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Home My WebLink AboutTR-6216A 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 # 0266C Date: October 4. 2007 THIS CERTIFIES that the construction of a sunroom with a second-floor bedroom above At 875 Eugene's Road. Cutchogue. New York ~ Suffolk County Tax Map # 97-2-19 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 10/07/05 pursuant to which Trustees Permit # 6216A Dated 10/19/05. 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 a sunroom with a second-floor bedroom above. The certificate is issued to FRED SEIFERT owner of the aforesaid property. r~~ Authorized Signature Albert J. Krups~i, presiden. 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 OFTRUSTEES 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. ~J .re,:fer+ INSPECTION SCHEDULE Pre-construction, hay bale line 1 st day of construction }2 constructed . / Project complete, compliance inspection.p~/o 1 () ~./ ~ Albert J. Krupski, James King, Vic~-President Artie Foster Ken Po]iwoda Peggy A. Dickerson BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 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 ½ constructed __ Project complete, compliance inspection. Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggs~ 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 Permit No.: 6216A Date of Receipt of Application: October 7, 2005 Applicant: Fred Seifert SCTM#: 97-2-19 Project Location: 875 Eugene's Rd., Cutchogue Date of Resolution/Issuance: October 19, 2005 Date of Expiration: October 19, 2007 Reviewed by: Board of Trustees Project Description: To construct a 17'X 16' sunroom with a second-floor bedroom above, onto the west side of the existing dwelling. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 97 of the Southold Town Code. The issuance of the Administrative Permit allows for the operations as indicated on the survey prepared by John T. Metzger last dated July 20, 2005. Special Conditions: Gutters and drywells must be installed in order to contain the roof run-off, and as indicated on the survey prepared by John T. Metzger last dated July 20, 2005. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 97 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Albert J. Krupski, Jr., President Board of Trustees /"k/~Oo//v PLANNING BOARD MEMBERS JERILYN B. WOODHOUSE Chair WILLIAM J. CREMERS KENNETH L. EDWARDS MARTIN H. SIDOR GEORGE D. SOLOMON PLANNING BOARD OFFICE TOWN OF SOUTHOLD To: Town of Southold Board of Trustees From: Mark Terry, Senior Environmental Planner LWRP Coordinator Date: October 17, 2005 Re: Request for Administrative Permit for Fred Seifert SCTM#1000-97-2-19 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY Telephone: 631 765-1938 Fax: 631 765-3136 FRED SEIFERT requests an Administrative Permit to construct a 17'X 16' sunroom with a second-floor bedroom above, on the west side of the dwelling. Located: 875 Eugene's Rd., Cutchogue. SCTM#97-2-t 9 The proposed action has been reviewed to Chapter 95, 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 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. 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 Office Use Only Coastal Erosion Permit Applicationa ~Wetland Permit Application ~ Administrative Permit Amendment/Transfer/Extension ~d:[eceiv~d Application: 101'gIB~ ~-d>.eceived Fee:$ o~O' ~,~--Completed Application ] O/Q ]O ~ Incomplete __SEQRA Classification: Type I Type II U~iisted __Coordination:(date sent)__ _ __LWRP Consistency Assessment Form , CAC Referral Sent: __Date of Inspection: _ __Receipt of CAC Report: ~ __Lead Agency Determination: Technical Review: --~ublic Hearing Held: /Off q/O __Resolution: Name of Applicant F¢~' ,'~ ,~I; ~ ~t-:~ T Phone Number:(6,~ Suffolk County Tax Map Number: 1000 - t~7 - 0/2. - I ? Property Location: ~:a ? ~-- (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: BOd of Trustees Applicatio~ GENERAL DATA Land Area (in square feet): Area Zoning: "~ ~' Previous use of property: '~ Intended use of property: Prior permits/approvals for site improvements: Agency Date /No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspende/d by a governmental agency? ~ No Yes If yes, provide explanation: Project Description (use attachments if necessary): I-/ Y- [~ :d of Trustees Applicati¢ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~,~,,~ ~-.~o~-x Area of wetlands on lot: C_._) _square feet Percent coverage of lot: 0 % Closest distance between nearest existing structure and upland edge of wetlands: ,~ feet Closest distance between nearest proposed structure and upland edge of wetlands: _~' feet Does the project involve excavation or filling? No v'''/ Yes If yes, how much material will be excavated? ~2> cubic yards How much mater/al will be filled? O 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): PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 617~20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2. PROJECT NAME 1. APPLICANT / SPONSOR 3.PROJECT LOCATION: Municipality '~'"7~"' ~"(..X~ County 4 PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc - or provide mae [] Expansion ~Modification / alteration 5. IS PROPOSED ACTION: [] New 6. DESCRIBE PROJECT BRIEFLY: SEQR 7. AMOUNT OF LAND AFFECTED: ~ Initially acres Ultimately acres [-~-~ { ~ 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [~es [] NO If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~esidential [---] Industrial r--] Commercial J-'~Agriculture [~1 Park / Forest / Open Space ---]Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, AGENCY (Federal, State or Local) I --lYes ~['~lNo If yes, list agency name and permit / approvak NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? --']Yes ~No If yes. list agency name and permit / approval: 12. AS A E~ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE, Applicant , Sponsor Name ~.~/.~-~ S~{~"~-.~' Date: I~/~a~ lOC If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II- IMPACT ASSESSMENT (To be complet&db~; Lead Agency)~ A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617~47 - If yes, coordinate the review process and use the FULL EAF, B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FO'~0~I~LISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency, 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, )otential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain bdefiy: C4. A commungy's existing plans or goals as officially adopted, or a change ~n use or intensity of use of land or other natural resources? Explain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in CI-C57 Explain briefly: I C7. Other impacts tincludin~ changes in use of either quantit~ or type of ener~ly? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? (If ?es, ex~olain briefly/: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, largo, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. 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 of the CEA. C heak this box if you have identified one or more potentially la rge or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. t~Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed ~ WILL NOT result in any significant adverse environmental impacts AND provide, on altachments as necessary, the aotior reasons supporting thi~ · ~determination, Name of Lead Agency Date Pdnt 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) of Trustees Application~ County of Suffolk State of New York '~/.~M~ ~q ~e'~4'~ 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 UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. 1N COMPLETiNG THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS 7~ DAY OF /~doJ~e& ,2o 0,.)---~ No'fY Pubio, S~te of New Yolk No. OlO~1~2o~e My Commil~lon E)q~ree August 22, of Trust~es Applicati~ (print AUTHOP~I ZATION the applicant is not the owner) of property) (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town on my behalf. (Owner's signature 8 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees. The purpose of this form is to t~rovide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. (Last name, first name, middle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (lf"Other", name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of(or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO ~ lfyou answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): A) the owner of greater than 5% of the shares of the corporate stock of the applic0nt (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); ___C) an officer, director, parmer, or employee of the applicant; or ___D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Submitted this . day of Ocx"t~ 200 Signature ~ ~':,. ~ Print Name ~ ~. Town of Southold 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 sipmificant 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" 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 exlflained in detail, listing both sum~orting and non- suol~ortin~, 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 SCT I# IC,cX3 ? ,:, - t q PROJECT NAME ':7~-~ ~:'-v~ ,~;'~ The Application has been submitted to (check appropriate response): Town Board f--I P anning.oaraf Build g Dept. Vi aoara of Trustees 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: Location of action: Site acreage: Present land use: Present zonh~g classification: If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: (c) Telephone number: Area Code ( ) (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? 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. [~es ~-~ 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 - Policies Pages 3 through 6 for evaluation criteria ~ Yes ~-~ 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 - 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 [-~ No [] Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria [] Yes [] No v~ot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. Yes No Not Appli~le 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. ~ 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 wastes. Sec LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. [] Yes ~-~ N~ Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. ~ Yes~ No<NotApplicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III- Policies; Pages 47 through 56 for evaluation criteria. ~ Yes [] No ~NotApplicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peeonic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ~-~ Yes ~-~ No'~'~Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. ~ Yes [~ No~. Not Applicable At~ach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. < Yes [-~ No [] Not Applicable PREPARED BY TITLE DATE