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TR-10349A
Glenn Goldsmith,President ®��®F S®U� 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 �® a® Fax(631) 765-6641 C®UhVT`�,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE 2103C Date: November 1, 2023 THIS CERTIFIES that the removal of existing 12'x32' deteriorated wood deck attached to back of house; construct new 12'x32' wood framed/composite deck in-kind in-dace with upgraded support, connectors and railings to meet current code; At 700 Goose Creek Lane, Southold Suffolk County Tax Map#1000-79-1-1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated March 24,2023 pursuant to which Trustees Administrative Permit#10349A Dated April 19, 2023 was issued and conforms to all the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for removal of existing 12'x32' deteriorated wood deck attached to back of house-, construct new 12'x32' wood framed/composite deck in-kind in-place with upgraded support connectors and railings to meet current code. The certificate is issued to John TaggartCarol Taggart& Eileen Mowry owners of the aforesaid property. 4-7." '4"'. Authorized Signature olu"Co wq ` Glenn Goldsmith,President *®f SO��� 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 DATE OF INSPECTION: 111 I 113 INSPECTED BY: M12A6+ Nbap s Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale line/silt boom/silt curtain 1St day of construction Y2 constructed Project complete, compliance inspection COMMENTS: profr41s m combl►a."C wick xyvk& -k 1*49A dkay }r issue CR.Y�'1T1� A'i' Cp�rinlnt,� , CERTIFICATE OF COMPLIANCE: Glenn Goldsmith,President ®� S®U�go Town Hall Annex ®� ®� 54375 Route 25 A. Nicholas Krupski,Vice President ® P.O. Box 1179 Eric SepenoskiB Southold,New York 11971 Liz Gillooly 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 procomplete, call for compliance inspection; project p 1 Glenn Goldsmith, President ®F Si Town Town Hall Annex A. Nicholas Krupski,Vice President ®" ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski l�RR [ Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 cou V, BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10349A Date of Receipt of Application: March 24, 2023 Applicant: John Taggart, Carol Taggart & Eileen Mowry SCTM#: 1000-79-1-1 Project Location: 700 Goose Creek Lane, Southold Date of Resolution/Issuance: April 19, 2023 Date of Expiration: April 19, 2025 Reviewed by: Elizabeth Peeples, Trustee Project Description: Remove existing 12'x32' deteriorated wood deck attached to back of house; construct new 12'x32' wood framed/composite deck in-kind, in-place with upgraded support, connectors and railings to meet current code 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 survey prepared by Peconic Surveyors, P.C., dated January 19, 2023, and stamped approved on April 19, 2023. 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 ADDRESS. 700 GOOSE CREEK LANE, SOUTHOLD N PROPERTY OWNERS.• SURVEY OF PROPERTY JOHN TAGGART 5JR 0 � A T SO UTHOLD CAROL TAGGART • ,��"06 Maw EILEEN TAGGART MOWRY t 62`2 TOWN OF SO UTHOLD SUFFOLK COUNTY, N. Y. ° GP�'P%3 ' 1000-79-01-01 �j� ,po� �,.- 'Op. s SCALE: 1'=30 `' G•'��' p'� v��' SQ:6 JANUARY 19, 2023 V' �J ��• / / PSP �P� l� cp. !, a1-011. _ c.5 B0AI�D OF 1 Rus_ TOWN OF SOUTHOL® o• � ®ATE r4PR�L_ lQ�ZoZj ; 0°S•9P �p,45 � � GPS �'e�� _ i To�;k5 �I` seo�� 24 i a� 9 O MAR 3 1 2023 0LoKEY � G 2 0. ,r-- �yo o °tip o — REBAR ® = WELL `� P5 U POLE �k8 A = STAKE Z lops = TEST HOLE �t��� ��F �,�UETZpFA • = PIPE G) o CMF co G yti� : /° } 0 = MONUMENT �QG� ti = WETLAND FLAG = UTILITY POLE PSQNP�� Al`'� </�N O. = HYDRANT °�. •pa5o EES �� - 77MBER U POLE S6Ac fig' N.YS. LIC. NO. 051132-01 ELEVA77ONS REFERENCED TO NAVD 88 CUR YDRA T N.YS. LIC. NO. 4961, ANY ALTERATION OR ADDI7ION TO THIS SURVEY IS A WOLA77ON OF CMF �O�sE PECONIC VEYORS, P.C. SECTION 7209 OF THE NEW YORK STATE EDUCA77ON LAW. EXCEPT �FpGE ``o (631) 765-5020 FAX (631) 765-1797 AS PER SEC77ON 7209—SUBDIVISION 2. ALL CER77FlCA77ONS HEREON P�` O econicsurvey6bptimum.net ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP GR R peconicsurvey@optimum.net COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE AREA= 23,572 SQ. FT. P.0. BOX 909 SIGNATURE APPEARS HEREON. TO TIE LINES 1230 TRAVELER STREET 00-145 SOUT7-lo EXISTING "" 'I" "" JIM DEERKOSKI, PE ' lf1 ' ' I phone: (631) 298-7116 ,ri1 lul 1„1 1111 O 1111 w W 1111 W 1111 W IIII lilt. �1111 �1111 Q 1111 I 1111� �1111 �1111 � Ilil I illl� (D 1111 12"dia.CONC.PIER (D lilt lJ lilt - nncJ Cliff MIN. In CJ fill I O Q 2X8 ACQ DJ @12"OC „ u 11l MIN.3'BELOW GRADE uu 111, 2X8 ACQ D1 @12"OC �, u lilt ooON UNDISTURBED SOIL oo"" oo "" I 'n uux x nil x In x nn nuN N nn (TYPICAL) N nn N nn unm m nn m nn m lilt I o sir .,ly i,,y ,ly ( ntl 1n1 � I lu1 I r-I Iill W W IIII W Itll W 1111 I IIII p O 1111 p 1111 p IIII I 1111 �_1111 �_ IIII nn C7 l7 uil l7 nn l9 nn C, du2X8 ACQ DJ @12"OC 0 111 01111 O nllu nit a. nn u nu nua Q nn u Q n1 Q nn u1 nnX x nn x nn X nn IIII N N II11 N 1111 N IIII _ IUM m nu m nn m lilt I O 1111n 1111 Illi —lilt I a 1 ' I`'I 1�1 1y11 1`11 i�u un fill i„i L — — — — — — — — — — — — — _ — — — — — — — — — — — — — —....... — — — — — — — — — — — 10'-0” 10'-0" 10'-0" 1'-0” 32'-011 U 701 v w z FOUNDATION PLAN W z SCALE: 1/4" = 1'-0" W w z w .4A EXISTING, cn O C) p� O x � O H 0 CABLE RAILING — _ L•:S 1111111 _ a- � S/4X6 TREX DECKIN I O 1111111 m 5 4 TREX DECKING — 9 — PROPOSED DECK REPLACE EXISTING DECK d.I 2X8 ACQ DJ @12 OC A (3) 2X8 ACQ GIRDER I I I I ( I r Ca 12"dia. CONC. S/4X6 TREX DECKING PIER (TYP) O CABLE RAILING TO CODE e: D D D cY7 p , • • • a: — DRAWN BY: JD 'b --------------------------- 12/20/2022 n I. 10'-01, �, •g 32'-0" aa, A CROSS SECTION A SCALE: SEE PLAN 1 1 SCALE. 3/8 - 1-0 o, n -- - ,-M•..- p NEW Y FLOOR PLAN Ar SHEET NO: SCALE: 1/4" = 1'-0" E w MA,9 3 1 2023 Lu was- I 2 O WIND LOAD PATH CONNECTION AND CONSTRUCTION DETAIL DRAWINGS h USE THE FOLLOWING OR APPROVED USP METAL CONNECTORS FOR PROPER WIND RESISTANT CONSTRUCTION. FOLLOW MANUFACTURE'S RECOMMENDED INSTALLATION INSTRUCTIONS TO ACHIEVE MAXIMUM UPLIFT LOAD CAPACITY. 4"MAX. 4"MAX. 4"DIA.MAXIMUM 4"DIA.MAXIMUM POST GIRDERMEADER 0 (O Z '° ' POST/COLUMN V• ao' I ? 12"x12"x12" G i0 CONCRETE FOOTIN m JIM DEERKOSKI" PE phone: (631) 298-7116 DECK POST FTG.CONNECTION DECK/PORCH RAILING LOCATION USP NUMBER I DESCRIPTION APPLICATION STAIR RAILING POST-TO-GIRDER/HEADER CONNECTION 4X4 POST PAU44 OR WE44 IPOST/BEAM ANCHOR JAPPLY TO EACH FOOTING USE MIN.(2)1/2"DIA.GALV.BOLTS WITH WASHERS AND NUTS 6X6 POST PAU66 OR WE66 I POST/BEAM ANCHOR APPLY TO EACH FOOTING 1-1/2"SPACE MINIMUM HANDRAILS GIRDER POST GIRDERMEADER o 0 BALUSTERS RIWDECK JOIST-- OIST o POST/COLUMN ; CONCRETE PIER o ; OPEN BALUSTER ATTACHED TO WALL HANDRAIL CONNECTION ALL HANDRAILS SHALL BE CONTINUOUS THE FULL LENGTH POST-TO-DECK CONNECTION OF THE STAIRS. HANDGRIP PORTION OF ALL HANDRAILS HEADER/GIRDER-TO-POST CONNECTION r , SHALL NOT BE LESS THAN 1-1/4"NOR MORE THAN 2"IN LOCATION USP NUMBER DESCRIPTION APPLICATION CROSS SECTIONAL DIMENSION,OR THE SHAPE SHALL USE MIN.(2)1/2'DIA.GALV.BOLTS WITH WASHERS AND NUTS V Z (2)BEAMS PAU44 OR WE44 POST/BEAM ANCHOR APPLY TO EACH PIER PROVIDE AN EQUIVALENT GRIPPING SURFACE GIRDER/HEADER TO POST/COLUMN CONNECTION (3)BEAMS PAU66 OR WE66 POST/BEAM ANCHOR APPLY TO EACH PIER W FLASHING TUCKED UNDER W TOP PIECE OF SIDING AND Q A a LAPPED OVER FIRST CONTIN. lull GIRDER/HEADER PIECE OF SIDING BELOW V J UNDISTURBED SOIL Q 2.1/2"DIA.LAG BOLTS W/WASHERS LAY PLASTIC BASE DIRECTLY ON CONNECTED TO BLDG.@32"OC UNDISTURBED SOIL(ORGANICS REMOVED) STAIR TREAD LEVEL BASE ° FIT CONSTRUCTION TUBE AND PLUMB POST/COLUMN ° RIM BOARD BRACE TUBE w °° FILL AS PER MANUFACTURES'INSTRUCTIONS . w — — — v , W CTRINGFR _ FLOOR FRAIo11NGO 2x JOISTS III=ISI-III— — —III=111'_ O � O BLOCKING FOR JOIST HANGER O POST-TO-GIRDER/HEADER CONNECTION LAG BOLTS p LOCATION USP NUMBER DESCRIPTION APPLICATION RIM JOIST/BD. 4x4 SOLID COLUMN PBS44/PBSE44/KC44 POST CAP ANCHOR APPLY TO EACH COLUMN DISTURBED/POOR SOIL V O O STRINGER TO DECK/PORCH CONNECTION 6x6 SOLID COLUMN PBS66/PBSE66/KC66 POST CAP ANCHOR APPLY TO EACH COLUMN LAY 4-6"LAYER OF CRUSHED STONE OR O O r^ HOLLOW COLUMN SIMPSON STRRI/2 H.C. ANCHOR APPLY TO EACH COLUMN GRAVEL v J DECK/PORCH LEDGER CONNECTION LEVEL AND COMPACT BY HAND LAY PLASTIC BASE ON COMPACTED GRAVEL LEVEL BASE FIT CONSTRUCTION TUBE AND PLUMB A'I'\ FILL AS PER MANUFACTURES INSTRUCTIONS BRACE TUBE III-11_111_11-III-II E ILIIaIIN Milll- 111 111 111 111 111=�� STRINGER -- - @16- �TTHRWOOD JOISTOILTS JOIST 1 Pea POST ANCHOR CONC.PIER FOOTING "IAR 3 1 rnr. $•a PIER 16'TREAD GIRDER/HEADER BIGFOOTSYSTEMS FOOTING FORM 3 . ,y IN ACCORDANCE WITH SECTION 104.11 OF N.Y.S.RESIDENTIAL CODE THIS DESIGN GRADE coNc.fLU9 ?t WOOD JOIST COMPLIES WITH THE INTENT OF THE CODE AND THE MATERIAL OFFERED IS IAS REQ-) �4 GIRDER/HEADER AT LEAST THE EQUIVALENT IN DURABILITY AND EFFECTIVENESS OF THAT >' PRESCRIBED IN THE CODE. •i b 8"du. ••?b, DECK PIER -- 3,Q" a:• CONC PER PLAN THE DIVISION OF CODE ENFORCEMENT AND ADMINISTRATIONS FINDS THIS PRODUCT ot9� PIER FLUSH JOISTS WITH HEADER/GIRDER ACCEPTABLE FOR USE IN N.Y.S.BASED UPON ICBG EVALUATION SERVICE REPORT ER-5495 AND SUBJECT TO THE CONDITIONS THEREIN. 9"• :4 ALL JOISTS CONNECTED TO A FLUSH HEADER TO BE SUPPORTED WITH •v 'a�>• THE PROPER STEEL CONNECTOR. SPLICED JOISTS OVER HEADER/GIRDER IF ABLE,SET FIR JOISTS APROX.1/4"HIGHER THAN LVL HEADERS LOCATION JUSP NUMBER I DESCRIPTION APPLICATION TO ALLOW FOR SHRINKAGE. JOIST TO GIRDERMEADER I RT10 ITYDOWN ANCHORI CONNECT TO EACH JOIST DRAWN BY: JD HANDRAIL NOTES: DECK& PORCH NOTES: CLIMATIC&GEOGRAPHIC DESIGN CRITERIA NAILING SCHEDULE All required handrails shall be of one of the following types 1).Unless otherwise noted,all framing material to be Nl ACQ pressure treated lumber. GROUN WIND SEISMIC FROST WINTER ICESHIELD NAIL NAIL 12/20/2022 or provided equivalent graspability. All fasteners,hangers and anchors to be galvanized or stainless steel. SNOW SPEED DESIGN WEATHERIN LINE TERMITE DECAY DESIGN UNDERLAYMEN FLOOD JOINT DESCRIPTION Q•ly SPACING NOTES 2 LOAD (MPH) CATEGORY DEPTH TEMP. REQUIRED HAZARDS 1).Type 1.Handrails with circular cross section shall have an ) Girders for deck joists to be bolted or anchored to each port or pier with washers and nuts JOIST TO: PER TOE Girders on concrete piers shall be anchored with 4-8d COMMO outside diameter of at least 1-1/4 inches and not greater P proper steel connectors anchored SILL,TOP PLATE OR GIRDER JOIST NAIL SCALE: SEE PLAN MODERATE SLIGHT TO into concrete with a minimum 1/2"dia x 7"Ion anchor bolt with washers and nuts. 20 PSF 130 B SEVERE 3 FT. 11 NONE than 2 inches.If the handrail is not ocular it shall have a g TO HEAVY MODERATE - BRIDGING 2-8d COMMO EACH TOE - perimeter dimension of at least 4 inches and not greater TO JOIST END NAIL0 NEf v than 6-1/4 inches with a maximum cross section of 3).Posts supporting girders shall be anchored to a 12"x12"x12"thick concrete footing. Y Use a minimum 1/2"dia x 7"Ion anchor bolt with washers and nuts.Footings Shall BLOCKING EACH TOE Q dimension of 2-1/4 inches. g g CODE:2020 IRC,2020 NYS UNIFORM FIRE AND BUILDING CODE To 101ST 2-8d COMMO END NAIL �P )(J`F-0y be 4 ft.below grade. BLOCKING TO: EACH TOE �� / C)s SHEET N O■ 2).Type II.Handrails with a perimeter greater than 6-1/4 4).Deck joists to have blocking at 8'0 o.c.. SILL OR TOP PLATE 3-16d COMMO BLOCK NAIL , ' yti inches shall provide graspable finger recess area on both LEDGER STRIP EACH FACE = W sides of the profile.The fin er recess shall begin with a 3-16d COMMO LU P g g 5).A minimum of 10 inch Flashing shall be installed between the building and ledger. TO BEAM JOIST NAIL n �[ distance of 3/4 inch measured vertically from the tallest Ledger to be fastened to building with 1/2"dia.bolts with washers and nuts SOIL COMPACTION: m Z portion of the profile and achieve a depth of at least 5/16 at 16"o.c. JOIST ON LEDGER PER TOE 2 1).CONTRACTOR TO PROVIDE SOIL TEST TO VERIFY EXISTING CONDITIONS.MINIMUM 3lX)OA' TO BEAM 3-8d COMMO JOIST NAIL N ra O inch within 7/8 inch below the widest portion of the CAPACITY. X72 profile.The required depth shall continue for at least 3/8 6).Concrete piers shall be a minimum 6"above grade. BAND JOIST PER END 3-16d COMMO inch to a level that is not less than 1-3/4 inches below the 2).NEW FILL TO BE GLEAN OF ORGANIC MATERIAL CONTRACTOR TO VERIFY EXISTING SOIL TO JOIST JOIST NAIL AROFESS\O tallest portion of the profile.The minimum width of the 7).All joists to be supported with hangers and anchors.Each Joist shall also be anchored CONDITIONS PRIOR TO FILL.REMOVE AND ADD ADDITIONAL FILL AS NEEDED. BAND JOIST TO: PER handrail above the recess shall be 1-1/4 inches to a to girder(s). SILL OR TOP PLATE 2-16d COMMO FOOT TOENAIL maximum of 2-3/4 inches.Edges shall have a minimum 3).COMPACTION OF NEW FILL SHALL BE AT LEAST 95%PROCTOR DENSITY(PER ASTM D 698 radius of 0.01 inches. 8).Use Simpson hangers and anchors with Z-MAX tripple protective coating or equal AND ASTM D 1557). COMPACT THE SOIL AT 12"LIFTS(TYPICAL).CONTRACTOR TO HAVE O for any contact with ACQ. FILL TESTED BY A PROFFESSIONAL AGENCY FOR COMPACTION. QS�FF01� Town Hall Annex Glenn Cioidsmith,President ��0�' � A.Nicholas Krupski,Vice President c < 54375 Route 25 vs Eric Sepenoski P.O.Box 1179 n, Liz Gillooly �y • �!� Southold,NY 11971 Elizabeth Peeples �a Telephone(631)765-1892 Fax(631)765-6641 Southold Town.Board of Trustees Field Inspection Report Date/Time:4111123 Completed infield by: ElltabyE-I1 PWIe3 William Conway on behalf of JOHN TAGGART, CAROL TAGGART & EILEEN MOWRY requests an Administrative Permit to remove existing 12'x32' deteriorated wood deck attached to back of house; construct new 12'x32' wood framed/composite deck in-kind, in-place with upgraded support, connectors and railings to meet current code. Located: 700 Goose Creek Lane, Southold. SCTM#: 1000-79-1-1 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: y/Chapt.275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card, posted on property: Yes No Not Applicable Info needed/Modification /Conditions/Etc.: Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly . Peeples 1 i ,,. " � a e � br 9 �Is it , rf "- M=Wft a i /.. � xs �t a 'Gr r r . . w' { + it � -� '� ,. �� � _._ i � � �� -.. �,. ` -",, X ` , . _ _ w .. __ -- ��{ .. . .� - � � „, "` -- b .. �� f ........ .Lr �-- �.. ,_ — ., ., ,, _.. . ,, . ,. _... 'kr,, ,,,� '�- _. ;... �,. ,,. 4� � •' � ,/e e � „/ _ �' "tiC .�yR .4'ifx�:.r: '�'.... � a' =yam �y�'� T �=--, �` ��.-,\` _ 1 f t �11�f_ i � �i �. /��_,_ ��;�`,t o �� �•� � n� �� `s l � } r..�.., - _ __ .. � r� �� �, �� -- i �„ • �. w ta+aY 0136Y � 636Y 2 1 y rl f YOSW / « 3a t33 3 e2 o5zaad 'a 3� �- 1 a/ S�T>'LDLD WMn Ot I y 5w t. 2 / • 3elcl a ar + d4Y +�aam Q7 r ro w Y.Osw o - )Wal • rx Jb e^ vi C �'z• �)A-� Yx,ua aawst.,� � x TWcI J.x N m q ^ _ A ^ 4+sa1 � 1.aNc1 p,SW 2R2PP2 ;t\ ,n 3r 13 • ^ ,3 y rJ u J J6 p w 2M ` ID d t 5p p w N 13-AY REM WERL2P o516Y �adJ dac[Es \t)Ncl to r b ^ � • m 1a ID.n 113 m r .,x xz2 z>w ID M 12 —a —14 Y-,z-te '"w°, �" a rc 3B n 4 ,��•cuorm. i u O ya^ a Y M� Ot ` 2 S Je+ Ya ID'zt, Ja,w 1 b d Y a sa as.i2 • p q / xw ryas. 4 �� � „� w >. n ° a ,�21n r.oyn ts. .g' 1+ • ar rova,or vie +u • '.6 P1 qa,, k w a ra> i u w - za w ^''r w s^. ,z +svt � ,a. • I _ Z )r21c) I ) • ].e 21 Sir- 2T &lam,_ z3r '4 fay I xsa '+" Q r 13Nc1 ID u t ata t)� � © IOWNOF � 23e1n m a+ " , BWINgp z.0 Wn ,zyn a Yto re.lr I ,w I m.s z., az a. Je 3a ro R ,sN.f • s6� ^ " 1 .en S 4] I I / ^ a a e u n u f p � „� a• • 2� r e e a w ae a :r I ti © • Y a N a,a A 312 2 3M 1.4 IZ3 2x An a i 1,d�'tt w Y b ©, _ - rye 1 ID 'St 1t 43 9 ra byv w � a+ • JZ `" A "ara� p w,t s.Wcl w O I' >• h w m.r. N .. CE�,gRO sa � s " _ '° s, w X 2f_g • rpz a °) ay tm uY m w.cR E SEE 9EC.tp.OY ranee COUNtt OF SUFFOLK © E a secnoR ra E ...�,.,a µ___ —� •..m, __�— —,,.—_ _ S$ Rea�I Property Tax Service Agency Y M 079 0 wr. u r ,).Nn•tx to W —___ __.__ r�—y-- r r y� 1 p tx.x0 N0 PROPERTYUM OFFICE LOCATION: ® MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold,NY 11971 (cor. Main Rd. &Youngs Ave.) Telephone: 631 765-1938 Southold, NY 11971 C®UN�V 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 17, 2023 Re: LWRP Coastal Consistency Review for TAGGART SCTM# 1000-79-1-1 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 proposal is CONSISTENT with LWRP Policies and with the LWRP. It is unclear if the deck was ever permitted. 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: Honorable Lori Hulse, Attorney Glenn Goldsmith, President %\®F S®(f j� Town Hall Annex A. Nicholas Krupski,Vice President ®� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski lit Southold, New York 11971 Liz Gillooly Elizabeth Peeples � ® � Telephone(631) 765-1892 `� Fax(631) 765-6641 COUNTi BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application X Administrative Permit Amendment/Transfer/Exten ions Received Application: Z •23 eceived Fee: $ 100.- ' ✓ Completed Application: 'Tl•Z7Z3 Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination date sent): TM :� F �' ��LWRP Consistency Assessment Form Sent: ;:r� - II AC Referral Sent: Date of Inspection: MAR 2 4 2023 Receipt of CAC Report: Technical Review: —7—Public Hearing Held: Resolution: ' 1 (,eejj P"kj�A✓'7 MOIJ � Owner(s) Legal Name of Property (as shown on Deed): �� � J n c A✓-o I I ag41 13G✓' � Mailing Address: 4-1 �9-t%C�sf'/ kck Pcmad Sou J&hvon" &I V -117-02 Phone Number: -! ( n �� 6- Suffolk County Tax Map Number: 1000 - -79 - D 1 —o 1 Property Location: ::700 Or-o aseCc&—' k— Lct vGc �t�JILD IGl (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT (If applicable): Mailing Address: 530 1& (4n o '-�f&-o Phone Number: 131. 3 15--- 140 S;'.S' Email: Co W�1G�� Gi' �/�A it! � 'v9►'►� Board of Trustees Application GENERAL DATA Land Area (in square feet): 25 .,C-71) Area Zoning: Previous use of property: ��'�n (-e, 45 r k4 Intended use of property: r Le a _ Covenants and Restrictions on property? Yes o If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? _zYes 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 e No If"Yes", please provide copy of decision. Will thi project require any demolition as per Town Code or as determined by the Building Dept.? Yes No Does the structure (s) on property have a valid Certificate of Occupancy?_j,�/es No Prior permits/approvals for site improvements: Agency r' rf Date ZJdO Sow No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes r If yes, provide explanation: Project Description (use attachments if necessary): cnt a 141 em- P�c 5-�- jnr, ale s ao' vw�-r-wo©®d decL dig 14v Lgc-L o P 1i otc&e- _ FId _ Pr,7 wood -L � cL ✓ Sa�Cr � ' 3P JR uvaw l-t g-s 'pX dCt`IyNin a Q,J dP f WQw1r Le a zx/Cccl 1yl �e p � t) V-it�c2��evt � A � �� r '( {,:,q s -f-o mee - Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ��L S�o n rq e a< cue�etftove . s B - ti t9 1 Bch C V— X60 IAek _s Lg, le, LJ 1*,- 4 ne4d _P a Area of wetlands on lot: q„prox i.(©O 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? i/ No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): 00 101 ►�.c� 01a �i�a � WaJe-- or We&Inds 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing 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 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: �vrLA ICL CZ l/'61 Project ion(describe,and attach a location map): 700 ke,,�se_ C—e�.r Ln�� SYe_u Tltptl) Brief Description of Proposed Action: p P� �Cc C� C'oC l S 1�t'n �2 i✓ 1�-f $1 w oo Cd Ae� `L t Name of Applicant or Sponsor: Telephone: Gl3 5�' t�\Ck,4A �Cti �l112,E -Mail:C0,1 Address: i V— a City/PO: Stat' V I / / e: Zip Code: cilk 1" ( �I` f f 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 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 approv o u;)L D I^ S0 -! 0 tc4 iu'u-%I Ck L-L; Dec- 3.a. L3.a. Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? 6001 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 1,5_4 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial Residential(suburban) ❑f=orest ❑Agriculture El Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑l 9 ❑ b. Consistent with the adopted comprehensive plan? E] 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 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: 0 ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ❑ 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:�7_ � n� �� unPly ❑ d1 Ppm['a- 1 1.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: D"�;jets- u,7rt5tz� ❑ 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? ❑ 1 I 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? El 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: Erghoreline El Forest ❑A ricultural/grasslands ❑Early mid-successional El Wetland El Urban [Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, ❑ Z- Ela. Will storm water discharges flow to adjacent properties? ❑NO YES b. Will stone water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO AYES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: [�T ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: �( ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE App I icant/sponsor name Date: 4/06/Ai- 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 I and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoningElregulations? 2. Will the proposed action result in a change in the use or intensity of use of land? F, fr ❑ 3. Will the proposed action impair the.character or quality of the existing community? Rr ❑ 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? Rr 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate fes' ❑ reasonably available energy conservation or renewable energy opportunities? /� 7. Will the proposed action impact existing: I� a.public/private water supplies? u b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, �j/r ❑ architectural or aesthetic resources? L J 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, Elwaterbodies,groundwater,air quality,flora and fauna)? IT Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? FI 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. F] 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 'Lrd of Trustees Applicatic AFFIDAVIT BEING DULY SWORN RrPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of PropertyOwner Signature of Property Owner SWORN TO BEFORE ME THIS �` `b DAY OF nf'C =20 Regina L.Cartselos Notary Public-State of Newyork No.01CA61989o8 Qualified in Suffolk County Notary Public -My Commission)Jxpires January 5,2025 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The nuKpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOURNAME: o(Last name,first name,Iniddle 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(or through your company,spouse,sibling,parent,or child)have a relationship.with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest_"Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(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 a3 Signature_I;�1^'Qer s Print Name (J 4 1 l c:..w ° t ✓ Form TS 1 Boy€rd of TruvteAer Applicatiort St stn" LHAITIVISMfElNL..$1APPLICANT LC` ABOVE DESCRIBED PEI2AUT'(S)AND THAT ALL STA TIMI'„QTS L`4TN'I AITkTE I IIL'REI :VIy$,IyI°'"TRUE TO THE IIPST T ISr`fJER 2�tit�WLIa;I)CF AND F ELIF F . )T THAT ALL W()ScK'kVI asi:. E:3QNF IN NE MA-NtNEk SL`ffi':f()Wf33 INN—HIS Akf*;,,A(< VTji0.N N AS MAY DE:APPROVFI)By"Tfil,Stat'#HOLD TO-v8W BOARD OF TRUSTEES, THE APPLICANT AGREE S TO HOLD TIM I-OWN OF SOU;F110h. 3 AND TtT X39 CL. ISIS ARISING t IND II OR BY VIRTUE OF SAID PERMIT(S),II GJ1,4 NN FD, IN COMPLETING THIS APPLICATION,I 11FREBly 1 UTHO�`11P THE THEIR AGENT(S)OR R II��S2It�Si"� I I��� [ , � Ti » CI SERVATION ADVISORY CotjS,4, If,,TO ENTER ONTO MY I'TTCIP :R '�'TiC) INSPECT )IT I'RFNIISES IN CONJ'UN(,°'F`lON i'Vd'['H TM.S—PPLIC TION. INC[,UI3UN'..A FINAL INSPECTION. I FVR'I'ULqAUqUORIZE TIlr,,BOARD OF '"$CPS`f`EE"i TO V:NTER ONTO NIV PROPERTY AND AS T T E 'r0_ TC SI,.I 1?. T'O.*4FLI,kp E,Y'TT`il ANY�y g 3���,�px w'fc',,kk C��y��'yr4.NY'fig '{I L:AUND ATTR CO STT L f`kt`��°s'f�..s�0..4 5„E 'pvipv �'I%a,.�i.�„ps"D R%/ A .Cbl;EP'4PAR9��?� @ RS.S 4.UN Dt!-%IMk A ngll PL;S.'s. Of THE PERt'IEI'T mat-n,ire 01 pro S? 7 Df`iYO y e t7, StATE'`' a OF ~���it tdjeSYPusuc EIr=r' A � p�✓XJ7$j 3aa54�� «s,..,, Board of Trustees Applica Dn AUTHORIZATION (Where the applicant is not the owner) I/We, owners of the property identified as SCTM# 1000 �• a` v 1 in the town of SO 64 TyD L b .New York, hereby authorizes w L. I- i q l-r d!U W y 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 Sign a Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF NICOLE RODRIGUEZ otary Publi NOTARY PUBLIC = STATE OF NEW JERSEY ,- ID#2398683 MY COMMISSION EXPIRES JULY 27,2025 Board of Trustees Applin ion - AUTHORIZATION (Where the applicant is not the owner) 7 4- owners of the property identified as SCTMti 1000- _79'— O/ —�2� in the town of S� V 0 ,New York, hereby authorizes t / (� t to act as my agent and handle all necessary work involved «pith the application process for permit(s) from the Southold Town _ I Board of Trustees for this property. operly ONNmer'S Si re Property Owner's Signature SWORN TO BEFORE ME THIS .S7- DAY OF l� , 202 i I Notary Public i i ROBERT.M HOLLANDER ' NOTARY PUBLIC,STATE OF NEW YORK Registration No.01 H06368337 ' Qualified in Suffolk Qounty� My Commission Expires; 1 I Board of Trustees Appli< ion AFFIDAVIT � �2oG -ri?6:2-,�W27— BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND. OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Prope y Owner Signature of Property Owner SWORN TO BEFORE ME THIS gDAY OF NICOLE RODRIGUEZ NOTARY PUBLIC augll( 02 otary Publ' ' STATE OF NEW-JERSEY ID#2398683 MY COMMISSION EXPIRES JULY 27,2025 � . APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts-of interest on the part of town officers and employees.The nurmose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: (Last name,first name,itiddle 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(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the ares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): _aA)the owner of greater than 5%of the shares of the corporate stock of the applicant _E (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 91 day of 20-2--3 Signature -L,—.9,0 Ls �o� Print Name Fonn IS 1 Board of Trustees Appli_._tion AFFIDAVIT , dhy 12, 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 i EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. i I i ature of Property O Signature of Property Owner I SWORN TO BEFORE ME THIS L DAY OF 1LWtiC(-F , 20 23 i i I Notary blic MICHAEL G.LEAVY Notary Public,State of New York No.02LE484-8451 Oualified in Nassau County i Commission Expires July 31,20 2 S f 6 APPLICANVAGENTIREPRESENTAMT TRANSACTIONAL.DISCLOSURE FORM The Town of Sombold's Code of Ethics p_tip its conflicts of int,= --the pan oftown offices and C—myknTM,Tha a-&=of t_lds form is b provide information whM can iikrt the town of4vssi4lcoaoflicta of•intenest and 4112wIt to tskowhIU rcEMAIIM Is YOUR NAME (bast,same,first name,jpiddle Initial.unless you are applying in the name of someone else or othcr'entity,'such iJ ai company.lfso;indicate tlte'other PC=Is or company's name.) NAMEOPAPPUCATION: (Check.allthatapply.),. . Tax.gricvaaoeBuilding Yadaaa - - - Trustee Change of?,one Cwstal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other Of"Other",nestl=e,the activity.) Do you personally(or through your company.spoux,sibling,parent,or child)hive a rcWi mWdp with any oflioer or employee of the Town of Southold? "Relationship"Inclixics by blood,marbge,or bus`new Interest."Business ifflace means■buainesa, including a partnership.in which the town officer or amployce has even a pa tw owttctship of(or employtnent by)a cosporttion in which the(own officer or employee owrs more thmr 5%of the shares. YES l— NO If you answered"YES".complete the balance of this form and date andsign where iridic aVA Now of person employed by the Town of Southold Title or position of that person Describe the rt:lsGon�ilp betwarryourself(the appolcarci/iBtr�/represurmtive)aPtd the town offiocrortnrployx.Either ehack the appropriate line A)through D)and/or des nbe in the space ptorided. The town officer or employee or his or her spouse,sibffn&parent,or child is(check all that apply): _aA)the owner of greater thtut SX of the shares of the corporate stock of the applicant (when the applicant is a eorpondiony; 8)the 160W orbenefreW ownerofury Interest In a wn-capar le entity(when the E1applicant Is not a corporation); C)an officer.director.pardr i.or dmployee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSW c� �3 Submittal thislfdoay 20 Signature i Print Ntrtte -�A-) 12 (161— Form IS I // Board of Trustees App].; tion AUTHORIZATION (Where the applicant is not the owner) owners of the property identified as SCTM# 1000_ � r� - C' J ' in the town of New York, hereby authorizes I 1 Gt yl to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold To`vn Board of Trustees for this property. Property Owner's Signature Property Owner's Signature �d SWORN TO BEFORE ME THIS DAY OF art . 20 2 3 %0%111111111.11�// •SAI +50.; :ti.o O:• .STATE OF '� = Public .TENNESSEE tary TARP 'yt PUSUC �'' AN Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it 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 NAMEla - — ( �� --j,� �� d��ccC�l�l The Application has beenJs�u�bmitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees [4 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: � � r I I &w toan- 2.X e SQA 51—Ce- 0-41,d Lt YOU,T ' 1 Location of action: 700 Site acreage: 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: C i (a) Name of applicant: ❑ l l ,.CLA„ (b) Mailing address: (c) Telephone number: Area Code 3 (d) Application number, if any: Will the action be directly undertaken,require finding, or approval by a state or federal agency? Yes ❑ No L"I 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 Q 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 Not Applicable 1 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 Q 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 F] Yes 1:1 No u 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 1:1 Yes [:] No u 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. ❑ ❑ El Yes No Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ No [Not Applicable Attach additional sheets if necessary Policy S. 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 1:1 No u 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 i 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. ❑ 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 orate s. See LWRP Section III–Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes 1:1 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 forevaluat'on criteria. 1:1 Yes ElNo Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III–Policies; P ges 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable PREPARED BY CV TITLE C QWVcLc ja — DATE a .-r a-3