sD II II j EXIST'G E iT EXIST'G II ALL HALL TUB co OPEN TO BELOW - - - - -- -- - -- -� I FLOOR AREAS : . SECOND FLOOR : ± 1829 SF 'U U AN ( INCL. BED # BREAKFAST AREA) A �, SECOND FLOOR PL ROOF DECK : ±333 SF SCALE= 1/4"=1'—O" FLOOR AREAS FOR BED t BREAKFAST USE : / 2 BEDROOr IS t 2 BAT�4ROO1 IS : ±664 SF � O N 00 A ' , � M N z z Seal / Signature rz , LINE OF EXISTING. HOUSE � '8 Ca 2"x10" NAILER SECURE J i' O — W/ VDIA. x 3" LAG " SCREWS ! Fri 16"O.G. `�� ✓, „� 2"x10" ACG? D.J. 0 16" O.G. Pr sect: DROEGE FAMILY — --- REVOCABLE TRUST 885 Petty's Drive (2)2"x10" ACG? HDR. Orient,NY 11957 W/(2) %" THRU Town of Southold,Suffolk County,NY BOLTS 0 EACH POST S.C.T.M#: 1000-14-2-24 6"x6" ACQ POST Architect of Record sIMP50N STRONG—TIE Nicholas A. Vero, P566 POST SASE, Architect, PC GALVANIZED 120 Mill Road Westhampton Beach,NY 11978 T:631-288-1404 14" DIA. P.G. 50NOTUBE F:631-288-0549 E:nveroarch@aol.com ON 24"x24"x12" POURED i •.. GONG. FTG.MIN. 36" Date Scale m BELOW GRADE ---- , - - ;., 3-18-21 AS NOTED Drawing Title 14" DIA. P.G. 50NOTUBE L_J ON 24"x24"x12" POURED _ 2ND FLOOR PLAN N r GOG. FTG:.MIN. 36" Cs)- I* A..Re V exu WAY JU'VUN 4 BELOW GRADE ZO21 ` � DETAIL & ELEVATION FOOTING DETAIL I SCALE. ,rs"_r_o. Southold Town ; Drawing No.: sorrd^ o- f 7-tjstpr� ___.... PARTIAL REAR ELEVATION FOR PROPOSED STAIRCASE A O SCALE Y4" 1'—O° i 0: 8 IJP JI 4p Y S 8 r ICP l r r t I I, p I r�I I � W - J_ y f . tt16B) M-21LB8 08 0199 Iters@ 10.}tae ttls, 83611 pD.65 '•" M' y x) xe ]° -a: t ulrt� SGN� 3.110 m 16 Wcl 'ry, i iNq x1z { n C�'C °BMcI 110 J.30 �Yi x+J � f sW11 5BNc1 i., -0, 321 Y~/ x11 A mY"-� .F-gip 6rj\ WA/ID xaz xts_ .ata°oI � M' 1 'WN. �o J x1 a I,yB t Nq `I))� ° s ° "' /.Z�.� ♦sz"� O EEEc.No. nt w.auF°NcY J.2s si4 J.]J � t.Ulc) l`+Ncl ® 020-OtaOI] 0 tl FOR SE O. EOSREE EECNNO. EEE EC.NO. / t2 s xt ♦V�7 d SEE EEG.NO. OtB02at0.1 OAOta01.I, x s.W�t xz xo. zs otamau.z twq � MAIN OLD MAIN +e 102Nc) JOt NE + e 112 SEE Et.NOL O10 mo0tmaa EE EC.O,.1° IS 16 +i.t 3 S.R.25 RB7 �R NOTICE mu'� COUNTY OF SUFFOLK © a sou7NOL0 SECTION NO —�— tz) �_�'_ --�-- --� m,m �.;... Real Property TaSe-itService Agency E t� 14 014 A uc[o a.BI r �y� P x 1000 PROPERTY MAP OFFICE LOCATION: MAILING ADDRESS: Town Hall Annexes P.O. Box 1179 54375 State Route 25 � � Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) �a Southold, NY 11971Telephone: 631 765-1938 , LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, Assistant Town Planning Director LWRP Coordinator Date: July 9, 2021 Re: Local Waterfront Coastal Consistency Review for MC DROEGE FAM. REV. TR. c/o MADELINE DROEGE SCTM# 1000-14-2-24 MC DROEGE FAM. REV. TR. c/o MADELINE DROEGE requests an Administrative Permit to construct a second story staircase from rear balcony to grade at (east) garage corner: 4'6" in width; 12'6" high with 2"x12" ACQ stair stringers with 2"x4" treads. Located: 885 Petty's Drive, Orient. SCTM#: 1000-14-2-24 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 determination that the proposed action is EXEMPT from LWRP review. 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 DiSalvo, Diane From: Shayann Walsberg <shayannd@icloud.com> Sent: Thursday,June 17, 2021 11:31 AM To: DiSalvo, Diane, Subject: 885 Petty's Drive Orient- Proposed second story stairs Attachments: Droege Amendment to Trust November 2020.pdf Good morning Diane, I understand we missed the June 14th meeting. I was unable to get the necessary documents on time. I attached part of the RLT stating Madeline Droege is the holder. Will this suffice? The proposed second story stairs dimensions are as follows: -Width-4'-6" -Height from grade up to balcony 12'6" -2"x12" ACQ stair stringers -2"x4" Treads i Glenn Goldsmith,President �Q� soTown Hall Annex Michael J.Domino,Vice-President ��� �l� 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III 116 Southold,New York 11971 A.Nicholas Krupski Telephone(631) 765-1892 Greg Williams �` Y® Fax(631) 765-6641 �eoUNT`1,� _ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application E C E P U p� E Wetland Permit Application Administrative Permit Amendment/Transfer/Extension JUN 4 2 Received Applica 'on:_ 6• Received Fee: $ 80,00 Southold Town Completed Application:__ • ,24 Board of Trustees Incomplete: _ SEQRA Classification: Type I Type H Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: �Coordination:(date sent): LWRP Consistency Assessment Form Sent: -- AC Referral Sent: e� Date of Inspection: Receipt of CAC Report:. Technical Review: Public Hearing Held: Resolution: Owner(s)Legal Name of Property(as shown on Deed): Mailing Address: Phone Number: 0931 �� Lf Sq S Suffolk County Tax Map Number: 1000 - 0H - 2 ZLl xx11 Property Location: �5 5 Ttt `S DY kf (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): ShOO Qn n �A f GLL SS G Mailing Address: S46 4(q Phone Number: Board of Trustees Appii;_ .•tion GENERAL DATA Land Area(in square feet): -�)'5, C� 3 Area Zoning: �_'L(0 Previous use of property: Rest Intended use of property: Re s) Covenants and Restrictions on property? Yes V No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? Zyes No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes",please provide copy of decision. Will this project require-any demolition as per Town Code or as determined by the Building Dept.? Yes ✓✓ No / Does the structure (s) on property have a valid Certificate of Occupancy? v Yes No Prior permits/approvals for site improvements: Agency Date r No prior permits/approvals for site improvements. Has any permitlapproval ever been revoked or suspended by a governmental agency? " No Yes If yes,provide explanation: Project Description(use attachments if necessary): �P���d � i►n�l _ S�GtI�C'aS� ba( ccqg 4oqraoy of �5� Board of Trustees Appli tion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: S-1�l�-I Area of wetlands on lot: 4 square feet Percent coverage of lot: 1 (.0 '-J % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: Sy. feet Does the project involve excavation or filling? x No Yes If yes, how much material will be excavated? Iv cubic yards How much material will be filled? h- cubic yards Depth of which material will be removed or deposited: NIR feet Proposed slope throughout the area of operations: N P, 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): �h��e �i �1 �� �b �-��ec-�- o� wed-la�►d�s-. 61 Z20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information qac&be/rq Name of Action or Project: S+Q1 Project Location(describe,and attach a location map):, ftp m,6 Ty,4e- or(p�\ 1 Brief Description of Proposed Action: 4Vm 13 of cove Name of Applicant or Sponsor: I W Telephone: �� S�s 1-M 6th h V E-Mail: skav Rmd 00me. 0-cm Address: City/PO: State: Zip Code: � I ! q�lq 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? 11-1 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: 0 +h cold 3(AcUra pf&av4olf la.Total acreage of the site of the proposed action? J & $2- acres b.Total acreage to be physically disturbed? —jT—acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? r 02,1 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial EResidential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 S. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? Er I--]- c. c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ' ❑ ❑ 1 l.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment:_ W I ❑ ❑ 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? 1 NI ❑ ❑„ 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? El 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 u 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? ff ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? NO DYES ❑ b.Will storm water discharges be directed to established conveyance systems(runo and storm drains)? If Yes,briefly describe: NO AYES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO -YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: 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 II n^II��AA PP Applicant/sponsor name: Uv hh W�I Date: Signature: f_ d 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 Elregulations? __ 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 rjj� Ll of a Critical Environmental Area(CEA)? F 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? u 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? ✓� 8. Will the proposed action impair the character or quality of important historic,archaeological, (-jf' (� architectural or aesthetic resources? E L _.1 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, (—I waterbodies,groundwater,air quality,flora and fauna)? E Page 3 of 4 i1! t No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? 0-1 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. 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. F] 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 Board of Trustees Appl,' 6tion AFFIDAVIT i � lO�,leb�l�� l �ING DULY SWORN DEPOSES D AFFIRMS THAT /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. Signature of Property Owner Signaturd of Property Owner SWORN TO BEFORE ME THIS_ 02, DAY OF 20J,1 No ary Public DANA LABIANCA NOTARY PUBLIC-STATE OF NLV YORK NO,O1LA6317406 O ualified in Suffolk county 1',1v t-ommission Expires of-08-2023 Board of Trustees Appl Ltion AUTHORIZATION (Where the applicant is not the owner) I/We, - -- ITO ®NW - owners of the property identified as SCTM# 1000- -( Z —Z q in the town of New York, hereby authorizes 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 Owner's Signature Property O er's Signature f SWORN TO BEFORE ME THIS DAY OF 20 f _ Notary 04lic DANA LABIANCA NOTARY PUBLIC-STATE OF NEW YORK No:01LA6317406 Qualified in Suffolk County My Commission Expires 01-05-2023 APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of towno'fficers and employees.The purpose of this form is to.provide,inforination which can alert the town of possible conflicts�of interest and allow itto,take whatever action is necessary to avoid same. j YOUR NAME:. W n (Last name,fust rdme,aniddle initlal,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 Southo d Title br position of that person 1�1 Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of h 206.1 Signature Print Name la 06, W Ct l Form TS 1 f; Town of Southold LWRP CONSISTENCY ASSESSMENT FORINT 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- 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# I - PROJECT NAME it UPI (�I� 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) T❑ (b) Financial assistance(e.g. grant,loan,subsidy) (c) Permit, approval,license,certification: Nature and extent of action: -A-Dp;w�-ea F r(or &?oqd 4al r M ba[ co -t-v Location of action: 's ����, W'evvIn Site acreage: Present land use: Present zoning classification: 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: C'n ( S (b) Mailing address:_ SO S 5��-PQM{- �`�f'� f)��- �Jy (c) Telephone number: Area Code( (d) Application number,if any: !�- Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No P 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 l.. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure,makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III-Policies; Page 2 for evaluation criteria. ❑Yes ❑ No Q/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 !�I 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 �ot Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages through 16 for evaluation criteria F-1Yes No Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III —Policies Pages 16 through for evaluation criteria ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. Yes No ��-—1 Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ NoNot Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. ee LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Yel—I No Not Applicable Attach additional sheets if necessary WORIUTG COAST R_;ICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See WRP 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 waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. 1:1 Yes 1:1 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 forZNot on criteria. ❑Yes ❑ NoApplicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; P es 65 through 68 for evaluation criteria. ❑ Yes E] No Not Applicable PREPARED BY W_GdTLE DATE