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HomeMy WebLinkAboutTR-10793A Town Hall Annex Glenn Goldsmith, President ��� S® �e�✓®� 54375 Route 25 A. Nicholas Krupski, Vice President �® ® P.O. Box 1179 epenoski Southold, New York 11971 Eric S Liz epeGill o Telephone (631) 7I65-1892 Fax (631) 765 6641 Elizabeth Peeples �� a® �COUNTi,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE TIV:T ES C BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE A OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction 1/2 constructed When project complete, call for compliance inspection; Glenn Goldsmith,President `�QF S0 Town Hall Anriex A. Nicholas Krupski,Vice President ®V� ®�® 5 Route 1 P..O.O. BOX 1179 Eric Sepenoski l l Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples • �O Fax(631) 765-6641 c®UNT`l,N ' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10793A Date of Receipt of Application: May 30, 2026 Applicant: Matthew & Eileen Vitucci SCTM#: 1000-66-2-35 Project Location: 620 Rogers Road, Southold Date of Resolution/Issuance: June 11, 2025 Date of Expiration:'June 11, 2028 Reviewed by: Board of Trustees Project Description: Construct a 14'4' x 13'-6" deck with steps attached to existing dwelling. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by Joan Chambers, received on May 30, 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. I� Glenn Goldsmith, President Board of Trustees EXIST. HOUSE EXIST. HOUSE — — — — — — — — — — — — — — — — — ! 2X12 ACQ LEDGER BOLTED TO Q HOUSE FRAMING W/ 3/8"x3-1/2" M EPDXY COATED SCREWS @ 12" OC ! STAGGERED � 0 PROPOSED WOOD FRAMED 00 co — X v DECK W/ RAILING (V O ( 2 ) 2X 12 ACQ GIRDER ANCHORED TO 4X4 ACQ POSTS ANCHORED TO 14" DIA O ICONC. PIERS TO 36" BELOW FIN. GRADE I tj W% 0 LINE OF DECK & ISTEPS j._..... _....... ......._ ..._.... ....... ...... STRUCTURE _ Lu o PLAN 1 Q _ _ 0 o _ ......... ......._. ...._.... ....... ...... 0 0 ry ry W co (D t''J N 0 2X 12 ACQ LEDGER BOLTED TO 0 HOUSE FRAMING W/ 3/8"x3- 1/2" O C) EPDXY COATED SCREWS @ 12" OC `� '� / N c) STAGGERED < 1 X6 WOOD DECKING o Vo 2X8 @ 16" OC DECK JOISTS APPROVED BY ( 2 ) 2X12 ACQ GIRDER 4X4 ACQ POST ANCHORED TO BOARD OF 'I RUSTEES 14" DIA. CONCRETE PIER EXIST. HOUSE .TOWN OF SOUTHOLD NE DATE W 77006 A� 1 A'��FESSION�� DECK SECTION # 1 1 /4" = 1 '-0" 10 . 23 . 23 OAN CHAMBER (631 )294-4214 EXIST. HOUSE EXIST. HOUSE — — — — — — — — — — — — — — — — — — 2X12 ACQ LEDGER BOLTED TO HOUSE FRAMING W/ 3/8"x3-1/2" EPDXY COATED SCREWS @ 12" OC i; STAGGERED (o co co 0 — — — — — — — — e 00 PROPOSED WOOD FRAMED x DECK W/ RAILING : ( 2 ) 2X12 ACQ GIRDER ANCHORED TO '4X4 ACQ POSTS ANCHORED TO 14" DIA PIERS TO 36" BELOW FIN. GRADE - - - - - - - - - - - - I LINE OF DECK & TEPS GRADE STRUCTURE PLAN ......... .... ...... ...... 00 -014 noo U)ry A'O W cy) 0 ry (.c) 2X12 ACQ LEDGER BOLTED TO O C) HOUSE FRAMING W/ 3/8"x3-1/2" C—) EPDXY COATED SCREWS @ 12" OC 0 STAGGERED 1X6 WOOD DECKING 2X8 @ 16" OC DECK JOISTS ( 2 ) 2X12 ACQ GIRDER 4X4 ACQ POST ANCHORED TO EXIST. HOUSE 14" DIA. CONCRETE PIER NE cy) A� 1'ssl DECK SECTION # 1 1 /4" = l '-O" 10. 23 . 23 JOAN CHAMBER (631 )294-4214 SIITEES- No. 1,01493 A 4 i : te.ssued To Mlt, � E IeeVccc DG /II I�Sa a G�o Qo�QrS A44 , Soul�olAddress ,, THIS NOTICE MUST BE DISPLAYED DURFNG CONSTRCiGT10N .TOWN TRUSTEES- O:FFICE,701NN OF 50UTHOLD SOUTHOLD, N.Y. 11971 �fEL.: 765-1892 � OfFO( Glenn Goldsmith,President �0��8 �<19 , Town Hall Annex A.Nicholas Krupski,Vice President * 54375 Route 25 Eric Sepenoski cm ,? P.O.Box 1179 Liz Gillooly o �0�� Southold,NY 11971 Elizabeth Peeples 1r �,� Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: (o Completed in field by: L (too MATTHEW & EILEEN VITUCCI request an Administrative Permit to construct a 14'-6" x 13'-6" deck with steps attached to existing dwelling. Located: 620 Rogers Road, Southold. SCTM# 1000-66-2-35 Type of area to be impacted: / Saltwater Wetland Freshwater Wetland Sound J Bay Part of Town Code proposed work falls under: /Chapt. 275 Chapt. 111 other Type-of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: 1�,!'getnl�.,k �0'rwokrd Present Were: G. oldsmith N. Krupski E. Sepenoski L. Gillooly E. Peeples S.C.T.M. NO. DISTRICT. 1000 SECTION: 66 BLOCK: 2 LOT(S):35 HIPPODROME DRIVE \ o GARAGE:::::;•: � V N 60020'40" E \ 182.35 U.P. 1.2N yl 1 2.1'S :7•7-7-7-7- o z �, \\ SHED N I EL 6.4 +� ASPHALT DRIVEWAY W.V. m Fly SHOWER EL 6.8 0 ¢ �J FOOD `" r n wSmop EL5.5 ' na \ : ::::::::....:::::::: EL 8.0 O i ;: .;.;.;.;;; (7 IV G m EL 7.1 o \ E 2 STY FRAME EL 7.4 \ DWELLING::::::::'w a \ 0520 CONCJSLATE WALK r� EL 5.3 FFL 8.5::::::::::: p z FY 1001, INTERTIDAL MARSH ��\ CELLAR 2.0 :::::::::::: l �G\ EL 6.7 EL 6.0 �':::::::::'::::::: o aEL v :.20 \ BILCO 35.4' N o M.H. EL 6.0 E 6.0 o EL 5.0EL 7.1 1% T ON EL 4.2 �L \\ rv_ `�Q\ kn 2�` z M HEDGE \ AY 3 \ 2� PIPE 202Jr S 60°20'40" W \\ 166.32' `-02� �02\\ moo e a°ro fTrustens \ 7k -i \ J 7HE WA7ER SUPPLY, WELD,, DRYWELLS AND CESSPOOL LOCA77ONS SHOWN ARE FROM FIELD OBSERVA77ONS FEMA MAP#36103C0158H AND OR DATA OBTAINED FROM 07HERS AREA: 13,074.95 SQ.FT. or 0.30 ACRES EZEVA7701V DATUM: NAVD88 UNAU7HORIZED AL7ERA77ON OR ADD17ION 70 THIS SURVEY IS A WOLA71ON OF SEC7701V 7209 OF THE NEW YORK STA7E EDUCA71ON LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED 70 BE A VAUD 7RUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY 70 7HE PERSON FOR WHOM 7HE SURVEY IS PREPARED AND ON HIS BEHALF 70 7HE 777LE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS717UIIOJV US7ED HEREON, AND TO 7HE ASSIGNEES OF 7HE LENDING INS777URON, GUARANTEES ARE NOT 7RANSFERABLE. 7HE OFFSETS OR DIMENSIONS SHOWN HEREON FROM 7H£PROPERTY LINES TO 7HE STRUCTURES ARE FOR A SPECIRC PURPOSE AND USE 7HEREFORE THEY ARE NOT INTENDED 70 MONUMENT THE PROPERTY LINES OR 70 GUIDE 7HE EREC77ON OF FENCES, ADD177ONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMEN7S AND/OR SUBSURFACE S7RUMRES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON 7HE PREMISES AT THE AME OF SURVEY SURVEY oF: LOT 2 CERTIFIED T0: EILEEN VITUCCI; MAP OF: BEIXDON ESTATES FTC: MAR. 16, 1946 No. 1472 SITUATED AT: SOUTHOLD Town oF. SOUTHOLD SUFFOLK COUNTY, NEW YORK KENNETH M WOYCHUK LAND SURVEYING, PLLC Professional Land Surveying and Design P.O. Box 163 Aquebogue, New York 1L991 FILE 9 223-91 SCALE:1"=20' DAIE: JUNE 19,2023 N.Ys LISC. No. 050882 FRONH (681)E98-16e8 FAX(631) 298-1588 • 47 AV 4 MP, , .R ' •4 �•, N• a. Tye 3- _ �� L.. �, M+ �k ll�• t _ `. - - ice". , �f • 40. �. + t 77,wvtl?N� : ► a; V yr y SEE sF��a oV, ME ., a.. `R t 'wu''� \ \\\ \ BM_I iaq(1 t 1'p A,�• \ N 4�" C�> \\ .j"� \ \- \ \ \�\�c`������'\\\�\ \ :6 '`� s .•�, a ,9w��' Cl � � \3.z. �� \ \� \,��\ `�� \ \ OWN pi Al s� d �� �v vAV �, � '� `� •tom v v�`V`�'���. v >. Aft M .. uu .., SECTION NO ..... — .. •,. _ "` CWP(TV OF SUFFOLK© rrUricE K '.,�ro�v,,�K ,000 kcal f'tapefly Tai 4eT,lc<:\Ken_ W E m1WBO1gNa M�f/eO iION M N ,w ypy�NpLp /�C N �_L� � _ ^ -_- �++ "' r.. ., )ro Crae.Pwr Rv.MW 1Y 1/W( Ccvtn,wtYN•RO/I�p a MAILING ADDRESS: OFFICE LOCATION: �� �� �, � Town Hall Annex `i `�'j 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 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 MATTHEW & EILEEN VITUCCI SCTM# 1000-66-2-35 MATTHEW& EILEEN VITUCCI request an Administrative Permit to construct a 14'-6 x 13'-6" deck with steps attached to existing dwelling. Located: 620 Rogers Road, Southold. SCTM# 1000-66-2-35 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 and Policy 4. 1. Minimize structure in the flood zones 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 SDUTy Town Hall Annex A.Nicholas Krupski,Vice PresidentQ� ��� 54375 Route 25 P.O.Box 1179 Eric Sepenoski [ Southold,New York 11971 Liz Gillooly G Telephone(631) 765-1892 Elizabeth Peeples ``•. y9. Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application D Administrative Permit __Amendment/Transfer/Extension Mp`( 3 0 2025 Received Application: _ Received Fee: $ Completed Application: Southold Town Incomplete:_ _ Board of Trustees 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): ijYhc,v Vt_�uec 1 6 f 1 e ew Vi 4UeC; Mailing Address: . �o /f o q f-S -Soo -kn O L 1 1 7l' Phone Number: Suffolk County Tax Map Number: 1000 - Property Location: d fir'S o J-/-�l© (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: Email:. , �e V +vCC Ve'ri Z-017,/Le-1 V � � e� ; JVi� L0/V EA,tan Viho24 , i � , I � �(oCo 5 rd. of .Trustees Applicati GENERAL DATA Land:Area(in square:feet): Area Zonin l- P T. Previous use,`of property: .�Q . Intended_use of property: --Aeef -. - Covenants-and.Restrictions on-property? Yes �No If."Yes':'-, as .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 Plaris-will be required. Does this project re hire a-variance from the-Zoning Board-of Appeals? Yes No q If."Yes''., please.provide.copy of decision: W' his project're y demolition as per Town_Code or:as determined by the Building Dept:? Yes No Does-the structure(s) ori:property-have a valid Certif ate of Occupancy?: Yes No: . _ . . .� Prior permits/approvals. for site improvements: - - Agency Date'. IS �--No.prior permits/approvals..for.site improvements... :Has.any-permit%approval ever been revoked-or,suspended by agovernmental=agency? No'' es if es provide explanation: .: Project.Description (use-attachments if necessary);- f Zj/�q' a7—f/I- ��G =. rd of Trustees Applicati WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose.of the proposed operations: : ..O' i._. lhid D�Gar 7L0 �'Pu n^ Area of wetlands on lot: O square feet Percent=coverage of lot / Closest-distance between nearest existing structure and upland-edge of wetlands: 3 1 feet. Closest distance:between nearest proposed structure and upland:edge of wetlands: .-J` 1 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: :. Statement of the effect, if any,-on the-wetlands andAidal waters of the towii that may result by.:. reason of such proposed.operations-(use.attachments if appropriate): �Vo � � 61 Z20 Appendix B Short Environmental Assessment Form Instructions for Comnletinp Part I -Project Information. The applicant or project.sponsor is responsible for the completion of Part I. 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 wouldbe 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. . Pa rt.V-Project_and Sponsor Information e V I Name of Action or Project: 1;1,s 11'a J:: A4 oz De-&k- Project Location-(describe,and attach(A location map): k 5EJ -Brief Description of Proposed Action: Name of Applicant or Sponsor:. I Telephone: (, - f4�cc , ` ITUCL E-Mail: Address:` . City/PO: State: Zip Code.. I Does the proposed action-only involve the legislative adoption of a plan,local law,ordinance, .NO YES administrative rule,or regulation? " 1011 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. 1f no,continue to question 2. 2". Does the proposed action require a permit,LLapproval or funding from any other governmental Agency? NO YES If Yes, list.agency(s)name and permit or approval:. 1a.Total acreage of the site of the proposed action? 0 5 pA acres b.Total acreage to be physically disturbed? n4 0 acres c.Total acreage(project site and any contiguous,properties)owned --or controlled by_the applicant-or-project sponsor? 0° O acres 4: Che La I I land us at occur on,adjoining an ar the prop 4 action. Urban Rural(non-agriculture) I ustrial Commercial ❑Residential(suburban) Forest ❑Agriculture- Aquatic they(specify):_We- - 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. ls.the site of the proposed action located in;or does it adjoin,a state fi ted Critical Environmental Area? ;NO YES If Yes,identify;P-F�1' d a 0 i/1 S W� �w � 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? TT F 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: 10.'Will the proposed action connect to an existing public/private water supply? NO YES If No,describe.method for providing potable water: OF 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 A YES Places? b. Is the proposed action located in an archeological sensitive area? ]3.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. Ldf ntify the typic bitat types that occ n;or are likely to be found on Anroject site. Check all that apply: orelirie 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? -NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO If Yes; � .. .- a. Will storm water discharges flow to adjacent properties?. ONO_ YES b..Will.storm water discharges be directed to established conveyance systems ff an m drains)?. If Yes, briefly describe: LNO LJYES 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)? IfYes,•explain purpose and size: ❑ 19.Has the site of the proposed action or an adjoining property been the location_of an active or closed :NO YES solid waste management facility? If Yes,describe: 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or ,NO YES completed)for hazardous_waste? If Yes,describe: . -I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE-BEST OF-MY KNOWLEDGE Applicant/sponsor n "V-(_. .(/ L I Date: A %J Signature: Part 2-Impact-Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the,following questions in Part 2 using the information contained in Part I and other materials submitted by the project sponsor or otherwise available to the reviewer. 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 - I.' Will the proposed action create a'material conflictwith an adopted land use plan or zoning. regulations? 2. Will the proposed action.result in a change-in the use or intensity of use of land? is 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 ❑ - 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: ❑ a.-public/private water supplies? . b.:public/private wastewater treatment utilities?. �' ; EJ 8: Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources?. El 9. .Will.the proposed action.result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater;air quality,flora and fauna)?" E1 El Page 3 of 4 No,or Moderate small to large impact impact may may occur occur T0. 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? Tart-Determination"of significance: The Lead Agency is responsible for the completion of Part 3. For-every question in-Part 2'that was answered."moderate to large impact may-occur",or if_there is a need'to explain why a particular . element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should'An 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. El Check this box if youhave 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 env ironmental:impact statement is required. Check this-box:ifyod 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 i 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 '_gird of Trustees Applicatir__ AFFIDAVIT vew 1/�T'�CGr�-�i_.fees?�i Ti/6Gr BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE.IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND--THATALL 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 AUTHORIZES THE TRUSTEES,THEIR AGENT(S)-OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTYTO 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. Signature of Property Owner Signature of P perty Owner- �A SWORN TO-BEFORE ME THIS`' 'v DAY OF Ct .20 otary.Public MARIA ZOUROS Notary Public,State of New York No. 02Z05068584 Qualified in Nassau County .Commission Expires Nov.4,20 Ord- of Trustees.- Applicati AUTHORIZATION: (Where the applicant is.not the owner) 'I/We; :owners:of.the property identified as SCTM#'1000-_ in the town of _ :N w e York,.hereby authorizes .: . - to act as my agent and-handle all necessary work involved with the application process for pennit(s) from the. Southold Town . -Board of Trustees.for this-property: Property. Owner's Signature Property Owner's Signature . SWORN TO-BEFORE.ME THIS _ . DAY OF. . _ ..: „2U, Notary Public _ APPLICANT/AGENT_ /REPRESENTATIVE =. - TRANSACTIONAL DISCLOSURE.FORM The Town-of Souihold's Code of Ethics prohibits conflicts of interest on the cart oftown officers and emalovees.The purmse of 'this=forrmis to•Diovide information which can alertthe town of possible-conflicts of interest arid allow it to take whatever actioa is. necessaivio aeoid'sam�el. YOUR NAME:. . V l. . U. (Last name,.—first nan e,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 ot.official-map. Planning " Other -_ -- /. / \" .. .. -(If"Other';name the activity.) Do-you persogally(or through your,compariy,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 abusiness,- 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_th s. 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 positiod of that:person Describe the relationship between yourself(the applicantlagentlrepresentative)and the town officer or employee.-Eithe'r.check the-appropriate line A):through D)and/or describe in the space provided.." w. The townofficer or employee or his or her spouse,sibling;parent,of child is(check all that apply): . �A)the owner of gfeaterthan 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 anon-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. o`-1Mda r of it �. 205 Signatur Foriir TS"]. Print Name Wit% — i ZER 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._uroposed' action will be evaluated as to its .significant beneficial acid 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 hi &Wl,.-listing both supporting and non- supporting facts: W 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 SrMAND PROPOSED ACTION SCTM# — _:— s PROJECT NAME: " r ' G 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 Iransaction) (b) Financial assistance(e.g.grant, loan;subsidy) (c) Permit approval,license,certification: . Nature and extent-of action '� 1 r,�4 a Location of action: n d,O 10"1JfOt1,1TfO11A41. 71 - Site acreage: 6--re _( . Present land use: /�4 /i e Iledtle4i Present zoning classification: 2: If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of'applicant: G� (P,C-�� / CG i (b) Mailing address: 0 0 (c) Telephone number: 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? 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: . ❑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—ZApplicable-. Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No 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 r/ No❑ Not-Applicable ❑. Attach additional sheets if.necessary NATURAL COAST POLICIES -Policy 4. Minimize loss of life,.structures, and natural resources from flooding and erosion. See LWRP Section*III—Polic''s Pages 8 through 16 for evaluation criteria ❑: Yes . . No'❑, Not Applicable Attach addtional_sheets if necessary Policy-5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III Policies.Pages 1 _ hrough'21 for-evaluation'.criteria El 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 ❑ Not Applicable Attach additional'sheets if necessary: Policy 7...-•Protect grid: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.ifnecessary l :Policy :8: Minimize environmental degradatioq in Town of Southold:from solid waste- and hazardous : . substances and : astes. :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 39 through 46 for evaluation criteria:.:.. . Ye l -No❑-Not Applicable -Attach additional sheets:if necessary.,- — - _ WORKING COAST.FOLICIE . 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.To waters:See LWRP.Sectiou III.—Policies; Pages 57 through 62 for evaluation criteria. Ye s - 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- 5-Not luation-criteria. Yes No Applicable Attach additional sheets if necessary Policy 13. Promote-:appropriate use and-'development of energy and mineral resources: See LWRP -.,Section III_Po ' es; Pages 65 through.68-for evaluation criteria. Eg/ Yes No❑ Not Applicable PREPARED BY .1M Tlw�•w,J , .V�`I'y TITLE iC� DATE S d o�s _ #a the ocvwa Glenn Goldsmith,President 0.101/4 Town Hall Annex A.Nicholas Krupski,Vice President �„ 54375 Route 25 P.O.Box 1179 Eric Sepenoski fr Southold,New York 11971 Liz Gillooly �,; � '�AP, �. 0 ., Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD OTHER STATE AGENCIES YOU MIGHT HAVE TO APPLY TO N.Y.S. Dept. of Environmental Conservation (DEC) SUNY at Stony Brook 50 Circle Road Stony Brook, NY 11-790-3409 (631) 444-0355 Wednesday & Friday only during.the hours of . 8:30a.m. — Noon & 1 p.m. — 3p.m. Email• r1,dep@gw dec state ny:us Suffolk County Dept. of Health-Services Office of Wastewater Management 360 Yaphank Avenue, Suite 2C Yaphank, NY 11980 (631) 852-5700 Email: WWM0suffolkcountyny:gov U.S. Army Corps. of Engineers, N.Y. District Attn: Regulatory Branch 26 Federal Plaza, Room 1937 New York, NY 10278-0090 (917) 790-8511 Website for applications & helpful information: 'httpa/www:nan.usace:armymiUMissions/Regulato.ry;aspx: N.Y.S. Department of State Division of Coastal Resources Consistency Review Unit One Commerce Plaza 99 Washington Ave, Suite 1010 Albany, NY 12231-00001 (518) 474;6000 Website: wwvu:nyswateffro.ntscom Town Hall Annex Glenn Goldsmith,President 54375 Route 25 A.Nicholas Krupski,Vice President i`o '1 olQ P.O.Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gillooly @` Telephone(631) 765-1892 Elizabeth Peeples ;,.,• �Q ' Fax(631) 765-6641 { CpUN `N t'S_ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD COASTAL .C'ONTRACTO:R �L�I.CENSE Effective as of January 1, 2018, Southold Town Board resolved to adopt a -local law entitled: "A Local Law in relation to Amendments to Chapter 275, Wetlands and Shoreline, in connection with Coastal Contractor Licensing"., A Coastal Contractor License is required for any work which is done in and around wetland areas which requires a Wetland or Coastal Erosion permit. A copy of the Adopted Resolution as well as a copy of an Application for a Coastal Contractors License is available on our Town website: https://www.southoldtownny..g.ov/391/Trustees