Loading...
HomeMy WebLinkAboutTR-10002A Glenn Goldsmith,President ��QF s®U��® Town Hall Annex 54375 Route 25 A.Nicholas Krupski,Vice President P.O. Box 1179 Eric Sepenoskii Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples ® y® Fax(631) 765-6641 00 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE 2112C Date: January 2, 2024 THIS CERTIFIES that the removal and replacement(in-place)of existing2_ 05sq.ft.2nd floor deck(to be equipped with drain and downspout and tiled into existingdrainage system),• remove and replace existing436sq ft 1st floor deck and 31sq ft attached shed/1st floor roof overhang with new 649sq.ft. 1st floor deck and 2.6'x2 I' stems torg ade (deck to be elevated approx. 26" above grade and partially covered by reconstructed 2nd floor deck on east side of house and 3' wide 1 st floor roof overhang on north side of house)-, and remove and replace existing 7'x7' hot tub with new 14'x8' swim spa located within footprint of proposed first floor deck(swim spa backwash to be piped to existingdrainage sy tem; establish and perpetually maintain a 5' wide non-turf buffer landward of top of bank; At 1555 Fleetwood Road, Cutchogue Suffolk County Tax Map 41000-137-4-34 Conforms to the application for a Trustees Permit heretofore filed in this office Dated August 27, 2020 pursuant to which Trustees Administrative Permit#10002A Dated October 20, 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 removal and replacement(in-place)of existing 205sq.ft.2nd floor deck(to be equipped with drain and'downspout and tiled into existing drainage system); remove and replace existing436sq ft IA floor deck and 31st ft attached shed/1st floor roof overhang with new 649sq ft 1st floor deck and 2 6'x21' steps torag de (deck to be elevated approx.26"above grade and partially covered by reconstructed 2nd floor deck on east side of house and 3' wide 1 st floor roof overhang on north side of house); and remove and replace existing 7'x7' hot tub with new 14'x8' swim spa located within footprint of proposed first floor deck(swim spa backwash to be piped to existing drainage system,• establish and perpetually maintain a 5' wide non-turf buffer landward of top of bank. The certificate is issued to Enno &Hannah deBoer owner of the i aforesaid property. Authorized Signature a Glenn Goldsmith,President SOF S®(/�� Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President ®� ®�® P.O. Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 ®��C®UNTY,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 10/21'72' INSPECTED BY: AL�Ktiask ✓ Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale line/silt boom/silt curtain 1St day of construction % constructed X Project complete, compliance inspection COMMENTS: 14 4 or PJ/ p f Gwl CERTIFICATE OF COMPLIANCE: CHARLES R.CUDDY " ATTORNEY AT LAW i FEB -2 '445 GRIFFING AVENUE RIVERHEAD,NEW YORK • Soiifhohi Tovm Mailing Address: Rc3F`A rjSW-P 9-8200 P.O.Box 1547 FAX: (631)369-9080 Riverhead,NY 11901 E-mail: cliarlescuddy@optonline.net January 25, 2022 Town Trustees 54375 Main Road PO Box 1179 Southold,NY 11971 Attn: Diane DiSalvo Re: Hannah de Boer and Enno de Boer-Declaration of Covenants 1555 Fleetwood Rd., Cutchogue,New York SCTM#1000-137-4-34 Dear Ms. DiSalvo: With reference to the above property, enclosed please find a'certified copy of the Declaration of Covenants recorded with the Suffolk County Clerk on January 20, 2022 at Liber D00013139 page 178. Please make it part of your,records. Thank you. Very truly yours, • v 1, Charles R. Cuddy CRC:ik Enclosures CC# : C22-2136 COUNTY CLERK'S OFFICE STATE OF NEW YORK COUNTY OF SUFFOLK I, JUDITH A. PASCALE, Clerk of the County of Suffolk and the Court of Record thereof do hereby certify that I have compared the annexed with the original DECLARATION recorded in my office on 01/20/2022 under Liber D00013139 and Page 178 and, that the same is a true copy thereof, and of the whole of such original. In Testimony Whereof, I have hereunto set my hand and affixed the seal of said County and Court this 01/20/2022 SUFFOLK COUNTY CLERK �i���z-•c. Q. �a.e.�a_e�� JUDITH A.PASCALE SEAL SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DECLARATION Recorded: 01/20/2022 Number of Pages : 6 At: 02 :13:29 PM Receipt Number : 22-0008797 LIBER: D00013139 PAGE : 178 District: Section: Block: Lot: 1000 137 .00 04 .00 034 . 000 EXAMINED AND CHARGED AS FOLLOWS Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $30 . 00 NO Handling $20 . 00 NO COE $5. 00 NO NYS SRCHG $15 . 00 NO TP-584 $0 . 00 NO Notation $0 .00 NO Cert.Copies $7 .50 NO RPT $200 . 00 NO Fees Paid $277 .50 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk County L J Number of pagesRECORDED.102'2 J.-n 20 02=11.29 P This document will''be public: =rCU:.;:01-IFIT.��,.. record.Please remove all L D0001-31-391 Social Security Numbers prior to recording. Deed/Mortgage Instrument Deed/Mortgage Tax Stamp` Recording/Filing Stamps 3 1 FEES Page/Filing Fee Mortgage Amt. 1.Basic Tax Handling 20. 00 2. Additional Tax TP-584 Sub Total Notation Spec./Assit. or EA-5217(County) Sub Total Spec./Add. EA-5217(State) TOT.MTG.TAX R.P.T.S.A. Dual Town Dual County � Held for Appointment Comm.of Ed. 5. 00 � Transfer Tax Affidavit Mansion Tax The property covered by this mortgage is C��erLCopy} or will be improved by a one or two NYS Surcharge 15. 00 family dwelling only. Sub Total YES or NO Other � �. If NO, see appropriate tax clause on Grand Total 2 page# of this instrument. 4 Dist. 10 4703943 1000 13700 0400 034000 5 Community Preservation Fund Real Property p T11111111111111111111111111111111111111111111 Consideration Amount $ Tax Service R SMI A Agency 02-DEC-21 CPF Tax Due $ Verification Improved 6 Satisfactions/Discharges/Releases List Property Owners Mailing Address RECORD&RETURN TO: Vacant Land Charles R. Cuddy, Esq. TD 445 Griffing Avenue Riverhead,NY 11901 TD TD Mail to: Judith A. Pascale, Suffolk County Clerk 7 Title Company Information 310 Center Drive, Riverhead, NY 11901 Co.Name www.suffolkcountyny.gov/clerk Title# 8 1 Suffolk County Recording & Endorsement Page This page forms part of the attached DECLARATION OF COVENANTS made by: (SPECIFY TYPE OF INSTRUMENT) Enno de Boer and Hannah de Boer The premises herein is situated in SUFFOLK COUNTY,NEW YORK. TO In the TOWN of Southold Town of Southold In the VILLAGE or HAMLET of Cutchosue BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. over 1 1 IMPORTANT NOTICE If the document you've just recorded is your SATISFACTION OF MORTGAGE, please be aware of the following: If a portion of your monthly mortgage payment included your property taxes, *you will now need to contact your local Town Tax Receiver so that you may be billed directly for all future property tax statements. Local property taxes are payable twice a year: on or before January 10th and on or before May 31,t. Failure to make payments in a timely fashion could result in a penalty. Please contact your local - Town Tax Receiver with any questions regarding property tax payment. Babylon Town Receiver of Taxes Riverhead Town Receiver of Taxes 200 East Sunrise Highway 200 Howell Avenue North Lindenhurst,N.Y. 11757 Riverhead,N.Y. 11901 (631)957-3004 (631)727-3200 Brookhaven Town Receiver of Taxes Shelter Island Town Receiver of Taxes One Independence Hill Shelter Island Town Hall Farmingville,N.Y. 11738 Shelter Island,N.Y. 11964 (631)451-9009 (631)749-3338 East Hampton Town Receiver of Taxes Smithtown Town Receiver of Taxes 300 Pantigo Place 99 West Main Street East Hampton,N.Y. 11937 Smithtown,N.Y. 11787 (631)324-2770 (631)360-7610 Huntington Town Receiver of Taxes Southampton Town Receiver of Taxes 100 Main Street 116 Hampton Road Huntington,N.Y. 11743 Southampton,N.Y. 11968 (631)351-3217 (631)283-6514- Islip 631)283-6514Islip Town Receiver of Taxes Southold Town Receiver of Taxes 40 Nassau Avenue 53095 Main Street Islip,N.Y. 11751 Southold,N.Y. 11971 (631)224-5580 (631)765-1803 Sincerely, Judith A.Pascale Suffolk County Clerk dw 2/99 12-0104..06/06kd DECLARATION OF COVENANTS ate. THIS DECLARATION made this day of '0V-M4/V-", 2021, by Enno de Boer and Hannah de Boer, residing at 1555 Fleetwood Road, Cutchogue, New York 11935, hereinafter referred to as "DECLARANT (S) ": W I T N E S S E T H WHEREAS, DECLARANT (S) is/are the owner(s) of certain real property located on 1555 Fleetwood Road, Cutchogue, Town of Southold, County of Suffolk, State of New York, described in the Suffolk County Tax Map as District 1000, Section 137, Block 4, Lot 34 which is more particularly bounded and described as set forth in Schedule "A" annexed hereto, hereinafter referred to as the Property; WHEREAS, the Property is situated on lands within the jurisdiction of the Board of Trustees of the Town of Southold (hereinafter the "Trustees") pursuant to Chapter 275 of the Town Code of the Town of Southold or its successor, and various activities conducted upon the property may thus be subject to the regulation and approval of the Trustees prior to being conducted; WHEREAS, the DECLARANT (S) therefore made application to the Trustees for a permit pursuant to the Wetlands Law of the Town of Southold to undertake certain regulated activities; and WHEREAS, as a condition of the granting of a Wetlands Permit to undertake such regulated activities, the Trustees required that a five (5) foot wide "non- turf buffer" adjacent to and landward of top of bank be established and perpetually maintained; and WHEREAS, the DECLARANT has considered the foregoing and has determined that the same will be for the best interests of the DECLARANT and subsequent owners of the Property. NOW, THEREFORE, the DECLARANT (S) do/does hereby covenant and agree as follows: 1) Upon the substantial completion of the aforementioned permitted activities there shall be established and perpetually maintained a five (5) foot wide "non-turf buffer" as defined by Chapter 275 of the Town Code, to wit: "A designated area where turf grass, pesticides and fertilizers are not permitted." and as depicted on the survey prepared by Peconic Surveyors, P.C. , last dated September 22, 2021, and stamped approved on October 20, 2021, and annexed hereto the Town Trustees permit see Exhibit "A" attached; and 2) These covenants shall run with the land and shall be binding on the DECLARANT (S) , his/her/their heirs, assigns, purchasers, or successors in interest and may only be modified after a public hearing and upon resolution of the Trustees. IN WITNESS WHEREOF, the owner(s) has/have duly executed this instrument this day of d'Vvvewib-0t' 2021. Enno de Boer Hannah de Boer STATE OF NEW YORK) COUNTY OF SUFFOLK) SS: h On the ,7 day of 6V&1 e- in the year 2021, before me the undersigned, aNotaPublic in and for said State, personally appeared A40 de6oci aAd 94,in,A de--7-96e- , personally known to me or proved to me on the basis of satisfactory evidence to be the individuals whose names are subscribed to the within instrument and acknowledged to me that they executed the same in their capacity, and that by their signatures on the instrument, the individual or the persons on behalf of which the individuals acted, executed the instrument. //410-ff9ry Public JONA 1 HAN D. FOGARTY Notary Public a State of New York NO.01 F06241421 2 Qualifed in Suffolk County k,y Commission Expires May 23,20P t SCHEDULE A DESCRIPTION ALL that''derta!h plot, be parcel`of"Iancl;'with the buildings and improvements thereon erected, situate; lying and being at Fleet's Neck, Cutchogue; Southold Town, Suffolk County, New York, bounded and described as follows: BEGINNING at a concrete monument set•on the easterly side of Fleetwood Road at the northwest corner of the'premises.herein described adjoining land formerly of Joseph Hahn, Jr., later of Andrea Jensen, said point of beginning being distant about 350.08 feet North of the northerly side of East Road; RUNNING THENCE along said last mentioned-Iarid,-,N:orth; 85;,degtees'57,:.minutes 20 seconds East through a concrete monument set in the'tip.of the.baP.. - G5 00 fe .t (actual), 275 feet, more or less (deed) to high water mark of East'Creek; THENCE South 06 degrees 23 minutes 28 seconds West, along high'water mark'of East Creek, 50.82 feet (actual), 50 feet, more or.less (deed), to land'formerly of Enda Brower, later of William A. Kennedy and Ava M. Kennedy, his wife; THENCE along said last mentioned land South 85 degrees 57 minutes 20 seconds West, . through a.stake set in the top of the bank 254.50 feet (actual), 280 feet, more or less (deed), to the easterly side of Fleetwood Road; THENCE-along1he...easterly side of Fleetwood Road, North.5 degrees 31 minutes 40 seconds West 50.00 feet to the concrete monument and the point or place of BEGINNING. Exhibit "A" Glenn Goldsmith,PresidentOOF SO Town Town Hall Annex A.Nicholas Krupski,Vice President {O 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III 1 Southold,New York 11971 Michael J.Domino G Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 UNVI BOARD OF TOWN TRUSTEES Permit No.: 10002A TOWN OF SOUTHOLD Date of Receipt of Application: August 27, 2020 Applicant: Enno & Hannah deBoer SCTM#: 1000-137-4-34 Project Location: 1555 Fleetwood Road, Cutchogue Date of Resolution/issuance: October 20, 2021 Date of Expiration: October 20, 2023 Reviewed by: A. Nicholas Krupski, Vice-President Project Description: Remove and replace(in-place)existing 205sq.ft.2nd floor deck(to be equipped with drain and downspout and tiled into existing drainage system); remove and replace existing 436sq.ft. 1st floor deck and 31sq.ft. attached shed/1st floor roof overhang with new 649sq.ft. 1 st floor deck and 2.6'x21'steps to,grade (deck to,be elevated approx.26"above grade and partially covered by reconstructed 2nd floor deck on east side of house and 3'wide 1 st floor roof overhang on north side of house);and remove and'replbee existing 7'x7'hot tub with new 14'x8'swim spa located withini"46otpfiht of proposed-first floor deck(swim spa backwash to be piped to existing drainage-system;,establish and.perpetually'maintain•a 5'wide don4u.rf buffer landward of top of bank. ; 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 Peconic Surveyors, P.-C., last dated September 22, 2021, and stamped approved on October 20,2021. Special Conditions: The Permittee is required to provide evidence thata copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit: inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Glenn Goldsmith, President Board of Trustees SURVEY OF PROPERTY AT CUTCHOOVE N TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. 1000-137-04-34 N10/F TWO STORYooac SCAM 11=20' CHRISTINE MALON FRAME HOUSE �$ JANUARY iZ 2017 TSTANLEY M ALO ''""� �"" r Na4-TUYF SEP7EMSER 29, 2020 (PROPOSED ADDITION) ` �/c uNir FENCE 1.3x SEFfI I DELIEMBER 14, 2020W7SIDL moor TOP BULK 59't LF. 1 ' S r' R20POSED 3 j F wAe�r.<s r /265.00' fEBRUARY 14' 2021ISWIDE,ST o avEN ro ee �aDre",°m�s MON. r BOT. BULK 1.9' FEBRUARY 24 2021 srERr RODE mRcvDvm I/C r BOTTOM OF BANK ( ) ovEsuNc `O a' I MARCH 3, 2021 L101M/MEN15 g _ — -of eAwr m� APRIL 12, 2021 ro fin. _ _ -- e -ttaz2r - I /^ f r AT BULKHEAD MMm►s N85'57'20'E POLEPROPOS4&" ' : SEP7EMBER 22, 2021 r0*1006 PROPOSEDra=h�e TIDAL WETLAND BOUNDARY ( ) ass, AAt +�+ m D� a t o ¢�rXr ;- '�� I i 'R r ALONG TOE OF BULKHEAD, F sx WOOD / �� A/C(313 Sxur SPA - I wpw i q AS DETERMINED BY APPROVE® B y,� 52.8' r.r `_', asr Cw EN-CONSULTANT'S, ON 5 n 2 STY 'o ' ,s N� 10-16-2020 BOARD OF 1 CRUST '�m s 2 STM I s' I � TOWN OF SOUTH e$��0'"�" ACCESSORY O N FR. HOUSE -�RDP. BUILDING rn D ms sr. M RmA o N s�Ers I I sr P g g s DECK TO BE REYDYID AND i PET4ACD(IN RACE) �� X -: r STEPS DDDD aGD( O RAMP GRIVEL a es B.D y J DATE 2Fi12o2� pRIkWAY 52.8' ' ,sD M'�a ,o',ry �,d. LANDING OEX TD 9E NoCCED + m tt-nr' �. K. 6.0' Ze V4 n n, A m oI A3s sf. DM asx ' BULK 2.5' PROJECT LIMITING FENCING. REPUGEDa AOVE GRACE) 0 -'1 ® APPROXIMATE_AREA OF. _\\ µD wasED Aae�Dx a5- -DISTURBANCE = 6,0OQ .F. \ Pos & 254.50NTLw a�9AAor 1��?i c t TCE IF >; 9.CMRg X ?� FEL 0M .�. N -- tt=rs.r• t x a 5 2F5 ADD T¢TAIW�WALL 28--I�aT.sNDNEF 1 RA10 bD - BR OC WALK AUDD DD d( DOM 5P'� S85'S7'20'W 8 W P, es°' 2 STY. FR. HSE. PpVERs pRIVf9AY EXISTING LOT COVERAGE PROPOSED LOT COVERAGE OCT d 2021 ' UPLAND AREA FROM BULKHEAD 12745 Sq.& UPLAND AREA FROM BULKHEAD 12745 nfL N101F "�'`i .S HOUSE W/ATTACfED SHED 1456 sq.fL HOUSE W/OUT ATTACHED SHED 1425 sq ft SoWho{-f own WATER METER '..• r' \ •- ACCE55aRY BU4lHNG 605 sq.ft ACCESSORY BUILDING 605 sq.ft 808T'd OtTNSt89iR VINCENT rLLUZZI `-- 2?\ WOOD PORCH 99 Sq.2 WOOD PORCH 99 394L c,r HOT TUB 47 sq.ft SWIM SPA 112 Sq.& � GENERAL NOTES. O LOWER DECK 436 sq.ft. LOWER"DECK 649 sq.ft 1- RECONSIRUC7ID UPPER LEVEL DECK TO BE REIR DECKS 306 sq-ft REAR DECKS 306 aq.ft -Op NEW yo 6,P EC µ77H DRAIN AND DOµNSPWT ro Bf m CERTIFIED TO: TED/NTD E77H D DRAINAGE SYSPOUT TO BE \ 2949/12745 23.15 3196/12745=25.15 Enno J. De Boer '; --- --- ------------- 2 PROPOSED SWU SPA BACKWASH TO BE Hannah De Boer PIPED TD ZXS77NG DRAINAGE SVSMWIDRYMML _ „� 3T ROAD Stewart Land title Insurance Compo 'y \�, ' EA c' N.Y.S. UC. NO. 49618 ■ -MONUMENT MEA n�p�'q GT YS. UC. NO 051132-01 PECOANY ACmuvom OR ADOMON 7O THIS SURVEY IS A WOLAn0M FLoD ZONE FROM FIRM 361O3C0164H AfIG/'�=1�.7oa7 SQ. r 1. (631) C S, P.C. OF SECnON 7209oF THE NEW YORK STATE EDUCAn0M LAW. MapEffectfm Dote: September 24 2009 (631) OX 90920 FAX(631) 765-1797 JXCEPT AS PET?SECRON 7209-SUBDIWMON 2 ALL CER71RCA71ONS TO TIE LINES P.O. eox sos HEREON ARE VAUD FOR THIS MAP AND COPIES THEREOF ONLY/F 1230 7RAVELER S7REET WMAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR SOWHOLD, N.Y. 11971 16-128 µ}HOSE S/GYVATURE APPEARS HEREON. Glenn Goldsmith, President �QF so(/Ty Town Hall Annex A. Nicholas Krupski,Vice President ,�0� ��� 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III l�[ [ Southold, New York 11971 Michael J. Domino G Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 UNT`t,�� 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.lin6/silf-boo.M/silt'eu.rtain When project complete, call-for compliance'in`specion; Glenn Goldsmith,President ��QE SO(/�yO Town Hall Annex A.Nicholas Krupski,Vice President ,`O 01 0 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 '� �� Fax(631) 765-6641 ��OOUNvi BOARD OF TOWN TRUSTEES Permit No.: 10002A TOWN OF SOUTHOLD Date of Receipt of Application: August 27, 2020 Applicant: Enno & Hannah defter SCTM#: 1000-137-4-34 Project Location: 1555 Fleetwood Road, Cutchogue Date of Resolution/Issuance: October 20, 2021 Date of Expiration: October 20, 2023 Reviewed by: A. Nicholas Krupski, Vice-President Project Description: Remove and replace (in-place) existing 205sq.ft.2nd floor deck(to be equipped with drain and downspout and tiled into existing drainage system); remove and replace existing 436sq.ft. 1 st floor deck and 31 sq.ft. attached shed/1 st floor roof overhang with new 649sq.ft. 1st floor deck and 2.6'x21' steps to grade (deck to,be elevated approx. 26" above grade and partially covered by reconstructed 2nd floor deck on east side of house and 3'wide 1st floor roof overhang on north side of house),; and remove and replace existing 7'x7' hot tub with new 14'x8' swim spa located withih�footprint of proposed-first floor deck(swim spa backwash to be piped to existing drainage system;,establish and-perpetually maintain-a 5'wide hon-turf buffer landward of top of bank. - s 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 Peconic Surveyors, P.C., last dated September 22, 2021, and stamped approved on October 20, 2021. Special Conditions: The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit: Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Glenn Goldsmith, President Board of Trustees SURVEY OF PROPERTY AT CUTCHOG UE TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 1000-137-04-34 N/0/F TWO STORY DOCK SCALE.- FRAME HOUSE CHRISTINE MALON c;$ JANUARY 12, 2017 ASJ)C LATTICE m�^� 5'NON-TURF STANLEY MALON ; `��� FENCE 1.3'5. ;m euFFEfr SEPTEMBER 29, 2020 (PROPOSED ADD/770N) nA/C UNIT / r S T. i PROPOSED 3' EX ATTACHED u BLOCK RET. I f B 5 I TOP BULK. 5.9' DECEMBER 14, 2020 COMMENTS ' WIDE 1 ST SHED/ROOF EXISTING HOT TUB WALL 1.4'S. 265,OO FEBRUARY f0, 2021 COMMENTS STORY ROOF �OVER E BE TO BE REMOVED MON. I i BOT. BULK 1.9' OVERHANG REMOVED _ _,.; ! ! I ��' I FEBRUARY 23, 2021 COMMENTS TOP OF BANK ' ^ ; ;O I ' BOTTOM OF BANK MARCH 3, 2021 (COMMENTS) [ '1 ,^^0; ;'N"; r AT BULKHEAD APRIL 12, 2021 (revisions) A UTILITY v EL-20.3' � APPROVED BY `o .57.20«E POLE �- PROPOSED roP 'oF eANK!:; l i r SEPTEMBER 22 2021 revisions iz N85 FE ASC ON m '�' 46.1' I , TIDAL WETLAND BOUNDARY ► ( ) a t"' PROPOSED BOARD OF 1 r�USTEES I F Y0.5N. cn ®PAD �' ASC �r]A�C ' o EL-19.7' :::.1, / ry DECK WOOD FEN O.6'S coNc. m °' 14'X6' L-- N X i ALONG TOE OF BULKHEAD, SWIM SPA W oD::, I ^la Oh AS DETERMINED BY ' 1 0.7s c�Re - 52.8 7.1' I :::. ► 36.7' I , = r O�„r EN-CONSULTANTS, ON (-'&&,0 TOWN OF SOUTHn!-D B o DATE _ ' � i ' 2 STY. \g o =-- 2 STY. A o— s—zo2o B.B.CURB FR. HOUSE �� I I I � '�' �'° o G1Y' B c�, �,w ACCESSORY , a x 1� "+ o ao N) EX. 205 S.F. 2nd FLOOR p A N STEPS x c,Td CP m V o O PROP X` CK i i i I �,� m BUILDING 1 �= I "�y DECK TO BE REMOVED AND o m A IN I I I I I (} CS O C3 ao lC9 I +/C m REPLACED (IN PLACE) X ,: j RAMP 4 GRA L e.sSRZ ,� : '....STEPS `� WOAD DOC C? 0 ' WAY 52.8' s.o LATnc eco f ;,O I f ,1... '`1J Ji ORI VE 16.0' 2.s' TOP OF k : ....^ �D� 241 - --- ---unun, LANDING POLE m� EX 436 S.F. FIRST FLOOR DECK P TI REMOVED AND EL=17.1' /�h^ / 4� TOP BULK. 6.0' ��L s�' -,? PROJECT LIMITING FENCING. 0.4'N. 4 `Q m s n REPLACED WITH 649 S.F. DECK (PARTIALLY COVERED WALL b 4' , BOT. BULK 2.5' a CB ®: APPROXIMATE AREA OF e�tJ AND RAISED APPROX. 26" ABOVE EXISTING GRADE) qq��LL I BUL/C DISTURBANCE = 6,00 F.� POST do LA CE ENC FE. 7S UL K c I �0.7S O r 1 B.B.CURB "a 0.25. 1.8 0.4' �x �^ �..r 254.50 ELEC.METER TOP OF BANK 7- CL - I C a e 0 .SX 2.65. m 0 WOOD FE CE 24'S. WOOD RETAININ 'WALL - JOUT.SHOWER EL=16.1' �Z ,o I m Z r--- x m�N g 1 FLOATING Ir '� SPIKE S85.57�20~�/ 'I BRICK WALK V o �m I *VODDOCK RAMP DOCK N O a B 9 CFR U .R HSE. ' -' 1 z 2 STY. a A Y P 1"1 � � E � � VERS ORIVENA pA t EXISTING L 0 T CO VERA GE PROPOSED L 0 T CO VERA GE OCT 4 2021 r `IN UPLAND AREA FROM BULKHEAD 12745 sq.ft. UPLAND AREA FROM BULKHEAD 12745 sq.ft. WATER METER N/0/F 'y ' ! HOUSE W/ATTACHED SHED 1456 sq.ft. HOUSE W/OUT ATTACHED SHED 1425 sq.ft. SouthoId Town � VINCENT ILLUZZI �E, L' 141, ~ -' ACCESSORY BUILDING 605 sq.ft. ACCESSORY BUILDING 605 sq.ft. Board of Trustees CN -' ;, WOOD PORCH 99 sq.ft. WOOD PORCH 99 sq.ft. GENERAL NOTES. HOT TUB 47 sq.ft. SWIM SPA 112 sq.ft. O LOWER DECK 436 sq.ft. LOWER DECK 649 sq.ft. 1. RECONSTRUCTED UPPER LEVEL DECK TO BE REAR DECKS 306 sq.ft. REAR DECKS 306 sq.ft. EQUIPPED WITH DRAIN AND DOWNSPOUT TO BE °o CERTIFIED T0: ` 2949/12745 >7'23.1% 3196/12745 25.1?: �oF"E"' rO9 71ED INTO EXISTING DRAINAGE SYSTEM/DRYWELL. � �� = = 2. PROPOSED SWIM SPA BACKWASH TO BE En n o J. D e Boer \ \ P '' 02 I 9 A PIPED TO EXIS77NG DRAINAGE SYSTEM/DRYWELL. Hannah De Boer IN '• ' ` '` ® = SP/KEEAST RpAD Stewart Land title Insurance Compagy N.Y.S LIC. NO. 49618 o = MONUMENT � YS, LIC. N0. 051132-01 ANY ALTERA77ON OR ADD177ON TO THIS SURVEY /S A WOLA77ON FLOOD ZONE FROM F/RM J6103CO164H PECON/C S MORS, P.C. OF SECTION 72090F THE NEW YORK STATE EDUCA77ON LAW. Mop Effective Date. September 25, 2009 AREA=12,983 SO. FT. EXCEPT AS PER SEC77ON 7209-SUBDIVISION 2. ALL CER77F/CA770NS (631) 765-5020 FAX (631) 765-1797 HEREON ARE VAUD FOR THIS MAP AND COPIES THEREOF ONLY IF TOME LINES P.O. BOX 909 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 7RA VELER STREET WHOSE SIGNATURE APPEARS HEREON. SDUTHOLD, MY 11971 16-1281 suFFQ�,�. Glenn Gold,, `h, President 0�0 Town Hall Annex A. Nicholas Krupski, Vice-President n$ -A,A 54375 Route 25 John M Bredemeyer, III o ` P.O. Box 1179 Michael J. Domino Southold, NY 11971 Greg Williams y O�� Telephone (631) 765-1892 0V Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Z/ Z� Completed in field by: ENNO & HANNAH deBOER requests an Administrative ,Permit to remove and replace (in-place) existing 205sq.ft.2nd floor deck (to be equipped with drain and downspout and tiled into existing drainage system); remove and replace existing 436sq.ft. 1St floor deck and 31sq.ft. attached shed/1St floor roof overhang with new 649sq.ft. 1St floor deck and 2.6'x21' steps to grade (deck to-be elevated approx. 26"-above grade and partially covered by reconstructed 2nd floor deck on east side of house and 3' wide 1St floor roof overhang on north side of house); and remove and replace existing 7'x7' hot tub with new 14'x8' swim spa located within footprint of proposed first floor deck (swim spa backwash to be piped to existing drainage system. Located: 1555 Fleetwood Road, Cutchogue. SCTM#: 1000-137-4-34 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: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: _e ,w a uN CW t a Nur -f t r�- Rog-y c� I have read & acknowledged the foregoing Trustees comments: Agent/Owner: � Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other DiSalvo, Diane From: DiSalvo, Diane Sent: Wednesday, September 22, 2021 9:47 AM To: 'hpjook@gmail.com' Cc: Krupski, Nick Subject: de Boer- 1555 Fleetwood Road Attachments: non turf buffer.pdf After a review of your Administrative application,Trustees would like you to establish and perpetually maintain a non- turf buffer which would run along the top of the bank. They are open to it being anywhere from 5'—10' in width. I have included information attached on non-turf buffers. You would need to contact your surveyor to have him add the buffer to your survey. FYI—Once a buffer is installed on a property it requires that Covenants & Restrictions are recorded against the deed and recorded with the Suffolk County Clerk's Office—so that future owners of the property continue to maintain the buffer. (This information and instructions on how to prepare such a Covenant and how to record would be sent to you after the permit is issued). If we receive the survey with the non-turf buffer shown prior to October 13—we should be able to put your request on our October 20, 2021 Agenda. DCn vq.e p%sCIIvo nice Ass�stnKt soRthoLc{ TOWVI,Trustees soutl�o�ol, N1' �L�;2 i SURVEY OF PROPERTY S A T CUTCHOG UE TOWN OF SO UTHOLD SUFFOLK COUNTY, N. Y. Ngo/F 1000-137-04-34 \ i TWO STORY ; m FRAME NOOSE DOCK SCALE.' 1'-20' CHRISTINE MALON I I { STANLEY MALON snC LArncE ��. L� JANUARY 12, 2017 i s SEPTEMBER 29 2020 (PROPOSED ADD1770N) �q/C UNIT FENCE 1.3S. rm i EX. ATTACHED 1J BLOCK REL aU;K' DECEMBER 14, 2020 COMMENTS PROPOSED 3' SHED/ROOF WALL 1.45. s 26�,00 D.5 N, TOP BULK, 5.9' WIDE 1sT EXISTING HOT TUB / FEBRUARY 10, 2021 COMMENTS o OVER TO BE MON. BC`T. BULK 1.9' o STORY ROOF ro REMOVED TO BE REMOVED % 1 FEBRUARY 23, 2021 COMMENTS OVERHANG r 6 CD "0 TOP OF BANK � BOTTOM OF BANK MARCH 3, 2021 (COMMENTS) � � o r ^ ` ,` O , I UTILITY I y EL=20.3' �I o POLE _ o i % N , I A T BULKHEAD APRIL 12, 2021 (revisions) �I N85'57 20 E FE i� AIC ON m PROPOSED TOP OF BANK i ' r Ii L WETLAND DECK 4a-1 PROPOSED IDA BOUNDARY r0.5'N. i447CD FENCE z 0.6S CONC. m rnIla I EL=19.7" r r , 2 t T FE " , - OPAD A/C L l,A/C o SWIMSPAo x woo 0 ; ! I i a Iv AS DETERMIN(n ALONG TOE OED BY BULKHEAD, D.7'Sv�g8 i 528' �.�' I DECK `1 36.7' i s I^ Q� EN-CONSULTANTS, ON t-� 2 STY. 2 STY. o- s-zozo a B:B.��RB ✓ ax FR. HOUSE o m m o `x j u ca�c4�*►� ti ^� tiy5 b ACCESSORY I rn BUILDING ) , PROP. pU�L�INV 2 �/ 5 S.F- 2nd FLOOR ZD EX. EXC.KOT BE cMCVED AND O o x A ra STEPS / s REPLACED (IN PLACE) n X r { RAMP A /� ZE: fig, ,� � G1�/-+ ij I STEPS iN00D DOCK 0 O (�R]VE rJA 52 8' LArnc E . - 00 UTILITY 16.0 2.6' TOP OF NK POLE z c FIRS? FLOOR DECK TO BE REMOVED AND EL=17.1' / LAN D I N�i PROJECT LIMITING FENCING.—� Ex a s s.. PAR (ALLY CovERED I WALL o FE. ! %d:;' / TOP BULK. 6.0' o m C5 REPLACED WITH 649 S.F. DECK 0.4'N. 0.4'3. i . �, �. APPROXIMATE AREA Qr o ^ . ABOVE EXIs 1NG GRADE) r ': BOT BULK 2.5' p m o > A z AtiC RAISED AP.RuX 2fi' Y y/A i BULc o DISTURBANCE = 6,QQQ : .F. POST do LA CE ENC FE FFa D- I'Lx 't};D.7_ a.a.CURB 254.50 0.2'S. 1.8's� 4' i , r -TER s ELE ,Ac TOP OF BANK- s o WOOD FE CE 2-45. 2-6'S� EL=16.1' «� WOOD RETk NlNG WAL - OUT.SHOWER - _ __ r--1 r-�9 W �y SPIKE '� n BRICK WALK zr v C I FLOATING `+ S85-57'20 W so RAMP WOOD DOCK DOCK a c R I-y r*1 z D 2 STY. FR. HSE. r P LJ L'� I IS D R 1 VE Wq v �---- � V j� ! V�R S � I i PA EXISTING LOT COVERAGE PROPOSED LOT COVERAGE ! /O/F AUGa2 ?n?� UPLAND AREA FROM BULKHEAD 12745 sq.ft. UPLAND AREA FROM BULKHEAD 12745 sq.ft sq.HOUSE W/ATTACHED SHED 1456 ft. HOUSE W/OUT ATTACHED SHED 1425 sq.ft. WATER METER SoutholdTownILLUZZI ACCESSORY BUILDING 605 sq.ft. ACCESSORY BUILDING 605 sq.ft. Board of Trustees WOOD PORCH 99 sq.ft. WOOD PORCH 99 sq.ft. GENERAL NOTESoo HOT TUB 47 sq.ft. SWIM SPA 112 sq.ft. LOWER DECK 436 sq.ft. LOWER DECK 649 sq.ft. 1. RECONSTRUCTED UPPER LEVEL DECK TO BE � REAR DECKS 306 sq.ft. REAR DECKS 306 sq.ft. EQUIPPED WITH DRAIN AND DOWNSPOUT TO BE CERTIFIED TO. 2949Sq, f 77ED INTO EXIS77NG DRAINAGE SYSTEM/DRYWELL. 2949/12745 = 23.1 ' 31.46/12745 = 25.11 2 PROPOSED SWIM SPA BACKWASH TO BE En n o J. D e Boer ----------------- PIPED ----------------- TO EXIS77NG DRAINAGE SYSTFM/DRYWELL. Hannah D e Boer r = SPIKE EAST ROAD Stewart Land title Insurance Company ■ = MONUMENT f ANY AL IFRA710N OR ADDI7TON TO THIS SURVEY /S A VIOLATION FLOOD ZONE FROM FIRM 36103C0164H S. LIC. NO. 49618 OF SECTION 7209OF THE NEW YORK STATE EDUCA77ON LAW. npn �+ T PECONIC SURVEYORS, P.C. EXCEPT AS PER SECT70N 7209-SUBDIVISION 2 ALL CER77FICA770NS Map Effective Date: September 25, 2009 AREA=12,983 SCS. I- !. 65-5020 FAX {631) 765-1797 7 (631) HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF TO TIE LINES P.O. 876 909 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE 1230 TRAVELER STREET q SIGNATURE APPEARS HEREON. SOUTNOLD, N. Y. 11971 16-12VD - INTERNAL LEADER CONNECTED TO DRYWELL FROM INTERNAL DRAIN AT NOTE: ALL NEW ELECTRICAL WORK TO CODE ROOF DECK ABOVE, CONFIRM EXISTING HOT TUB To BE REMOVED � �0WITH CARBON MONOXIDE AND SMOKE uu '�-,' �t� G-a u l - TYP. 2-2X12 ACQ GIRDER W � i;� � � �� ��� � �9`tiJ � C� n3 K ANCHORED TO 8" DIA. CONC. PIERS ON 16"x8" CONC. FTGS \ f- NEW 12"X12" SQUARE TRIMMED COLUMN DETECTORS TO CODE. info@petersonarchitecturatworks.com ON PIER & FTG. BELOW j � I '-0" -8'-0= -8'-0" — -8'-0" —4'-0" ,----------------- PROVIDE DECK LEDGER I l I I I i i I ° mo����a............ti �.� -em��mm���uuu�w��s-�aa. I �I oc? 1 \\\ I I ��� , _ - NEW 1 STORY ROOF OVERHANG 6'-0° NEW FREESTANDING L— - p O STAINLESS STEEL SINK LINE OF NEW 3'-0" ROOF OVERHANG T - - _ J --- -- ---- — NEW ROOF BEtC `T E® N � �o NEW 14FT X 8 FT SWIM SPA x (2) ML HSR °� I (SPA CONTRACTOR TO PROVIDE DRAWINGS Z� ADDITIONAL LEDGER ABOVE TO SUPPORT ROOF OVER AN 1, 2X 1 2 ACO DECK. LEDGER BOLTED TO HOUSE FRAMING W/ N L FOR CONSTRUCTION TO CODE) � � � _ i 1/2" EPDXY COATED LAG BOLTS @ 16" OC IN. STAGOERIED ROWS co C0 ,i_J Lli 00 i MATCH H�IGHT OF TEWI SLIDER ^�� w Oz �p NEW 2-2)(10 HDR. I� �I ®4 T1 869 W co 0 � � o ( \\' ( 7 \ o 0p� Q WITH ;?RAPD NG TO POSTS AS PER � U_ z _- _ ° ` � FRAMIN ? CONNECTOR SHEETS O = = n Q o L � ra La� � � w o �.xa w OPTION FOR WlOX45 FLUSH STEL GIRDER 0 U � l U z WITH 5"X5"X 1/4" COLUMNS ON kX 116"X3/4" O -W w U _ 0 0 wo�� Seal zc7M 00 BP WITH (4) 5/8" AB DRILLED NV/EPDXY & tD Lr z r z m _U U) O zNcz7 N i 12" EMBED. 3UILD O T WALL RA��ING AS J Q � � ��� Y __J i It is a violation of the law for any person,unless acting under the NEEDED TO ACCOMMOD TE NEWTRI)CTURE. z z ' w LL o z U �Q - I TAPERED D.J. direction of the licensed architect,to alter an item in any way. I I X w W � v �— � o o o - 1 1-3/4" x 9-1/2" ML z n r Q z w �O z0 A w w 'o @ 16" O.C. FOR W.P. DECK O O z w O o a U (� U O > 000 (SEE NOTE) I u> I U Z z z �. z >O o NEW 3-1/2"X5-1/4" 1.8E ' 00 �w MASTER BEDROOM BALCONY x U 2 Q Q N cz� U) PSL COLUMN CONTINUOUS I- oo J 1 z I w 0 U) °� N O e x O l < < z `L OPTION `0 W 1 0X45 FLUSH STEEL J Q O O I w z m w w 0 TO UPPER xD _J GIR ER �V'Ti 15"X5"X 1/4" COLUMNS. Q I z 10� o x w U x Q a (2) 2X 10 HEADER o wz� o _ 2 0 - INTERNAL W I LIVING ROOM t Q w N o e Q� a O 0 ��z o BUILD OIJT WA L FRAMING AS NEEDED r� > O c� � O w U) x �� Q TO ACCOMM DATE NEW STRUCTURE, DRAINS & Q z MASTER BEDROOM - �/ 3 REVISED SPA LOCATION 11/04/20 z z Q 4 LU v O D_ � w w Q U \ - DOWNSPOUTS —E7TS7N7 SEAM — � �— o > o (� —1 0 I1 z W �I r. Axa FL. J Isrs _ — LU v _ z '� - LL I W I— �(NO CHANGES) — LU w o � J Cl-' _ � W J o Q �°� 2 ADDED EXIST DRYWELL 09/10/20 o m ` ,. I ( O� z - W rr ° W " z CONFIRM FL(.)o ol. _E AND 3' �.1 \' 1 UPDATED DECK & SPA 0$/26/20 ' ( 1 3 U r Q - Q p°o� W z Z x C� U co- _ I ,- Q z � � � w DIRECTION ION 0 xi x wz CC C°> REV REVISION DATE I z O N d' � N N Q > D I I �� I _X I o O ' I N N \ N N O a �i O Iw W�¢O = C LIVING ROOM \ \ I \� W 1�2X45USH cv ( w I w � �r z I U Q w NOTIFY ARCHITECT WITH ROOF zC7M N co J W M z D C7 U z CONDITION, FLASH AND REPAIR AS zN� x FL i. � w 0 0 U z �, 1 REQUIRED �Q 1 rij�d r` 1 I DECK-' I FIBER CEMENT BOARD • • �bc� o . f- -I r-\-1 w EXISTING WINDOW TO REMAIN, NEW +I I revisions CONTRACTOR TO TEMPORARILY SUP ORT I I w ( +1 1 1 PORCH CEILING FRAMING ABOVE FOR NEW OPE�ING. I I U)) C° z U I Q u -mss o O I I W.P. DECK MEMBRANE TO SILL. , +I CONFIRM FRAMING IN CEILING SUPPORTING �- —� I- -� �O Q i V CONFIRM SCREEN AND SILL WITH CLIENT - ( IFLAH E4C� R h WALL ABOVE AND NOTIFY ARCHI ECT. _J --------------- I _ --------------- ---- --- 3E4 X9 1/2" I EXIST. FL. .JOISTS �q ------------ - 2X8 @ 16" QQ D.J. C r o @ 16" O 2X8 @ 16 , OCLU ° BALCO Y \OISTS c DECK JOISTS $ AB TYP. ON 12"X12"X3/4" EP WI fJ (4) ' H D IE - - ON NEW PIER AND _DOTING IF W10X45 Q FLUSH GIRDER C PTION IS SELECTED 4'-9" F— J I Ex15T. ROOF BF+flW � REPAIR BLOCK FOU DATION AS NEEDED - LU N � — F-, � �� - - — --- -, project LU (2) ML H�R U1111-1 � � — — - -- - - - - — - - - - - - - - - - L F I ALIGN DEB ER RESIDENCE EXIST. 6'-0" SLID. GL. DOOR \ `- REMOVE EXISTING W.P. DECK AND INSTALL. 6"X6"X1/4" COLUMNS ON 16"X16" PIER 8� _INE OF BALCONY ABOVE ' 1555 FLEETWOOD RD. TO BE REPLACED FOR A FIXED UNIT, �• NEW TAPERED ML JOISTS FOR 3'X3'X 1' FTG WITH 3-#4 REBAR GRID AT 8" OC ATCH HEIGHT OF NEW SLIDER 7'- " 7'- " -0'1'-4" '� WATERPROOF DECK ASSEMBLY OVER PROPOSED PARTIAL 6, PROPOSED PARTIAL FINISHED LIVING ROOM BELOW. W.P. TO 312C)X12"X,`3/FF THE BO BE W/ (4)TTOM 07 HABFTTYPICAL CjUT`jl 1 G E FIRST FLOOR PLAN `, RE-BUILT DECK 0__SIEC ON® FLOOR PLAN O U � EXTEND UP WALL MIN. 18 INCHES 1 Scale: 1/4" = 1' -0" \ Scale: 1/4" =1'-0" NEW INTERNAL DRAIN AND CAST IRON FLUSH W10 X 45 NEW YORK `- 6"X6"X 1/4" COLUMNS ON 16"X16" PIER & 3'X3'X 1' LEADER CONNECTED TO DRYWELL `� FTG WITH 3-#4 REBAR GRID AT 8" OC 3" OFF THE BEAM pp ®PTI®N p T LIVING IN� ppAe 0 5' 10' 15' BOTTOM of THE FOOTING. 0 5' 10` 15' 1 scale: v4"- 1'-o" !� II�V� 1 2"X 1 2"X3/4" BP W/ (4) AB TYPICAL - Omni NOTE: REFER TO ENGINEER'S NOTES FOR r REFER TO SURVEY FOR EXISTING D C E p 17 I BRACING INFORMATION FOR NEW WORK STRUCTURE LOCATIONS IIr 2 7 EXISTING HOT TUB TO BE REMOVED, NEW SPA TO BE CONNECTED ---- -- TO EXISTING DRYWELL SOUthold Town EXI'r Board of Trusteos IJ, NY %C111V \ I I client NEW 2-2X10 '-IDR. PARTIAL WITH STRAPPING TO POSTS AS PER - \ I I \\ FRAMING CONNECTOR SHEETS `\ (a7�caeo POSED SECTION DEBOER : 1/4"= 1' -0" EXISTING BEVEL CEDAR SIDING EXISTING I ': \ TO BE REPLACED. I 12 I:I R CM v - _ rc'xakivi o I .� \ NEW \ FIXED 6'-0"XF'-O" I"I APPROX.LOCATION \ - 2X8 @ 16" OC JOISTS TECO TO NEW 2X10 LEDGER OF EXISTING 1,000 GAL. \ I BOLTED TO HOUSE FRAME W/ 1/2" EPDXY COATED DRYWELL LAG BOLTS @ 16" OC STAGGERED - ��,..�� 'j N'EW METAL AND CABLE HANDRAIL SYSTEM TO NEW N NEW I I �•vi�" �\ ZZ-k-0 'SLID content I CODE, CONFIRM WITH CLIENT NLGD 4380S NLGD 80L NLGD 4380S NEW METAL&CABLE RAILING EX. 1 SYSTEM INSTALLED TO CODE PARTIAL LAN S I } j OP--ION FOR WATERPROOF BALCONY: \ ---� DW . RIP 1-3/4" X 9-1/2" ML JOISTS MIN. 1/4" PER FOOT . 112" PLYWOOD NEW MASTER BEDROOM I = BALC 6NY 60 MIL MIN. EPDM WATERPROOF MEMBRANE OVERHANGCr SECTION & ELEVATION • 2X TREATED SLEEPERS ±16 0'EXISTING DECK +15'-0"EXISTING DRYWELL j • 5/4 x 6 DECKING AS PER CLIENT, ALIGN WITH DOOR SILL ----- -- NEW 3-1/2"x18" 2.0 PARALLAM PSL W/ I/2" . MINIMUM (3) DRAINS CONNECTED TO INTERNAL STEEL FL PL AD NEW WALL FRAMING TO. I ACCOMMODATE NEW BEAM - SEE ENGINNER'S NOT I DOWNSPOUTS INSTALLED WITHIN CORNER 10" TRIMMED APPROX.LOCATION COLUMNS - 12 OF EXISTING DOWNSPOUT CONNECTED TO DRYWELL FIBER CEMENT BOARD AS PER CLIENT EXIST. 2X8 FL. J ISS -- -®-I®-- EXIST. BALCONY TO REMOVED AND REPLACED AS PER DETAILS EXISTING PARTIAL cV I------------ -I i ---'-' ---'---"- ----7 r ----- -------'--',r--- ----------------1 _ NE':V W 1 2 X 45 STEEL GIRDER (DROPPED) �- --- "---- ViiTH TYPICAL SHEAR PLATE CONNECTION - c T FIRST FL?OR PLAN CONFIRM FLOG JOIST SIZE AND JI AND WELD FLANGES TO COLUMN C) 3-0 Scale: 1/8" = 1' V 9 IE 10 DIRECTION p 112'1 UL! olON 16"X16" PIER & NEW 12"WIDE IM LIVING ROOM =% 6"X6"X1/4' COLUMNS TRIMMED PORCH BEAM J NEW Q 3'X3'X1' FTG WITI-1 3-#4 REBAR GRID AT 8" OC s 1 I CUSTOM 24'-0" x 7'-6" SLID. GL. DOOR REFER TO DETAIL 1 FOR W10X45 FLUSH ' 3 OFF THE BOTTOM OF THE FOOTING. STEEL BEAM IF SELECTED FOR TRIMMED NEW 12"SQUARE - ARCHITECT'S DRAWINGS ARE SUPPLIED BY CLIENT WITH PERMISSION OPTION FOR W 10 45 FLUSH STEEL = i Mh ! 1 2"X 1 2"X3/4" BP W/ (4) AB TYPICAL (FULL HEIGH SLIDER DOOR) My oo I TRIMMED COLUMNS COLUMN AND BEAM SIZES FROM PREVIOUS DESIGNER. ARCHITECT ASSUMES NO LIABILITY FOR drawn by: GIRLER , SEE DETAIL +1 I 1 _ EXISTING HOT TUB TO INACCURATE REPRESENTATICN OF EXISTING CONDITIONS OR UNSEEN EP +I DECK 5/4x6 WOOD DECKING (CONFIRM W/ CLIENT) � BE REMOVED I I 2x8 @ 16" OC ACQ DECK JOISTS STRUCTURAL DAMAGE. FLA H L _-IDG-R CONFIRM SCREEN AND SILL WITH CLIENT - I L TYP. 2-2X12 ACQ GIRDER ANCHORED TO checked by: 1 I 8" DIA. CONC. PIERS ON 16"x16"x8" CONC. FIGS DOOR INSTALLER TO P VIDE SHOP DRAWINGS L ALL PROPOSED WORK TO BE APPROVED BY ENGINEER, CONTRACTOR TO --- ---------- --- ------ FOLLOW SPECIFICATIONS PROVIDED BY ENGINEER FOR CONSTRUCTION TO 1, EXIST. FL. JOISTS I I 2X8 @ 16" OC D.J. I CODE. CONTRACTOR TO REPORT ANY CONFLICTS OR INACCURATE 'I - I 1 DIMENSIONS TO ARCHITECT FOR RESOLUTION. date: 8"X 16"X3/4" B WITH (4) 5/8" AB ; 07/28/2020 DRILLED W/EPDXY & 1 " EMBEDMENT FOR EXISTING DECK TO BE REMOVED AND REPLACED AS PER DETAILS �� ORIGINAL DRAWINGS PREPARED BY: fl W10X45 FL SH GIRDER OPTION drawing no. I I PROVIDE CONCRETE PAD J;' NEW 14FT X 8FT SWIM SPA,CONTRACTOR TO PROVIDE DRAWINGS I' AT IACQ FRAMED PLATFORM FOR IS 11EPS PARTIAL FOR CONSTRUCTION TO CODE WOOD SIDES, CONFIRM WITH CLIENT JOAN CHAMBERS �I DISCUSS WITH CLIENT OPTIONS FOR CRAWL L-� L_� \' PROPOSED REAR ELEVATION SCTM# 1000-137-4-34 SPACE, INSPECT AND REMEDIATE ANY -' ` REPAIR BLOCK FOUNDATION AS NEEDED, PO BOX 49 SOUTHOLD NY 1 197 1 Q I MOISTURE AN VENTING ISSUES. NOTIFY ARCHITECT OF STRUCTURAL DAMAGE Scale: 1/4" = 1'-0" 631 -294-4241 .ZONE R-40 .31 ACRES 1 D I � 1 �=� ufFoc Glenn Goldsmith, ,�sident �tiO% `�C�G Town Hall Annex a � A Michael J. Domino, Vice-, resident ,� yJ,�'� 54375 Route 25- a`���w• John M. Bredemeyer III y z P.O. Box 1179 A� A. Nicholas Krupski Southold, NY 11971 Greg Williams �A-, a�l� Telephone (631) 765-1892 9 p Fax (631) 765-6641 ' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD � G Date/Time: 671g, Ijo Completed in field by: ENNO & HANNAH deBOER requests an Administrative Permit to replace in-place the 26'x16' deck in rear of house; remove existing shed and deck on side of house and construct new 36'x6' deck; remove existing and install new 14'x8' hot tub on corner of deck to be connected to existing drywell; replace in-place existing 6'x26' 2 nd floor-balcony and 10'.2"x5.2" deck above living room. Located: 1555 Fleetwood Road, Cutchogue. SCTM#: 1000-137-4-34 .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 Z: 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 V Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standdards:I // —(je_aA (v SeP �cN�' IOCA� � - 4 h6 Chew !N O ' 0ewi00c �a rl.� 5 Ct,'-T r,3rwarlS /o f'tre M�� I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith ./ N. Krupski G. Williams Other o ----To � _ _ �Ir ir Menlo —�� -. -ter _w=-� � ■ �'`4�! ■�� ■' 111f T or LL v S a • s' _- .W'".EWE,. Ap HIM r `f k , J 't ill ;e! w- afl, - � . T rE; �� g /�0 t i c o' f. I �1 ++ r•- ,Y � 1 r , r, Ia ' v� 6i L 1 .. :.+!nom` �+,- ..`.�.��i� .r'w����'.:� ... F•0.: 1.,�,,_ � ,. j \ 1 1 �3�26�20 6.3apw, Fteet,Nood Rd Fleetwood Rd F1ept wood Rd ?N .n 0 1555 Ftegtwogd Road 4 - J'u111 1700em .. � ` � P �5 v+ooa m IL kpe 10, 6 ' 6 o a s ` C, 0- t.Rd •� Rd M Rd ��� ., �:.♦, jam,. N Google ` .P• o . P. - P .. .. • o i t r, s '�r t g � ���P � t\ \\`�.—� \\.'•tel �-. �..- 1. O \m - 8.3 WO 6 as ,ow .eunlelo n • o tiA106 _ Q n104 J / glcGk- 19 2S 24 AN ,� f `Pte. ►` ;l _ �' 11 ZP 16 RD- T � � g ♦ 1 ,�:.1 � O p� SA to ss 14 NOTICE uwpy� COUNTY OF SUFFOLK © E ,uMor _•OLITHOlD SECTION NO E —zz ....r....♦� R�1... .... Q .�, __ m"' —— Property Tax Service Agency wAga ac W w♦ ----�. — — �... -- Real �r-NYIIM137 a m[ m 1 .. � wlKu�wwrtrc osl� re[r. ID A -� -..-r ...._. � �ewro�e� y�TQ usnaL•f�lo J BOARD MEMBERS Southold Town Hall Leslie Kanes Weisman,Chairperson hO��OF S�UjyOlO 53095 Main Road•P.O.Box 1179 Southold,NY 11971-0959 Patricia Aa Office Location: Eric Dantes ntes 00 Town Annex/First Floor, Robert Lehnert,Jr. �. YOQ 54375 Main Road(at Youngs Avenue) Nicholas PlanamentoOI,YCf7U0Southold,NY 11971 http://southoldtownny.gov CEI�/ED ZONING BOARD OF APPEALS V & 3 1 TOWN OF SOUTHOLD fG 2320111 Tel.(631)765-1809 Fax(631)765-9064 LPa rholdTown Cie Sou rk FINDINGS, DELIBERATIONS AND DETERMINATION MEETING OF AUGUST 19,2021 ZBA FILE#7516 NAME OF APPLICANT: Enno and Hannah de Boer PROPERTY LOCATION: 1555 Fleetwood Road(Adj.to East Creek),Cutchogue,NY. SCTM#1000-137-4-34 SEQRA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this ,application and determines that this review falls under the Type H category of the State's List of Actions, without further steps under SEQRA. SUFFOLK COUNTY ADMINISTRATIVE CODE: This application was referred as required under the Suffolk County Administrative Code Sections A 14-14 to 23,and the Suffolk County Department of Planning issued its reply dated August 13,2021 stating that this application is considered a matter for local determination as there appears to be no significant county-wide or inter-community impact. LWRP DETERMINATION: This application was referred for review under Chapter 268, Waterfront Consistency review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. The LWRP Coordinator issued a recommendation dated June 18, 2021. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department,as well as the records available, it is recommended that the proposed action for side yard setbacks are EXEMPT from LWRP review The proposal to increase the permissible lot coverage over 20%is recommended as INCONSISTENT with the LWRP pursuant to Policy 1 and Policy 4.1 because it does not support a pattern of development consistent with the Town Code and the recommendation to minimize losses of human life and structures from flooding and erosion hazards. The residential structure does not functionally require a location on the coast and is not water dependent. Furthermore,the proposed deck extension encroaches further seaward toward the bank. The Board can consider this action to be CONSISTENT,since the proposed improvements will not be any closer to the tidal wetland boundary than existing structures. PROPERTY FACTS/DESCRIPTION: The subject property is a 12,983 square foot parcel located in the Residential R-40 Zoning District. The northerly property line measures 265.00 feet, the easterly property line measures 50.82 feet and is adjacent to East Creek(Eugene's Creek),the southerly property line measures 254.50 feet and the westerly property line measures 50.00 feet and is adjacent to Fleetwood Road. This nonconforming lot is improved with a two-story frame residence with first floor wood deck with a hot tub and attached shed and a second-story wood deck. There is also a two-story accessory building located landward of the residence as shown on the survey map prepared by John T.Metzger,LS and last revised April 12,2021. Page 2,August 19,2021 47516,DeBoer SCTM No. 1000-137-4-34 BASIS OF APPLICATION: Request for Variances from Article XXIII, Sections 280-124; and the Building Inspector's March 18, 2021 Notice of Disapproval based on an application for a permit to construct additions and alterations to; an existing single-family dwelling; at 1) located less than the code required side yard setback of 10 feet; 2) located less than the code minimum required combined side yard setback of 25 feet; 3)more than the code permitted maximum Iot coverage of 20%; located at 1555 Fleetwood Road (Adj. to East Creek), Cutchogue,NY. SCTM#1000-137-4-34. RELIEF REQUESTED: The applicant requests variances for additions and alterations to an existing single-family dwelling located at 1555 Fleetwood Road (Adj. to Eugene's Creek) Cutchogue,NY. SCTM#1000-137-4-34. The proposed construction, on this nonconforming 12,983 square foot lot in the R-40 Zoning District, is not permitted pursuant to Article XXIII Section 280-124 which states; lots measuring less than 20,000 square feet in total size require a minimum side yard setback of 10 feet,a combined side yard setback of 25 feet and a maximum lot coverage of 20%. The construction will have a minimum side yard setback of 7 feet, a combined side yard setback of 16 feet and lot coverage of 25,1%. ArchitecturaI drawings of the deck replacement and addition of a swim spa in place of the now existing hot tub and revised spa location were submitted by Eric Eugene Peterson, Architect last revised November 4,2020. ADDITIONAL INFORMATION: Letters from the applicant's neighbors were received by the Board voicing no concern and in support of the proposed improvements. The applicant agent submitted documentation on other r properties in the surrounding neighborhood that have benefited from prior ZBA side yard variance relief specifically ZBA File s 44843,#7266 and#7072. In ZBA File#e 7072 side yard setback relief of 6.8%was granted as well as lot coverage of 29.7%. During the public hearing,the applicant testified that the accessory structure located on the property is not habitable,not conditioned,and is used for storage only without any plumbing. In the application,the applicant's representative outlined the following improvements: 1. The existing southerly side yard setback of 9 feet will remain unchanged and the second-floor deck and most of the southerly portion of the first-floor deck will be replaced within the same footprint, 2. The most northerly portion of the first-floor deck would be increased by 23 6 square feet,reducing the existing northerly side yard setback by 3.5 feet, from 10.5 feet to 7 feet (where 10 feet is 'required); reducing the existing total side yard setback by 3.5 feet,from 19.5 feet to 16 feet(where 25 feet is required);and increasing the existing lot coverage by 247 square feet from 23.1 to 25.1 percent of buildable land. FINDINGS OF FACT/REASONS FOR BOARD ACTION: The Zoning Board of Appeals held a public hearing on this application on August 5,2021at which time written and oral evidence were presented. Based upon all testimony,documentation,personal inspection of the property and surrounding neighborhood,and other evidence,the Zoning Board finds the following facts to be true and relevant and makes the following findings: 1. Town Law §267-b(3)(b)(1). Grant of the variances will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. The Fleet's Neck community is characterized by similar sized dwellings along with narrow lot widths and many have similar nonconforming side yard setbacks and/or excessive lot coverage. Variance relief has been granted in the past to similar properties. 2. Town Law &267-b(3)(b)(2). The benefit sought by the applicant cannot be achieved by some method,feasible for the applicant to pursue, other than an area variance. The narrow property width of 50 feet and the fact that the existing dwelling is already characterized by nonconforming side yard setbacks and lot coverage require additional approvals from the Board of Appeals for the proposed improvements. r Page 3,August 19,2021 #7516,DeBoer SCTM No. 1000-137-4-34 3. Town Law§267-b(3)(b)(3). The variances granted herein is mathematically substantial,representing 30% relief from the code for the single side yard setback, 36% relief from the code for the combined side yard setback and 25.5%relief from the code for the proposed lot coverage. However,the project mainly consists of replacing existing wooden decks with a total increase in lot coverage is 247 square feet. 4. Town Law 4267-b(3)(b)(4). No evidence has been submitted to suggest that a variance in this residential community will have an adverse impact on the physical or environmental conditions in the neighborhood. The applicant must comply with Chapter 236 of the Town's Storm Water Management Code. The reconstructed second- floor deck will have a drain and downspout to be tied into the existing drainage system and the backwash from the proposed swim spa will also be piped in to the existing drainage system. 5. Town Law $267-b(3)(b)(5). The difficulty has been self-created. The applicant purchased the parcel after the Zoning Code was in effect and it is presumed that the applicant had actual or constructive knowledge of the limitations on the use of the parcel under the Zoning Code in effect prior to or at the time of purchase. 6.Town Law &267-b. Grant of or the requested relief is the minimum action necessary and adequate to enable the applicant to enjoy the benefit of a replacement decks and swim spa while preserving and protecting the character of the neighborhood and the health, safety and welfare of the community. RESOLUTION OF THE BOARD:In considering all of the above factors and applying the balancing test under New York Town Law 267-B,motion was offered by Member Acampora,seconded by Member Weisman(Chairperson), and duly carried,to GRANT the variances as applied for, and shown on the survey map prepared by John T.Metzger,LS, last revised April 12, 2021; and Architectural drawings prepared by Eric Eugene Peterson,Architect, last revised November 4, 2020. SUBJECT TO THE, FOLLOWING CONDITIONS: 1. The applicant shall install a drywell for dewatering of the swim spa. . 2. The applicant shall receive approval from the Southold Town Board of Trustees. 3. The proposed lower decks shall remain unenclosed and the upper decks shall remain open to the sky and unenclosed. This approval shall not be deemed effective until the required conditions have been met.At the discretion of the Board of Appeals,failure to comply with the above conditions may render this decision null and void That the above conditions be written into the Building Inspector's Certificate of Occupancy, when issued The Board reserves the right to substitute a similar design that is de minimis in nature for an alteration that does not increase the degree of nonconformity. Any deviation from the survey, site plan and/or architectural drawings cited in this decision will result in delays and/or apossible denial by the Building Department of a buildingpermit, and may require a new application and public hearing before the Zoning Board of Appeals. Any deviation from the variances)granted herein as shown on the architectural drawings, site plan and/or survey cited above,such as alterations, extensions, or demolitions, are not authorized under this application when involving nonconformities under the zoning code. This action does not authorize or condone any current or future use,setback Glenn Goldsmith,President �Qf S0( Town Hall Annex Michael J.Domino,Vice-President ,`O� ��� 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III [ [ Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 COU ® c - LE3 D BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD AUG 3 1 2020 TO: SOUTHOLD TOWN BUILDING DEPARTMENT DNGDEIPT. RE: VERIFICATION OF BUILDING DEPARTMENT PERMIT REQUIREISY1TOID `Pffipert,�i owner Dame: ,- - -- ... IR a? ,6•;, .6 The Office of the Board'of Trustees,is forwarding.the above referenced.application for ,-verification of the Building Department's_perpitting,requirements stated below: YES NO Will the proposed project require a,Building Permit? Will the proposed project.require;a valiance determination-' - from the Zoning Board of Appeals?_ ° 4,.,•. _. _f, Will any part of this application'be considered 'Demolition r as described under Town Code? - COMMENTS: / eallx 4ig1/Xht/1 !y nature of Reviewer Date Page 4,August 19,2021 #7516,DeBoer SCTM No. 1000-137-4-34 or other feature of the subject property that may violate the Zoning Code, other than such uses, setbacks and other features as are expressly addressed in this action. In the event that this is an approval subject to conditions, the approval shall not be deemed effective until such time that the foregoing conditions are met, and failure to comply therewith will render this approval null and void. Pursuant to Chapter 280-146(B)of the Code of the Town of Southold any variance granted by the Board of Appeals shall become null and void where a Certificate of Occupancy has not been procured,and/or a subdivision map has not been filed with the Suffolk County Clerk,within three(3)years from the date such variance was granted. The Board of Appeals may,upon written request prior to the date of expiration, grant an extension not to exceed three(3)consecutive one(1)year terms. Vote of the Board:Ayes:Members Weisman(Chairperson),Acampora,Dantes,Lehnert,and Planamento(5-0). eslie AKanesl Weisman, Chairperson Approved for filing f lAO /2021 f PROJECT DESCRIPTIONFOR ENNO &HANNAH de BOER 1555 FLEETWOOD ROAD CUTCHOGUE,NY SCTM#1000-1374-34 Remove and replace (in-place) existing 205 sf 2nd floor deck (to be equipped with drain and downspout and tied into existing drainage system); remove and replace existing 436 sf 1St floor deck and 31 sf attached shed/1St floor roof overhang with new 649 sf 1St floor deck and 2.6'x 21' steps to grade (deck to be elevated approx. 26" above grade and partially covered-by reconstructed-2"d-floor deck on east side of-house and-3' wide 1St floor roof overhang on north side of house); and remove and replace existing 7'x 7' hot tub with new 8'x 14'swim spa located within footprint of proposed first floor deck (swim spa backwash to be piped to existing drainage system), all as depicted on the survey/site plan prepared by Peconic Surveyors, P.C., last dated April 12, 2021. E C E V f AUG 2 7 2021 Southold Town Board of Trustees OFFICE LOCATION: so MAILING ADDRESS: Town Hall Annex P.O.Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) qr Southold, NY 11971 ® Telephone: 631 765-1938 Comm LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date:, September 9, 2020 Re: LWRP Coastal Consistency Review of DeBOER SCTM# 1000-137-4-34 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. The structures were constructed without the issuance of a Wetlands Permit pursuant to Chapter 275 Wetlands and Shorelines of the Southold Town Code. 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: Hannah <hpjook@gmail.com> Sent: Friday,August 28, 2020 11:05 AM To: DiSalvo, Diane Subject: Re: 1555 Fleetwood Rd. Project Description Hi Diane, Apologies,please see description amendments: Existing 2nd floor balcony in same span of 6'D x 26' W that wraps to existing 2nd floor deck in same span of 10'2 L x 5.2 W. Backyard deck is to be replaced in the existing span of 26' W x 16' D and deck will wrap around left side of house 36' L x 6' D. Thank you, Hannah On Fri, Aug 28, 2020 at 10:53 AM Hannah<hpiook@,gmail.com>wrote: Hi Diane, Please note the following description amendment for 2nd floor balcony and deck: Existing 2nd floor balcony & deck above living room will be rebuilt in existing size of 6'D x 31'2 W and wrap around to deck of 10'2 L x 5.2 W. 9 j I believe I wrote 331 in description but side deck should be 361: I Backyard deck is to be replaced in the existing span of 26' W x 16'D and deck will wrap around left side of house 36' L x 6' D. Thank you, Hannah j n E n �, II11 L�� AUG 2 8 2020 $nn.;pNi!ip,,vn Board 0?G9.;'npc 1 Glenn Goldsmith,PresidentTown Hall Annex Michael J.Domino,Vice-President ,�® y®� 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III Southold,New York 11971 A.Nicholas Krups1d G Q Telephone(631) 765-1892 Greg Williams %�Gy \�� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD ti This Section For Office Use Only Coastal Erosion Permit ApplicationDn [ �`,�, Wetland Permit Application f _Administrative Permit i Amendment/Transfer/Extension I AUG 2 7 2020 X Received Application: ZZ720 I —� X Received Fee:$ 00,OV !C Completed Application: �Z8' Bo�id r,r i�r;, Incomplete: SEORA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): LWRP Consistency Assessment Form Sent: AC Referral Sent: Date of Inspection: Receipt of CAC Report: Technical Review: Public Hearing Held: • Resolution: Owner(s)Legal Name of Property(as shown on Deed): t YKKQ � 1RIAAVe 1, Mailing Address: I�sGod �. Phone Number: Suffolk County Tax Map Number: 1000- I�J� K - Property Location: �SS 5 Poe-6tood U. F�l 1� L7WrT Sk • `'f houve �,�AAIh V, 41M IF, got % 4ve K �+ 5 (If necess ,provide LILCO Pole#, distance to cross streets,and location) AGENT(If applicable): Mailing Address: Phone Number: Board of Trustees Application GENERAL DATA Land Area(in square feet): 1�') Sg.4. Area Zoning: Previous use of property: Intended use of property: ��1/Dl'� �aw`2."ISS' 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? ✓Yes No If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. / Does this project require a variance from the Zoning Board of Appeals? Yes V No If"Yes",please provide copy of decision. Will this project requir any demolition as per Town Code or as determined by the Building Dept.? Yes V No Does the structures on property have a valid Certificate of Occupancy? y Yes No ( ) P P Y Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Hasanermitla roval ever been revoked or suspended b a governmental agency'? V No Yes Y P PP P ,Y g If yes,provide explanation: Project Description(use attachments if necessary): O �1P• &- Project Description: The project is intended to replace and renew existing windows,deck, balcony and spa that have all deteriorated and at end of life. We are replacing the windows on the back fagade of the main house, upstairs and downstairs in the same layout of existing windows. Backyard deck is to be replaced in the same current span of 26' W (width of house)x 16' D.The deck,will wrap around the left side of the house 33' L x 6' D to replace existing deck and sheds for a much more streamline, and clean visual character(some side decking, sheds, roofing already removed due to deterioration &safety). The current broken hot tub is to be replaced with a hot tub of 14' L x 8' W in the left corner of the deck. Existing 2nd floor balcony&deck will be rebuilt in exact same size of 5'D x 31'2 W and right side deck of 10'2 L x 5'2 W above living room. Project is intended to replace existing structures within or close to current square footage, repair and enhance functionality,visual character and quality of home and presiding area of the "Pequash" Cutchogue Hamlet and East Creek shoreline. In anticipation of this project we have already installed two new dry wells on the backyard near project, one on the right side next to the beginning of deck and one on the right side next to the start of stairway down to dock.Tke-new-spa-will-be-able-to-connect-tom the-dry-well,—carrent existing-cannot—As we have previously had a flash food that took storm water from Fleetwood Rd into our basement all the way down into East Creek, we have proactively added a gutter on our driveway as well as the new dry wells to mitigate any flooding and erosion on our property coming from the street or from our own land. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: IVB PWK &5JA (motA01fMQ�� �PakAo�e116&our 6A.--e *Pe V q GQa�aa lu+ Wacs V e� + j �►=h�•. V� (pu�Qo�,��j D'��s� ,�C.��1�►�lA ��f�l-)� G�1K ��. .�CP�rdtD+P� quaC6 4ow 6v-e- 4KA �( i�asb;' C, ,��u InA e-�a�a as�►e��c w�,�(C �+9�a�e���¢ . Area of wetlands on lot: 1- 300 square feet Percent coverage of lot: /-3 —% Closest distance between nearest existing structure and upland edge of wetlands: w 6 feet Closest distance between nearest proposed structure and upland edge of wetlands: 26 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): 1 me 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing 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 I. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part I-Project and Sponsor Information Name of Action or Project IDQQeAl Project Location(describe,and attach a location map): I5455 4. 1 m35� .13n-e�f Description of Propo ed Action: WcmJe �a 4c` �wt1 sS,�C,klla�lco AUC � �i Cu COtkSlvl }�►�t'aq� �� '�b U�� csF lc�t�ri�C �e -�-o�GPSh�. �►svNc9o�-sS. o4 Actc ail , �►�to 3 aced l ►�t(>o�c �" u�wc- }��e o a 4e��tt ,-�a 3Ikls kun. s �nto�Me�-+b,lel„► VJ �►� � K-61�l��U N e f Applicant or Sponsor: EE- phone: -1 l WN65a Ime. t1 Je V1ail: 4c'� Ma •G� Address: �S�S fig Rd• City/PO; - - —` _ State: Zip Code: !N� I 1 ld%ls 1.Does the proposed act n 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? a b.Total acreage to be physically disturbed? c.Total acreage(project site and any contiguous properties)owned 983 or controlled by the applicant or project sponsor? • 4. Check all land uses that occur on,adjoining and near the proposed action. / ❑Urban [--]Rural(non-agriculture) ❑Industrial []Commercial P Residential(suburban) ❑Forest ❑Agriculture []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? ❑ ❑ 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? k YES If Yes,identify: 8. a.Will the proposed action result in a substantial increase in traffic above present levels? O'e YES b.Are public transportation services)available at or near the site of the proposed action? ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? F]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: a 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: 12. a.Does the site contain a structure that is listed on either the State or National Register of 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: El Shoreline El Forest ❑ gricultural/grasslands ❑Early mid-successional ElWetland ❑Urban Eff 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? ❑ 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, K a.Will storm water discharges flow to adjacent properties? ❑NO L]YES- ❑ b.Will 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)? 011 If Yes,explain purpose and size: ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ; 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO XES completed)for hazardous waste? If Yes,describe: F( ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Q Applicant/sponsor a e: �IvkA� i7ow Date: 00 Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? El n 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 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 El 7. available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ a a.public/private water supplies? b.public/private wastewater treatment utilities? F] 8. Will the proposed action impair the character or quality of important historic,archaeological, El or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ Elwaterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 i 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 1:1 1:1problems? 11. Will the proposed action create a hazard to environmental resources or human health? F] 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. 1 Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of,Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list,policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated' as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town)., 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- `. 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 f SCTM#_ I000 13T PROJECT NAME The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. i�� 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: (� 4;6, a6wAqrcX Ad< 1o^6v% alA 16 ;VA V 1 Location of action: ISSSC Cpgh� N !I �3 r Site acreage: 2 1 g3 •' '• Present land use: Pes4en W 6v-L Present zoning classification: Re%Am� 0 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: II ; (a) Name of applicant: �MM4 (b) Mailing address: M5 a eat. lAAhAX0 (c) Telephone number:Area Code ?0+ q05 (d) Application number,if any: Ift Will the action be ' ectly undertaken,require funding,o'approval by a state or federal agency? Yes 0 No If yes,which state or federal agency? = C. Evaluate the project to the following policies by analyzing how the project,willfurther support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that'the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space,makes efficient use of infrastructure;makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section IIT—Policies;Page 2 for evaluation crite 'a. Yes No Not Applicable iS •b ec,►I vqw- o► -9(ae v<%-*46JihA avft64 kqm V+k AvA ac• S cure A - aCg � 'M t �► G K (¢ SCK O S Mp • 1C wtt em ac. 0 VOW I F6 rx � Attach additionNAeets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LNW Section III—Po 'cies Pages 3 through 6 for evaluation criteria ❑. Yes 1:1 No Not Applicable pc 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 dYes ❑ No ❑ Not Applicable 1k f Vm9ws d Itiw�res �1, 3.I.g ro' G1Aavo�GdW t " s use QKa .l ot-eN 1Z 3. .0 a AIA-A&, abltt. c2 � aS'r- tl�w ' s H a S.5 2 h Atta additional sheets if necessary $S�AAK�1�he 3•` J,�k, NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Sectio III—Policies Pages 8 through 16 for evaluation criteria ; Yes ❑ No ❑ Not Applicable 1L� rrI 'I k 'log �1dniti lam►D� NQM S ['f WCS ; c t-o►IZOlieta-Wa d l r a NA ivy a =Nev oln wkwaarok -fx1AC. ' s. x buy _C!2apt da Awtte-Ifs j% AwU ike ftw !l qct k�vS C,u v - spa, %a SD 1���� �+►� � iZ 2-Fi Attach ad onal sheets if neces ary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section In —;"'YesEl, ies Pages 16 through 21 for evaluation criteria No ❑Not Ap licable L d C 1% AA ak W mXPA aw Q is 0 G ' �•eAj&Atbi& c('Int at t���ti' to `L a w til' 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. F-1 a Yes No V Not 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 ❑No dNot Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous = substances andwast See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. I'esD No VNot Applicable Attach additional sheets if necessary WORE ING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. S e 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 andTown w ters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages _ 62 through 65for�'Notuationcriteria. es -No Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; ages 65 through 68 for evaluation criteria. ❑Yes ❑. No 9 Not Applicable -MIA PREPARED BY &Lt gW TIME /� . DATE 2S�2o Board of Trustees -Application AFFIDAVIT II [fGlNV10l� dam- ey- 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. f Sign6re of Property Owner Signa a of Property Owner SWORN TO BEFORE ME THIS.a<n _- DAY OF Qin�� ,20 cl No lic LYNDSEY BARKER NOTARY PUBLIC,STATE OF NEW YORK No. 01BA6156676 Qualified in Suffolk County commission Expires November 27,20 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purom 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: JC %e I V�MhA (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 mapa 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 than5%o 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/agrnt/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); S)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 thi day of 20dO Signature Print Name Form TS 1 ' Zo Zo Qa-✓