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HomeMy WebLinkAboutTR-10829A Glenn Goldsmith, President ®F S0 Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President ®� ®W P.O. Box 1179 Eric Sepenoski J Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples � �� Fax(631) 765-6641 COum BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE #2295 C Date: September 10, 2025 THIS CERTIFIES that the excavation of an approximate 5'x35' area ajZainst the northern foundation wall in order to waterproof the wall,• clay soils that were removed to perform the work taken off site and replaced with clean fill in-place of existing within this area, At 545 Glen Court, Cutchogue Suffolk County Tax Map#1000-83-1-6 Conforms to the application for a Trustees Permit heretofore filed in this office Dated August 5, 2025 pursuant to which Trustees Administrative Permit#10829A Dated August 13,2025,was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the excavation of an approximate 5'x35' area against the northern foundation wall in order to waterproof the wall; clay soils that were removed to perform the work taken off site and replaced with clean fill in-place of existing within this area. The certificate is issued to GLEN COURT,LLC owner of the aforesaid property. m r Authorized Signature lhS Glenn Goldsmith, President �®g®a` s®�/' Town Hall Annex A. Nicholas Krupski,Vice President ® 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly de G Q Telephone(631) 765-1892 Elizabeth Peeples ® �® Fax(631) 765 6641 COONTY,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: INSPECTED BY: L 66&A Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale line/silt boom/silt curtain 1st day of construction '/2 constructed Project complete, compliance inspection COMMENTS: ov CERTIFICATE OF COMPLIANCE: .. a^.nex - -�o�,,,n Ha;: is ern Gcids ^. :l. P:2s:de tiJ�� ��U�e�� �P ��Box �! 1 9 V:ce P: ;de �� o� ; . New. York 1,9 A as 9 u `6:3. 76� Te'.e�r.o L:z G:::co.v cax(63=' r65 664, E::zabe_�. Pee�:es JJy✓ BOARD OF TOW -N TRUSTEES TOWS` OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CO NTACT THE OFFICE OF THE BOA HEOF TRUSTEES OFF 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES BE` INSPECTION SCHEDULE Pre-construction• hay bale line/silt boom/silt curtain 1 day of constructior Z constructed When project complete, call for compitance inspection. Glenn Goldsmith,President `�®� S®�/,� Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President ®V� ®�® P.O. Box 1179 Eric Sepenoski l l Southold, New York 11971 Liz Gillooly Q Telephone(631) 765-1892 Elizabeth Peeples • �® Fax(631) 765-6641 BOARD OF TOWN TRUSTEES _ TOWN OF SOUTHOLD Permit No.: 10829A Date of Receipt of Application: August 5, 2025 Applicant: Glen Court, LLC SCTM#: 1000-83-1-6 Project Location: 545 Glen Court, Cutchogue Date of Resolution/Issuance: August 13, 2025 Date of Expiration: August 13, 2028 Reviewed by: Board of Trustees Project Description: Excavate an approximate 5'x35' area against the northern foundation wall in order to waterproof the wall; any clay soils that were removed to perform the work will be taken off site and replaced with clean fill in-place of existing within this area. 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 545 Glen Court, LLC, received on August 5, 2025, and stamped approved on August 13, 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 F 5ld Townf Trustees NO t PE SN / MNGS'fROM SUFFOtX COUNIT ATLAS NAP 23. GRID GM 99 630' TO DUCK POND LANE ACCESS FOR CONSTRUCTION �t 1000..83,1 jpp Off w ® '� f Q -5 co — Sr LU U- r 0 o J ` Gus" c I 545 i Q ADJACENT PROPERTY OWNERS ® ' :::::c LOT 35 RENE GENDRON 4710 MAYFLOWER WAY W 1,� ESTERO FL 33928 tw- LOT 7 Cif 645 GLEN CT G> ANTONIO VANGI PO BOX 48 CUTCHOGUE NY 11935 LOT 19 v� 340 VISTA PL BULKHEAD REPLACEMENT ROBERT 600 VISTA PL OUNN 600 4 LONG ISLAND SOUND VI CUTCHOGUE NY 11935 '14 CUTCHOGUE, NY PLAN VIEW TOWN OF SOUTHOLD THOMAS YANNIOS SSE 1'-40' DRAWN BY: D. CORWIN NOVEMBER 11, 2005 j FILL 20 CU.YDS. SHEET 1 OF 2 } FROM UPLAND SOURCE REVISED JANUARY 2. 2007 i SOUTHOLD R ES T USTE No. laga9 Issued. T'04� G1e� Co.��Y, �.�c Date- s /� 3 /as Address � N5 Glen,. CoucY� CuTc��uce THIS. NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD SOU7HOLD, N.Y. 11971 TEL: 765.1892 c D AUG - 5 2025 2�t'500 Southold Town v Board of Trusteet N _ � Est►='-°- - A.w HMSTR011 SUFFM COUIM ARM ROB YAP 23. GRID Gad 99 631T TO DUCK POND LINE ACCESS FOR CONSTRUCTION 110' OpE N° �ol�` c 83.�+ c+ SGt►b N° 1�g3 ��¢i ADJACENT PROPERTY OWNERS Z LOT 35 B RENE GENORON �, 4710 MAYFLOWER WAY W ESTERO FL 33928 LOT 7 1� 645 GLEN CT ANTONIO VANGI PO BOX 48 CUTCHOGUE NY 11935 LOT 19 v 340 VISTA PL. BULKHEAD REPLACEMENT ROBERT DUNN 500 VISTA PL LONG ISLAND SOUND CUTCHOGUE NY 11935 'S CUTCHOGUE, NY PLAN VIEW TOWN OF SOUTHOLD THOMAS YANNIOS SCALE 1'-Q' DRAWN BY: D. CORWIN FILL 20 CU.YDS. NOVEMBER 11, 2006 FROM UPLAND SOURCE SHEET 1 OF 2 REWSED JANUARY 2. 2607 `8/5/25, 12:53 PM IMG_6353.1'pg N r A � I i . I. P N, V 1 Qy a. • I '11 https://mail_google.com/mail/u/0/?tab=rm&ogbl#inbox/FMfcgzQbecSmwixgLGITbvctWMFzMZtB?projector-1&messagePartld=0.3 1/1 •8/5/25, 12:52 PM IMG_6352.jpg I 4lot i Wit WW AN JOE- - -- �Y sue' tw " v w V � � '. ! � •�1Yly'�I �>.. � YJ. 'aye � y •� - '� P v f lak w � ol I https://mail.google.com/mail/u/0/?tab=rm&ogbl#inbox/FMfcgzQbecSmwlxgLGITbvctWMFzMZtB?projector-1&messagePartld=0.1 1 � � !li..•3P.� ��P � �� Asia _ L "tie o;-zap a:R% " °° •��' ..<� ,- NA,L�aEENEL No o]� oo-ie.a PD 0� Iew z SCH.D.9 F.D] 29 �a RR,ya1 ! tia o os 6.R w SS l.th(cl. ]] it -IS r • - R Wc) Ei ofNE 2.`i5 1 i.e f r 12.3 IM 1aEveawEx]dervry ''P 9.R 127 ♦ r t]Wcl 12t r� w PEVHave]rn¢Irrsi w r � 4, g f?`a -. - i '� '•S�+i. u[rarneanrmrrn y A %�' 2P ,�Pl .. ��,r O sM1 • ~ av¢a]aaErrmmwrw tal ' ? sr 4�� � 8 w za en SY . ,o"�" '9.e �w' l't's'i ^ J ✓b. IAI *, `.�) r a ueNNOPNe,,.ao,rs:>_sa IS, < d`�3 w Frog. au .:« �'i ,3_, '•�� " �F 4 "•9 ! ♦s. w NNI PCL NO _— •,Nio:'�,O e' t .'tJ /. J•� 4�. y \ b%. " ., NEE E SEC NO 3 w i1r' AI FOR PCE NO FOP PCI.NO FOR PCL.NO FCRPLC NO - - - SEE SEE.NO SEE SEC.NO. SEE SEC NO. • ^ -- x " 09i0t DOS.a OBSOt.00B 095-01010 SEE SEC NO '.yy p.; FOR NO OaSLtLtt� _ SEE SECEC.NO OBELRLOtt _ INC —N LIN see os. w SEE SEC NO OBE SEE SEC NO.05 A.N e ^^a R ,,,••"` "'•`••»• •. — "."`.. s �u,� COUNTY OF SUFFOLK© N raorcE SecraN NO R-1 A 1 ert T S 1K I Y a P OFFICE LOCATION: , MAILING ADDRESS: ��►r:: ,�0.:.; 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 • - �' LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: August 11, 2025 Re: LWRP Coastal Consistency Review for GLEN'CO-U-RT, LLC SCTM# 1000-83-1-6 GLEN COURT, LLC requests an Administrative Permit to excavate an approximate 5'x35' area against the northern foundation wall in order to waterproof the wall; any clay soils that were removed to perform the work will be taken off site and replaced with clean fill in-place of existing within this area. Located: 545 Glen Court, Cutchogue. SCTM# 1000-83-1-6 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 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 S®U� Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President ® ®�® P.O. Box 1179 Eric Sepenoski3B Southold, New York 11971 Liz Gillooly G Tele hone(631) 765-1892 Elizabeth Peeples • y® a946 7 Cou E. I D rj - BOARD OF TOWN TRUSTEES AUG - 520- TOWN OF SOUTHOLD r. Southold Tow This Section For Office Use Only Board of Trustees Coastal Erosion Permit Application Wetland Permit Application Administrative Permit Amendment/Transfer/Extension Received Application: Received Fee: $ Completed Application: o� 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: oZ� Receipt of CAC Report: Technical Review: _Public Hearing Held: Resolution: Owner(s) Legal Name of Property (as shown on Deed): I tr Mailing Address: �j � Phone Number: V0 '�I '" —zt Suffolk County Tax Map Number: 1000 - M 3 ©O O 1 — o o— OO — CX!,(- Property Location: 5j 5�- 61" C-77 CuACA v & - /O ®� (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT (If applicable): Mailing Address: Phone Number: Email: ward of Trustees Applicat!,�,,- GENERAL DATA Land Area(in square feet): A-Cy, = 'Mo 6 E Area Zoning: Jr'Ot5 i(v t4eAiyk^40l, Previous use of property: Per 4�SaT)CACC— Intended use of property: Covenants and kestrictions 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 ny demolition as per Town Code or as determined by the Building Dept.? Yes V No Does the structure (s) on property have a valid Certificate of Occupancy? I% Yes No Prior permits/approvals for site improvements: Agency Date Dec, No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? V__�No Yes If yes, provide explanation: Project Description (use attachments if necessary): GAS J 19JA&yh ^^ _ o% e iAT"Ie,r rcJF-F ,ard of Trustees Applicati:_Y WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: got V44to/-\- Area of wetlands on lot: © square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: W feet Closest distance between nearest proposed structure and upland edge of wetlands: W 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: Mop 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): �n C, 3 61 Z 20 Appendix B Short Environmental Assessment Form Instructions for Completing 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 I -Project and Sponsor Information Name of Action or Project: W: a., Project Location(describe,and attach a location map): u Ct— Co+C'�W _ JV Brief Description of Proposed Action: Name of Applicant or Sponsor: rr Telephone: �3 i S�&. tx � da 9 Ye 4'I E-Mail: Address: Id 3(-9 s , �, /Zaa� City/PO: State: Zip Code: fficA -r tte e2._ )00 d C 5 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: ❑ ft 3.a.Total acreage of the site of the proposed action? c s b.Total acreage to be physically disturbed? S acres c.Total acreage(project site and any contiguous properties)owned � or controlled by the applicant or project sponsor? ZZ EOAQdcres 4. Check all land uses�th occur on,adjoining and near the proposed action. � ❑Urban ®Rural(non-agriculture) ❑Industrial ❑Commercial 2 esidential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 I i 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? NOA YES b.Are public transportation service(s)available at or near the site of the proposed action? 0 ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? �J ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: El El 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: I`/I El12. a.Does the site contain a structure that is listed on either the State or National Register of Historic ��N---O��r YES Places? ❑ b.Is the proposed action located in an archeological sensitive area? IT 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. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline El 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 YES NO 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? dNO ❑YES b.Will storm water discharges be directed to established conveyance systems(ru &t al nd storm drains)? If Yes,briefly describe: NO AYES Page 2 of 4 I ' 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)°for hazardous waste? If Yes,describe: 5-0 I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: r).-� �G�LJ Date: 20 Z- a� 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 conflict with an adopted land use plan or zoning ❑ regulations? M/ 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ 3. Will the proposed action impair the character or quality of the existing community? SJ ❑ 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? ❑ 8. Will the proposed action impair the character or quality of important historic,archaeological, V1 ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage Elproblems? [S�' 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail, identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 THANSM-11ONAL DISCLOS1111"` """.1 Y01111 NAW:: -C lit filiddle ini in 111C flail ciNc(it other emi(y,m,I/,w� cmwtpany.If sx),iuvlicahe of cmillially'.,it-1111C.) NAMIF OF AMILICA I ION: (ClIcA all that NIPIP Tax Ffic-vallu . ...................... Iluilding Val iancc- of"ore Cowslal 1:1-0510A ...... Appwal of 11lat liloorilir ..................... Fxemptioll ffoln Plat of official limp ......................... 011wr (if"olher",naine the,.activity.) Nyou pc-f-s"nally(of ibling,patent,or child)113ve.1 relationship%v i lit any officer of elm It of lit,: -interest"in ;ws aby blood,marriage,iage, interest_of thcTeoml of Southold? "Rel-itiowhiii!,includes by) f colployce 113S evc,,,,pa --iticat ,t mr-plif-ill'ill partial otvne, int.11,11fin,P a parinct.,hip.in-Ilich IIW tt)N'-"occicer(I hip of(or in tt Mich the nwn officer or culip1cyee 0%%Ils more than 5%of the shares. Yrs \110 —1—/ an"licred"YES-,c,linplete the halavice of this form and(late and Nign,Owle indicated_ elophlye'l loy fjjc,l I ille of this per:.)n Dtsctibe the relltifpll>hip bCt%%e-v)Voill.wif(file and the town officer Dr011ployoz.Either check the appropriate firw A)through D)andtor x1civritV in file aP;Icc Provided. officer or emplo)-ce lit hil of IIC(Sprouse,Sibling, ur child is(check all that apply): hares of the colixitate.stock tic(lit applicant A)the o%%Aer Of 91catel thm'5"'of the S (%%,hcjl the applicant is a colpration); B)the legal of hencricial owner ofitily iolcwst illa 11oll-corcturafe entity(vtIlto[tic. applicant is not a cuip0latioll); MI officer,director,p'-wiler,of employee of theapplicaul'.of 01:P.[-'.I,A'l IONSHIP —---------- .............................................................. ....................... .............................. ........................ ...................... Submitted this (1a),of Signature..... . Print Name Appl i cia 1.i on AFFIDAVIT llf-'.IN(; DI'II,V SWOWN" �n[6 ,�Ttuvi�Iluslmll-, i i'I'LICANTFORT11F, All()Vl--, PE NIFF(S) AND THAT ALI,STATEMENTS CONTAINFD [IFRFIN All FJ till F,T0,I.1IF REST'I,OF IIIS/111",R KNOWI,F[)(;I',AND IIELIEF,AND THAT pp I,I ":-k,l I N WORK WILL IIF DONE, IN THE' INJANNFR SFTFORTII INTIII.S A C ' () AND AS MAY BE APPROWD 11y'ru,sourmou)TOWN IWARD OFTRI*ISTEFS. 'flIF Al'I'LICANTACRUS To I-IOLDT(IF TOWN OF SOUTHOLD AN. l)'t'l]Fl .1 F 110ARD OFTRUSTEFS IIARMI.FSS AND FREF FROM ANY ANDALL DAMAGE.S AND CLAIMS ARISINGUNDF11 OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETINGTtIIS APPLICATION, I lirimu AurmoRlu THE TRUSTFES,T)IFAR AGENT(s)OR REPRESENTATIVES,IN(AXI)ING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY O I NNSPECT'I'l-IF,PRFMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDINC A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES T`O ENTE-R ONTO MY PROPERTY AND AS REQUIRED To INSURE COMPLIANCE WITH ANY CONDITION OF ANY wt4,.,rt.ANI)OR COASTAL FROSION PFRMITISSUED BYTIJE BOARD OF TRUSTEESI)URIN(;'I'IIE'1'1,'.R-.\l OF mEwmrr. IN ......... ....... ..................................... SignaturcotAlrop riyOwner Sigoatuw of 11toperly Owner 57" DAY OF AA/4qSr. .20 25-- TIFFANY LAIN NTARY PUBLIC STAOTE OF WYOMING COMMISSION ID:16W MY COMMISSION EXPIRES:MARCH 26,2028 .. ............... . 'Ronyd c.)f App i 0,1 0 h AUTHORIZATION J-A OW,Iefs Of the property Identified as SC-1-1\411 1()()I)- in the town of ............. ................... ........... New Y(jrk,hereby authorizes ------ Fig, ((),lei as my agent and handle all neceNsiry work involved with the application process for permit(s)from the Southold Town Board ofTrustees for this property. property Own s Signature Property Owner's Signature SWORN TO Bl"FORE NIFTHIS ............—DAY 01' ............... 20.7?—,5— TIFFANY LAIN NOTARY PUBLIC STATE OF WYOMING COMMISSION 10:166804 MY COMMISSION EXPIRES:MARCH 25,2M AI'PLlCANTIAGr,N 'lit E Pit ESF;NTA- !VE Tit ANSAC"TIONA1, DISCLOSUIth, DORM r cs f Th� � 'r C Ac r^L_►1blui'l�iM, s c II Ii !. �t `c&i— cT �t��!IS�L'�'t~R2)rce�N 1 r4 r Vic= this font is k �'t.lc infG r Hall m tt tie t can SIl!Ie lOtsn of).ati ie icL�g�irttiref end aij !I_s -- cc tsar)to avid same. t Y01,T,NA-ME Mqr Id tl ast nalrnii .first name,middle initial,unless you are applying in the namc of someone else or other entity.such as a company.If so.indicate the other person or company's-n'me.) NAME 01:APPLICATION: (Check all that apply.) Ta.\griev.-Mce Building— Variance Trustee — Changc of Zone Coastal Erosion Approval of plat Mooring L•xemption from plat or official map Planning Other (If"OtheC',name the activit).) no y ou personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the To%%n of Southold?"'Relationship"includes by blood;marriage,or business interest"Business interest'means a busi"s>_ including a partnership;in which the town officer or employee has cven.a partial ownership of(or employment by)a COTO, uun in i%hich the town officer or employee owns more than 5%of the shares. YES NO If;ou ans•.scred"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.yourse:lf(the applicant/agent/representative)and the town officer oremployee.Either chick 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); I3)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. DESCRIFrION OF RELATIONSHIP Submitted this day of US( 100 z Signature_ �-, _ Print Name u _.4.dL�t1f yS Form T'S board of Trustons Application AFFIDAVIT -� f21F Y DI.POSF S AND AFFIRMS THAT HEINHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRITE TO THE BEST OF 1iISAIER KNOWLEDGE AND BELIEF,ANDTHAT Ala.WORK WILL BE DONE,IN THE MANNER SET FORTH IN THIS APPLICATION A\D AS.IAY BE APPROVED BYTHE SOUTHOLD TOWN BOARD OF TRI'STEE.S. 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 PEP-NIIT(S),IF GRANTED. IN CO IPLETING 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 CONJUi•ICTION WITH THIS APPLICATION, INCLI-DING A FINAL:INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO IMY PROPERTY AND AS'REQUIRED.TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR_COASTAL EROSION PERN117 ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF TIIE PERMIT. Signature o: Pr cr v Owner Signature of Property Owner i i SW01UN TO.BEFOItE ME'fHIS DAY OF vs, .20 Z_ { I __- Notary Public MICHAEL D RICCHIONE Notary.puW State of NeWiersey Lamm.#50226953 My Conxnission: f Ql16lZ029 doat•d of Tzustees AppJ cation. AU"1110RI ATION (Where the iliplicant Is ljot this own.er) t l We- YAW YAW o%%'acre ofthe property identified asSCTM# 1000- O83 --QQ- :� " in the town of New York,hereby authorizesJ/l to act as my°agent and handle all necessary Avork involved wiiththe application process for pennit(s)from the Southold Town Board of Trustees for:tliis property. Property wn is Signature Properly Owner's.Signature SWORN TO BEFORE ME THIS DAY OF A.4w� ,26 Notary Public MICHaF.L D RICCHIONE NMary taubt«c Stateof New:Jersty ' Corru'n..�t'Sa226953 tiny Corroniaton F�iibs 10i18JZ029 . j `8/5/25, 1:41 PM IMG_6355.jpg w L.LM „thF vT Fps 1 �.. a -iN ) F to.k a . 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MY$i 1rD ■a"wM {t;1pLs?`�t, T� e1�r`{x' �..yA►KT,`QI C.ty��� r v 7'�w� �." t tr, i a7 ■ ,i1iJ 10�ji31.i� ib�l',1�'��f'�JV V 4 i:J�/,D A�S .#ra PKE '#E Oti1 A1`11',ei d1�A ,�;OAMA ;r>r,$ tl `l� L 'f 1 1t1 obt o KL�1' `l�TP3 o��';Wt)PlkNijT,()per £ . h`TEP `[#, Ct?t�ik' F:'I(tC TK1S P'I��CAflnY i HERERV AM, . JZ TRUSTEES,`1 HEAW GE.-N"i(S)EAR KEP SMMAI VL5,1 "C,Li�UI�'�'tt COMtR%lAT-1Q-N-A,DV SO, COUNCtLxTU.E 'tER;Q�'TC}NAYPK4 1�,�C � t LtiSP RCS�1tR PR��►'�1SES N CQ�tJ[N( TIUAt♦Yl'�'jEI-T lls�'P�'P.'LC9�t`�C�l , i1'C UD N. G..k Fl AL I SPECTIOY i' R"t lTF'[ i�rtliQRI FTil CP `M, 5 'EE a'TO E Lit Uti'C,®•W'$Y PRflPERT'�'s �► R1�Q`Uli��.��?�5 CQA3P'].��.s'�CP` jTtCl, l' ERQSi�: PEttI�tIT 5[1RD M THE ;.•> i.� t .t - aS tea,. ,� £ a��s°�S*,,'�.'t�d^s ro � _ 87 ` a 3�71 a r 1tk1lttG31 e4Glft �1 t a $7 r r b TO PIMAN WL alL>t Ak,fin' u /"�7 ; NOTARY PtJBLM4TA Fig "ddfiilU#iifi'4*$wj Cooky dry Cmrsr><lt E? C 7•�t)?.� '<�,. ' y •,� rib IN , _s•' t � s f https://mail.google.comima!Vu/O/?tab=rm&ogbl#inbox/FMfcgzQbecSmwgVxQVpzrhwKfgpknmJH?projector-1&messagePartld=0.5 1/1 8/5/25, 1:49 PM processed-5C08C1 F6-2968-4635-851 D-8( DAD992.jpeg APPIACAA TA kris kc ON-Al x�, rgqstne1 :YYfk r.i } nfl 4m c"',es� - 1 1 k N A'N,il_' lying in 33)e rtat� ui_ (Last t23m first aatste>fiddle Wti€l,tmicas y so.Y d �tt�,ortr clst ar otlxz<nllty,such tts a com(seaty.tf ui;cndtrate UFc ashen � ,. ler,?�o'soromptity nante.t y,31.Of Al'F$j X'\Tt0N4 (Cllmt all that apply-), . 1'ik t rrrt Fu cc Building . v� `1'tttstce , zge t,Core K ara Coo1'Erosion Approral of plat moolin� _.`. ptanniitls !tcttspti`ron faont plat or ufFic}at ntap _w LL Othwr ' (if"'0thet-.nrum d"t Wi}ily'-). .....,,,�-.---•-- ., . . •. tAa you personally for through y'ottr Company.spouse,sibling"patent,or child)113W a[etatiosrship z+iLS any offieti or u tp y"u of the Town of Soutl:ald "Relationshift includes by blood,marr`age,or business interest"business inttrest°rtreatas a businc3� f the in a pof Soud,i}s,in«h ch the town offiecr or cnsploy�cC lint c%,Cn a partial ownt ts1f1p of{orcmploymnt by)a Corporation i���Fi 1}tlx:t,so,neflimrremployc'.o�+•ns inure than 5%ofthe$1wres: Y4: NO if you ansts ucd r'Y F ,W30cie the ltatan ce or dtis ji}rrn ai%)date and sign sltEre iodic rr l CaiDe or tKnitivn of ttut P<Mort Dcsctitae lit-relationship tx tip cen y'ot rsrif(tire appliranvagent!re tn4ntive)and the town r?flirrr or etnploI I Liilact cl k the appropi cal,lint IV)through D)and'ur dtscribc in+hE sp p}aviScd Tts 3o>rn a neuron cmplayCe or his or her spo tsc.sthlin�parent ar child is{t heck di that apply):., A�ilr o:}r�cc of grc3tcr than 50%of the.sham or the 6q*r to stag;of ti>z appli4f f�;lien the applicant i.:a car f�tatian); ' S)Uic 9t�a1oC bcncfiEial-ownerorony interest in a tip evr ieentil �tihi n it?c applicant is not a corporation} j an officer,diirestcr,:p,utrnr.Or cmpioytc of the applicant;or D)the acttkd VPllrant. !)t ltif'ri0IR Cal p�!it't i�1SS4lli' Submiktcd tilts t✓, day taf,� �11 `L z 711..Snnture of � VR SUtAN E Kl1RAU. .. ... NOTARY PUBLIC-STATE'OF NEW YORK a t k No:01 KU634957 � u t 3 R � � + � '1 �°� .Qwlif(ad in Nassau County, T f My.Comniiaaion Expire ti~s 1 G 17=a0Z$ https://mai1.googIe.com/rnail/u/01?tab=rm&ogWinbox/FMfcgzQbecSmwgWsTrgzZQbVTfvHlcxL?projector-1&messagePartld=0.1 1l1 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 significant icant 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 supporting 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# 106C� - ®8 5 - 0( -P C9 6 PROJECT NAME C�►Ie-e,�- C-F- 0— The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees LJ 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: 1 XCaJUrn� �+,� n a C-4-f L-) 6 t9 1/jP.7ehO V\ L. 1 e Dom- _ /Re. c.,no �T e�,-� �t �s a✓a� Ate a �f�L t'/C�,r!N i l� 1�� ' Location of action: C-- Cr1- '�is�.�c )Ux1 Site acreage: Present land use: Present zoning classification: �1 ii ,nJ A,1'1k I uv'r) 7 m 4 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: �f L� (a) Name of applicant: v (b) Mailing address: ,�'y �,� L T- (c) Telephone number: Area Code( ) (d) Application number, if any: A)/A Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No J I 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—Pol' - s Pages 3 through 6 for evaluation criteria ❑ Yes 0 No 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—Pol' ies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies P es 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 throw 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. � 1 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 a aluation 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 wZApplicable ee LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No 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. n ❑ Ye ] No ENot 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 WRP 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❑ Townn w{waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria.Yes ❑ No U 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 forZNot on criteria. El Yes El NoApplicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pa 65 through 68 for evaluation criteria. ❑ Yes ElNo Not Applicable PREPARED BY �C�✓L �G0�+ TITLE &6XV4— DATE 7 i