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TR-10133A
Glenn Goldsmith,President ®��®F sU� Town Hall Annex A. Nicholas Krupski,Vice President ® 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly G ® � Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 ®l�eoua� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1986C Date: December 7, 2022 THIS CERTIFIES that the repairs to existing 16'x22' deck with new stainless steel cable horizontal railing system, and stairs approximately 42"wide; At 855 Soundview Road, Orient Suffolk County Tax Map#1000-15-3-11.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated April 5, 2022 pursuant to which Trustees Administrative Permit# 10133A Dated May 18, 2022,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 repairs to existing 16'x22' deck with new stainless steel cable horizontal railing system, and stairs approximately 42"wide. The certificate is issued to Claire&David Air owner of the aforesaid property. Authorized Signature Glenn Goldsmith, President ®�®F S®�, Town Hall Annex A.Nicholas Krupski,Vice President e` ® 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly G @ Telephone(631) 765-1892 Elizabeth Peeples �® �® Fax(631) 765-6641 C4Um� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Dti`G.2o2z INSPECTED BY: �ir►� .� �� Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale line/silt boom/silt curtain 1St day of construction % constructed Project complete, compliance inspection COMMENTS: �,a•` �'s�t�w(.�•�G �-y /�.fC/Zr�i►�-u- G�� J��'tir»� !J!G �a.v�a�,'•,c• j 9 (�• CERTIFICATE OF COMPLIANCE: ClG �f!'Gcc. Glenn Goldsmith, President ®� ®��'� Town Hall Annex A. Nicholas Krupski,Vice President A®� : , , ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski 3 Southold, New York 11971 Liz Gillooly -k, Telephone (631) 765-1892 Elizabeth Peeples �® 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, hay bale line/silt boom/silt curtain 1 st day of construction % constructed When project complete, call for compliance inspection; - I Glenn Goldsmith,President ®V so�/�� Town Hall Annex A. Nicholas Krupski,Vice President ,�®�. ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski £ Southold, New York 11971 Liz Gillooly � Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 C®UNTi,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10133A Date of Receipt of Application: April 5, 2022 Applicant: Claire & David Air SCTM#: 1000-15-3-11.1 Project Location: 855 Soundview Road, Orient Date of Resolution/Issuance: May 18, 2022 Date of Expiration: May 18, 2024 Reviewed by: Eric Sepenoski, Trustee Project Description: Repairs to existing 16'x22' deck with new stainless steel cable horizontal railing system, and stairs approximately 42" wide. 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 Robert I. Brown, Architect, P.C., received on April 5, 2022, and stamped approved on May 18, 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. Glenn Goldsmith, President Board of Trustees �_. r ;'F14t L ? a. mG r' H t OXY' "4" .:' NJ q i Eta a r i .... .a.. ,..,.:.:1s,M cn nw.a.�w-�.....,,:,�. �'`` - 4 � ,+ti.�` s €� xr �.�Y}.d ti' Vii, C '°'� °. �, c J ��1.'�'t3`•'3 3 qC,,,�"�;�,� 1 _ 1 , ' d , RE51DENTIAL GENERAL NOTES ? - - M*SC.GENERAL NOTES CLIMATIC AND GEOGRAPHIC CRTTERIA R®��,PI{p_gg (/yam bs ' .. SrRaeer,s COxSmuCnou er R[xOVAnpx3rowPmiWG rvti<N;•M"L+R[dDExR. GROVxo SxGw iMD 20 rsr - R[R rR:.R3p:2,e 4•x5 K`ifs Y t V ' r-usslnm AS Ra- L2c wvn ?[R nG.R3c1z aru.~:l '� 999 GGG9 II HH 66`a,r9 YYY 2.M[nEIGniG Tn[er.9nx0 BVILDxG aS DCnxeaB+inE Rt_rC2xG4^..U.!::m;rOrF Siare l3 �� _ -R✓i5 • Zy`.�'i � " [nrl OP COxsiRLcfIW Xi M4 vIB} NtM RD[�(.N rz}.tPa`�r '��? M4rA%[x:,p 2'.l 1 - - tWD2Dx[ (PtRre ® � E I VIE wpwSnN}�[D�D° no�Dti, e.x.SwD [�xG dpre ;�[� �[R �D ,3 .x: '60ARD OF i RUSTEE �9 ®® ®® ��sScx Low ea¢urwx Au eAsee w: DESIGN LOAD CALCULATIONS(UNIFORMLIVELOADS) - - AD- RsreRTABLe Rao�.�.RfslDexBN COplb xrex'rO;V-sine. "IRI^ ���}�// (/�� /\/q�� p�9yJy OM CAtCvt0.Tlp AS PCRR30i,3 A5 r[RR°+5. - R wdeenW 9J5 IrCR rML[3n:.s-._v-.. II® Y Y ® !/ �����+'�•o ow LOM.+srS,GROuxDSxOty Low LAsrERrlG.ruGIZIB:R,^xr5. 5roR 20 Ls1 •rerpq rAe 3p�+aOw•I NEW WINDOW REFRAME AND NEW WINDOW REFRAME AND . ..aMle DedGu ewi .POR IZD MM3seearo Gus?. .. m�r T1*ep _ PATCH A5 NECESSARY.INCWDING 'PATCH AS NECESSARY,INCLUDING _.- SroRAGe 5TNR5 +o rr r R TLSLe 3OI sC�,nse EXTERIOR BRICK VENEER. _ EXTERIOR BRICK VENEER. _ wT - ' ANDERSON 4005ERJE5 ANDERSON 4005ERrES e _ L$ H " x9 �o A'Lvox sr tp D 6 OVER I 6 OVER 1 IPS /y APR kl 6 AZ zo LB. s uscD WOH 3046(EGRESS) WDH 3046(EGRESS) DATE �J if Zoz�I Tneueenlren AssuNes xo Revoxsldum roRira wsiwJcnw oras.Memaos. - - "-.- J,U�tl L� r V. $pUlftOld TOWii RrROCCWR[S.OR eOR SaCrr PREWxOxS A•e rROGRw"9W i A¢RANrIC9 NOR/wTM[RCartldulY Dr P,NN[e6 rCP.wSPt°r¢IbC DP4F3PP a4CINftaD ix Mt US[CP M[5[YW5. - - COxiRIGroRTDYtNDwLD,N[xS�B[rp�SrARnxG�51��W>,r.pDxDrSeALt S ENT NOTES Board afTnutees 5.rOu.Ow DNBFi1IXe Dar. _ Gyp.BD.TAPED.SPACKLED AND PAINTED. CAHLRgCTORb)SnAU WRx15n ArD,xsTaa NL NAieWA N¢:e0..Pn¢xis,ON+.LYSRD.ce - ung VnxG59uBRCT To ouatalGnoxs.uwnnaxs.ceexAs ( NG . xay ruRxlsn ut LamR.swrcuxxe.aro rtosaecessatr ro - �LAT)OVER6 MIL POLY SHEETING APPLIED TO CONCRfjR AND EXISTING EXISTING LINPt[T[,nlxD�. �,xSTwLeD.xSrRIReD"I�x.,weE«n„IR»,r,<Tu�R[DDR[x�Irs ` ,- w° BEDROOM '6EDROOM iRw RSxNI OBTNx uL PLOV:4[D IvSrCenDS.;wRWAiS arp eehivxpRp - DEMOLITION COxiRAOTOR Snail DCNOUsn wat9 N+D rL000.1ND0ARG Ou DRAwrXs wpw u[ClY+wr. PROVIDE IN ALL14M30GB CROWN (2)NEW 2068 DOO 5400 OMS ANDHEXISTING IZ".,CoxiRACTo4 SnNUDo xL rwrenlue ReOLRReD D,¢ro P2N0✓NYemnxG wOu awce 'MOLDING IN ALL BEDROOMS AND TO MATCH EXISTING BEDROOMS AND MALL TO NEW 6OVER ISOL DOUBLE HUNG rewmRX. BATHROOMS.SMOOTH,PRIME RIOR DOOR PE''a"I - WINDOW IN IXLSTING FRAME Aiu+wvD Neer oven io emnxc waw.As Dosnr a9 rosdde umess AND PAINT. _ rORX soul N NEW 6 OVER 15DL DOUBLE HUNG CV.T OPENING It E%15MNG ' r"nxG smu�cn£ oxrzWORsTO Remau sow Pe rRar[crEpwxecerrarwwxG WINDOW IN EXISTING FRAME I - CUT NG '"0R,1' ore W51I 52WC s TOReMvxwpsnwxpnrrwunun[sa�D I I eS wDM At GeuexrsrORnootuP.ReNtivai,ceUvrWGorednrN[xr I I REFRAME AND PATCH PS s. c 1100 LFR ttL[rnox[9ERVIC - e9 xeeessARr. NECCESSARY NQW POL_DIHG 1 _ GENERAL CONSTRLCTION - - 'STAIR ( - PRov1 xuleGal9.TwunroRrAnox.eaRrNear ArD svonces wtfl ri0 T ATTIC I REPLACE E%ISTING R[TC Flr.v.DOD AND Pu5110 WORK R[DnR[D Br n:[DUwxG5A55R[IrapnlRew.OR 2 154 . n`E°wSgxPgr,NrueDAs xeeBsvxerrorDnwCTe inewaRA --J VANITOAY NEW TILE z.aTu.A5.90PNis wDezrzwOR rRIMSnw NarC CaSiwG. IAVATUI{t' FLOOR Ix RrWN s�Na MATpf[mnxG. DIEy✓; NEN VANftt .a,rRAN rw.wxe LUNxR snNa x GRane sTAxveD rougas r:R-uer✓•siRuruwa Grope xp.z n[ O WALL MOViIIED AND R O TOILL'f LAVATORY °R Mnl.R .1-D WNB[RSn MA51"DCARD 01 6-AND Srtw e<wsiNL(p.Gli OgmZ '-B I(' 10' wD wx LLeoE,u°xsohpavice mrn NwurAauRERS R[aLoherneurs Aro sPeoP,Gn-re: (2)NEW WINDOWS:REFRAME AND U I PROVIDE (27�QURORA CUSTOM A5512 50L FIBERGLASS , TO PATCH AS NECESSARY,INCW DING ry N N ''�MEAD TAU4ET NEW SLOPED (,IA55 PANEL EXTERIOR DOOR 36'rB0'BYJELDWEN. NEW CLOPAY OVERHEAD GARAGE DOORS.COACHMAN ewe,�woN ,eCSNRo-_; [[ ��:Mlx-nom EXISTING F at neve -P Ax0 oven snail B[9ureoRRow.m[vreLe lvwenis.9.O AxD O+Fx EXTERIOR BRICK VENEER. (RELO,^,grep) PAN PROVIDE NEWAWMINUM SCREEN DOORS.IN SERIES I DE5IGN 12 WITH INSULATED GLA55 UPPER w wenrs.rat neweRs snAaLBtANlx.p2)2•tl-ce As snoxxox ceavnxe. ANDERSON 400 SERIES ` jf G�FE MEAD ISTNG OPENINGS PANELS.'STEEL INSULATED DOORS TO FD EXLSTNG "r.�gouo dnctmG snN[B[rvnvoeD roR UL DOIsn am rLooRewaA5 re4x.r,s.cope 6OVER1 BEDROOM Su (RELOCATED) OPENINGS. MIx..PROv,D[T5PAe[rORaRCLRevUnDx W ROP. O ErV TU OP�OWR °R i� REMOVE P owce DDLmte rRNnING aROuxD ut ortxxcsweraRs.ervAs xorzpux oRAvnxw WDM 3046(EGRESS) ORAwwG :npe MMe ur IRANnxG uxp[R ue rows rARata n°b-Rw xDrzp°+ EPWCE ErtSTI SHOWER IXI571rIG .Nt FW woo-COxx[CTOuS.-B[r/SRx w;n RARO---MCTN � '^FO .. 51MPSOx•ORAFPROv[D[WN. . - �ucrsenepuLe51-W X5 1.15.W101xG cope AS AMW+%Atw cesium REPLACE IXISTING GARAGE REPLACE IXISTING GARAGE NCne o NG w:[wuitAi du wD cure.Au eXRRiceuats sow BeeNVA%zm. DOORS IN IXISTING DOORS IN EXISTING DECtN.CER i l,2015 _ NEW STAIR 111 OPENINGS.PROVIDE NEW OPENINGS.PROVIDE NEW xG TD Lx xNte-v vuL9®.rD.e.eXrePice ecrr3 Aro a xaLs®Iz• D, rvreRM_Aie"sGee aTraenepxxuxG xneDR4. EXISTING OPEIIII�G ) MOTORIZED(REMOTE MOTORIZED(REMOTE xreROR 0.xD[NTlWOR t:Nlsn[SrOO[SeIKi[p Br Oman WITH PINE R)5ER5 e.M uLL Rpor RArteR9 snort Be AnA<neD*°Toerurz Aw Bnt wmGavAwupevRGw+e 40NEWANDERSON CONTROLLED D)DOOR CONTROLLED)DOOR es Br elNrSorr oR amhOv[n eouN.rohnMeehnlC^-Lx_pMus.PRwIDe AND OAK 7RPAC, 4D H 210ES OPENERS. OPENERS. RCp,1`r°,w"I[CLIP AT ALL PewmeieR}OsSroeIRGeReoxxeenwa. ,EXISTING CEI LING TO MATCH UVII�3 Tit _ _ WDH 210210 THESE PLANS APE hF!.:OF.U1:•_!IT OF Stas:CE 12)13/4'x11-I/4' TO REMAIN ROOM s NLuew wxpOws rO e[TneRMN lxSuu eD Lowecu`Xi.-GM.-- If IHC M1 leu :.L P. NEW 6 OVER 150L DOUBLE HUNG MICROIlAM LVL ___. - P A - AND G I.OM PATn9 ARC N0G PBV SCcnp+DN S - .--. --.- -.-- -�-- -_ >eouuee:,oxs SnatL ee W tT u wCORD Ce wlm AxS)u.x PAwOu Ees Flee xvuxc WINDOW IN EXISTING FRAME N CATH2ORAL _ ) _ - - _ ' DOW IN IX15MN A4 -r P _ _ JREMOVE A1;9n5TING BASE„- P: I.B'._ '36"_,. _ yyyy NEW(;OVER I SDL C _ -Lwnr- +_..nxraA Nm Esc Emu:_iN+vn:eD wceewaD BUILT- NG MOLDING THROUGHOUT HOUSE. Y B OM RF1R � WiN G McN[wre A .. cx rnN BOO E REPLACE WITH 28320-MDP BASE. C SET. SINK eUSn NG aT ROa�G^NxeOT ox::.vHL[5.nw:E5 Aw fIxCrEra-xh.0 h}+nrvxt - csr xmeD Ar ail xrzP�eenousv$LOPlD Are veRileNwwM®exasr SMOOTH PRIME AND PAINT. _ _ rzr naso xe IxG sow ee usepar WreRSecrox pr RnaAxo _ I ' 111 onRs°rW MWW1'usuunoxo mleRxess,ImuirD ou MI DuvnwsaIDduu Se C , I Q I - B[RCU95 BATi9 COuroRMIxG ro me 9Pfl�PIGi Or.9 rcerRe-r°w:eD' \:•l �e�1=L ��^nDx.xAa'^N=TwD,;,�.">D' EXISTING LIVING ROOM /^LL I a1Z i A Robert �I. Brown wnaROw 9nkL NArm wsnrp0c. I GAUWRAIL RAND y /� snot e[eA9�DtW[Tme.coxrow.nuc T-AsrN c3c.Avo sluu¢e EXISTING FIREPLACE Architect, P.C. 'Srlewcr sw cD.oR NPRovmeopN.Grrum+wNLeoePn irxa[ass9nALL Pe TO REMAIN - LEVEL EXISTING FLOOR .EXISTING NL uew AxD RePNR[p Gttu mARu snxL ee uveD ND gPAaLID rnRg 131 cools.NL exreRlwL - BRICK TO BE STAINED C _ _ ! �:I PROVIDE ZOS Ba)/AVe. GrCCnpOft NY Ai gMAp.j. TO MATCH NEW HOOD . GARAGE mfo@rlbrownarchr c[.com EXTERIOR FINISH VENT WITH STOVE FINISHESaL x e I REMOTE WITH 63 1-477-0752 Ser ADn°''u"id'e^ne rLDOR soul B<seteerep Br w.++us Nrt:IxsiNupvmn mW - REMOVE IXISTING MANTEL NEW HANDKOL TO HOOD. r rn xLU LA1exAGn:e Br va.wwx NDDeeceAreeovee PATCH BRICKASNECESSARY• - EFICL05E 5TA:M'AY MOTOR PROVIDE errewoR o:x ACCORDAvc[vnm NAwrAeluReRs SrtDrlGrxMe wp PROVIDE NEW MANTEL TO BE I 4-0 I NEW GAS - OLORTOC[9[ifcRD. 3,ueis*Ouc�xrzwoR wwsAND cenlxmWRaveArrEeLeD Brine wDP,R SELECTED. C-------- = I /� I LINE IT ISAVIOL:.T01;^..•'TtY'J::u/`.`R f,eiY?CtiSCY.:, BeeLewep AxD e[raxrcD.xew woos Axo awwrmPa Suaep C REMOVE CEILING IN THE AREA CREATING \Yj ,?; axrzp.raxnxe SHALL Bt iv.D lzJ[nom Bex}A u AQUA PURL : L'NLE55 f•CTII:v U)!0'ER.1`_"DIRECTiCIE C•`A NxrzD.emozrod:seieerto. .A3 CATHEDRAL CEILING 4,y GYP.BD PATCH EXISTING FLOOR AS MCCE55ARY I NENDOW IN ISDL IRTNSED A.RCHnP.Ci','.'i1 a:.lER a.r:':TE,!N: �xTr eC swVOe-9MOOTn,TjNeD.Nmrwlsnen vnin rv.D N) IWHLRE WALLS ARE REMOVED. I WINDOW IN IXISTINL. THIS 0RAW!I G n:A. •.At.ANYM;'}eO.Rf_:`.0 covers eeIw MooRe uTrx acxrue sewraossraxr. NEW 6 OVER 1 SOL DOUBLE HUNG REF:.15N WOOD FLOORS WITH 4 COATS I ALTERATION M1NST BC PFOTED,SEAtSD.Ar HVAC WINDOW IN EXISTING PRAMS PROVIDE NEW 315'DRESSED FIR I I �RWlpeAu ueoR.NAttwats.rcAvvoRtAilDx.eonvMBvrwDseRv1¢s COLLAR TES 4B'O.C.0.5 SHOWN POLYURETHANE. PAM Ut`.'::CT3BF.0.I:q^.CUPil/•?ICE:a^T.Ih:E;A:Y i ABOVE TO SUPPORT e sMrio rROLnpeA Huse snTeN To nut wDe°a56-" raff-s BUILT- C___ __-_-_-_-__-_-= I 'ABOVE E v/(2) 2�"4' as�odReD Br me DRAro G9 wD veanunore.ceRAasdxretrlxvuepM _ BOO E _eolt[R a�D nor wnreRn TeR rRnu dvseNexr,Nm DL _ }'STEEL PIA7E5 EXISTING DOOR TO ROv:DC sxe°a YMGwx wM9>�er wauNwxrtp GAS SOLER bei wrce 6Y ING CCrjWI C HEDRAL_I OI REMAICLUN REMAIN Are),I,OAOO BTD/n.95%ADR OR AFrRO.2p CDA4. . IRCRrrvE-noT WAI[RnW[R =..PRWID[2a4 naxO�LRS.OxE Iu aLTC OLRRB[pRO0M4wo OUCW ' Bas[M[M. PROv:p[OVCrwOW..wDCOx1ROL9wxP�.NTO COWtR[in[x9W.. FIAT CEILING PLAT CEILING FWMBING .PROVIM TO LABOR,MATCRIaaS.WTPixsrORTAnC4DlWlrMexr, YAxCl9 1 [59ARr D-ea WJYnNG9 psrec real oxs OR Rta90uAeL'tr -4 wn oAs xectsSaeY To eeMFlne me EXISTING WINDOWS -EXISTING WINDOWS . woaR. acaxs[RVATIox uwwm :TO REMAIN TO REMAIN . R[GPRp3 TO WATeR 9ANx6 YOAxDCOUSeRVAnOx.Nl ru'IURG SIWLB[ON me - _,i . AnROKD v5T or e[RnIR-1 0 rtuMdrlc ru(ruRe•Y As NdadRD Br - SrAR ovMru[xi Or dMRDauxra CareeRVAnW. - CLIENT!O.Y'.IEP. ' HALL e!Re>-RMm BrgLUrvmR me SPWM&RSnuOF AP [➢,iYtxStD�rIGR A9 R[OURIDuro"CONrLt["ai,ThC �` '�p� '� p nNt oBrNx.SpBNrt.Ax-rArrce wPeRxR�. NOTE:ENTIRE'INTERIOR OF NOTE:REPLACE ALL 9a q -- � ^ _ � - -AIR I\E5 DENCE T"CA, S 'C MD x moo sAssRtD Rwe tDG SrAe.w HOUSE TO BE PAINTED WIOD({W AND DOOR TRIM _ 855 SQUNDVIEW ROAD r waw,nownes.wDAxYDTneRAPPUGd[3RDSDlpIDx. COLORS TO BE SELECTED. WITH i°X 4"SINGLE BEAD ,m EVEC R7CAL FILL SPACKLE AND REPAIR CPSING(WOOD)TO BE EXISTING DECK ORIEPJT,NY R s NL ASDR MAr z�.e0VA'xT. ax.pD�.AD S Rye s .ECE55ARrwVR UDIORPROrERMIG COMPL[R IxSTNL.nOV O•aL N[w , , - et[erweNsrereNSAxoREARowoRKWouw G.B w uAreD% AS NECESSARY. PAINTFfD. �) Cox_.R rTLY IxsTNi[D[LWCr SYSID6.vnWw.LK+inw. 1-90=L Dx wp rROT[CnOxCW[NEM.OJxMC-nD8ro - aux-WG.,wD ut I-Au[cwuEcnae Nm mites �xcrEor me wN0W-sY'=0 xm ArwG 0=1;swe Fr0.-CT TT^ M W r[eS1rP[OF rRORer wD .. ' xwcLUG COxx[C<'W°5io"rRLVIdisLr°KirOBlAulpTPNL+oRwLE�AMr eunDu sibreNe. - [L SnNteovroRM TO MC CLW RENEx1S Dr Th[200ltECiNea 11 [CiPJCN DST;u eooxwrcRSTAia exAnoxxeurneumx.wPAxo.>o-i9e " RENOVATIONS xED).LDDNDnL-SiwDARDB.OcrAiX#NSHe uAnNThGT05N. PROPOSED FLOOR PLAN rn[rui ONN I__MAxuPADiuR[RB A9'AOnnOx ARxvJ 0x9 N+r OmlR A uaABeaD-[s x 1E[ r 3. weDme. eM-R sm�x EXISTING ACCEPT AS NOTED I ReDu:ReMexrswl.aAPnYD POR ILCC XL PROOY_45= rPUCN wUeASnat&ARTff VxDlhw:yttRS LAmwTpwes.,Ne.LAeeL wpaz wrtaBLe rcemeex,nRONnexrwwn,en finer -. - ._.. -..__ wuB[,vro: eltrnoeasrsrzMSnwxrtRreRM[DBrDRaxDeRme .. I/4"= I' .�{�• .• -- - - - - -- I=- -- DPAxmc-r::iE NSTtREpD�Gw. o^„=mke [Dk.sr ^K r FIRST FLOOR PLAN o.�r�"o"�'w'w�rpRA�N�wI,nA.rpD.,aE� 5Lr � _ . 6.CARBOx NC CC°RD iOln[1p:niWG ORCUi9 veno xOlxreRv[NNG row. BxNiBeDaµaRp.aaxx[ORD.DREGTrD,�Ix.ArDaArr[Rrr�w[REpN.RN�. 1 R�_:. t " nLC[n.ABI[. CCAM. Snw B[,mrAufD Cx C/O,l[v[Lrxws . uG C7OR5 iN CANPORMNKC vnTh Tne tleelRKKCORO MwmrJ. --- 3:.A.: 5..11-1 MG RC9 D[xixu eODe Or uew rOP,K STAR.TheraPA xAn°aa a:ee AF?IL 14,_0 l. 1 NaRN CO�x0>2 9935nNi e[PROVIpCD°N10C CAC SV fiStEenluG Al' 0.^.[a Le Px axeA ANDOx L!cn PLOOR1ev4. _ 1,11� � ir4•„i. E C E I V E APR - 5 2022 ' y w 24'm Southold Town Board of Trustees r - V 14 D 1 q. ' ® C E I' VE REPLACE EXISTING WOODEN SHINGILS WITH 'ERICKTOMATCNEXI5nNGBKCK5IDING 7t p7� ® 20 2 I APR L C • - . Southold Town - - - - - - - - - - - - - - - - - - - Board of Trustees ALL IXTERIOR BRICK TO Be WHIR WASHED ' _ ALL EXTERIOR BRICK TO BE WHRE WASHED REPLACE EXISTING GARAGE DOORS WITH NEW'GARAGE DOORS TO BE CLOPAY COACHMAN SERIES WITH 2•INIEWCORE 400 Se 4W 5 - - INSULATION,DESIGN 12 WITH REC 1 1 127 NEW ANDER50N ut �WDX,�G WOH a046 . INSULATED GLASS -' '— 400 SERIBS _ "'— WD"210210 ALL D(fER70R BRICK TO fiI°WHTIE V/ASFf/:D CONTRACTOR TO PROVIDE SAMPLE AREAS _ TO DETERMINE FINAL COLOR PROPOSEDFRONT ELEVATION PIGORT AND RENG. ICKASNECESSARY INSPECT AND RENG.CONTRACTOR BRICK S MALL Y EX15TING ACCEPT A5 NOTED 1/4•a V _5 DECEMBER 21,2015 . SE PLA'L AFf AN Nz--TRULIDIT Of SERVi� AND APIE THE PROPERTY Or TIl[ARCt.'TCCT. EJPrWlr-.tEn5 WILL DE PKOS'ECVtti:� _O L4 ALL PJGHT5 PE5ER:'ED Robert I. Brown Architect, P.C. 205 Say Ave. Greenport NY info@r0rownarchitect.com G31-477-9752 RIS A VIOLATIONOP Tt2it'PL7.R Ati!(F,yyY:, UNL eSS ACTING UNDm THE DL�ELTG i OP A eXISTING WOODEN SHINGLES UCE-0 ARCHITECT,TO ALTER ANY MYNI C'1 TO BE PAINTED - THIS DP�.v7NG uI uH:v:,'I:un AVTFARI3D" AL,CCRIBEMD MUST BE IiOTE7.STATED,AND _ O�iCRIBED IN A:�P3AI:CE`!•97H Fr2 iF:Y. 19I 151 ALL EXTERIOR BRICKTO BE WHBE WASHED Of15TING WINDOWS EXISTING WINDOWS Lj ALL OMRIOR BRICK TO BE WHITE WASHED CONTRACTOR TO PROVIDE 5AMPLE AREAS TO REMAIN TO REMAIN '� - - - `- TO TRACTO TFINAL rAIDR SAMPLEo PROVIDE AREAS TO DETERMINE FINAL COLOR - — -- CL'E'R/OATJG " - � � AIR RESIDENCE ENT.NY - — — ��-•d PWJEC.mlr PROPOSED REAR ELEVATION (NORTH) REMOVE AND DOOR MDEFL5OW. ' REFRAME AND REPLACE wI ANDBRSON STO.iM'ATCM PWGD GOGBL SLIDING PATIO DOOR RENOVATIONS EX15TING ACCEPT A5 NOTED PATCH A5 NEC.wcw01NG BRICK FACE ORA:':t!!r.Tp u BUILDING ELEVATIONS AF/JL 14.LJIG 1la•n i, rpx, x-F y, . iL �r;f�+ � �;r j ,jf s�1 ka � ,�" ��. � ►, Iraq �' a'' �� � p '100 • t a r eti7_ �Iti h . 9. " 1itik k.t. >'j �` ( �'�!! ew ■■ ■r ix'« r , WON • - � 1sli3. yy �y kX7trNIMM i ik r .. lA ^ y, �a "t er�rf;3 '•"q, �i���i.� ;��`���j�'�"'C_.i` t •_ �;ii�y U j�� r ( �(4 r t' '��}` +. s��., 'S`O 'S �y�.�sJjY.�i� a r/�t '9'�F�'i #���t'�ryF`�'{�r�. q{��p�oFf� ; A I J r µ _ Y `. p i T T F ,x��•,.»»,c�,r«�=_vim--' t��' i�- x --��.,�,�, 4 j� _ a s y • (�� � �` \`-�1���. �:. �s�'�;;�h�w. ,� f 4'� � ��'�i1 ���y `��',.Y t s/ 're'. #�V' � � kl" ��A,` * �t� ,�+ �• > '�.'�,3 ��` K� kY` rib-W �( �� 1��� •A"'SA4 ,�v '`+ `+T�'^ Mad TZ z MIT Av AIN _ I �? b��": � � c�"4",,:z ♦ ��`7t�.r�r ��` VV..ww '3�`F :.�. 4.1,'x': 'i {(T t iY k{�_����-a wy;Y ��r' i �� `tom' '"•. r��r „r �G ��'j�� , 'fig. may';, e. � .,+�; S.C.T.M. NO. DISTRICT: 1000 SECTION: 15 BLOCK: 3 LOT(S): 11.1 ® EC IVE FAPR - 52022 DD wnSouthold ToBoard of Trustees =LONG ISLAND SOUND-TIE LINES ALONGMEAN HIGH WATER LINE Ng3.06'34E S8®•33'3,260.518.50WOOD BULKHEADTW 8.6 3 Olde I'd ZONE VE EL 15 =.n 4 TOP or BLUFF x IL20:9 I EL 24.0 x T FIRM ZONE BOUNDARY — C 1 ZONE X ` �`26.3 x d' p I p a CV �« v a o LANDOF�F T LOT 24 I� LOT 23 GERARD H. BELLESHEIM O o SARA A. BELLESHEIM I LEA OLHING 65' 1 45' i SEPTIC 40' L. TANK t1 � v 1 42' 22.6' WOOD i3 DECK „ EL 128.0 EL 28.8 7 rv'Y''!;) '>�?'Y'�r'''y'•'••,`•;�'4''�"!`; :i�:::'••r.•':iS''`::):i:':::?�''":i'?:si':�:'•;;rig`;:?; ?`?; y..... r::•iik:::•:�::•)i:•riii'•i:•: i4: ii'r'r>ei'riii:?4>ri:r:•1r'rii...... f iiS'rii'ri'r"ffiti'r bii.i•:: A NOTE: SANITARY & WELL`,LOCATIODA7 NS ARE., GARAGI N 9 3 pWELLING .......; •A DEC. 1974. 5;:;; '•i:•r::o,:: •....:.::,:..•.,.., i:N`•ili:ir;isisiii:i.;:f5>Sii;:iiiri.`•iiiitii EL 128.8 / :W:t;ca:;•::;•;;:•.r:.;•>.iS:aSiS:;:yiiii:�;:•`.Ek J COVERED 3 PORCH i U p 1 2 20.9' CQ EL 31.5 O 3 - Z 1 M 0 35' F 35' o WELL MON. EL 10.2 El 29.5 R-548 16 L=11 j 77' MON. 41-52- POINT OF CURVATURE EDGE OF PAVEMENT U.P. SOUND VIEW ROAD FIRM MAPS 136103CO067H & 136103CO086H THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL LOCA77ONS SHOWN ARE FROM FIELD OBSERVA77ONS AND OR DATA OBTAINED FROM OTHERS AREA: 25, 181 SQ.FT. or 0.58 ACRES ELEVATION DATUM. _MAVD88 ------------------ UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY 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 THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. 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 TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS AND/OR SUBSURFACE STRUC-TURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EWDENT ON THE PREMISES AT THE TIME OF SURVEY SURVEY OF: LOT 24 & DESCRIBED PORTION CERTIFIED T0: DAVID AIR; CLARE AIR; MAP OF: ORIENT BY THE SEA —• SECTION ONE FIDELITY NATIONAL TITLE INSURANCE COMPANY; FILED: NOVEMBER 21, 1957 No.2777 SITUATED AT: ORIENT rowN 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 # 14—186 SCALE: 1 "=30' DATE: DEC. 14, 2014 ' "— PHONE (631)298-1588 FAX (631) 298-1588 N.Y.S. LISC. NO. 050882 maintaining the records of Robert J. Hennessy & Kenneth M. Woychuk Glenn Gol ' iith, President ®�OSUff('o,. D� Town Hall Annex A Nicholas Kruk.,..., Vice-President 54375 Route 25 Eric Sepenoski o '` P.O. Box 1179 Liz Gillooly o Southold, NY 11971 Elizabeth Peeples Telephone (631) 765-1892 ®1 �� Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Z i Completed in field by- CLAIRE & DAVID AIR request an Administrative Permit for repairs to existing 16'x22' deck with new stainless steel cable horizontal railing system, and stairs approximately 42" wide. Located: 855 Soundview Road, Orient. SCTM#: 1000-15-3-11.1 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275_ Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission *57 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: E. Peeples L. Gillooly G. Goldsmith N. Krupski E. Sepenoski Other t DECLARATION OF COVENANTS .THIS DECLARATION made this ke day of AVbL1S�. , 20_k,�p, by , residing at hereinafter referred to as . "DECLARANT(S) ": W I. T N E S S E T H WHEREAS, DECLARANT(S) is/are the owner(s) of certain real property located on �� �py►J\� l� '1���0 \�1J� Town of Southold, County of Suffolk, State of New York, described in the Suffolk County Tax Map as District 1000, Section, Block which is more particularly bounded and described as set forth in Schedule "A" annexed hereto, hereinafter referred to as the Property; WHEREAS, the Property is situated on lands within the jurisdiction of the Board of Trustees of the Town of Southold (hereinafter the "Trustees") pursuant to Chapter 275 of the Town Code of the Town of Southold or its successor, and various activities conducted upon the property may thus be subject to the regulation and approval of the Trustees prior to being conducted; WHEREAS, the DECLARANT(S) therefore made application to the Trustees for a permit pursuant to the Wetlands Law of the Town of Southold to undertake certain regulated activities; and WHEREAS, as a condition of the granting of a Wetlands Permit to undertake such regulated activities, the Trustees required that a "non-turf buffer" adjacent to and landward of NOW, THEREFORE, the DECLARANT(S) do/does hereby covenant and agree as follows: 1) Upon the substantial completion of the aforementioned permitted activities there shall be established and perpetually maintained jr � ©j FTE �LyF� ll�` \�� "non-turf buffer " as defined by Chapter 275 of the Town .Code, to wit: "A designated area where turf grass, pesticides and fertilizers are not permitted." and as depicted on the pe�lZ0� 7 kVW ZOOS , see Exhibit "A" attached; and 2) These covenants shall run with the land and shall be binding on the DECLARANT(S) , his/her/their heirs, assigns, purchasers, or successors in interest and may only be modified after a public hearing and upon resolution of the Trustees. IN WITNESS WHEREOF, the owner(s) has/have duly executed this instrument this !g� day of 20 lku O R'S SIGNATU 0 OWNER'S SIGNATURE STATE OF NIFIW YORK ) COUNTY O . ss: On the day of -G , in the year 20 , before me the undersigned, Notary Pub is 'n and for said State, personally appeared ,bg(�1A-ic Mwe L )r , personal known to me or proved to me on the basis .of satisfactory evidence to be the individual (s) whose name(s) is/are subscribed to the within instrument and acknowledged to. me that he/she/they executed the 'same in his/her/their capacity, and that by his/h, /their signatures) on the instrument, the individual or the persons on behalf f hich the div• l (sX acted, executed the instrument. 2 6-tarPub is CYNTIAT1 Not@ry 1•'crbl I N'w Ybrk 2 No.Qr1W610t050 0?ual 5c-'d iro Stiffollr Coypty C96nMG.i.on apices 00 20_f Cl 13LAND It 'WMa 2HILM \\ \ ¢ maz.° 't .F r No �8 J �4A� awn z �. 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R- .i � ♦ .} o Y ti �• n m •• Y Ma,cn �cav' - w m ?�f to .``'�i, r xWu c ,�•+ ` sm I E ""�.. 04,x. .,...a+..,..K., �• — O e...o_ —.�-- .w ¢,un.nw .--�; COUNTY OF SUFFOLK N __ 2 .�y ______ ,u.w Real Pr pet,.7'-Sc is \K .uanaa wca v 1);W�i wuwOMwttn Y xwas WU1110{D 015 p u __.__ ri _—w—_ —__— w•ww Itt) o.... .. rtmu t;IXE p ww A v 1 � � - OFFICE LOCATION: � ®� SU(/�y0 MAILING ADDRESS: Town Hall Annex e`o l0 P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold,NY 11971 • Telephone: 631765-1938 NT`9 LOCAL.WATERFRONT��R��EVITALIZATION PROGRAM f.: MEMORAND MHOLD -To: Glenn Goldsmith, President = Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: May 4, 2022 Re: LWRP Coastal Consistency Review for CLAIRE & DAVID AIR SCTM# 1000-15-3-11.1 CLAIRE.& DAVID AIR request an Administrative Permit for repairs to existing 16'x22' deck with new stainless steel,cable horizontal.railing system,-and.stairs,approximately 4T wide;, Located: 855 Soundview Road, Orient. SCTM#: ,1000-15-3-1.1..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 proposed action is INCONSISTENT with LWRP Policy 6.3 and therefore, INCONSISTENT with the LWRP. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. The as-built structure was constructed without Board of Trustee review or permit. A permit for the deck was not found in Town records. 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: The Honorable Lori M. Hulse, Attorney F Town Hall Annex Glenn Goldsmith,President t SoU// ' 54375 Route 25 A. Nicholas Krupski,Vice President f.� } x `A G> 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 This Section For Office Use Only �® Coastal Erosion Permit Application 780ardnfTrustL3eS Q! E Wetland Permit Application Administrative Permit _. `mendment/Transfer/Extensi9Qn 2022 Received Application:_ Received Fee.;$: .,�OD.f1f1 wn -Completed Application:, 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: . - _ Date of Inspection: Receipt of CAC Report; jechnical Review.:w, ✓ Public Hearing Held:. Resolution: Owner(s) Legal Name of Property (as shown on Deed) Mailing Address: �— Phone Number: Q�Ik(cl' �—��' C—) J Suffolk County Tax Map Number: 1000 Property Location,. (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): �\ _ Mailing Address: Phone Number: - Email::.. c a aL r d gc-At. Cry r� Board of Trustees Applic< on GENERAL DATA Land Area(in square feet): Area Zoning: �L— Previous use of property; �L- Intended use of property: S�nSw Covenants and Restrictions on property? Yes No If"Yes", please provide a copy. / Will this project require a Building Permit as per Town Code? y 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 _ ✓. No If"Yes", please provide copy of decision. Will this project requ.. any demolition as per Town Code or as determined by the Building Dept.? Yes No Does the structure (s) on property have a valid Certificate of Occupancy? f Yes No Prior permits/approvals for site improvements: Agency Date ZC)C�� No prior permits/approvals for site improvements. / Has any permit/approval ever been revoked or suspended by a governmental agency? -✓ No Yes If yes, provide explanation: Project Description (use attachments if necessary): L-0 7 QR>c u5 'Board of Trustees AppliCa" "On WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations:,,. ............... Area of wetlands on lot. -C) square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? --.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'.J. feet Proposed slope throughout the area of operations�., Manner in which material will be removed or deposited i- 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 Z20 Appendix S Short Environmental Assessment Form --Iiistrtactto "s for'Co><utixlet �►�,. Part l -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 l 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 I Name of Action or Project: Project Location(describe,and attach a location map): Brief Description of Proposed Action:, ` �V Name of Applicant or Sponsor: Telephone: w(a2k -(nZy'._�\may � - 'E-Malr'C_z�X-(�sc!A\ \N& Address City/PO: -State: Zip Code: I.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rale,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? N.O YES' If Yes, list agency(s)name and permit or approval: w: 3.a.Total acreage of the site o'f the proposed action? Q T'S�b acres b.Total acreage to be physically disturbed? rU' acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial [Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland ::Page.1_of4 Page-2mJ4 — - ~---- ----=— - --- -------=� —+ 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: R ❑. 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 1 Applicant/spo sor 4aamLe:._�UA%?44���� ���-- Date: 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 I. Will the proposed action create a material conflict with an adopted land use plan or zoning a ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? I 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 ® ❑ 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 D. 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? 8. Will the proposed action impair the character or quality of important historic,archaeological, I 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 iX 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. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Board of Trustees Applica," ��n AFFIDAVIT 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 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. Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS,_ - DAY OF,.,- NotaryPublic THOMAS S.VITALE Notary Public,State of New York Registration No.01VI6276776 Qualified in Suffolk County � —><-, Commission Expires 2!251 d"'� 0 Soard of Trustees Applicai )n -AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THffAPPLICANT 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 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. Signature of Property O er Signature of Property Owner SWORN TO BEFORE ME THIS-_ _ DAY OF.,. =_ 2Q. � _ Notary Public THOMAS S.VITALE Notary Public,State of New York Registration No.01VI6276776 Qualified in Suffolk County ..,..:--- Commission Expires 2125/ ab APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE,FORM The Tawe f to of Sautl►old's Code of Ethics nrohrbits conflicts of interest an the part own aflicers"and employees The purpose of: thtstfotm is'to�mvide triforination which can alert the fawn of possible canflrcts of]merest antl allowitt to take wh fever acgan is :.: nee ssa to avat_d sAme: YOUR NAME: ��� c L 21� (Last name,first name,ipiddle initial,unless you are applying tnae 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.) N Building Tax grievance :. _ Variance �, - Trustee ''� Coastal Erosion Change of Zone ---- Approval of plat Mooring - - :._ Exemption from plat or official map Planning Other (If"Other',name the activity.) Do yod'Pip"Onally(or through your;coinpany,spouse,sibling,parent,or eht(d)Have a relntronsttip wrth any officct^oremployce of the 1'oN';trof-S0uthpld? "Relationship" includes by blood;trjarrtager,or bustncss interest` BustA interest ,meansa husiness; including a partnersti p;in which they own"officer or,tmpioyee hWcvcn°a partiak,oOy cshtp of(or employment by}a corporation; in which the=town of6ciT or employed a'Wn ;more,than�59%,of the shares. YES NO ' If you answered'YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold; - Title br 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't is " day o - ��•� `�-��� S guatq. - Print Name. Form TS l APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The town of Soutltold's Cade of Ethics prohili�ts conflicts of interest on the uartof town oft'icers"and em 'lo ees The u UNC.0 this farm is to provide tnformatian which can alert the town of possible conflicts of thtereSt andzallow it to take whatever action ys ecess to avoid stiff&. r. YOUR NAME: w (Last name,first name,-rluddle initial,unless you are applying tn.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.) Building Tax grievance - - " - Variance Trustee ' Change of Zone Coastal Erosion Mooring Approval of plat _- -- Exemption from plat or official map Planning Other (If"Other',name the activity.) - - Do you pers60t511y(or through your,company,spouse,sibling,,parent,or child have a retattonship with any oiCicoi aremployce of the Town of Southold? "Relationship"includds.by blood;:it)arriage,oT business tntete t Busuiess ntcresf;means a business; including a partnership,in which the,tavt�tift4er:or,employee h��s. vgn a parUAl pwricjship of{or eFnployment by)u corPRrAtion: in which the:towtt offidix or employee'own�:m�rc than-5°r!o of the shares, p YES 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 br 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 day f 2S� 24)0-�--c5�' Signature - PrintNatne. ���� Fonn TS 1 Town of Southold LWRP CONSISTENCY.ASSESSMENT FORM, A. INSTRUCTIONS 1., All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency.Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2: Before answering the questions in Section C, the preparer of this form should review the exempt minor action list,policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A-proposed action .will be ;evaluafed as to its sian_ificant 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- supportin�facts: If anaction cannot be certified as consistent with the LWRP policy standards and conditions,,it shalfnot.bemndertaken. 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 PROJECT NAME _ 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: Nature and extent of action: . p Location of action: Site acreage: Q>—� Present land use: 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 applicant: (b) Mailing address: (c) Telephone number: Area Code( ) (cg�o— (d) Application number,if any:. A)/8 Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No Z 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 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 ❑ Yes ❑ No X Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies'Pages 6 through 7 for evaluation criteria Yes ,0 No 0 Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ,13 Yes No 0 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 nn " Yes No �1 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. 0 %0 0 Yes No Not. licable 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® 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 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. Ye No Not Applicable Attach additional sheets if necessary WORKING COAST POLIO_–:.�5 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. E] Yes No Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III–Policies; Pages 57 through 62 for evaluation criteria. Yes No ® Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III – Policies; Pages 62 through 65 for evaluation criteria. Yes -❑ 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. 0 Yes No 0 Not Applicable PREPARED TITLE. PJ. � DATE -4b 12—