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HomeMy WebLinkAboutTR-10636A ��� SO&�� Town Hall Annex Glenn Goldsmith, President 54375 Route 25 A. Nicholas Krupski, Vice President � P.O. Box 1179 Southold, New York 11971 Eric Sepenoski Liz Gillooly Telephone (631) 765-1892 Elizabeth Peeples �.� Fax (631) 765 6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE TIV T O RD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF T OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 s' day of construction '/2 constructed When project complete, call for compliance inspection; Glenn Goldsmith, President *®f SO(®,� Town Hall Annex A.Nicholas Krupski,Vice President ®V� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski JI Southold, New York 11971 Liz Gillooly rv' Telephone(631) 765-1892 Elizabeth Peeples • a� Fax(631) 765-6641 co BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10636A Date of Receipt of Application: August 15, 2024 Applicant: Hay Harbor Club Inc. SCTM#: 1000-9-3-1 Project Location: Fox Avenue, Fishers Island Date of Resolution/Issuance: September 18, 2024 Date of Expiration: September 18, 2027 Reviewed by: Board of Trustees Project Description: Rebuild deck boards, decorative railings, and painted trim boards on existing porch; install finish ceiling boards on existing frame; install new light fixtures and ceiling fans. 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 Kinlin Rutherford Architects, PLLC, received on August 15, 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. X pjol��X Glenn Goldsmith, President Board of Trustees U a a F- W . i fi M1, ARmti ., x , 7R' CL Ii -����044'�C�==0!:xD�t44 � H�: F,.!.. A----- Y. -I�T--I,r,-u-�s 4 ?H 4 R B"' - O R v- .;�-. w7E'"O V 41K I�1.. 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DESCRIPTION SHEET " �° :+4' 4 S w x „a k" r §.1 :. A-001 TITLE SHEET .. J PLAN A— 20 SITE ,a. ,`' w 0 �/ W J , ,I f, iI w A-101 FINISH PLAN f ({ ED FILING PLAN �' A-111 REFLECT C I. 4l, c ,x' i' .' . E 101 EL ECTRICAL PLAN ;, :,. v'J F -N " " , 7 d 'h' , - `3' Y /. f k .j �1+ : 1 y t . , 1 l '` , 'n; ga✓^ - - .... ' s, „' Yam,...\ s-,, ., x 1r, r r { 'a. ra _ , e / ; N, 1, µ a'; sa'` t a �- � . r, -', a ,. "5-, a �" :„.s W� .. ,;gin., . .I ' 9 , t1 I m Yang d 'r ` 'k u ,�d J"{� � 1 ,. § '`r t ., - - < i e, .K�y tb.e' '{a�,(.. I a :4 , ..�. ,N v .s#. t. .u,� . .,, , r -a # -,s .'''i .. Jam*' .,r4'-' ,°�'w 1, f e - r"z;.? _ - , . ti .. ., 't h ,, - - } ) , ", { cfi'$ . s a i , . . I. -T , , h 1 ,3. { as - a • ,",, , . ., .3` k FR N 0 T POR CH PERMIT 08. 5.2 I 0 4 , :-. tl , "4- '�� .'t ��,.- �.' i- ,', � .ice , k.' ` , y' REVISION ISSUE DATE - . } w: I ,„ e ..W { ,: , HAY HARBOR CLUB RF ' . k: p N ;, �' PORCH RENOVATION _ „ _ FISHERS FOX AVENUE W a.._ _,_ e.. �..�..�_,�,. .. __1.—Z. .�" ISLAND,NY 06390 ��RED ARcyi D. ki �F Gu qy, % r� ;L �a ,. +,:��� « I 2 T . 029481 y�01 F OF NE`N - , I q '+ ". .9 I , r U KINLIN RUTHERFURD ARCHITECTS, PLLC SClltt0.d 7bwr) 59 EAST 54TH STREET,SUITE 92 TEL:(212)695-2988 NEW YORK,NEW YORK 10022 FAX:(775)582-1736 a ,� x TAX MAP NO . 1000 — SECTION9 — BLOCK3 — LOT1 M N N FOX AVENUE TITLE SHEET w N cn w FISHERS ISLAND, NY 06390 x cn K- - . . - . II j I � A-003. o 1LUG 1 r(12�, PROJECT: 357 " 500101d i"a,v —'rd Of TRlSfees r i r L0 00 - APPROVED BY . BOARD OF 'I RUSTEES - - - TOWN OF SOUTHOLD SPA �P�� DATEC7 r , I. , _ -_ - ' r _ - J, _ ' I - / s J l _ i \ EX - EX. POOL' OM N S r H SE _ I r r EX f EX. PORCH II ' - Ho TO REMAIN e H ! I y � r - I, r , I I AREA OF WORK I - REPLACDEMENT OF FINISH II II I \ NO WORK TO PORCH I I _ _ k STRUCTURE OR I I i - g FOUNDATION. - I i PORCH \ T REMAIN EX. / BUILDING O REMAIN FRONT PORCH PERMIT 08.05.24 REVISION ISSUE — DATE " HAY HARBOR CLUB PORCH RENOVATION r - FOXAVENUE - . - - - _ - - FISHERS r ISLAND NY 06390 , ED Aq' cli Ll - ----- D r] t 029 - �o 0 OF i AUG_1 _ 202 Board of Trustees ! KINLIN RUTHERFURD ARCHITECTS, PLLC 59 EAST 54TH STREET,SUITE 92 TEL:(212)695-2988 NEW YOR EW YORK 10022 FAX : 82 17 r - - Nc O r _ \ i - -J N - SITE PLAN w ,j o I : _ 0 2 t�- p N — - 38. 5' ! EzU f a �, \ x _ -020 0 0 1 SITE PLAN PROJECT: 357 ' Southold Town Board of Trustees CONSTRUCTION LEGEND W-98 NOT IN CONTRACT u NEW DECK BOARDS ON EXISTING PORCH DECK FRAMING. NO WORK [ImHld � d !OR CHANGE TO STRUCTURE. COD 7 16 71" 01 L 0 �J E7 Lo i L) I L .L F 0 U) z ARDS U-j DECK 00 (EXISTING E)EeK t Q STRU CTU RE-40—RE-M AIN) Lo co FRONT PORCH PERMIT 08.05.24 REVISION ISSUE DATE PORCH RENOVATION FOX AVENUE FISHERS ISLAND,NY 06390 CC EE R"i i III L L- 02ge,$�yp OF 0 11 c �F t IN KINLIN RUTHERFURD ARCHITECTS, PLLC D59 EAST 54TH STREET,SUITE 92 TEL:(212)695- 988 nn . . . . . . . NEW YORK,NEW YORK 10022 FAX:(775)582-1736 REPLACE DECORATIVE RALINGS TO MATCH EXISTING (PORCH DECK SURFACE TO REMAIN LESS THAN 30- ABOVE GRADE) AUG 2024 .1 1 1 1 1 i REPLACE EXISTING DECORATIVE TRIM AT POSTS AND EXISTING FASCIA. NO WORK TO STRUCTURAL POSTS AND BEAMS 57'-11j" SCREENED PORCH ouuaiuld Town Board of Trustees (ALL DIMENSIONS VIF) 7'-1111, W i/ I I I FINISH PLAN _ _ A A 0:1 3. 0 AUG 1 2024 0 1 PORCH DECKING PLAN PROJECT: 357 --o21 1 �southrlid 5wn- Bmrd of Trustees RCP LEGEND NOT IN CONTRACT U NEW BEADBOARD CEILING BOARDS ON EXISTING FRAMING. NO WORK TO PORCH STRUCTURE. o ID —0 (5 oc r\ -71 1XI lz —� I X I I X I EXISFING d 0 E F E E OFCH C) L I 0 c" C, -TF FRONT PORCH PERMIT 08.05.24 � 71 REVISION ISSUE DATE I Z-x I r----T— HAY HARBOR CLUB �IEV—PAftTED—BEADBOARD--CE4 OARDS— INSiALLE11-0 LIS]ING HAF UHS vI PORCH RENOVATION FOXAVENUE FISHERS ISLAND,NY 06390 ----------- 0 U III I III N� z �j ED Apo 2 029 NEB 0 0 Cl NEYTIPAIN IF 1) HF ADHOARD CF If ING HOAHUS !NSTAILLE-D ON EXISTING RAFTERS L KINLIN RUTHERFURD ARCHITECTS, PLLC 59 EAST 54TH STREET,SUITE 92 TEL:(212)695 2988 NEW YORK,NEW YORK 10022 FAX:(775)582:1736 :3 AUG Soutt+od Town Board offrus"- I j x EXISTING SCREENED PORCH REFLECTED CEILING PLAN ---------- ki 1:1 1E A AUG 1 01 REFLECTED CEILING PLAN PROJECT: 357 Board of Trustees U W a a ELECTRICAL LEGEND H U W E~ NOT IN CONTRACT v Q¢ WALL MOUNTED LIGHT FIXTURE u__ U(olRECESSED LIGHT FIXTURE � J � � WATERPROOF RECESSED LIGHT FIXTURE i + HORIZ. SURFACE MOUNTED LIGHT FIXTURE T N VERT. SURFACE MOUNTED LIGHT FIXTURE \ �J UNDER CABINET STRIP LIGHT - a Ic I INTERCOM o $ SWITCH — ---- $D DIMMER SWITCH $3 3—WAY SWITCH �J it $3D 3—WAY DIMMER SWITCH � ~ i FIXTURE ON A JAMB SWITCH n DUPLEX RECEPTACLE =Qw.R WATERPROOF DUPLEX RECEPTACLE Ioj i SWITCHED DUPLEX RECEPTACLE tiJ ` J 71 OUTLET, ONE SIDE ONLY I �c.F.l. GROUNDED FAULT RECEPTACLE OUTLET I ,� \ I� I QUADRUPLEX RECEPTACLE Rs I X FLOOR RECEPTACLE _ h TELEPHONE/DATA 0 TELEVISION ® EXHAUST FAN \ 0 THERMOSTAT 1 SMOKE CARBON MONOXIDE DETECTOR 0 DOORBELL EXIS ING COV RED M5 MOTORIZED WINDOW SHADE PO CH RS Rs RECESSED SPEAKER FRONT PORCH PERMIT 08.05.24 ELECTRICAL NOTES 1. ARC—FAULT TYPE OUTLETS ARE REQUIRED UNLESS NOTED I x i REVIISION ISSUE DATE AS GFI - - �DDF HAY HARBOR CLUB 2. ELECTRICAL INSTALLATION TO BE DESIGN—BUILD BY A LICENSED v CONTRACTOR PORCH RENOVATION FOX 3. GC TO FURNISH AND INSTALL ALL LIGHT FIXTURES AS PER I j FIISHERSrUE ISLAND,NY06390 ARCHITECTS SPECIFICATIONS 4. ALL EXTERIOR LIGHTING AND POWER TO BE WEATHERPROOF I 1 -� RS RS � 71 I / 1 BAR L' RED Az chi I �5 GE D. lu L -Ann J — —— q 0294a p F dF No� ,: s 21171� AUG 1 % \ KINLIN RUTHERFURD ARCHITECTS, PLLC wn 1 Soutt,zjlo To 59 EAST 54TH STREET,SUITE 92 TEL:(212)695-2988 ,01rd Of T"15fneS NEW YORK,NEW YORK 10022 FAX:(775)582-1736 EXISTING __—_J SCREENED PORCH I I I I I M X N 1 uo N rii 1 ELECTRICAL PLAN w 0 E ®ii o AUG 1 !1 22/4 01 ELECTRICAL PLAN PROJECT: 357 3/16'=V-0' Southold Town BO?rd of Trus+ees OLD TR U EES .. SOUTH. s rro. 10 � 34� A . lssued, ,To UG�bo� C�% ,b zn�. D a te.. 9 ,/l g/2 4 Address Ave n U:e simt. r s ISla,.l .THIS. NOVICE MUST BE DISPLAYED DURING- CONSTRUCTION TOWN TRUSTEES OFFICE ,TOWN OF SOUTHOLD SOUTHOLD N.Y. 11971 TEL.: 765-1892 Glenn Goldsmith,President S;,�3�Og11FF0(,l-cpG ��p Town Hall Annex A.Nicholas Krupski, Vice President 54375 Route 25 Eric Sepenoski ti ?f; P.O.Box 1179 Liz Gillooly Southold,NY 11971 Elizabeth Peeples ��� ��r Telephone 631 765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time:_ 9/i6/24 Completed infield by: Bruce Kinlin, Architect, on behalf of HAY HARBOR CLUB INC. requests an Administrative Permit to rebuild deck boards, decorative railings, and painted trim boards on existing porch; install finish ceiling boards on existing frame; install new light fixtures and ceiling fans. Located: Fox Avenue, Fishers Island. SCTM# 1000-9-3-1 Type of area to be impacted: ° Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: Chapt. 275 Chapt. 111 other Tyge 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.: Present Were: ✓ G. Goldsmith N. Krupski E. Sepenoski L. Gillooly E. Peeples Hay Harbor Club Porch photos i View of porch from driveway entrance • No work to the driveways, hedges or grading • No work to porch foundation • Existing concrete sidewalk to remain Hay Harbor Club Porch photos YA View of porch entrance • Existing concrete sidewalk to remain • No work to existing driveway • Decorative railings and painted trim boards to be replaced Hay Harbor Club Porch photos 01 _ 1 � View of existing front porch • Deck boards and painted trim boards to be replaced • Finish ceiling boards to be installed on existing framing • New light fixtures and ceiling fans to be installed Hay Harbor Club Porch photos Detail views of existing front porch • Decorative railings and painted trim boards to be replaced • Deck boards to be replaced Hay Harbor Club Porch photos MJ dog �e 1 Il it 11 View of existing front porch • Deck boards and painted trim boards to be replaced • Finish ceiling boards to be installed on existing framing • New light fixtures and ceiling fans to be installed 9, w l G Oft � a B6 6 y = �° . b .;\`� Q O B')Ncl d .V~�Btr iQ6 g.. at n �y rn�.. \`• $� tt� yG•wt itA WT-24 0 oB-s mse ra F fFD 27 0.D.81. - �j x a lip F i ' u zav u 0 ca' z k x B. 1 a nl:urx�oriB��x J+ wEft P ,� ��� '^'.`-'�✓ - sz iN 1 L �CIA .4 x }6y 3 CR t a - HAY HARBOR � IayBl ��i a �-{ A 'k �t�w�kti ♦ mac .s Q ` •! _ j t• AH3 9 �JIw''�fib\�i.t , `9xJ� yl I 4� 'e�BMI@ oTxm4i9 y3' A 4 ,. .. 3NB1 56 a, TV t RIke a zsiac� (72) �+ ETTRICK 4 a s 'i9 'y •�' '�';. .� 216 BW `•. 8. ie w, m a -a2,.. 2)e jzB �.as..._ atA i.rs&�LS, _' °•: )'^ ;� a� v'�.^ M BI o _ A Rb 3f 9 .1 M-Wcl 't aD A iit )s B ✓ Ba K e .,uo •. '.... _��_ , _ COUNTY OF U N n ME ,.,,u t� •A scc,ia�rs� < E R al P­r­ly 1 �gen�s u..rtew.°Fr,rcs+cae ax v N �--Y--__._— w ._dL_—_ 'n�• -- wu ...: o.w,.... �; rxr.. x.x.\> r/ W SU'WLx COWly iaa ww69+vB+EB A An OFFICE LOCATION: MAILING ADDRESS: Town Hall Annex P.O.Box 1179 54375 State Route 25 ; Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) '.: ;!Southold, NY 11971 Telephone: 631 765-1938 �' ►'. • y0;'. 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 HAY HARBOR CLUB INC. SCTM# 1000-9-3-1 Bruce Kinlin, Architect, on behalf of HAY HARBOR CLUB INC. requests an Administrative Permit to rebuild deck boards, decorative railings, and painted trim boards on existing porch; install finish ceiling boards on existing frame; install new light fixtures and ceiling fans. Located: Fox Avenue, Fishers Island. SCTM# 1000-9-3-1 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 I Glenn Goldsmith,President �F S�UT Town Hall Annex �� �® A.Nicholas Krupski,Vice President i4 �� 54375 Route 25 P.O.Box 1179 Eric S'epenoski Southold,New York 11971 Liz Gillooly G Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only LM Coastal Erosion Permit Application Wetland Permit Application AUG ' r Administrative Permit Cv�A Amendment/Transfer/Extension Received Application: So�t�old7nwn Received Fee: $ aT Completed Application: Incomplete: SEQRA Classification: Type I Type II 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): Hay Harbor Club Inc Mailing Address: 990 Fox Ave. PO Box 477, Fishers Island, NY 06390 Phone Number: (631) 788-7323 Suffolk County Tax Map Number: 1000 - 9-3-1 Property Location: Fox Avenue, Fishers Island, NY (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Bruce Kinlin Mailing Address:59 East 54th Street, Suite 92, New York, NY 10022 Phone Number: 212.695.2988 Email:.bruce@ kinlinrutherfurd.com __ _-:,,)ard of Trustees Applicati`=:? GENERAL DATA Land Area(in square feet):,± 432,986 Area Zoning: R-80 Previous use of property: Commercial (Outdoor Sports) Intended use of property: Commercial (Outdoor Sports) Covenants and Restrictions on property? —ayes �No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? 2—Yes _nNo If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? =Yes _Z _No If"Yes",please provide copy of decision. his project re any demolition as per Town Code or as determined by the Building Dept.? Yes ✓ No Does the structure(s) on property have a valid Certificate of Occupancy? ✓ Yes=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?_No_E] Yes If yes, provide explanation: Project Description(use attachments if necessary): Rebuild deck boards on-existing porch --aoard of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Install new wood to replace existing which is in poor condition Area of wetlands on lot: square feet Percent coverage of lot: _ % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands:_ feet Does the project involve excavation or filling? 0 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: Not applicable 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): There will be no effect to tidal or fresh water wetlands. � T^ 61 Z20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: Hay Harbor Club Project Location(describe;and attach a location map): 1000-9-3-1 Brief Description of Proposed Action: ` Rebuild deck boards on porch Name of Applicant or Sponsor: Telephone:212.695.2988 Bruce Kinlin E-Mail:bruce@kinlinrutherfurd.com Address: 59 East 54th St, Suite 92 City/PO: State: Zip Code: New York I NY 110022 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 ❑ a 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: :Building Department permit 3.a.Total acreage of the site of the proposed action? 9.94 acres b.Total acreage to be physically disturbed? (1 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor'? 9.94 acres 4. Che La I land us at occur on,adjoining an ar the prop action. Urban Rural(non-agriculture) Industrial Commercial ©Residential(suburban) Forest ❑Agriculture Aquatic ❑Other(specify): Parkland Page 1 of 4 I' 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? F�1� [1, b.Consistent with the adopted comprehensive plan? V 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, I YES b.Are public transportation service(s)available at or near the site of the proposed action? ✓ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 9.Does the proposed action meet or exceed the state energy code requirements? NO YES Ifthe proposed action will exceed requirements,describe design features and technologies: W1 10. Will the proposed action connect to an existing public/private water supply? NO YES Not applicable - If No,describe method for providing potable water: ❑ ❑ r 11.Will the proposed action connect to existing wastewater utilities? JN0_ 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 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 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. ntify the typic -habitat types that oc n,or are likely to be found on tl"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? NO YES 17.Will the proposed action create storm water discharge,either from point or non--point sources? NO If Yes, a. Will storm water discharges flow to adjacent properties? ✓❑NO DYES ❑✓ El b.Will storm water discharges be directed to established conveyance systems ff an m drains)? If Yes,briefly describe: O ES 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 Applicant/sponsor name:BCUCe Kin in _ Date:. _ Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the.fol lowing 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 l. 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? aEl 3. Will the proposed action impair the character or quality of the existing community? El a 4. Will the proposed action have an impact on the environmental characteristics that caused the a establishment 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 ❑ ❑ reasonably available energy,conservation or renewable energy opportunities? 7. W ill the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? El 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, E J 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? 1 l. 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. Check this box if you have determined,based on the information and analysis above,and,any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Board of Trustees Application AFFIDAVIT L s C. 1P(eS -'den�- v �w i n-e I I BEING DULY SWORN DEPOSES AND AFFIRMS THAT-HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(,SIAND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF EWYMR 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,IF GRANTED., IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENTk9fOR 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. x :i Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS L0 DAY OF GO$,4' ,.2011-N _ otary Public o,0,tG.2 4et 4F.{oLZZS�o3 Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) IIWe,LC� C i 2 l —r owners of the property identified as SCTM# loon-9-3-1 in the town of Fishers Island ,New York,hereby authorizes Bruce Kinlin 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. i Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS G DAY OF Acc�iy5r ,20 Zy otary Public Ie f 05'2-1.* APPLICANT/AGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Towmof Southold's'Code of Eihics prohibit§conflicts.of interest on the-hart o`ftown officers and emolovees.The numose of .this form is to,provide inforinaddii which can-alert the town of possible conflicts of interest and'allow ith iake whatever action is necessary to'avoid same. YOURNAME: Bruce Kiniin (Last name,first name,ipiddle initial,unless you are applying in-the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map. Planning Other (If"Other",name the activity.) _- Do you personally"(or through your company,spouse,sibling,parent;;or child)Piave a relationship with any off car or-employee of the Town-of Southold? "Relationship"includes'by blood;.marriage,.or business interest:"Busine"ss interest'means wbusiness, including a partnership,in which the town officer or employee has'even.a partial ownership-of(or employmentby)a corporation in which ih'e town officer or employee owns more than.5%o ofthe 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 i 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): JJA)the owner of greater than 3%of the shares of the corporate'stock of the applicant _n (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when;the applicant is not a corporation); C)an officer,director,partner,or employee of ther applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of. (/ 20 `7 Signature . Print Name U Fonn TS 1 1 V0 a 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 si 'ficant beneficial-and adverse effects: von the coastal..area(.which,includes all of.Southold Town). z - 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 su6porting and non- supyortim facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shaTnot'be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website(southoldtown.northfork.net), the Board of Trustees Office,the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE,AND PROPOSED ACTION SCTM# 1000 PROJECT NAME Hay Harbor Club - Porch 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: 0 Nature and extent of action: Rebuild.deck.boards on existing porch Location of action. .990 Fox Ave. PO Box 477, Fishers Island, NY 06390 Site acreage: 9.94 Present land use: Commercial (Outdoor Sports) Present zoning classification: R-80 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: 'Bruce Kinlin . (b) Mailing address: 59 East 54, Suite 92 New York, NY 10022 (c) Telephone number: 212.695.2988 Will the action be directly undertaken,require funding,or approval by a state or federal agency? r Yes.0 No❑✓ If yes,which state or federal agency? r 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. 4 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. r✓ Yes ❑ No Not Applicable Preserve existing_historical porch Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria 0 Yes ❑ No❑ Not Applicable � I I Attach additional sheets if-necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ® Yes ❑No❑ Not Applicable Attach additional sheets if necessary Policy 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. l ❑Yes ❑ No 0 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. Z WE] No❑Not Applicable Improve public space near coastal waters Attach additional sheets if necessary Preserve existing historical.porch Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑✓ Yes ❑ No❑ Not Applicable . reserve existing historical porch 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 21 Not Applicable s Attach additional sheets'if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No ❑✓ Not Applicable Attach additional s eets 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 Z Not Applicable - ti i WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑Yes ❑.No ❑ Not Applicable Attach-additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town 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. ❑Yes ❑ No 0 Not Applicable Attach 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 TITLE ((��f}t DATE ��