Loading...
HomeMy WebLinkAboutTR-10086A Glenn Goldsmith,President *®F Sso Town Hall Annex ®A ®� 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 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE #2009C Date: February 1, 2023 THIS CERTIFIES that the existing 8'7"x19'3 5"deck with steps and as-built 5'1"x3"10"outdoor shower; as-built 4'6"x5'8"closet addition on north side; At 2285 Little Neck Road, Cutchogue; Suffolk County Tax Map#1000-103-10-1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated February 4, 2022 pursuant to which Trustees Administrative Permit# 10086A Dated March 16, 2022, Amended on March 15, 2023,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 existing 8'7"x19'3 5" deck with steps and as-built 5'1"x3"10" outdoor shower-, as-built 4'6"x5'8" closet addition on north side. The certificate is issued to Jennifer Maye&John P. Bernhard owner of the aforesaid property. Authorized Signature Glenn Goldsmith, PresidentSDyO Town Hall Annex A. Nicholas Krupski,Vice President ,`O �� 54375 Route 25 P.O..Box 1179 Eric Sepenoski 14. J�E Southold,New York 11971 Liz Gillooly v, AIC. Elizabeth Peeples Telephone(631) 765 1892 Fax(631) 765=6641 BOARD OF.TOWN TRUSTEES TOWNOF SOUTHOLD SOUTHOLD TOWN BOAY2D OF TRUSTEES YQU ARE REQUIRED TO CONTACT THE OFFICE QF THE BOARD:OF TRUSTEES.' . 72 HOURS PRIOR TO COMMENCEMENT OF,THE ACTIVITIES:CHECKED:OFF' INSPECTION SCHEDULE .Pre-construction, hay bale.line/sift boom/silt curtain 1st day.of construcfion '/?constructed When project complete;.call for compliance inspectiorl, J. - l Glenn Goldsmith,President QF SO&P Town Hall Annex 54375 Route 25 A.Nicholas Krupski,Vice President �O l0 P.O. Box 1179 .. Eric Sepenoski ;:; JL Southold,New York 11971 Liz Gillooly G Telephone(631) 765-1892 Elizabeth Peeples • ;. JO Fax(631) 765-6641 BOARD'OF TOWN TRUSTEES TOWN OF SOUTHOLD . Permit No.:. 10086A Date of Receipt of Application: February 4, 2022 Applicant: Jennifer Maye & John P Bernhard SCTM#: 10007103710-1 Project Location: 2285 Little Neck Road,. Cutchogue Date of Resolution/Issuance March 16,.2022 Date of Expiration: Mardi-16, 2024 Reviewed by . A.' Nicholas.Krupsk- Vice-Presiderit Project Description: As-built 8°7"x19'3.5" deckwith,steps and.as=built 5'1"x3"10" outdoor shower. 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, LPE received on February 4, 2022, and stamped approved on March 16, 2022. 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. 0 Glenn Goldsmith, President Board of Trustees Glenn Gold ih, President o��S11FFU(r Town Hall Annex A Nicholas KruVice-President ,�� -�,,, 54375 Route 25 Eric Sepenoski c '` P.O. Box 1179 Liz Gillooly o Southold, NY 11971 Elizabeth Peeples 4,o �ao_ Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: /Z'7 Z2 Completed in field by: 1)°�• James Maye on behalf of JENNIFER MAYE & JOHN P. BERNHARD requests an Administrative Permit for an as-built 8'7"x19'3.5" deck with steps and as-built 5'1"x3"10" outdoor shower. Located: 2285 Little Neck Road, Cutchogue. SCTM#: 1000-103-10-1 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK 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 V' Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Surveys 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness//comments/standards: I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: `/"E. Peeples L.Gillooly ✓_G. Goldsmith N. Krupski E. Sepenoski Other o EXISTING COTTAGE FOUITDO-ORR r c•1 I AR 21 I NEW CLOSET ap IEXST. HANDRAIL I EX ST. 5/4 X 6 WOOD DECKING 2,Y8 Gff?DER HC\?F�n& NRkFL, TO 4X4 POST TO CONC. FTGS. _ 2X8 @ 16"OC DECK JOISTS TECO TO GIRDER&TO LEDGER BOARD EX ST. 2X8 LEDGER NAILED TO HOUSE FRAMING CELLAF ENTRY O I 7 f e r r I 1 00 ® pp 5/4x6 WOOC DECKING `r z PLAN5/4x6 HANDRAIL ON N DECK SECTION OUTDOOR SHOWER DECK & CLOSET N 4X4 POS-S TYP. ' 1/4" = 1'-0" 8.25.21 1/4" = 1'-0" 8.27.21 1 -62.. 19'-32" 1 1'-7" ZZ/1 24.. EXISTING COTTAGE _o OUTDOOR SHOWER 1 M E E ■ v r� -- J V—3 ml-d- FEB -4 202 V, L? LINE OF WALL ABOVE _LINE - - - APPROVED BY SoIJtllo?d Town (Aire o.Trustees 2X8 LEDGER BOLTED TO II BOARD OF I RUSTEES HOUSE FRAMING : 2X6 FL.JOISTS @ 16"OC 00 (2) 2X8 GIRDER ON II I POSTS TO 4XTOWN OF SOUTHOLD 4 II 12' DIA CONC, PIERS I� DATE IttARC# 1G, zn7_ 2X8 LEDGER NAILED TO HOUSE FRAMING&ALSO SUPPORTED IPJ PART BY 2X4 BELOW. EX ST. CELLAF ENTRY I f---•• r I N 2X8 LEDGER NAILED TO FDUSE FRAMING co 2X8--BEAM ff1.7€B X N J' 4X4 POSTS ON CONC. js O ul e (` STRUCTURE AS- BUILT DECK,CLOSET OUTDOOR SHOWER, DECK & CLOSET L - - - - - - X !i 1/4" = 1'-0" 8.27.21 _ - - - - ®;® -- _- - ® - - �__ _ ®� & OUTDOOR SHOWER 2X8 BEAM BOLTED TO MAYE RESIDENCE 4X4 POSTS ON CONC. FTGS. ,I r fit' ,ri i c 1 2285 UTTZE NECK Rte. CUTCHOGUE N.Y. Z 1 SCTM# 1000-103-10-1 ZONE R-80 4.73 ACRES `i1 A' I S.C.T.M.# DISTRICT: 1000 SECTION: 103 BLOCK: 10 LOT: 1 ECEIVE FED -'r �.. EUGENES ROAD Southold Town Board of Trustees N W O to 1 S 8 0,54'00 LAND N/F OF �\ 160.24' JOHN PAUL BERNHARD JR MANAGEMENT TRUST S 77007' .�• \.. \ x � N O� d :.'...':.'•.. ':. ' C '�+�\ yam'—\ ��\ N Oap N N I 2 w $, 7°42'30"� ` \ ----�,, �3 N o C a� r�0 \ \ \ .- Tq „ 375.Ob' rry r �`./'��.�„`` ' '�Mf►�,ld1MY. ♦ •, , _r—j \ \ C `'•�^� 1 / I / / % j MAL WERMID IWNOMI Y �'�'�/ C �•�,,,� .a \ t / / % I / ! Dk1XWAED dY COVE2021 I,E'►K SlRNCkS Ar • f � % / 1 �s' 1 1 � 19\ �__ ; / Q•:;:y;;cy:;; —1 y ( 1 1 M INN \ `` \ \ \\\� `•:;2;'i±E:•,�a�i;' \ \ 1 ` � Furl OD 1 1 Ar N 81°51,1 1 ' \ 1.OWN \�78 350.20' N82011'10" \'\ �__ •� `� \� \ � �� \ 1 �`�` ;�• LAND N/F OF 719% �\ 1 CHARLES BUCKEL 208.4,0# 1 u.. 1 y 1 1 S loot N 84°00'10" co 8 °36'50" W�, ! S 8 020'N W o o, A, �O�\ ° A � S 86 o, O I M/8.00 I LAND N/F OF I a I DAWN CARROLL I O � I p FEMA MAP#36103CO164H SEPT. 25, 2009 THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL LOCATIONS SHOWN ARE FROM FlELD OBSERVATIONS UPLAND AREA: 188,690 S.F. or 4.33 ACRES AND OR DATA OBTAINED FROM OTHERS AREA: 194,378 SQ.FT. or 4.46 ACRES ELEVATION DATUM: NAVD88 UNAUTHORIZED ALTERATION OR ADD17701V TO THIS SURVEY IS A VIOLATION OF SEC77ON 7209 OF THE NEW YORK STATE EOUCA7701V LAW. COPIES OF THIS SURVEY TOWN OF SOUTHOLD MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM 7HE SURVEY IS PREPARED AND ON HIS BEHALF 70 THE 777LE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LOT COVERAGE LISTED HEREON, AND 70 THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. 1 STY DWELLING W DECK & SHOWER: 862 S.F. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED 70 MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADD17IONAL STRUCTURES OR AND 07HER IMPROVEMENTS EASEMENTS 1 1/2 STY. DWELLING: 855 S.F. AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON 7HE PREMISES AT THE 77ME OF SURVEY SHEDS: 181 S.F. GARAGE: 260 S.F. SURVEY OF:DESCRIBED PROPERTY CERTIFIED TO: JIM MAYE; 2158 S.F. Or 1.1% MAP OF: FILED: SITUATED AT:EAST CUTCHOGUE TOWN OF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design P.O. Box 153 Aquebogue, New York 11931 FILE #221 -175 SCALE:1 N=40' DATE:NOV. 18, 2021 N.Y.S. USC. N0. 050882 PHONE (831)298-1588 FAX (831) 298-1588 2285 Little Neck Road As-Built Deck & Shower 1. +p9 m ...,,.a .'.s M. T. Wv. r 4 z k,h° e . Deck — Facing South Deck — Facing East Deck As-Built 8/18/2021 9:00am 8/18/20219:00am 04/06/2021 6:00pm 2285 Little Neck Road As-Built Deck r _ I I r s Deck Stairs Deck — Facing North Outdoor Shower 8/18/2021 9:OOam 8/18/2021 9:OOam 8/18/2021 9:OOam a. ti•pe '`„' Y r �,,„s� d"' ,� � grew. 1EUra , 911 00Pm p w Ix t o s A '..! .. 4'f` ✓ 41RA a., i � `w' •} 1Y} 'ate, z 'w •e^a, °I " ,o�r"'P 1 } :q xo a 1_. t 'n 'S. _ x to EE e °Mry 1 4 aEL 4`' x .3. iS 9-R, I , *e } auelct 5 1 1 xE 4 p};7 <>uk-3 2 h �C L � _ ,.... � .: ��♦ '+, '�\ '�.��s ✓awe ` �,°FO.,"2 un -- y 1F< y E w AQP x ;. , e, 1 _... d � �3�5 �.„ ... �.� �' �":` vx�.,.�' 4 ,yxt.a•'*e ... q �tl +° .. Y ..., - ,. .; o,°y� '•;� .._,. ' I,,t .P. 1:;.'„ •z;:s�fs 1i �5 �' t'.. 5''. � „I L- 1 j � E� [v EE °� '.po, �" ° x1 'i i'o. '�Si * - 3i WCo BALI'Mt PL �Eay't) M` 'r 1 3 p ., "*•w.," t t .s ,y :may �,.,�."�`� ^5�� .� y �� �3� � :M�" �. ,,. a °'"R ,a *�,.,. r ak.. n b .� w i.. ♦ / r' l Es ¢ � ;t. 13 r C, � ,.. � C C � � tt l �'a Quo` � •,S a ' -.. d r r � h 3 COUNTY OF SUFFOLK •m*ct l000 Gi a �_ - .rnr•:. - w.. n..mo:.. - ..rr 4,Ncr `r'E'�3, P-1�t011CttV•JdY Sem Ag A4Er non pF TP Y "qq 4` n N ..�_ - - _ "' �_- a."'^ • �", t10CmMrrlYEr.MvrA,u( YI1W w•l y4'Wy[ p�PP6,wxditu A vxn OOUTXDW 103 J 34 r -`R, r�r» 8 IJ OFFICE LOCATION: ��rjF.SO(/jyO MAILING ADDRESS: Town Hall Annex ,`O l0 P.O. Box 1179 54375 State Route 25 .1L Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) T Southold, NY 11971 • Telephone: 631 765-1938 a Comm LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Glenn Goldsmith, President Town of Southold Board of Trustees From: 'Mark Terry,,Assistant Town Planning Director, AICP LWRP Coordinator Date', March 14, 2022 Re: LWRP Coastal Consistency Review for JENNIFER MAYS &JOHN P. BER NHARD SCTM#1000-103-10-1 James Maye on behalf of JENNIFER MAYE�&JOHN�P.-BERNHARD requests a`nAdministrative Permit for an as-built 8'7"x19'3.5" deck with steps and as=built 5'1"x3"10" outdoor shower. Located: 2285 Little Neck Road, Cutchogue. SCTM#: 1000-103-10-1 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 action is INCONSISTENT with below Policy Standards and therefore is INCONSISTENT with the LWRP. Policy 6. Protect and restore the quality and function of the Town of Southold ecosystem 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. The deck and outdoor shower were constructed without proper permits. How the outdoor shower drains is not shown. 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 Sob Town Hall Annex C ` 54375 Route 25 A.Nicholas Krupski,Vice President a P.O. Box 1179 John M.Bredemeyer III _ Southold,New York 11971 Michael J.Domino., Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only FEB 4 202 Coastal Erosion Permit Application Wetland Permit Application Southold Town Administrative Permit Board of Trustees Amendment/Transfer/Extension _:i�Received Application: 2`4.2z- ,Received Fee: Completed Application:. ZZ?v Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: oordination:(date sent):. LWRP Consistency Assessment Form Sent: AC Referral Sent: 3. `�� Date of Inspection: Receipt of CAC Report: Technical Review: Public Hearing Helf%O Resolution: Owner(s)Legal Name of Property (as shown on Deed): Jennifer Maye & John Bernhard Mailing Address: 606 Riverside Road, North Palm Beach FL 33406 Phone Number: 256-653-2839 (Jennifer Maye) Suffolk County Tax Map Number: 1000 - 1:03.-10-1 Property Location:2285 Little Neck Road, Cutchoque NY 11935 (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): James Maye Mailing Address: 606 Riverside Road, North Palm Beach, FL 33408 Phone Number: 757-254-4372 Email: jjmaye4a--mail.corn Board of Trustees Application GENERAL DATA Land Area(in square feet):, 194,378 Area Zoning:. R-80 Previous use of property: Residential Intended use of property: Residential Covenants and Restrictions on property? Yes X No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? X 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 . X No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes X No Does the structure (s) on property have a valid Certificate of Occupancy? Yes X No Prior permits/approvals for site improvements: Agency Date X No prior permits/approvals for site improvements. Has any permit/approval ever been revolted or suspended by a governmental agency? X No Yes If yes,provide explanation: Project Description(use attachments if necessary): As-Built Deck 8'-7" x 19'-3.5" with.steps and_ an as-built outdoor shower measuring S-1" x 3'-10" on Dwelling #1. - Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Outdoor Deck & Shower Area of wetlands on lot: 5,688 square feet Percent coverage of lot: . 2.9 % Closest distance between nearest existing structure and upland edge of wetlands: 81 feet Closest distance between nearest proposed structure and upland edge of wetlands: 75 feet Does the project involve excavation or filling? X. . No Yes If yes,how much material will be excavated? cubic yards How much material will be filled? N/A cubic yards Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations. N/A Manner in which material will be removed or deposited:. N/A Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): 61 Z24 Appendix B Short Environmental Assessment Form 1tts'tructibns for-Cti 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? 0 x ❑. b.Consistent with the adopted comprehensive plan? ❑ rnv---' ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? X 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? FV-1 F c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? M F1 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: M 0. 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: N/A-As-Built 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: N/A-As-Built 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? Dwelling#2 ❑ b.Is the proposed action located in an archeological sensitive area? 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ❑ b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: . 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ® Wetland El 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' X Ll 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? ❑NO ❑YES , .❑ b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,brieflyOescribe: E]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: 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: -- Fx] Fl, 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or ''NO _YES completed)for hazardous waste? If Yes,describe: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor nam : James Maye Date: L h F,110-Z--L- Signature:, ZSignature .Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the,foliowing 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 I. Will the proposed action create a material conflict with an adopted land use plan or zoning n regulations? t' 0 2. Will the proposed action result in a change in the use or intensity of use of land? a o3. Will the proposed action impair the character or quality of the existing community? a 4. Will the proposed action have an impact on the environmental characteristics that caused the n establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑' D 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 ❑ Q reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? D ;o 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, 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 F] problems? 11. Will the proposed action create a hazard to environmental resources or human health? o 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-tenn,long-term and cumulative impacts. EjCheck 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. aCheck 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) PRIM Page 4 of 4 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM 'Th67briyn,of Southold!s,C:oile of Ethics proliibits conflicts`of interest on the part of town inters and'emnloyecs°Tha ouroo5e- f his fonts is to,provide information which'can alert the town ofpossible conflicts.ofmterestand allow•itlo,'take wfiuti;veraction<is ;iiecesW.jo avbi&same: YOURNAME: Mate, James J (Last name,first)S0h&V#iidu f ttitial,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 X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other`',naive the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO X 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(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this.4 19dayof :�J-Irt 20�°zti Signi(tire- Print Name Form TS l APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town ofSouthold's>Co'de of Ethics prohibits=confliots'af interest.on the partof town.ia`fficeis tiriii.empJoyaes.Th©Laumose of this form is to.provide•inforination which can.alert the'town ofyossible conflicts.of rnterest'and'allow if`fn take tivliateyer acfidri is' necessaryoto,avoid.5anie. YOURNAME: _ Maye Jennifer, E (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 X ` Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other`',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest"Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO X _ 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(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 1.6 day of 200 7,1- Signaturoyct 1��tc lA_ Print Name Form TS l i APPLICANT/AGENUREPRESEN'TATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts ofinterest on the pgrt of town officers and em ovens The gumm of this form is to provide information which can alert the town orpq-%tble conflicts.of interest and allow it to take whatever action is neceMa to avoid same. YOURNAME: Bernhard, John, P. (Last name,first name,iriddle 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 X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other,name the activity.) Do you personally(or through your company,spouse,sibling,parent,or chili)have a relationship with any officer or employee of the Town of Southold? "ReladonsbV'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 X 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(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this f4zday of d&V-I- Signature I IT Print Name P ard Form TS 1 Board of Trustees Application ,AFFIDAVIT Jennifer Maye 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. s jSigature of Aroperty Owner Signature of Property Owner SWORN TO BEFORE ME THIS `� DAY OF -. C&I 20 ZZ CHRISTINA MACMULLEN _*; *: MY COMMISSION#GG 343892 9;. Qo EXPIRES:September 27,2023 Notary Pub is °Ff: Bonded Thru Notary Public Underwriters r�\ Board of Trustees Application AFFIDAVIT John P. Bernhard 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. 'Ahl j4&1 1@ature of Property Owner Signature of Property Owner ii SWORN TO BEFORE ME THIS DAY OF ,20� AA Not Nblic PU8�1G --3oard of Trustees Appli.cat. AUTHORIZATION (Where the applicant is not the owner) I/We, Jennifer Maye Type text here owners of the property identified as SCTM# 1000- 103.-10-1 in the town of Cutchogue New York,hereby authorizes James Maye 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. ��jr �erty er's Signature Property Owner's Signature SWORN TO BEFORE ME THIS Irl DAY OF4QQ-aCq-,,20 _ L---- otary.rublic YP�• cHRISTINAMACMULLEN < ... MY COMMISSION#GG 343892 :w�. •`off: EXPIRES:September 27,2023 •9ra0Pf;;°p` Bonded Thru Notary Public Underwriters i Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, John P. Bernhard owners of the property identified as SCTM# 1000- 103.-10-1 in the town of Cutchogue New York,hereby authorizes James Maye 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. rty Owneel Signature Property Owner's Signature SWORN TO BEFORE ME THIS �DAY OF ,20 pub PU6�� 0 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 oMPPWMA1 rWnot 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 sigificant beneficial and adverse effects upon the coastal area(which includes all of Southold Town) 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus,.each answer.must be explained in detail, listing both supporting and non- supporting--facts.. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall-not-be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website(southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 103 10 1 PROJECTNAME 2285.Little Neck Road, Cutchogue, NY 11935 The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital El 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: Trustee approval for as-built outdoor deck&shower Location of action: 2285 Little Neck Road, Cutchogue, NY 11935 Site acreage: 4.46 Present land use: Residential Present zoning classification: R-80 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: James Maye (b) Mailing address: 606 Riverside Road, North Palm Beach, FL 33408 (c) Telephone number: Area Code( ) 757-254-4372 (d) Application number,if any: Will the action be directly undertaken,require funding,or 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 will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. .DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure,makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes No XX Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ,0' Yes 0 No 0 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 [-1 Yes '❑ No 0 Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Nfinimize 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 ElNo rx] 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 0 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. F1, a o 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. 0 Yes .0 No FX� Not Applicable Attach additional sheets if necessary 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. ❑ Yes 0 No 0 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. 0 Yj:lNo 0 Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III.—Policies; Pages 47 through 56 for evaluation criteria. 1 Yes ❑ No n Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes 0 No Z Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages 62 through 65 for evaluation criteria. ❑Yes ❑ No 0 Not 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. :0.Yes ❑ No ❑X Not Applicable PREPARED BY James Maye , f TITLE Agent DATE_1 1� 2022