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HomeMy WebLinkAboutTR-9999A Glenn Goldsmith, President + O(/�7"" Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President 1" P.O. Box 1179 John M. Bredeeyer III Southold, New York 11971 Michael J. Domino Telephone (631) 765-1892 Greg WilliamsFax(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 1 st day of construction % constructed When project complete, call for compliance inspection; Glenn Goldsmith,President `s � � Town Hall Annex A. Nicholas Krupski,Vice President � 'b � � 54375 Route 25 ?� P.O. Box 1179 John M. Bredemeyer III Southold, New York 11971 Michael J. Dominoa,pd Telephone(631) 765-1892 Greg Williams r Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9999A Date of Receipt of Application: October 1, 2021 Applicant: N&L Properties LP SCTM#: 1000-73-2-4 Project Location: 8850 Bridge Lane, Cutchogue Date of Resolution/Issuance: October 20, 2021 Date of Expiration: October 20, 2023 Reviewed by: A. Nicholas Krupski, Vice-President Project Description: Clear an approximate 4'x225' walking path through right-of-way to the Sound/Bluff—without the removal of any trees. 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 project plan prepared by N&L Properties LP, received on October 1, 2021, and stamped approved on October 20, 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 .,.. �� �APPROVEEJ BY 6Rib 6-E BOARD OE I h-t-STEES- TOWN OF SOUTHOLD DATEi� 2°yl � 4and OCT 1 (1 1 � Y i r �South f �9 ��,� Board w No R � r g w \'. 6 �� s F�5�3,Sbo 5►'-�,�- a cue- = . l 3 a cre.=:4w qc acrmtep(z)poua Qc'tio, f f r = A 90 . / l = C ®-/-o4q I acrerLlt phyr.'c,,Jly r r . o xt Glenn Golds, �i, President �OcpFFO(�ca' Town Hall Annex A. Nichko rupski, Vice-President „�� - ,� 54375 Route 25 John M. Bredemeyer, III o '` P.O. Box 1179 Michael J. Domino o � Southold, NY 11971 Greg Williams y�Jp® �� Telep on765 6641-1892 Fax (631)BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 1o�zADate/Time: Completed in field by: Sheri Winter Parker on behalf of N&L PROPERTIES LP requests an Administrative Permit to clear an approximate 4'x225' walking path through right-of-way to the Sound/Bluff—without the removal of any trees. Located: 8850 Bridge Lane, Cutchogue. SCTM#: 1000-73-2-4 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 • " Ch. 111 SEQRA Type: 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:64 ' Pk+� m4+ 6e Vj P4 i o o✓ wr l( 6-Q I-e���,�►�? ,JLM I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J,. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other '�,� ���-- _" �M°' � �.� � Y ''2GAS►� sisS P�x 16 6c OCT 1 ?n?I Southold'Town Board of Trustees F v r cleq,r--- wd de real v ved. ' as' R ow w 33S75- /ZoW 1e,�5tt� �1 ?P(",. �cc ,b 9Iva 4Gv ,fiec4 S, 6 -S F/y3,sbo sF�e, Q crt — . 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' 000 - 73 -0 ' - 02. `\ SCALE = 1 00� \� LOT 3 FEERUARY 1, 0, 10-0- 9 \` \ \ 80,487 sq. ft. � ��'r Y X96• � ` h1 ho LOT 2 AREA = 1 ,353,536.00 sq. ft. \\ \ a 80,031 sq. ft:., i ;70 '!F _INF) 31 .073 QC. /0 /y j Qy M,g Ir5, C'ZRTIFIED T0: y�° S �. �' \ ��8,°• CHICAGO TITLE INSURANCE COMPANY ' N & L PROPERTIES, LP PH -0 R4YM*RY BY I _ ' LOT 1 80,002 sq. ft. Photo Bete February 29, 1999 � \ ,.^rcAc"^ \' 4�CC=�A\CE N-_ - �,r`.�r_•h rY r*� � X10 yt•' 3__ COR C R --_E S_.;,-.•c ec �4:A IS-_S E.EVATONS ARE REFERENEED TO U.S.C. d G.S. TO°OGRAPH'CAL MAP, NA'TITUCK HILLS QUADRANGLE Q9 c �_r L;A L.S. <N^ gcvz• r^ ANS ADOcTr•. EXISTING EL:YATICN$ ARE Si )A'N THUS:• o � �0�� - q c-:- _S 5 r r NE S -: � . n n � EX.STING CON'OUR UNFS ARE SHORN THUS 2021 + Southold Towns �s ,o rJ � 1 J ° y� dg �P o°•�� Board of Tr�.,st . ,S _ oa f� c c; c A v_ - - fb �t? y �pY�Fv I Jose ph �■ �� � 0 7209 Cr Tn,r NE,y`YCcv c�A-` ti "va 5;0 A _ _ S f �!! �! COc,ES Oc T-IS SjQ'.T' VAc NO' REAPNG Lend Z034 {�6 V `�`\.�' vr- LA`„ SyA•cvOA- NOt SEA_ Ca k ./ EMi i^GSL^ S:.f_ S^IALL n^i ✓Gc rI��S;-:ACC' BEEE �r I ONLY TOY Tl-E c-74SON FO- v.'LO4 T='E SJ°7_" S'_ P'�,nS — CO LCv:u, IS F-R�?ARE^ AN� C"+ HIS E'EHA..r T.^, INE i 7lE GC' _ ';VENTAL AGENC`' A';, r+cF.O',, A';C PHONE (631)727-2090 Fcx (631)727-11727 7C Tr_E ASS 3a YES C= T LEti^':G INS-- - T.r-,% CE= CNSARE TFA%Sc7ERAB�. A ?^==S�c THE EXISTENCE OF RIGHT OF WAYS L AND/OR EASEMENTS OF RECORD, IF z F ._G ANY, NOT SI-OWN ARE NOT GUARANTEEC. 99- . 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UNDBR UCTION .121-901 OF THt,REVi88D LZMSTZD PA1tTN8RMXP 'ACT • " The' undereigned hereby certifpi '''• �+ 1. 'Tho.risme $f-the• limited'partnership is N `. L PROPERTIES► L.P, r` (the %44toq•FortAorship").. o t► • 'The dtf ice of the Ur4ted Partnership is to be iodated in surto#k, county. , a. ;fihs 8scretary od• 8tate of the state of.Now York -is deaigaat •d 'the agent or' -LimitadPa tnetahip 4Ron-wooao prodess against t flay bo ®etved, 'The post,office-•address-to' whXch the' , ieeretax of stats 4hal3.Inall a copy of any.,procees againpVtha nLi�ai;®d'• artinetship earved Up0%.h11h as agent- of the.limited- ' PaiF'tner8!•ip is- c/o Albxand4x Group, 1200. Horth F'ed'eral -highway, •® �` suite sOT, See& Raton, rlorida 33432. . 4. 4he names Ana addresses of each general partner Is; aimIV g - 8 i L Tarins, 'LLC 1200 N. Federal Highway, - Boca Raton, ISL ,y9d]2 'S. The• latest'date upon Which, the Limited'Partnership is to 410aolve 'lo Deeember 31, a09e unie6e sooner terminated art a prior time in a¢coordance with the Limited partnership Agreement. _ S. :The effective date of the Limited*Partnership shall be _ upon'til;nq of- tqs -earticiate of Limited Partnerahip► 6 IN 42TNE55 'WM2RE0F, the undoreigned oonsistinq of. 211 of the general partners of the Limited.PArtnsrship have executed this certificate-this 17,N, Maq 19990 and affirm the atato'bants eontairied herein.'as trud under uemidtLew,99,perjury. a a (S i L Par , L -by • • Leslie_ Ai 'ander, Manager) •• - 2103 qFk4ew York State Department of State . NEW YORK Division of Corporations, DIVISION OF CORPORATIONS, Aovr+oa F fry. State Records and STATE RECORDS AND Uniform Commercial Code UNIFORM coMMeRcuuCODE One Commercc e Plaza 99 Washington Ave. Albany.NY 12231.0001 www.dos.ny.gov CERTIFICATE OF CHANGE OF THE CERTIFICATE OF LIMITED PARTNERSHIP OF L Lroer-A ex Name ofDammic Lin6ted•Pamiera tp) Under Section 121-202-A of the Revised Limited Partnership Act FIRST: The name of the limited partnership is: If the name of the limited partnership has been changed,the name under which it was formed is: SECOND: The certificate of limited partnership was filed by the Department of State on: MA-V 130 19 R91 THIRD: The change(s)effected hereby are: [check appropriate statement(s).] The county location,within this state,in which the office of the limited partnership is located,is changed to: The address to which the Secretary of State shall forward a copy of process accepted on behalf of the limited partnership is changed to read in its entirety as follows: I!o ,44-14,11 f'i c Area .S ik ,3.2D, L 33 qq V The limited partnership hereby[check one]: Designates as its registered agent upon whom process against the limited partnership may be served.The street address of the registered agent is: 21030100048314117) J • • Changes the designation of its registered agent to: The street address of the registered agent is: ® Changes the address of its registered agent to: aRevo s the authority of its registered agent. X '�Js ,,eheeyj 4ry ('90o7 d Partner) (Type or Print Name) r CERTIFICATE OF CHANGE STATE of NEW YdRK OF THE DEPARTMENT OF STATE CERTIFICATE OF LIMITED PARTNERSH49 MAR 0. 1 2021 OF TAX S 11 gel PA,C's . I (Insert game of Dom isfic Irm—iled Parte hip) < ;'. :,• Under Section 121-202-A of the Revised Limited Partnership Act --Filer's Name and Mailing Address: . • d7' cwi o(. ���Or1 5 b l - 8b`1- 3755 Name: P(baie±cs L, �. Company,ijApplicahle: [it) r c� ��' �G✓1 G S . 3y�`� MailingAd&=: City,State and Zip Code- NOTES: 1.The name of the limited partnership and the date of filing of its certificate of limited partnership must exactly match the records of the Department of State. This information should be verified on the Department of State's website at www.dos.ny.eov. 2.This form was prepared by the New York State Department of State for filing a certificate of change by a domestic limited partnership.You are not required to use this form.You may draft your own form or use forms available at legal stationery stores.. 3.The Department of State recommends that legal documents be prepared under the guidance of an attorney. 4.This certificate must be accompanied by a fee of S30 made payable to the Department of State. , /y (Fur office use only) ����(�n • DOS-13884(Rev.04/17) Page 2 of 2 N A uM ------------ --- ..................... COUNTY OF SUFFOLK OC R-1 P=ft=. =Age,.Y �13 p OFFICE LOCATION: )'' � � "' a, MAILING ADDRESS: Town Hall Annex " �h P.O.Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold NY 11971 Telephone: 631 765-1938 X ti � f y' 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: October 12, 2021 Re: LWRP Coastal Consistency Review of N&L PROPERTIES LP SCTM# 1000-73-2-4 Sheri Winter Parker on behalf of N&L PROPERTIES LP requests an Administrative Permit to clear an approximate 4'x225' walking path through right-of-way to the Sound/Bluff—without the removal of any trees. Located: 8850 Bridge Lane, Cutchogue. SCTM#: 1000-73-2-4 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the LWRP policies and therefore CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Damon Hagan, Assistant Town Attorney Glenn Goldsmith,President o Q so Town Hall Annex A. Nicholas Krupski,Vice President 54375 Route P.O.Box 11799 John M.Bredemeyer III Southold,New York 11971 Michael J.Domino Telephone(631) 765-1892 Greg Williams ' ] �^ Fax(631) 765-6641 ���✓6i6Y1 ti4$�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application Administrative Permit Amendment/Transfer/Extension Received Application: 10• eceived Fee: $ 100.0 Completed Application: O®y d2j Incomplete: SEQRA Classification: Type I Type H Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: _¢—'oordination:(date sent): -------------� / LWRP Consistency Assessment Form Sent: ECAC Referral Sent: D (— d Date of Inspection: i t Receipt of CAC Report: OCT T 2021 echnical Review: Public Hearing Held: 1D•ZO•ZO Resolution: Owner(s)Legal Name of Property(as shown on Deed): L Mallin Address:Mailing C A v-e , S.' 1pav Aen Fl- 33 Phone Number: Suffolk County Tax Map Number: 1000- ® 7.3—P a ` O O l/ Property Location: 8 Sb f3/l o4 4P 6a CT. (0, rC (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): S/1Pe-1 Mailing Address: o25'5-co Mala /C C rG�loT l� 3s Phone Number: (,e3 - q9 773 D Email: 6 w D '' Cor o Ca,.l Co jjA Maim Diane From: Winter Parker, Sheri <SWP@corcoran.com> Sent: Monday, October 4, 2021 2:21 PM To: DiSalvo, Diane Cc: Alison Cohen; Christina Jackson Subject: RE: CORRECTION-N&L PROPERTIES 8850 BRIDGE LANE CUTCHOGUE Diane, correction a 4 foot x 225.ft(all numbers are approximate) walking path to the Sound/Bluff—without the removal of any trees. Sheri Winter Parker Licensed Associate Real Estate Broker 1 North Fork 2005-2020 Top 1% Realogy Brokerage Group Nationwide NRT Top 100 Corcoran o: 631.899 0613' d: 631.765 8093 c: 631.848 7730 f: 631.488 2523 View Corcoran website: Ji r i e"9 In tararn.< Facehook I- ouTube I About me I, co IT0n. 25500 Main`Road Cutchogue, NY 11935- , From:Winter Parker,Sheri Sent: Monday, October 04, 20211:34 PM To: DiSalvo, Diane<diane.disaivo@town.southold.ny.us> Cc:Alison Cohen-<aIisonc@otterconsulting.com>; Christina Jackson <cj@sheriwinterparker.com> Subject: N&L'PROPERT[ES"8850 BRIDGE LANE CUTCHOGUE Dear Diane, The application is for clearing portion of the ROW to create a 4 foot x 335.5 ft(all numbers are approximate) walking path to the Sound/Bluff-without the removal of any trees. Please let me know if that clarifies. As ever,sheri Sheri Winter Parker Licensed Associate Real Estate Broker 1 North Fork 2005-2020 Top 1% Realogy Brokerage Group Nationwide NRT Top 100 1 Board of Trustees Applit.';a,.ion //GENERAL DATA Land Area(in square feet): _ T Area Zoning: Previous use of property: U Are Intended use of property: U Inre qg 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 i✓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? Yes No L/9 Ab Prior permits/approvals for site improvements: tj 1� Agency Date a No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ✓No Yes If yes,provide explanation: Project Description(use attachments if necessary): c%ar Ri 0 'D Cry a.� a W a l�,�4 DDcLik 4o �o Suva d Board of Trustees Appli`_Aon WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations:, dear a T n f-i o� o-C ROW Creek o- wsli, ,a pe& - �k SoUad. Area of wetlands on lot: square feet AO k a ow l Q d l e Percent coverage of lot: , % Closest distance between nearest existing structure and upland edge of wetlands: feet NIA Closest distance between nearest proposed structure and upland edge of wetlands: feet r4� Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? cubic yards �A How much material will be filled9 cubic yards �I n Depth of which material will be removed or deposited: feet N1A Proposed slope throughout the area of operations: N! Manner in which material will be removed or deposited:--.--4A Statement of the effect, if any,on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): N f 61 Z20 Appendix B Short Environmental Assessment Form Jnstructions for Completing Part I -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 I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information Name of Action or Project: c lea"r Q o IR o w - _88Sb a21 66- C.A A6 Project Location(describe,and attach a location map): 995-0 131"d .e 4,re Cc-VC ko v-e 1 I `� 35- Brief Description of Proposed Action: C teccr qrear L q 1'J C 11L(AJ J Pqci� 4o Jl e So u,i c Name of Applicant or Sponsor: Telephone: 561- -3 N p� 2 • e G E-Mail:_4 I I SC� e o u 141Mj•[a M Address: I o �4+1Qa i e /ase3�0 City/PO: State: Zip Code: TL�ttrm ea"ckn FL 33q V 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that Q 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: [a E] 3.a.Total acreage of the site of the proposed action? 13 acres b.Total acreage to be physically disturbed? , o A acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 3 f.S acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban EgRural(non-agriculture) ❑Industrial ❑Commercial EgResidential(suburban) ❑l±orest lEfAgriculture El Aquatic j]Other(specify): ❑Parkland Page I 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? M 2 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? c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 2 0 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? I ^ NO YES If No,describe method for providing potable water: ��1 ❑ ❑ i 11.Will the proposed action connect to existing wastewater utilities? �I NO YES If No,describe method for providing wastewater treatment:_ ❑ E 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? I� ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: L�1 14. Id ntify 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 E3 Early mid-successional ❑ 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? ❑ 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, [:]YES ❑ a.Will storm water discharges flow to adjacent properties? ❑NO YES b.Will storm water discharges be directed to established conveyance systems(runoff and stone drains)? If Yes,briefly.describe: ❑NO ❑YES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: F; ❑ 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 YES completed)for hazardous waste? If Yes,describe: (f F] I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: N L L & Q Date: LO�� ' Signature:, oll Part 2-Impact Assessment, The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part I and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"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 El E]regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? El, Fl- 3. Will the proposed action impair the character or quality of the existing community? E, 1-1 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 ❑ ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: 0 El a.public/private water supplies? b.public/private wastewater treatment utilities? El F] S. Will the proposed action impair the character or quality of important historic,archaeological, (� architectural or aesthetic resources? L_J 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, D, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? El 11. Will the proposed action create a hazard to environmental resources or human health? E El Part 3-Determination of significance. The bead 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. i ® 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. EJCheck 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 i President I Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Sigriature'of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) i { PRIN�77] Page 4 of 4 i r e Board of Trustees Appli�R�.ion AFFIDAVIT �r Q 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 TROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF i 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 i EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM ' OF THE PERMIT. Signature of Property-Owner Signature of Property Owner 6 N � � &pe.r4'Qs C P 1 SWORN TO BEFORE ME THIS_ G® -_ DAY OF S'�O 4n , 20 s t PUN i i Yw, EDNAMAMENEX CommissioO GG 175820 c� Expires March 31,2022 i 9�OpF�Q` eondediFw6dpetNobrySenicec 1 Board of Trustees Appliva-cion AUTHORIZATION (Where the applicant is not the owner) I/We, owners of the property identified as SCTM# 1000- D 73 - 6 a - OG 7 in the town of �G( l C o 7 c Aoq yt ,New York,hereby authorizes I _ ,5A,vf/ 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 Owner's Signature SWORN TO BEFORE ME THIS /d DAY OF �-,� ��► ,20 votary P lic EDMUJIMM Comffissimn#GG V5820 1 c� Expires March 31,2022 �lFOF fLOP` 6dlded T1YU Bi,dget Notary Services APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Lown of.Southold's Code of fit is rohiliits caritlicts of interest on the dart ofi wti 4f$cers and eMploye©s.The purpose of this form is to nrovide'inforlipgtion which 69 alert the t of�o,,ssIbJ6 eon id&`gf' to st a d al owjt' , e.whaij!� er action is necessnry Ig avoid write. r YOUR NAME: { (Last name,fust name,-;niddle initial,unless you are applying'iti the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) 3 NAME OF APPLICATION: (Check all that apply.) j 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.) Ad`(ijlnll,,�� �(re��„�,/lt I,1' � C(�CtT' ��r'�•� 0� A-17 l(��1/z/ .r Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater 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(whets 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 -da-da s 2opL ,Sigpatitra. Print Na i C j Form TS i 1 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 shallmot 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# 16 D D 7Z3 G � — d o PROJECT NAME ,$85?6 The Application has been submitted to(check appropriate response): ��/ Town Board El Planning Board ElBuildingDept. El Board of Trustees E 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: D ����(l�o Location of action: A ;of Site acreage: 3! acl.r I Present land use: VIN B V aTd Present zoning classification:_ Q 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: (b) Mailing address: (c) Telephone number: Area Code( ) (d) Application number,if any: 10 Will the action be �--ydirects undertaken,re uire funding�or approval by a state or federal agency? • Yes ❑ No LYJ 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 [JNot 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 g 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 Not 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 8 through 16 for evaluation criteria 0 Yes O 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 21 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. ! I Yes No 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. I ❑ Yes ❑No Not Applicable Attach additional sheets if necessary j Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous i substances and wastes. 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. ❑ WE] No g Not Applicable Attach additional sheets if necessary WORDING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No dNot 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. ❑Yes ❑ No E Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages f 62 through 65 for evaluation criteria. i -E]Yes ❑ No 2rNot Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑,Yes ❑. No 2 Not Applicable q /o PREPARED BY �I�.Sa�J P.J TITLE���Zty�1 Ze�Q a q�,� DATE la � �G pinpQrh.e.r �P