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HomeMy WebLinkAboutSwing, Robert (2) oo FOCI Michael J. Domino, President �o�� 100 Town Hall Annex John M. Bredemeyer, III, Vice-President 54375 Route 25 Glenn Goldsmith P.O. Box 1179 A Nicholas Krupski y • o�� Southold, NY 11971 Greg Williams col , 'ia Telephone (631) 765-1892 ax 631),765-6641i: SOUTHOLD TOWN BOARD OF TRUST P MAR 1 2 2019 TO: SOUTHOLD TOWN BUILDING DEPARTMENT `'-.''``` `' `=' `"�• RE: VERIFICATION OF BUILDING DEPARTMENT PERMIT Re,00IREMEN-1`m` D SCTM#: 53 " Property Owner Name: `SwlAl� Date Sent to Bldg. Dept: {" "`d The Office of the Board of Trustees is -'ferenced application for foniv_ard���- verification of the Building DepartmE j�31d,7 �- As stated below: YES NO Will the pri v�&Aee_ Aal k� 'wilding Permit? oAs�l �%�-Will the pro �r.:. reau�rP�- •- -lance determination from the Zor;_--'-' � • 71-1 4 z Will any p art', 3/ idered a Demolition -� as described P615� GQ Z' o✓���� A- - COMMENTS: �Qv� f`dn �S �_ g nature of Reviewer 'i Michael J.Domino,President ��OF SOUj�o Town Hall Annex 54375 Route 25 John M.Bredemeyer III,Vice-President ,`O l0 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Telephone(631) 765-1892 Greg Williams 'Ol Fax(631) 765-6641 r y00UN'f`1,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application Administrative Permit —,LAmendment/Transfer/Extension ✓ Received Application: 2,jq•IQ Received Fee: $ 20,00 6ompleted Application: •��• Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): 5 n i-_; ;, Date of Inspection: l0 Receipt of CAC Report: Technical Review: Public Hearing Held: Resolution: Owner(s) Legal Name of Property (as shown on Deed): S yJtT\9A Mailing Address: q U C'1 u y-\ C N�j b R6 , Phone Number: LPG 3`) Gil 89 Suffolk County Tax Map Number: 1000 - 53 GL-\ - d� Property Location: S k��U1 YOU rf 'P 11� S•� (If necessary,provide LILCO Pole #, distance to cross streets, and location) AGENT ( applicable):licable): C5�f1 p�c�\S l JGtiSar\ S,y` .Or\moaS NQ Mailing Address: 76 �-I� �-CAA- "\ 1 M 3 0 Phone Number: . �� Board of Trustees Apply' tion J GENERAL DATA Land Area(in square feet): 2- S J S Area Zoning: ��S 6C N1 C�.\ Previous use of property: 'R S" (A Intended use of property: PN 2 STS 6 2rY--,�A-1 C�,-X Covenants and Restrictions on property? Yes X No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? 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. Will this project require 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 I—No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: Project Description (use attachments if necessary): 1 N%UA- ICU 1 M Chi IS, X"'30 V0, p— SVVCoAV\' C ��cvact vixy, 1 XLf 'l VAq I 1 � � )UP , \j& o\nrl ld' lniGle� Board of Trustees Appli' tion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ok OL a \ Ot,V-\ Cam. Area of wetlands on lot: 5o square feet Percent coverage of lot: 2 . 9 % 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? No y Yes If yes, how much material will be excavated? S cubic yards How much material will be filled? LJ cubic yards , Depth of which material will be removed or deposited: S feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: C�''�/Q O� C)1�d' 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): ��aN ands (Aa 6ft 0\-Q- V aG _ 0-� 7CO_t=_X(t0 617.20 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: Project Location(describe,and attach a location map): Brief Description of Proposed Action: 1�S 1 at�O`CN & G S ' C-,v�n`��� S v�( 1 VVL►vti�l�� �oo �Oki W�d Name of Applicant or Sponsor: Telephone: _,3 9z R,-)SLH aSOn ° D � OS �CS � 5i l(VE-Mail:I C k CQ. a Q'sW 0► S Address: i COo\ , C O t0 gox '239 9 City/PO: State: Zip Code: A-M� L-A tAl- I . 1 J\_f 11 Ci 3 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 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: Llpk 3.a.Total acreage of the site of the proposed action? Ur ILA acres b.Total acreage to be physically disturbed? "11 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? , 'In acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban Rural(non-agriculture) ❑Industrial ❑Commercial [Residential(suburban) ❑Forest ❑Agriculture El Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ LZ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? El K - 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: 54 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES M ❑ b.Are public transportation service(s)available at or near the site of the proposed action? ® ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: SW�V%A�%,r1CA p00\ n ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: S\t f\\MWA�,n TOYQ El 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? � ❑ b.Is the proposed action located in an archeological sensitive area? ® ❑ 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ❑ b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? © El Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: MA LN Shoreline ❑Forest ❑Agri cultural/grasslands ❑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 VES If Yes, a.Will storm water discharges flow to adjacent.properties? ❑NO EJYES �y,.}[ '� ❑ b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO AYES Page 2 of 4 r 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,darn)? If Yes,qxplairl purpose and size:,� 0. ' �C0. Jti ._ `�Ou(\ �� �-.__•, 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; © Q 20.Has the site of the proposed action or an adjoining property been the subject of retnediation(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:. 5� �Sx � S Date: Signature: J — 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 maiy 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? ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the,proposed action result in an adverse change in the existing level.of traffic or �7`l ❑ affect existing infrastructure for mass transit,biking or walkway? t 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, ® ❑ 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)? I t 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? 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 Applic ' Lon AFFIDAVIT: si-tp 1 y vi l t Swriy\-G( BEING DULY SWORN DEPOSES AND AFFIRMS THAT--IE/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 SO.UTHOLD 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 AGENTS) 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. ignatu oY Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS I I DAY OF 20Mal Lary Public , v STATE OF NEW • YORX N n�'PUBLIC,.., a`? Board of Trustees Applicr -Lon AUTHORIZATION (Where the applicant is not the owner) I/We, �N2, �G �. S } owners of the property identified as SCTM# 1000- Ll 6 in the town of IS00 C� ,New York, herebyauthorizes. Sao ��_ p A\`S P(5Q\S , _3b S(/1M . .31 YYl W)MA-S 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. AIA ary-V Propert Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS I DAY OF 11� , 20ja — Notary Public 6NMCP STO • OF NEW YORK .7 -c p0 fARY PUBLIC - h�icCarAY,. $� 0i ; l APPLICANUAGENUREPRESENTA.TIVE TRANSACTIONAL DISCLOSURE.FORM nie Town of Sotithold's t:ode of rthics pr6hibits conflicts of interest-on-the part of tt)wn officers and:cmRlovecs.,tiic purpose of "s fa'm i's:tb tr J'de inf r' tion wliic "b;uva1'Lrt'ihe tolvri ot'' t)5Sihle C/711fI1cfS`d?f li)tGrCStYtm 61101'V it tdt`tit e`Whitevt:r action t . necessary to avnid,�amc: YOUR NAME: S�f 7 �V11'C Sv�J 1✓\� ... (Last name)first name,.tatiddle initial,unless y e applyingin 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 Coastal Erosion Change of Zone �. Approval of plat _ Mooring Exemption from plat or official map _ Planning Other (if"Other",name the activity.)._.._, Do you personal ly(or through your company,.s0ouse,sibling,parent,or child)have a rclationshi.p ai%jtlt any officer or cutployce of the Town of-Southold? "Relationsljip"includes by blood;nian•iage,oe btisincss interest..".B►asincss iittcrest".ineans a business; including a partnership, in which the tdwn.o.fficef•or:eiii{loyee has'even a partial ow.neislrip off(or calployniettt by).3 corporation in which the town officer or employee avrns n3om.than'Ab.of the shares. YES NO If you answered"YES",complete the balance of this forni 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): A)the owner of greater than 04,of the shares of tlic corporate stock of tlie`opplicont (when the applicant is a corporation);. B)the Icgitl or bend icial'oyvner of any interest in anon-corporate entity(tVhen the applicant is not p corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted thi day of 200 Signature. . Print Name, . Form TS I Uj APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of ssible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: (Last name,first name,diddle 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 Trustee k Variance 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 Ifyou 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): A)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 applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submftted this V Ck day of f e e uc4 20 0, Signature '' Print Name ,aSo SrN• µ Form TS l y PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK ,residing at ,being duly sworn, deposes and says that on the day of , 2C , deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at , that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this Day of 520 t Notary Public NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: -SCTM# YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: I 2. That the property which is the subject of Environmental Review is located adjacent'to your property and is described as follows: 3. That the project which is subject to Environmental Review under Chapters 96,111 and/or 275 of the Town Code is open to public comment on: DATE: You may contact the Trustees Office at 765-1892 or in.writing. The above-referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. PROPERTY OWNERS NAME: MAILING ADDRESS: PHONE M AGENT: MAILING ADDRESS: PHONE #: Enc: Copy of sketch or plan showing proposal for your convenience. Board of Trustees Applj\_ _.'lion AFFIDAVIT 1�UDVA— rNG BEING DULY SWORN DEPOSES AND AFFIRMS THAT /SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION' AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO-MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF EZZ/Z1-jA41-C-( , 20_Z Keith R.Moehringer Notary Public,State of New York P No.01 M06054930 0ualilied in Nassau County Notary Publi Commission Expires Feb.12,20� Board of Trustees Appl. -,Ltion AUTHORIZATION (Where the applicant is not the owner) I/We, U Sv Ayt owners of the property identified as kTM# 1000- S3--CYu'T ) in the town of New York, hereby authorizes J O'so f1 ° S Pa n VS . 0\-So,n S`-,MW-\QV ,Sto 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, Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS Z'* DAY OF_ /�� ,20 Keith R.Moehringer Notary Nob01 jVi06054�ptSt State of Now York Notary Cluaiilied in Nassau Coun Commission Expires Feb.12,2®.Z3 APPLICANT/AGENTmEPRESENfiATIVE TRANSACTIONAL DISCLOSURE FORM e Toiyn-dtSoutfiol& of' terest 6n the ' t w •a and m o e e e o fo ` et urliiah a e' e t i e w file of inters t w it to take whatever abdon is neCB,SSarVltO�yaid 3artte, o YOUR'NAME: (Last name,first name,*iddle lriitiat,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)haven relationship with any officer or employee of(lie Town of Southold? "Rclationship",ineludes 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 chlil l6yee awns more than S%of die 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 bescribe the relationship between yourself(the appiicanVagenerepnesentative)and the town officer pr employee.Either check the appropriate line A)through Mandlor describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner,ofgreater tliari S%of the shares of die corporate stock of the applicant (when the applicant is a corporation); 13)the legal orbenCficial 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 j�. day of b_VA % ,20 tc S,igpature PrintName, Form TS 1 R Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a.determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form.should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated. as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3: If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supportin'g 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 '7 Q\QL S The Application has been submitted to(check appropriate response): Town,Board ElPlanning 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: 1 hSD3A o\ 1S' x 30' G\J n i fie. S\N`wwm iy\ Location of action: fun Wer !" Site acreage:(. S29 Q.C. Present land use: t.Q sf�d P yy l L\ Present zoning classification: bC J. 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: 50�SUYl�f �,� S f oo\S k (b) Mailing address: V 0 �—N c) A 1"1\noQ 4+y Sc` -t- 1 —1 11C130 (c) Telephone number: Area Code (d) Application number,if any: N/ Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes 91 No❑ If yes, which state or federal agency? 1D E� G C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a'coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies, Page 2 for evaluation criteria. ❑Yes ❑ No � Not Applicable `2-es►cue �t; `o` Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III-Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No 1$ Not Applicable Attach additional sheets if necessary" Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No �0 Not Applicable 4L%d w xla-i cw-\ C-kc '51-�00\C� fc b S ►� 1n�r ►-�. 1`�c , 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 LIN Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No �Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. Yes No of Applica Attach additional sheets if necessary Policy 7: Protect-and improve--air quality-in -the Town -of Southold..-S-ee-L--WRP-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.. ❑ Yes ❑ No Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the.Town of Southold. See LWRP Section III-Policies; Pages 38 through 46 for evaluation criteria. ❑ Ye❑ No 1� Not Applicable Attach additional sheets if necessary { t r WORKING COAST POLICIES r 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 [SNI 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 Not Applicable Attach additional sheets if necessary Policy M 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 J O�SV�1 Snt �f�(}� TITLE DATE - - - - - - I o SURVEY OF - - IUJI LOTS 27 & 28 J a I I AMENDED MAP A„ OF M PECONIC BAY ESTATES o I I FILE No. 1124 FILED MAY 19,1933 Uj SITUATE a) I GREENPORT M I I TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-53-04-07 SCALE 1 "=20' JANUARY 18, 2019 I I TOTAL AREA = 23,055 sq. ft. (TO TIE LINE) 0,529 aC. UPLAND AREA = 16,330 sq. ft. I I I I I � I NOTES: 1. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM �1 EXISTING ELEVATIONS ARE SHOWN THUS:AKX ( I EXISTING CONTOUR LINES ARE SHOWN THUS: XX— — — — —XX F.FL. - FIRST FLOOR G.FL. - GARAGE FLOOR TW. - TOP OF WALL IO I BW. - BOTTOM OF WALL I � � / / I / o 0�9 M JPR�9,z LO COVERAGE OVER UPLAND AREA DESCRIPTION AREA % LOT COVERAGE 5 6g /QPRE N\GN I HOUSE 2,326 sq. ft. 14.2% FRONT PORCH 240 sq. ft. 1.5% E _ X2 Z WALL LS SCREENED PORCH 479 sq. ft. 2.9% 1.9 \ X.� 7.5 \ I f E B 9 2019 (2) WOOD DECKS 86 sq. ft. 0.5% OUTSIDE SHOWER 26 sq. ft. 0.2% \ NA-0 i y (2) CONC. SLABS 38 sq. ft. 0.2% X� �'� PAVER WALK 433 sq. ft. 2.7% O J N I _45 X 3 BRICK PATIO 640 sq. ft. 3.9% Y ` U U 4 \ I PROPOSED POOL 450 sq. ft. 2.8% 19. TOTAL 4,718 sq. ft. 28.9% FIRE PIT TO WETLAND ALONG CONC. SEAWALL 2 �34 \ BE REMOVED BY R. FOX, JANUARY 2006 BRICK WALK BRICK WALL 6 WALL _ FLAG�4 \ STONE 0.5'N. POLE FIRE PIT -PROPOSED 5A::::r`:: �(:::• N BRICK PATIO a FIRE PIT ............... 14' 18.2' IX 0 33.2' ............................................... U PROP. DRYYJELL FOR X5 7 04 FRAME SCREENED PORCH POOLBAGKWA5H ALL - X WOOD 26.3' 24.7' 1.1'S. 6.3 PS o c41i CONC. WALL o z {{ WOOD DECK 3 WALL 0.4's. PROP. POOL 17•6, " EQUIPMENT LL z 5Z CHIMNEY a R V Q, X OUTSIDE Uj N \� SHOWER n CATE 6.2 X p ZA AIR COND. UNITS '? [ti ON CONC. SLAB N Y \� C3 CRAWL 41 'J ENTRY 6.6 Uj 2nd STORY V) > ~ XWOOD DECK =O F.FL.10.29 a y h s: 10.6, = o.o' 4 Ll ROOF OVER FENCE AIR CUNT Q WOOD PORCH m 0.4'S. U_ A X OIL TANK ON z CONC. SLAB 0 WOOD l' X In n ° STEPS ri N n d e. e • ` e Z.0 ° X 20.6_ 24.4' FENCE 0.3'N. b° a' FENCE e .. . a e ` 14'S. I d l STOCKADE e m FENCE v e � � X� FENCE LLj X 7.6 I I 5 1.3'S. SEPTIC--e ` t TANK al �p e y a M e o I w � tee . °. E N X = r- Y X_ y I 0 e ., X&_2 X� I ve ; N PREPARED IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS AS ESTABLISHED 502.70 WATER BY THE L.I.A.L.S. AND APPROVED AND ADOPTED METER a e' FOR SUCH USE-BY THE-NEW YORK STATE LAND I I S TITLE ASSOCIATION.OUND ONC. MON. ELECTRIC METER UTILITY POLE ( LIPA#30 WI �ERHEAD RES- —' —4 - ° OVERHEAD WIRES N 44° 12'40" W i 100.00' •� ° 6_7 <BELGIAN BLOCK i � EDGE OF PAVEMENT 6.55 a' 6.41 CURB APRONZ' CATCH �. d• a ..' .. e. _ e a• ° •° . e . 4. d < BASIN ° '� C e d //p��. n e, .a .. a ,d X6.97 BAY 1Y s ° X654 •tee. O R E R A - N.Y.S. Lic. No. 50467 UNAUTHORIZED ALTERATION ADDITION Nathan T of t Corwin III THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. Land Surveyor COPIES OF THIS SURVEY MAP NOT BEARING v. THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. CERTIFICATIONS INDICATED HEREON SHALL RUN Successor To: Stanley J. Isaksen, Jr. L.S. ONLY TO THE PERSON FOR WHOM THE SURVEY Joseph A. Ingegno L.S. IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND Title Surveys - Subdivisions - Site Plans - Construction Layout LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTI- PHONE (631)727-2090 Fax (631)727-1727 TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. OFFICES LOCATED AT MAILING ADDRESS AND/OR EASEMENTS OF RECORD, IF THE EXISTENCE OF RIGHT WAYS 1586 Main Road P.O. Box 16 ANY, NOT SHOWN ARE NOT GUARANTEED. Jamespod, New York 11947 Jamesport, New York 11947 - . , it t r/` � r "" • w� R . x 1 s.'��)' �` a.�:,"s�` - - x -.. ,.,..., • 3 -.�,�. h gyp'.:S� '���". 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