The URL can be used to link to this page

Home My WebLink AboutTR-10749A Glenn Goldsmith, President `�®� SD(/I� Town Hall Annex A. Nicholas Krupski,Vice President ®�v ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski l�6 Southold, New York 11971 Liz Gillooly @ Telephone(631) 765-1892 Elizabeth Peeples ®� �® Fax(631) 765-6641 c®UNTV,�1 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE #2229 C Date: April 25, 2025 THIS CERTIFIES that the 35'x 14.5'on- rg ade paver patio, At 1225 Westview Drive,Mattituck Suffolk County Tax Map#1000-139-1-1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated April 5 2025 pursuant to which Trustees Administrative Permit#10749A Dated April 16, 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 35'x 14.5' on-gradepaver patio. The certificate is issued to JEFFREY&RE STRONG owners of the aforesaid property. Authorized Signature Town Hall Annex Glenn Goldsmith, President �� S®��®� 54375 Route 25 A. Nicholas Krupski,Vice President `® P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly = Telephone (631) 765-1892 Elizabeth Peeples �® Fax(631) 765-6641 NV BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICEOF FTIHE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE AkCOFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 sc day of construction '/2 constructed When project complete, call for compliance inspection; Glenn Goldsmith,President `�®F so Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President ®VV ®�® P.O. Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples � a� Fax(631) 765-6641 c®u ,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10749A Date of Receipt of Application: March 26, 2025 Applicant: Jeffrey & Re Strong SCTM#: 1000-139-1-1 Project Location: 1225 Westview Drive, Mattituck Date of Resolution/Issuance: April 16, 2025 Date of Expiration: April 16, 2028 Reviewed by: Board of Trustees Project Description: For the as-built 35' x 14.5' on-grade paver patio. 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 Kenneth M. Woychuk Land Surveying, PLLC, received on March 26, 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. Glenn Goldsmith, President Board of Trustees S.C.T.1L NO.. DISTRICT:9000 SECTION: BLOCK.T LOTM l _ Aw MAR 2 6 2025 N78'42'40"8 178.17' Southold Town / m Board of Trustees m `� i o 45.4' Cc .aar �..' ZONE AE(EL 8) he4 n water f7 '�ronsroa�ww C/1 4H ZONE %: paver ~ ^ J R patio, .g�j. .!��•.� SJ7J t} N F� i {��V�i C 2 � I APPROVED F 1 `E gam°, 9 �� 4 ".II t� � 578'9E 90"1I 216:80' � r 5000' BROWER ROAM? :.BOARD OF I RUSTEES f FEIaA IAAP 36T03C048TH I W WA0?SUPPLY, JIMS DRMETISAND CESSMOl TOWN p�A u LOC417OW SNOKN ARE FROM M0 OBSERVATKMJS TO VY 1 V OF. SOUTfIOL® f EFFECTIVE 09/25/2009 AND OR DA;rA 08TAtxED mom ongm, AREA:.34 390 SO.Fr. OR 0.79 ACRES EUVADON canna (A1AU1 w2w Atrmr4v aR Amnav d] ®� 10 WS SRWY IS A WMAnOY O�'SECn0N=9 ar nt NEW MW SUM mLCARON LAIC W S a<vw may 1 • l7®� W NOT�iiRHY IA,nE ND SIL Wval45 d053D SM,SHALL Wr SE.COVSM?0 W BE A VALID.REC COPr G'I/,t4AN7EM FXC41ID7E7WdJ SHALL mm CVZY ro»E PFR974 iaR wtaa tJE 5LR4EY rs PREPARED A7D M IiiS E1IHALF ro'TFE flnE L17YPAVY.OM2NU PEAL AMCr Ado LfJIDDJO HMnMMV r, , USLv AWWX AND TO TW ASSIMMM Or ME LWWV WSMUK allR.WM AW AOr 7RUS9VWMA _ USE'07ZM ON OfflAMaMSHOIRM MI RLU4 FR W HE FRWMJY LIES?D.I E SIRUCA.GSS ARE F07 A 3E870 Rial=AND USC VER70W AEY A11- Fpr 1Ylt]1LE'D rD Yp1lAY7d'AE 771prRTY[1LS O4 ro CLAY DIE ERELRON OFE1NfES ALYYOLHAt•57AUC7UE5 G4/!�6DlJi�4fl[7v1S FilsE7eTHts AmgAw SA7 WAEf SfRVCRv'S RELmIEO OR t#mo 70ED Aw ADr CvARANrm IA m pmmm4tLY sw f Or VX FMCM Ar JIVE'TW OF StR Y SRCDs: DESCRIBED PROPERTY !��t4�`Nri"p� CESR11FIED M JEFFERY STRONG; RE STRONG; way s. ~x"ri ADVANTAGE TITLE GROUP AGENCY LLQ -- stuatm at MATiTrIlCK z FIRST AMERIC4N TIT,IE INSURANCE .TPANY- r Hr TaAwi OF,SOUTHOLD C+ �D3 1(TOTCHUE LAND SUBM3=6 PLTC SU�OLK COUNTY, N£W'YORK ��!` asa¢ JF" rnfeutonal':Land survQfea and neltn 'P.O.Ben ISS Aqumbogua New York 11931 224-70 SIAL£:.t e=30' Date.JUNE 17; 2024 r Pon(anDaaa-7m In(an)ulu uaa my-%,tJSG NO 0=832 SOUT 0 T , STEES LD RU Issued To 1e�ce�t Q.t s�tronq Date. Addr ess 1 aas we5i'veb 6 W THIS'NOTICE MUST BE DISPLAYED DURING CONSTRUCTION ,TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765.1892 Glenn Goldsmith,PresiL.___ /.�o�� 0.9, - r Town Hall Annex A.Nicholas Krupski,Vice President = < 54375 Route 25 c Eric Sepenoski C* ,? P.O.Box 1179 Liz Gillooly �y ® �� Southold,NY 11971 Elizabeth Peeples �Ol Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report t Date/Time: Oqhs Completed infield by: JEFFREY & RE STRONG request an Administrative Permit for the as-built 35' x 14.5' on-grade paver patio. Located: 1225 Westview Drive, Mattituck. SCTM# 1000-139-1-1 Type of area to be impacted: Saltwater Wetland Freshwater Wetland ✓Sound Bay Part of Town Code proposed work falls under: _,/Chapt. 275 Chapt. 111 other Typ of Application: Wetland Coastal Erosion Amendment 7Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly E. Peeples j i 1 Y�• ,�`,ry J, �'• _��•1 � � 7� � 11 23:'{C�1 �` �I� 9 ! i �:•�. � Imo►.\, q I �fl�„}��I$�w�'rlf�19��le1�'11:h► �$�_N`�la.�!i!It .�'fi •as . u I I .. I I ff � 4-51,jo 5 1 I t i • � � �1'.af yy u i • ,Ii 1'�•µ,0h'k��ll �iy'" �� h �.�� <'F��r� `Y.�,R�I: 4l n R n { h Al el 14, 7- 03 vW7 mw NO 00 \ �� ,. ,�e 'lt r�♦'� Q Pam. .,�` �` ,'�:. ' s , NOTICE .E w. tOBp v w, COUNTY OF SUFFOLK E �•�_ .,• ..... - °"' � _ u.imsrwa.rrevak sr.e oe v sEclwN No ------ .� ,rut .,_ A � woo 139 p ea _ _ wr♦rxu Ynw__.w__ u —__-- r,rt 121) ur, x p 8 OFFICE LOCATION: Q sp r'oy , MAIIJNG ADDRESS: Town Hall Annex �= P.O.Box 1179 54375 State Route 25 Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) Southold,NY 11971 �:. ', Telephone:631 765-1938 YCIlwJ fY LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: April 14, 2025 Re: LWRP Coastal Consistency Review for JEFFREY & RE STRONG SCTM# 1000-139-1-1 JEFFREY & RE STRONG request an Administrative Permit for the as-built 35' x 14.5' on- grade paver patio. Located: 1225 Westview Drive, Mattituck. SCTM# 1000-139-1-1 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 INCONSISTENT with policy 6.3 of the LWRP. • The patio was constructed without a Wetlands 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 v �a� (�U�y, Town Hall Annex A.Nicholas Krupski,Vice President ;�O ` ®� 54375 Route 25 P.O.Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples ► • a0,' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application LGE VE ` ` 1 Wetland Permit Application Administrative Permit Amendment/Transfer/Extension MAR 66 ?�?5 Received Application:. Received Fee: $ . _.- .__...____.__ ._ Southold Town Completed Application:' _ BoardofTrustees Incomplete: SEQRA Classification: Type I Type 11 Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent):. L WRP Consistency Assessment Form Sent:—__—__._--_---- CAC Referral Sent: Date of Inspection: Receipt of CAC Report: Technical Review: Public Hearing Held: Resolution: Owner(s) Legal Name of Property (as shown on Deed): Mailing Address: 0 2.f Ide--��%� P�;YQ Phone Number: C— 01 ` 9 6 — Suffolk County Tax Map Number: 1000- 132, —1 Property Location: 6�e-r lib'<6W Pri Ye , ,A► 14 4, XJ-Y (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): /Z) Mailing Address: IV A, Phone Number: Email: '),rd of Trustees Applicativ'-- � GENERAL DATA p Land Area(in square feet): ��'7 yr�c1 r� OC70 Area Zoning: e- S'r e1, Previous use of property: ,e,y 1 n Intended use of property: R,2is'. �►,�-� Covenants and Restrictions on property? Yes No P If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? Yes X"oo'No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes No Does the structure (s)on property have a valid Certificate of Occupancy? Yes No 6 ZA PI' .1&V GP-A kA Prior permits/approvals for site improvements: Agenc J Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?-Y—lo, No Yes If yes,provide explanation: Project Description(use attachments if necessary):. - rd of Trustees Applioati(- WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: /D� ,� (24 i s�t eye q S ��, f ►S 'k / ✓� ' P�cr er- ��a�f d �Z -r�eo.�r� ) ✓�I Area of wetlands on lot: square feet Percent coverage of lot: /IF Sa" % -P,,r l/e-4-�R O 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 Yes If yes,how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited:. V 7---) t�- 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): A I II r T.>` traJecl��e. : 617.20 Appendix B Short Environmental Assessment Form Instructions for ComT)letin Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification.,. Complete Part I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information Name of Action or Project: 0] II ) Project Location(describe,and attach a location map); Brief Description of Proposed Action: n >7f 0-T ` - /�i / ��PX 1t�L7J_fY�Cttv�vp o'1 �CcSvJ� G'rk�` -rx . Name of Applicant or Sponsor Tele hone- v� Z' c'nP• E-Mail. e_AA '<A'cn .r ry)q 1-,h P. tbw- Address: City/PO: r State: o Zip Code: /y 1.Does the'proposed action only involve the legislative adoption of a plan,local law,oidinance, -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: 3.a.Total acreage of the site df the proposed action? c 7 ,320 j aeres b.Total acreage to be physically disturbed? O r. acces— c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? rr . acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial [:]Commercial ,Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 j 5. Is-the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ a b.Consistent with the adopted comprehensive plan? MET F] 6. is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? El 10111 7. 1s 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? I(��J 9.Does the proposed action meet-or'exceed the state energy code requirements? _NO____YES If the proposed action will exceed requirements,describe design features and technologies:. 10. Will the proposed action connect to an existing public/private water supply? NO YES. If No,describe method for providing potable water: l I.-Will the proposed action connect-o existing wastewater utilities? NO YES, If No,describe method for providing wastewater treatment: J ( L�-1J 12. a.Does.the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? b.Is the proposed action located in an archeological sensitive area? 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? El 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: 21 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: Shoreline ❑Forest ❑Agricultural/grasslands 0 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? j' 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? .9N0 [DYES b.Will storm water discharges be directed to established conveyance systems(run and storm drains)? If Yes,briefly describe: RNO DYES 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: . n 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:, a 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 (t f4 Applicant/sponsor name: C 0_ 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 1. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ regulations? 2. Will the proposed action result iri a change in the use or intensity of use of land? K7r ❑ 3. Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or 1p( ❑ 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? L7.f 7. Will the proposed action impact existing: (� a a.public/private water supplies?. L� b.public/private wastewater treatment utilities? a 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 i No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? - : - -__- 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if differefiffrom Responsible Officer) PRINT Page 4 of 4 1"' '�cd of Trustees Applicaticr AFFIDAVIT J 2C�pay cS b-ctg_ anA 3tr_or1 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 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. �l Si o rop Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF KAREN OLIVER NOTARY PUBLIC-STATE OF NEW YORK �( No.01 OL6391332 LY�.t. h Qualified in Suffolk County Notary Public My.Commission Expires 05-06-2027 APPLICANT/AGENT/REPRESENT'ATIVE TRANSACTIONAL DISCLOSURX,FORM The Town ofSoufhold-s Code of Ethics:prohibit" conflicts of inte"reston the part of town oflicer&and emnlovees Tl a nuroase of this't is to Qrovide information which can'alert t}a town of nosstble-conflicts`dinterest_and_allow it io take•whatevei action k necessary.to'avoidsame: YOUR NAME: : t ppe v�z st (Last name,first name,ari ddle 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 ofttie"Towii of Southold2 "Relationship"mA udes by blood,rrlarr age,or busmess'iiateresL"Business interest"meansa business; including.a.partnership-m% hrch the town officer or erripioyee has,even a partial owneiship of(unemployment by):acorporati, n in which the fawn>officeror employee owns Wort 110115/o ofthcshan m YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southol ® - .. Title or position of that person, ,Q Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than S%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or ---:=D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this r Z da fK) r Print Name: 6r,, Form TS 1 Town of Southold f LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 11. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action- will be evaluated as to its :significant. beneficial and adverse effects.ubonthe coastal area(which includes-all of-Southold Town) 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be.mlained in detail, listing both supporting and non- sugl2ortiggfietsi If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall-not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all „ local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# PROJECT NAME 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: Nature and extent of action: Location of action: � 02. oZ � �Y,,SJ✓!rAW Site acreage: Present land use:- Present zoning classification: (OY4-)C 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: . �ie �t1�r� n� (b) Mailing address:. 1 a. l�e_f�`vT@ o> r^• ny 4 Z (c) Telephone number: Area Code( C — 631— / /39R_ (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes 0 No If yes,which state or federal_agencyZ C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. VIYes 0' No n Not Applicable f flu p. IT-y rir__ o c 17 Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria 0 Yes ❑ No �Kiot 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 Q Yes 0. No eNot 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 ❑° Yes No W"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 0 Yes El No Kot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. Yes No Not App� �de Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. a Yes No Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. Cl Yes ❑ No eNot 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. F1 YeO No Not Applicable Attach additional sheets if necessary WORKING COAST POLICIE" 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. 0 Yes ❑ No kfNot 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. 0 Yes No KNot 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. El Yes 0 No eNot 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. 0 Yes Q No Not Applicable PREPARED BY TITLE Ar �'1� DATE