HomeMy WebLinkAboutTR-10669A Glenn Goldsmith,President QF SO(/,� Town Hall Annex
A. Nicholas Krupski,Vice President ®� ®�® 54375 Route 25
P.O. Box 1179
Eric Sepenoski 9�[ Southold,New York 11971
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 BOARD OF TRUSTEES
72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF
BELOW
INSPECTION SCHEDULE
Pre-construction, hay bale line/silt boom/silt curtain
1 st day of construction
% constructed
When project complete, call for compliance inspection;
Glenn Goldsmith, President ®F so Town Hall Annex
54375 Route 25
A. Nicholas Krupski,Vice President ®� ®�®
P.O. Box 1179
Eric Sepenoski l l Southold, New York 11971
Liz Gillooly G Telephone(631) 765-1892
Elizabeth Peeples • a® Fax(631) 765-6641
COWN
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 10669A
Date of Receipt of Application: October 24, 2024
Applicant: Dahna Basilice Revocable Trust
SCTM#: 1000-53-6-8
Project Location: 3255 Bayshore Road, Greenport
Date of ResolutionlIssuance: November 13, 2024
Date of Expiration: November 13, 2027
Reviewed by: Board of Trustees
Project Description: To construct a 133 sq.ft. roof over entrance area to
dwelling; install a generator on a concrete pad on-grade plus small pad for
propane tanks.
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 Nicholas J. Mazzaferro, P.E., received on October 24,
2024, and stamped approved on November 13, 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.
�t' �A"
Glenn Goldsmith, President
Board of Trustees
i
SOUTH. . IOLD . TRUSTEE.s
rroo l o C (ocN A
i
- Dat
Issued To a 6CAL << ►�Nse �Il 3 44.
Address. ,- 3as5 �c�a �l�,vc� P�oc.� . Gceen porl�
THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION,
TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD
SQUTHOLD, N.Y. 11971
TEL: 765.1892
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.... .. 4/ 01 PERMIT SET 10.15.24
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SKYLIGHT SCHEDULE ----
NOT
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- ELEMENT ID W X H SIZE - BOARD OF 1RUSTEES
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SURVEY OF PROPERTY
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SUFFOLK COUNTY,
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LOT NUMBERS REFER 70 'AMENDED MAP A —
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Glenn Goldsmith,President ���\O COGy � Town Hall Annex
A.Nicholas Krupski,Vice President < 54375 Route 25
Eric Sepenoski * ,? P.O.Box 1179
Liz Gillooly �y • 0�� Southold,NY 11971
Elizabeth Peeples ` / 9 Telephone(631)765-1892
Fax(631)765-6641
Southold Town Board of Trustees
Field Inspection Report n
Date/Time: 27 pdbBy 2"2'6ompleted in field by: it'd d `
Sol Searcher Consulting on behalf of DAHNA BASILICE REVOCABLE TRUST request an
Administrative Permit to construct a 133 sq.ft. roof over entrance area to dwelling; install a
generator on a concrete pad on-grade plus small pad for propane tanks. Located: 3255
Bayshore Road, Greenport. SCTM# 1000-53-6-8
Type of area to be impacted:
'Saltwater Wetland Freshwater Wetland Sound Bay
Part of Town Code proposed work falls under: "'Chapt. 275 Chapt. 111 other
Type of Application: Wetland Coastal Erosion Amendment
✓ Administrative Emergency Pre-Submission Violation
Notice of Hearing card posted on property: p Yes No Not Applicable
Info needed/Modifications/Conditions/Etc.:
(71
Present Were: G. Goldsmith N. Krupski L./E. Sepenoski
L. Gillooly E. Peeples
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OFFICE LOCATION: r .: Q:;, MAILING ADDRESS:
Town Hall Annex a` ;' t. fQ;`. P.O.Box 1179
54375 State Route 25 � :��
Southold,NY 11971
(cor. Main Rd. &Youngs Ave.)
Telephone: 631 765-1938,
Southold, NY 11971 LOCAL WATERFRONT REVITALIZATION PROGRAM
TOWN OF SOUTHOLD
To: Glenn Goldsmith, President
Town of Southold Board of Trustees
From: Mark Terry, AICP
LWRP Coordinator
Date: November 12, 2024
Re: LWRP Coastal Consistency Review for DAHNA BASILICE REVOCABLE TRUST et al.
SCTM# 1000-53-6-8
Sol Searcher Consulting on behalf of DAHNA BASILICE REVOCABLE TRUST request an
Administrative Permit to construct a 133 sq. ft. roof over entrance area to dwelling; install a
generator on a concrete pad on-grade plus small pad for propane tanks. Located: 3255 Bayshore
Road, Greenport. SCTM# 1000-53-6-8
The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the
Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy
Standards. Based upon the information provided on the LWRP Consistency Assessment Form
submitted to this department, as well as the records available to me, it is my recommendation that
the action is CONSISTENT with the LWRP.
Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its
written determination regarding the consistency of the proposed action.
Cc: Honorable Lori Hulse, Attorney
Glenn Goldsmith,President Town Hall Annex
A.Nicholas Krupski,Vice President 54375 Route 25
P.O.Box 1179
Eric.5epenoski Southold,New York 11971
Liz Gillooly -4
Elizabeth Peeples
Telephone(631) 765-1892
CS.
Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
This Section For Office Use Only
—Coastal Erosion Permit Application
-Wetland Permit Application
Administrative Permit
Amendment/Transfer/Extension
—Received Application:
Received Fee:S
—Completed Application:
—Incomplete:
—SEQRA Classification: Type I Type 11 Unlisted Negative Dec. Positive Dec.
Lead Agency Determination Date:
—Coordination:(date sent): I' C E I V E
LWRP Consistency Assessment Form Sent:
CAC Referral Sent:
Date of Inspection: 0 CT 2 4 2024
—Receipt of CAC Report:
—Technical Review: Southold Town
Public Hearing Held: Board of Trustees
Resolution:.
Owner(s)Legal Name of Property (as shown on Deed): Dahna Basilice Revocable Trust
Mailing Address: 52 Monterry Drive, Saint James, NY 11780
Phone Number: 516-650-2276
Suffolk County Tax Map Number: 1000-53.-6-8
Property Location: 3255 Bayshore Rd, Greenport, NY
(If necessary,provide LILCO Pole#, distance to cross streets, and location)
AGENT(If applicable):David Bergen, Sol Searcher Consulting
Mailing Address:Box 1008, Cutchogue, NY 11935
Phone Number: 516-848-6438 Email:,Vincentbasilice@gmaii.com
Board of Trustees Application
GENERAL DATA
Land Area(in square feet): 13,068.
Area Zoning:R-40
Previous use of property: Residential
Intended use of property: Residential
Covenants and Restrictions on property? Yes _Z_No
If"Yes",please provide a copy.
Will this project require a Building Permit as per Town Code? Yes Jallo
If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review
and Elevation Plans will be required.
Does this project require a variance from the Zoning Board of Appeals? =Yes _✓ _No
If"Yes",please provide copy of decision.
is project re any demolition as per Town Code or as determined by the Building Dept.?
Yes ✓ No
Does the structure(s) on property have a valid Certificate of Occupancy? Yes_D_No
Prior permits/approvals for site improvements:
Agency Date
TR 4650, 6770A, 19394 . . 9/96, 10/07; 6/23 .
ZBA 6409 10/10 . .
❑ No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a governmental agency?]a No_n Yes
If yes, provide explanation:
Project Description(use attachments if necessary):Construct a.133 SF roof over entrance area to
house; install a generator on a concrete pad on grade plus small pad for propane tanks.
Board of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: To provide a covered entrance area to house plus a
generator to provide emergency power during power outage.
Area of wetlands on lot:. 0 square feet
Percent coverage of lot: 0
Closest distance between nearest existing structure and upland edge of wetlands: 13 feet
Closest distance between nearest proposed structure and upland edge of wetlands: 13. . . feet
Does the project involve excavation or filling? ❑ No Yes
If yes,how much material will be excavated?<1 cubic yards
How much material will be filled?0.. cubic yards
Depth of which material will be removed or deposited: 1. .. feet
Proposed slope throughout the area of operations:
Manner in which material will be removed or deposited: hand dug
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):
none
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
Dahna Basilice Revocable Trust
Name of Action or Project:
Basilice entry roof and generator installation
Project Location(describe,and attach a location map):
3255 Bayshore Dr, Greenport, NY
Brief Description of Proposed Action:
Construct roof over entry area of house and install a generator plus two propane
tanks along side of house.
Name of Applicant or Sponsor: Telephone:516-650-2276
Dahna Basilice E-Mail:vincentbasilce@gmail.com
Address:
52 Monrerrey Dr,
City/PO: State: Zip Code:
St. James NY 11780
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: ❑
:Southold Building Dept
3.a.Total acreage of the site of the proposed action? •30 acres
b.Total acreage to be physically disturbed? c 01..:. acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? •30. acres
4. Che 1 land us at occur on,adjoining an ar the prop action.
Urban Rural(non-agriculturej Industrial Commercial ❑✓Residential(suburban)
Forest ❑Agriculture ✓Aquatic QOther(specify):
Parkland
Page 1 of 4
5. Is the proposed action, NO f YES N/A
a.A permitted use under the zoning regulations? ✓
b.Consistent with the adopted comprehensive plan?
6. Is the proposed action consistent with the predominant character of the existing built or natural NO. YES.,
landscape? ✓
7: 19 the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO .YES /
if Yes,identify.. ....
8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES
b.Are public transportation service(s)available at or near the site of the proposed action?
c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action?
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:
❑ 171
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: . ❑
12. a.Does the site contain a structure that is listed on either the State or National Register of Historic i 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. .ffYE
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
✓ Wetland Urban Suburban
. . . _. L
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? in.
✓_.
16.is the project site located in the 100 year flood plain? NU 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 ❑YES
b.Will storm water discharges be directed to established conveyance systems f an¢�m drains)?
If Yes,briefly describe: 150 L_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:
mow,.-....�. ✓
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:_David Bergen..... __.._. .. Date:
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 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 conflictwith an adopted land use plan or zoning Elregulations?
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 El
of a Critical Environmental Area(CEA)?
5. Will the proposed action result in an adverse change in the existing level of traffic or El ❑
affect existing infrastructure for mass transit,biking or walkway?
6. Will the proposed action cause an increase in the use of energy and it fails to incorporate
reasonably available energy conservation or renewable energy opportunities?
7. Will the proposed action impact existing: El ❑
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)?
Page 3 of 4
No,or Moderate
small to large
impact impact
may may
occur occur
10. W i I I the proposed action result in an increase in the potential for erosion,flooding or drainage
problems? El:
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.
EJCheck 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
--trd of Trustees Applicati "
AFFIDAVIT
1 �tg4eG DULY SWORN
DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN
ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT
ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION
AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES.
THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE
BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES
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 t DAY OF 20
Notary Public
DOMINICK J.ARCHER
Notary Public,State of New York
Reg.No.01AR6138531
Qualified in Suffolk County
Commission Expires December 19,2025
�Lrd of Trustees Applicati_
i
AUTHORIZATION
(Where the applicant is not the owner)
I/We,
owners of the property identified as SCTM# 1000-_ 7? 0.0 I 53,b-9in the town of
SO 1Aq -0 ` .New York,hereby authorizes
�1 )aVL
1! to act as my agent and handle all
necessary work involved with the application process for permit(s) from the Southold Town
Board of Trustees for this property.
Property Owner's Signature Property Owner's Signature
SWORN TO BEFORE ME THIS . S DAY OF jo b , 20 2-Y
Notary Public
DOMINICK J.ARCHER
Notary Public,State of New York
Reg.No.01AR6138531
Qualified in Suffolk County
Commission Expires December 19,2025
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 purpose of
this form is to p vide information which can'alert the town of possible conflicts of interest and allow it to take whatever action is
necessary to avoid s�ameI. to
YOUR NAME: J�V'uQ't' ��1�� ��, "�.�T_
(Last name,first name,.griddle 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 intest"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 then,5%of the shares.
YES NO 5_
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 applicantt
_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,partnei or employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONSHIP
Submitted this�,If-�r'-da�y of Ddp�� 20)y
Signature 6�Csuxvr .
Print Name ✓1cr. M
Form TS I
7
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town.o€Southold's Code of Ethics-orohibits conflicts.of interest on the oast oftown oflicers and emoloveesi,The numose of
this form is°to provide information which can alert the town of possible conflicts of interest and all it to take whatever action is
necessacii to avoid same.
YOURNAME: David Ber-gen
(Last name,first name,iriddle 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 ofplat 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'arelationship with any officer or.employee
of the Town of Southold? "Relationship"inlaid by.blood,marriage,orbi.s':ness interest:"Busin'm interest meansa:business,
including a partnership,in.which the town officeror employee has even a partial ownership of(or.employment by)a corporation
in which the town.-officer oremployee owns.more thsn.5%of the shares.
YES F NO n
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):
fIA)the owner of greater than3%of the shares of the corporate stock of the applicant
12 (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
Submitted this day of 0.4, 20—&T
Signature
Print Name Dayi @r
Fonn TS I
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
3ninor action list, policies and explanations of each policy contained in the Town of Southold Local
Waterfront Revitalization Program. A...p ojiosed.action.will be evaluated as to..its si ' scant
beneficial and:adverse effects uponthe coastal:area(which'include&all of Southold Town).
3. If any question in Section C on this form is answered "yes" or"no", then the proposed action will
affect the achievement of the LWRP policy standards and conditions contained in the consistency
review law. .Thus, each.answer must be explained in detail,.:listing both supporting'and non-
supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and
.conditions,it shall not be undertaken.
A copy of the LWRP is available in the following places:online at the Town of Southold's
website(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 i..-53 _6-8
pROjE,CT NAME Basilice Covered Entry and Generator Installation
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. a
Nature and extent of action:
Install a.i33.SF.roof.over house entN area plus a generator and two propane tanks
along side of house,
r
Location of action: 3255 Bayshore Dr, Greenport, NY
Site acreage: -30
Present land use: residential
Present zoning classification:R-40.
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. Dahna Basilice Revocable Trust
(b) Mailing address: 52 Monterrey Dr, St. James, NY 11780
(c) Telephone number: 516-650-2276. _
Will the action be directly undertaken,require funding,or approval by a state or federal agency?
Yes ❑ No 0 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 LMW Section III-=Policies; Page 2 for evaluation
criteria.
Ryes No ❑Not Applicable
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See
LWBP Section III—Policies Pages 3 through 6 for evaluation criteria
❑ Yes 0 No 0 Not Applicable
Attach additional sheets if necessary'y_'_"µ
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
Attach additional sheets if necessary
NATURAL COAST POLICIES
Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRF
Section III—'Policies Pages 8 through 16 for evaluation criteria
❑ Yes ❑ No RI 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 EJ No Zot Applicable
Attach additional sheets ifnecessary
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 n Not Applicable
J
Attach additional sheets ifnecesoary
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'ifnecessary
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 FV1 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 0 Not Applicable
Attach additional sheets if necessary
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 ifnecessary
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 SY David Bergen, TITLE Agent DATE
Box 1008
Cutchogue, NY. 11935
October 24, 2024
Southold Town Trustees
Town Hall Annex
54375 Rt. 25
Southold, NY. 11971
Dear Trustees:
I am respectfully submitting to you the attached application packet for an Administrative permit
for the construction of a roof over the house entry area plus the,installation of a generator and
propane tank pads for the Basilice house located at 3255 Bay Shore Dr in Greenport...
Enclosed you will find:
Administrative Permit Application R
2 '
Copy of title page for Dahna Basilice Revocable Trust Lam,
Short Environmental Assessment Form
Authorization Form . .
Owner Affidavit 0 CT 2 4 2024
Applicant Transactional Disclosure Form
Agent Transactional Disclosure Form Soutlwld7own
LWRP Consistency Assessment Form BoardofTn�6ees
Site construction plans
Property survey
Color photographs
-Check to cover the$250 application fee
Thank you for your consideration of this application. Please do not hesitate to contact me at
516-848-6438 should you have any questions.
Sincerely,
David Ber ,Sol Searcher Consulting
Agent for Dahna Basilice Revocable Trust