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HomeMy WebLinkAboutTR-5883 . . Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August24,2005 Mr. Thomas Samuels Samuels & Steelman Architects 25235 Main Rd. Cutchogue, NY 11935 RE: JOHN & PATRICE KEITT 280 BASIN RD., SOUTH OLD SCTM#81.1.19 Dear Mr. Samuels: The following action was taken by the South old Town Board of Trustees at their Regular Meeting held on Wednesday, August 24, 2005: RESOLVED, that the South old Town Board of Trustees APPROVE the Amendment to Permit #5883 to re-shingle and re-roof the entire house and re-construct landward entry porch in-kind, and as depicted on the plan prepared by Thomas C. Samuels last revised June 27, 2005. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, 4/./,.,-1 ? ~,.~. Albert J. Krupski, Jr. President, Board of Trustees AJK:lms . . j T~lephone (631) 765-1892 Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Wed., August 17,2005, the following recommendation was made: Moved by Doris McGreevy, seconded by Jack McGreevy, it was RESOLVED to recommend to the Southold Town Board ofTrustees APPROVAL of the Amendment application of JOI;iN & PATRICE KEITT to Amend Permit #5883 to re- shingle and re-roofthe entire house and re-construct landward entry porch in-kind. Located: 280 Basin Rd., Southold. SCTM#81-1-19 Vote of Council: Ayes: All Motion Carried . . MAIliNG ADDRESS: P.O. Box 1179 Southold, NY 11971 PLANNING BOARD MEMBERS JERILYN B. WOODHOUSE Chair WILLIAM J. CREMERS KENNETH L. EDWARDS MARTIN H. SIDOR GEORGE D. SOLOMON OFFICE WCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY Telephone: 631 765-1938 Fax: 631 765-3136 PLANNING BOARD OFFICE TOWN OF SOUTHOLD To: Town of South old Board of Trustees ~ AUG 1'6 m From: Mark Terry, Senior Enviromnental Planner L WRP Coordinator Date: August 15,2005 Southold llWR Board of lfY!/@ Re: Request Amendment to Permit #5883 for John and Patricia Keitt SCTM#1000-81-1-19 The proposed action involves re-shingling and re-roofing entire house and reconstruct landward entry porch, in-kind, in Southold. The proposed action has been reviewed to Chapter 95, Waterfront Consistency Review of the Town of South old Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the L WRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is generally CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. Pursuant to Chapter 95, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Please contact me at (631) 765-1938 if you have any questions regarding the above. Cc: Conservation Advisory Council Heather Tetrault, Environmental Analyst . . Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD APPLICATION FOR AN AMENDMENT TO ~d~~~~~rm ln11 JUL 1 2 ~ lW DATE duLl! /~ ;005" OWNER W/IN.f (ftTT<1CB..J(fltr PHONE 765- /~// ADDRESS .'1tO f 51# rr: N'tlW rOKK, J/C( fOOZl AGENT700 &1tnvas PHONE '7lJti -~ '1D5 ADDRESS ~;tUft{ folrD. CUrcHoWC . PROPERTY LOCATION fRO eA~IJI RP: &VTf/O,J) TAX MAP NO. m-~(~[-('! Southold Town Board of Trustees I/We TftJ1 r-)Muuns request an Amendment to Permit # j8g~, To Rf'...sUINGlE <t Rf-R,ooF fNTrKE HoUSE AND RE-crxVS7fiUCT J..ANPWA-~ 'fIJTR'I {02.cll IN KINO. Signed By: ~. ~d ,. tI~ \O~ ~~\\ ~/ V~ . . Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-~"VI BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of ---~tA!1.-i:-.f~~~~--h-~~:~-------m--- COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I,7JMJs(f1m(~tS ,residingat 7092 lVav5v~J:{/_ )4Z{J $"(;!C?OLI;::" being duly sworn, depose and say: That on the, day of , 2~ personall posted the proper! known as 0( f r( l0C7vC~ by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight ys prior to the date of the public hearing. Date of hearing noted thereon to be held . ~y c=t~ - tI Dated: (~ IIONNIrJ.IlOROSII ". Public, StIlI Of"" 110. 01D06095321. Sltffal ~ Tenn Expi..~ 7.20~ J;OOVl.,LT 0&;'697 {'v\ ~ hOA-e.Q ( f/iir ,t1 A- OI7~\.{ r.J .s~ ,IJ{ uq-; I ~ PROOF OF MAILING OF NOTICE ATTACHCERT ~CEIPTS 3" ~ ~\jJ~~ or PO Box No c~-s;a;e;~ rn ['- = Cl .:r ..D rn fTl .. ~ .. rn rn rn gr~;lg",~ .:r- .:rUrn rn rn rn rn rn 0 o 0 0 o 0 o Returr. Cl Re\lJ (Endorsemt C1 {Enct0rS81 CJ o Restricted Cl Restr\Ctf. U1 LI1 (Endorseme U1 (Endorsee 1"- I'- I'- 0 o TotaIPosti CJ Tot8IP(.:r o 10,,0 el.il'- ~-~ orpOBG cil}i,-Si8it lAL USE 0.83 utll1 In: 09"35 P...... $ ...., p.Jij.. \ l1!'l' Clerk: ~ZV/O / ::0: '< / 06!16/()':i J_' ? " 1"", .,0 4.66 q~ 0cJyy~ ,residingat LffeJ G-vaV1.~ P--d 50 I NY , being duly sworn, deposes and says that on the ) LP day of '~ ' 2o::rl, deponent mailed a true copy of the Notice set forth. in the Board 0 rustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of,tb.e Town of Southold; that said Notices were mailed at the United States Post Office at C ^1~ ' that said Notices were mailed to each of said persons by (certified) (registered) 1. Qn~~ Sworn to before me this 11 +" Day of A v,J'J " -\- , 20 () \- ~p~~ John M. Judge NOTARY PUBLIC, Slala 01 New York No.01JU6059400 Qualified In Suffolk County . Commission Expires May 29, 20 0 7 Town of Sonthold . . o ~ cr: IU 11 I: ij AU G - 4 20050 LWRP CONSISTENCY ASSESSMENT F A. . INSTRUCTIONS Southo\d Town 1. All applicants for pennits* including Town of Southold age ies, shalB~ e for proposed actions that are subject to the Town of South old !Water ont 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 ill Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. 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 South old'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# )( / 01 /1 The Application has been submitted to (check appropriate response): Town Board 0 Planning Dept. 0 Building Dept. 0 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) o o (b) Financial assistance (e.g. grant; loan, subsidy) (c) Permit, approval, license, certification: .c6 Nature and extent of action: ---fJ'4J'~ roof dA1.d wP..R.ld.. ~u eAfy''l.1 ()()rc~. U;U, h-d 1Vt.OIJ~tlm 16 YO('")f/~e, , ' 2R! 8uLit, Recu4JemL {),(p rgg aereu tf~ ~.~ VUI'~ I!-{-O Location of action: Site acreage: Present land use: Present zoning classification: 2. Iran application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Nameofapplicant: aJOht1. cf {1riv'/U kei,t-t (b) Mailing address: j PO E. 67!1t Sf. Perttho 11 tf-e )(fJi) Vorkr Ji LJ. /00").;;' (c) Telephone number: Area Code () r2/ 'l 75'1 q / '1 5 (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes 0 No ~ If yes, which state or federal agency? DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of South old 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 L WRP Section III - Policies; Page 2 for evaluation criteria. 6Yes 0 No 0 Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of South old. See L WRP Section III - Policies Pages 3 through 6 for evaluation criteria ~ Yes 0 No 0 Not Applicable Att~ch additional sheets if neeessar. . 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 !If Yes 0 No 0 Not Applicable WfJtJt.{ ~ ,A-id.2/.1 '1 N IUnYl.. IPWti c ~ uJJ,u'fR altUM'Yul#1 ~{cLi"U}. Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Se~ III - Policies Pages 8 through 16 for evaluation criteria [!] Yes 0 No 0 Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water qnality and supply in the Town of Southold. See LWRP Section III - Po~es Pages 16 through 21 for evaluation criteria [!] Yes 0 No DNot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of South old ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria, ~es 0 No 0 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. 0' Yes DNoD Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous sub~nces and wastes. See L WRP Section III - Policies; Pages 34 through 38 for evaluation criteria. o Yes 0 No D 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 South old. See L WRP Section III - Policies; Pages 38 through 46 for evaluation criteria. DYes D No G:1 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 suittle locations. See L WRP Section III - Policies; Pages 47 through 56 for evaluation criteria. o Yes D No D 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. DYes 0 No GJ"Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of South old. See L WRP Section III - Policies; Pages 62 through 65 for evalu1ion criteria. DYes D No IJ21 Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See L WRP S~n III - Policies; Pages 65 through 68 for evaluation criteria. o Yes D No 0 Not Applicable ~j~~~d~~ ~ ~t;rAn;~ ~dJ-Po f-h tV'!. Created on 5/25/05 11:20 AM Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. -~, INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction ¼ constructed ~'~ Project complete, compliance inspection. Board Of $outhold Town Trustees SOUTHOLD, NEW YORK ISSUED TO PATRICE & ~OHN KEITT Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952; end the Soufhold Town Ordinance en- titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS?, end in accordance with the Resolution of The Board adopted at a meeting held on ,..~.a~.~,h...~. · ~., and in consideration of the sum of $...2Pq.~.~0 ... paid by .......... ~.a,~.~....~ .. J.9.bn...~i~ ...................................................... . ........... : ......... of ......... $?~.c~J.~ ........................................... N. Y. e.d ,uSie~t to me Terms and Conditions listed on the reverse side hereof, of Sonfhold Town' Trustees authorizes end permits the following: Wetland Permit to construct a 24'X 26' wood trellis, and as depicted on the survey prepared by Joseph A. Ingegno last dated February 18, 2004. all in accordance with the dete~d specifications es presented in the originating app/icaflon. IN WITNESS WHEREOF, The said Board of Trustees here- ~ ceuse, ~, co,,,or.te, s..? to ~..~,ed, aed th..t~..~, ,o sul~.~'bed .by ~'malo~fy of the said Board aj of.. daf.. Artie. Foster ~h~ont) TERMS ~nd CONDmONS ~ p_~ Patrice & John Keitt residing at 280 Basin Rd. ~ Southold . . r. , lq. ¥~ ~s ~ respe~ d~re~o, m ~e eampl~e ~,a,,a of thc lk~d of Tnu~es ot the Town o~ SoudxoM for ~n earepmJon ma>, I~ nnale to I~e Boeat at a l_.~_t ~ That thls Pemfit ~ao~dd be ,Mim~ia ~he ~ or project odzatlon w~ odglmlly 4. That ~he work involved wtllbembject to the its s~ggnts, and no~-co~pllance with the pm~isloas s~catlo~ of this Peff~t by resolution of the said Board. 5. 'l"bac chert will be no u~)~ble im~tf _e~.~_ with ~ ~ · muir of the w~ hera apo~ due noti~ to ttmove or alte~ ~J_~ wodc m pwject beseln ~tated wltbout ezpemes to the Town 8. Th~c the s~d Board wifl be no~sed by the Pennittee ot the cumpletk~ Of the ~lc aud~ odzed. That the Petmitt~ will ~,, ~1 o~et t,,~,,~ ~d coasems ~,* nay be mlda:d mi~ plemeatal m chls petmlt ~ may be ~bject to tevo~ ulX~ ~t, nm.~ to oi~i,. _,-,,~ Albert J. Krupski, President James King, Vice-President Attic Fester Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 March 24, 2004 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Robert E. Herrmann En-Consultants, Inc. 1329 North Sea Rd. Southampton, NY 11968 RE: PATRICE & JOHN KEITT 280 BASIN RD., SOUTHOLD SCTM#81-1-19 Dear Mr. Herrmann: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, March 24, 2004 regarding the above matter: WHEREAS, Robert E. Herrmann on behalf of PATRICE & JOHN KEITT applied to the Southold Town Trustees for a permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated March 4, 2004 and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on March 24, 2004, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 97 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of PATRICE 8, JOHN KEITT to construct a 24'X 26' wood trellis, and as depicted on the survey prepared by Joseph A. Ingegno, last dated February 18, 2004. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/Ims Albert J. Krupski, President James King, Vice-President Attic Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, NewYork 11971-0959 Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD TO: Please be advised that your application dated ~l ~1LY~ reviewed by this Board at the regular meeting of ~lc~'-tlt3~ following action was taken: has been and the ,/ ( ~")Application Approved (see below) (__.) Application Denied (see below) ( )Application Tabled (see below) If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: SIGNED: PRESIDENT, BOARD OF TRUSTEES Telephone {63 l) 765-1892 Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southoid Town Conservation Advisory Council held Monday, March 22, 2004, the following recommendation was made: Moved by Doris McGreevy, seconded by Tom Schlichter, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Permit application of PATRI(:;E & JOHN KEITT to construct a 24'X 26' wood trellis. Located: 280 Basin Rd., Southold. SCTM#81-1-19 Vote of Council: Ayes: All Motion Carried PATRICE AND JOHN KEI'IT, 280,BASIN ROAD~ SOUTHOLD Figure l. Looking west at existing bulkhead. Figure 2. Looking north from upland over existing bulkhead and into Southold Bay. PATRICE AND JOHN KEITY, 280 BASIN ROAD~ SOUTHOLD Figure 3. LooMng south at locution of proposed trellia Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fex (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application · ~etland Permit Application ~'- Major Waiver/Amendment/Changes se' Received Application:_~l~ ,,,,'Keceived Fee:$~ ~'Completed Applicat ion~t~[~~ Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) - neAC Referr. l Se.t:, ~.l~ate of Inspection: ~ ~.~.'~ Receipt of CAC Report: Lead Agency Determination: Technical Review: ,~Public Hearing Held: ~/~([C~¢ Resolution: Minor Southeld Tov~n f~oard 0I Trustees Name of Applicant PATRICE & JOHN KEITT Address300 EAST 56TH STREET, 29G, NEW YORK, NY 10022 Phone Number: 212-759-9795 Suffolk County Tax Map Number: 1000 - 81-1-19 Property Location: 280 BASIN ROAD, SOUTHOLD (provide LILCO Pole #. distance to cross streets, and location) AGENT: EN-CONSULTANTS, INC. (If applicable) Address: 1329 NORTH SEA ROAD, SOUTHAMPTON, NY 11968 Phone: 631-283-6360 Board of Trustees Applic~ Ion Land Area (in square feet): 29,986.88 Area Zoning: R-40 GENERAL DATA Previous use of property: RESIDENTIAL. Intended use of property: NO CHANGE. Prior permits/approvals for site improvements: Agency Date __No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description (use attachments if necessary): CO STRUCTION OF A 24 X 26 WOOD TRELLIS ALL AS DEPICTED ON THE SITE PLAN PREPARED BY JOSEPH A. INGEGNO, LAND SURVEYOR, LAST DATED 18 FEBRUARY 2004. Board of Trustees Applica pn WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: TO CONSTRUCT A RECREATIONAL TRELLIS/PERGOLA ADJACENT TO EXISTING DWELLING. Area of wetlands on lot: 0 square feet Percent coverage of lot: 0 % Closest distance between nearest existing structure and upland edge of wetlands: <10 feet (DECK) Closest distance between nearest proposed structure and upland edge of wetlands: 43.5 feet Does the project involve excavation or filling? X No Yes If yes, how much material will be excavated? N/A cubic yards How much material will be filled? N/A cubic yards Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations: N/A 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): THE PROJECT CONSISTS OF THE CONSTRUCTION OF A TRELLIS/PERGOLA OVER AN ALREADY DEVELOPED UPLAND AREA, WHICH WILL LEAVE NO IMPACT ON THE ADJACENT, UNVEGETATED TIDAL WATERS OF SOUTHOLD BAY. 14-18~4 (2~7)--Texl t2 PROJECT I.D. NUMBER 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION (To be completed by Applicant or Project sponsor) SEQR I APPLICANT/SPONSOR~)AT~JC£ & JOHn' [~IT~ BY I 2. PROJECT NAME I ~2N-CONSULTANTS, INC. 3 PROJECT LOCATION: Municipality SOUTHOLD County SUFFOLK 4 PRECISE LOCATION (St~e~t address and road intersections, prom}nent landmarks, etc, or provide map) ).80 BASIN ROAD, SOUTHOLD, SCTM #1000-81-]-19. 5. IS PROPOSED ACT N [] New ~ Expansion [] Modificatiol~/aheration 6 DESCRIBE PROJECT BRIEFLY: 2ONSTRUCTION OF A 24' X 26' WOOD TRELLIS ALL AS DEPICTED ON THE SITE PLAN PREPARED BY JOSEPH A. [NGEGNO, LAND SURVEYOR, LAST DATED 18 FEBRUARY 2004. 7. AMOUNT OF LAND AFFECTED Initially 0.69 ac~es Ultimately 0.69 ac~s 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ~Yes [] No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? [] Residential [] Indusb'ial [] Commercial [] Agriculture [] Park Forest/Open space [] Other Describe: lo. ODES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? [] Yes [] NO If yes, list agency(s) and permiUapprovals NYS DEC 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [~Yes [] yes, agency name pem3itJapproval No list and I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor nanl~ RO%R~,~HERRMANN, COASTAL MANAGEMENT SPECIAL[ST DATE MARCH 2, 2004 If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES~ TOWN OF SOUTHOLD In the matter of applicant:PA~q~/CE&3OH]WKlEIT~ SCTM9 1000- 81-1-19 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the Permit from the Board of Trustees to: undersigned to request a CONSTRUCTION OF A 24' X 26' WOOD TRELLIS ALL AS DEPICTED ON THE SITE PLAN PREPARED BY JOSEPH A. INGEGNO, LAND SURVEYOR, LAST DATED 18 FEBRUARY 2004. 2. That the property which is the subject of Environmental Review-is located adjacent to your property and is described as follows: 280 BASIN ROAD, SOUTHOLD, NY 11971 3. That the project which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment on:N~dkCH~,~7:~pm You may contact the Trustees Office at 765-1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does riot reference any other agency that might have to review same proposal. OWNERS NAME: PATR/CE&JOHNKEITT MAILING ADDRESS: 300 EAST 56TH STREET, 29G NEW YORK, NY 10021 PHONE #: 212-759-9795 Enc.: Copy of sketch or plan showing proposal for your convenience. Name: PATRICE & JOHN KEITT PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Address: 4311 GULF OF MEXICO DRYVE LONGBOAT KEY, FL 34228 DOREEN & KEVIN BARR l I DIRKSEN DRIVE WILTON, CT 06897 STATE OF NEW YORK COUNTY OF SUFFOLK ROBERT E. HERRMANN 1329 NORTH SEA ROAD SOUTHAMPTON, NY 11968 doing bus iness atEN42ONSULTANTS, INC. · being duly sworn, deposes and says that on the 3~ day of® .2o 04 , deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addressesset opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at SOUTHA3~PTON , that said Notices were mailed to each of said perso s by (certified) Sworn to before me this3~ day o f MARCH .2004 ~-~_~-_/ M~ Notary ~'ublic Albert J. Krupski, President James Irdng, V/ce-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING being duly sworn, depose and say: ~ That on the }/~ day of ~, 200 g pers~nallE posted theproperty ~om ~ by plac~g ~e Bo~d of T~tees official posteiwhere it c~ e~ily be seen, ~d that I have checked to be sure the poster has remained in place for eight days p.rior to the date of the public hearing. Date of hearing noted thereon to be held ~ Dated: (signature) Sworn to before me this T'~day or;~t '~200 ~t AUTHORIZATION (where the applicant is not the owner) (print owner of property) residing at ~ =--~6= ~%9-- (mailing address) do hereby authorize ~N- ~q~$~L, .-~1-~, lNG (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. /(Owner's~ignature) ~oard of Trustees Application County of Suffolk State of New York DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONT.~X/ED HEREIN ARE TRLrE TO THE BEST OF FIlS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN TIlE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD TH]E TOWN OF SOUTHOLD AND THE TOV~rN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), ff GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEI~ AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. . ' ' -, Signatt/re .. SWORN TO ~EFORE ~ ~rms t -7r~ DAY oTAJ0¥ern~r' IMl~¥ M, ~l~Ub NOTARY PUBLIC - STATE OF NEW YORK NO. 01~OE8056607 QUALIFIED IN NEW YORK COUNTY~'/ MY COMMISSION EXPIRES 03-~:~20___~ / APPLICANT TRANSACTIONAL DfSCLOSU~ The Town of Southold's Code of Ethics prohibits conflicts of in~eres~ on tbs part of town officers and employees. 7'he R~rpose 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. (bast name, first name, middle initial, unless you are applying in bbs name of Someone elsa or other entity, such as S company. If so, indicste tbs other person's or compsny's nsme.) NATUEE OF APPLICATION~ (Check all that apply.) Tsx grievance Variance Change of zone App~ovsl of plat ., Exemption from plat.~r official map Other (If "other," name the activity,) 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 YES NO If you ansvered 'YES,' oomplete the balance of this form and date and sign where indicated. Name of person employed by the Town off Soutllold Title or position of that person Describe the relationship between yourself (the applicant) and the town officer or employee. Either chec~ the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or Ills or her spouse, sibling, parent, or child is (check all that apply). A) the owner of greater tban 5% of the shares of the corporate stock of the applicant (when the applicant corporation); C) an officer, director, partner, or employee of the __.D) the actual applicant. DESCRIPTION OF RSLATIONSIIIP EN-CONSULTANTS, INC. 1319 North Sea Road Southampton, New York 11968 631-283-6360 Fax: 631-283-6136 E-maih encon@peconic.net www.enconsultants.com ENVIRONMENTAL SERVICES March 2, 2004 Town of Southold Board of Trustees Post Office Box 1179 Sonthold, New York 11971 Attn.: Lauren Standish Re: Patrice & John Keitt 280 Basin Road, Southold SCTM #1000-81-1-19 Dear Ms. Standish: In regard to the above referenced property, enclosed are the following for the Board of Trustees review: 2. 3. 4. 5. 6. Three (3) Wetland Permit Applications. Three (3) Short Environmental Assessment Forms. Three (3) copies of authorization & disclosure forms. Three (3) copies of survey. One (1) set of site photographs. Application fee of $200.00. I trust this information shall allow you to process our permit request. Should any additional information be required, please do not hesitate to contact our office. Coastal Management Specialist /khs Enc.