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HomeMy WebLinkAboutTR-10003A Glenn Goldsmith,President �QF so(/j Town Hall Annex A. Nicholas Krupski,Vice President ,`O� ypll 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III Southold, New York 11971 Michael J. Domino cn �r G Q Telephone(631) 765-1892 Greg Williams YO Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction;-shay-bale.lirle/silt­boom/silt curtain 1, ,d'ayof consffutiart R %z CQr]StfuCt�dr�~ When;project,coMplefe, 'call-for compliahobinspection; Glenn Goldsmith, President ��oE S0(/� Town Hall Annex A.Nicholas Krupski,Vice President 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 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10003A Date of Receipt of Application: September 30, 2021 Applicant: Jennifer Maye SCTM#: 1000-137-4-22 Project Location: 910 Fleetwood Road, Cutchogue Date of ResolutionlIssuance: October 20, 2021 Date of Expiration: October 20, 2023 Reviewed by: A. Nicholas Krupski, Vice-President Project Description: As-built 9'x13'5" deck with 4' wide stairs to ground. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by Louis Schwartz, received on September 30, 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 Ec W E { 7-P S E P Sou,e A Town � wDs Q e b%WT_4N CC S Alt` Board f Tr�l�,Ge.,s�4 ;' 1 �� ,.4 ,.t � �:.-: � 14°DPA _ .. . .. _ I 4, I 1 2X10 L H I ADD 3FPOOATED .� 12-37 S1AGG FEDD COATED TO SECURE H d i � t FUSE FRAMING ——I I BOAR ( j.. a r . U, TOWN k� � ,ID - _ ISTING COTTAGE EXISTING COTTAGE I o DATE BUS - 20 20 - _ DECK PLAN u DECK STRUCTURE 1/4" 1'-0" 8.25.21 1/4" = 1'-0 8.25.21 EXISTING 1.:Use CA .. No Flti� , CRIT 2XBOCK7015S,EC, , AS BUILT DECK UST-2X8 D CK JO'STS R SY ON(2l 2X8 GIRDER. - .GIST 2X A IEtX�Ek J - - ��R BAR 1EIR4-C�Y ON 4x4 I'llRS 'ThAT ARE - ADD 3,g.> a lD yn o, �D I � ATTACHED TO COTTAGE ANCt BRED 70 4 DIA,CAM REFS n y ADD.NF_W SMP'O%IS HURRjt.ANE STRAPS AT EA..'v `-EGURE N FIZ.O 1}Jcf t. /�� r*h,y\ '/ ADD STRAPRr4G FPCf.4 GIRDER 'O ROS-S 1 ' MAYS RESIDENCE +1 t 875 FLEETWOOD RD. r J it CUTCHOGUE N.Y. I I � SCTU# -: I000 137-4-22 DECK SECTION ZONE;7-0.0.41 ACRES 1/4" V-0" 8.25.21 1v,, n. Glenn G, mith, President �o�OS� ni`CSG Town Hall Annex A. NII: ,;,aS Krupski, Vice-President „ 2�q 54375 Route 25 John M. Bredemeyer, III o '` P.O. Box 1179 Michael J. Domino o Southold, NY 11971 Greg Williams y�1p ©� Tel x -1892 (631) 765 6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: - �a�z/z� Completed in field by: W. James Maye on behalf of JENNIFER MAYE requests an Administrative Permit for an as-built 9'x13'5" deck with 4' wide stairs to ground. Located: 910 Fleetwood Road, Cutchogue. SCTM#: 1000-137- 4-22 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver'Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 ✓ Ch. 111 SEQRA Type: I II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other E c E t V MAYE RESIDENCE 875 FLEETWOOD RD. SEP 3 0 2021 13'-5' CUTCHOGUE N.Y SCTM# 1000-137-4-22 f I I I I I EXISTING ZONE,R-40 41 ACRES i i ! SINGLE FAMILY RESIDENCE Southold Town i I I I t 538 SO FT ONE STORY ONE BEDROOM WOOD Board of Trustees j ! ' I I FRAMED HOUSE WITH ATTACHED 178 SO FT I I i � � ' � DECK GENERAL NOTES ' i ` j j s'wk ca+n am+aa oearina.aawaa+a.w,„ by 11 I zaa9aeby wmdekam d ue wwv aea+3e Iareh wn h 212' 45'DH 3 x 45'DH 3 x 45'D 32'z 45'DH 1 �°1dly qae vvvnl F' w"an .aakaada d w mmaed N C HOW ® 0 SAW® ISLO11D. ECIU- 81. 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ADD3,e'x3" J a ? A RED ATTACHED TO COTTAGE j(fAS c3UELT. DECK I Q .__UFt LCx,t. ,NC 1 •H.,/itJ�] /}' 't T ._ � TAC T E MAYS RESIDENCE 875 FLEEW4 00D =7 C UTCHOCUE N.Y. DECK SECTION �< aP 1/4" = 1'-0" 8.25.21 ; ` a a� s , r ` +'•� ,, � d,F ,.." tial=.. 4� � 7�{ 4�` �d, C� I x � n w f � � Ls��^::,-. ^''r,�.�•�`$.+«,�z:�`�'se��1,,..Str Cs xsL�'^ z s rT- I 7 �vwaS''� �F x t lir aa F F tl OFFICE LOCATION: 9 �� "u MAILING ADDRESS: Town Hall Annex �� �„ ^� ,a P.O. Box 1179 54375 State Route 25 $ �� Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold NY 11971 ��� t , Telephone: 631 765-1938 u � ZZ 4 k mW 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 JENNIFER MAYE SCTM# 1000-137-4-22 James Maye on behalf of JENNIFER MAYE requests an Administrative Permit for an as-built 9'x13'5" deck with 4' wide stairs to ground. Located: 910 Fleetwood Road, Cutchogue. SCTM#: 1000-137-4-22 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 the LWRP policies 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. According to Town records, the structure was completed without obtaining Board of Trustee review or regulatory permits. 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 ' _ Town Hall Annex Glenn Goldsmith,President 1 54375 Route 25 t A.Nicholas Krupski,Vice President , V- P.O.Box 1179 John M.Bredemeyer III Southold,New York 11971 Nfichael J.Domino Telephone(631)765-1892 ; _ Fax(631)-765-6641 Greg Williams �oq •� x a Y BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use'Only E E Coastal Erosion Permit Application Q r Wetland Permit Application _Administrative Permit SEP 3 0 2021 Amendment/Transfer/ExtensW' n Received Application; Received Fee: $ Southold Town Completed Application:,_ _ Board of Trustees Incomplete:` SEQRA Classification:' Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date*, } � Coordination:(date sent),., . . LWRP Consistency Assessment Form Sent: CAC Referral Sent:. Date of Inspection: Receipt of CAC Report: /Technical Review:, V/ Public Hearing Held--- -0`ZO Resolution: Owner(s)Legal Name of Property (as shown on Deed): � � 1"'a 4 � x Mailing Address: (a G 2_1i G_f�t�� -U � �-�- Phone Number: 956.-,653 - Z&3 Suffolk County Tax Map Number: 1000- Property Location:, �/b �1e e4w an A f�a of ��.� Ulf i . (If necessary,provide LILCOYPole#, distance to cross streets, and location) AGENT(If applicable): M45 An Mailing Address: tktfs110` �� Nd��VI P'�1 ge�^*�� Phone Number: '?51 'ti S`�"`�a Z Emaih, (M r < C d { Board of Trustees Application Y GENERAL DATA Land Area(in square feet),;,. Area Zoning: (f t Previous use of property: rt Intended use of property: Covenants and Restrictions on property? Yes ZNo If"Yes",please provide a copy. y Will this project require a Building Permit as per Town Code? Yes _ t /No If"Yes",be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review E and Elevation Plans will be required. E Does this project require a variance from the Zoning Board of Appeals? Yes ✓ No F If"Yes",please provide copy of decision. i Will this project require y 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 i Prior permits/approvals for site improvements: Agency J Date x No prior permits/approvals for site improvements. / Has any permitlapproval ever been revoked or suspended by a governmental agency? V No Yes, If yes,provide explanation:; _ Project Description(use attachments if necessary): d F5 io I� Ov oa✓ � , . .. Y s i Board of -Trustees Application Y 'WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: _ Qu-�Wdo./ e cv, - , t Area of wetlands on lot: _ =�square feet I � A Percent coverage-of lot: % Closest distance between nearest existing structure and upland edge of wetlands: _._2�, ., feet Closest distance between nearest proposed structure and upland edge of wetlands: Z 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): i t 617.20 Appendix B Short Environmental Assessment Form Inst���>hons,>it�r+Coznnl�ti>a� , 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-]-Projeef and Sponsor lnforination ! Name of Action or Project: Project Location(describe,and attach a location map): p i r- 0 D lnt it dta, Brief Description of Proposed Action: l Ix E t Name of Applicant or Sponsor: Telephone: 257 c.1 ZS L . _ E-Mail: 6_ l__ .0 Address: City/Po: Stats: Zip Code: NorAd w1 e. 14dgL" 5 I.Does the proposed"action"only into ve the legislative adoption of a plan,local law,ordinance, NO ;YES administrative rule,or regulation? 'If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval- 3.a.Total acreage of the site of the proposed action? ( acres b.Total acreage to be physically disturbed? oa T25 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? - �" acres, 4. Check all land use`s"thafoccur on,"adjoining and near the proposed action. M Urban El Rural(non-agriculture) [:]Industrial ❑Commercial [residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 f s t e --5. Is-the proposed--action, VES'- NO- a.A permitted use under the zoning regulations? 71 b.Consistent with the adopted,comprehensive plan? 6. 'Is the proposed-action consistent with the predominant character of the existing built or natural NO VES, landscape? 0 —I.—Is the site of the proposed acti Area? "' NO. -YES 1 If Yes,identify:- a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES,, El% 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? act�n? 1 t 9-.Doe's-the proposed action meet or exceed the-state energy code requirements? -YES- I If the proposed"action will exceed requirements,describe design features and technologies: '4 ............ 10. -Will the proposed actiowconnect to an existing public/private water supply? YES, If No,describe method for providing potable water: on A"A, - '11.Will the-proposed action connect-to existing'wastewater dtilitie§?' - NO YES It YESI�,No,describe method for providing wastewater treatment:- ' f2.--a.-Does-the s site contain"a'structure tfi'a't is'listed oil either the State or,Natibnaflegister of Historic R70 Places? b.Is the proposed action located in an archeological sensitive area'? 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? E3, b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? If Yes,identify the wetland orwaterbody and extent of alterations in square feet or acres: ­14. Identify the I typical habitat types that occur on,or are likely to be found on the project site. Check all that apply D Shoreline DForest D Agricultural/grasslands [I Early mid-successional 0 Wetland El Urban 0 Suburban 15.Does the site of the proposed action contain any species of animal',or associated habitats,listed -NO YES by the State or Federal government as threatened'or endangered? M o 16.is-tl-fe project site located intfie 100 Year flood plamT-­----­- `N� YES' �17.Will the-oroposedic-tio7nc-reat'est6iiii-wite-rdischarge,eitli6ffr6-mpoini ornon-point sogrces? :'NO' YES If Yes, -1 NO F_�YES a.Will storm water discharges flow to adjacent properties? F b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,,briefly describe: F_JNO ❑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)? i 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 -E`YES solid waste management facility? If Yes,describe. ( J� 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: c - a I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE a Applicant/sponsor name: . �d�m-L S Date: Signature: t E 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?" i No,or Moderate ; T,small to large ;impact impact may may occur occur i 1. Will-the proposed action create a material conflict with an adopted land use plan or zoning regulations? EJ i 2. Will the proposed action result in a change in the use or intensity of use of land? F1 0 i 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 t(� establishment of a Critical Environmental Area(CEA)? �--j 5. Will the proposed action result in an adverse change in the existing level of traffic or )� Q 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? L-_I 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? ❑° 8. Will the proposed action impair the character or quality of important historic,archaeological, ; architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e g.,wetlands, '(�I waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 3 i No,or Moderate' small to large ;impact impact I may may occur Occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? L"J � 11. Will the proposed action create a hazard to environmental resources or human health? 1 Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every; question in Part 2 that was-answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental"impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by r 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. z k } L I � 3 n k 3 S i F { (� Check this box if you have determined,based on the information and analysis above,and any supporting documentation, Ll that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. rmation and analysis above,and any supporting documentation, Check this box if you have determined,based on the info '• 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 i Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from ResponsibleOfficer) 7 SPRINT Page 4 of 4 L��,3 r- Board of Trustees Application i t AFFIDAVIT " —BEING DULY SWORN 3 `DEPOSES-ANDAFFIRM THAT HE%SHE IS THE APPLICANT FOR THE ABOVE # DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN 3 ARE TRUE TO-THE BEST OF,HIS/HER KNOWLEDGE AND BELIEF;AND THAT ALL WORK WILL BE`D.ONE 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 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 EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. f R 2 1 i 7 ig ature of"Property Owner. Signature of Property Owner SWORN TO BEFORE ME THIS ZJ DAY OF &k E Notary Public � Y p� o DANIEL FLORES :r,` Notary public-state of Florida � Commission k HH 073289 MY Comm.Expires Dec 17,2024 Bonded through National Notary Assn. c s 5 k t Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I i I/We,- owners of the property identified as SCTM# 1000in the town of SMA ;New York,hereby authorizes AS 5 ;to act as my agent and handle all f necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. j i jPriorty Owne 's Signature Property Owner's Signature SWORN TO BEFORE ME THIS. Z OF, 20 •G' DANIEL FLORES Notary Public ��, �Q: Notary Public•State of Flonda , Commission#HH 073289 t Bond dyOMExpires Dec 17,Y014 through' ational Notarygssn. i i i t APPL-ICANT/AGENT/REPRESEN'I'ATWE TRANSACTIONAL DISCLOSURE FORM Ftri' n ffiaers` sm 1 s: te,tiTl " ese o fe�'"rivvn cif'SttuthotcY'sCacleo � "+es'-�hibi"'ronflicis�cifinter 'on•thc""art'a -' thts`formas`to.nmiv�de`infciririafiiari wtilcti°cari�Ieirttlte'tciwii iif'vriossl'Fitec�ari#li'cis ofi2tter€s't�isd�3ow�it`'to=tal;�e^iy"taiift,Ver>�`.r_�€_i'o`ri`�ts= �rtececaiirv`�[bintiii�'�atrie`: V . w . x C t (bast nartie,first name;middle mrtiat,�unless you are applying in the name of someone else'or other entity,such as a company.If so,indicate the other person's or _company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance _ Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official•map°..� Planning _ Other (If"Other",name the activity.) siblin` jil circhilil)'hav'eu"rolati nshi�ay+it3iriuty?`a icer.,cor,eiripinyee ; Do youpispnillYf(orthrough,yotl-company,'spouse, g;Peansii'liusine s of the�"Cown,pSo>Jtlrold? "Relatii�iisliip"incltiiiesrli}'blood', itarriag,, rbissine :iCtteres usirtes `inteiest'tti°" including a p u th rsliip;'in tii�hich the tntyp officer or emplgyee.l7ms ep n p irtial'awrsefsh%p`ol'oz,et�tytliaj ietit WA ro",rporat►on w in which'th zto ry of�cpr,'o employee,"ns marc ttitiri"°Io afthe shares. 1 NO, YES If you answered"YES",complete the balance of this form and date and sign where indicated. Name of persoh 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)througb�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)theownero-&eater than5/a`ofSlioslla s;Q : orpl?ratgstockofihe:€iPpli4 (when the:applicant is a cgfporaiJQn) B)the legal ryot ben �:ial,owner of any,dtcreA iitt,a rton-ctttpo hte,en'tity.,(.Wheti the - applicai?t:is not_n cgrporati`on); � t•^ C)an officer,'director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of S� 20 ' E SigtaaEu"rs - _ Print Name_ t MV Form TS 1 5 8 Y M1 APPLICANT/A,GENTIREPRESENTATWE TRANSACTIONAL DISCLOSURE FORM wn Mors L ii -M -the ewwblg�f,�bssiblec-onfli�4tgr�Ln YOURNAIVIE, t7 (Last name,first name,ipiddle initial,unless you are applying in the name of someone else or other entity,such.as EL company.If so,indicate-the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Building Tax grievance Trustee % Variance -------- Coastal Erosion Change of Zone ------- Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Doyoio,fs!*ill�'.'( through your company; orempl9yee " , �,�b—ness� &1smess�imeresf l.tBusiness interest-'means a, usi d by)A!0000 0 of the of-Southold? "Retatf6fi'sihip"inciQi4,*'bloo4,a�hrijag ,* '6�even a f(0 MP 9*11kerit" including a,pa I rinersw Southold? thetoWir�,officeroi"etooioyee. , in which th c 1bW Int�oj,iqerpre pordtbdfi,'5%ofth6,s ares. IT mplom,� - 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( presentative)and the town officer or employee.Either check the applicant/agent/re 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): o the owner,pfjrbatcr than 5%,of1he-sh4 Obbe',66MOON,jq rick-f (when the,#011cant is a corpor*qr*� the jegajoi'beneiciial-owner of aqyJ t applicant is not'ar corporation), an officer,director,partner,or employee of the applicant;or —D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this ay of 20-ki Sigriaor' ---------- Print Name A-Y&. ........ Form TS I r Town of.S'outhold E t LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS t 1. All applicants for permits*� including Town of Southold agencies, shall complete-thin 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 includ( g;Building,Permits and other ministerial permits not located within the Coastal Erosion,Hazard Area. 2 Before-answering Alid ,qudstiofis in Section C,-the preparer of this .forin_should review the exempt ies and_explanations-of each policy contained in the:Town of Southold.Local minor action list, polic Waferfront'Revitalization Program. A t�foiaosed'acCon° rll 'die nvaluatd ° °to axts§szcatit E I�eiae�cia�'`snnt�`aci.�crsey�fFoos'ut�on� ito�coastal area�v�luch= chid`eskall'zcr�,Sot�hold'Ti�wl. z 3. If any question in Section C on this form is answered "yes" or."no", then the.proposed action will 4 'affect the achieyement.ofthe L'WRP policy;standards and,aonditions contained in the consistency review-law. ''I'hu§41ac i austi ir'itiust;;3ae o ` air ell an.`,ilet"' .= uW:'3Tiotbiksi�i `o�rtait'^ au aiiiiin', itlnptMrni If an action cannot be certified as consistent•with the LWRP policy standards and r conditions,iLtAajjatil+e`jWditalcefi., ' r 'A copy of the sLWRP is available,-in the following places: online at the Town,of Southol'd's, website(southoldtown.riofthfork.net), the Board of Trustees Office,the Planning Department, all loeatlibraries and the Town Clerk`s office. `{ B: DESCRIPTION.OF SITE A",PROPOSED ACTION PROJECT NAME_ The°Application has been submitted to(check appropriate response): -- Town-Board F Planning Board❑ Building Dept. ❑ Board-of Trustees ,l lCT 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)'y Financial assistance(e.g.grant,loan,subsidy) (c) Permit,approval,license,certification: - z Nature,and extent of action: { E x j � f Location of action:' cf 0 °?'&4i,� Cu p 5 vim- 'Site acxeagei� d �� - - Present land-use: 0 4-4--v6 - - Present zoning classification: _ 2: If an application for the proposed action has been filed with the Town of Southold agency;.the following information shall be provided: (a) Name of apfilicar t __ ��''��•5- a � y Mailing'address: o U(0tac- �L d t (c) Telephone number:Area-Code (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state`or federal agency? v. J vI If es,,which state or federallg&� cyl- - Ye"s�� No Y ... 'C. Evaluate the.project to the following policies by,analyzing how the project will further support or '. ;nonsupport the policies. Pxovide all proposed Best Management Practices that will further each policy. Incomplete answers will'require that the form be returned for completion. DEVELOPED-COAST.POLICY f 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 III—Policies; Page I for evaluation criteria. Yes No �ot Applicable : e 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 L J 'Not Applicable : 6 C Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See 3 LWRP Section III—Policies Pages 6 through 7 for evaluation criteria 7 l D Yes Ej No dNot Applicable 3 x Attach additional sheets if necessary C Y NATURAL COAST POLICIES i -Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—PoIicies Pages 8 through 16 for evaluation criteria 0 , - Yes No Not Applicable r _ - - ' `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 thro gh 21 for evaluation criteria Yes 0' 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 evaluati n criteria. F1 10- NA S x k Yes No Not Applicable Attach additional sheets if necessary - a Policy' 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. } E Yes , )No'�, . Not Applicable - 4 t Attach additional sheets if necessary - r Policy 8: Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. El"Yes �-E_ No Not Applicable r 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. YeF-1 u No ot Applicable licable Attach additional'sheetsif necessary r ` a 4 y 7A}� WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in ` suitable locations. See LVVRP Section IH—Policies; Pages 47 through 56 for evaluation criteria. =Q;Yes ;'i ] No 0 Not Applicable _ r E Z 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. 0 Yes No 9Not Applicable ` k ,Attach additional sheets if necessary i 3 Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages 62 through 65 for evaluation criteria. 9 .[:] Yes 0, No u Not Applicable 3 i 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. M Yes F: No LD Not Applicable S PREPARED B�' �R NAS .. �y��- TITLE - _DATE 2`� 3 September 24, 2021 Town of Southold Building Department 54375 Main RoadV PO Box 1179DLI Southold, NY 11971-0959 SEP 3 0 2Q21 James Maye Southold Tovin 606 Riverside Road Bo?,d od North Palm Beach, FL 33408 SUBJ: 910 Fleetwood Road, Cutchogue, NY: As-Built Wetlands Permit Building Department/Board of Trustees, A rental permit inspection was completed on June 24, 2021 at 910 Fleetwood Road (STCM 1000-137-4-22),which consists for 2 dwellings (875 Fleetwood &835 Fleetwood) and Trustee approval was identified as being required for an as-built deck located on unit 875 Fleetwood Road. Please see enclosed documents to initiate an administrative wetlands permit: 1) Application Packet 2) As-built deck plan 3) Survey of property 5) Photos of Deck Regards, � Jam�aye 757-254-4372