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HomeMy WebLinkAboutTR-10517A Glenn Goldsmith, President *®f SO Town Hall Annex ®� ®� 54375 Route 25 A. Nicholas Krupski,Vice President ® P.O. Box 1179 Eric Sepenoski 18 Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples a® Fax(631) 765-6641 COUN11,� 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 1St day of construction % constructed When project complete, call for compliance inspection; 3 2'-0"± \6,� Paul H Bosco Architectural Drafter 0 P.O.Box 2473 Aquebogue, NY 11931 631 .375.7374 pauldrafter.com v , structural reviewed by Condon Engineering, P.C. I � L_ L-------------------------------------------------------�_J 1755 Si sbee Road foundation line beyond foundation line beyond g Mattituck, NY 11952 631 .298.1986 SEAL NEWco yo — — — — — — — — — — — — — — — F_ - - - - - - - - �► I Foundation Notes: CtfThe contractor is to verify all measurements in the field and any discrepancies are to be brought to the attention of the Engineer prior to construction. ,n '---- 1 - All concrete 4,000 psi after 28 days minimum. ,r�FESSI�\vP� 2-All rebar ASTM A-615 Grade 60. 3- Footings are to be installed on undisturbed virgin soil. The bottoms of all footings are to be installed a minimum of 3' below grade unless indicated otherwise. PROPERTY OWNER 4- Rebar installed along the top of the foundation walls without windows are to be installed 10"below the top of the foundation wall. Rebar installed along the top of foundation walls MATTITUCK VETERANS _ with windows are to be installed 3"below the bottom of the window opening. MEMORIAL BEACH M 5-All snap off form ties are to be removed and remaining openings are to be sealed/grouted. ADDRESS A S-1 6-The foundation contractor shall coordinate with the plumbing and electrical contractors 11280 PECONIC BAY BLVD relative to installation of sleeves and other penetrations prior to pouring concrete. Mattltuck Park District 7-The Engineer is to be contacted if unacceptable or questionable soil is encountered Town of Southold, NY during excavation. Unacceptable soil is soil containing clay and/or organic material. II PROJECT NAME 8- Install isolation joints along foundation walls and at column and other floor penetrations. 9- Foundation excavation is not to be back filled prior to the installation of the floor Ocean Front framing. CABANA 10- Backfill along foundation walls is to be clean material and is to be mechanically CONTRACTOR compacted in 6" lifts to 95% of maximum dry density. L� - - - — - - - - - - I Slab Site Preparation L— —I *The area where the slab is to be installed is to be excavated to the necessary elevation to meet the final top of the slab elevation shown on the Architectural drawings. SOUTHOLD TOWN LICENSE# Foundation DetailsPlan *The areas where the slabs is to be installed are to be Proof Rolled in accordance with A ACI 302.1 R. The Engineer is to be notified if unacceptable soils are encountered during DRAWING NAME Scale: 1/4" = 1'-0" excavation and if Proof Rolling produces results that exceed ACI standards. *The excavated areas along the stem walls and footings are to be back filled with clean 29'-0" material and mechanically compacted with clean fill in 6 inch lifts. Each layer is to be SCALE compacted to 98% modified proctor. as noted * Base Material layer shown on the drawings is to be a compactable, easy to trim, granular fill that will remain stable and support construction traffic. A clean fine-grained material with NOTE proposed 6" concrete slab cabana floor at least 10 to 30% of particles passing a No. 100 sieve but not containing silt, or organicWz_ r approximated rade Y approximated grade pp 9 APPROVED A :t w.. ..- ..:,r . .• ; A;. ••• -.•.' ••• : : . :, .; •.••A •• '` ••••: .. ••,r " �; •- ••� ..,.. 'A•: •-.• •: ,. ' • �'• .• •. .:.,• :; , ..: - : :•• . ., material is recommended. BOARD OF i taUSTEES i ..: '• Slab Notes: TOWN OF Sfl UTHOLD ♦'• , ••d, �` •' •• * Isolation joints are to be installed between the slab and the walls. Use preformed joint DRAWING NUMBER 6x6 welded wire mesh : ' filler that is to be cuts inch below the slab surface and the resulting joint is to be filled with DATE T1 �7r �Zt WIT#CB0823VM • y a an elastomeric joint sealant. 4" minimum thick gravel a. : __y _ Drawn (maximum 2" m rock) ' °�. *Contraction joints are to be installed as shown in the drawings and are to be Ya the i 08i-15-2023 thickness of the slab but not less than 1 inch deep. *The welded wire reinforcement is to be placed in the top third of the slab and is to be SHEET vapor retarded (plastic sheeting) adequately supported by precast concrete bar supports to assure that the reinforcement is (compacted or previously held in position during concrete placement and finishing. undisturbed sod) s-a Plans are prepared by Condon Engineering,P.C. It is a violation of the New Yak State Education a Law,Article 145,Section 7209,for any person unless acting under the direction of a licensed E Professional Engineer,Architect,or Land Surveyor,to alter an dem in an way.If an item bearing 29 the seal of an Engineer,Architect,or Land Surveyor is altered,the altering Engineer,Architect,or I Land Surveyor shall affix to the item his/her seal and the notation'Altered by"followed by hMerJ A H - 4 2024 Foundation Details �o signature and the date of such alterations,and a specific description of the alteration. r ul 77: A Scale: 1/2" = 1'-0" 803rd of i rL-' Simpson MSTA 3 14'-14" 14'-14" — — — — 5.25 116 Plus PSL I I I I Simpson H impson H8 I W I I I I 1 I I I I I Paul H Bosco 1 Roof Section Details 0 Architectural Drafter c� 2x10RR N 2 1 1 ci 2 x 10 RR � SIN 1 i 02 I O O I O O X 16"OC X 16"OC °' X (A)—Scale: 1/4"N N N = 1'-0" M M v P.O.Box 2473 I v Aquebogue, NY 11931 1 x 6 Post I I I I 631 .375.7374 C 5.25 16 Plus PSL — � _ _ _ L _ _ � _ _ _ � _ pauldrafter.com S-� 16no� oR 1oR� R �s"o 2x10 RR 2x10 RR12 2� C Simpson BCS 3/ c.i 16"OC c� 16"OC `'� N o olumn Base A X X X M Zone 1 Zone 2 Zone 3 s-z M M Ce) structural reviewed by y v 5.25 x 16 Plus PSL ; ; Field s" OC 12" OC 4" OC Condon Engineering, P.C. 5.25 16 Plus PSL v, 4„ 4"to Panel Edges s" oc s" oc 4110 C 1755 Sigsbee Road — — — — — — — Mattituck, NY 11952 Nailing Requirements for 140 MPH, 3 Sec. Peak Gust, 631 .298.1986 B 4, 5 4 x 5 4 Plus PSL- 4" 2" Thick Roof Sheathing with 8d Common Nails or 10d Box Nails s-i I - 2 x 10 RR 4) 2 x 10 RR 4 x 54 Plus PSL 00 Roof Sheathing Nailing Details 1 16"OC :a 16" OC r-lN weld column plate 10"x 10"x'/2'base 1 Scale: 1/8"= 1'-0" � SS6X6X 5 ,. SS6X6X N N 1 N 1 2 with (4) /8 0 x 1 2 long anchor bolt 2 I � V— 0) X X X SEAL N N N 1 4° 4" ce) c i ro o5ed 6" concrete 51ab cabana floor approximated grade ��(�QF NE W 5.25 i 16 Plus PSL o IL�6x6 welded wire mesh 4" minimum thick gravel (maximum 2" 0 rock) Framing Notes: 16 vapor retarded (pla5tic 5heetmg) 'r 3 a (compacted or prev,ou51y 1. The contractor is to verify all measurements in the field and any discrepancies are to be brought to undisturbed Soil) the attention of the Engineer prior to construction. 29'-0" 29'-0" 2. All lumber is to be No. 2 or better Douglas Fir Larch (N)with the following minimum specifications: Section Details SSIO�P B Scale: 1/4" = 1'-0" Fb= 825 psi Fv=95 psi Fc perp=625 psi E = 1,600,000 psi PROPERTY OWNER • • 3. All Parallam (PSL) Lumber is to have the following minimum specifications: • Fb=2,900 psi MATTITUCK VETERANS Fv=290 psi MEMORIAL BEACH x 6 Post Fc perp=750 psi 5 4 x 16 us SL 8"0 Galv. Screw Bolt E =2,000,000 psi ADDRESS 8'0 Galv. Bolt 4. All beams fabricated with multiple Laminated Veneer Lumber boards are to be nailed/bolted in 11280 P'ECONIC BAY BLVD HSS 6 x 6 xZ ZHSS 6 x 6 xz accordance with the manufacturer's specifications. Mattituck Park District 5. All straps, connectors, plates, bolts, nails, etc. are to be galvanized or stainless steel. Designated Town of Southold, NY connectors, strap etc. on these drawings are made by Simpson unless indicated otherwise.All 4 x 5 4 Plus PSL connectors, straps etc. are to be nailed/bolted in accordance with the manufacturer's specifications. Ile PROJECT NAME F 1 6. All bolts nuts and washers are to be hot dipped galvanized. Ocean Front 5 4 x 16 Plus P Beam Connection Details Beam Connection Details l� Column Base Detail Steel CABANA C Scale: 1/2" = 1'-0" D Scale: 1/2" = 1'-0" Scale: 1/2" = 1'-0" 1. All steel is to be ASTM Specification A-992-50 CONTRACTOR 2. All steel used is to be Galvanized in accordance with ASTM Specification ASTM A123 5"0 Bolt Hole 5"0 Bolt Holes 10" 10" 3" ' ! 3. All bolted connections are to be made with A-325 Galvanized bolts. 1„ " 4 1„ 3" 5 4.. I 2" 5 4 3 2 -- — — ' — —1 SOUTHOLD TOWN LICENSE# M I 3. Square/rectangular and circular columns are to be ASTM Specification A500 Galvanized. — — --- — — — — — — — — — — — — — — — — — O ' 5'0 Bolt Hole - ih �` - I _ I j 4. All welded connections are to be done by a certified welder and conform to AWS and AISC DRAWING NAME - - - - - - - - - --- -------- I I I I - ----- - - - - �*- - - - - — -- - - - - - --- ; 1.. j 5. All weld tints are to use E70XX electrodes. -- - ------ -- - ---- ------------------- ------ a / I 3-1 3 2' I SCALE �• 3 2, 1„ 5 5„ — 6. Steel is to be prime coated. j 4 8 I - - - - - - - - - - - - 12„ i aSnoted All Plates are 2"Thick Galvanized Steel All Plates are 2"Thick Galvanized Steel '9° 3" 5 4' Beam End Saddle Detail Perimeter Column Base Plate Detail NOTE Scale: 1" = 1'-0" Scale: 1" = 1'-0" All Plates are P'Thick Galvanized Steel Beam Brace Detail Scale: T _ - DRAWING NUMBER WIT#CB0823VM 4 Drawn 08-15-2023 s"0 Bolt Hole a"0 Bolt Holes 5 R„ a"O Bolt Holes i 1., 3„ 3" 1„ 5 8.. 5"0 Bolt Hole 8'0 Bolt Holes 3ll 4 2 5 4 3„ SHEET „ 3., z" 3" Fh = _ j co ch - I 2 174„ 6 �- - - - - `- - - - - - - - - - - 11 - - - - - - - j � -!- - T- v7 I ch It `� ___ _ _ _ — — 1D— — — —__ `' Plans are prepared by Condon Engineering,P.C. It is a violation of the New York State Education „ Law,Article 145,Section 7209,for any person unless acting under the direction of a licensed — — 3 3-1- — — — 1i 31„ Professional Engineer,Architect,or Land Surveyor,to alter an item in any .If an item bearing 1„ 2 2 ----------- ------ ------------ ------ -- -- — ------ -- ------------------------ the seal of an Engineer,Architect,or Land Surveyor is altered,the altering Engineer,Architect,or All Plates are 2 Thick Galvanized Steel - 1„ _ 1 Land Surveyor shall affix to the item his/her seal and the notation"Altered by'followed by his/her – �,,) -° 5.. ' 1.. signature and the date of such alterations,and a specific description of the alteration. E. Column Base Detail 4 5$ 32 12" 5 5., 1, _ _ Scale: 1" = 1'-0" 8 4 All Plates are 2"Thick Galvanized Steel 12" `i J A PJ - 4 2024 Beam Central Saddle Detail All Plates are 2'Thick Galvanized Steel Beam Opposite End Saddle Detail Scale: 1 = V-0" Scale: 1" = 1'-0" Paul H Bosco x 6 Post Architectural Drafter P.O.Box 2473 Aquebogue, NY 11931 631 .375.7374 2 pauldrafter.com z �6 12 5 structural reviewed by Simpson BCS 3/ olumn Base Condon Engineering, P.C. 1755 Sigsbee Road Mattituck, NY 11952 631 .298.1986 5.25 x 16 Plus PSL , -H 1�� r 4 SEAL P.��OF NEW y0 J. coN • �„ 5 x �„ >°� �0 4 4 4 4 ,k r x °° us PSL � - 4 4 � weld column plate 10" x 10" x %2" base � ESSIO SS 6 x 6x2 with (4) 5/8" 0 x 12" long anchor bolt HSS 6 x 6x2 ]PROPERTY OWNER 4 ro o5ed G" concrete slab cabana floor 4 MATTITUCK VETERANS p p approximated grade MEMORIAL BEACH d •a t• ADDRESS • 11280 PECONIC BAY BLVD zo Gx6 welded wire mesh a: •� Mattituck Park District d a: • - 4" minimum thick gravel Town of Southold, NY . d ' (maximum 2" 0 rock) PROJECT NAME vapor retarded (pla5tic 5heeting) Ocean Front 6� (compacted or prev1ou5ly CABANA undl5turbed 5011) CONTRACTOR 29' Section Details SOUTHOLD TOWN LICENSE# Scale: 1 /4" - V-011 DRAWING NAME SCALE as noted NOTE DRAWING NUMBER WIT#CB0823VM Drawn 08-15-2023 SHEET Plans are prepared by Condon Engineering,P.C. It is a violation of the New York State Education Law,Article 145,Section 7209,for any person unless acting under the direction of a licensed Professional Engineer,Architect,or Land Surveyor,to alter any item in any way.If an item bearing r _ the seal of an Engineer,Architect,or Land Surveyor is altered,the altering Engineer,Architect,or Land Surveyor shall affix to the item his/her seal and the notation'Altered by'followed by his/her signature and the date of such alterations,and a specific description of the alteration. Ll I JAN - 4 2024 1 6 4 r. Board of T^Sf,cs Sluwv OPERTY SITUAT E.* =4 , CIC TOWN: SlUFFOL14: COUNNEV, SUF=FOLK COUNTY TAX #'5 1000 — 126 — 6 — I-7 1000 - 126 - 6 - 18 SURVEYED: JUNE 23,2006 o 5EPTIG 6 ADDED JULY 0, 200 x�lkCERTI=TO: siPs^ N/att'ite^l Pek Disttict pl o C ' V \ eA 0 m 7 N ° j ------- gozebo �\ \+\ ° O IL \ + O O O sig,-y \\ p /� F � o\IL pc 4a''Q x Wo-'• t \ ------------- + `lt. \ x s xI \` \ 0 o x� o \ / OG O S Off°, °v P. CIL mo 0 a S'o 9 GoJe , Qq 104\00 S N \\ 11 0 o Q \ o \ za Al i, \�3(� V R I \ O/O °-\O 0 01 \ \ O/ � \ \ / - 3.4141 \ ; c C t+ a ! I i i F�°% ti° o o � r- \ O� 010 V 0 lty,� Of\\ i X61 �1 JAN r- 4 2024 Notes: ` MONUMENT POUND � (3oardi of Tn:s`.s cs �i /! vMann�x>roa a1teWLlon a amrto-,n to a wrvey 1=E.MA 1=LOOD ZONES AS ANNOTATED FROM FIRM MAP NO. 3610300482 6 DATED MAY 4, IGGB F�.a K.L— 'Only cop's from tM ork)Nol or Nls,I,r..ey TOrkBO su�tn,z.prtGMt p(11'e IdN g,irvoya'S \ .[omnpea Sea!&ia�Oe ccvl5lOe^B4 b Ue WKI Imb �jJ , S YC.er(Ifkatkrs trN•rdM Mrecm etontiy Mlpt tltt� AREA = 286,305 51= or 6.573 Acres „ bt+[tj com os rract¢e ro-t.ata�.veye m,>Fxea gat ns no�nll5m Ine Ln���of Froreso,r�l L�xntl 5nwynn 5rsb ur:Mkotbni SII rie:u.:ly tm[M pnroon for Nunn tM sway k pre( ae, yowArr.nan- ra a mercy mo Iw.yl,g w.uwcwn InLee r.areon.as N b tM,osakry.'rs of tb IerHh;Mntn�twn C iHKa- Lbres orn no[troeiwoM.b oaGl[4 I Yel4�[Idw G1aE JOFW C. ERS LAND SURVIEffOR 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 GRAPHIC SCALE I"= 30' RWERHEAD, N.Y. 11901 369-8288 Fax 369-8287 REF\\Compagserver\pros\06\06-20i3.pro Glenn Goldsmith, President QF sollr Town Hall Annex A. Nicholas Krupski,Vice President ,`®� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski A Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples ® �® Fax(631) 765-6641 C®Uit9T�,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10517A Date of Receipt of Application: January 4, 2024 Applicant: Mattituck Park District SCTM#: 1000-126-6-18 Project Location: 11280 Great Peconic Bay Blvd., Mattituck Date of Resolution/Issuance: January 17, 2024 Date of Expiration: January 17, 2027 Reviewed by: Glenn Goldsmith, President Project Description: Removal of a 20'x28' 1 'h story frame building with covered porch, and replace with a 32'x29' pergola. 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' Paul H. Bosco, Architectural Drafter, dated August 15, 2023, and stamped approved on January 17, 2024. 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. 4 41 "- Glenn Goldsmith, President Board of Trustees Glenn Goldsm ii,;'President �o�p �oGy Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 0 Eric Sepenoski P.O.Box 1179 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: ) 11IZIA Completed infield by: Stephen Kiely on behalf of MATTITUCK PARK DISTRICT requests an Administrative Permit for the removal of a 20'x28' 1 Y2 story frame building with covered porch, and replace with a 32'x29' pergola. Located: 11280 Great Peconic Bay Blvd., Mattituck. SCTM#: 1000-126-6-18 Typ of area to be impacted: Saltwater Wetland Freshwater Wetland Sound ✓ Bay Part of Town Code proposed work falls under: ✓Chapt.275 Chapt. 111 other Typq of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info need ed/Mod ificatio`ns/Conditions/Etc.: Present Were: ✓ G. Goldsmith N. Krupski E. Sepenoski L. Gillooly E. Peeples Nday 4, 202 ") a. 1 0 0, 0 I � j I , I �l �� Ll ��J Ll 1�1 I � r ,•a t I ` -= - -__ /V N n ited } ��_ _ �.� ■Sys ;ii { r Y t ` J rdr �"� � \ � r7vSr 1� �r�' .�''. FS'9' �<�' 'x��Z� "��.� �► � � e' �,.., -.`e' - �9�t f� ,/ -�yN ,� re =.� t` '^k�!���� � '.`� o+�a� �'o��s_'� y.:k.� y' �� n 3� � � r-„o-a y�"i Ar•.;' - 11j* ,,• �i ,.,� �•,� s::4Y�r.�y � i- 4C"'y f�i _ �'�'i.... 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L M,;;,�.�.,r. _ .^ .... ---_ ..._.. - •, COUNTY OF SUFFOLK© ri ME x SEc rlcry w.1 Kcaprp.1 I i-Agn„—) MarmtSsIlxw.ttuNx,r mcwoNNwMlTlur>xiwl.tx.laMa.Fw+mvawu na Y Nza° :�. w tro° 126w A(21) ._.___, V NK I I �oF soar OFFICE LOCATION: O� yQl MAILING ADDRESS: Town Hall Annex h O P.O.Box 1179 54375 State Route 25 1 Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) y Southold, NY 11971 G • Q Telephone: 631765-1938 � � olyCOU ,� 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: January 16, 2024 Re: LWRP Coastal Consistency Review for MATTITUCK PARK DISTRICT SCTM# 1000-126-6-18 Stephen Kiely on behalf of MATTITUCK PARK DISTRICT requests an Administrative Permit for the removal of a 20'x28' 1 '/2 story frame building with covered porch, and replace with a 32'x29' pergola. Located: 11280 Great Peconic Bay Blvd., Mattituck. SCTM#: 1000-126-6-18 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. It is recommended that the any new construction be designed to withstand flooding. 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 a ,,Q " Town Hall Annex A-Nicholas Kru ski,Vice Presidents 54375 Route 25 p P.O.Box 1179 Eric$epenoski ,.P` ;�3 Southold,New York 11971 Liz Gilloolysn - Elizabeth Peeples k, as t Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES JAN - 4 2024 TOWN OF SOUTHOLD This Section For Office Use Only Southold Town Board of Trustees Coastal Erosion Permit Application Wetland Permit Application Administrative Permit Amendment/Transfer/Extensio Received Application: � `�� =Received Fee: S ZSb. Completed Application: Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): K LV,/RP Consistency Assessment Form Sent: CAC Referral Sent: _ K Date of Inspection: Receipt of CAC Report: _Technical Review: _Public Hearing Held: Resolution: 1/w, PI .If P✓� CJMp11.�):J'�t7 Owner(s) Legal Name of Property (as shown on Deed): earl,t��rlr�cf-,Fll�F °F f k ^+#Muck P44 Mailing Address: P.O. &Y 111-9.0 ma ,4"Sle' N7 614jZ Phone Number: 01 A4r­9103 Suffolk County Tax Map Number: 1000- /z6 '6 1 + /P Property Location: 112 9'c) 6rca} Piem:1 R.4.., A h✓1 04#•/vik ,//1 to ]— T (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): 5h4t17 1'4%el-1 Mailing Address: A0. fir 4-6-7 . 141A V6k--, Na 11 J"Z Phone Number: Email: f cm'I"ZLg:2 114 C�� c,.«�:l • co,,►., Board of Trustees App] ation GENERAL DATA Land Area(in square feet): 2 X6a 3o r Area Zoning: Q" Yo Previous use of property: /*7 Intended use of property: p k L Covenants and Restrictions on property? Yes _IfrNo If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? flYes ZNo 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? JD_Yes �No If"Yes",please provide copy of decision. V�ill,�his project rany demolition as per Town Code or as determined by the Building Dept.? Yes L—LNo Does the structure(s) on property have a valid Certificate of Occupancy? F1' YesJK 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?ErNo_n Yes If yes,provide explanation: Project Description(use attachments if necessary): /lra,us f o{ / ��Z 5�'or� F�AMa ��,ld•�� ✓��� C�ytrtC� rJora� ,ar11 f��14�t wa�i� w If1tr®►•�A W��'►i�► (,, l P 44 S� ef.� wA. ;b•a0 k 3 A tT�Illig . LQI���"� � � � W 16-r 4 � 6 Board of Trustees Appl ._ation WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: /DrOW 1ifn 60e' J, 19p.h SC J 1 14 004 /d:.4 d; I, to y t rd d to re 4*4 A ple oge w J01 Area of wetlands on lot: —' square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: /2-0 +`+feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? 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): NoNt 61 Z20 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 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 l -Project and Sponsor Information Name of Action or Project: �q'�i!✓!I[. Qi}(I� IJ�S��i G'r J,/i�A�l9Aak� �f'd•���ry �(MOV4 / Project Location(describe,and attach a location map): 114P V/,fw� tuo,l 4 /fi.,1 /rlsil.�,.�,� Brief Description of Proposed Action: AIJ r0ww 11gl aF k ct OP"'W (✓MI's. � �J!/�o� 1r���.:t �k :qr� �t►A�►Iiw�Fl 41 Name of Applicant or Sponsor: Telephone: 5A/1&' J:;c` Al" 4 E-Mail: ecu9,46Jv-- M;I r co Address: / 49- box xi City/PO: State: Zip Code: 111,T2 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 [Rr F 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 otherlevernmental Agency? NO YES If Yes,list agency(s)name and permit or approval: S��(„1t T�v,. (�(dj, 'cvf r T/`r�k`f ■ El 3.a.Total acreage of the site of the proposed action? 73 acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Ch I land us at occur on,adjoining an the prop action. Urban Rural(non-agriculture) Industrial Commercial Residential(suburban) Forest [:]Agriculture Aquatic QOther(specify): Parkland Page 1 of 4 1 i 5. Is the proposed action, NO YES I 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 I Y landscape? Li LVJ- 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO 1 YES FK1 F] 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 wil I exceed requirements,describe design features and technologies: El Rr 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? b.Is the proposed action located in an archeological sensitive area? 13.a.Does any portion of the site of the proposed action,or sands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. tify the typic bitat types that oc n,or are likely to be found on olect site. Check all that apply: Shoreline Forest Agricultural/grasslands LJ Early mid-successional Wetland Urban Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO oYES by the State or Federal government as threatened or endangered? 19 F] 16.Is the project site located in the 100 year flood plain? NO YES I M-11 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? DO DES b.Will storm water discharges be directed to established conveyance systemsf andrains)? If Yes,briefly describe: CTO YES Page 2 of 4 I 8.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: _ M_._..��...� ❑ 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 T Applicant/sponsorname: U" !� ��T� Date: "l 2J Signature: __ Part 2-Impact Assessment. The Lead Agency is responsible forthe completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ regulations? 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? 1:1 El 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 F1 1:1affect 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 El available energy conservation or renewable energyopportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? E 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ architectural or aesthetic resources? 9_ Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? El Page 3 of 4 1 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 D ❑ 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. DCheck 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 App]'' �3tion �i AFFIDAVIT �-Jv ck, /��' �c� 1r- ij..rw' BEING DULY SWORN DEPOSES AND AFFIRMS THA /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. SignaturVof Pro erty weer Signature of Property Owner A6- At' SWORN TO BEFORE ME THIS `f Til DAY OF 20 2Y 51A- 111.4 + - Krist na Martin M disova / NOTARY PUBLIC,STATE OF NEW YORK Registration No.01 MA6422200 Qualified in Suffolk County o ary u 11 Board of Trustees Appl...:ation AUTHORIZATION i (Where the applicant is not the owner) I/We, ��V�� �k d�.�' Ifvgn rr-t owners of the property identified as SCTM# 1000 6 ' 179 1 Ir in the town of faha I� .New York,hereby authorizes awlxn 1"� 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. PropeAy Owner's Sfignature Property Owner's Signature Q1 a-Ain, SWORN TO BEFORE ME THIS 7 "l DAY OF J� ���'� ,20 F7 e Kristi a Martin M ' iso a NOTARY PUBLIC,STATE OF NEW YORK Registration No.01MAG422200 Qualilicd in Suffolk County O lc 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 emploXees.The mune of this form is to provide information which can alert the town of possible conflicts of interest and allow itto take whatever action is necessary to avoid same. .^ YOUR NAME. u; 0 1 . (Last n e,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 A#of 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 applicantlagent/repmsentative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space prodided. The town officer or employee or his or her spouse,sibling,parent,oir child is(check all that apply): J,A)the owner of greater than 5%of the shares of the corporate stock of the appiic*nt = (when the applicant is a corporations B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporations C)an officer,director,partneii,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this'i day-of 2013 Signature Print Name J k.. 1C, t: r Form IS 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 evaluated. as to its sigpificant 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(southoldtownnorthfork.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# __ _ 1-714 PROJECTNAME ,�+1„di~- .yk �I,i1J.z� 1.�•'�•, �f R Al4f,��1�1,1 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: s, &,-pbyl i Location of action: 0 2 e I.&Jeel- t(3l✓�, Site acreage: G•r 7 �y/�J Present land use: fi4 4fA 1.4(: &46� Present zoning classification: �C 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: fhelo, X& (b) Mailing address: is-V1 J6 7 Y" IJ6611C0 hi hof 'L (c) Telephone number: 142"? — — 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. LV Yes F� 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 M- [T ies Pages 3 through 6 for evaluation criteria Yes F-1NoNot 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 Ef Yes ❑ No❑ 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 Yes ❑ No❑ 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 throug h 21 for evaluation criteria E] YesEl No 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 ❑ Not Applicable Attach additional sheets ifnecessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. F Yes ❑No 2 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. F1Yes ❑ No I"1 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 trite 'a. yell No❑Not Applicable Attach additional sheets if necessary WOREING 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 M 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 1:1No D 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 LJ Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; ages 65 through 68 for evaluation criteria L]YesE] No " Not Applicable PREPARED BY �L!'�'' TITLE /h r DATE