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TR-10780A
��� ®��� � Town Hall Annex Glenn Goldsmith, President ®� 54375 Route 25 ® P.O. Box 1179' A. Nicholas Krupski, Vice President Southold, New York 11971 Eric Sepenoski Liz Gillooly � � Telephone (631) 765.1892 Fax(631) 765 6641 Elizabeth Peeples �CUUNII,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OFT H T ES BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE AC BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction '/2 constructed X When project complete, call for compliance inspection; Glenn Goldsmith, President SO Town Hall Annex A. Nicholas Krupski,Vice President ,`®� 0�® 54375 Route P.O. Box 1179'9' Eric Sepenoski l 1 Southold, New York'11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples • �® Fax(631) 765-6641 UNTI,N� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10780A Date of Receipt of Application: April 16, 2025 Applicant: Jorgo Cikolla SCTM#: 1000-115-11-21 Project Location: 380 Lupton Point Road, Mattituck Date of Resolution/Issuance: May 14, 2025 Date of Expiration: May 14, 2028 Reviewed by: Board of Trustees Project Description: Remove existing open porch in front of property; construct new 5' x 6' open porch in front of property; replace existing windows; raise roof on existing front dormer within existing footprint. 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 K.V. Lambiris, Architect, received on May 20, 2025, and stamped approved on May 27, 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. 4L Glenn Goldsmith, President Board of Trustees . . PROPOSED APPROVED BY ALTERATION BOARD OF AT'. ' � � ) EXISTING ,.. " 5� )ir10LD TOWN ONE FAMILY' . DST AT A� HOUSE' ' 90'4r �' -6. . ' (EXISTING-NO CHANGE) ,' '- (IXISTINGNO CHANGE). .(EXISTING-NO CHANGE) i 380 : - EXIST GUTTER. --. LUPTON. POINT ' ROAD EXIST GUTTER - - MATTITUCK,NEW YURK I I EXISTING ExrENpED ROOF ,z I I ..I 3 EXISTING GARAGE ROOF. o I ' Vi .. I '. EXISTING MAIN ROOF z +zI z. ' �. Is I I J . �� I 'EXIST GUTTER' . .. .. .. I _ I � 0 23062 N._GUTTER GUTTER .. .. OF . - � H GUTTER PORC ROOF "GUTTER' -. .. - .. _ NEW SHINGLES OIJ 30 LO.S ROOFING PAPER,ON SIB°COX PLYWOOD SHINGLES ON0.LBS.. .. _ - .. .. - .. .. PAPER ON 583EXYERIOR PLYWOOD 05-.19�25.�RENSED AS•PER 7RUSTEES.60M: .. .. - .. - - ON 2X8 @,e"o.e RAFTERS - - ,, .. .. .. .. � .. . .04-04-25 FILED,N7TH D.O.B. .2X8 RIDGE No DATE .. .ISSUE/REYISION .. nj • K.V. LAMBIRIS 43'�•. 2,'-0• s � A F2 C H:I T E CT : .,'(EXISTING-NO CHANGE) '(EXISTING-NO CHANGE) �', 77-25 CRESCENT STREET,LI.C,NEW YORK,1108 F( TEL:667-004-8248 EMAIL•KLAMBIRIS(1AJ10LCOM 11� PROJECT: ROOF:PLAN : A 2 0 025 � . . Style:1/4^=1'-D•� '� � PROPOSED � � � � � - � � � 380 LUPTON POINT ROAD . . .. .. TITU.CK,NY .. - .. Southold Town ..Board of Trustees ' - .. DRAWINGTITLEi ROOF.PLAN . (Proposed) — - SEALBSIGNATURE: DATE: 05-i9-2025 ' PROJECT'No:2024.00 - DRAWING BY:Ev' I ' CHK BY: KLAMBIRIS DWG.No: RIDGE FA Pt� : �° PROPOSEDSHINGLES• : .. ",RD OF .�, TL_ SALTERATI.O.NFSC� c� ®GUTTER ROOF EXTENSION- ATTIc �. CEIL NG DATIo IA .. . . HOUSE AT NEWWALEAOE - STUCCO LL 380 ' .. 15.00'MIN.DISTANCE FROM .. _ - .. .. . .. ... - SIDE PROPERTY UNE V.I.F. - _ 2ndF.L. . -.:: z z LUPTON. POINT. .. .. - .. - CEI .. .. _ .. .. Y Wt MATTITUCK,NEW URK .. - STUCO STUCCO [G.CNEWFINISH) (NEVJF SH1ST FL.. LEADERLEADERBX6 POST � BX6 POSTELI ..CEIL NG .GRACE: ' � -�. .. .. -- - ... .. DE .. - I I FM-AY 2 0 P025 _j F7---=----=--=-==------r--------------------.------=-ri r=----..----=------------ CELLAR ' Southold Town �i------=--=--------------------------------------- —Lr-� BoarddfTrustees .. . -. . . FRONT ELEVATION. . Cy scale:'174a_.1,_D•• - PROPOSED. -- — .. _ ' EXITING NO'CHANGE)'. (EXITING NO CHANGE) ' RIDGE I �TFO .. _ FRO�IE .REAR.12 - I .. .. I ATTIC" R j .EXISTING 3� ROOF EXTENSION � � � - GUTTER, NEW GUTTER �NEIIV GUTTER' EXISTING - - NEW GUTTER .F F'FLOOR. GUTTER CEI NG 'I 4U.00'MIN.DISTANCE FROM;� .. .I' � 05-.19�ZS.�RENSED AS PER TRUSTEES.COM: FRONi�PROPE,RTY UNE V.I.F. � �1 �•04-04-25 FlLm.N7TH D.O.B. - 1. No 'DATE .� �ISSUE/REYISION _ EXISTING GOUTTER, EXISTING .T B MODIFIED I S'-0' -NEW LEADERNEIIV LEADER �' -EXIGTING. . _ ■ �A,■'YIPORCH ROOF I LEADER *1- .K.V /� C/-� 2nd FL. GUTTER SHINGLES ON 5f8' .. I ... .. "A FZ C H I T E C T EXTERIOR PLYWOOD.ON 2X8(d 1 6'o.c RAFTERS - I - 71-28 CRESCENT STREET,LI.C,NEW PORK-11106 - .. - - _ .. .. CEI N. . . -- .. .. _ ROOF - TEL 661�04-8219 �EMAIL'NLAMfiIRIS�JIOLCOM '. 1 ST FLOOR 'EXISTING � EXISTING � EXISTING .I � EXISTING EXISTING - PROJECT: GUTTER TO �• �' GUTTER TO� GUTTER- L GUTTER GUTTER BE MODIFIED BE MODIFIED I 380 WPTON POINT ROAD .. NOTE:TERRACE NOT SHOWN 6X6 POST _ I . .. .. .. .. l MATTITUCK,NY 1ST FL. LEADER I 'LEADER G LEADER' DRAWINGTITLE' EXISTING EXISTING -EXISTING .. LEADER � 'LEADER . EL 04^ _Tn i LEFT SIDE,&FRONT ELEVATIONS .. .. CEIL NG .. .. . _ .. .. .. . _ .. GRACE -GRADE . . . . ..-I L-:i '�.. .I• 1. .. . I I I I 1 I - m .. ----_--� L-------� I' EXISTING L .. CELLAR F ' NOTE, . . I. EDT E LLE'S _ _ --- DOTING AS PE.TRUSTEES COMMENTS,ALL LEADER/GU TO BE CONNECT O EXISTING HOUSE DRYWE SEAL&SIGNATURE: DATE:- 05-19 2025 " PROJECT No:2024-00 yIII IIr1 . - - za'-4•, ' '• , CHK BY:GK LAMBIRIS CLEFT SIDE ELEVATION (EAST) : (EXITINGCHANGE) o-STORM WATER DIAGRAM " DWG No: NO SCale:1/4•=1'-0^ .. - .. 3 Scale:N.T.S. - - PROPOSED A-OO5:00.. " RIDGE ' . PROPOSED - . - SHINGLES - ALTERATION ATTIC. EXISTING' . .. CEIL NG .. - .. _ .. ONE FAMILY HOUSEIT-11 IT] p AT LLA I XIS�TING LEADER .. .. 3 - 80 2nd F.L. . . UPTON: POINT. .� SHINGLES .. CEIL NG.. 11 .. - • IIIIATTITUCK,NEW YURK _3 m • EXIST NG LEADER 1ST FL. EXISTING LEADER 11 T11 .. .'CEI'NG ..GRADE .. .. ... ... GRADE. .. .. NOTE*TERRACE NOTSHOWN' L—.---------------------1 -------------------------- .. CELLAR' .. - - _ - _ L•_� L.I _ - I I _ .. . -- .. ____________________ z REAR ELEVATION.-. { � . - • (EXITING NO,CHANGE) I. (EXITING NO CHANGE)' . # �F .. PROPOSED RIDGELn Tv E BRICK b. - .. .. - ROOFEXTE NEW GUTTER NSI ON � 1� MAY 3 3 .. ATTIC . EXISTING GUTTER 40.p0!MIN.DISTANCE FROM - - - SOUI)IDId Town .1. 04 d4-5 RLEDD.T}i D.O.B.TRUSTEES FROM PROPERTYLINE Y.I.F: .. p .. E TO PEG GUTTER .. BQard OP.Trustees .COM: .. .. .. .. m F' PORCH ROOF FlED .. .. ._ - .. I No '-DATE �.� ISSUE/REN90N K.V: ' e SN N .LJI B .. ROOFING PAPERON 513' � '' � �� � �- � � � � � I� S EXTERIOR PLYWOOD ON .. - _ .. .. - ® r1f1V H,ITCCT 2nd FL. - 2X8-@JS'o.c RAFTERS 31-28 CRESCENT STREET,LI.C,NEW YORK-11106 �}• .. -- _ TEL:661�404-0248 'EMAIL-KLAMBIRIS@AOLCOM CEIL NG .- .. EXISTING GUTTER .. . PROJECT: SXS POST .. - .. . 3c UPTON.POINT a m 0 LIUATTITUCK,NY ROAD . 38 AD DRAWNG-TITLE: 1ST FL.- . EL. 9-9' . RIGHT SIDE&REAR ELEVATIONS .. CEIL NG ..GRADE. '' .. - .. .. ..GRADE .. .. . (Ptoposed) /! ----- - _ m _ FOOTING - I - I - • CELLAR_ ------ ---- ------------------ CTNo202400 rr F SEAL& I NAT RE: DATE: PROJE DRAWING BY:.EV Y:' �.. K RIGHT.SIDE.'ELEVATION.(WES f) . rlo TI No : WG.NQ:...LAM BIRI EXITING CHANG ) (EXI NG" CHANGE)': scale:114-_1,-0• PROPOSED D A7006.00_ ' PAGE 10 OF 12. S ' OLD E 0 UTZ— TRU- ST -Es No. -' . 103 to A Issued To 10r1� C' Kd 1�01 Date SAS Address slo LypTd^ \ Port RIM Mat1.TNcK THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION ..TOWN TRUSTEES OFFICE,TOWN OF S0IJTHOLD SOUTHOLp, N.Y. 11971 TEL.: 765.1892 g�FfO(� Glenn Goldsmith,President �' �0 COGy ti. Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 CO Eric Sepenoski ? P.O.Box 1179 Liz Gillooly �y�• a0�t Southold,NY 1'1971 Elizabeth Peeples Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: 5 P- 2 Completed infield by: JORGO CIKOLLA requests an Administrative Permit to remove existing open porch in front of property; construct new 5' x 6' open porch in front of property; replace existing windows; raise roof on existing front dormer within existing footprint. Located: 380', Lupton Point Road, Mattituck. SCTM# 1000-115-11-21 Type of area to be impacted: ,./ Saltwater Wetland Freshwater,Wetland Sound V" Bay Part of Town Code proposed work falls under:ZChapt. 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.: 4 Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly E. 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FENCE .. ELEC.. 1'. z1.0.6' 1 000-115.OC 1 QO=OZ1:000. . i- . - _ . ER . .. . . 0\`� 24'N .. ,.o� . . oi:. . . . . . .. .. . . .. .. . . . . . !�- . . _ . . . . .. . .. �W. .'GONG AR "'I . NOTES. . . :. ' .. . . . . .. . . - .. - - . - GRAPHIC SCALE;' . '- ..' -. \ �8. . . Qo . ' \ _ .. .. ., . . . . .. . . . . .. 0.3 W . ' . . .. . . .. . . . .. .. . .. .. . . . 20 . .. .0 • 10' 20 . 40 .. . . . .. .W. h m • . .. - - - . .. . - FT P(0 494�ACR S)-AND UPLAND LO AREA52 0 �.. ¢. OVERED WOODS ^ :`� . . . .. . . ... . PROPERTY,4D RESS• 380 LUP . . .. - ?0 2. 14.4.42LSQ.FT (0331 ACRES) .SQ .. .. . . . O 12.2�: - 3. ELEVA710NS:AS'SHOWN HEREON:WERE BASED UPON 1HE.NORTH AM . ... . o ' � ®.WV PO Cli- � . C ( IN FEET )' ` \: 'N. v3.. �-. 40.35 '. �. VERTICAL.DATUM'OF 1988 (NAVD'88): .-, . .. 1 INCH =.20 FEET _` _ . . . - . .:. TYLPANE�G36103C0482HEEFFECTIVENDATEL00 .. . .. �. 4 SEPTEMBER 25,2009' IN�CATES THAT PORTIONS OF THE SUBJECT PROPERTY LIE. . & " , ' AR oo ME E X E M E . '.FFE . .�- . ���FRA TOR a ' WITHIN:ZON :--(A'R AS.DETER IN_D'TO BE.OUTSIDE':THE•0.29 ANNUAL;'CHANCE_. xll:� . ... LEGEND - N \ . . . . 8.1� } E �/ E . z S.. :. N G 1 3 ELLING: 3SO:- ' FCOODPLAIN) AND SPECIAL FLOOD HAZARD.AREA'REGULATORY,F- ... W Y ZON 5GE . w . . Z. AE'.(EL.6). . . .. . .. . .. . . . . . .. _ . .. . . .. .. ._ . , - .- - PROPERTY UNE. _ "' ADJOINING'PROPERTY LINE' .w N'. 22.3.' .N '. . . . ..27.1' 39 4':. 10 1'x : N TA ST .. .. .. ' t R. - WOOD'"o ON SURVEY . . . . -. . -- - EXISTING RIGHT-OF-WAY'. - .. ' . . . r rn .' - ©z 4' o'o.. PROPES NCESNARE-IN US SURVEYRFOOTR'S - - - . . , _ . . . .. .. . .. . .. .- ^.�` w 3 . - '' - .. . .. _ - 5. .'SURVEYED ON'JANUARY'5, 2025.. .. . .. • .. . . .. mom' WQ02 -_ N' --. . . . o_ BUILDING. w D - �_ EN z c�. . ... _- _ . . ¢ "WOOD R - -- - \ 'N z DECK ... e - - -r �` ¢Q,¢ . .. . .. - �- - _r = _- .... .... .... . .."° ' PLIT-RAIL FENCE x -�S .. 3N a .. '. - ' . . . . . .. - .. .. . . . OVERHEAb POWER LINE W g' �-- �- r-i:• \ a -- . . _ . .. . .. .. .. . . _ • .. CONCRETE' .. I. W '� --/ �:� '�. �\� _ 1\. \\ \� �w w .. .. EDGE OF ASPHALT /ZONE X: . `\\. ' .. - . .. . . . . .. . .. . .. . .. . .. . - .. . .. . . .. - - . . .. . CLEARING LINE . . .. . .. \�i. - _ u_¢. . z . . . .. . . - :': .. . -. . . .. - .. - .-._.-.-.-.-.-:- --•- -•-' . M .�!. �v ZY . _ . .. . .. ... ... . EAN HIGH WATER LINE' - __-„ , �� , _ 0. .. .. .. - e - .. ... . . i \ . • . N i -. -. ' . FEMA FLOOD ZONE LIMIT.UNE SFLOOD' .. Zc \ .1 `\�' .. .. .. ZONE LIMIT .. .. .. . N - -- . -. '-• - . ' .LIMIT OF MODERATE. WAVE.ACTION LWE .`� i. C . . _------- .. -- .CONTOUR-MAJOR- .• LINE �. - ?F '. \\,_ __ - - . _ _ _ . (ELEV��_--- ----- CONTOUR MINOR . .. 5'=..------ _ ` - - . .. .. . .. . ---- - . . . . - . .. .. . .. . . . . . .. .4N r. . • SPOT ELEVATION:. . .. .. _ _ :Nj(�-�\ .. . . BANK � '' .. .• . . . .. . '. - . .. _ _._ - -- = _._ ___ - _- _ _ . . . . . .. : . . ' . . .-. . ® .. - - .. . . .. - CATCH BASIN ' ^`� . . . . .Os. SEPTIC.MANHOLE . . . . . \ .. . . • . :. . _ . . . .. . ` - W . 0.. . WATER VALVE :. . . . .. SCALED... . . p- . . R/W . . . . . .. . . .. . • -••. MHWL . .. \ 3 . .. .. . . ®::. WATER METER . o -. . �! : .. . .. . .. .. POSTION OF" -� a ' POWER POLE FLOOD 3 Q N . .. . . .. .. .. .. y. .. --• .. .. .. . ..• . .. . . TR . .. Z ONE ,AE . .. . . CONC. 'CONCRETE. .- . - _ . .. .. . .. . . . .. . .. . .. . SQ.FT. SQUARE.FEET .. wAT)NG. . . - . \ ` FL OOD MHWL' -.MEAN HIGH WATER._UNE:.' QRED . . - . . .. .� . . �. DOCK GEp .; SCALED �. '.O A ZONE;AE . .. . .. CL .. . . CENTERLINE . .. N.. . .. LOCATION . .. . ..- . .. . .. .. EP "EDGE'OF P.AVEMENT. " .. .. �... . . . .` .. LIMI OF. . . .. .. . . .. \ MODERATE .. . . • : . - . . - - BBC - BELGIAN B O.CK. CURBING _ . . .. - .. . . . .. . RW : . . . -RETAINING.WALL . . . . . . -'- `-. % :.. . . .. . .. �•� . .. . .. S •' _ .. A' . .WAVE . • ':.FFE.'. . .. . .FINISHED, FLOOR ELEVATION . ... .. . .. . . 'V s ,.• . - . - - - . .. .. - . . ACTION' . 'w, . . . . 4 . .. . . . • . .. . .. . .. . . .. .. . ... . .. .'. . . . . . ' .. .. . . .__ ; .. . . . . :. . . . .. ... . :'. . . STANDARD NOTES .. - . . 7.s ; . .. . off, . . . I. -COPYRIGHT 2025'DENNIS W.-.1AYTON'LAND SURVEYOR,:P.C.• ' ' �.. ' ' .. . .ICERTIFIED TO= . . 2. :UNiQUTHORIZED ALTERATION.OR.ADDITION TO.THIS,SURVEY:MAP.BEARING A LICENSE.D.'.LAND. SURVEYORS SEAL - ` . . . , . . . . . . . .. . .. .. -_.` .. .. - - JORGO.CIKOLLA & CHRISTINA CIKOLLA IS.A VIOLATION OF SECTION''7209; SUB-DIVISION 2;.'OF'NEW'YORK STATE EDUCATION.LAW. : . .. .. . . . -. . ' ' : . . • 3. -ONLY BOUNDARY•SURVEY MAPS IM.TH THE.SURVEYORS..EMBOSSED.SEAL ARE GENUINE TRUE;,AND CORRECT . ' ., : . . . ' - . ' . . . ' - . • . 'COPIES.OF THE SURVEYORS ORIGINAL.WORK AND'OPINION, ' - . - 4: 'CERTIFICATIONS ON'THI BOUNDARY SURVEY MAP SIGNIFY'THAT THE MAP WAS'PREPARED IN ACCORDANCE .' - .' - - .. - ... . S . . . . . . . \. • I . •: • - WITH THE CURRENT EXISTING CODE'OF•PRACTICE FOR LAND SURVEYS ADOPTED-BY THE NEW. YORK••STATE . ' . .. . - . . ASSOCIATION OF PROFESSIONAL LAND SURVEYORS INC.. THE CERTIFICATION.IS LIMITED TO-THE PERSONS FOR - - . - . . .. . . .. . :� .. '' _WHOM.THE BOUNDARY SURVEY MAP IS'PREPARED, TO-THE'TITLE COMPANY TO' THE GOVERNMENTAL AGENCY,-, -- ', .. - DENNIS,W.'_L. . .. AND TO 'THE.LENDING INSTITUUON LISTED-ON.THIS.BOUNDARY SURVEY MAP. . PROFESSIONAL.LAND SURVEYOR . • 5.- THE CERTIFICATIONS HEREIN ARE•NOT TRANSFERABLE. P . 'NEW YORK LICENSE'.NO. 050920 , 6.`THE LOCATION;OF UNDERGROUND IMPROVEMENT S.OR ENCROACHMENTS-ARE NOT ALWAYS-KNOWN'AND..OFTEN- '' ' '' - • .. I .. -.. . ' - . -_ . . MUST'BE ESTIMATED..IF.ANY UNDERGROUND IMPROVEMENTS OR.ENCROACHMENTS-EXIST.OR ARE SHOWN, THE . -. . - ..• ;. . ' .. '. • - . . IMPROVEMENTS-,OR ENCROACHMENTS.ARE NOT.COVERED.BY.THIS SURVEY. . - . . . . . . DENNIS W. LAYTON . � '. 5 .. t.I ..._L..�..,,.. ... ..... ..,..D:.. SU-�R....V...�E. 7. THE'OFFSET'(OR'DIMENSIONS) SHOWN HEREON''FROM THE STRUCTURES TO.THE PROPERTY LINES ARE FOR;A '' - ' "- SPECIFIC-PURPOSE:AND.USE-AND.THEREFORE-ARE NO INTENDED,TO-GUIDE THE ERECTION.OF FENCES,'. .- - ' . - YOR, P.C: . - . RETAINING.WALLS, POOLS,.PATIOS, PLANTING AREAS,'.ADDITIONS TO'BUILDINGS, AND ANY OTHER TYPE.-OF- - . . . - ..CONSTRUCTION.. - : . - • • . . '.. .. '. • - - -.. - - o N CE LAN OWEIN O . - 8. 'COPIES OF THIS SURVEY MAP'NOT.BEARING THE LAND.SURVEYORS INKED,OR EMBOSSED SEAL SHALL NOT-BE NNW L.eoCN. NTER M RI HES,NEW YORKE11934 .. 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UPTONS POINT ROAD . .. . . . 20'WIDE PRIVATE.ROADWAY" . PR O . . .. - . 35 ooF ooF . . O. PROPERTY LINE OO. ALTERATION — — — . — . — . . . .. . .. SITE INFORMATION. ... ' :. - .. . . -. . . ADDRESS ' - •• - - 380 LUPTONS POINT ROAD;MATTITUCK,NY 11952. . . - .. I - .. '' - .. �. - - . :. -. . . AT - . .. ..ACREAGE' ,-.. -- .. - 0.49',-.. ... -- .. .. .. .. : .. - .. .'-_ . . . . - -- - - . . . .. ' LAND USE--- • .. . -'_ . .- MEDIUM DENSITY RESIDENTIAL. � . . . . .. .AN- .. - . . . . _ - - . . . . , - :.FRONT ONT YARD .. . " o CLASS. - " .. .ONE FAMILY YEAR-ROUND RESIDENCE ': "' - - - . - ,. - "- - . ' '.ZONING'PRIMARY� � �� 'R-40.�.� �. .' '". �- - = ONE FAMILY OU .. ,.FRESHWATER WETL/1NDS 0.00-. '- . . . . - _ . . . . . . - ' ASPNALT� AT �' .. .TIDACWETUWDS - ",0.18 -- . . _ . . .. �. .. . . .. .. - .. - — - .. .. .- .. 'COSTAL EROSION HAZARD AREA 0.00 ... .:. . ,. .' : . .. .. - ovEN Poach sts•• Z •. . .. - - '' . .. - .. . . .. .. .. - .. . '' . .. - ..PROP SWN 40 FT.MIN. . .. . .. .. .. ... . .' .. _ 'ppNCE FROKFRONT - .- .. _ .. .. _ .. _ .. J .I PROPERTY 11NE V1F... - .O . .. . . L. LUPTON POINT - . - . . .. - - .. - o . . . .. .. � . . _ . . . . ROAD -- 28.58' , 2125' . .DRAWING LIST.' - .- . .. 1 ��'MIN MATTITUCK;NEW YORK . I.. ._1 1 . .. ;.A-o01.00 .TITLE SHEET.PLOT.PLAN. .. -- .. - - .. .._ -- . - _ '- .. '. _. . ,. . .. .. - ... , . .. - -- I " . ': A-002.00 - ROOF PLAN Pro ose --- .. '" -' '' .- - -- .. -. . . . • • .. ' . . . . . .. . ' ..PERiirENsw aF�r epuri. . . . . . , _, . . .. l P � . . � A-003.00 .. LEFT-SIDE&FRONT ELEVATIONS(Pmposedj. .' .. .' .. .. - ... _. . I vaoPear v�E- -. .. . . _ 6 .. . . . . . . .. - - _ .. -O \ :. .-TOTAL• .3 . .. .. /y�, _ .. - _ .. . - .. . . . .. . .. . .. .. . .. . . .. . .. .. . .. .. . . :_ .. . . . . - -. . . — ..-. _ . . .. . :, . . - . .. _ . . _ . .. . .. . .. . .. . .. . .. .. . .. .. . .. t FAMav owEuwG N _ _ - E%ISTING OARAGE'1 .. .. .. STORY. . .. . .. . .. . .. . .. . .. - . .. .. . .. . .. . I . . .. . - . 1 . .. . .. - . .. . .. .. . .. - .. . .. . . . . . . .. . . .. .. . .. .. . . . .. _ _ - . .. .. . .. - .. .. - ..N:000 DECK. .N , _ (EXIJfING) . N. - -- -- N . ' .: .• . :. : . :. : : : _N .. V ' . .. .. .. .. . . I. . -' -. I IN ' : . .. . . .. . . . REAR �.. . . , , . . . ' �.I 1/. - .. - .' . .. - . . — . - . .. . . . . . . - .. . .. F ' . . . . . F H- . - _ - __ . o c� � D--" REAR YARD I a �'. �>�` �D: . . . . . . - . . - :. ' . . . .. .. " „ - - , . . . :. .- '- '_ . (f) ,. . .. . , '• . .. qT�O .. .. .. .. . . . . . . . . . .. . .. . .. . . .. .. . . .. . . .. . . .. .. .. .. .. .. . . . .. . ' . - . . .. . .. .. . . - .. .. . . . . . .- . . . . - . .. . .- . . .. . .'BANK.- -. . . . . . . . . . . . . . . . . .. .. .. .. .- . . . . . .. --- . . .. .. . . .. . . . .. . _. . .. - . . - - . .: I. egNL. I � 1 -I 04'IS 2025.FOR WETLAND ADYMSTATIVE.PERMIT .. . .. . .. .. . .. _ .. ._ .- . .. . .. .. - No .DATE' IS9UE/REVISION .. .. .. .. . .. .. . .. .. . .. . .. - . - . .. . K.v.'� .Ann . . . . ARCH1 BIRIS ' . . .. . . - . .. . . .. . . . . . . . . . . . . . . -' . WOO D GK 31 28 CRESCEN787REET.LI.C,NEW YORIC-11108 . .. . . - - .. . .. . .. . .. - .. . .. . .. . .. . .. . .. .. .. " 7F1:667;404-8249 .EMAIL IO.AMBIR19�10LCOM .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. PROJECT. . . .. . . . .. . .. . . . . .. .. .. .. . . . . . . . . _ -, .- _ _. - . . . . . ..- . _ . - -- --.. . .. . .. .. �_ 380 LUPTON POINT'ROAD. .'_ - - - -- - -. - --. . + -.- . .. .. . . . . .. . . . . . . . . ..- . .. . . . .. . .. I- DREDGED CANAL. . . . .. . .. .. .. . .. . .. . . - • . : 1 ��.. .. DRAWING TITLE: . . . . . . TITTLESHEET PLOT PL AN ' . . - . . .. ' . .' . • . . ' .. . ' - .. .. - . .. .. - . .. . .. , �. - . � \. . I . ..�. . . .' . . - .. .. . . . . .. - . . - . .. - . .. . . . . . .. . . .- �. .. . . . . . 1 .6 5 R 2 02 . . . . .. . . . \ .e „ . . .. - '' .. .. _ - . .. . . - . . . .. .. \ .. ._ . . .. .. - SEAL&SIGNATURE:. DATE: .04-15-2025 - . . . .. ` CT No:2024;O .. . .. . PLOT:PLAN �'G�NE�? � PRo�E 1 utholdrustees... S So . rd of T Boa , . .. Seale.t776^-.1-0` .. .. .. DRAWING BY:EV' .. - .. ' , - . . . .. .. .. .. . .. - . . CHK BY: K LAMBIRIS . . . . . \ WG'No: . . . . . . . . . . .. . . _ ' \, a PAGE 1 OF J . . . . . .. .. . - :. . . .. .. - - . . . . - . - .. .. _ . .. -- . . - - . - - - . . - . . . . .. . .. . . . .. . . .. .. .. .. .. .. .. .. . . .• . ' - . . .• - . . . - . .. EXISTING . . .. . .. . .. . . • . . . .. .. . . . . . . . . . . .. ' . . . ONE FAMILY . :. . . . .. . .. . _ . HOUSE . . . �' (EXISTING-NO CHANGE)� .' .. . . (EXISTING-NO.CHA. .• .. (EXISTING-NO CHANGE' - - _ . .. . .. . .. .. .. :. .. _ _ .. EXIST GUTTER . . . .. 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ARCHITECT (EXISTING-NO CHANGE) 31-28 CRESCENT STREET,:LI.C;NEW YORIC-I1708 . . .. (EXISTINGNO CHANGE)•- . . , - .. - . TFU.q61408249- .EMI11L 10.A618IRIS@OLCON .. - . . .. .. .. ' . .. .. _ .. .. r,�ROOF PLAN, ' . . .' . . .. .. . . . . . . .. . . . .. -- . .. . . _. . .- . Scald:.v4•=r-0•. .. '— — - .-- - _-----. - " P.R0380 LUPTON POINT ROAD- „ . PROPOSED .. . .. -- .- . . . . . • . . . .. I. .. . .. . .. . .. ... "MA.:. TTI TUCK;NY . .. . .. . DRAWING TITLE:" . � OF PLAN �+'� . .. . ... ' .. .'. . .. . - .. - . a - . - . .. . . - .. .. . . . . .. . .. . .. . .. .. ' '. . . . . .. .. .. . .. . . ... .. . . . .. . . . . .. .. :. . . . - APR . . .. . . . .. .. . .. . .. ' . .' . . . ' SE AL BSIGNATURE: DATE:� '.04-152025 . .. ' . . 'Southold TDWII PROJECT No;2024-00 . . .. - ' . ' . .'. . ' - .. . . . .• .. - - . . . .. . . .. . .. . . .. - . . . . .. Board ofTrusEees . � ' DRAWING BY:EV . .. . . . . .. .. . CHK.BY:.K.LAMBIRIS - .. . . . . . . - - .. - . . WG No: . 4A 002'.00 . 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I—....-.-.---.-,-......* ,SHINGLES . - .. .. . . .. ,. UTTER .ROOF.EXTENSION .. .. .. .. .. .. ... . .. . . . .. .. .. .. .. .. � - .. " . .. .. .. . . ' ' . ATTIC . -EXISTING . . - ' . .. . . .. .. . .. DE. NG' - ONE FAMILY . . ... .. .. . . :. . . . - .. HOUSE NEW W m .. F: LEAD STUCCO. - . , . 380 .. 15.WMIN,DISTANCE FROM , .. I .. .. . . SIDE PROPERTY LINE W.F. .. . . .. . . 2nd FL. . . . 12 . is . .,. - -_ . . .. .. . .. . .. -- CEI NG .. ,.. - .. .. � .. . .. - .. . . - .. - .. .. .. .. .. .. .. .. .. .. .. . g STUCCO. STUCCO ,' .X' - (NEW FlNISH) (NEW FlNISH) .. .. .. .. ,. .. . "1ST.F. ER' LEA D ER _ � - _ . -'BXB POST �� 8%8 POST' _ .. . .. .. . .. .. . .. . .. .. . "' . .. _ - _ .. . . . .. . .. .. .. EL•0'-0 . . .. CEI N6 ,. GRADE' . '' .. - , .. .. .. .GRADE. .. .. - .. .. .. .. .. .. . . . .. . . . 1' .. , .. . .. . . .. .. .-. .. Fa . 1 . .' .. .' - .. .. .. � .. .. . .. . .. . .. . .. . .. . .. ., .. .. .. .. .. .. .. m II 1 . .. � I „ . .. . . . . - .I . .. I_ '' -------------------------------------------------- ---------------------- . . . .. . . - . .. . . .. . - • . . .. . .. - . .. . - . .. . . . . . . . . - . CELLAR : . ' . - I I - .. I I r-� - . :. , .. : . . .. ., . . .. .. .. .. . . .. . .. . .-- --------------------------------. .. .--. -------- . ,. .. . . . .. 1".I I I . L_ LL .�' . p FRONT ELEVATION .. J: .. . . .. k _ .. ;'� - ' - .. . .1: PROPOSED.. .. .. •. - .. .. - .. . (EX . . . _ n `- . .i. .. .. , .. ... . . . .. . . . . . . . . . . . .. . . - . .. . . . .. . . . .. . . . . ' .. ITING NO CHANGE)_ (EXITING NO CHANGE) .. . . . . .. .. . . . . . .. . . . . . . . . . . . . - /r. , .. .. . .. . . . . . . . - . , . . . .. . . ... . .. . .. .. . .. . .. . .. . . :. RIDGE.. - - ' _ .. . . J�%) . .. .. .. . . .- . . - -. • . . .. - - . . .:. - .. .. .. . . . . n . . . . ' \ 230 . . .. . FpFN . .. ., .• .;2 -.. '- "- -12 . .. - . . '' . .. . .. .. . .. , -. - .. - .. . . . . -� - - ROOF E7(TENSION� ATTIC' , .. . .. . .. . . .. . .. . ,. .. . .. . - ." .. .. . _ CEI NG... - . . .. . .. . . ... ... . .. . .. . .. . .. . 40:00'MIN.DISTANCE FROM�. . .. _,, ._ - - .. FRO47.PROPERTY LINE V.LF.. - 1 04 15-2025 FOR 1VEilAND AONINISTATIVE PERMIT . ... .. - . .. . .. .. . .. . . . -No .DATE ISSUE/REVISIDN .. . . .. .. _ .. . .. - . .. m .. - - .. .. .. . .. .. .. _ . . - . sv. - :. . . - .. .. K:V. LAMBIRIS . . . . .. 2nd FL:. . .. . .. - . .. .a.. . ' .. - .. EXTERIOR PNYla1DODON' .. o .. . 16^o:c RAFTERS.. .. ... . .. - . .. . .. 3f-28 CRESCIEN`7RC,H� WERCT .. . .. .. .. ,. .. .. .. . .. . .. . .. .. .. . .. . .. CEI NG - .- .. . .. _ . . . .. - . . .. . . .. . . .. - _ . . 2X8 @. TEL:6674Oa-8248 .EMAIL•KLAMBIRIS@OLCOM .. .. .. - .. .. . . .. :, . . . . .. . .. . . . . 1 . . .. .. . . . . . ..PROJECT: .- - . . Sc - exevosr - .-- - " ,380 LUPTON POINT ROAD.. . - . .-, - NOTEiTERRACE NOT:SHOWN -- - . . .. - :. - .. . . m .. . .. . . . .. . . . .. . . . .. .. . . . . - . . .. :. - .. .. .. .. .. .. - .- .. .. .. . ,.- . . - .. .. .. 1ST.. .;- FL , .. . .. - . . .. .- .. DRAWING TITLE: . — . . . . . . +; LEFT SIDE&FRONT ELEVATIONS . EL. 0'-0" .: . .. CEIL NG' .- GRADE' ! .. . ,. .. .. .. - .. .. .. .. . .. L�-1==�� 1 L4_ __�j I. I I . 1, 1 .. I . I. . .. .I. 1 .- I- .. . .. '$ cRaDE 1 .. I I . - e L J L---=-= '. L' . - APR . T. 6: -2025 .. .. _ _ _ . . .. . .. .. .,.. - .. .. . . ... . . .. .. 00 .. . .. . .. .. . .- .. . I, .. .. _• - - . ,. . . .. I. -I . F 1 1 TING-. . I I LJ . . ' -. " . CELLAR I' I' I. . . . . . . , , .. ,. 1 1 . ' . . •. ..- . .' So0oldTOW�L. . '' . .' . " SEAL&SIGNATURE:�. DATE: '.04-15-2025 . .. . .. . .. — -- --------- . - .. . . .. .. .. .. -------------------- . . . . r-_cF. - --. . . . . . - . . . - .- .. - . • . . " . BOa�d Of'TNSfeOS PROJECT Nb:2024-00 :. . . . . .. '- . . .. - - . .. . . . . . .. .. .. . .. . .. . . . . . .. . . . J L DRAWING BY EV .. .. .. .. .• 2e'-a .. CHKBY: K.LAMBIRIS UT . I-I (EAST) . . ; : . ;:(EXIT. NGE) ' .' . . . . . . . .. .. . LEFT SIDE;ELEVATION _ .. DWG No: .. .. .. ING NO CHA. scale.va .1 0 - :.PROPOSED . .. : .. :. -: .. . . . . . .. . .. - - _. _ .. _ _ : -0(]100 : . . L - - __ - 11 _ 'PAGE '3 OF 3 EXISTING PHOTOGRAPHS LUPTONS POINT ROAD 20'WIDE PRIVATE ROADWAY 1 11PROPERTY LINE 100.00'FRONT YARD TASPHALT EXISTING E ON -po\ FAMILY BUILD NO EXISTING GARAGE I STORY WOOD DECK REAR YARD SITE PLAN X 1 , a ..,r. • • PHOTO#2 - FROM THE FRONT OF THE LOOKING AT THE OPEN PORCH GARAGE LOOKING AT THE OPEN PORCH _ 4 �1 te.°aN<yF�aa+'A. � .,..,-,Ex.w..,� Rt .....•.....->At-^._ �_. a g z2t °' .�'an°a `/2� �...,}-•' Pt`�' `L M z a x J D°G ae S Y oaoua n� w zeoe '. , ,§ <w. C.•-..'-.- i-+'i,-i i�I ,a 'r,�f.. �a .. �x a k...wwx...w. 1" * as .... RO•..•-."•"^• r` � YI°`r"?'�.. 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P.O.Box 1179 54375 State Route 25 Southold NY 11971 (cor.;,Main Rd.&Youngs Ave.) Southold,NY 11971 Telephone:631 765-1938 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: May 8, 2025 Re: LWRP Coastal Consistency Review for JORGO CIKOLLA SCTM# 1000-115-11-21 JORGO CIKOLLA requests an Administrative Permit to remove existing open porch in front of property; construct new 5' x 6' open porch in front of property; replace existing windows; raise roof on existing front dormer within existing footprint. Located: 380 Lupton Point Road, Mattituck. SCTM# 1000-115-11-21 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 Glenn Goldsmith,President *Of SO(/jy Town Hall Annex A. Nicholas Krupski,Vice President ,`O� ®l0 54375 Route 25. P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly G Q Telephone(631) 765-1892 Elizabeth Peeples' � • �O NV BOARD OF TOWN TRUSTEESE13 6 2a TOWN OF SOUTHOLD buvm This Section For Office Use Only Tratstm Coastal Erosion Permit Application Wetland Permit Application Administrative Permit Amendment/Transfer/Extension Received Application: L1 j w).J ?Received Fee: $ 450- 00 Completed Application: Incomplete: SEQRA Classification: Type I Type 11 Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: S Receipt of CAC Report: Technical Review: Public Hearing Held: I Resolution: Owner(s) Legal Name of Property (as shown on Deed): ci �la Mailing Address: 2''S—�� QfP_SceNAk ';�re_P.k N< o"�\G_ t j Phone Number: 1 — fo'}— �00 6�► Suffolk County Tax Map Number: 1000 - 1`S•— Property Location: S90 Lam,pknnv Po:w - AosW ikkak N\1 1 1l5-2-- (If necessary, provide LILCO►PFole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: Email: Board. of Trustees Applica: " ':)n GENERAL DATA Land Area(in square feet): \ 5 Sa . �k Area Zoning: — Li Previous use of property: 0 vA•e 'o,w•',1�I �St �—PAAk Va i Intended use of property: �v. �o w�iwl 12es%&pAn�\a. 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 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 >C No Does the structure (s)on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency '�--atS # V00 Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?__)�_No Yes If yes, provide explanation: Project Description (use attachments if necessary): V,3-1 ®D 4PIA Hew SX 6 no'em ;Zro� �� �� o� '��o�P��y �-e�o�•-ev�,�,..o�n� c'�� ���S�`i �^9 ��v�C'�o cA.,S Rq,,j:-A9 k'(a 4 040 '1� 9 froJ 111v"r (oo Board of Trustees Applies. " on WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: t _,c;cO j v.o fan .lore LA .� ;�v�(�eX �► eA� c e e.�:.-1 Cn i o i v^i w i yc(o w S w �n��► I - Area of wetlands on lot: ';:�l OS square feet I Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: G'S feet Closest distance between nearest proposed structure and upland edge of wetlands: 9 y feet Does the project involve excavation or filling? X No Yes i If yes,how much material will be excavated? A cubic yards How much material will be filled? P A cubic yards Depth of which material will be removed or deposited: �U feet Proposed slope throughout the area of operations: Q 14 Manner in which material will be removed or deposited: /V/ i I I 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): v �oS w®, Wall V,0A 4n J 0.en S ! 617.20 Appendix B Short Environmental Assessment Form Instructions for Comaletin2 Part l -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 1 -Project and Sponsor Information Name of Action or Project: Project Location(describe,and attach a location map): S60 Brief Description of Proposed Action: '�Nwto'c CL,, �2Mi x6 o�e ?ocC i,,. ro«4 d f Pro Ter Q_e Soce AMA © T 'Cr,iQA��� �r iti�wS WA A"' LI00 S e.g .ti � ��C�YS � Name of Applicant or Sponsor: Telephone: 9 6d6G O� O C 1 k®1k a E-Mail: G ICio IIt)•S ' o.6O.CO0'1 Address: 2%-G0 Crc-&cvAk 9Yre,e_+ City/PO: �^1A State: �� Zip .� ri0, 0p 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: 3.a.Total acreage of the site of the proposed action? 0.LJ 14 Li acres b.Total acreage to be physically disturbed? Jki 14 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.y 9q acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial Residential(suburban) ❑l orest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 • • \ 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ FX ❑ b.Consistent with the adopted comprehensive plan? ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: � ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? ® ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ❑ 9.Does the proposed action.meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: NZ4 0 ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water:_ Al © ❑ —� 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? � ❑ b.Is the proposed action located in an archeological sensitive area? 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? � El Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply:- El Shoreline El Forest ❑Agricultural/grass lands ❑Early mid-successional Wetland ❑Urban Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ©, ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? ❑NO DYES 1E-Si ❑ b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO ❑YES Page 2 of 4 f 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)? 1f 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:.. :El -20.Has the site of the.proposed action or an adjoining_property been the subject of reniediation(ongoing or' . NO YES. completed)for hazardous-waste? . If Yes,describe: .. I AFFIRM THAT THE•INFORMATION:PROVIDED ABOVE IS TRUE.AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: . . . `C➢�' .• . Date: Signature: i 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 bonsidering the scale and"context of the-proposed action?" No,or Moderate. small. to large. . a. impact impac t may. may :.. . .occur-- .'.occur 1. Will the proposed action create a material conflict with an adopted.land.u se.plan orzoning. El regulations? 2. Will the proposed action result in a change in•the use br 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 Ar �ea(CEA)? : 5. Will the proposed action result in an adverse change.'in the existing level oftraffic or . affecfexisting infrastructure for mass transitbiking: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? a ��o 7. Will the proposed action im a.ct existin g . a.public/private water"supplies. El' �.. . b.public/private:wastewater.treatment utilities? 8.. Will the proposed action impair the character or qualityof'important historic;archaeological; architectural or aesthetic resources? . 9. Will the proposed:action result in an:adverse change to natural resources(e.g.,wetlands, Waierbodies;.groundwater;air quality;flora and fauna)? El 0 Page 3 of 4 No,or Moderate, small to large Impact . impact . may. :may. occur occur. . 10. Will the proposed action result in an' increase in,the-potential for erosion,flooding or drainage problems? 11. Will the proposed action create a hazard to environmental resources or human.health? .. a a Part 3.-Determination.of significance. The Lead.Agency is responsible for.the completion of Part3..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; n'sufficiept'detail;identify.the impact,including-any measures or design elements that have been included by* the project sponsor to avoid or reduce impacts..Part3 should also explain how the lead.agency determined'that the impact may or will not be sigriificant.•Each potential impact should be.assessed.considering.its setting,probability of occurring' duration,•irreversibility,geographic'scope and magnitude'. Also consider the'potential for:shorf-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'stafemenf 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.Trustebs ' Name of.Lead.Agency. . . . Date President Print or Type Name of Responsible Officer in Lead.Agency Title of Responsible Officer-, ; Signature of Responsible Officer in Lead Agency .Signature of Preparer(if different from'Responsible Officer) PRINT . Page 4 of 4 . .. . :Board of Trustees- AFFIDAVIT O r :: : �. :0. BEING::DULY'SWORN DEPOSESAND. IRMS THAT.HE/SHE IS THE APPLICANT-FORTHE'ABOVE :DESCRIBED PERMIT(S)AND.THAT ALL STATEMENTS CONTAINED HEREIN.. = :ARE:TRUE TO THE.BES:T•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 DF.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 •TRUSTEESTOINTER-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.:TERiVI. .. OF THE-PERMIT:. g P Y. P. . Y. Si nature of Pro ert Owner� � �. Si ature of Pro ert: Owner . _. .• DAY.OF .SWORN TOBEFOREME THIS. y : 20.:.225:: : : KAT H Y.P UO SIS N ' -Notary.Public, afe of New York � Otary:PubI,C 1 _ of y.P bli ,St Qualified in Queens County ' �1 commission Expires Dee 4, ',Board of Trustees Applica, >n AUTHORIZATION (Where the applicant is-not the owner) owners of the property.identified as•SCTM# 1000- 11-S -.1\--2� m the town of . M U��'� u.C� New York,hereby authorizes . to act.as my agent and handle alI .. . o ermitOf necessary work involved.with the aPPlication rcess for. s rom the:Southold Town_ .. . Board. ' f Trustees for this property. _. 1 Property Owner's,S gnature' f P�operty.Owner'.s.Signature ; SWORN TO BEFORE ME.THIS Y ;20 Notary Pub KATHY P. LIOSIS 4 Notary Public,State of New York. f� Qualified in Queens County y pit s - No: 01 L1.5052694 l Commission Expires Oec94,' } APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM= -The'town'of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and emtiloyees.The nurnose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same: i YOUR NAME: ast na ;first name, iddle initial',unless. ou area 1 in in the'name.:of. ZZ' Y PpY .g someone.else or'other entity,such as a company.If so,indicate,the other person or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building _.. . Variance Trustee Change ofZone I Coastal Erosion. Approval of plat . . ! Mooring. Exemption from plat or official map C Planning Other . (If"Other',name the,activity:). f Do you personally(or through,your company,.spouse,sibling,parent,or child)have a relationship.-With any officer or employee of the Town of Southold? `•`Relationship"includes by bloody marriage,or business interest.:`Business interest"means a business; including a partnership,in:which'the town officefor employee.has even'a partial•ownership of(or employment by)a corporation in-which th6 town officer or employee owns more than 5%bf the shares: YES NO If you answered"YES",,complete.the balance of this form and date and sign where-indicated. Name of person employed'by.the Town of Southold Title or position of that person Describe the.relationship'between yourself(the applicant/agentirepreserifaiive)and the town officer or employee::Either check the appropriate line A)-through D)and/or describe in the space provided. .' . The.town officer or employee or his or her spouse,sibling,parent,or child-is.(check all,that apply): A)the owner of greater than 5%'of the shares of the corporate stock of the applicant :. . (when the applicant is'a corporation); B).the legal or beneficial•owner of any interest in.a non-corporate entity(wlien the applicant is not a do_rporation); C)an officer,•director;partner,or employee'of the applicant;or " D)the actual applicant:.: DESCRIPTION OF RELATIONSHIP Submitted this. . y.of 200 Signature. Print Name-: -6, Form TS 1 Town of Southold LWRP CONSISTENCY ASSESSM ENT.FORM i A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to 1 its significant beneficial and adverse effects upon the,coastal area(which includes all of Southold Town). 3. If any question in Section C on this rm is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot ibe 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# I o og - its - 1 ( — 2 PROJECT NAME, 360 L 1,40+ovh ,0;A+ pl oa. I The Application has been submitted to(check appropriate response): I Town Board 0 Planning Board[K Build g Dept. 42-1 Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital U construction,planning activity, agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant,loan,subsidy) (c) Permit, approval, license,certification: i Nature and extent of action: ` l � �J �cX(i� tg p p rCL\ i in 47r-o►^-i c 1 ��.. i��1 A%A6PX",4-n lio,3 I Location of action: $�3 L-txlg -oh FdiH+ 2,oad Vo 4(Ac Site acreage: Present land use: QyAP Fa \AA,' 1N P ems.;.; Lpovn o_ Present zoning classification: O\ 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: (c) Telephone number:Area Code( ) (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No© If yes, which state or federal agency? i I 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 bye returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal)location,and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. [—]Yes ❑ No © Not Applicable 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 allot Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No 0 Not Applicable I I Attach additional sheets if necessary NATURAL COAST POLICIES I 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 ® Not Applicable I i Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No ®Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ Yes No Noi,, �_1plicable 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. ❑ 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 I Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria.❑ Yen No YM Not Applicable Attach additional sheets if necessary WORKING COAST POLI''Y2,,aS Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No © Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No L1SJ Not Applicable I 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 IN Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable PREPARED BY flCao G1 iw \\0. TITLE DATE I S 2S