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HomeMy WebLinkAboutTR-10419A Glenn Goldsmith,President so Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President ®V ®� � ® P.O. Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gillooly @ Telephone(631) 765-1892 Elizabeth Peeples • �® Fax(631) 765-6641 WWI BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10419A Date of Receipt of Application: July 7, 2023 Applicant : Brian O'Reilly SCTM#: 1000-70-5-31.1 Project Location: 659 Pine Neck Road, Southold Date of Resolution/Issuance: July 19, 2023 Date of Expiration: July 19, 2026 Reviewed by: Elizabeth Peeples, Trustee Project Description: As-built 6'x24.3' (145.8sq.ft.) trellis, and as-built 4'x9' (36sq.ft.) outdoor shower. Findings: The project meets all the requirements for issuance of an Administrative Permit.set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by Anthony M. Portillo, RA, dated April 25, 2023, and stamped approved on July 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 d termination from an other agency. A Nicholas Krupski, Vice-President Board of Trustees 2414• p_, Q I l T.Anow 1 I 4M•wcm PIG. Q / is ewsr. EMST. M)EXW LL! 2SN00%91 DH. 4',1Y>O'&k M. 213-AW"DK Lu cu Ll (y) I o O N F I � F Fr I I � O —0 STOOP ) + d'L)>_CO L O cmzo —•1p I I n" E705T. co(.0 V GREAT _ I ROOMI _ c AXON �, 04- II I I � I � 0 cm 4 }' 1 1 fdltI� O R O O C N EXIST. dy I + II Q d 0 � I IXx i YC L TLIONr Ow� YM1 TC4-E00 W F � I r EKI9T. -0 RoomI �_ _R f I ! ern y .(... fl 0 I 1 11618 ❑ L ! (3 Q 1 • 1 F 607TM6 LON71T101b041420?2 I - far. - U [112ew6n1I6 f.0lOITI0IO 04x2022 E)9@Z o •': FAM ) s MUST- � emsm EXL4I. I` ) CA_ BATHROOM Q •� -- L „1 DOOR ATTG wsG 1 57 I 11 /l I yMiA,ID,,, Lv-1 Q �;NIFINI' O F O 'o Eat@L MST, STE _S�L E>ftL n yam,. OIL TNl. GGT. PMB EXNJT. EMT. EXIST. p09T. 2'6YIM'211 BLIDM 2'61607X mLmGt 2'OHW7M DM GGT 767^0(4171 DH rLfOt O 5 10 20 O 5 SO 20 EXISTING BASEMENT PLAN GRAPHIC SCALE ue_1'-0 EXISTING FIRST FLOOR PLAN MGM ICSCALE 18"-Sb 646 S.F. HABITABLE SPACE SCALE: Ile'-V-0• 1223 S.F. HABITABLE SPACE SCALE: va•'1'-0' W 0 U I7-11 _ - E�d- Li lI — oa == L u U PROJECT: O'REILLY RESIDENCE EAST ELEVATION (RIGHT SIDE) WEST ELEVATION (LEFT SIDE) 659 PINE NECK ROAD SCALE: 11e., V-0. scALe: va•- r-o• SOUTHOLD, NY 11971 DRAWING TITLE: EXISTING FLOOR PLANS EXISTING ELEVATIONS PAGE: E-2 455Fril 17-1 nri Frf��--lr E 0i-. eI DATE:04/25/2End, u --1.3 I. _- JUL - 7 2023 .�I�. ,4��'�pA L Snuthcl"Town � •� "11 Board of Trustees 4 P' ""J SOUTH ELEVATION (FRONT) Sf } a; SCALE: I/W = V-0• NORTH ELEVATION (REAR) t 0F i9 SCALE: 1/8•- V-0. S.C.T.M.# DISTRICT: 1000 SECTION: 103 BLOCK: 9 LOT: 12 r� EEIE =--- 7 11 Roard of Trlsi^es WILSON ROAD Z" f 16 , DWELLINGS w/PUSUC WATER 15 t 150' 13 t EX,STING REAR DECK , '% 14 %, LAND N F OF TO REMOVED -,.11 384.771 wm PEGGY SCHWARV _ owmt \ - - ` ' 11 4 51 Z �� 9 `10 . PORCH ` -___ ,�.__ -- i1' w.M. UA 16 ` a ' \ N 84°09 40 g \ y= 2 3 1' 349-S" SIX iIt .1 ;'g► ;' - - , ;::.,�, t , t 1 , , + X11 r / /t':. :.:. i :::::::ti: r[ s,,\,�+ \ ► ` t / i m 1 1 I I y121 / I+Z tX1T......iii{i: ii«o y ♦♦�`♦��������� \ \V,, y I�a•1` i:i?.+.•.;� •F'•i K��\���������� �\ \ \ ,4 ......... B"tA Ol�j1 `15 DWEL NGS�3 . w/Pusuc WATER VODOW �:STY fRM150SWT I I rr ,, '.::4:..ZONA(L 8) 84 0,I ` . : •:!'•:.`•ti• Y \ V •�:r:�•�{::�•;:.: \ 1 \ 1 AN w Hua \ \ ttooD 1 \ r \ 1 � / \ , 1 t \ t \ t s \ / t 1 \ 1 \ I t 11 TQ ;x'..'..........•.1..11' -.• •.�;= : y�!d;'• ::' � 14 � \ 1 4 75 CNS \ �\ Mf POLE FUG Pow i / i \ \ �`� CE►t�R N ,.t-: ::;.% ` I \ u t ��, �,�;p { \\ /'� / i ► i `�\ A� (31TO BE RETIA�l + ` 1 MDw! / + 1 \1 + \ '�\ •::;;:2�:;�: ; - / ;' ;1 � ; 95.561 ►..1 U.P. NE 00 \ ' it `�T \\ 4`'rte' ;;;`;. ;: `+ �' 1 + 1 12 I .i``` :'`:: / 3.5N i 10 DWELLINGS + W/PUBLN: WATER 150' ZONE WEL 1) \\ZONE,E(a.e) 00 wEOW 4 LAND N/F OF \ EILEEN OAKLEY S 81003'0011 W \\ 40 U 20 40 80 160 ELEV. 12.5 ' THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL SM ANDY LOAA4 0.0-2.3 FEMA MAP 36103C0164H LOCATIONS SHOWN ARE FROM FIELD OBSERVA77ONS AND OR DATA OBTAINED FROM OTHERS. SILTY AREA:83,460.17 SQ.FT. or 1.92 ACRES ELEVATION DATUM: NAVD88 SM SAND 2.3'-3.1 ' UNAUTHORIZED ALTFRA77ON OR ADD177ON TO THIS SURVEY IS A WOLA77ON OF SEC77ON 7209 OF THE NEW YORK STA 7E EDUCATION LAW. COPIES OF 7741S SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VAUD 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. MIXED SAND7HE OFFSETS OR DIMENSIONS SHOWN HEREON FROM 7HE PROPERTY LINES 70 THE STRUCTURES ARE FOR A SPEC117C PURPOSE AND USE THEREFORE THEY ARE S '-1 .5 TO' NOT INTENDED TO MONUMENT 7HE PROPERTY LINES OR GUIDE THE EREC7701V OF FENCES, ADD177ONAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS & 3. AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT 7HE 77ME OF SURVEY HIGHEST EXPECTED ELEV 2.0 GRAVEL SURVEY OF:DESCRIBED PROPERTY WATER ELEV 1.0 CERTIFIED TD:DANIEL OAKLEY; EILEEN OAKLEY; WATER IN MAP OF: SP MIXED SAND 11.5'-18.0' FILED: GRAVEL SITUATED AT:CUTCHOGUE TOWN OF:SOUTHOLD KENNETH-M WOYCHUK LAND SURVEYING, PLLC MARCH 14, 2321 SUFFOLK COUNTY, NEW YORK 01 Professional Land Surveying and Design SHAWN M. BARRON M.S. ,1' P.O. Hoa 153 Aquebogue, New York 11931 FILE #221—136 SCALE: 1"=40' DATE:AUG. 19, 2021 N.Y.S. USC. NO. 050882 PHONE (831)298-1588 PARC (831) 298-1588 v;16,,n Goldsmith,President � S1 x.049, " Town Hall Annex A.Nicholas Krupski,Vice President s 54375 Route 25 0 Eric Sepenoski W ,? P.O.Box 1179 Liz Gillooly �A • o�� Southold,NY 11971 Elizabeth Peeples l �a Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: 1 123 Completed infield by: la-Y,246fA Pep-ple,S AMP Architecture on behalf of BRIAN O'REILLY requests an Administrative Permit for an as-built 6'x24.3' (145.8sq.ft.) trellis, and as-built 4'x9' (36sq.ft.) outdoor shower. Located: 659 Pine Neck Road, Southold. SCTM#: 1000-70-5-31.1 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other Typ,p of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: Skya.talnk vvm4 J Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly ✓ E. Peeples t SURVEY OF PROPERTY N ® TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. JUL " 7 2023 1 SCAi�0540'1 JULY 26, 2001 JULY 29, 2022 Southold Town JANUARY 26, 2023 (TREE LOCATIONS) Board of Trustees eJ cy CAIF HEWN KV4,y^4pOMb'yK C•� Wvu xup \\4ro TREE U % d� � rEND WE '�ry X10 Q � st�0— cm 7� 4SpyALr0 / Dvv% 0.2'N tBA4L,Q,tyD r`""oa z 9 � '?� �� "���� ''`�n'�'"'''l\ � � °��Ev SRN"•BE'`'^aa Y < N Q LAWN wwwk \¢¢ °E' °/ }�, ,a MAX SLOPE •�' 12.0' VERTICAL DROP 44.0' HORIZONTAL LAWN I �° 12'/44 = 0.27 OR 27% J 3 I LAWNIDGE / 'EDGE OF�� WO DSF U POLE �✓ .h Cry WOODED AREA EDGE OF ChW O WOODS p PCLE O 3 ; $ ONW W 13-TREE WOODED AREA �1. 27'CIIERNY �1I� Z � 25•pAR Y IYTREE ,B'TREE a -- -- -- ----S83 27'30'e �r EL,4,g 70.76' WOODED CUF EL74,8' AREA z z !K S { 11-TREE -Y'�� ".IR LL p o 0 � EDGE OF �I oAR ,2'iREE 3' WOODS IyB'TRET V<q' Z q N y -"TREE -WWll7T' f U �{ ,1'IREE w SN OE �` � iB'iREE II. A E 3 V ` 12-INE, WOODED AREA ELI 5- 3 ON EN -� AIN D RT S �48�(fEMC'E o a ���if 9 FE 'F°p 83'45'00" yy ONO p p� yy �^ Wxn,ENCS 4 ESERIEN DE OMA�E ON 0. O. x162.0 �'z�2' .OTR 2N ENON Y E o o.a'w c) O J N r i A `I C3 Q w r N/O/F �. MARK E OSMER ' wDWELLING USES PUBLIC WATER 3 M � T I {ry�� l ��S O (PF nNG O R or�,fkF[L M � r F�"I z Z � 3 633' Ry r � e• EL7g.gg' LE INC) EDP CMF WATER ME1ER . 20.00' U P E� EDP KEY N83•45'00"yy cMF EDP Q RKU EBAR PINE—sE a&g rlNlJ �P.�E OF NE{y rAK 49 TEST HOLENECK ROADa�`�J MFS°� • m PIPE ■ —NLNTUMENT § ro.a m U110TY POLE �F WtT LAND fLA0 TREE EANDt ELEVATIONS REFERENCED TO N.A.V.D. 1988 HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYORN.Y.S UC.NO.O3 N.Y.I UG Ni WHOSE SIGNATURE APPEARS HEREON. PEIXWlO SU A4%P G ANY ALTERATION OR ADD17ION TO THIS SURVEY IS A VIOLATION AREA ® 63,056 SF TO TIE LINE �E)783-w FAx,,pt 763-7787 OF SECTION 72090F THE NEW YORK STATE EDUCATION LAW. p.a PK09mMTr�EptmlAanet EXCEPT AS PER SECnON 7209-SUBDIW570N 2. ALL CERnRCATIONS or 1.447 ACRES 12J BRAM 11J0 7RAYQER STREET SOUTNOLD,N.Y. 11971 of t f } "'� �� �•- ~�tJ ,�'�;jam '""")m a,"`',s t� .',. z, i As-Built Outdoor Shower to Left "a` �a�� s h. O'Reilly Residence-659 Pine Neck Road Applicant:AMP Architecture All Photos Taken:April 18,2022 n j + t = a r 1 , Y 1 1 _ - ��. � • 1 ����` to-_^ n .as ,y i y r t r r 17 • 4 �4! t :. As-Built Trellis O'Reilly Residence-659 Pine Neck Road Applicant:AMP Architecture All Photos Taken:April 18,2022 .eesEc.N°� ,E ,6N re SEE sec No.m3 y wrcR .ro uATCN z IµW �,CI' ylE3T NN1 RD I,nY / ,.ka Lown creek b 1 2 � a TMAI a sanRan Oaa6ot __ p onasat �• + 2 b � 1 WW 16, 31 ,.wcl n.wW ,aeez us 3 421 31 9e.WW � w 12-1902 C Bwi�k gg1TIKK➢SCNOOl DI3TRN:T N05 6 pI � k liA � � 06,2-02 e6 " 68 to 'c N 0 ({•.�. _ 00609 lk� 0693ro —ter v W ae ,� 4 1pp` 1I• �'" 32Nd ' r' N e6w13 ro0.610 .01 3 FJR PGL ND. n ,T` 5 3 p y� % 1• ��. ni Z •' b. 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Located: 659 Pine Neck Road, Southold. SCTM#: 1000-70-5-31.1 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 as-builts are INCONSISTENT with LWRP Policy 6.3 and, therefore, INCONSISTENT with the LWRP. 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 t3�~ Glenn Goldsmith, PresidentTown HallAtinexYti"�pF S�(/j�, A. Nicholas Krupski,Vice President #" P.O.Box 1179 �O� pfO''AM 54375 Route 25 ki Eric Sepenoski 1, Southold, New Mork 11971 Liz Gillooly Telephone 631) 765-1892 Elizabeth Peeples , �ybtM`Y RMC(gal)E5-�64V E E�.,t, D LJC —— courr����.0 k�. BOARD OF TOWN TRUSTEES At — 7 2nP3 TOWN OF SOUTHOLD This Section For Office Use Only I Board of Trustees Coastal Erosion Permit Application Wetland Permit Application _Administrative Permit _ Amendment/Transfer/Extension Received Application: -7.TZ-5 _Received Fee: 5?6P. Completed Application: 7,/0•Z Incomplete: SEQRA Classification: Type I__ Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): 1C LWRP Consistency Assessment Form Sent: CAC Referral Sent: 1C Date of Inspection: Receipt of CAC Deport: __Technical Review: X Public Hearing Held: Resolution: Owner(s) Legal Name of Property (as shown on Deed): Brian O'Reilly Mailing Address: 72 Oak St Floral Park NY 11001 Phone Number: 917-583-2168 Suffolk County Tax Map Number: 1000 - 70--05-31.1 Property Location: 659 Pine Neck Rd Southold NY 11971 (If necessary, provide LILCO Pole #, distance to cross streets, and location) AGENT(If applicable): AMP Architecture (Anthony Portillo)_ _ Mailing Address: PO Box 152 Mattituck NY 11952 Phone Number: 631-603-9092 Email: bepperson@amparchitect.com _� Board of Trustees Application GENERAL DATA Land Area(in square feet): Total: 63056 S.F. Total Landward of Wetlands: 60772 S.F. Area Zoning: R-40 Conforming Previous use of property: Residential Intended use of property: Residential Covenants and Restrictions on property? _Yes __z _No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? ZYes F-1 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 _Z_No If"Yes", please provide copy of decision. his project re any demolition as per Town Code or as determined by the Building Dept.?r� Yes No Does the structure(s) on property have a valid Certificate of Occupancy? Yes F-1—No Prior permits/approvals for site improvements: Agency Date ❑✓ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?fl No ❑✓ Yes If yes, provide explanation: Project Description (use attachments if necessary): _ As-Built Trellis: 6' x 24.3' - 145.8 SF As-Built Outdoor Shower: 4' x 9' - 36 SF Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Legalize as-built outdoor shower & trellis Area of wetlands on lot: 2,284 ____ square feet Percent coverage of lot: 3.6 % Closest distance between nearest existing structure and upland edge of wetlands: 38.7 feet Closest distance between nearest proposed structure and upland edge of wetlands: 42.6 feet Does the project involve excavation or filling? ❑✓ No Yes If yes, how much material will be excavated? 0 cubic yards How much material will be filled? 0 cubic yards Depth of which material will be removed or deposited: 0 feet Proposed slope throughout the area of operations: < 1 Manner in which material will be removed or deposited: N/A Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason,of such proposed operations (use attachments if appropriate): Minimal affects. Both the trellis and outdoor shower are open to above and do not create runoff 61Z20 Apperu[ix B Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: O'Reilly Residence Project Location(describe,and attach a location map): 659 Pine Neck Rd Southold NY 11971 Brief Description of Proposed Action: As-Built Outdoor Shower& Trellis Name of Applicant or Sponsor: Telephone: i AMP Architecture (Anthony Portillo) E-Mail: bepperson@amparchitect.co! Address: PO box 152, Mattituck NY 11952 City/PO: State: Zip Code: Mattituck NY 111952 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 W1 ❑ may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes, list agency(s) name and permit or approval: ❑ DEC , Southold Town Building Dept. and Suffolk County Health Department 3.a.Total acreage of the site of the proposed action? 1.4 acres b.Total acreage to be physically disturbed? U acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 1.4 acres 4. Che La 11 land us at occur on,adjoining an ar the prop action. Urban Rural(non-agriculture) �lndustrial Commercial ❑✓ Residential (suburban) Forest ❑Agriculture ❑✓ Aquatic ❑Other(specify): _ Parkland Pane I of 4 5. Is the proposed action, NO_( YES C N/A a. A permitted use under the zoning regulations? b.Consistent with the adopted comprehensive plan? 6. Is the proposed action consistent with the predominant character of the existing built or natural # NO YES landscape? FF I I ✓ 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: 4 � ❑ j 8. a.Will the proposed action result in a substantial increase in traffic above present levels? f 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: T T ❑ # s 1 10. Will the proposed action connect to an existing public/private water supply? �,NO YES If No,describe method for providing potable water: ❑ 11. Will the proposed action connect to existing wastewater utilities? E NO YES If No,describe method for providing wastewater treatment: ❑ W1 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic ( NO YES r Places? b. Is the proposed action located in an archeological sensitive area? 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? b. Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ✓ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: i I 14. ntify the typic bitat types that oc n,or are likely to be found on t roject site. Check all that apply: iaWetland Shoreline Forest Agricultural/grasslands Early mid-successional 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 If Yes, a. Will storm water discharges flow to adjacent properties? ONO OYES ( Z El t b. %VIII storm water discharges be directed to established conveyance systems ff an¢ m drains)? If Yes, briefly describe: CINO L—YES r Pane 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES I 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: _ __w _ _ ❑ 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: 7 ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsorname. AMP Architecture (Anthony Portillo) Date:07/06/23 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 zoning El 1:1regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑ 3. 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 El 1:1establishment of a Critical Environmental Area(CEA)? S. 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? EJ 1:1 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ ❑ a. public/private water supplies? b.public/private wastewater treatment utilities? S. Will the proposed action impair the character or quality of important historic. archaeological; ❑ architectural or aesthetic resources? I. 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ D waterbodies,groundwater,air quality,flora and fauna)? r Page 3 of 4 No,or [Moderate small to large impact impact may may i occur occur j S e 10. W ill the proposed action result in an increase in the potential for erosion,flooding or drainage 1:1 ❑ i problems? 11. Will the proposed action create a hazard to environmental resources or human health? 0 El Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part Z 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. F1Check 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(ifdifferent from Responsible Officer) PRINT Page 4 of'4 Board of Trustees Applica__'n AUTHORIZATION (Where the applicant is not the owner) I/We, U N14L, owners of the property identified as SCTM# 1000-70-05-31.1 in the town of Southold ,New York, hereby authorizes AMP Architecture to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. CJ wner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS l DAY OF , 20 2� Notary Public MARY O'REILLY NOTARY PUBLIC,STATE OF NEW YORK Registration Na 02OR6107270 Qualified in Nassau County Commission Exfiires March 03.2024 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 emQlo-Ms The nuraose 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.�Q (� I YOUR NAME: (Last name,first name-jpiddle initial.unless you aro 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 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 descAbe 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 50/6 of the shares of the corporate stock of the applicpnt _n (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,partnei,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitte this syM20?-3 Signatu Print N ' iL Form TS 1 Board of Trustees Applica Dn AFFIDAVIT Voun �. Q �1�'� 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 WORKWILL 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. J ignature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF 4°`� , 20 3 otary Pu lic MARY O'REILLY NFOTARY PUBLIC,STATE OF NEN YORK Registration No.02086107270 (Qualified in Nassau County Commis,iot, Ncirch 03.2014 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 purvose 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: Anthony Portillo (Last name,first name,ipiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee ✓ Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) _ Do you personally(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 F-1 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): LLA)the owner of greater than 5%of the shares of the corporate stock of the applicant L2 (when the applicant is a corporation); 13)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 6th day of June 2o23 Signature _ Print Name Anthony Portillo Forth TS I M 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,,fistinLy 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# 1000-070 -05 -31.1 PROJECT NAME O'Reilly Residence 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: Legalize As-Built Outdoor Shower&Trellis P Location of action: 659 Pine Neck Road,Southold, NY Site acreage: 1.4 Acres Present land use: Single Family Residential Present zoning classification: Roo 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: AMP Architecture (b) Mailing address: Po Box 152, Mattituck (c) Telephone number: 631-603-9092 Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No❑✓ If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑✓ Yes ❑ No ❑ Not Applicable The existing residence,as-built shower and trellis maintain the character of the neighborhood and are situated at a similar distance from Wetlands as neighboring properties 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 Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the 'Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑✓ Yes ❑ No❑ Not Applicable The AS-built shower and Trellis do not hinder any scenic views from Jockey Creek Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑✓ Yes ❑ No ❑ Not Applicable The AS-Built outdoor shower and Trellis are both open to above and do not create any excess stormwater Attach additional sheets if necessary --i--- Policy 5. Protect and improve water quality and supply in the 'Town of Southold. See LWR.P Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No ONot 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. ❑ Yes ❑No W] 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 0 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 ❑✓ 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 WORIKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LVVRP 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 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 LW12P 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 LWIIP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑Yes ❑ No 0 Not Applicable PREPARED By AMP Architecture TITLE Architect/Applicant DATE