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Home My WebLink AboutTR-6167 . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. 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 CERTIFICATE OF COMPLIANCE # 0207C Date: June 6, 2007 THIS CERTIFIES that the construction of first & second floor additions to the existing dwelling, new decks, new detached garage all with gutters and drvwells. At 1275 Bungalow Lane, Mattituck, New York Suffolk Couuty Tax Map # 123-3-17 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 06/08/05 pursuant to which Trustees Permit # 6167 Dated 07/20/05. 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 construction of first & second floor additions to the existing dwelling, new decks, new detached garage all with gutters and drvwells. The certificate is issued to Louis Giglioli owner of the aforesaid property. ro<~ Authorized Signature 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 151 day of construction Y, constructed ,/' pmject romplete, rompll,"oo I",POOloo'6) '/'1. ~)/~ CHARLES M. THOMAS, R.A. PO Box 877 .JAMESPORT, NY 1 1947 (637) 727-7993 (637) 727-8033 FAX Letter of Transmittal October II, 2005 Board of Town Trustees Town of Southold PO Box 1179 Southold, NY 11971 Re: Louis Giglioli 1275 Bungalow Lane Mattituck, New York SCTM# 1000-123-03-17 To Whom It May Concern: In regards to your letter (copy enclosed), please find the revised site plan for the above referenced residence. If you have any questions please call the office. Thank you for your time. r.....- "j" '";""d~ . 'iiiOS r --, 1 I' , DO iJI I - ---' _,J G">:; I .:::;- L-, I I! L ,; ~ ~I ~ ~I! \':'1 Albert J. I~rupski, President Jsmes King, ¥ice-President Artie Foster Ken Poliwoda Pegg~ 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 st 1 day of construction ¼ constructed V'//Project complete, compliance inspection. Board Of $outhold 'Town Trustees SOUTHOLD, NEW YORK PERMIT NO.... 6~-..6]. ...............DATE: .~.~.R!~ .?.~...].o..o5 ISSUED TO [,ou~s OZCLZOLI Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Ghapter ~0~ of the ,~.ws of Se · State of New York 1952; and Se Southold Town Ordinance titled ."REGULATING AND THE PLACING OF OBSTRUC~QNS IN AND ON TOWN WATERS AND PUBLIC I.ANDS and the REMOVAL OF SAND, GRAVEL'OR OTHER MATERIALS.F~OM LANDS .UNDER TOWN WATERS;.,?, and in accorda~ca w'dh 'the Resolution of The Board adopted at a meeting held on ..~.u):.l.~,.2;,0..,, 200,.5......., and in consideration of the sum of $...[~..0..;...0...0. ........ paid by Louis Giglioli of ............... ..i~...~.~:.U.,c.~ ................ i .............................. N. Y. and. ~ubiect to the Terms end Conditions listed on the reverse~Ide hereof, of Southokl Town Trustees authorizes and pern!ifs the followlnq: Wetland ?ermit to construct f±rst .and second-floor addit[c~n to t' exist, dwelling,construct new decl~s,remove,exist, attached gara: and construct new detached ~arage with the condition gutters & are %nstalled to contain the roof run-off- and all as on t~ site ~a~ pr~e~a~e~ 'by g~ar~es M. Thoma~ ~ch. accoraanca wnn Tee aetattea speenmattoes as pre~emea tn .the orynafietg appl~cafio., last dated October 11, 2005. IN WITNESS WHEREOF, The ~ald Board Of Trustees here- by causes its Corporate. Seal to be affixed, and thesa preL~ to be ,ub~c~'bed by ~ 'malmlty of the said Board .as of this date. ~S ~d ~ ~,~_~_ Louis Giglioli · 1275 Bungalow Lane, Mattituck N. ¥~ ~ 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 July 20, 2005 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Charles Thomas, R.A. P.O. Box 877 Jamesport, NY 11947 RE: LOUIS GIGLIOLI 1275 BUNGALOW LANE, MATTITUCK SCTM#123-3-17 Dear Mr. Thomas: The Board of Town Trustees took the following action during its regular meeting held on Wed., July 20, 2005 regarding the above matter: WHEREAS, Charles Thomas, R.A. on behalf of LOUIS GIGLIOLI 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 June 8, 2005 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 July 20, 2005, 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 LOUIS GIGLIOLI to construct first and second-floor additions to the existing dwelling, construct new decks, remove existing attached garage, and construct a new three-car detached garage, with the condition gutters and drywells are installed to contain the roof run-off, and all as depicted on the site plan prepared by Chades M. Thomas Amhitect last dated October 11, 2005. 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 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 Please be advised that your application dated reviewed by this Board at the regular meeting of 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: r o_t TOTAL FEES DUE: SIGNED: PRESIDENT, BOARD OF TRUSTEES Telephone (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., July 13, 2005, 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 WITH A CONDITION of the Wetland Permit application of LOUIS GIGLIOLI to construct a first and second-floor additions to the existing dwelling, construct new decks, remove the existing attached garage, and construct a new three-car detached garage. Located: 1275 Bungalow Lane, Mattituck. SCTM#123-3-17 The CAC recommends Approval of the application with the Condition gutters and drywells are installed to contain the roof run-off. Vote of Council: Ayes: All Motion Carried 06/09/200§ 10:§3 6317278~ BUTLER THOMAS PAGE 02 A~bet~ J. Kmpski, P~esident Jamee King, Viee-Pt~sident Ken Pollwoda PoS~' A. Dicke~son Town Hall P.O. Box 1179 ~outhold, l~w York 11971-0959 Telephone (eSl) 766.1892 BOARD OF TOWN TOWN OF 80UTHOLD Office U*e Only ______~t~,Jand~l E~ion P~-nuit AppliCation P~'m/t Application Admiuiat~atiw Permit JUi - 2005 Southold Bo~rdd~'ustee$ PhoneNumbcr:( ) 0,\'3 - "-lqq- ~9~,~ 1 Suffolk County T~x Map Number: I000- ~o~ ' Ot"~" IW (provide LILCO l~le #, ~stnncc to cross streets, and location) (If applicable) Phone: ~Board of Trustees Application GENERAL DATA Land Area (in square feet): ~1, OlD ~. ~ ~:~. ~-'-r. Area Zoning/"-~- Previous use of property:~v.r_~de X'~CX\ Intended use of property.'~-4C~CX\ Prior permits/approvals for site improvements: Agency Date __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspenfled by a governmental agency? ,/ No Yes If yes, provide explanation: Project Description (use attachments if necessary):~,~C~tS~('t~r~-~ OlhC~ ard of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Pu~ose of the proposed oporations.'~eq-,~C~v~O,\ Area of wetlands on lot: '~>~ c:~ square feet Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands: L o0,. ~ feet Closest distance between nearest proposed structure and upland edge of wetlands: t oOl. 4 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? ID 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 and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): ~Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity:~_-~O~ '~\ ~x~\¥~x% Are wetlands present within 100 feet of the proposed activity? No / Yes Does the project involve excavation or filling? No v/ Yes If Yes, how much material will be excavated? How much material will be filled? 0 \ ~:> (cubic yards) (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) . 617.20 'PROJECT ID NUMBER 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} 1. APPLICANT I SPONSOR 2. PROJECT NAME 3.PROJECT LOCATION: Municipality ~c%.,-~'~'~'~C._'V..- County .~_) 4, PRECISE LOCATION: Street Addess and Rood Intersections. Prominent landmarks etc -or orovide maa SEQR 5. rs PROPOSED ACTION: ~] New [] Expansion I'~ Modrflcation / alteration 6. DESCRIBE PROJECT BRIEFLY:'~:~.~--~.CO-~O~'%~ 7. AMOUNT OF LAND AFFECTED: Initiarly acres Ultimately acres 8. W1LL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [~:]Yes [] No If no, describe briefly: 9. WHAT iS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~-IResidentia, r~llndustrta, [--"]Commercial r-:]Agrtcuiture C]Park/Forest/OpenSpaoo I~other (descHbe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) r~lYes I~No If yes, list agency name and permit I approval: 11. DOES ANY ASPECT OF THE ACTION HAvE A CURRENTLY VALID PERMIT OR APPROVAL? r--lYes I~"-INo If yes. list agency name and permtt I approval: Ir~AS A Rr~ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I lYes I I NO ~[~T+~T THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Signature''''-U~'~'---~C~'''¥~'4;:~/~Applica~/_T:sorjamc~_~-~. ~~'"-"~:>.~ t~. ,, Date: (j - '~' OS ~ If the action Is a'~Costal Ama, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 61 ?.47 If yes, coordinate the review process and use the FULL FAF. [~] Yes B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR. PART 617.6? If No. a negative declaration may be superseded by another involved agency. F--"~ Yes [~No C. COULD ACTION RESULT IN ANy ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricuifural, amhaeological, historic, or other natural or cultural msoomes; or community or neighborhood character? Explain briefly: C3. Vegetation or f~una, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or' intensity of use of laild or other natural resources? Explain bdefly: C5. Growth, subsequent development, or related activities likely to ha ir~luced by the proposed action's? Explain briefly: C6. Long term, shod term, cumulative, or other effects not identified in C1 -C57 Explain briefly: C7. Other impacts (including change~'in use of either quanti[~ or type of energy? Explain I~riefly: D. VVILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? (if yes, explain briefly: r--~ Yes E. iS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yea explain: [~Yea F-~No PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachedverseeffectidenti~edab~ve'determinewhatheritissubstantia~'~arge~imp~rtant~r~tharwisesigni~cant~ Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreveraibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting matariala. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics oftha CEA. Check this pox if you have k~entified one or more potentially large or significant adverse impacts which MAy occur. Then proceed directly to the FULL FAF and/or prapare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed acflor WILL NOT result in any significant adverse environmental impacts AND provide, on aflachments as necessary, the reasons supporting thi= determination. ~, Signature et' Responsible Officer in Lead Agency Date ~espo.sibre Officer Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-~1 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 residing at [_~-~ being duly sworn, depose and say: That on the Ioq day of -'~IM ,200~$ I personally posted the property known as by placing the Bo~ of Trustees official poster where it c~ easily be seen, ~d that I have checked to be sure ~e poster has remained in place for eight days prior to ~e date of the public hemng. Date ofhemng noted ~ereon to be held ~} ~ {(~ ~t~ ' , - ' Dated: ~' ~ ~0~ ~P~, Ho. ~ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK - \c~X---c~-~N'~"-~'s~' k ~ , residing at ~--~ \~'~"t~ ~ ~--~[X~, ~"~ , being duly swom, deposes ~d sa~ ~at on ~e I ~ day of ~ ,20~, depon~t m~led a ~e copy of ~e Notice , set fo~h, in ~e Bo~d of T~tees Application, dk~ted to each of~e above n~ed p~ons at ~e ad~s~ set op~site ~ere ~sp~tive nines; ~at ~e ad.eases set opposite ~e nines ofs~d p~om m ~e ad&ess ofs~d p~ons ~ sho~ on ~e c~t ~sessm~t mil ~f~e Tom of Sou~old; ~at s~~e m~l~ at ~e Uffited S~t~ Post o~. ~t ~M~ . ~t ~o,~ w~ m~a to ~h ~ p~.o~ ~y Sworn to~befo~ me ~s I D~ Not~ublic ~ ~ p~o,S~Y~ No. ~ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SLFFFOLK , residing at , being duly sworn, deposes and says that on the day of ,20 , 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 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 the Town of Southold; that said Notices were mailed at the United States Post Office at (certified) (registered) mail. Sworn to before me this Dayof ~fu~ ,20 ~._~ Notary Public , tha~aile~, to each of said persons by NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trust.s to: 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: That the project which is subject to Environmental Review under Chapters 32, 37, and/or 97 of the Town Code is open to public comment on: . 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 not reference any other agency that might have to review same proposal. OWNERS NAME: MAILING ADDRESS: PHONE #: Eno: Copyofsketch orplan showing proposal for your convenienc.e. OBoard of Trustees Application County of Suffolk State of New York ~J ~21r3~,\~' k ~ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING LrNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING TH/S APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN C ONJUNCTION~ O~F THIS APPLICATION. SWORN TO BEFORE ME THIS ~ ~ r/ DAY OF ~Y-w~/c~ ,20 ~ ~ Notary Public _ ~li~:l in Suffolk C, ourj~ ~oard of Trustees ApplicaOn AUTHORIZATION (where the applicant is not the owner) (print o~n4r of property) residing at tS.'"'~ ¢'""'~'h~ ~f"¢% (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. 8 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of £~hies prohibits conflicts of inte~ on ~c om of ~Wn offi~ ~d emolo~s. ~ ~ of · b ~ is ~ ~i~ ingestion which ~ ~ ~e to~ of ~ible ~nfli~ of ~ ~d ~iow it to ~ ~ ~ion is ~ to avoid ~e. (~t n~e, fi~t n~e, middle ~iti~, ~te~ you ~ ~plyiag in ~e n~ of ~ ~1~ or o~ enti~, such ~ a ~m~y. If ~n's or ~m~y's n~e.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Tros~ce Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other", name thc activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employe~ of the Town of $outhold? "Relationship" includes by blood, marriage, or business interest "Business interest" means a business, including a parmership, in which thc 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% oftbe shares. YES NO ~ ~ If you answered "YES", complete thc balance of this form and date and sign whe~: indicated. N~me of person employed by the Town of Southold Title Or position of that person Deacrihe the relationship between yourself(the applicant/agen~reprssentative) and the town officer or employee. Either check the appropriate lir~ A) through D) and/or descr~bc in thc spoce provided. The lown officer or employee or his or her spouse, sibling, p~nt, or child is (check all that apply): A) the owner of greater than 5% of the sha~s of thc coq)orate s~ck of the applicant (when ~ applicant is a corporation); B) the l~gal or 'hemficial own~ of any interest in a non-corporate entity (when the applicant is not a corporation); C) an officer, director, parmei', or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Sub d'.this _ 200 __ Via: Mail Letter of Transmittal Town of Southold Board of Town Trustees PO Box 1179 Southo|d, NY 11971 Re: Louis Giglioli Bungalow Lane Mattituck, NY SCTM # 1000-123-03-17 June 20, 2005 Enclosed please fred the following: · LWRP Consistency Assessment Form upon your request Please call the office at (631) 727-7993 with any questions or concerns you may have. Thank you. Sincerely, Charles M Thomas JUN 21 2005 Board o( Trustees Town of Southoid LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 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. 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 sign/ficant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). 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 tmdertaken. 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# \ c~ c>~ \"7 The Application has been submitted to (check appropriate response): Town Board [] Planning Dept. [] Building Dept. [] Board of Trustees ~ Category of Town of S outhold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital constmetion, planning activity, agency regulation, land transaction) Co) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: Site acreage: ;71c~ ~ld~o Present land use:'~--~_,~>'x~C x-x5%O.\ Preset m~g cl~sificafion: ~ ~- ~D If m application for ~e proposed action has been fil~ wi~ ~e To~ of Sou~old agency, ~e fotloMng ~o~ation sh~l be prohd~: (c) Telephone number: Area Code ( ) QC'/- '7 ~4q - o~,~q~ \ (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency. Yes ~ No ~ If yes, which state or federal agency?. 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 ~'~/NotApplicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pa/ges 3 through 6 for evaluation criteria ~ Yes ~ No ~ Not Applicable Attach additional sheets tfnecessary Policy 3. Enhance visual quality and protect scenic resources thro,ughout the Town of Southold. See LWRP Section III - Policies 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 Pages 8 through 16 for evaluation criteria Yes 7] No Not Applicable Aitach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria 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 [~/rNot Applicable A~ach add/tional shcets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. [-'] Yes [] No ~ Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and waste~. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. [ [Yes [ [ No[ ']NotApplicable 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. ~'~ Yes ~ No [~/Not Applicable Atlach 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. S~e LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. ~'~ Yes ~-~ No~L..J Not Applicable ARach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. S~.LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. [] Yes ~ No ~] Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. ~ Yes ~ No ~Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. E Yes No Not Applicable Created on 5/25/05 11:20 ~4M