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HomeMy WebLinkAboutTR-10717A Glenn Goldsmith, President ``�®F S0(/j� Town Hall Annex A.Nicholas Krupski,Vice President ®�V ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoskil Ji Southold, New York 11971 Liz Gillooly Telephone(631) 765'-1892 Elizabeth Peeples � �� Fax(631) 765-6641 COUfd 1 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE #2243 C Date: May 21, 2025' THIS CERTIFIES that the 12' x 22' deck added to back of dwelling, At 380 Hickory Road, Southold Suffolk County Tax Map#1000-54-6-10 Conforms to the application for a Trustees Permit heretofore filed in this office Dated February 3, 2025 pursuant to which Trustees Administrative Permit#10717A Dated February 12,2025,was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the 12' x 22' deck added to back of dwelling. The certificate is issued to CURTIS &RITA WINKLER owners of the aforesaid property. A Authorized Signature 1 - Glenn Goldsmith,President QF 3UU,�� Town Hall Annex O� ®� 54375 Route 25 A. Nicholas Krupski,Vice President e` ® P.O. Box 1179 Eric Sepenoski J�L Southold,New York 11971 ' Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples • aO Fax(631) 765-6641 COM BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10717A Date of Receipt of Application: February 3, 2025 Applicant: Curtis & Rita Winkler SCTM#: 1000-54-6-10 Project Location: 380 Hickory Road, Southold Date of Resolution/Issuance: February 12, 2025 Date of Expiration: February 12, 2028 Reviewed by:.Board of Trustees Project Description: As-built 12' x 22' deck added to back of dwelling. 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 Curtis Winkler, received on February 3, 2025, and stamped approved on February 12, 2025. 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. elL 4" Glenn Goldsmith,, President Board of Trustees TH TRUSTE OLD SOU . No. Issued T Datevlh.a /2.5 4, Address , sso' NA.,cv o6b oul1.o�� THIS. NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD SOUTMOLD, N.Y. 11971 TEL.; 765.1892 i i ` Town Hall Annex Glenn Goldsmith, President ®�� S®UT�® 54375 Route 25 A. Nicholas Krupski,Vice President �® P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly Telephone (631) 765-1892 1 Elizabeth Peeples Fax (631) 765-6641 �C®U01 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 1st day of construction % constructed When project complete, call for compliance inspection; 1 C" 1, ^�1 '•1 71fi rrv.n•P' /�-} ��:�+/�I) �q{1•,_—�.v 1 �,t�a 6'•0.,,,,1 V�1j�4�91�S 4 �J�I 1..�0�...;rJV d CL.�U,,.'_-:v,�li U Lolb�l4l:�.1� LOT AREA = 12,650 SQ.FT �•�; � rypry�ya��•a �- 4n*� r�^ 15-272 /1GC'tt�� '.#��J• `alt� 'T�4rlva.4b=YvaV j.._„ 16-175 APPROVED g��I' �jp d'�9 �1'�O V E® BY 0 —I OOa� 1 BOARD OF 'i r?USTEE� =-_Z:)�-___= ^ �IC; �'�L`'xf..''']rfid=,._.�t+;Jw•C''G.�.1J:li.,-?.lr.'�,"-�I�..,,�L.'_-.Jt;1 'TOWN OF. SOUTHOLD , DATE e\9 f uC,f 1 1 nbbon7 12-17-2014 nbbonI D [RCIROV, \ edge of standing water ,--, D nbbong JUL 2 2 2016 edge of standing water/ b �bon2 nhbon5 3-17-2014 freshwater wetlands as flagged by/ nbbon4� nbbonJ 13=DINr;D ff. THOMAS W CRAMER, ASIA, 12-14-2014 I TOWN WSOUMOLD EGEIVE NOW OR FORMERLY FISHER u , S 44-12'00"E 100.06' PI E F C LJ 2025 FID MON Vs'W N 0.4 S C Southold Town Board of Trustees ^ 8'dla x 12'deep w/high dome buned _ o N tank c 4 o 'o 0 a rd ell landing o x6' & steps -1 w 480' 220 Dzs (� o drain L2 STY FR o 1` n DWELL N o I/J �, o UJ M ] r 4.6' O 0 o p _ > GAR dwell Z Z �` 1- 12 5' _0 L 3 30.0' 21.2' �i 4 0' 4 42' � � � 43.5' s � oo roofed over 2 5 Z m conc stoop Ip �' 3.7 x 12.5' N G591.87' 0 3 C� 0 FD ole N 42'10'20"W O p 100.00' PIPE HICKORY ROAD ECENED SUFb QeOa HEr�1T J 0,F-VAC_€-S I II�p F.,v, ,,.a . W z NOTE: CESSPOOL, SEPTIC TANK & WATER OL SERVICE LOCATIONS BY OTHERS. 7-7-2016 FINAL SURVEY 1-2672016 LOCATED' FOUNDATION 12-17-2014 LOCATED FRESHWATER WETLANDS AS FLAGGED, 10-21-2014 REVISED LOCATION OF PROPOSED DWELLING RELOCATED STANDING-WATER, AND LATHED B-7-2014 REVISED LOCATION OF PROPOSED -DWELLING PROPOSED BUILDING CORNERS 7-10-2014 ADDED -SILT FENCE & LEACHING POOLS DATUM ASSUMED (41.0) FINISHED GRADE 5-23 201144REVISEDDSANITARYYSYSTEM DETAIL-DETAIL THE OFFSETS (ORDIMENSIONS) SHOWN HEREON FROM THE STRUCTURES To THE PROPERTY UNES ARE FOR A SPECIFIC PURPOSE AND USE AND THEREFORE ARE NOT ,JOB No. 1 4-38 FILE. No. 956 F INTENDED TO GUIDE THE ERECTION OF FENCES, RETAINING WALLS, POOLS, PATIOS, PLANTING AREAS, ADDITION TO BUILDINGS OR ANY OTHER CONSTRUCTION ' SURVEYED FOR UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION.LAW. GUARANTEES INOICATED HEREON SHALL RUN ONLY TO THE-PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL SITUATED.AT SOUTHOLD AGENCY AND LENDING INSITTUTION LISTED HEREON,AND,TO THE ASSIGNEES OF THE LENDING INSTTTUTION. GUARANTEES ARE NOT TRANSFERABLE TD ADDITIONAL INSTITUTIONS TOWN OF SOUTHOLD. SUFFOLK- COUNTY, N.Y. OR SUBSEQUENT.OWNERS _ . •COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR SCALE 1"•= 40' DATE 3-13-2014 -" EMBOSSED SEAL SHALL NOT BE CONSIDERED TO-BE A VALID TRUE COPY FILED MAP No. DATE CERTIFIED ON o� NFL' TAX MAP No. (REF ONLY) 1000-54-6-10 DISK 2014 TRAIVC, �o �° HAROLD F. TRANCHON JR. P-.C. o eb tt� 2 t: I LAND SURVEYOR ` L •t P.O. BOX 616 <� 1866 WADING RIVER-MANOR RD. WADING RIVER, NEW YORK, 117.92 HAROLD F. T � Y.•LIC. No, 048992 631-929=4695 N PENN. L•IC No. 2115—E !V WIND' RESISTANT CONSTRUCTION "'CONNECTORS-'" _...._._....._ ._..---_..._._...__._... � DECK & PORCH CONSTRUCTION DETAILS 8c WIND LOAD PATH CONNECTION DETAIL:. CONNECTION LOCATION PART NUMBER NOTES 4x4 POST TO F 4 w 1 LT C u� 6x6 POST TO FOOTINGANCHOR PAU66 OR WE66 PAU66; USE w MIN. 1/2" M. x 7" ANCHOR 8CLT ,�a- so 4x4 POST TO GIRDER EADER PBS44 PBSE44 KC44 USE ONE 'TYPE 'FOR EACH POST -� � to 6x6 POST TO GIRDER HEADER PBS66 Z PBSE66 KC66 USE ONE TYPE FOR EACH POST 01 ti *■+ POST./COLUMN TO GIRDERH T 4 FOR EACH "_ CO RAFTER . STAIR STRINGER CONNECTION TMU26 OR MPA1 USE ON EACH STRINGER �� N i Uj RAFT R JOIST TO HEADER TYDOWN RT1 5 U FOR ACH .RAF ER RAFTER TO LEDGER BOARD TMU26 OR MPA1 USE ON EACH RAFTER. MPA1 USE ONLY Oso RAFTE WHERE TMIJ26 CAN NOT BE USED = d LEDGER­ USE E FOLLOWING OR APPROVED USP METAL CONNECTORS PROPER RESISTANT FOLL WM NUFACTURES RECOM NDED NSTAL ATIONNSTR CTIONSTO ACHBE MAXIMUMUPLIIFT LOAD�CCAPACITY. .4 RIDGE 2o HEADER Table 3.1 NaNktg Schedule(Wood Framed C.o ft4on Manual .-,Pages 149 and 193) Nu RAFTE mber of Numtter of Joint Common Nalls Box Nets �. ROOF INAILK3 V"' Ratter to Top Ptah(Toe-pelted) 3-8d 3-8d per rdW TYPICAL RIDGE TO RAFTER STRAPPING RAFTER TO WALL CONNECTION ALTERNATIVE RAFTER TO HEADER CONNECTIJN '1o�bTa' @R08 -� 3-8dperjow Ceiling Joist to Parallel Reim(Face-w14 5-16d 5-16d each lap Ce&V Joist Las Over Ptxt torts(Face-ndW 5.16d 5.16d each leer �•• COIN Tie b Raft(ToeqetSed) 2-10d 2 40d partle Bioddng to Rafter(Toe nailed) 2-8d 2-10d sad►and STAIR TREAD RIM Board to Ratter 2-i6d 3-10d each end G)R D E R/HEADE WALL FRAMING P O S T RI M B Q A R Tap Plate b Tap Plate(Face�Iaited) 2-led(i) 2.16d(1) per foot Top Plates of ln*"*m(Face-mlfed) 4-16d 5-16d olft-each aide POST/COLUM STRi`NGE —� SludtoSlud(Few-n�ed) 2-16d 2-i6d 24"oc. Header to Heads(Face-tal!ed) 16d 18d 16-oc.along edges �.. RIM/DECK. J01 S_T_; 0° Top or Bottom Plate to Stud(End Nslled) 3-16d 2-40d per stud STRINGER TO DECK,/PORCH CONNECTION 4w GIRDER ZHEADER TO POST/COLUMN CONNECTION Bottom Plat$b Floor Joist,Band Joist,End joist or Wloe ft(F IF%led) 2-16d(1,2) 2-16d(1.2) per foot POST TO DECK/PORCH CONNECTION FLOOR FRAMW to Joistb Sit,Top Me or Order(Toe-rued) 4-8d 4-10d perms Bridging b Joist(Toe led) 2-8d 2-10d each end I .� Blod ft to Joist(Toefialled) 2-8d 2-10d each and Bbd&g to SIN or Top Platte(Toe palled) 3-16d 4-16d each WA � E Ledger$*to'Beam(Fees-nailed) 3-16d 4.16d each)clot Joist on Ledger fit Beam(Toe led) 9-8d 3-10d per jolet GIRDER/H E A D E o Band Joist n Jowxm"4 3-16d 4-16d pb 10W Barns Joist b 811 orTop Ple Toe�ed) 2-16d(1) 3-16d (1) pero I oGIRDER/HEADE �"�ROOF SHEATHING f POST/C 0 LU M J01 S iStructural n zon Panels(See Notes 4,5 end 6) -- 10d61 erige 117 field POST/COLUMH Perimeter Edge Zone 8d 10a s-eager 6 tiara Gable End Rake with up to 1 Race Overhang 10d G'edge/V field GIRDER/HEADER GIR'DER/HEADER CEILING SHEATHit Gypsum wammid ra 5d coolers T edge 110-field WALL SHE4Tf'IING fo_ Sir d=l Psneis(See Notes 1,2,and 3) 8d 10d 6-edge/12"tiek! w GIRDERZHEADER TO POST/COLUMN CONNECTION GIRDER�HEADER TO POST/COLUMN CONNECTION LOST TO_GIRDER/HEADER CONNECTIO 5dwolers 5dwolers radp 10-%M Gypsum Wallboard FLOOR SHEATHING Structural Panels 1'or less 8d 10d IV edge 112'field (1)NaNing requk nwb are based on wail sheathing nded fron4wtorat the panel edge. Alternate naiing schedules shall be used vi wm wd sheathing rmiNrtg Is rreduoed. For example,If w16 dvatft is naiad 3 Indies on-canter at the panel edge b olMn higher aheer,capacilies,nailing requkemenb for dwchxat mertbn*W be doubled,or ahw ate oonnecbrs aw I GIRDER ire used to ffek in load path. (2)Forwall*WNM wtWn 4 feet of Ste owners,fhe for foot edge zone attactw wd req*em"04 be used. TabbrkW 12 krh o.e.malt ° p P S T (4) For roof Oreattdng within 4 ft�perlm� t�oc�� g 4 Bet on each side of fhe0 roof peak the 4 foot FED B r WOOD ;J01 3 2,�2, perimeter zone attadtmerlt requirelrterlts shill be used. (5)Tabubed 12 Inch ox,nil apart swunes roof sheatlthtg ate+ohed to mf'lerI ha h rdng members with G>0.49.For. _ CONCRETE PIE " , GIRDER/HEADE ono men hers wllh<0.42<G<0.49,the�spackrg shell be rediwed to 6 inches o.a. SOUthold Town v•, 12 x 12 x 12 CONCRETE F 0 0 T - >' I wind speeds g►saterttran 130 mph,bloe9ung to required wMt fransters shear Lead b two addtlorraf ratters(3 rafters In Board orrrustees `" WOOD 'JOIST-- ` (7)Far extterbr panel Ong,gaivar><zea bout palls stall be parmNfelt b be substituted for cxxerlon rre)!s. I Y Y ' POST TO FOOTING CONNECTION DECK AND COVERED PORCH NOTES: UNM a8rerwbe nobd,as hemp msft to be t i AM pnssun t►altbd txrbw. JOIST FRAMM FLUSH W 1ITH GIRDER/HEADER A�taebnsm,IlmomssWwwhonbbeg&Mriladorebt+baesteel. GIRDER TO CONCRETE PIER CONNECTION 2)Ghdentordecrc0*tDbebaWorwdmedsoachpostorprerwlfhwashmandnutL Ordws on aancrsi s plops Oil ba awhomd with proper abd mmscbn axa"w CLIMATIC AND GEOGRAPHIC DESIGN CRITERIA ttr000naa»+ hamt�tnamt►z maxrlonoanahcrt>atwrn►weeharaandnuta Ground Snow Wind Seismic Weathering Frost Line Termite Decay Winter 0e Barrier Food Hazarcb 3�Poab aqw"ghkn shill be ww w W b a 121*12"?alit wnmb#x ft Use a rnbfmum Vr dim x T"w of or brlh wNh mhm and m b.FaMnps SW Load spew Depth DeStgn Jr4edayment be 3 tL below prada.OUdara w lh roofs"haw 12'ilia.concnts piss a bsiowprada. Term Wred 25 pal` 140 mph B Severe 36 in, Moderate, Slight to er Yes s}Dadtlobts to hmva Wo ttg at 8`0 me- to Heavy Moderate 4 A mitt =or 10 V4 ft tip andt bo Nebsed bntwasn the bu*V sad Ledger. I� c 1 and Hula LLe r o be ballw ill to bump W1h UY rta.boar a0th wad�era ` 4 cbrrcnte pin OW to a ff**A t a"ab&*prsft. 71.as Johns b be supported wM helpers and ahft?L Each Jobs shad a*be exhamd Y,l .. _ .. . . _. .. .. ,. ... _ . 81 Covered Roo1a sites be aseenttled and arvNnd"Jre eeme raspier as a typical btdlft i N � ,J, � z C 4— %D OD J I •� • 01 I-PI Gt H'r I-&KKK&I._ d sn m C1 N N �i 2'Z c Jc Cw U i r aC f, O 1 C � 1 - N M N %O LU 2x v P.r �Er_>&Pt, C r_)V ^, Z4"X24"X 12 PG F=t�c5TjU W 12 PL i Z_ ICWDTUM _x ,r `i GG Kt N G•I� ,. '� a � _x � pToIly 2Xtb tit`, l.��GtE b1 6bH. /1 - jZKlai Pf" L�12�E�p �� -�-�-�-- --�? .. p, ��-�•�k�t�� � Il�'1 Ott 64PAD� ?C 22- 0 I ' FEr3 3 20^5 r 'SOut —r-)U 1 D�.�I Q 6a—=rdhof T�r�stees �G.aLC% 14 - 1'49+3 ►` A6 5Ull T DE .��,OF NEWY C ONE O�'� o� Q q .J — FEssko�' m � lD�! 'Glenn Goldsmith,President SpFfO(�\` �p�0 COGy Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 0 Eric Sepenoski o ,z P.O.Box 1179 Liz Gillooly �y • p�� Southold,NY 11971 Elizabeth Peeples l �a Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time:f�lrvaN 10.7_06Completed in field by: Eli Zw,6eA Peq[e3 CURTIS & RITA WINKLER request an Administrative Permit for the as-built 12' x 22' deck added to back of dwelling. Located: 380 Hickory Road, Southold. SCTM# 1000- 54-6-10 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: Chapt: 275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: S�rc�i G��•Fov-�rav� Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly \,/E. Peeples From: Curtis Winkler curtiswinkler57@gmail.com B Subject: Date: February 4,2025 at 8:24 AM To: Rita Winkler winklerfour@icloud.com �✓ I i/ 11 151 le i sb� R - � r, C.bQ .:. ` Sent From my Whone �. -d i P l 'sA✓`la ; �'k� �f,�►��a'� g y� , T, tr b ��p �1'� �"f"rtl��, lr�'1 �' .�, r 1S f,J% lF�� '+`{�i'.� '� ♦ +'�� �/ (l�+'11 3 dti,yay� r ht. t A+ r I}' ,y ' ,.,, w r. i �.\�-+(. \\�'0 , '`(�,�5�t`+'•0` \ 4> �.3 ..YgP\YA. ,� > ,; 4`�t` `� l;, �vyx t� �' �� 'S ��r♦�f.'�� ; " ,�� �3'•q.j��/1 �S r j'I» I _ ' �, f 6�`.^� � �11, _ �'!s^� �> 1 .r �'t4�t� i�M4i1 ��� rR��,�;-'N�t ti�a • .�� a . r t. r ' S J. 0 w eff a®c rra 'jl MA— • ♦ l,u ray 4 � / � \ 4 ♦a � !} f F �I`. � c�>Kmrvn awry ~ �O ! i • m• m �, � • °I r m a� • b J w •J rpm ,y l � °; b•,y �Iq `9 Tj 4 TI.0 •4, it TY a ° p0 � � h 0...• � Bf '�'4 �� 4 N l� l�q !� A� f♦ �, N ♦ h N ey ,y N D, 4 a Jr� n 7 4� aaa xrs ty.• ♦ . 8 +r O f 4 6 b L iaw ar dyr'r A oeranw.e:»rxony 1• N ♦ . f NA • �1r�9 N , J� � ��'• • a, `R ,> ' �' b b •� aor�n �s Q s b 4 •-♦ a>A >s ' f nyH -a 4' � •" ® �oseo�oze� �' zsvq. ms ;•J `•o y,'�o ' ♦�.. �: ,a rye% � a�-:�5 ..z�9*,�� j, r .:.�„�:�,.,,.,. "�`"`"""'a»•`•" •��• — O ."^ " COUNTY OF SUFFOLK© IN NOTICE N _ _ r.*w ,aao SECno1 No E S .rfner•�.arewq»s.[oa E Re Property Tax Service Agency rarrsn,n,vw»ra.ro»ar nc T r a. eouT»otn M =�—__ _— ___._— „ —_— ,• • ,ao a.r..ak rv.»�.t.vr,rva W E areax ra.nr T.z rrs a mo,a� ` 0.� 3 r� r : �o�sour •'. _ OFFICE LOCATION: off: S'0� MAILING ADDRESS: Town Hall Annex O �� P.O.Box 1179 54375 State Route 25 Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) ; 'H', =ae Southold, NY 11971 Telephone: 631765-1938 ;�► •� �O,' r x _nti1 . LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Glenn Goldsmith, President Town'of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: February 7, 2025 Re: LWRP Coastal Consistency Review for CURTIS & RITA WINKLER SCTM# 1000-54-6-10 CURTIS & RITA WINKLER request an Administrative Permit for the as-built 12' x 22' deck added to back of dwelling. Located: 380 Hickory Road, Southold. SCTM# 1000-54-6-10 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 as-built is INCONSISTENT with LWRP Policy 6.3 and, therefore, INCONSISTENT with the LWRP. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. The as-built deck was constructed without a Board of Trustee review or permit. 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 ���� g0(��y ., Town Hall Annex T'` 54375 Route 25 A.Nicholas Krupski,Vice President t� P.O.Box 1179 Eric Sepenoski JLy Southold,New York 11971 Liz Gillooly i G Telephone(631) 765-1892 Elizabeth Peeples � ' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only _ Coastal Erosion Permit Application rp; E CWetland Permit Application 7C Administrative Permit I --Amendment/Transfer/Extension FEB 3 2025 Received Application: j Received Fee: $ � ' � — Southolo Town k Completed Application: a(.3 25 Board of Trustees Incomplete: _ SEQRA Classification: Type I__ Type II k Unlisted Negative Dec. Positive Dec.. Lead Agency Determination Date: Coordination:(date sent): LWRP Consistency Assessment Form Sent: /IS CAC Referral Sent: X Date of Inspection: a/S71-5 Receipt of CAC Report:— _Technical Review: Public Hearing Held: Resolution: Owners) Legal Name of Property (as shown on Deed): /1)/j Mailing Address: Phone Number: 6--� "! �^'S Suffolk County Tax Map Number: 1000 - Property Location: (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: Email: _ __ Board of Trustee's Appli, - ion GENERAL DATA Land Area(in square feet): Area Zoning: Previous use of property:- -Intended use of property: Covenants and Restrictions on property? Yes No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? PfYes .-D.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 1f"Yes", please provide copy of decision. Mhis 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?.L_L Nol�Yes If yes,provide explanation: Project Description(use attachments if necessary): IV Ja 1Z < Z� WJa� _ - - - - Board of Trustees Applir_: . ;ion WETLAND/TRUSTEE LANDS APPLICATION DATA ' Purpose of the-proposed operations: 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? No f Yes If yes, how much material will be excavated? cubic yards . How much material will be filled?. -_ 0 . cubic yards Depth.of which material will be removed or deposited: ,..-.d feet Proposed slope.throughout the area of operations. Manner in which material will be removed or deposited: .. Statement-of the effect,if any, on the wetlands"and tidal waters of the town that.may result by . reason of such proposed operations (use attachments if appropriate):- , 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 1 based on information currently available. if additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. "Part h='Project-Anil Sponsor Information Name of Action or Project: 1 'Project Location(describe,and attach a location map): Brief Description of Proposed Action: I` Name of Applicant or Sponsor: Telephone 37 Cl?//_ / /1P 1�� E-Mav27y SG1/IJL6 - 7 l�JL '"Address:- - City/PO: — State: - Zip Code: `I.Does the:proposed action~only involve the legislative adoption of a plan,local law,ordinance, _ NO AYES, administrative rule,or regulation? 4f Yes;attach a narrative description.of the intent of the proposed action and the environmental resources thatOTT 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:! i If Yes,list agency(s)name and permit or approval: l 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? _acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres `4. -Che I land'us at occur on,adjoining an ar the prop action. Urban I,IRural(non-agriculture) industrial Commercial Residential(suburban) Forest ❑Agriculture b.Aquatic ❑Other(specify): Parkland Page I of 4 r '5.`Is the proposed action, NO. YES N/A a. A permitted use under the zoning regulations? b.Consistent with the adopted comprehensive plan? t fl-fj 6. Is the proposed action consistent with the predominant character of the existing built or natural T.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: EICI .8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES 1 b.Are public transportation service(s)available at or near the site of the proposed action? I 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 thestate energy code requirements? NO .4 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., :• . I,. - If No,describe method for providing potable water: y �,' ❑ II__JJ -11."Will the proposed action connect to existing wastewater utilities? - .,NO ;'YES If No,describe method for providing wastewater treatment:., ' ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO . YES Places? I' 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? If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres:. • gtif�the typic bitattypes that oc n,or are likely to be found on tl�e.groject site. Check all that apply: horeline Forest Agricultural/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? 16.1s the project site located in the 100 gear-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 ❑YES b.Will storm water discharges be directed to established conveyance systems ff an m drains)? If Yes,briefly describe: 10 �'ES- Page 2 of 4 18-.Does the proposed action include construction or other activities that result in the impoundment of NO YESA. 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 THKINFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor n _ _ . Date: . Signature: Z-_ Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the:following questions in Part 2 using the information contained in Part I and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering.the scale and context of the proposed action?" No,or Moderate small to large impact _ impact :may may ' occur occur 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)? ❑�I ❑ :5: Will the proposed action result in an adverse change in the existing level of traffic or j 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 1 ' ❑ - reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact.existing: a,public/private water supplies? El 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 Page 3 of 4 No,or Moderate � l ;'small W to Iarge i impact. . impact may may occur occur i f 10: Will-the proposed action result in an increase. n the potent!al.for erosion,flooding ordrainage ti 1 :problems? 7 T.4 Wtil the proposed action create a hazard to environmental resources or human healthy Tart)='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_tlie proposed action may or will not result in a significant adverse environmental impact,please complete.Part 3. i., 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 thai_the impact i. 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. r } i l l; 1 I 1 7 1 Cfieck this'box if you havedetermined,based on the information and`analysis above,and any supporting documentation, ;i .`._ 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_in,osed action will-not result in any significant adverse environmental impacts. f'Town"of Southold-Board of Trustees i "Name of Lead-Agency _ - Date President. Print of Type,Name of Responsible Officer in Lead Agency _ Title of Responsible"Offcer Signature of Responsible Officer in Cead Agency Signature of-Preparer(!f diffarentfrom Responsible Officer) . PRINT i Page 4 of 4 Board of Trustees Appli__-_ion AFFIDAVIT, _ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT j ALL WORK WILL BE DONE IN THE MANNER SET FORTH INTHIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. ' 4 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, i 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-bF TRUSTEES DURING THE TERM 1 OF THE PERMIT. r yf } Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS. _ ✓� :DAY OFF r l to ;;20 -.- �Y 1 Notary Public CONNIE D.BUNCH i Notary Public,State of New York Na 01SU6185050 ®ualifled in Suffolk County Commission Expires April 14,2,CQ - _ '1 Board of Trustees Appli=_=ion AUTHORIZATION (Where the applicant is not the owner) I/We, iJJ2 owners of the property identified as SCTM# 1000-_ _ _ in the town of �S' New York, hereby authorizes i 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'Owne?s Signature Property Owner's Signature A C SWORN TO BEFORE ME THIS_ /�G _ DAY OF �r 1.4-LL ,.20 _ _ ch Notary Publi,�� c CONNIE D.BUNCH Notary Public;State of New York No.01BU6185050 Qualified in Suffolk County Commission Expires April 14,2� APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town4f�S6uth6ld'-s Code of Ethics arohibits:conflicts of iniereki:iuthe -of; tthis,form'f s't6,Drovide informati6ri w1iich can;ale`rt the town of oossttiie"eorifl�cis of inieiest and all6W A to�take-wtiafever.aedbi is _- .. _.•. necessary o avo' : • -_ ';� v YOUR NAME . _ .�U��w=.• __- .�. -_.- (L'ast name;first name,middle iniiial;'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.) 3• • LO. 1 NAME OF APPLICATION: (Check all that apply:) jl Tax grievance Building Variance Trustee ' Change of Zone Coastal Erosion ti Approval of plat Mooring j4 Exemption from plat or official map' Planning Other t (If"Other",name the activity.) Do you personally(or;through your:company,spousS,,sibhng,parent &,child)haves relationship with any ofBeer or employee of the Town of Southold? "Relationship"includes`by blood` m*riage,'or liusiness'iiittfdtt"Business interest",meansabustness, d' including a;partnership in which thetown officer or employce`hase4en a partial ownership,of(or employment:by)_a corporation; in which the'town-officer of employee.owns more th6n,5%o alie;shares. i` YES ,_.. NO If answered"YES",complete the balance of this form and date and sign where indicated. " Name of person employed b the Town of Southold,,-,- Title µ L P . Y. or position of that person- Describe Pe � 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 proAded, The town officer or employee or his or herspouse,sibling,parent,or child is(check all that apply): f,A)the owner of+greater than S"/o of the shares of the cor'jiorate stock of ttieappi--,-i _n (when the applicant is a coiporation); B)the legal or beneficial owner of any interest in a non_corporate,entity,(whenitlie » applicant is not a corporation); r. y C)an officer,director,partner or employee of the applicant;or D)'the actual applicant. DESCRIPTION OF RELATIONSHIP . Submitted this day of_ 20 S i'gnatuie,,_ Print Name Form TS 1 _ " t 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 minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. _:propose, •_..action :will`Abe, evaluated- asp.to its_.sioifcanf beneficial arf&adverse effects;upon the coastal.area(which includes'all of Southold 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 I review law..-Thus, each answer_mast be._exnlained in.detail;_li§tins both-supporting'and'non- suaporting'facts. If an action cannot be certified as con_ sisteni with the LWRP policy standards-arid conditions,'t shaft-not be undertaken. 4' f 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 s local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 5 LA PROJECT NAME The Application has been submitted to (check appropriate response): Town-Board El PlanningBoard❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate'response): 11 (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: �x/6 Location of action: ��l�l�/� , c50 1)7#bL6 d Site acreage; _ Present land use: Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: { (a) Name of'applicant: (b). Mailing address. . I fjv (c) Telephone number: AO _ { Will the action be irectly.undertaken,require funding,or approval by a state or federal agency? Yes 0 No If yes,which state or federal agency? ' C. Evaluate the project-to the following policies b analyzing how the project will further support or P J g P Y Y g P J PP . 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- 'R No Not Applicable 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 Not Applicable i Attachadditional 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 - - - -- _ - `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 ❑ ❑ M _- Yes No Not Applicable r• - ' "Attach=addihonal sheets if necessary - - Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III• 4 —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No [&ot Applicable ttac a itiona -sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies;_Pages-22 through 32 for evaluation criteria. ❑_Yes ;❑No Not Applicable Attach additionaf 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. 0 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 wast s. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. `. El>Yes 0 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. nn Yell No Not Applicable 'Attach additionaf sheets if necessary - - - - - , I WORKING COAST POLICIES j 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 additionalsheets'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 L"J Not Applicable i Attach additional sheets if necessary .i 1 Policy M Protect agricultural lands in the Town of Southold. See LWRP Section III— Policies; Pages. 62 through 65 for ev luation criteria. i. ❑Yes ❑ No Not Applicable :Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III--Policie Pages 65 through 68 for evaluation criteria. ❑Yes ❑ No Not Applicable PREPARED BY TITLE DATE