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HomeMy WebLinkAboutTR-10637A Glenn Goldsmith, President `�®F S®U�*� Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President ,�®V� ®�® P.O. Box 1179 Eric Sepenoskit Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples ®�� �® Fax(631) 765-6641 C®Uil9T`l,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE #2238 C Date: May 13, 2025 THIS CERTIFIES that the repair of existing deck with pressure treated lumber, installation of one 4"x4"weather treated wooden post to be covered with PVC with two attached grab bars;removal of existing side rails and replacement with PVC railing; redecking of raised wooden walkway, At 65 Beachwood Road, Cutchogue Suffolk County Tax Map#1000-116-4-29 Conforms to the application for a Trustees Permit heretofore filed in this office Dated August 16, 2024 pursuant to which Trustees Administrative Permit#10637A Dated September 18, 2024,was issued and Amended April 16, 2025, conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the repair of existing deck with pressures treated lumber,• installation of one 4"x4"weather treated wooden post to be covered with PVC with two attached grab bars-, removal of existing side rails and replacement with PVC railing-, redecking of raised wooden walkway. The certificate is issued to JOSEPH&NANCY COCOPARDO owners of the aforesaid property. 'f Authorized Signature Glenn Goldsmith,President QF S®Ur Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President �O �O P.O. Box 1179 Eric Sepenoski J�[ Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples � �Q Fax(631) 765-6641 coUNT`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 17, 2025 Nancy Cocopardo 117 Oxford Boulevard Garden City, NY 11530 RE:, 65 BEACHWOOD ROAD, CUTCHOGUE SCTM#: 1000-116-4-29 Dear Ms. Cocopardo: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, April 16, 2025: RESOLVED, that the Southold Town Board of Trustees APPROVE the Administrative Amendment to Wetland Permit #10637A for the as-built redecking of raised wooden walkway; and as depicted on the site plan prepared by Nancy Cocopardo, received on March 26, 2025, and stamped approved on April 16, 2025. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, 4"� Glenn Goldsmith, President Board of Trustees I '.'.:.'GARAGE•:•::: 3.9x O OJ? x5.0 O O� QO x4.0 A��,P� x4.0 3.9x 15.5E Opp cn O� 12'W x4.2 p 4. x O N 0 g / x4.5 x4.4 APPROVED BY LOT LOT 4 BOARD OF I RUSTEES LOT 2 4.5x1 TOWN-OF SOUTHOLD U.P. DATE der;\ III0 {V _ 7 NJp x4.9 4I9x / 1)4.4 \'y 1 N *Ipl I 1 I\ OSED E PORCH N I x4.9 3� . ................ 4.SX x4.1 ROD 2 STORY ROD9.5' . ......•:•:•:•:... 4.0 'E 1 t 4.1 Z W.V. ........... 10.3' 7'E J BOVNOPR� STORY:-:-:(..,, SIP x4. 1 ':FRAME::::..' 78' . ENPOR LOSED CH MOO�RP�E DWELLING co L .::1 STORY:•:•:•: x4.2 4 •....DWEL LING.::: OOP P��EL 6) :::.2.3 N./ ZONE :3.7 cn (x4.0 :.;.:.;.:.. ifl �- x4.1 04g NE ......::::::::... c4. .......25.5'''' ' 46r 7 ��0005 ZO �x5.3 9.7' _ D WOOD DE -/ x6.4 6 5 9.4 3. ' x7.5 x7.2 WOOD DECK �0 / 7 AeLw-L PiaA +' _ x5.7 . 7.3x x6.3 �7.4x 6.5x 1 a. )j^/� �, d 7. 8.5x � V W x6.3 I5x 7.Sx �Py(/� n Gy Lp, xs.z 6.3x _ - r min V6cha ZA, ° o � � E ROD 2,t 69 ROD TOP OF A8 8rOE OF BANK ¢G ¢9 REVISED 03-25-21 N UPDATE 12-09-20 d- AREA: 12,872.5 SQ.FT. 'or 0.30 ACI TIDAL WETLAND BOUNDARY oM UNAUTHORIZED AL7ERA77ON OR ADD1110N TO THI: AS OELINIATED BY rn MAP NOT BEARING 7HE LAND SURVEYORS EMBO; JMO ENVIRONMENTAL CONSULTING ONLY TO THE PERSON FOR WHOM THE SURVEY k AN. 18, 2019 MHW ELEV 1.5 HEREON, AND TO THE ASSIGNEES OF THE 7HE O 7HE OFFSETS OR DIMENSIONS SHOWN HEREON FR NOT INTENDED TO MONUMENT THE PROPERTY LIN r MHW 39.401 ANDIOR SUBSURFACE STRUCTURES RECORDED OI MAR 2 6 2025 S 8502110311 W SURVEY OR LOT 3 MAP OR 13EACHWOOD COLONY NIC BAY SLED: FEB. 14, 1917 No.727 Southold Town C O Board of Trustees E sirvATED AT.CUTCHOGUE GREAT p Tom OF: SOUTHOLD FEMA MAP#36103CO501H SUFFOLK COUNTY, NEW YORK EFFECTIVE 09/25/09 FILE # 19-09 SCALE. -, ==20' DATE: FEE PA� MAR 2 6 2025, Southold Town L _ oaUSLur ����� ��� Town Hall Annex Glenn Goldsmith, President 54375 Route 25 A. Nicholas Krupski, Vice President �� �� P.O. Box 1179 Eric Sepenoski 3 =� Southold, New York 11971 Liz Gillooly Telephone (631) 765 1892 Elizabeth Peeples Fax (631) 765 6641 Ares BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF H T ES RD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF TCE OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain ist day of construction '/z constructed When project complete, call for compliance inspection-, �� 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 Telephone (631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10637A Date of Receipt of Application: August 16, 2024 Applicant: JOSEPH & NANCY COCOPARDO SCTM#: 1000-116-4-29 Project Location: 65 Beachwood Road, Cutchogue Date of Resolution/Issuance: September 18, 2024 Date of Expiration: September, 2027 Reviewed by: Board of Trustees Project Description: Repair existing deck with pressure treated lumber; install one 4"x4" weather treated wooden post to be covered with PVC with two attached grab bars; remove existing side rails and replace with PVC railing. 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 Nancy Cocopardo, received on August 16, 2024, and stamped approved on September 18, 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&'X':9 vx Glenn Goldsmith, President Board of Trustees 3.9x 2'E I GARAGE wry_ x4.7 ro N 12.5 T05 APPROVED, BY 3.9x x5.0 .,BOARD. OF •I RUSTEES TOWN OF- SOUTHOLD x4.0 ,�� Py x4.0 DATE SeQ� r-,��er G9P�� �Q� I 3.9x 15.5'E •�� O 4 3x 0 9 x4.4 x4.5 � p LOT 3� LOT 4 4.5x1 N p� x4.9 4I19x p 1) .44 o � w I 1 \ I \ ENCLOSED VVV PORCH 6 2024 DR x4.9 �� 2.9E pUG 1 1� w I N ,I dToWn g�afTtusbees 31 1 4.8x ? x4.1 ROD � 2 STORY ROD 9.5' 22A . 9' DWELLING 4.O'E I 1 4.1 ' LIP C. W.V. ).3' t 7 E o O 0 PRE a cn G.�\ON �r V Ulf• V�-�1 1 STORY FRAME. . , E P x4. 1 7 8' ENCLOSED RP�E Y DWELLING PORCH MOOS c 3 � FFL 5.8 C( OF I. x4.2 o c� c E STOOOP 4 I 2.3 � 1 ) f � y�� `� /'�-E 1.I /�/} ^i 3.7' l.i W V aj N) 3.D' 1.4 E-- Ln to x�_ x4.1 d e I v 4g0��vE�E\ �> lJ � c� _ Zo ��E x4.6 25.5' x� 7 L�5 Z n/��� /��Qr� n / �/ 0 9.7' ._ .= 4.6' �_ F x5.3 3�o I.3LVt)CJ� 1 0f � q/ q ROD WOOD DEC ° / x6.4 -6 i- I I 5 x 29.4' 3 x7.2 x7.5 (( �;-,y�5.3 � ol � h0 1 &Uji) x5.7�✓ a >� 7.3x A� �� -6-- - 7.4x � (.�X 0 di t o x6.3 /7.4x �m ^ ,�A ��y� �8d� 6.5x ed 0 QY�•I �J -- U4 x6.3 I7.5x 7.8x 8.5x 1 1" vc -:�k SOUTH.OL D ..TR..Us. TEES No. 10�3�-1� lssued ' .T -Date Address �5 �e.�.�l, wooa , R, , . Cup c�,ogwe. THIS. NOTICE, MUST BE DISPLAYED DURING- CONSTRUCTION TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD 50UTHOtD, N'Y"L 11971 TEL.: 765-1892 S.C.T.M.# DISTRICT 1000 SECTION 116 BLOCK 4 LOT 29 TIDAL WETLAND BOUNDARY AS DELINIATED BY JMO ENVIRONMENTAL CONSULTING JAN. 18, 2019 / REBAR 4.Ox RMAR / �0 1�) ®W.M. BEAC PR`042401 MON. 4.1x I / MON. M; 3.9x :::::::::::::::::::::::::::: W.M°�.0'S 2.�:..... .%,.•GARAGE•:•:•:: MON. / ::::W •V.... V . ...................... x4.7 3x ;:::: 0.51w : i2.5:::::: 10.5 '.'.'..'GARAGE 3.9x I ... ...... .. ?� �J x5.0 O� V� x4.0 ,<v x4.0 JF.�0Q cj 3.9x 15.5E z c O� 12V x4.2 4. x O ' O Iv / 0 9 v x4.5 x4.4 � O N LOT 3� LOT 4 LOT 2 4.5X1 m U.P. tQ p` x4.9 I NO / 1)4.4 \�y� 4 9x 1 ENCLOSED PORCH x4.9 �' I 3� r x ` 4.8x 4.1 ROD 2 STORY• RO 9.5' ?.''........ 9 •.•.•.DWELLING; ::::::::::.......... 4.0'E r . 4.1 W.V. 10.3 0 7'E ................... 00vNOPR� .::::::•1 STORY:::w PNE P0�\ON x4. x5 1 .•'''•'.FRAME.:::..' 7.8' ENCLOSED '::.:DWELLING•:•:•:•: PORCH OD�RP�E . ...-4#65co ....... ........... z ::1 STORY*.`%: i�, x4.2 4 :.. DWELLING...... COMP / 6� :::.2.3 MON./ ZONE 3.7 3.0 :0 (x4.0 t�OP`91 f.4 E cfl �_ x4.14gOV 4.6 '%'-%�'%%*' 4.6, 7 F�00�5 Z0 ZONti �x5.3 9.7' - D WOOD DE -/ x6 -" 6 5 9.4' 3.6' x7.5 x7.2 5.3 WOOD DECK /7 Y x5.7 / ��7.3x 7.4x x6.3 �7.4x 6.5x W x6.3 V.5x 7.8x 8.5x 7� 00 xs.z s.3x N (� O r.. z 6 ROD G?! 69 ROD TOP OF ¢8 •8 .9 OE OF BANK �6 THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL REVISED 03-25--21 LOCA77ONS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS N UPDATE 12-09-20 d' NAVD88 0 o AREA: 12,872.5 SQ.FT. or 0.30 ACRES ELEVATION DATUM: TIDAL WETLAND BOUNDARY OM UNAUTHORIZED AL7ERA77ON OR ADDITION TO THIS SURVEY IS A NOLA71ON OF SECTION 7209 OF THE NEW YORK STATE EDUCA77ON LAW. COPIES OF THIS SURVEY AS DELINIATED BY MAP Nor BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN JMO ENVIRONMENTAL CONSULTING ONLY 1O THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE 7711.E COMPANY, GOVERNMENTAL AGENCY AND LENDING 1NS77TU77ON JAN. 18, 2019 fb MHW ELEV 1.5 LISTED PEREON, AND TO THE ASSIGNEES OF 7HE LENDING INS717U770N, GUARANTEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT IN7TJVDED TO MONUMENT 7H£ PROPERTY LINES OR TO GUIDE THE EREC7701V OF FENCES, ADD17701VAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS MHW 39.40' AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT 7HE TIME OF SURVEY S 85021103" W SURVEY CF: LOT 3 CERTIFIED TO: JOSEPH COCOPARDO; MAP OF: BEACHWOOD COLONY NANCY COCOPARDO; NIC BAY FILED: FEB. 14, 1917 No.727 PARTNERS ABSTRACT, INC.; PE SITUATED AT:CUTCHOGUE MEADOWBROOK FINANCIAL MORTGAGE BANKERS; GREAT Town oF. SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC FEMA MAP#36103CO501 H SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design EFFECTIVE 09/25/09 4 P.O. Box 153 Aquebogue, New York 11931 FILE B 19-09 SCALE: 1„=20' DATE: FEB. 8th 2019 PHONE (631)298-1588 FAX (631) 298-1586 N.Y.S. LISC. NO. 050682 1 meinteining the records of Robert L Hennessy & Kenneth M. Aoychuk Glenn Goldsmith,President Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 Eric Sepenoski � ,? P.O.Box 1179 Liz Gillooly A • 0!� Southold,NY 11971 Elizabeth Peeples Telephone Telephone(631)765-1892 ` Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: `Z 6a 2 Completed in field by: A),Kof lk JOSEPH & NANCY COCOPARDO request an Administrative Permit to repair existing deck with pressure treated lumber; install one 4"x4" weather treated wooden post to,be covered with PVC with two attached grab bars; remove existing side rails and replace with PVC railing. Located: 65 Beachwood Road, Cutchogue. SCTM# 1000-116-4-2 Type of area to be impacted: Saltwater Wetland Freshwater Wetlan/Chapt. Sound Bay Part of Town Code proposed work falls under: 275 Chapt. 111 other Type f Application: v 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.: - bS .yIFY� Wo�dS Present Were: G. Goldsmith v N. Kru ski E. Se enoski P p L. Gillooly E. Peeples I�OD �(;HWUUU I-)J GUI CHU6C12' r 1 �I�- 1.•.� 1 � \ .. �. 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OFFICE LOCATION:.. s ,.` ,'.��'. �.�„", MAILING ADDRESS: Town Hall Annex P.O.Box 1179 54375 State Route 25 Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) y' Telephone:631 765-1938 Southold, NY 11971 _ OQ' LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: September 12, 2024 Re: LWRP Coastal Consistency Review for JOSEPH & NANCY COCOPARDO SCTM# 1000-116-4-2 JOSEPH & NANCY COCOPARDO request an Administrative Permit to repair existing deck with pressure treated lumber; install one 4"x4" weather treated wooden post to be covered with PVC with two attached grab bars; remove existing side rails and replace with PVC railing. Located: 65 Beachwood Road, Cutchogue. SCTM# 1000-116-4-2 The proposed action has been reviewed according to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based on the information provided on the LWRP Consistency Assessment Form submitted to this department and the records available to me, I recommend that the action is EXEMPT from LWRP review pursuant to: § 268-3. Definitions. MINOR ACTIONS item "B" which states: B. Replacement, rehabilitation or reconstruction of a structure or facility, in kind, on the same site (inplace), including upgrading buildings to meet building or fire codes, except for structures in areas designated by the Coastal Erosion Hazard Area (CEHA) law where structures may not be replaced, rehabilitated or reconstructed without a permit and shoreline erosion control structures (including, but not limited to, groins, jetties, bulkheads, filled piers) located within Great Peconic Bay, Cutchogue Harbor, Little Peconic Bay, Hog Neck Bay, Noyack Bay, Southold Bay, Shelter Island Sound, Pipes Cove, Orient Harbor, Gardiners Bay, Long Island Sound, Fishers Island Sound and Block Island Sound (excluding all creeks); Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Honorable Lori Hulse, Attorney Glenn Goldsmith,President *F�t ►a "T. Town Hall Annex A. Nicholas Krupski,Vice President � � 54375 Route 25 P.O.Box 1179 Eric Sepenoski +� Southold,New York 11971 Liz Gillooly CIO Telephone(631) 765-1892 Elizabeth Peeples p p .�* t Fax(631) 765-6641 LV { BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only D E ' G I N Coastal Erosion Permit Application Wetland Permit Application AUG 1 20 Administrative Permit Amendment/Transfer/Extens ion Received Application: Southold Town Received Fee: $ SoandofTnmtm Completed Application: Incomplete: SEQRA Classification: Type I Type 11 Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: 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): Joseph A. Cocopardo Nancy A Cocopardo Mailing Address: 117 Oxford Blvd Garden City NY 11530 Phone Number: 516 459-4356 Suffolk County Tax Map Number: 1000 - 116.4-2 Property Location: 65 Beachwood Road Cutchogue NY 11935 (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: Email: , "yard of Trustees Applicati GENERAL DATA Land Area(in square feet): Area Zoning: Previous use of property: Deck and entrance ramp Intended use of property: Deck and entrance ramp Covenants and Restrictions on property? Yes No If"Yes", please provide a copy. Will this project require a Building Permit as per ToiN4:eXCtode? Yes �No If"Yes",be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? _Yes _✓ _No If"Yes", please provide copy of decision. W' is project re9 any demolition as per Town Code or as determined by the Building Dept.? Yes ✓ No Does the structure(s) on property have a valid Certificate of Occupancy? Yes=No Prior permits/approvals for site improvements: Agency Date Southold Town 9/14/21 Southold Town 2/15/22 Southold Town 4/11/24 ElNo prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?A No ❑ Yes If yes, provide explanation: Text . Project Description(use attachments if necessary): Replacement of weather damaged boards.New pressure treated lumber to be installed in exact place of rotted lumber. Installation of one 4"M" weather treated wooded post to be covered with PVC with 2 attached grab bars to provide hand support for the exsisting single step down off the deck, to be placed in the center of the south sil Side rails to be removed and replaced with PVC railing. and of Trustees 40pplicati; WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Deck and walkway require repair to fix current safety issues. Some boards have warpped and need to be replaced. Current wooden fencing is a splinter hazard and needs to be replaced with PVC to prevent contiued splintering. New owners require a hand post to navigate single step down to beach. Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands:0 feet Closest distance between nearest proposed structure and upland edge of wetlands: 0 feet Does the project involve excavation or filling? 0 No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? 0 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): No effect. r 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part I -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. if additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: A�D - 0 T tow siah- ' lia . t;>1 0 �d Projed Location(describe,and attach a location p): ►Sou. o � L o C �Dz.v Brief Description of Proposed Action: 0,1-d D d. Xd" 0_)C ALL _/Lb PA 60 Name of Applicantor Sponsor• �I Telephone: J!/G `T'9. 1_13 d v �/ ��� E-Mail:COIC0 11 WJ Qd 4 Address: if l City O: U State: ,` /J ZipCode: 1.Does the proposed action only voive the legislative adoption of a plan,local law,ordinance, 1! NO YES administrative rule,or regulat n? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that © . —1 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; ❑ 3.a.Total acreage of the site of the proposed action? �/ 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? t/,3 acres 4. Che I land us"jat occur on,adjoining an ar the proposed action. Urban 19JRural(non-agriculture) Industrial FICommercial Residential (suburban) Forest ❑Agriculture WAquatic ❑Other(specify): Parkland Page 1 of 4 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? R 9, ILL 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 services)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? NO YES If the proposed action will exceed requirements,describe design features and technologies: 10. Will the proposed action connect to an existing publiclprivate 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: ❑ M 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 lands adjoining the proposed action,contain NO Y S 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. ntify the typicaLhabitat types that oc n,or are likely to be found on t"roject site. Check all that apply: Shoreline Forest Agricultural/grasslands Early mid-successional VJ 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? 171 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 ,.q If Yes, a.Will storm water discharges flow to adjacent properties? NO ❑YES b.Will storm water discharges be directed to established conveyance systems ff an m drains)? If Yes,briefly describe: dO YES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond, waste lagoon,dam)? If Yes,explain purpose and size: 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 - n. Applicant sor name: �6 � � & Date: d 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 I. 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? 4. Will the proposed action have an impact on the environmental characteristics that caused the [� ❑ establishment of a Critical Environmental Area(CEA)? LYJ S. Will the proposed action result in an adverse change in the existing level of traffic or iA Elaffect existing infrastructure for mass transit, biking or walkway? ILYYJJ 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? 8. Will the proposed action impair the character or quality of important historic,archaeological, (-"7`) ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, a waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage � ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? Ez— 0, Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail, identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation,El 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 f `)ard of Trustees Applicati AFFIDAVIT Nancy A Cocopardo 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 WORD 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. Ily at 4of Property OVvner Signature of Property Owner SWORN TO BEFORE ME THIS UA DAY OFF gL1S , 20A- Notary Public i CONNIE D.BUNCH Notary Public,State of New York No.01 BU6185050 Qualifled in Suffolk County Commission Expires April 14,2 1- 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 pump se of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: (Last name,first name,rpiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning _ Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a'business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): _nA)the owner of greater than 5%of the shares of the corporate stock of the applicant � (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the 44applicant is not a corporation); C)an officer,director,pardne�,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of U 20� Signature Print Name Fonn TS I Coo c ,, v, 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 sip ificant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supportiny- 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 .0ls�k 5 I The Application has been submitted to (check appropriate response): ) AN J 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: - (, ' I-J�L. lip, 6A. 4V cop" Location of action: ��C) Site acreage:81 w A9111 a Present land use: Present zoning classification: �07 r 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provi a) Name of applicant: A. 'i 494 11 r b) Mailing address: o I 0Telephone number: N `7 6 — — Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No RI 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. FV Yes ❑ No ❑ Not Applicable A14DLt AA&W UiUL'fi) ttach 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 L.Lm Not Applicable ulltict ;-PL ttach additional sheets if necessary _ e 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 ttach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life structures and natural resources from flooding and erosion. See L Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No Not Applicable ttach additional sheets if necessary --- Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section HI —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No 14Not Applicable ttach 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 661, ttach 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'E� Not Applicable ttach 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 K 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 W1 Not Applicable ttach additional sheets if necessary N.Uf 61XO�6 Am-M, WORKING COAST POLICIES Policy 10. Protect Southold s water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑Yes ❑ No `�' Not Applicable ttach 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 ttach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages 62 through 65 for evaluation criteria. ❑Yes ❑ No® Not Applicable ttach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑Yes ❑ No Not Applicable PREPARED BY L d TITLE DATE �"