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HomeMy WebLinkAboutTR-10736A Glenn Goldsmith, President `�®F SO �Y Town Hall Annex A. Nicholas Krupski,Vice President ®�V ®1® 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples � y� Fax(631) 765-6641 c®UNTI,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE #2223 C Date: April 1, 2025 THIS CERTIFIES that the as-built backup generator, At 5400 Peconic Bay Boulevard, Laurel Suffolk County Tax Map#1000-128-2-12 Conforms to the application for a Trustees Permit heretofore filed in this office Dated February 5, 2025 pursuant to which Trustees Administrative Permit#10736A Dated March 19, 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 as-built backup generator. The certificate is issued to LAURIS RALL owner of the aforesaid property. o Authorized Signature s®jfJ Town Hall Annex Glenn Goldsmith, President �� �✓® 54375 Route 25 A. Nicholas Krupski,Vice President �® �® P.O. Box 1179 Eric Sepenoski 3 Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples a® Fax (631) 765-6641 �00 0,`� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OFTTHE IV T BOARD OF TRUSTEES OFF 72 HOURS PRIOR TO COMMENCEMENT OF THE A BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 s' day of construction '/2 constructed When project complete, call for compliance inspection', Glenn Goldsmith, President _w��®F S®�/�� Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President ®�v ®�® P.O. Box 1179 Eric Sepenoski ! l Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 C4d1W,N� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10736A Date of Receipt of Application: February 5, 2025 Applicant: Lauris Rail SCTM#: 1000-128-2-12 Project Location: 5400 Great Peconic Bay Boulevard, Laurel Date of Resolution/Issuance: March 19, 2025 Date of Expiration: March 19, 2028 Reviewed by: Board of Trustees Project Description: As-built backup generator. 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 Sean O'Neill, received on February 5, 2025, and stamped approved on March 19, 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. e* 4Anzy V,_0- Glenn Goldsmith, President Board of Trustees 5URVEY OF PROPEMY SITUATE: LAUREL TOWN: 50UTHOLD N 5UFFOLK COUNTY, NY SURv�YED lo-as-soo4 C�a �,�, e w E . AMENDED 11-24 2004,II-30-2004 y 12-10-2004,DIMS O4-I6-2o18 SUFFOLK COUNTY TAX# l000-128=2-12 g�dq,{�sq 1000-I28-2-23 APPROVED 1 R Cam: �,� OVER BY LAmQM>� BOARD OF I RUSTEE .TOWN OF SOUTHO IrDATE : \ `ti (: Ik Sl D F E CIE I V_L E 5 2029 \y V t- � uthold own " B rdofTrustees Z5 ` APR 1_7 2018 D \,� at e&tlg Dept Copy ..7' `C"��o�! a Fl1a jai j end `r3 a ` Date. C. O o NOTES. °9 nor MONUMENT'FouND < 9c ELEVATION5 REFERENCE N6VD'211 s solo � 0 04' � Q�/a ''M„w gmz PARCEL JOOO-128-2-12 AREA=42,864 SP OR 0.48 I ..r +�..+.....r... .. PARGELI000-128-2-28 AREA=3,877 5F OR OfJc{'AGRES TOTAL AREA=46341 5F OR L07 ACRES V ` NOTE A. 10 FOOT R O.W, As PER L.5522 DEED GP.bo AND L 4586 rP.GP. 70 JOilN C. FN1 FR CLAID SURVEYOR GRAPHIC SGAL.E I"= 4G+' 6BASTMAD(STR88T NY.S.LIC.NO.=M RIVBR88AD,N.Y.11901 3694M Fax 369-=REP.CAUr.IMM apbo:1U4 OM440-1 p- � 0 No. S 0 TEES UTHOLD TRUS, i'vo R Issued To. Rail Date_ 3/I� /aS Address 54UC� ?cion:c. ` g4�, Q�v� � 1.-.c,ure THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFfCE,TOWN OF SOUTHOLD SOUTHOLD; N.Y. 11971 TEL.: 765-1892 Glenn Goldsmith,Pm, ..it ON;S�fFO(�COG f, Town Hall Annex A.Nicholas Krupski,Vice President .-,'`� ti� 54375 Route 25 CM Eric Sepenoski w ,? P.O.Box 1179 Liz Gillooly �y • 0�� Southold,NY 11971 Elizabeth Peeples - Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: .3111$ Completed in field by: ('2. 60� 1A Sa+,,%A Sean O'Neill on behalf of LAURIS RALL requests an Administrative Permit for the as- built backup generator. Located: 5400 Great Peconic Bay Boulevard, Laurel. SCTM# 1000-128-2-12 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.: Seca►a�� �®�-wo.g� Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly E. Peeples &'vP t e a� WFJLI PO 6 1 , AN _ i `)I l � ' LL SAL F t L T BL LIRIAL 11947 ` s 4. 2 l r 5 r �r ��,te r �`1U ek h t mal , includedaGt-1031 Cbritroller (Ni den)16.Y-ear WcIrrranty, b� 200 Amp symphony,Il Power t�.artagerrmerat'Transfer�wrfchV. g Pa`-'re 4Pad {f6r l pre�e x Dlivey eieratear to site and sefi pan pd Interstate 1754DT heoy f � start Drp Parchasf2 ,Ptank, T BI III Pli Trench.ard Gas hcal�up fr°c�r�,tnk terr "ratar sae reulir a A 3 rIS@ Electrica O Laborond riiat6ijaf `. firoun ' and neutr #s . qua separated 7r, ;.ro '1+.7A4iai t7'ekR 6P llie Aft ^� Y� `` Pr9Iatr, Trenr rns � e` trar } Remue and rernstIw sri� enrnc wire:frra ` rich tcpendth. a . ,• � i Caput lmprauer�r h orm M, 3 e -50% d r rt ter de iu�ry c� clu�pmnt , IAW ppy ent, do at st rtuP- a fi`gq ff r x we !' y� INU MAIN s. � ?"� .... �f •\b A z a 41 .,. 'ZOOna A 1 _ �AAMM-W of so ASS YOM lot Ar flit x i x , •v cf p $ 1uw , a 4 6� ' _ NQj A i AL Ali �Ir. .• ={:,T e��',L'T Nat}�ti Q8 � C i {,, �'rPn ,x �,.... _. ,1 w.,: .+, �•, 4�. q,..1)r� SC: �:.... ..n� f.�0<.,"^: �n .-.: �' +�1m." .:.. � ad� �� A6 kF At Al a vaeo, ,MTp, sE,:eEc.NO.,a1 ,aE / �16WOTI33 y 'SEE .C. O ♦ / 1YVe / I / e t 1 � ,• rz a �� 'I a • a e 6 P, m �a ` � re / aEE nSiRT.•.. �.[� aY z '` ( a, \ n rI O ., 13./� a.• 4 31 �4 1e2 : a a,�•� ,.W,N C �/ Y ,Mw , za r s `/ I 1�, q u a n J PII4 � W E�•`� _�_ uti y a„ '— 757 2 �- _""_ NOTICECOUNTY OF SUFFOLK © E +tea SOUTHOLD SECTION NO Reac Property Tax Service Agency Y 128 A ,ro 1.So P PROPERTY IMP OFFICE LOCATION: -` S'O:,- a`4 MAILING ADDRESS: Town Hall Annex �' -'s!►d. f P.O.Box 1179 54375 State Route 25 �'� '`�a i Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) g Telephone:631765-1938 Southold, NY 11971 ��caU 1 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: March 17, 2025 Re: LWRP Coastal Consistency Review for LAURI$ RALL SCTM# 1000-128-2-12 Sean O'Neill on behalf of LAURIS RALL requests an Administrative Permit for the as-built backup generator. Located: 5400 Great Peconic Bay Boulevard, Laurel. SCTM# 1000-128-2-12 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 LWRP Policies and, therefore, 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 3 Town Hall Glenn Goldsmith,President rt ' Annex A.Nicholas:Krupski,Vice President 543Z5 Route 25 . P.O.Box 1.179 Eric Spenoski Southold,New York 11971 Liz Gillooly ' Telephone(631).,7654892 Elizabeth Peeples ]a ax(631) 765-6641 BOARD OF TOWN TRUSTEES TQW1V.OF-SOUTHOLD`: 'This Section For Oftke Use.Only Coastal Erosion P..ermit Application Wetland PermitApphcation Administrative Permit'. FEB B 5 2025 Amendmerit/Transfer/Extension Received Application _ southo�dTown �Received,Fee $ S D_D Board of Trustees Completed Applications Incomplete: SEQRA Classification: Type I Type II< Unlisted Negative Dec. _ Positive Dec, ,.,, ,.,,, Lead'Agencypetermination Date: r Coordination.(date sent): LWRP Consistency.Assessment Form"Sent. . 3/:.� . CAC Referral Sent Dateof Inspection; 3 D > Receipt of CAC Report:; . Technical Review: _X Public Hearing Held.*, Resolution: Qwner s Le al.Name of Pro ert as shown on>Deed L— R U,� S 4 �1 Mailing Address: ... Phone Number: l [, Z 2 b, 2- 03 Suffolk County Tax Map Number: Pro ert Location. 00 �2Co,,:G jj � La�; P Y (If necessary,provide LILCO'Pole#, distance to cross streets,and location) 0/1 AGENT(If applicable) Mailing.Addres : "` a � s S� aa' Email.Ui'!Pj�1� - �r CD Ht Phone Number: s cv=e/ -r�— C e JoAkd o.E Trustees Applica.t : . :. ... GENERAL DATA Land Area,(i .3 � ? 0 n square:feet).. Area Zoning: Q. Previous use of property, ' 5 ✓t �. n .. 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? Yes No If"Yes",be advised this application will be revewed.b the Bu li di ' Dept.'prior pp. y ng ep p or 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 N0 P J 9 .. pp. � .. If"Yes", please provide.copy of decision. -T�his project re ny demolition as per Town Code or as determined by the Building Dept Yes No . . Does the structure s on ro ert have a valid Certificate of Occu anc ? .Yes� No� ) p P Y , . p y Prior permits/approvals for site improvements:. Agency Date No prior permits/approvals for site improvements Has any permit/approval ever been revoked`or suspended.by a governmental agency?�No_n Yes If yes, provide explanation: Project Description(use attachments if necessary). ' G.J . j Ard:of Trust PPees A licat . - WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the' '': proposed operations �.l- s Powel' Area of wetlands on lot Z 3Q2 square feet Percent'coverage of lot: 1 C` Closest distance between nearest existing structure and upland edge of.wetlands::3.iJ feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? cubic yards . How much material will be filled?. cubic yards Depth-of which material:will-be removed or deposited: feet Proposed slopeahroughout�the area operations: Manner to which.material will be removed or deposited X IA 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): G Fi . '61720 . Appendix S - Short-Environmental Assessment Form Instructions for:Comnleti 1F_ Part 1 Project lnformation 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 furtherverification. Complete Part I based on information currently available. 1f additional research.or.investigatiori would be needed to.fully respond to an item lease answer as thoroughly as possible based on current infoPmation. P. Y >.P... g.. Y Complete all Items in Part ...'-You may also provide any additional,information whiclt.you believe:will be.needed by or useful to the lead agency;attach additional pages'as necessary to supplement any item. Part l -Project and Sponsor Information Name of Action or Project: n Project Location(describe,and attach a location map): . o o m . Brief Description of Proposed'Action. powef 5 e,ne•a.�r /41� JjD lve r' Name of Applicant or Sponsor: Telephone 9 ? .22G . Zg3 E Mail* F' Address: ... P0_Bo, �v . City/PO: State: Zip Code:. 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: ..Z 3.a.Total acreage of the site of the proposed action?-- b.Total acreage to be physically disturbed? _ ,yt.�. acres c.Total acreage.(projest site and any contiguous properties)owned orcontiolled by the applicant or project sponsor? acres 4. Che I land us t occuron`,adjoining an arthe prop action. Urban Rural(non.-agriculture) . Industrial Commercial ❑Residential (suburban) Forest A icgriculture A uat Other(specify): .. . Parkland • Page l of 4 - 5. 1s the proposed action; a. A permitted use.under..the zoning regulations? b.Consistent with the adopted comprehensive plant „ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES, landscape? .. 7. .Is.the,site of*proposed action located-in;or.does it:adjoin,.a state listed Critical Environmental Area? NO YES If Yes,identify: LEN . El S. 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 nearthe site of the proposed action? I - c.Are any-pedestrian accommodations or bicycleroutes available on'or near site ofthe 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: 1 � 0 .`EP 10. Will the proposed action connect to an existing public/private water supply? NO YES.Fl . If No,describe method for providing potable water: 11..Will the proposed action connec(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? b. Is the proposed action located in an archeological sensitive area? 13.a.Does any portion of the sitebfthe proposed action,or lands adjoining the proposed action,contain NO. i',YES wetlands oe other.waterbodies eegulated.by a federal,state or local agency? b.Would the proposed action physically alter,or encroach:into,any existing wetland or waterbody? If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres:,. 14. ntify the typic bitat types that oc n,or are likely to be found on tF�groject site. Check all that apply, orelme '. Forest,,, ,' Ag O ricultural/grasslands Early mid.-successional: . Wetland Urban burban 15.Does the site of the proposed action contain any species:of,animal,or associated habitats,listed NO , YES F by the State or Federal government as threatened or endangered? 16.Is the project site in the`100 year flood plain?:N YES. 17.Will the proposed action create•storm:water discharge either from point or non-point our6es1 O if Yes, a.Will storm water discharges flow to adjacent properties? ❑NO DESb.Will storm water discharges be'directed to esta b I i s h ed co n vey an ce systems ff an m drains)? If Yes,briefly describe: N0 YES Page 2 of 4 I S.toes the proposed action include construction or other activities that'res'ult in the impoundment of_ '` NO °VES. wateror.other:licjuids-(e.g:'reiention pond,waste lagoon,dam)? IfYes,explain purpose,andaize 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO: solid waste management facility? If Yes,describe: ... 20.Has the.site of the proposed action or an adjoining property beenahe subject of remediation(ongoing or NO .YES completed)for hazardous waste? If Yes,describe: i AFFIRM THAT THE(INFORMATION:PROVIDED;ABOVEJS TRUE AND ACCURATE TO THE BEST OF MV KNOWLEDGE Applicant/sponsor me ; 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 I and other materials submitted.by the project sponsor or otherwise available to the reviewer, W hen-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 withan 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 oi• affect existing infrastructure for mass transit,biking or walkway? Lin- El 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. W ill.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. Will the proposed action result in an:increase in the.potential.foe erosion,flooding or drainage .Problems-?. lyEl 11. Will the proposed action create a hazard to environmental resources or human healthy Part 3'-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in-Part 2 thaf 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 wi11 not result m a significant adverse environmental impact,please complete Part 3. Part 3 should,in,sufficient detail,identify'the impact,including any measures orAesiggn elements that have been included by the project sponsor to.avoid-or reduce impacts. Part3 should also explain how the lead:agency-determined thar 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.tb.e potential..for short-term,long-term and cumulative:impacts. Check this boa 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 orsignificant adverse impacts and an environmental impact statement is required. Check this:box ifyou:.have determined,based on the information and.analysis above and anysupporting documentation, that the.proposed action will not result in any significant adverse environmental impacts. Town ofSouttiold-hoard of;Trustees. Name'ofAgency. Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Resp�nsibfe Ufficerin Lead Agency Signature of Prepares(ifdifferent from Responsible Officer) PRINT Page 4 of 4 .4oard, of Trustees Applicat-,�. AFF IDAVIT : BEING'DULY SWORN. DEPOSES rND AFFI . 'S THAT HE/SHE IS THE APPLICANT FOR THE ABOVE" : DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND'THAT ALL WORKWILL 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.ONT:O MY PROPERTY TO INSPECT THE PREMISES IN CON3[7NCTION WITH`THIS-APPLICATION, INCLUDING A FINAL INSPECTION. 1FURTHER AUTHORIZE'THE.BOARD OF TRUSTEES TO ESTER 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.: Signatu of o ert O p y er Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF F-�KIA A20. rvNS Notary Public CONNIE D.BUNCH. Notary Public,State of New York No.01'BU6185050 Qual{fied in.Suffolk Countyb .� Commission Bxpir§$April 14;2. APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM :. s w . T.he Town of Soutliold's Code.of Ethics nrohit its_conflicts of intereSKbnthe Hart aftown officers and emolovees - numose of: this form is'to provide it formatron which c'an'alert the fowd'of possiblefco iflicts of interestand allow if Io take whatever action'is necessary to avoid'same YOUR NAME. (Last name,first na'me,, fiddle initial;unless' are applying in.the name of someone else or other entity .such asa:company.:If so,'indicate the other person's or coin an's name NAME OF APPLICATION- (Check.all that apply) Tax grievance Building Variance Trustee Change.ofZone Coastal Erosion Approval of plat Mooring Exemption from plat orofficiai map Planning Other (if"Other•',name.the activity.) Do you personally.(or through your;company,spouse,;sibling,parent,or child)have;a mlationship with any officer:or employee of the Town:ofSouthoid? `Relationship includes.by'•biood marriage,or tf"ess interest,"`•B4siness interest''means a'busirress; including a partnership rn which the town officeror employee hasveyen,a partiai.ownership-of(or employment by)a corporation. in which the°tawniofBeer or.employe6 owns•more thant5'!o of the shares. YES NO If you answered`.`YES' complete the balance of this form anti date and sign where indicated. Name of person employed by,the Town of Southold Title or position of that person: f • Describe the relationship:between yourself(the applicant/agent(representative)and the town oft;icer or.employee.Either check the a ro riate line A throw h D and/or describe.in the s ace r&ided, PP P ). g.. P P The town ofticer or.employee or.his ocher spouse,sibling,parent;.or child'is(check all that apply): _ELA)'the owner of.greater than 5%of the'shares of the corpotatc stock of iheapolicont when the a licant is a corporation); pR ... � B)the legator beneficial owner of any interest in:a non-corporate•entity(when the � applicant is not a corporation),, C)an offCcer;..director;partner,of employee of the applicant;or D)the actual applicant. DESCRIPTION OF.RELATIONSHIP ' • . Submitted this da}o �&` r�M 20 q:y. Signature; L _QJ Form:TS I Town of Southold • LWRP CONSISTENCY ASSESSM%NTI FORM, A- INSTRUCTIONS 1. All­applicants for permits* �ncludmg Town of:Southold agencies; shall`:com'1 it this: CCAF for:: proposed actions that are sulije,... the Town of Southold Waterfront Consistency Review Law: This: assessment is intended to :supplement other information used.by a Town of:Southold agency:in: makmg',a,determination of consistency *.Eiecept moron exempt actions including.Building Permits and other,ministerial permits"not Igeawd within:the Coastal.Erosion Hazard Area., 2, Before answering the questions M:Section C, the preparer of this form.should:review the exempt p y. minor action list, policies and explanations of each olic contained in the Town of Southold Local Waterfront Revitalization ;Program. A :proposed action-.will be ,evaluated. as o =its_sigluficant�- beneficial and�_adverse effects upon tho coastal,a'rea•-(which,ineludes all.of•Sovthold,Town). . 3:, 'If any question in Sectton.0 on his 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, efi&Answer:must: a e'xitlamed.in 1. detail, listinis both supporting and none_ subuortina I. ffacts. If an:action cannot be.:cerhfied as consistent:with.the LWRP policy standards:and' conditions, t,shall`,notbe,underfi en A copy of the:IMP: s available in the following places online at.the Town of Southold's website(southoldtown northfork net), the Board of Trustees'Office,the Planning:Dep.4trnent, all local libraries:and theTown Clerk's office. B. DESCRIPTION OF SITEAND PROPOSED ACTION SCTM# 1000 ,:, ZI J PROJECT NAME.. �..s,1�,•.�. . . 3 4:LIt :V f� . : C�P.n�✓'_ao .. . The Application has been submitted to:(eheek:appropriate-response): Town Board ❑ .Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of.Souihold agency action(check appropriate response): .. (a) Action undertaken y directl b Town agency(e g,capital ..y construction,planning activity,agency regulation, land tansaction) sbFinancasstancea oanusid (c) Permit,approval,license,certification Nature and extent of action: -CS :�/1 s 4 � Location 0 C of action �U��.� �Site.acreage rr Present land use- F:S �` -`:cal I� ✓e_ Present zoning classification: S eTwn of2. If an`application forthe fiith th> Southold agency,the following information.shall be provided: n (a)„Name of (b) Mailin address.;�-." .. LA,�r Q (c) Telephone nurnber I w: Will:the action be direetly undertaken require fundin or a'" royal b"'a,state or federal enc �. g, pP _ Y Y Yes ❑ No: 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 COA ­!POLICY,, Policy.l `Foster a pattern of development m the Town of Southold that enhances community character, p . p p , ' p , makes beneficial use of:a coastal location,and m n mizes adverse•eff mct'of development oSee L sWRP 5ect�on:III—Policies; Page Z for evaluation criteria. :. Yes No. Not A hcable ❑' ❑ Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LW"Section:111-PoliciesFages 3 g ,throu h,6 for:evaluation.:criteria:::: :. .. Yes ❑'No of 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 0 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 E. ❑ Yes No of 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 0 No tNot Applicable. Kt-tach additional s eets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats And wetlands. See LWRP Section:III—Policies;Pages 22 through 32 for evaluation criteria: Yes No MNot Applicable Attach additional.sheets if necessary Policy 7. 'Protect and improve air quality in the Town of Southold.See'LWRP Section Ill — Policies Pages 32 through:34;for evaluation criteria, Yes ❑No Not Applicable Attach additionatiheets if necessary Policy 8. Minimize environmental degradation.in,'Town Hof Southold from solid waste and hazardous substances and wastes. See LWRP Section III Policies; Pages 34 through 38 for evaluation criteria. x .. El 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 Southoldc See LWRP Section III-Policies; Pages 38 through 46 for evaluation criteria. Yes—J No Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES . Policy 10. Protect Southold's water-dependent uses andpromote siting of new water-dependent uses in suitable locations._See LWRP Section 111 Policies; Pages 47 through.56 for evaluation criteria. ❑Yes ❑;No Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP`Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑Yes '❑ No Not Applicable Attach additional sheets'if necessary Policy 12. -Protect agricultural lands in the Town of Southold._See LWRP.Section III- Policies; Pages 62 through 65 for evaluation criteria.. ❑Yes ❑. No_ONot 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 a