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TR-10115A
Town Hall Annex Glenn Goldsmith,President 54375 Route 25 A. Nicholas Krupski,Vice President , 'w P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly " Telephone(631) 765-1892 Elizabeth Peeples �" ' Fax(631) 765-6641 � it 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 ACTI'V'ITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction % constructed Whenjroect complete, call for compliance inspection; p P P P Glenn Goldsmith, President � r Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President �� P.O. Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10115A Date of Receipt of Application: April 4, 2022 Applicant: Maureen Danilczyk SCTM#: 1000-90-2-16 Project Location: 550 Cedar Point Drive East, Southold Date of Resolution/Issuance: April 13, 2022 Date of Expiration: April 13, 2024 Reviewed by: Elizabeth Peeples, Trustee Project Description: Proposed 217 sq. ft. (15.4'x14.1') enclosed sunroom; proposed 50 sq. ft. (10'x5') vestibule; and a proposed 111 sq. ft. (14'x8') wood deck; proposed drywell. 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 AMP Architecture LLC, received on April 4, 2022, and stamped approved on April 13, 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. -1�1 'IV 4 A A� Glenn Goldsmith, President Board of Trustees KE y U SED BOLDINS AD Z SED clj ACCESSORY SED 2ND STORY �y DA ONILCZ K SUNROOM d FE_>i T I.. LID FAOE <E*r : Lf)(z I FROM SHYERS TD NEAREST - PROJECT LOCATION&SCOPE PROPOSED INSULATED, NON—HEATED SUNROOM 4 VESTIBULE SITE PLAN&ZONING DATA ADDITION. LU LU PROPOSED FRONT PEr,< CID GENERAL NOTES ENERGYTABLE STRUCTURAL DESIGN CHARTS z>: FfPOJECT DATA� —— _- OLDOWN,ANCHOR BOLT, LL Lu STRAPPING,&NAILING DETAILS m r-=a u) —If FASTENING SCHEDULE M,in FRAMING GRAPHICS ....'l,'I'l",',",�,���,,,�,,,�� Al"--VTIL POLE k� TAX MAP 0 1000--10-2-16 BEAM CONNECTION PATTERNS ZONING D15TRIrT R-40 C FIREBLOCKING DETAILS LOT A-101.00 AEA 01 ArRFS PROPOSED PLANS 6WO-RRESIDENCE(EXISTING) Z-q5&2;0612011qlq X1 S-T.' APPROVED BY r�FO-PORCH S ROOF DECK Z-1125q;aq/15/1955 60FO-AUDITFON A ATTACHED Z-15366,01/15/1'12,q PROPOSED EXTERIOR ELEVATIONS BOARD OF _�RUSTnl E°W/ / �. EES CoFO DECK ADDITION Z-21009;09/11/1992 PROPOSED SECTION yr WI, 600 ADDITION/ALTERATION -31-5;01,25/2011, 0 p N TOWN OF SO1,1THOLD A-401.00 DETAIL SECTIONS FEMA FLOOD ZONE I DEC DISTRICT NON-JURISDICTION DATE OAR5F_ L F DESCRIPTION(FOOTPRINT) AREA 96 LOT OVERAGE TOTAL LOT AREA 51,532 0 5P .......... Y EL 119 AV EXISTING BUILDIN& 5F 63% EXISTIN6,SHED 1244 S.F 04% EXISTING OVTDOOR STONER 12,0 SP 02% _EXISTING ENCLOSED PORCH 5500 S.F, 15% O_Hlilfq-1-P'-fLIO Sr, 2�q PROPOSED ENCLOSED PORCH 261D 5" P, CRY PROPOSED COVERED VErK EIIS l',12' rR 0114�L��O PLATFORM 5a �<A TOTAL AREA Or ALL STRUCTURES SOqb 1 5 F, lq% S%ZY.A�rt L,07 COVEVA45C AI,L&ttV 23Z II 191 CHIMNEY EXIST .2 . . . POQCF' REQUIRED EX15T 1---.E- 1--FIIES APR 4 2022 Qo FRONT YARD 400' 1045, 1043 y A50V'DECK FRDJECT: SIDE YARD I50' 17.1 y WT 11 H SIDE YARDS 550, 650, 459' y WoDANILCZYK REAR YARD 500, 11&0 tl15 0' &Wof Twn SUNROOM go" 2------j 550 CEDAR POINT DR.E. 170A EL 10 SOUTHOLD,NY 11971 T -—-----------------—- LOCATION&SCOPE NG DATA PAGE: G 0Q: — LON ............................... ------------ MEAN HIS9H WATER VIII, I.THIS 15 AN ARCHITECTS SITE PLAN.is �CT TO VERIFICAMON SY A LICENSED SURVEYOR. THE INFORMATION Q REPRESEN=ON THIS SITE PLAN 15 TO THE ARCH11'E TS 5E6T OF�OHLEV5E Maa 2 SURVEY INFORMATION WAS OBTAINED MEAN I PIZ M A LA D011232AND (P_ 3RD L S P C2aRL TON AVE EAST ISLIP,NY 11130 E3 A 'T' SITE FLAN L I T T L E FD E r- 0 N I r- LOCATION MAP ............................................ SCALE:I.= SCALE:NTS Glenn Goith, President ®�®SV��p t®� Town-Hall Annex A Nicholas Kruk Vice-President a� 1J► 54375 Route 25 Eric Sepenoski ® -` P.O. Box 1179 Liz Gillooly o Southold, NY 11971 Elizabeth Peeples ��jp� ®@ Telephone (631) -1892 Fax (631) 765 6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Mar& 31 JZ12. Completed infield by: t✓, PeP,pi n AMP Architecture on behalf of MAUREEN DANILCZYK requests an Administrative Permit for a proposed 217 sq. ft. (15.4'x14.1') enclosed sunroom; proposed 50 sq. ft. (10'x5') vestibule; and a proposed 111 sq. ft. (14'x8') wood deck. Located: 550 Cedar Point Drive East, Southold. SCTM#: 1000-90-2-16 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 y 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: Si-rai A1 -��WWWA Ori J'm►al Stm-lurisd►chavi ivwludej dvuw6l W tn,lro dnicc;� lesu-inn'Mn In hea. I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: E. Peeples L. Gillooly G. Goldsmith N. Krupski E. Sepenoski Other SITE PLAN HATCH;KEY, B, U 1t ^ 563APROPOSED BUILDING ADDITIONI I2'8 CATCH BASIN_ ' N ]- PROPOSED ACCESSORY 5TRUGNR: W Imo;N PROPOSED 2ND STORY DAN' lLCZYK >: Q" W T RE NA (L Z ^ Z EL=4�' GRYWEII/DRAINAGE STRUCTUTE, I A MINIMUM 10'SEPARATION IS Y I I« LIW I RED BETW.'EEN MATER SERVILE � O LINFJ7.ATERALS/7+IAINS/SEPIIG/LEAGHI I{{ii--�� '9' Com/ {�-^ vp-�+ /� t}�-Y O.. � m /SEVER AND THE EO6E OF ALL ����1=� ��d®•: I1.,/ <ls 1 I00 n MSTORMWATER DRAINAGE LEALHIN6 } 'S GI 5 RWNRES LEADER Nor, -QQ ,QQ PROJECT LOCATION&SCOPE Z (+ CONNECT ALL LEADER$GOMIN6 >W3 PROM e�mERS To NEAREST - PROPOSED INSULATED, NON-HEATED SUNROOM VESTIBULE SITE PLAN&ZONING DATA F DRY ELL. ADDITION. a W - MODIFICATION OF 1 XISTIN6 FRONT DECK. 5D_I PROPOSED FOUNDATION PLAN >0t I' EXIR5T. I FROJECJ E AA7A: zZ>:Q I SHED I �j]�-2 PROPOSED FIRST FLOOR PLAN 9-I. I1 21.1' In M a-I 1 EL=q.p' rZ,In 1 pROJECT/ZO>INC-,NAT PROPOSED ELEVATIONS ',I--IL.POLE TAX MAP 3 1000-W-2-16 (l'1'P) ui I I ZONING DISTRICT R-40 G 1 I LOT AREA 0.7 ACRES (� W GoFO-RE510ENCE(EXISTING) Z-9562;06/20/1979 �' U / EXISTI I = J 1 I E%15T.Y DW/ CofO-PORCH 6 ROOF DECK Z-1729191 09/13/1988 (3 J GafO-ADDITION 6 ATTACHEDQ I I / 1 , GARAGE Z-)6366;09/13/1989 GaFO-DECK ADDITION Z-21009;0q/II/1992 / GoFO-ADDITION/ALTERATION Z-39478;01/25/2018 I 1 FEMA FLOOD ZONE X DEG DISTRICT NDN-JJRISDIGTION 3 1 1 I I I 01 ELc'12.1' I 1 I I /PROP.1 I I EXIST. 1 I I 421`0 r�. I LOT•r_dv OZ_ I ADDITION I I DESCRIPTION(FOOTPRINT) AREA COVERAGE 1 I�-28.2Y fI PRO TOTAL LOT AREA 31,333.0 S.F.1 � i �I , I UNHEATED WD.D[L q I VESTIBULE 17.7'•1 EXI5TIN6 EUILDING 1,9"11.'1 S.F. 6.3% OM EL=11.9' I II EXISTING SHED 124.4 S.F. 0.4% 1 I I I I EXI57ING OUTDOOR SHOWER 72.0 5.F. 0.2% 1 EXISTING ENCLOSED PORCH 550.0 S.F. 1.81% pN_wIRES�_-( EXIST. 1 T, 1 PROPOSED ENCLOSED PORCH 267.0 S.F. 0.9% EXIST.6'x12'WD. FRI DWEL INC I PROPOSED COVERED DECK III.O 5.F. 0.4% 5H0 ER I TOTAL AREA OF ALL STRUCTURES SOgb.l S.F. 9.9% PLATFORM 1 I EXIST. I ""MAXIMUM LOT COVERAGE ALLOWED-20% g 0 EXIST.STEPS. CHIMNEY EXIST . 1 1 I ENCL05ED u PORCH EL=11.B' REQf)f�2_�D SETB�GKS-MAlN @U1tD1KG' ` 1 I l I I REQUIRED EXIST PROPOSED COMPLIES EXIST.DECK I a0 ABOVE FROM YARD 40.0' 104.3' 104.3' Y SIDE YARD 15.0' 17.7' 17.7' Y I PROJECT: BOTH SIDE YARDS 55.0' 65.0' 45.9' Y- DANILCZYK REARYARD 50.0' 116.0' US.0' Y SUNROOM I 550 CEDAR POINT DR.E. STONE a LONG.RET.KILL T.O.W.EL.10.6' I SOUTHOLD,NY 11971 d tea` DRAWING TITLE: ,. PROJECT LOCATION&SCOPE. T.O-N.EL.7.91' Y . STONE I CONC.RET•WALL `�'� < ' SITE PLAN&ZONING DATA I B.O.W.EL.4.8' -----_ tF4 k � V SO'REPR SETBACK RET.WALL T.O.W.EL. B.O.W. I MAI 1 15 . 2022 i v"�R• j'Ir t j p 1 7 's tY MEAN HIGH WATER 51TE LAYOUT NOTES ' 926s015 I. THIS 15 AN ARCHITECTS SITE PLAN 115 �' '� C1 W I I; SURVEYOR. THE SUBJECT TO R1INFORMATION CATION BY A LICENSED 1 1i. SoutholdTown 8 I I p REPRESENTED ON THIS SITE PLAN IS TO THE {r - V ARCHITECTS BEST OF KNOWLED6E. "* - ti'.£' 1 .! Board of Trustees i.. ^y H 2.5URVEY INFORMATION WA5 OBTAINED 1 Z I MEAN HIGH WATER FROM A SURVEY DATED Oq/23/2013 V:'.; 7�°• '�{ % _ 9.21.1989 N ANO PREPARED BY 0` - 9 ' 16 CARLCTO�V P.C. 5 3RD L.S 9.852 -�� N15-4535-14L I T L E P E C O N I C 8 A Y EAST 15L1-NY Al-= ,4 1 SITE PLAN 631-SBI-1688 LOCATION MAP == • SCALE:I"=IS'-O" SCALE:NTS GENERAL SYMBOL KEY: �a v EXISTING TO REMAIN Imo`--`"=q NEW FOUNDATION WALL � u'ZmU W ma¢ag¢ NEW WDOD FRAME O z�+w o o za�"�axrn Iwo Fw,.i F LL O vxi�3a�F Za o,°ywQ a W a J Z Z Z S U N U 0 D N 4 w O O m'=N a aw ¢,,: � F"Oox a C z x Z ZIJZ- czZ =05� aZa W N N�zz U owog¢N� owaO�z .. QZlti Gca7a d N ¢-qC EXIST. FOUND, O 5'-O" 0 Z E S w w (NO WORK) 2 c N N?_ =N a o F—n-1SPAC �ATO — �—� tc � FOUNDATION. I a I iv I• 3 m CRAWL SPACE LU W/ GONG. SLAB Q � I ® i.. ' •s' O 1 — — — — — — — — — — — — — — — — cv InD E C E I VE n -rye" L/ U MAR 15 2022 U 0 O z Southold Town VOoz Board of Trustees Z = o ® a0 V) w � LL O O En ti+ PROP05ED FOUNDATION PLAN50ALE, 1/411 11-oll a. ��";�� < lad � !X. cv 40 0 N N OF N- C w W a o a O ENERAL S`rME30L KEY: M% LL a W < W p w �-����.�� O Z N m d EXI5TIN6 TO REMAIN N'cW FOUNDATION WALL maagQ NEW WOOD FRAME �wo�wti N�3a�r p Q p p W U a WW Q JQ Z Z z=U C N U o �w a W�❑�W O p m F N a awoaos z o'az>�o z =zNa'Z z z U p W pQ2fA w� z 7'i a Q Z W Z aU Q W �EXIST. /�� HOME o g�Wsww _ O W li<� NORK) -O a�Cow�w, yu xxrxy q w Z U r O U N s ® 10" PROP. I'-V2 E 15T. VE5TIBULE� / \ �y 3Qx6� i G�RAVEL SPAG HATG 7 ri 3-0Y2 �Y „ I PROP. VAULTED i 10'-2 GLO. TO �? FOLLOW ROOF w 7'6" CLO. HE I CHT _, `1\ r `RPOP05ED r l�il U u1 )/2" mv Lu O . — . — . — N I'-4' 5'-IjY2„ I EO. EQ Fp) -7�nn q) E � EIVE 7y2, MAR 1 5 U 02 � 2 w I UOO z >- 0: n. Southold Town o z J o Board of Trustees Z ? ¢ o 5UNROOM AND VE5TIBULE TO BE INSULATED 4 ® � w U NON-HEATED 0 0 U) to in v°lj. PROPOSED FIRST FLOOR PLAN 5GALE: 1/4.._ I.-O° `` Y� I` w o a K d U cLL ¢=3 � U ma�ag¢ Z.�w<m Q�=�OLL = O Z a O w w G awQ�zz z W m K y U O`L pWp F-Nd PROPOSED ROSE HEIGHT w G d p= ELEV.♦18B'V.f,F. z R=Z y �? z^�Qzaya Z Y S Z U O O Q 2 V N 11E] is m���z3a �a w2U=1-T ED oc=.>u�i 0000 noon � UTU - 0000nano 0000 nano 0000 0000 ELEV.= FRONT ELEVATION SCALE: 1/5" = I'-O" w' w rc a f PDECEIVE � nn MAR 1 5 ' El EJE 2022 w g -- - `� Southold Town V ® o z - - . Board of Trustees J m a Z Z m UJ � ao ir ® � 0 0 LOElcn 1 �✓ ` ew �a � 'sa to IL �c 1`�� r✓ f i'G i � d k.d R15HT ELEVATION - 1 cm SCALE: va, = 11-o.. off=" �� ` O o IF SITE PLAN HATCH KEY: Q V PROPOSED BUILDING ADDITION 0 F 01 m I i EL-2B CATCH BASIN PROPOSED ACCESSORY 2ND STORY STRUCTURE J 7 DANILCZYKSUNROOM a } II lof.45 S �" d' 2 I I N DRYWELL/DRAINACE STRVETVRE NATE, OJ } I A MIN'H ID'SEPARATION 15 J J « REEVIfZED BETHEEN WATER SERVICE O O LII�/LATERALS/MAINS/SEPTIC/LEACHING p-� {{{•••���// ppp���--���Y- p� '/ d' O O Lf) 111 m STORM ANDTHE INA OF-LFRO IE/ ,T Ex fOF--: FA(- E K E T r I STORMWATER DRAINAGE LEACHING I` J 4A le FA0E!a `bbb��� } *m STRUCTURES g } I 0-001.00 0 LEADER NOTE: PROJECT LOCATION&SCOPE CONNECT ALL LEADERS COMING SITE PLAN&ZONING DATA F FROM GJRERS TE NEAREsr - PROPOSED INSULATED, NON-HEATED SUNROOM 8 VESTIBULE 1 _ K I DRYWELL ADDITION. Q W IIPROPOSED FRONT DECK 0-002.00 GENERAL NOTES J 0D ENERGYTA QQ I / //�� STRUCTURAL LDESIGN CHARTS z}Qd II Qq EXIST. FRO JEl./T 1:: "STA: Q Z� HOLDOWN,ANCHOR BOLT, LL J N SHED I STRAPPING,&NAILING DETAILS In�.�-I 4 21.1' I EL=9.o' FASTENING SCHEDULE g O Pip�ECT r zows'�i�T 0-004:00 FRAMING GRAPHICS UTIL.POLE TAX MAP n 1000-10-2-fel BEAM CONNECTION PATTERNS w (TYP) I I ZONING DISTRICT R-40 G FIREBLOCKING DETAILS LOT AREA 0.1 ACRES PROPOSED PLANS V // A-101.00 w 1 E%1571 I GofO-RESIDENCE(EXISTING) Z-9562;06/20/1979 = J I I /EXISTY DW/ C-10-PORCH'S ROOF DECK Z-17289;09/13/1988 U J �� I I CDPO-ADDITION G ATTACHED Q GARAGE Z-18366;09/13/1989 -2O ,QQ PROPOSED EXTERIOR ELEVATIONS C fO-DECK ADDITION Z-21009;09/11/1992 PROPOSED SECTION C00-ADDITION/ALTERATION Z-39478;01/25/2018 FEMA FLOOD ZONE x A-401.00 DETAIL SECTIONS I 7 I DEG DISTRICT NON-JURISDICTION I I I I i t SII II I B I I I EL=12.1' I ' � I I 1 /PROP.1 ' I?'DW/ EXIST. LARGE. 62ND FL. i LOQ COVERAGE ..„. °`-•. -,: . 1 CA Z* ADDITION 1 %LOT OE I DESCRIPTION(FOOTPRINT) AREA COVERAGE 28.2'2 5. 14.1. vi PROP./'% I TOTAL LOT AREA 31,332.0 S.F. UNHEAPROP. TED r EXISTING BUILDING 1,911.7 S.F. 635s yFl I.� 10.2' //// F'�. %;•%%i I 11 EXISTING SHED 124.4 S.F. 0.4% 11 � 5D' 205 1 EL=II.9' Y I EXISTING OUTDOOR SHOWER 72.0 S.F. 0.2% _ EXI5TIN6 ENCLOSED PORCH 550.0 S.F. 1.8% EXIST. I� I PROPOSED ENCLOSED PORCH 261,0 S.F. 0.9% I EXIST,bkl2'WD. FRDWELLING I STORY I ' PROPOSED COVERED DECK 111.0 S.F. 0.4% PLATFORM SHO R I 1 TOTAL AREA OF ALL STRUCTURES 3096.1 S.F. 9.9% CHMNEY I I "MAXIMUM LOT COVERAGE ALLOWED-20% ' E%1ST.STEPSI I EXIST, 1 I ENCLOSED PORCH I � I REQUIRED•5E"f!�P.G�S-MAIN SUILPING R[ //� //�//� `1'3 EXIS.DECK I I REQUIRED EXIST. PROPOSED COMPLIES APR M 4 2OZZ o ABO E � I FRONT YARD 40.0' 104.3' 104.5' Y PROJECT: SIDE YARD 15.0' 17.7' I1.11 Y BOTH SIDE YARDS 35.0' 65.0' 45.9' Y SoutholdTown DANILCZYK REAR YARD SO.O' 118.0' 118.0' Y o Baa1d afTnlstees SU N ROOM 0 I v T;_-- L O1'1EL.10.81 550 CEDAR POINT DR.E. STONE 6 CONE.RET.WALL LIa' I SOUTHOLD,NY 11971 DDIDRAWING TITLE: PROJECT LOCATION&SCOPE :STONE6 GONG.RET.WALL ;� � SITE PLAN&ZONING DATA F* PAGE: , SE I 50'REAR SETBACK L.4.0' B.O.W. . I ' Y G-®®J�.OQ WOOD RET.WALL DA KA EL15' " _ MEAN HIGH WATER SITE LAYOUT NOTES1L 9.26.2013 I I.THIS IS AN ARCHITEET551TE PLAN 4 IS SUBJECT TO VERIFICATION BY A LICENSED 3 1 y�,� W I ; SURVEYOR. THE INFORMATION '�' ) T` p O REPRESENTED ON THIS SITE PLAN IS TO THE If O Ll ARCHITECTS BEST OF KNOWLEDGE, ".2.SURVEY INFORMATION WAS OBTAINED z I MEAN HIEN WATER FROM A SURVEY DATED 09/23/2013 921.1989 AND PREPARED BY: 9965' WILLIAM R.SIMMONS 3RD L.S.P.G. f tj•� -�� Nl5°43'33°W L I T T L E P E G O N I G BAY 128 GA LIP,NY AVE 3740- EAST y EAST ISLIP,NY 11130 3( 40 51 TE PLAN 1688 LOCATION MAP SCALE:I"=IS'-0" SCALE:NT5 b� eUA'- SURVEYED FOR: WILLIAM & MAUREEN DANILCZYK p LOCATED AT: BAYVIEW,T/O SOUTHOLD,SUFF.CO.NY. LOT: 106 (5) MAP OF: "CEDAR BEACH PARK" VI MAP# 90 D 6 S.C.T.M.#�10.00-90-2-16 ' S 2o2Z SCALE. 1 "=30' C�•®� \ 1��R 1 DRYWELL CALCS. 11.0 i �/� Southold Town CIV o0� \ Board of Trustees 1,091sf(.167)=183cf/42.24=4.3'ht.Req. /� Ss rq �`O\ Provide; (1)8'dia.x10'dp.Drywell=422 cf. o/ % 72.20„� M U 7p 4 NOTE: 0 74S 0 All proposed structures shown with ° dimensions and property line setbacks are as per owner and/or Architect / w N design. o ai o 8 X00*•. Co o a o f 10.2 m cl� N o � / w o / e/.9.6 21.1 proposed. I 2�OpOSF g,dia., 9rave7 CO l A no. f oor O DrYwe/110 ap o O u? I / l Story 4 r, toxt9. 4 b�teration Trail o, ta/ ratio bear, / (proposa m Q�e� covern9 to ai)aroom . aQ t) Z cone, - � 1 ' T 3 3 ,�weod deck y 2.Sht. Q a• CU v J � h .9 � a o,�,�,�•�5__ 205 O klljv S7 �STSORyO e1.11.9 Z 2 % FSM N S f fel.50k N ' & I o � O landing CO enclosed /' Z O Porch o 4 O v GAR. el'1 j•3 34.3 / o J TEST HOLE x 30 \'9/16/2013 de e1.11.8 G ck above / m 31 � 0 0/ TOPSOIL 0.5(0) f+ U C BROWN - Stone a cone wall 3 CLAYEY LOAM 1.O(OL) t.o.w.el.10.8 , Ston -0,W-61.8.8 / BROWN CLAY e a conc'ret•wa11 2.0(CL) ) t.o.w.el.7,8 I b•o.w•e1.4.8 GREY CLAY Q4U Wood ret. I 2.0(CL) ) wall p t°•w.el.4•o GREY N b'0 W-el.1 5 SANDY CLAY %(0 2.0,(CL) 4fE4NHIGHwATER9?62 p SAND& 013 d• 10%GRAVEL N N MEAco N Hicy WATER 9.21-89 � 2.5(SW) 75 43'33„ 10.0+ WATER ENCOUNTERED LI TTI p 99.85 1CO Vlc Rev.3-11-2016 IV l• qy FILE# 49232 0� N& 1ONSCO CP Ir- WILLIAM R.SIMMONS 3RD.L.S.P.C. f, Q 128 CARLETON AVE, EAST ISLIP,NY,11730 No. 9237 0 PH 631-581-1688 FX 631-581-1691 `rFO LAND Svc DATE:9/23/2013 SCALE:V=30' DRAWN BY:E.S. Glenn Goldsmith,President of soar Town Hall Annex . 54375 Route 25 A. Nicholas.Krupski,Vice President �� l0 -P.O.Box 1179 Eric Sepenoski l�L Southold, New York 11971 Liz Gillooly G Q Telephone(631) 765-1892 Elizabeth Peeples �Ol� �O Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD NON JURISDICTION rNSPEC:TIO'N- -DATE OF INSPECTION` MavGh 31,:2,022 INSPECTED BY: E,pee6 e,-3. Ch: 275 - COMMENTS: As.::fleir Soo. 6.ld. To WA, CoA.e. 0.,to' 2'15-.5.$.(2-) writ ..reauive ah :�4dtmiviiS �iVe . cylMi�'. RCHITECTURE Operating Business Address:1075 Franklinville Road,Laurel,N.Y.11948 Business Phone:(516)214-0160 LLC Date: March 10, 2022 Southold Town Trustees P.O. Box 1179 Southold, N.Y. 11971 RE: Non-Jurisdiction Application for: Maureen Danilczyk 550 Cedar Point Dr E. Southold NY 11971 SCTM: 1000-90-2-16 Dear Trustees, We are applying on behalf of the owners and property listed above for a letter of Non-Jurisdiction for proposed work within the existing single family residence. The proposed work which we will be applying to get a building permit from Southold Town involves the following: - Proposed sunroom, 550 sf(14.2'x 15.3') - Proposed covered deck, 110 sf(7.10'x 14) - Proposed 2' drywell I have included a Site Plan of the proposed work for you reference. Thank You, Jess Magee AMP Architecture,PLLC Administrative Assistant E:jmagee@amparchitect.com O: 516-214-0160 www.amparchitect.com p E EIVE -Jul MAR 15 2 i 1 SOUDWIRTowo Board ofTn-m— i Board of Trustees i. _,,'licaton AFFIDAVIT MAUREEN DANILCZYK BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORD WILL BE'DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE- TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION,. INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner .of Property O ignaturewner r SWORN TO BEFORE ME THIS. DAY OF f/° 0 a -all Notary Public TONI ANN MATTEL Notary Public;State of New York No.a1MA61'60870I Qualified in Suffolk County Commission Expires:02/12/20 V Board of Trustees _ lication AUTHORIZATION (Where the applicant is not the owner) I/We, MAUREEN DANILCZYK owners of the property identified as SCTM# 1000- 90-2-16 in the town of SOUTHOLD New York,hereby authorizes AMP ARCHITECTURE to act as my agent and handle all necessary work involved with the application process for permits)from the Southold Town Board of Trustees for this property. Property Owner's Signature Pro erty Owner's Signature SWORN TO BEFORE ME THIS_ DAY OF 20 2 j7V4 Notary Public TORI ANN MATTEL Notary Public;State of New YO* No.Oi MA6160870' Qualified in Suffolk f county 12120�t s� . Cmmission Exp' APPLICANT/AGFNT/RE-PRESENTATIVE TRANSACTIONAL DISCLOSURE FORM -Tlic Town of Soutliold'S Code of Ftliics_piohibiis conflicts of interest oit-lite n•trt of town officers and_emnloyecs 1 lie rittmodc`of this form is to�rimMe information which.can alert the town ofpossiblc conflicts-of lntcnezand allow itlo take wltatevcr action is neccssay.to avoid same. YOUR NAME: DANILCZYK,MAUREEN (Last name,Rist name,ipiddle initial,unless you are applying iii 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 Twee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Db you personally(or tfirouih your company,spouse,sibling parent;or child)have'a tolalionslup with any.oflicer or employee of the Town of,Sotitliold? "Relationship"includes,by blood,ularriagc;ocbustttess interest "Business it►tc.r 'st"'means:a'.bustucss; tnclutling'a tsnctncrsttip,in.which'ttie[own officer or c:niployee has even:a partial arviers[lip of(or employment by):a corporation in which ft-town officer or employee owns tnore1han 5%Of-the sh lms... YES NO If.you answered"YES",complete the balance of this form and date and sign where indicated. Name of perspn•employed by the Town of Southold Title or position of that person Describe the relationship lictwe en yourself(the tipplicant ftg nUrepresentative)and the town officer or employee.Either check .the appropriate line A)through D)and/or describe in the space-prodided. The town officer or employee or his or her spouse,sibling,parent,or child is(check alf that apply): A)file owner'6f greater than 5%of the shares of.ihe corporate stock of the applicant (when the applicanhis a corporatibn); B)the legal or•bencficial owner of any interest in a non-corporate entity(when the. applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of 200' Signature Print Name i A-W i z� Form TS 1 APPLICANTJAGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE,FORM Tiie Town of Soudiold's Code of Ethics grohibits-conllicls'of intereston the'part of town ofrcers and empiovees:'Ile.purpose'of" this form is:fo provide information which can alert the town ofpossiblc conflicts of inten:st and tillpw ii lo_false whatever action'is necessary fo a6id same YOUR NAME: Portillo,Anthony_ (Last name,first name,ipiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate-the other person's or company's name.) _ NAME OF APPLICATION: (Check all that apply.) _ Tax grievance _ Building _ Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do-you personally(dr-through yout.company,spouse,sibling,.parent,orchilil)haven relationsh p.with any officer orenipioyee of the Town of Southold? "Rclntionship"incfudes:by b'loo'd,,t-gar•iage;,or business interest"Businvss-iiiiert st'1 mCdits a busings4, including a.partnership,in which the town officer or employee has evcn_n pair al o►vncr hip of(or employmadt byj'a cgrporation in which the town officer or employe%owns mocetlian 5%of the shares. YES NO X if you answered"YES",complete the balance of this form and bate and sign where indicated. Name of person-employed by the Town of Southold Title or position of that person Describe the relationship between yourself(fl a applicantlageWrepresentative)and the town officer or employee.Either check the appropriate line A)through,D)acid/ordescrlbe in-the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)atiii owner.bfgrcater than.S%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 14 o arch 20(Z2 Signature. Print Name nffo-nyVo-rTflFo . Form TS 1 i y k.: _ N 0; rn Jig - *L - -- -- Onwp- 7jw . » :E,: " L Im bn i � F 1 1 Danilzcyk Residence CC IN Applicant:AMP Architecture All Photos Taken: November 21,2021 R¢rIom I-- ,2o,.txOr e os nar axtax os.xi oo" oxa<ac ono.i< n.t ,oaaLOE ttOVIMpLD w �'- tsNq re CEDAR ' pR - r'OINT I Z w U.KESaIE a •� ' a-7 r w COD a.t e m w 6.f y SCAR r O P Ni u rOwN or sourNan L i.. ) }.M(<) to ,. NEST ° N oLA mf KE S i 1. h CE �• / sourrtoLD mj :__-- W LarrE I/ . /..\w \ 'y/ ill , ?�m • - --' to • xt 1?I4c) NOG HECK MY 3 cum, COUNTY OF SUFFOLK © K SOLIMOLD SECTION NO V+9N.aw...NYi1-.1 Agency v 090 w--Z Np _ P .aicr xo 1000 PROPERTVMM OFFICE LOCATION: � � � MAILING ADDRESS: x Town Hall Anne " P.O.Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold,NY 11971 Telephone: 631 765-1938 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: April 7, 2022 Re: LWRP Coastal Consistency Review for MAUREEN DANILCZYK SCTM# 1000-90-2-16 AMP Architecture on behalf of MAUREEN DANILCZYK requests an Administrative Permit for a proposed 217 sq. ft. (15.4'x14.1') enclosed sunroom; proposed 50 sq. ft. (10'x5') vestibule; and a proposed 111 sq. ft. (14'x8') wood deck. Located: 550 Cedar Point Drive East, Southold. SCTM#: 1000-90-2-16 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 Policy Standards and therefore is CONSISTENT with the LWRP. 1. It is recommended that a vegetated, non-turf buffer between the retaining walls is established and noted in any approval. 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 Michael J.Domino President' so�r�~ �`�`Z Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 Glenn Goldsmith P.O.Box 1179� Southold,New York 11971 A.Nicholas Krupski �4 Telephone(631) 765-1892 Greg Williams ��:�®U '°� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application , E 0 E I V is e __ 4. c Wetland Permit Application �4 Administrative Permit Amendment/Transfer/Extensio A P R - 4 2022 Application: ZZ 4Received Received Fee: $. 100, O Completed Application: Southold Town Incomplete: Board ofThmWes SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: oordination:(date sent): LWRP Consistency Assessment Form Sent: _CAC Referral Sent: Date of Inspection: Receipt of CAC Report: —Technical Review: Public Hearing Held: •l3.22 Resolution: Owner(s)Legal Name of Property (as shown on Deed): Maureen Danilczyk Mailing Address: 550 Cedar Point Dr East Southold Phone Number: 631-682-8414 Suffolk County Tax Map Number: 1000 - Property 000 -Property Location: 550 Cedar Point Dr East Southold (If necessary,provide LILCO Pole#, distance to cross streets,and location) AGENT(If applicable): AMP Architcture Mailing Address: 1075 Franklinvill Rd Laurel NY Phone Number: 516-214-0160 Board of Trustees Application GENERAL DATA Land Area(in square feet):: 30,492 SF Area Zoning: R-40 C Previous use of property: Single Family Residence Intended use of property: _ Single Family Residence 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? x Yes No Prior permits/approvals for site improvements: Agency Date Building- Residence 6/20/1979 Building-porch and roof deck 9/13/1988 Building- addition&attached garage 9/13/1989 Building- deck addition 9/11/1992 Building-Addition/ teration 1/25/2018 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? x No Yes If yes,provide explanation: Project Description(use attachments if necessary): Proposed enclosed sunroom -217 sf(15.4'x 14.1') Proposed vestibule-50 sf(10 'x 5') Proposed wood deck- 111 sf(14'x 8') Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: proposed vestibule and sun room and wood deck. Area of wetlands on lot: - 0 square feet Percent coverage of lot: 9'9 % Closest distance between nearest existing structure and upland edge of wetlands: 100.4 feet Closest distance between nearest proposed structure and upland edge of wetlands: 141.8 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?. - cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: 4.2% 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): The proposed work will not have any affect on the wetlands.All work will take place landward of mean high water line. 61 Z20 Appendix B Short Environmental Assessment Form Instrattions P6r Coiripletin�►' Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 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: Danilczyk Sunroom Project Location(describe,and attach a location map): 550 Cedar Point Dr East Southold Brief Description of Proposed Action: -Proposed enclosed sunroom- 217 sf(15.4'x 14.1') -Proposed vestibule-50 sf(10 'x 5') -Proposed wood deck- 111 sf(14'x 8') Name of Applicant or Sponsor: Telephone: 516-214-0160 AMP Architecture E-Mail: jmagee@amparchitect.com Address: 1075 Franklinville Rd City/PO: NY State: Zip Code: Laurel 11948 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 X❑ ❑ 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: Southold Building Department ❑ 'EJ 3.a.Total acreage of the site of the proposed action? 7 acres b.Total acreage to be physically disturbed? .006 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? .7-- acres 4. Check all land uses that occur on,adjoining and near the proposed action. p Urban []Rural(non-agriculture) ❑Industrial ❑Commercial ®Residential(suburban) ❑Forest ❑Agriculture El Aquatic ❑Other(specify): ❑Parkland Pagel of 4 5. is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ a ❑ 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? FI El 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 a ❑ b.Are public transportation service(s)available at or near the site of the proposed action? a ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? X❑ El 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? b.Is the proposed action located in an archeological sensitive area? a ❑ ❑ ❑ 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 El Forest ❑Agricultural/grasslands ❑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? � ❑ 1.6.Is the project site located in the 100 year flood plain? NO YES X 17.Will the proposed action create stone 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,briefly describe: ONO OYES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of !VO . YES water or other liquids(e.g..retention pond,waste lagoon,darn)? If Yes;explain purpose and size: 1.9.Has the site of the proposed action or an adjoining property been the Iocation of an active or closed NO YES solid waste management facility? If Yes,describe: �1 ❑ 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:_ ❑X 1 I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE I Applicant/sponsornam . �`� Date: 4/1/22 Signature:. Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the;following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning EL 2. regulations? 2. W ill the proposed action result in a change in the use or intensity of use of land? ❑ El- 3. 3. Will the proposed action impair the character or quality of the existing community? ❑ ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ ❑ 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 proposedaction impact existing: ❑ ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? ❑ El 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 ❑, a problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3_ Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. 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. FJI Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PR�fVl Page 4 of 4 Board of Trustees Application -AFFIDAVIT MAUREEN DANILCZYK BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SH IS THE APPLICANT FOR:THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/ITER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN TIME MANNER SET FORTH IN THIS APPLICATION _. AND AS.-MA I EE AFROVEF D,BY-THE S0UT'"H0L D T'0 130ARD,OIC°Tfl3USTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLgD 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 AIPPLICATION,I HEREBY AUTHORIZE THE TRUSTEES9 THEIR AGENT(S)OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISlES 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 DAG THE TERM OF THE PER I T. Signature of Property OwnerignaturCC)f Property Ownerr WQRN TO BEFORE ME THIS p� DAY OF Y'+`- p C� ti.. w Notary Public T0y1'ANN MATTEL Notary public;State of.New York No 01MA6160870, Qualified inZuffolk County � C0mmissiorr Expires;02M2/20'0`.3 Boar, of Taus tees Application AUTHORIZATION (There the applicant is not the owner) IIWe, NlAUREEN DANILCZYK - , .owners of the property identified as SCTM# 1000- . 90-2-16 in the town of TmSOUTHOLI7 URE New York,hereby authorizes AMP ARCHITECT __ 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 Pro erty Owner's Signature WORN TO BEFORE ME THIS-. � DAY OF y� IC � 20 Notary Public TONT ANN MATTEL Na4ary Public Stale of New YC* No.a7MA6I6007A Qealified;ir�.S�ffoIkCoo . gmtsnlssiort Expires:02H2t20 ; . APPLICANTIA.GENTIREPRESENTATIV E TRANSACTIONAL DISCLOSE FORM Tl�e-Town of Southold's Code.of.Ethics.prohibits conflicts of int0eston-the nartaftown officers and e111ployeas The of tfEis>fe►rm is;to.ptovidc fnforma ion-which tan conflicts of hiterp4tand allow-it to ts}'e wba(ef vcr action`,5 awwrary to`avoid saltie. YOUR NAME: DANILCZYK,AUUPI. (Last name,fist name xniddle Initial,Gutless you are applyinghi,the name of someone�elsc or other dutity,such as a company-If so,indicate the.other person's or company's name.) .NAME OF APPLICATION;-(Check:allthat,apply.) Tax grievance Building R Variance Trustee — Change of Zone Coastal Erosion Approvalof plat Mooring Exemption from plat.or official map Planning Other — (If"Other',name the activity.) Do you pe[sonalty.(or through yotu company,spouse s[l(ing,pato or ci itd)16avc`'n rc:.Iggonsh[p wiili any:afficer or employee of tha Town of SotF ljbld? "Relationship"mcieides by bEogd ttlarrisegc,or.GiistnesS;intcrest�`J3t�s6ness iritemsF`'incar[sa'I�ustt ess, inelicei6ng a pzutttersh,p to vrhteli ilte toy tit ofticcr or employee itas cvc n:a_pallial owncrsh6p Qf(or ernptoymonl by)a cUrpatatgn in wficlthe:toiuir oticer o"r etriployee;ovrrts inAte than 5°10 oI the shares. I YES N0 . . If you answered"YES",complete the balance of this form and slate and sign where indicated. A - Name of.person-employed by the Town of Southold Title or position of that person IDcscribe the relationship k etween youiself(the iippl6ca6t/6genfi(Kepresentative)and the town officer or employee.Either check ilio nrimpriat .line A)throuilD)ancUoi'descrize�rti tlip.spacc provided. The town officer or employee or his or her spouse,sibling,parent;or child-is.(check all that apply): Y A),- owner of greater tttan 9 of the shares of the corporate stock of the applicant (L!Tien the ppR�art is Gcsr ii*atzen);M- = l3)the legal or benefic[af_owner of any'interest in a non-corporateentity(when tile`" Y - applicant is not a corpoeatlon); C)an officer,director,partnee,or employee of the applicant;or ` D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this �-"day ofve_ 20 - Print 1Vame Form TS 7 APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's;Coile of Ethics prohibits conflicts of interest•on the part.of town officersandgnployees 'Me puw§e of this form is to arovide-inforination which can alert the town-of possible conflicts of interest"rind allow it to take tyhltever action is, necessary to avoid some. YOUR NAME: Portillo,Anthony (Last name,first name,-griddle 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 yourcompany,spouse,sibling,paren4 or'child)have a relationship with any officer or-en. r ei.lp-16 dee of the Town o€Southold? "Relationship"includes:by blood,iparriage,or business interest "Business interest",ineans-a business; including a partnership, in which the town,afficer.or employee has even a partial,ownership of(or e1hploytnent by);a corporation in which the town officer or employee ownsJnare 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 le 11,or benef icial oivger of any interest in anon-corporate entity,(whe i the applicant is nota corporation), C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 1 1, April 200 22 Signature Print Name - AnUQnyPortfl10 Form TS 1 1 Town of Southold LVW.--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 j)ronosed-action_will,..:be.-evaluate ' as jo ' ts!.significant beneficial and adverse effects upon the coastal area(which includes all of Southold Towni. 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 listin >-both.supportingand.non- G _supporting acts: If an action cannot be certified asconsistent 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# PROJECT NAME Danilczyk Sunroom The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g.capital ❑;' construction,planning activity,agency regulation,land transaction) _❑. (b) Financial assistance(e.g.,grant,loan,subsidy) (c) Permit,approval, license,certification: x ❑Y Nature and extent of action: Proposed sunroom (15.4'x 14.1') Proposed vestibule 50 sf(10'x 5') Proposed deck-112 sf(14'x 8') Location of action: 550 Cedar Point Dr East,Southold NY Site acreage: -- - . . ..7 acres_ Present land use: - - Single Family Residence ` Present zoning classification: .. R-40 C 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: AMP Architecture , (b) Mailing address: 1075 Franklinville Rd Laurel NY t (c) Telephone number: Area Code( .) 516-214-0160 x (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. 0 Yes ,F No 0 Not.Applicable The proposed work will preserye open space, as it is only adding 378 sf to the lot. _ 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 J Not Applicable P ' There is no historical or archaeological resources on the property. 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 The proposed sun room and deck are one story and furthest from the wetalnds.Therefore they will not affect the scenic resources. 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 ® Yes ❑ No ❑ Not Applicable The proposed construction will be controlled through out the project. All work will take place landward of mean high water line. 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 Proposed work will not affect the water quality. 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. n ❑ ❑ Yes No Not Applicable The proposed work wil take place before the wetlands and construction equipment will be as far from the wetlands as possible. Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ No RX 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 ❑ No ❑X 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. ❑ YeO No 0 Not Applicable There is no public access on this property. Attach additional sheets if necessary ` / r 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. 0 Yes F] No 0 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. 11 Yes :E No ® Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. Yes .l No® 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. ❑ Yes [] No 0 Not Applicable PREPARED BY AMP Architecture TITLE Applicant DATE 4/1/22