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HomeMy WebLinkAboutTR-10603A �,�f S®���� Town Hall Annex Glenn Goldsmith, President 54375 Route 25 A. Nicholas Krupski, Vice President �� P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly CAP Telephone (631) 765-1892 Elizabeth Peeples ® `ram 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 F OKED OFF 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHE BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction '/z constructed When project complete, call for compliance inspection; Glenn Goldsmith, President QF S0 Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President ,`®� ®�® P.O. Box 1179 Eric Sepenoskii Southold, New York 11971 Liz Gillooly sos ,c Telephone(631) 765-1892 Elizabeth Peeples � a� Fax(631) 765-6641 c®UNT`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10603A . Date of Receipt of Application: June 26, 2024 Applicant: North Fork Realty Holdings, LLC SCTM#: 1000-88-5-65 Project Location: 1095 Watersedge Way, Southold Date of Resolution/Issuance: July 17, 2024 Date of Expiration: July 17, 2027 Reviewed by: Board of Trustees Project Description: Construct a 4' post and rail fence on East, West, and North sides of property. 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 Linda Perillo, received on June 26, 2024, and stamped approved on July 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. GleX41" GoldsmitY, President Board of Trustees LOT 54 "MAP OF BAY HAVEN " IVBLEP:E D 22 JAN. 19s9,AS FILE N0.2910 ATSOUTHOLD, TOWN OF SOUTHOLD F 2024 SUFFOLK CO., N.Y.1000- 88 - 05 - 65 Town SCALE: 1'--30' NOTE.THIS SURVEY IS NOT FOR TITLE PURPOSES. V p • ;e 8,*-r"`4144_ FPS HUO,o FIP FD--- V°Ai SBBe �OV \ 'DETAIL / O 4 c LOT 5o A% COMMUNITY BEACH 1 NOTES. AC:ASPHALT AP:ANGLE POINT / BC:BEG.CURVE \ LOT BG:BEGIN - RAQ SETS © BLD:BUILDING �'*C BLDR:BOULDER -STggqSZ� BS:BOTTOM STAIR 1- CE. CELLAR ENTRY &/LKy �/L 6/e�Q` CL:CENTERLINE EP.EDGE OF PAYING FH.FIRE HYDRANT 5EE DETA� � +�X Ham, S FF:FINISH FLOOR -,_ABOVE Nj?esj�+� C.� FS:FINISH SURFACE GB:GRADE BREAK GS.GAS SERVICE MO:MARK OUT NG.NATURAL�F^ OH:OVERHEAD GRADE Ow --- -- ---— - -- - PCC:CONCRETE IC — —.-- � REr:RETAINING WALL APPROVED BY S ROOF OVER LT:SLATE a BOARD OF 'I RUSTEES BEAD a TOWN OF SOUTHOLD IS. OPOF T`aR TW.TOP OF WALL DATE 3.,` `� ' ��`�� UIL:UPPER LEVEL WD:WOOD DECK O� � ETER y,�P THE OFFSETS OR DMIENSIONS SHOWN HERON FROM THE PROPERTYLINES TO • THE STRUCTURES ARE FOR A SPECIFIC PURPOSE d USE.THEREFORE,THEYARE NOTMITEND DTDMONUMENT THEPROPERTYLINES OR TO GUIDE THE ERECTION OFFENCES,ADDITIONAL STRUCTURES OR ANY OTHER II~VEMENT. Q l UNAUTHORIZED ALTERATIONS ORADDTIONS TO THIS SURVEYISA VIOLATION OF •.it BAR W/PLASTIC CAP 0 O 9 SECTION 7200 SUSDMSON 20 OF THE NEW YORK STATE EDUCATION LAW. COPIES UNLESS NOTED OTHERWISE OF TINS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S NOW SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. ■.CONC. MONUMENT TYPICAL LANDSU . 50869 CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM P.O. BOX 704 R GE, NY 11961 THE SURVEY IS PREPARED, AND ON THEN:BEHALF TO THE TITLE COMPANY,GOV- SURVEYED.13 APRIL 2022 ERNMENT AGENCY ANDLENDING INSTITUTION LISTED HERE ON. CERTFICATION.S UPDATE:20APRIL2024MONUMENTLOCATIONSONLY 631.849.4750 ARE NOT TRANSFERABLE TO ADDITIONAL INSTITZITIO RS OR SUBSEQUENT OWNERS NO RESPONSIWTY IS ASSUMED BY THE UNDERSIGNED FOR ANY SURFACE ELEVATIONS SHOWN HEREON sUe-suRFACF AERIAL EASEMENTS,sUasuRFACE UMMESAWOR ARE BASED UPON AN ASSUMED DATUM STRUCTURES IN OR OUT OF EASEMENTS IF SO PROVIDED. SCTM NO. 1000-88-05-65 � R ' S . OUTH, O. L.D . T S USTEE rro. lO(4vo3 A Issuedlro No� �or�c R,uaYy �to\a��ssDate AddresS ��; � �� „ Wa`Cersec�c�G� Sou�•old .THIS. NOTICE. MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE OW OF 30UTHOLD SQtJTHOLD, N.Y. 11971 TEL.: 765.1892 Glenn Goldsmith,Presiderif ti��\O -rep Town Hall Annex A.Nicholas Krupski,Vice President < 54375 Route 25 0 Eric Sepenoski w ,� P.O.Box 1179 Liz Gillooly �y • ��� 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:3vly 12,2o2A Completed infield by: E1,2A0?.-� Re�.n,� lts NORTH FORK REALTY HOLDINGS, LLC requests and Administrative Permit to construct a 4' post and rail fence on East, West, and North sides of property. Located: 1095 Watersedge Way, Southold. SCTM# 1000-88-5-65 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 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/Modifications/Conditions/Etc.: S'n-A(a)L\G'(WArA. SvaacsV a RGLAc 61 aW-en a"A sAPeAv Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly ✓ E. Peeples Revlsh1ls 149] W2424 W 90 m-0&98 0]-2800 Od0a01 OSfI-01 ny LL15N 'D 2J03 , 12 229OJ 1D MATCH LINE t—��-- MAICN LJ$ ONE 2-7 3]m b.J 2 294 ,pq FOR PCl.NO. ]-T]-09 b3°4 �+x so,.. n� SEE 6EC.N0. � 5 W90p0153 I Wt8-11 � 8a �2oaiFhi-"nWa 1901.055 �' x � / O W 2Mba 4 / 9 r 2 Ja : l� B 21ibNq 1).i JZA ----- ,2/aa- '� y� "z6. »w� �' a)Al i •� e +$� 'qz� �/ / ! ate'•�" n m�: 2 B �•S„ " ,] _ 3 c r ,>s ^' I awF�•' a0" ,wiia; a'"o m QO B pw,6RfemmeRFS RD," SO—D v 13.4 3 n. FOR PCL NO. a a5 '4p • h .�Qna ' $ © w, $ 1928 " "•laf2 ,a15 �J SEE SEC.NO. x+blB M6 Alba°.u,f Fie ar4,vwc1! 1]2s 138� w '", �•t .b. " W � OB1m-012.1 " 1p y "+ q OB a yr_, oa 1331 y,S,v` ,� 'aSb O a 13B] j0 .m 19.11 h 13.16 p,q a J>a w 2nva,x,sE -40ry°'x dl � 2e t]al F m' a 1a26 � 1s,0 n i SM¢y„'is Q 4l � ,4• - '"I fu wJN ,3.9a a w'la9dr e' F� ,� a y °' s,•dB c It °w ..._ w 13 de � la.ae o' .,, (� ,a 1a,., i 'Bf � ^6� 'O q•Y x N P a8' ) `— w " v a� m lazf� �9 ' U= wAr e � a 1 13.0 'aN 1]Aa a 1].59.wm� 11AP 13 a! II.. We �.P 28 ,e ml•r-J.n.zmwn]y F a2 43 12`'wa+ra'� 14 15 I..°rn rae HOG NECK ma SAY r L ..au ,.,. •+ ,,. — -- c..0 --w,-- o.,.0 --"-- , K D+6 +os SECTION NO E��� _�_ r.ax. 27) O _..0 _—r-- e..0 --.-- per, NOTICE COUNTY COUNTY OF SUFFOLK C E solrrxoLo E '• m+u N {R' yy.Real Property Tax Service Agency r --_--- " -- -- -- -- P'n el a.. Cenro,WrarMa6,NYtreat M 088 N r...w - "a. .. u.,u --L-- uau--n-- �t� w 0• u is w ,zfya> u —__— �..eu --.-- ma.,,.--rr-- a yi,s�' a^ P m.ctw 1000 PROPERTY MAP OFFICE LOCATION: O.':; 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 _ yC►s LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: July 10, 2024 Re: LWRP Coastal Consistency Review for NORTH FORK REALTY HOLDINGS, LLC SCTM# 1000-88-5-65 NORTH FORK REALTY HOLDINGS, LLC requests and Administrative Permit to construct a 4' post and rail fence on East, West, and North sides of property. Located: 1095 Watersedge Way, Southold. SCTM# 1000- 88-5-65 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 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 Glenn Goldsmith,President � �(j1� Town Hall Annex A.Nicholas Krupski,Nice President 54375 Route 25 P.O.Box 1179 Eric$epenoski Southold,New York 11971 Liz Gillo X G Telephone(631) 765-1892 Elizabeth Peeples - Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD i This Section For Office Use Only Coastal Erosion Permit Application FE I V E Wetland Permit Application Administrative Permit Amendment(Transfer/Extension JUN 2 M24 Received Application: Received Fee: SddTown Completed Application: T Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Dater Coordination:(date sent): LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: Receipt of CAC Report: _Technical Review: Public Hearing Held: Resolution: Owner(s)Legal Name of Property (as shown on Deed): Fr k ,eg Mailing Address: /1 Phone Number: Suffolk County Tax Map Number: 1000 Property Location: /0 9-5- -s'�c � , ' c� /V (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): ,Mailing Address: Phone Number: Email: "-yard of Trustees Applicat. ,t GENERAL DATA Land Area(in square feet): 2 I, 3 Y q, �• �/9/� Area Zoning: - V6 Previous use of property: Intended use of property: A=St dc,-Y7�o Covenants and Restrictions on property? __ __Yes No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? _aYes �No If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and.Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? =Yes No If"Yes",please provide-copy of decision. is project re any demolition as per Town Code or as determined by the Building Dept.? Yes No 1 Does the structure(s) on property have a valid Certificate of Occupancy? Yes=No Prior permits/approvals for site improvements: Agency Date e -/0!7 &0 a _ No prior permits/approvals for site improvements. Has any permittapproval ever been revoked or suspended by a governmental agency? No_a Yes If yes, provide explanation: n Project Description(use attachments if necessary): _ c 1 0-S kcrl csL, 'ard Of Trustees Applicati, c WETLANDITRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: e /�noes -_ S D el- Pf-C)*c:6 cr-1 Area of wetlands on lot: ��' 21 1 a square feet Percent coverage of lot: e V® g l % Closest distance between nearest existing structure and upland edge of wetlands:�W , 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?_ N A cubic yards Depth of which material will be removed or deposited: N j4 feet Proposed slope throughout the area of operations:_ /V 14 Manner in which material,will be removed or deposited: I Statement of the effect,if any,on the wetlands and tidal waters of the town that may result.by reason.of such proposed operations(use attachments if appropriate): - i 617.20 Appendix B Short Environmintal 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 l based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information Name of Actio or Project: Project Location(describe,and attach a location map): -W, L Brief Description of Proposed Action: ` Ce vz- Name of AZf'_7cl cant or Sponsor: Telephone: /-1 LfE'.�/f!� E-Mail: J Address: �/ q City/PO: State: Zip Code: Y L 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 approval: I FR ❑ 3.a.Total acreage of the site of the proposed action? acres a 50 b.Total acreage to be physically disturbed? acres ` t/t qec°? c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? J. acres 4. Che ki I I land us at occur on,adjoining an ar the propqsc4 action. Urban Rural(non-agriculture) Industrial Commercial ®Residential(suburban) Forest ❑Agriculture HAquatic Other(specify): un i7� Parkland Page 1 of 4 ' k 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? b.Consistent with the adopted comprehensive plan? 2913 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: �` ❑ 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? 4.Does the proposed action meet or exceed the state energy code requirements? N0 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 forproviding potable water. �� �V�� j� ❑ 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? R 13.a.Does any portion ofthe site of the proposed action,or 1 s adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal state r 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: �__ —2-L'i I ikrIdpritify the typicE Lhab itat types that oc n,or are likely to be found on t roject 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 YES by the State or Federal government as threatened or endangered? 16.Is the project site located in the 100 year flood plain? N0 YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO If Yes, 5 gNODES ❑a.Will storm water discharges flow to adjacent properties? b.Will storm water discharges be directed to established conveyance systemWNO -tQ and {m drains)? If Yes,briefly describe: ES Page 2 of 4 f k i 18.Does the proposed action.include construction or other activities that result in the impoundment of NO YES, water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: I ❑ 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: � LCIJI ❑ ' I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: v Date: 0 �2 Signature:_ -- Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all ofthe following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsoror 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? El 4. Will the proposed action have an impact on the environmental characteristics that caused the El of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or El ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate El ❑' 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? El El S. Will the proposed action impair the character or quality of important historic,archaeological, 0 architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 i 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? El D. 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 i 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-tern 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. QCheck this box ifyou 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_7 Page 4 of 4 ";ard of Trustees Applicatia L f AFFIDAVIT /�j L C lj nv5/ 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 1 AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,"THEIR AGENT(S)OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner Signature of Property Owner 9 1 f SWORN TO:BEFORE ME THIS `S DAY OF .� _ , 20�1— IGm E.Fuentes Notary Public,State of New York Qualified in Suffolk County UC.#01 FU4811709 Notary Public Commission Ex ires A dl 30 o�a� " - f _ 4 APPLICANT/AGENUREPRESENTAT(W TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees Be_n urmoce of this form is to grovide information which can alert the town of passible conflicts of interest and allow it to take whatever action is necessary—to—avoid some, YOUR NAME: PIFP d L L O o (Last name,first name,.griddle initial,unless you are applyingin the name of cc someone else or other entity,such as a company.If so,indicate the otter person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building rVariance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (if"Other'.name the activity.) i r 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 taa r Describe the relationship between yourself(the applicant/agentImpresentative)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): JaA)the owner of greater than 50A ofthe shares of the corporate stock of the applicant EL (when the applicant is a corporation); M 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 _ay o ,, 20 Signature Print Name �.� _ — Form TS I ' � l 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 deternunation 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 signifcant 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 gnlained in details,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 NAME Mo,-- -f-h T— 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: Aou fiwt v- j4,4 / C_ on , _ 1 Location of action: 9 Site acreage:_ 21/4 Present land use: icsr o ��ca Present zoning classification: ' &siz cc 2: If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: „-e Il J (c) Telephone number: 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?_ NIA- - C. Evaluate the project to the following policies by analyzing,bow 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 l: 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 '?te_ a wl / s ace Y M� C5 aC_ e.r► e-V'C,s 010, cs Attach additional sheets if necessary 1 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 t Aftach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pager 6 through 9 for evaluation criteria ❑ `des ❑ No® Not Applicable Attach ditional sheets if necessary ^ N'ATURAL COAST POLICIES J Policy 4. Nffinfinize 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 she if necessary Policy S.' Protect and improve water quality and supply in the Town of,Southold.See LWRP Section ffi —Policies Pages,16 through 21 for evaluation criteria ❑ Yes ❑ No &ot Applicable Attach adcuumd 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 1 l - I Attach additional sheets ifnecessary Policy 7. Protect and improve air qua➢ity in the Town of Southold. See LWRP Section in— 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 m—Policies; Pages 34 through 38 for evaluation criteria. ❑Yes ❑ No RNot Applicab➢e - r 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 33 through 46 for evaluation criteria. ❑ n—Ye�[.J] No KNot Applicable - J Attach additional sheets if necessary C 1 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. 1 ❑Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 11. * Promote sustainable use .of living marine resources in Long Island Sound, -the Peconic ,Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑Yes. ❑ No Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages _62 through 65 for evaluation criteria. ❑IYes ❑ No Not Applicable Attach additional sheets ifnecessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑Yes ❑ No D9 -Not Applicable . PREPARED BY TITLE_ DATE 1 ARTICLES of oRGANIzATroly�OF North Fork Realty Holdings,LLC Under Section 203 of the Limited Liability Company Law of the State of New York J THE UNDERSIGNED, being natural persons of at !oast eighteen (18) years of age and acting as organizers of the Limited Liability Company(the Company )hereby being formed under Section 203 of the Limited Liability Company Law of the.State of Nevi► York (the 11LCL11 eertifiw that: r FIRST:The name of the company is North Fork Realty moldings,LLC. SECOND: The purpose of the Company is to engage in any lawful act or activity for which limited!lability companies may be organized.under the LLCL. THIRD: The county within the State of Now York which the-office of.the Company is to be located is Suffolk County. FOURTH: The Secretary-of State is designated as th -Company upon e agent of the ' whom process against the Company may be served. The post office address within the State of New York to which the Secretary of State shall mail a copy of any process against the Company served upon such Secretary of State is G Ridge Drivel Melville,NY 11747. r FIFTH: The Company shall have the power to indemnify to the full extent permitted by the LLCL,as amended from time to time,all persons whom it is-permitted to indemnify pursuant thereto. IN WMESS WHEREOF,we have,subscribed this certificate and do hereby afi`iiim the foregoing as true under the pepalties ofperjury_this_•_•L_day of October,2012. EDI H PERYLLO,Organizer r ' 121012000902 s • a _ 4 �! ` Mum �. 1012 On CT Articles of Organization Of North Fork Realty Holdings, LLC rn-d Under Section 203 of the Limited Liability Company Law STATE OF NEW YORK . DEPARTMENT OF STATE ' 'FILED. OCT 12 2012 TAX S BY Er :By. Willis B. Carman, Jr., Esq. 280 Main Street Farmingdale NY 11735 O. - ' C -08Q ROUTINE Q, SAMEDAY • 24 HOUR Q 2 HOUR DRAWDOWN N. Y. S. DEPARTMENT OF ATE DIVISION OFCORPORATIONL�--. D STATE RECORDS ALBANY, NY 12231-0001 FILING RECEIPT ENTITY NAME: NORTH-FORK REALTY HOLDINGS, LLC - -- - - - - - - - DOCUMENT TYPE: ARTICLES OF ORGANIZATION (DOM LLC) COUNTY: SUFF FILED:10/12/2012-DURATION:********* CASH#-121012000992 FILM-#Y1210120009 -02 DOS ID:4307691 FILER: EXIST DATE ------ ---------- WILLIS B. CARMAN, JR. , ESQ. 10/12/2012 . 280 MAIN STREET FARMINGDALE; NY li735 . ADDRESS FOR PROCESS: ---------------- THE LLC 6 RIDGE DRIVE MELVILLE, NY 11747 , REGISTERED AGENT: ------- ----- ti�b� x�J'-• sal, �� B i a WV n �+ r•�,:4 { ' @ Fry ' 4a �1 u L;-� ��_+�;a;1 4'.'�' +.i .'�h to • d T ��C dj W KCi v The limited liability company is required to file a Biennial Statement with the Department of State every two years pursuant to Limited Liability Company Law Section 301. Notification that the biennial statement is due will only be made via email. Please go to www.email.ebiennial.dos.ny.gov to provide an email address to receive an email' notification •when the Biennial Statement is due. SERVICE COMPANY: COLBY ATTORNEYS SERVICE COMPANY - 08 SERVICE CODE: 08 FEES 235.00 � PAYMENTS 235 .00 FILING 200. 00 CASH 0 . 00 TAX 0 .00 CHECK 0. 00 CERT 0. 00 CHARGE 0.00 COPIES 10.00 DRAWDOWN 235 . 00 HANDLING 25.00 OPAL" 0. 00 .REFUND 0.00 - -----------------------------------==-==DOS-1025- (04/2007) = a t � E STATE 4F NEW YU.RK DEPARTMENT STATE I hereby certify that the annexed copy I tas been compared with the original document in the custody of the Secret of State and that the same is a true copy of said original.. Q ,. �� NE .•• WITNESS my hand and official seal of R 0 �. •.6 the Department of State,at the City of Ir �,�,• Albany,on October 16,2012. : � v I �}� I • �j, E LBtOR • . % .rs IV,• j �'�,, Sy • Daniel E. Shapiro •'••;'SENT First Deputy Secretary of State Rev. 05109 I I I 1 NORTH FORK REALTY HOLDINGS, LLC AI NUTES A meeting of the North.Fork Realty Holdings, LLC (the`LLC")was held on June , 2024. Present were: THOMAS V.PERILLO,JR, CYNTHIA MOFFATT LINDA PERILLO being all the Members of the LLC. It was noted that the Members desire to install fencing on the LLC's real property located in the Town of Southold, 1095 Watersedge Way, Southold,New York. It was noted that the Town of Southold requires a permit prior to the installation of fencing. On motion made,it was unanimously RESOLVED: That LINDA PERILLO is authorized to sign and submit any and all documents and applications to the Town of Southold that are required for the installation of fencing, including but not limited to;applications for fence,special use and variances. RESOLVED: That LINDA PERILLO is authorized to submit Freedom of Information Law ("FOIL') requests to any municipal entity to obtain documents related to the LLC's real property. ' RESOLVED: That the signing of these minutes constitutes a waiver of notice of this meeting and ratification of all actions taken at this meeting. There being no finther business,the meeting was adjourned Dated: June ,2024, r CYNTHIA MOFFATT, Secretary THOMAS V.PERILLO, JR. i I L CYNTMA MOFFATT LINDA PERILLO e p X Capacity of Sis.,�°r(Check appropriate box): (Signat e Cy hia Moffatt Member (Type or print name) [:,]manager 0Authorized Person i l � - CERTIFICATE OF CHANGE OF Prime Estate Holdings, LLC (Insert A►ame of Domestic Limited Liability Company) Under Section 21 1.-A of the Limited Liability Company Law Filer's Name and Mailing Address: Willis B. Carman, Esq. l , .Name: Carman, Callahan & Ingham, LLP i Company,ifApplicable: 280 Main Street MainngAddress: Farmingdale, NY 11735 City,State and Zip Code: i l i MOTES: 1.The name of the limited liability company and the date of filing of the articles of organization must exactly match the records of the Department of State. This information should be verified on the Department of State's website at www.dos.ny.aov. 2.This form was prepared by the New York State Department of State for filing a certificate of change by a domestic limited liability company. You are not required to use this form. You may draft your own form or use forms available at legal supply stores. 3.The Department of State recommends that legst documents be prepared under the guidance of an attorney. 4.The certificate must be submitted with a$34 filing fee made payable to the Department of State. (For office use only) DOS-1359-f(Rev.03/17) Page 2 of 2 i -- ' New York State Department of State NEW YQRK Division of Corpprations, DIVISION OF CORPORATIONS. STATE FUNITY State Records anti STATE RECORDS AND UNIFORM COMMERCIAL CODE Uniform Con mercial Code one Commerce Plaza i 99 Washington Ave. Albany.NY 12231-0001 r www.dos.ny.gov CERTIFICATE OF CHANGE OF; North Fork'Realty Holdings, LLC (Insert Name of Domestic Limited Liability Company) Under Section 211-A of the Limited Liability Company Law FIRST: The name ofthe(limited liability company is: North Fork Realty Holdings, LLC If the name of the limited liability company has been changed,the name under which it was organized is: SECOND: The date of filing of the articles of organization is: 10/12/2012 THIRD: The change(s)effected hereby are:[check appropriate statement(s)] 1•❑ The county location, within this state,in which the office of the limited liability company is -located,is changed to: 2.[✓ The address to,which the Secretafy of State shall forward copies of process accepted on behalf of the limited liability company is changed to read in its entirety as follows: 1 Harbor Hill Road, Huntington Bay,-NY 11743 3. ❑ The limited liability company hereby:[check one] Designates as its registered agent upon whom process against the limited liability company may be served. The street address of the registered agent is: Changes the designation of its registered agent to: The street address of the registered agent is: D Changes the address of its registered agent to: Revokes the authority of its registered agent. t DOS-1359-f(Rev. 03117) Page 1 of 2 l �i NORTH FORK REALTYHOLDINGS,UC ' IyJmtTi7TES A meeting offheNorth Fork Realty Holdings,LLC(the`LLC-)was held on June . 19, 2024. Present were: THOMAS'V.PERILLO,JR CYNTHIAMOFFA'IT LINDA P.MLO r being all the MMbers of the LLC_ It was noted that the Members desire-to install fencing on the LLM real properly located' in the Town of Soutbold,1095 Watersedge Way,Southold,New York. fencing It was noted that the Town of Southold requires,a pennit prior to the installation-of bri motion made,it was unanimously RESOLVED. That LIZ`DA PERJU0 is authorized to sign and submit any and all documents-aad applications to the Town of Southold that are mudzed for the installation.of fencing,including but not limited to;applications for fence,special use and variances: RESOLVED:, That LItVDA PERII.LO is'autltorized to submit Freedom of Information.Law("FOW) zequests to any municipal entity to obtain documents related to the LLC's real property, RESOLVED: That the.signing-of these minutes constitutes a waiver of notice of this meeting and mdfication ofall actions taken at this meeting. There beingno fintha business,the meeting was adjourned Dated: June_r 2024. 1 9 MTM MOFFAWij Y MA$V:PERILLO,JJR. L Cry THE M ,ITT IlaDA PERILLO i