HomeMy WebLinkAboutTR-10788A ��� 5���� Town Hall Annex
Glenn Goldsmith, President ®� 54375 Route 25
®
A. Nicholas FCrupski, Vice President �® P.O. Box 1179Southold, New York 11971
Eric Sepenoski
Liz Gillooly Telephone (631) 765-1892
Elizabeth Peeples �® Fax (631)
765-6641
UNTi,�
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
SOUTHOLD TOWN BOARD OF TRUSTEES
YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE
BOARD OF D TRUSTEES
72 HOURS PRIOR TO COMMENCEMENT OF THE ACT
OFF
BELOW
INSPECTION SCHEDULE
Pre-construction, hay bale line/silt boom/silt curtain
ls' day of construction
'/2 constructed '
When project complete, call for compliance inspection;
Glenn Goldsmith, President _`�®F S0 Town Hall Annex
A. Nicholas Krupski,Vice President ®may ®�® 54375 Route 25
P.O. Box 1179
Eric Sepenoski Southold, New York 11971
Liz Gillooly Telephone(631) 765-1892
Elizabeth Peeples � Fax(631) 765-6641
coo
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 10788A
Date of Receipt of Application: April 14, 2025
Applicant: Thomas Hug
SCTM#: 1000-126-3-14
Project Location: 1285 Albo Drive, Laurel
Date of Resolution/Issuance: June 11, 2025
Date of Expiration: June 11, 2028
Reviewed by: Board of Trustees
Project Description: As-built 12' x 21.7' deck.
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 AMP Architecture, received on April 14, 2025, and stamped
approved on June 11, 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
PRO,IEGT/ ZONING`DATA
TAX MAP# 1000-126-5-14 ' 1 �� J �` �j o Z w 14
3
ZONING DISTRICT R-40 NO =.w - �✓ S�'�\''..' ? S =a o
LOT AREA 0.5 ACRES -•z "a d
GofO - PRIVATE ONE FAMILY ;% _ ___ BP / w a
NO.Z?43"1 DEC.;DEG 30, Ig96 a \\
DWELLING sls�cT Nxcr�rc x LL J o€J
GOfO - PRIVATE ACCESSORY `' 0 3:a
STORAGE BUILDING NO. ZL5025;NOV.29 19 T iw°0 3 w
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FEMA FLOOD ZONE X d AE (EL(?) F J a z o a
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WETLANDS DISTRICT PENDING `' > .3\•" ,,ri ' ! "� SA S A°�S�sF� / eFL�� 1 ry a 0 LL 0 Z
DEC, ORMA
DISTRICT NJ PENDING �� - ,w ,,:`, ovoano2a ��/� �F •4 I o a F\ J Q w a
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5UFFOLK COUNTY HD APPROVAL 650 102 3 BED. + \ �3 J l �'
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FLOOR AREAS FER_SOUTHOLD TOWN GORE'2&0-4' ,,,'`:' �J , ti, w2 __---------I-----1O' E �a a E LL
EXISTING EXISTIN6 7 a z Q o
HABITABLE 6R055 LOCATION MAP
SPACE AREA FLP�i I (/ �' °_ a o
SCALE: NTS "1 v / d, LL°'w
BASEMENT AREA O 5.F. 1,050 S.F. L
2.8�-� `' w z m o o
FIRST FLOOR AREA Ip30 S.F. 1,030 S.F. _ '- 1 Ex15T I L a a N a S2
BOARD OF 'ItZUSTEES $ FRAMEApo q c ��_�>
SECOND FLOOR AREA O S.F. 0 5.F. tn1 1 APR n I Q ,n?1 =w °�o
"TOWN. OF. SOUTHOLD 1 I
AREA TOTALS Ip30 S.F. 2p60 S.F. I �
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1 Southold Town
1 Board of Trustees �
LOT COVER ACE DATE (� 0 j
1
500THOLD-TOWN CO,DE,280-1248
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DE50RIPTION(FOOTPRINT) AREA % LOT
GOVEfZA6E 1 ___-- /-' I ¢��- n
TOTAL LOT AREA(LANDWARD OF P V/
12,324.0 S.F. '"{ J` ,- '� 1 / �� T
FLA66ED WETLAND) SITE LAYOUT NOTES:
EXISTIN6 HOUSE 1,050.0 5.F. 8.4% I. THI5 15 AN ARCHITECT'S 51TE PLAN S 15 20 1 21.1'
SUBJECT To VERIFICATION BY A LICENSED 1 �`�,j� EX15T. p ,-
SURVEYOR. THE,(NFORMATION ( FRAME /-
EXI5TIN6 DECK 260.4 S.F. 2.1% per-
ARCHITECTSI U
REPRESENTED ON THIS SITE PLAN IS TO THE
EXISTIN6 STOOP 66 8 S.F. O.5% BEST OF KNOWLEDGE. 1 2 X,; '
EXISTIN6 SHED 64.0 S.F. 0.5% 2.SURVEY INFORMATION WAS OBTAINED car IM m
FROM A SURVEY DATED JANUARY 21,2025
TOTAL AREA OF ALL STRUCTURES 14212 S.F. 11.5% AND PREPARED BY: /0 1
MICHAEL K.WICKS �' iq
MAXIMUM LOT COVERAGE ALLOWED: 20% LAND SURVEYING /
15 FROWEIN ROAD 1
CENTER MORICHES,N.Y. IIcI34
ZONING REGULATIONS MAIN B)ILDING LL
TELEPHONE: (63U 574 0156 I
_ 1
5OUTHOLD TONN GODS 280,ATTACHMENT 3 E 250=2148 s'r15.4 ,' 52
EXIST. PROPOSED COMPLIES NOTE: I
I. FLOOD MAP DATA FROM FEMA 3
MA":3610300451 H 1 p
MIN.FRONT YARD 35.0' 44.1' 44.77' YES MAP DATE: 9/25/2009 1 EXI�fIN6 m
FLOOD ZONE X b AE(EL6) I 4WAVEL IT
MIN. SIDE YARD 10.0' 152, 15.2' YES j 00
DRIVEWAY
2.SURFACE WATt=R5 OR WETLANDS ARE 1 I cj� _j A J_ 0 vq
MIN.COMBINED LOCATED WITHIN 300'OF THE PROPERTY. s1 I �N -® � ? 0 >-
SIDE YARDS 25.0' 30.6' 30.6' YES
FLA66ED ELEVATIONS REFERENCE NAVD 55 DATUM. W 1 j ci �' = mi m Z
WETLAND 100' 82 5' 52.5' NO �! / J O - cn a W
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SOUTHOLD'TOWN GORE,280-20'I (A)(I) / /
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LOT 51ZE/AREA IN 3p24.4 ALLOWABLE TOTAL Q '- fi
EXGE55 OF IOp00 S.F. S.F. 6FA 6FA i'
(b) LOTS CONTAINING UP TO 3350 S.F. �/ ��'R/� �� o
20,000 S.F. MAX. z
ALLOWABLE S.F./PLUS 2O' D R a.
12.5%OF EXCESS LOT 2,100.0 S.F. 3"18.1 S.F. 2,4718.1 S.F. 1,050 S.F. 8 O
AREA OVER 10,000 S.F. P`
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PROPOSAL FOR: MARK UP DATE: COMMENTS
DATE: 03/1B/25 HUG AMP Architecture
AS-BUILT THESE PLANS ARE FOR DESIGN PURPOSES ONLY AND SHALL NOT BE USED FOR CONSTRUCTION.THE
PAGE:
1285 ALB0 DRIVE Design B u 11 d DESIGNS PRESENTED HEREIN ARE THE PROPERTY OF AMP ARCHITECTURE,MC AND SHALL NOT BE
DUPLICATED WITHOUT WRITTEN AUTHORIZATION FROM ANTHONY PORTILLO,RA,LEED AP,THESE PLANS ARE
SD-2 PROTECTED AGAINST ANY UNAUTHORIZED USE UNDER FEDERAL LAW BY THE ARCHITECTURAL WORKS
LAUREL,NY 11948 11 1 COPYRIGHT PROTECTION ACT OF 1990 AWCPA WHICH HAS SEVERE PENALTIES.
S0UTq0.L,D , .TRqSTEE.S
No. 0�8$l�
Issued To. 7?homcs Kea Date
Address.* I �►$5 Albo, L�� vex la..fe\
THIS. NOTICE MUST BE DISPLAYED DURING CONSTRUCTION
TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD
SOUTHOLD, N.Y. 11971
TE L.: 765-1892
Glenn Goldsmith,PresiL.ic ���. OGy Town Hall Annex
A.Nicholas Krupski,Vice President 54375 Route 25
Eric Sepenoski w ? 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
Date/Time: 4e 9, Completed in field by: G' auum,-A
AMP Architecture on behalf of THOMAS HUG requests an Administrative Permit for the
as-built 12' x 21.7' deck. Located: 1285 Albo Drive, Laurel. SCTM# 126-3-14
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
,i Administrative Emergency Pre-Submission Violation
Notice of Hearing card posted on property: Yes No Not Applicable
Info
rrneeded/Modifications/Conditions/Etc.:
ti7 Tcq.n�r -V-oc�.✓
Present Were: ✓ G. Goldsmith N. Krupski E. Sepenoski
L. Gillooly E. Peeples
- 1
SURVEYP�FROPERTY
SITUATE
LAND LAUREL
TOWN OF SOUTHOLD
` SUFFOLK COUNTY, N. Y.
Y SURVEYED: JANUARY 27 2025
SCTM. 1000 �2— 6. 00-03. 00-014. 000
1285 ALBO DR, LAUREL, NY, 11948
LOT AREA
\��� 13024.44 S.F.
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IRREVOCABLE
A APR 1 4 2025
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CIDz� m \ ' a Southold Town N
0 r3_ �� \ \\ \ ao Board of Trustees
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POLE
FND90 203y43 l\ 00
COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED
S87"43'10'N \ OR EMBOSSED SEAL SHALL NOT BECONSIDERED TO BE A VALID COPY.
I \\\ ` MICHAEL K. WICKS, P.L.S. #50390 J
MICHAEL K. WIcKs s
N/F MARK MINCIELI LAND SURVEYING
Res2ae'zee & RACHEL MINCIELI 15 FROWEIN RD — SUITE E2
CENTER MORICHES, NEW YORK 11934 N
VOICE. 631.874.0156
GRAPHIC SCALE: 1 INCH = 30 FEET www.wtickslandsurueying.co�n W
RECORDS OF RICHARD C. DRAKE 4
30 0 15 30 60 120 SCALE: SURVEYED BY: DRAWN BY: SHEET: W
1"=30, M.W. J.W.W. 1 OF 1 a
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STANDARD NOTES: 1.COPYRIGHT 2024 MICHAEL K.WICKS LAND SURVEYING 2.UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY MAP BEARING A LICENSED LAND SURVEYOR'S SEAL IS A VIOLATION OF SECTION 7209, SUB-DIVISION 2, OF NEW YORK STATE EDUCATION LAW, 3. ONLY BOUNDARY SURVEY MAPS WITH THE SURVEYOR'S EMBOSSED SEAL ARE GENUINE TRUE AND CORRECT COPIES OF THE SURVEYOR'S ORIGINAL U
THAT THE MAP WAS PREPARED IN ACCORDANCE 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 PERSONS FOR WHOM THE BOUNDARY SURVEY MAP IS PREPARED, TO THE TITLE COMPANY, TO THE
WORK AND OPINION. CERTIFICATIONS ON THIS BOUNDARY SURVEY MAP SIGNIFY 3
BOUNDARY
LISTED ON THIS BOUNDARY SURVEY MAP.THE CERTIFICATIONS HEREIN ARE NOT TRANSFERABLE. THE LOCATION OF UNDERGROUND IMPROVEMEMS OR ENCROACHMENTS ARE NOT ALWAYS KNOWN AND OFTEN MUST BE ESTIMATED. IF ANY UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS EXIST OR ARE SHOWN, THE IMPROVEMENTS OR ENCROACHMENTS ARE NOT COVERED /
GOVERNMENTAL AGENCY, AND TO THE LENDING INSTITUTIONELEVATIONS REFER TO A NAVD 88 DATUM L,)
BY THIS SURVEY. THE OFFSET (OR DIMENSIONS) SHOWN HEREON FROM THE STRUCTURES TO THE PROPERTY LINES ARE FOR A SPECIFIC PURPOSE AND USE AND THEREFORE ARE NOT INTENDED TO GUIDE THE ERECTION OF FENCES, RETAINING WALLS. POOLS, PATIOS PLANTING AREAS, ADDITIONS TO BUILDINGS, AND ANY OTHER TYPE OF CONSTRUCTION.#
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. 0025 . . . . . Date . . . . . . . . . . . . . NOT. . . .29. . . . .. 19. 77
THIS CERTIFIES that the building located at . A.bo• Drive. . . . . . . . . . . . . . . Street
Map No.Xx. . . . . . . . . . Block No. . ..xx. . . . . .Lot No. . . xu• • • • •Laurel. . . .N OY.0. • • . . • . .
conforms substantially to the Application for Building Permit heretofore filed in this office
dated . . . . . . ... . . . . .Aug .19, ., 19.77. pursuant to which Building Permit No. 9417Z .
dated . . . . . . . . . . . . .Aug ,19. . ., 1977. ., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is Xrlvnte. acces.sory. .atorage.bui&ding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The certificate is issued to . MphAPT. A. ThY3,11s. Poro"d . . .0mers. . . . . . . . . . . . . .
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . .N.R•.• • • • • • • • • . • • • • • • • • • • • • • • • .
UNDERWRITERS CERTIFICATE No. . .H.RA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HOUSE NUMBER . . . .128 5 . . . . . Street . .A1ho.Drive. . . . .L uvel(•1.1;) • • . • .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . jt:`. .`. . . `. . . . . . . . . . . .
Building Inspector
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As-Built Frame Deck
Hug Residence-128S Albo Drive
All Photos Taken:September 20, 2024
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OFFICE LOCATION: . ;,` MAILING ADDRESS:
Town Hall Annex P.O.Box 1179
54375 State Route 25 Southold, NY 11971
; ,
(cor. Main Rd. &Youngs Ave.)
Telephone: 631 765-1938
Southold, NY 11971 r ►,. _ YO
LOCAL WATERFRONT REVITALIZATION PROGRAM
TOWN OF SOUTHOLD
To: Glenn Goldsmith, President
Town of Southold Board of Trustees
From: Mark Terry, AICP
LWRP Coordinator
Date: June 3, 2025
Re: LWRP Coastal Consistency Review for THOMAS HUG
SCTM# 126-3-14
AMP Architecture on behalf of THOMAS HUG requests an Administrative Permit for the as-
built 12' x 21.7' deck. Located: 1285 Albo Drive, Laurel. SCTM# 126-3-14
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 the LWRP.
The as-built deck is inconsistent with policy 6.3.
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 solyto ` Town Hall Annex
54375 Route 25
A. Nicholas Krupski,Vice President ,`O o`d .
P.O. Box 1179
Eric Sepenoski ] ( Southold,New York 11971
Liz Gillooly G Telephone(631) 765-1892
Elizabeth Peeples `�► �O Fax(631) 765-6641
'
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD APR 14 203
This Section For Office Use Only
Southold Town
Coastal Erosion Permit Application Board of Trustees
Wetland Permit Application
Administrative Permit
__Amendment/Transfer/Extens ion
Received Application:
Received Fee: $ —
Completed Application:
Incomplete: .
SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec.
Lead Agency Determination Date:
__Coordination:(date sent):
LWRP 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): Thomas Hug
Mailing Address: 1285 Albo Drive, Laurel NY 11948
Phone Number: 917.697.8843
Suffolk County Tax Map Number: J 1000 - 126-3-14
Property Location: 1285 Albo Drive, Laurel NY 11948_
(If necessary, provide LILCO Pole #, distance to cross streets, and location)
AGENT (If applicable):AMP Architecture
Mailing Address: PO Box 152, Mattituck, N.Y. 11952
Phone Number: 631-603-9092 __ Email-..a ortillo@amparchitect.com
Board of Trustees Appli� `;ion
GENERAL DATA
Land Area(in square feet): 13,024 Sq. Ft. (12,324 Sq. Ft. Landward of Flagged Wetland_
Area Zoning: R-40 N/C
Previous use of property: Residential
Intended use of property: Residential
Covenants and Restrictions on property? _Yes No
If"Yes", please provide a copy.
Will this project require a Building Permit as per Town Code? fiYes ]Z_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.
his project re any demolition as per Town Code or as determined by the Building Dept.?
his
_ ✓ No
Does the structure (s) on property have a valid Certificate of Occupancy? ✓ Yes—0_No
Prior permits/approvals for site improvements:
Agency Date
BD-1 Family Dwelling 12/30/1976
BD-A_ccessory Storage Bldg 11/29/1977.
❑ 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): As-Built Deck 12' x 21.7' (Deck was existing (No
CO), new owner modified deck, and replaced with all new decking)
Board of Trustees Appli' ",;ion
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: Legalize as-built frame deck
1
1
Area of wetlands on lot: 700 square feet
Percent coverage of lot: 5.4 % -
Closest distance between nearest existing structure and upland edge of wetlands: 36 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? 0 cubic yards
How much material will be filled? 0 cubic yards
Depth of which material will be removed or deposited: 0 feet
Proposed slope throughout the area of operations: %
Manner in which material will be removed or deposited: N/A
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):
Minimal effect. Standard decking installed.
61 Z20
Appendix B
Short Environmental Assessment Form
Instructions for Completing
Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses
become part of the application for approval or funding,are subject to public review,and may be subject to further verification.
Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully
respond to any item,please answer as thoroughly as possible based on current information.
Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful
to the lead agency;attach additional pages as necessary to supplement any item.
Part 1 -Project and Sponsor Information
Name of Action or Project:
Hug- As-Built
Project Location (describe,and attach a location map):
1285 Albo Drive, Laurel NY 11948
Brief Description of Proposed Action:
As-Built Deck 12' x 21.7'
Name of Applicant or Sponsor: Telephone:631-603-9092
AMP Architecture E-Mail:aportillo@amparchitect.com
Address: -
PO Box 152
City/PO: State: Zip Code:
Mattituck NY 11952
1.Does the proposed action only involve the legislative adoption of a plan, local law,ordinance, j 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
1 Agency? NO YES
If Yes, list agency(s)name and permit or approval: ❑ IFv�
Trustees, DEC NJ
3.a.Total acreage of the site of the proposed action? 0.3 acres
b.Total acreage to be physically disturbed? 0 acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? 0.3 acres
4. Che 11 land us at occur on,adjoining an ar the prop action.
Urban Rural(non-agriculture) industrial Commercial Residential (suburban)
Forest [:]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? ✓
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? N,O, 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: 1 ❑ ❑
10. Will the proposed action connect to an existing public/private water supply? NO YES
If No,describe method for providing potable water: ❑
11.Will the proposed action connect to existing wastewater utilities? NO YES
If No,describe method for providing wastewater treatment:, ❑ Fv
12. a.Does the site contain a structure that is listed on either the State or National Register of Historic ( NO YES
Places? s/TIH
b. Is the proposed action located in an archeological sensitive area? ✓
i
13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES
wetlands or other waterbodies regulated by a federal,state or local agency? �/
b. Would the proposed action physically alter,or encroach into, any existing wetland or waterbody? `/
If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres:
14. ntify the typic bitat types that oc n,or are likely to be found on troject site. Check all that apply-
Shore
line Forest Agricultural/grasslands }�Early mid-successional
✓ Wetland Urban Suburban
15.Does the site of the proposed action contain any species of animal,or associated habitats, listed NO YES `
by the State or Federal government as threatened or endangered? ✓
16.Is the project site Located in the 100 year flood plain? FFRI
YES
17.Will the proposed action create storm water discharge,either from point or non-point sources?If Yes, ❑
a. Will stone water discharges flow to adjacent properties? ❑NO DYES
b. Will storm water discharges be directed to established conveyance systems ff an m drains)?
If Yes, briefly describe: ONO �i'ES
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: ❑ ❑
19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES-
solid waste management facility?
If Yes,describe: ❑
20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES
completed)f'or hazardous waste?
If Yes,describe: O❑
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE
Applicant/sponsor name P Architecture _ __ Date:
Signature: _
Part 2-Impact Asses ent. The Lead Agency is responsible for the completion of Part 2. Answer all ofthe;•following
questions in Part 2 using the information contained in Part I and other materials submitted by the project sponsor or
otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my
responses been reasonable considering the scale and context of the proposed action?"
No,or Moderate
small to large ;
impact impact
may may
occur occur
l. Will the proposed action create a material conflict with an adopted land use plan or zoning El Elregulations?
2. Will the proposed action result in a change in the use or intensity of use of land?
i. Will the proposed action impair the character or quality of the existing cominunity? a a
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 ❑; ❑
affect existing infrastructure for mass transit, biking or walkway?
6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ ❑
reasonably available energy conservation or renewable energy opportunities?
7. Will the proposed action impact existing: ❑ El
.
a. public/private water supplies? -
b.public/private wastewater treatment utilities?
8. Will the proposed action impair the character or quality of important historic,archaeological, El
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)? El
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? El 0
11. Will the proposed action create a hazard to environmental resources or human health? El E
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.
J
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 different from Responsible Officer)
PRINT Page 4 of 4
Board of Trustees Applic,�-"'ion
i
AFFIDAVIT
�1 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.
ignature of P y O er Signature of P o erty Owner
SWORN TO BEFORE ME THIS R'D DAY OF A PffhL , 20215
Itius �i�
Nota blic
ALLISON L.STARON
Notary Public,State of New York
No.01ST6239228
Qualified in Suffolk County
CCammission Expires April 18,Atl
Board of Trustees Appli," ;ion
AUTHORIZATION
(Where the applicant is not the owner)
I/We,
owners of the property identified as SCTM# 1000 M-60—03-0 01q,040 in the town of
CCA' `'NN� )New York, hereby authorizes A'\"'
kk'yV.T e 1"y to act as my agent and handle all
necessary work involved with the application process for permit(s) from the Southold Town
Board of Trustees for this property.
Property Owner's ig ature Property Owner's i tur
SWORN TO BEFORE ME THIS ;3" DAY OF APRJL _, 20
VV1�C��
Notary P lic
ALLISON L.SrARON
Notary Public,State of New York
No.01ST6239228
Qualified In Suffolk county t"ammission Expires April 18,20?1q
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and,employees.The purpose of
this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is
necessary to avoid same.
YOUR NAME: 4Sy�.
(Last name,first name,ipiddle 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
(lf"Other%name the activity.)
Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee
of the Town of Southold? "Relationship"includes by blood, marriage,or business interest."Business interest"means a business,
including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation
in which the town officer or employee owns more than 5%of 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/agent/representative)and the town officer or employee.Either check
the appropriate line A)through D)and/or describe in the space provided.
The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply):
_nA)the owner of greater than 5%of the shares of the corporate stock of the applicant
_n (when the applicant is a corporation);
B)the legal or beneficial owner of any interest in a non-corporate entity(when the
applicant is not a corporation);
C)an officer,director,partner,or employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONSHIP
Submitted this ay of `(L
Signature _A-
Print Na
Fenn TS 1 � �� �� � �,,n�+. � \/'v��1z
APPLICANT/AGENT/REPRESEN`I'ATIVE
TRANSACTIONAL DISCLOSURE FORM
77�e I ovvn of Southold's Code of Ethics nrot ibits coritliats of inteMstnn•lltcTart of town off¢ersand emnlopees The vuiposc of
then form is to provide information whfeli can alert stown oflsossible conflicts.of mterest and allow rt to take whatever action is
necessary=to'avoitt'same. II R_ .
YOUR NAME: l/ �Ur �1 ICJ ----
(Last name,first ame,jliiddle initial,unless you are applying 14 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(o through.yout:dbnipaiiy,spouse,sibling parent,ar ciitld)have a relat oaship.witl any otTiceror employee
of the Town of Soul(iold? "Relationship"includes by blood;marriage,or business hiterest s a liusmess,.
including a>partnership•in:whieh'the town ofGcee orempfoyee las even a partial opWnersltip of(or employment by)a corporation
in which the.town offieer:or employee owns mo>a than'S%.of the:shams
YES NO
If you answered"YES",complete the balance of this form and date and sign where indicated.
i
Name of person employed by the Town of Southold
Title or position of that person
Describe,the,relationship between'yourself(thee applicgntf criUmpresentative)and the town officer or employee.Either check
the;appropriate line A)through D)andfor describe in.the space•proJided. ;
The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply):
A)the owner ofgreater thrin,5°7o'of ft shares of the corporate stock of the applicant
(when the applicant is:acorporation);
B)the lcgal'br beneficial owner of any interest in a non-corporate entity(wheat the.
applicant is not ircorporation); -
C)an officer,director,partnec,or employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONSHIP'
Submitted this day of A 20OL5
. Sigtiatttt•e_ _ .
Print Name
Form TS 1
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
1. All applicants for permits* including Town of Southold agencies, shall complete-this CCAF for
proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This
assessment is intended to supplement other information used by a Town of Southold agency in
making a determination of consistency. *Except minor exempt actions including Building Permits
and other ministerial permits not located within the Coastal Erosion Hazard Area.
2. Before answering the questions in Section C,,the preparer of this form should review the exempt
minor action list, policies and explanations of each policy contained in the Town of Southold Local
Waterfront Revitalization Program. .A proposed action will be, evaluated as to its, simnificant
beneficial and adverse effects_upon:the 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 explained in detail, listing both supportiny, and non-
supporting.facts. If an action cannot be certified as consistent with the LWRP policy standards and
conditions,it shall not be undertaken.
A copy of the LWRP is available in the following places: online at the Town of Southold's
website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all
local libraries and the Town Clerk's office.
B. DESCRIPTION OF SITE AND PROPOSED ACTION
SCTM# 126 _3 „14
PROJECT NAME Hug- As Built
The Application has been submitted to (check appropriate response):
1
Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees ❑
I. 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:
Legalize As-Built Deck 12' x 21.7'
Location of action: 1285 Albo Drive, Laurel NY 11948
Site acreage: 0.3
Present land use: Single Family Residential
Present zoning classification: R-40 _
2. If an application for the proposed action has been filed with the Town of Southold agency, the following
information shall be provided:
(a) Name of applicant: AMP Architecture
(b) Mailing address: PO Box 152, Mattituck NY 11952
(c) Telephone number: 631.603.90912 _
Will the action be directly undertaken,require funding,or approval by a state or federal agency?
Yes ❑ No Wl If yes, which state or federal agency?
C. Evaluate the project to the following policies by analyzing how the project will further support or
not support the policies. Provide all proposed Best Management Practices that will further each policy.
Incomplete answers will require that the form be returned for completion.
DEVELOPED COAST POLICY
Policy 1. Foster a pattern of development in the Town of Southold that enhances community character,
preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and
minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation
criteria.
R]Yes ❑ No ❑ Not Applicable
The existing residence accessory building and as-built deck maintain the community character.
Congruent distances to wetlands are maintained throughout the neighborhood.
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the `Town of Southold. See
LWMP Section III—Policies Pages 3 through 6 for evaluation criteria
❑ Yes ❑ No RI Not 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 ❑ Not Applicable
The as-built deck does not obstruct the visual quality of Horton Creek and Husing Pond Preserve.
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 Not Applicable
Attach additional sheets if necessary
Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP`Section III
— Policies Pages 16 through 21 for evaluation criteria
❑ Yes ❑ No R]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 ❑� Not Applicable
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.
✓❑ Not Applicable
❑ Yes ❑No
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.
❑ 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.
❑ Yell No❑ Not Applicable
Attach additional sheets if necessary
WORKING.COAST POLICIES
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See LWRP Section III--Policies; Pages 47 through 56 for evaluation criteria.
❑Yes ❑ No ❑✓ Not Applicable
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic
Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria.
❑Yes ❑ No Not Applicable
Attach additional sheets 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 0 Not Applicable
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Section III—Policies; Pages 65 through 68 for evaluation criteria.
❑Yes ❑ No Not Applicable
PREPARED BY AMP Architecture __TITLE Architect DATE 03/20/25