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Home My WebLink AboutTR-6259 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel 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 # 0149C Date September 6. 2006 THIS CERTIFIES that the screened porch At 570 Hippodrome Dr.. Southold Suffolk County Tax Map # 66-2-12 Conforms to the application for a Trustees Permit heretofore filed in this office Dated August 29.2005 pursuant to which Trustees Permit # 6259 Dated Dec. 21. 2005 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 a screened porch The certificate is issued to Kathryn A. Campell owner ofthe aforesaid property. ror~ Authorized Signature Albert J. Krupski, James King, Vice-President Artie Foster Ken Poliwoda Peg~' 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 L//,/½ constructed Project complete, compliance inspection. Board Of $outhold 'Town Trustees Xut'tmri atiuu ........ Pursuant to the provlsions of Chapter 615 of tho I~ws o{ the. Stele of New York, 18731 end Chapter 404 of frae Laws of the ' State of New York 1952; end the Southold To~n Ordinance en- titled · '~REGUI_~TING AND THE.PLAC;ING OF OBSIRUC~!LQ.~S IN AND ON TOWN WATERS AND PUBLIC; LANDS end-the REMOVAL OE SAND, CoRAVELOR OTHER MATERIALS.E[IDM LANDS ·UNDER TOWN 'WATERS;.?. and in accordance wHh 'the Resolution of The Board adopted at a meeting held on .. 277.~.., end in conslderetlon of the sum of $.~Q.~.Q.Q ......... paid by of .......... ~.?~:.~'.~J:.d. .................. ' ......................... 14. Y, and subject to the Terms and C;ondHions listed on the reverse slde hereof, of Southold Town· Trudees authorizes and permlH the followlng: Wetland Permit to construc~ a screened porch, and all as de- picted on the plans surveyed by Joseph Ingegno, and last dated November 23, 2005. all in accordance with the detailed specifications as presented in · the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- ~ causes its Corporate Seal to be affixed, end these presents 1o subscribed bt' ~'majorily of the said g~ard .as of this date, TERIdS and CONDITIONS ~p~ Kathryn Campbell Southold ...... , .... time' t~lUired tO C&nplete ehe work ~vol~ ~t '~ ~ ~ ~ .' t. ~. dxe sild ,Board o/Trustees and the Town c~ SoGtbold ate tele~d from any and all ,~,.~%~. or _,-vu,.~ ~o~ '.~..~-ges. of ~ eml.~ dL.~=tty'~ tndtt~tS.v -. a ~ of soy opet- ~.~ ~. ~-~c ~ of ~.~ ~ T~. ~X~ . .- ~ ~c~~'~dfot~of 24 ~ '~'~~ ~ to.d~ ~ ~ mq-b~ subJ~ to t~voko utcn tJl~o to G~-~- _,,,~- 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 December 21,2005 Meryl Kramer P.O. Box 683 Greenport, NY 11944 Re: 570 HIPPODROME DR., SOUTHOLD SCTM# 66-2-12 Dear Ms. Kramer: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, December 21, 2005 regarding the above matter: WHEREAS, Meryl Kramer as agent for KATHRYN CAMPBELL 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 November 29, 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 December 21, 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 proposal 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, RESOLVED, that the Board of Trustees approve the application of KATHRYN CAMPBELL to construct a screened porch, and all as depicted on the plans surveyed by Joseph Ingegno and last dated November 23, 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.) This is not a determination from any other agency. Fees: $50.00 Very Truly Yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/hkc 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) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated /'/i/oh/~ ? reviewed by this Board at the regular meeting of ~-~c · g~ .t 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 Tel,phone (63 I) 765-1892 Town Ifall 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., December 14, 2005, the following recommendation was made: Moved by Jack McGreevy, seconded by Jennifer Mannino, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Permit appliation of 14v, ATHRYN A. CAMPBELL to construct a screened porch. Located: 570 Hippodrome Dr., Southold. SCTM#66-2-12 Vote of Council: Ayes; All Motion Carried 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 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 To: Town of Southold Board of Trustees From: Mark Terry, Senior Environmental Planner LWRP Coordinator Date: December 1,2005 Re~ Request for Wetland Permit for Kathryn A. Campbell SCTM# 66-2-12 KATHRYN A. CAMPBELL requests a Wetland Permit to construct a screened porch. Located: 570 Hippodrome Dr., Southold. SCTM#66-2-12 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 with the following conditions: 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. Office Use Only __Coastal Erosion Permit Application ~...,Wetland Permit Application __ AmendmentYTransfer/E xtensj, on ~'~R_ eceiv~ Applicafion~"- ~l~'Received Fee:$ ~.xj~j~ ~_-*:C~mplete. d Application ___Incomplete ___SEQRA Classification: Type I Type II __Unlisted Coordination:(date sent) ~AC Referral Sent: ~_<l~te of Insp~cXion: __.Receipt of CAC Report: Lead Agency Determination: Technical Review: ~.----~ublic Hearing Held:_ toT/o2d/05 __Resolution: Administrative Permit Name of Applicant K^~Y~/ ,~. Address ~]~4t~ ~tO~F---, /kJ~f Phone Number:( ) Suffolk County Tax Map Number: 1000- ~ (_0 - 0 0- - I 9_ Prop~ty I~ocatio~,: .5"~'0 ~ ??Ot~:P~ bi~. ~ (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: ~t?,~_~iq POr~r'., NY Phone: County of Suffolk State of New York ~A~__.~).~{ ~ ~.~:z~d~_~-- BEING DULY SWO~ DEPOSES A~ AFFI~S T~T ~/SHE IS T~ APPLIC~T FOR T~ ABO~ DESC~BED PE~T(S) AND ~AT ~L STATE~NTS CONTA~ED HE~IN A~ TRUE TO THE BEST OF ~S~R ~O~EDGE AND BELIEF, AND t~T ALL WO~ ~LL BE DONE ~ THE ~ER SET FORTH ~ T~S ~PPLICATION ~V ~S ~Y BE APPRO~D BY THE SOUTHOLD TO~ BO~ OF TRUSSES. T~ APPLIC~T AG~ES TO HOLD THE tO~ OF SOU~OLD ~ THE tO~ TRUSTEES ~ESS A~ F~E FROM A~ ~D ~L D~GES ~ CLAIMS ~S~G ~DER OR BY ~R~E OF S~D PE~T(S), IF G~NTED. IN CO~LET~G THIS APPLICATION, I HE'BY AUTHO~ZE THE TRUSTEES, THEIR AGENT(S) OR ~P~SE~AT~S(S), TO ~TER ONTO MY PROPERTY TO ~SPECT THE P~SES ~ CON~ION ~TH ~EW OF T~S ~PLICATION. otary Public Veronica F. Cidone / Notary Public, State of New York No: 52-4661406 Qualified in Suffolk County Commission Expires Dec.31,o20 0 4Itoard of Trustees APPlicatio~ GENERAL DATA Previous use of property: IOj1-CjIC .1-"1 1<- -4 0 .5\N6Ge PAMIL.'t f<J3;, D8NOB Land Area (in square feet): Area Zoning: l' Intended use of property: Prior permits/approvals for site improvements: Agency Date 12E~c,1l \-4~B-O?-?f\t2-toool sl?:/\/OJ IWJN \R~es -f\ S'b~ T q/4-/:2001 __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ...,., No_ Yes If yes, provide explanation: Project Description (use attachments if necessary): ~t:.BNeD mP-O\ ADD\TlO~ tllbard of Trustees ApPlicati~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~EE;NBD ~t\ f><.pD ITIQN Area of wetlands on lot_\ \ W 1- square feet Percent coverage oflot:_IO B % Closest distance between nearest existing structure and upland edge ofwetlands:~ .k feet Closest distance between neajest proposed structure and upland edgl' of wetlands: (01- - ~ feet Does the project involve excavation or filling? No V' Yes IfYllS, how much material will be excavated? -5 cubic yards How much material will be filled? ,l) cubic yards Depth of which material will be removed or deposited: 3 feet Proposed slope throughout the area of operations: EX\SI." Tn REM Al N Manner in which material will be removed or deposited:~ Statement of the effect, ifany, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): ~o N€- 4Itoard of Trustees ApPlicatio~ County of Suffolk State: of New York _--y\P--R,'{ L..- KAAtv1e~ 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. IN 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 LJ~ DAY OF~DVetrL ~ ,200S J Veronica F. Cidone Notary Public, State of New York No: 52-4661406 Qualified in Suffolk Count~ Commission Expires Dec.31,c.2DOs-' Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peg~,%, A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-~/~1 BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD BO.~RD OF TRUSTEES: TOWN OF SOUTHOLD h~ the Matter of the Application of .... .................. COUNTY OF SUFFOLK) STATE OF NEW YORK) Pd~'FIDAVIT OF POSTING being d~ That on the ~ day of ~l~.,., 200~ .I personall~ posted theprop.e, rty .known as by placiug the Board of Trustees ~cial poster where it ca/[ easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held ~tJq,~_ AtO~('. ,.~lr ~059~ ~ .. ~. O~q oqoOo~7 Q ;O0 lwQ Dated: Sworn to before me this ~>/4'day o fl$~,,d400b- Notary Public LINDA S. TAGGA~T No. fy Public, State of New York No. 4948~06 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION (To be completed by A~plicant or Project Sponsor) 1MEA~P~3-C~;;S O R /2~ cPR~E°~TDNpA~ ;CH AD DITION- C AMPB ELL RESIDENCE 3. PROJECT LOCATION: Municipality SOUTI-IOLD County SUFFOLK 4. PRECISE LOCATION (Street address and road intersections, prominent {andmarks. etc., or provide map) 570 HIPPODROME DP_WE, SOUTHOLD, NY 5. PROPOSED ACTION IS: [] New [] Expansion [] Mod~ficationlaReration 6. DESCRIBE PROJECT BRIEFLY: SCREENED PORCH ADDITION TO EXISTING SINGLE STORY SINGLE FAMILY RESIDENCE 7. AMOUNT OF LAND AFFECTED: Initially .008 acres Ultimately .005 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? m [] Yes ~.~[~ No If No, desndbe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? [] Residential [] Industrial [] Commercial Describe: [] Agriculture [] Park/Forest/Oben Space [] Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? L~ Yes L~ No If Yes, list agency(s) name and permit/approvals: NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION, SOUTHOLD TOWN BUILDING DEPARTMENT 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? []y~s [] No If Yes, list agency(s) name and permit/approvals: DEC PERMIT # 1-4738-02842/0000l 12. AS A RESULT OF PROPOSED ACTION WiLL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? []Yes []No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: MERYL ~ER Date: 1 [/22/05 Signature: I If the action is in the Coastal Area, and you are a state agency, complete the ~ Coastal Assessment Form before proceeding with this assessment I OVER P__ART I! - IMPACT ASSESSMENT (~e completed by Lead A~lenc¥) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. I--]Y~ r--iN° B. WiLL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED 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 levats, existing traffic par(em, solid waste production or disposal. potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cuiturat resources; or community or neighborbood character? Explain bndfly: C3. Vegetation or fauna, fish, shelifsh or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's exisbng plans or goals as officially adopted, or a change in use or intensi[y of use of land or other natural resources? Explain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the preposeq action? Explain bhefly: C6. Long ierm, short term, cumulative, or other effects not identified in C1-C57 . Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy)? Explain bdefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? [] Yes~.~r~ NO If Yes, explain bdefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? [] Yes [] No If Yes, explele briefly; PART III - DETER~IINATION OF SlGNIFIC.a~ICE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, 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 explanattons 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 mu st evaluata the potential impact of the proposed action on the environmental characteristics of the CEA. ] ~heckthisbexify~uhaveidenfi~ed~se~rm~ep~tent~a~y~arge~rsignifcantadverseimpactswhichMAY~cur~ ThenproceeddirectlytotheFULI EAF and/or prepare a positive declaration. [] Check this box If you have datermined, based on the information and analysis above and any supporting documentation,that the proposed action WILl NOT result in any significant adveme environmental impacts AND provide, on attachments as necessa~j, the reasons supporting this datermlnafl¢ 1/22/05 Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Date Title of Responsible Officer Signature of Preparer (if different from responsible officer) LETTER OF AUTHORIZATION Kather-h~ Campbell 570 Hippodrome Drive Southold, NY 11971 October 27, 2005 I hereby authorize MERYL KRAMER, ARCHITECT to act as our agent in obtaining all permits required by TOWN, SUFFOLK COUNTY and NEW YORK STATE for the renovation to our home at 570 Hippodrome Drive, Southold, NY. Owner Date APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on thc part of town officers and employees. The px~-pose 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 necessar~ m avoid same. tLast name, first name, middle initial, unless you are applying in the name of someone els~ or other entity, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: {Cbeck 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 (If "Other', name the activity.) Do you personally (or through your company, s~ousc, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, mamagc, or business iaterest. "Business interest" means a business. inc h~ding 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 dian 5% of the shares. YES NO ~f if ~,ou 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 applicara/age n~/represen tafive) 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 emphiyee or his or her spouse, siblMg, parent, or chdd 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); B) the legal or beneficial owner of any integst m 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 200 5 Signatur~ ~'5~j_ ('5)C~'t~z.~..r;7/$e~ ~ntName ~ ~,/~ ~ . ~-~ Town of Southold LWRP CONSISTENCY ASSESSMENT FORM " * INSTRUCTIONS , ' i,~ _~' ~005 · I 1. All applicants for permits* including Town of Southold agencies, shall complete thi~ CJCAF!for proposed actions that are subject to the Town of Southold Wate~ff?_on_t Consistency ReView Law._~. ~his 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 Watert~nt 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). 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 unde~aken. 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 SITI~ AND PROPOSED ACTION The Application has been submitted to (check appropriate response): Town Board [] Planning Dept. [] Building Dept. [-~ Board 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:_ ~'[ N~bV-- Present zoning classification: ,; OOTh cO ;N y 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: (c) Tel~hone numbs: ~aCode( ) (d) Application numbeL iffy:. Will ~e ~ion be d~ctly und~, ~qui~ ~d~g, or appmvfl by a s~te or fed~ agency? Yes ~No ~ If yes, which mate or federal agent? DE.LOPED COAST ~LICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient usc of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section lli - Policies; Page 2 for evaluation criteria. Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological r~,ources of the Town of Southoid. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria ~-~ Yes ~ No [] Not Applicable Athach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. Sec LWRP Section II1 - 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 II! - Policies Pages 8 through 16 for evaluation criteria [] Yes [] No [] Not Applicable £Ckl T'Cq-d -r'tot(! - ' ...... Attach additional sheets if necessary Policy 5. Protect and improve wa~er quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria [] Yes [] No ~-~'/NotApplicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southoid ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section IH - Policies; Pages 22 through 32 for evaluation criteria. [] Yes [] Noa~ 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. ~ 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. See LWRP Section Ill - Policies; Pages 34 through 38 for evaluation criteria. ~-~ Yes [] No ~-'-'-'-~Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section HI - Policies; Pages 38 through 46 for evaluation criteria. [] 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 LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. [] Yes ~ No ~ot Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Pecunie 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 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. [] Yes [] No [--~Not Applicable Created on 5/25/05 11.'20 AM M E R Y L K R A M E R a r c h i t e c t November 22, 2005 Board of Town Trustees Town of Southold Town Hall, 53095 Main Road P.O. Box 728 Southold New York 11971 RE: Campbell Residence 570 Hippodrome Drive, Southold Tax Map # 1000-66-02-12 NO'V 2.° C05" Dear Trustees: I am requesting a permit for the above referenced property. There was a permit issued for this property (# 5397) dated Septem bet 4, 200:[ for a project of much larger scope. The Owner was undecided u ntil now as to the scope of work and therefore allowed the original permit to expire. I am now submitting the following application documents for a new single story screened pomh addition for your review: 1. Three copies of Completed Application for Permit including General Data, Wetland/Trustee Land Data, Notarized Affidavit and Transactional Disclosure Forms 2. Completed Short Environmental Assessment Form 3. Completed LWRP Consistency Assessment Form 4. A letter of authorization from the owner 5. Three Surveys prepared by Joseph Ingegno Land Surveyor showing proposed addition. 6. Application fee of $250.00 If you have any questions, please do not hesitate to call me. Sincerely, Cc: ½a~l~n Campbell 31 SOUTH STREET P.O. BOX 683 GREENPORT, t~ 11944 63/--477-8736 631 477 8936 FAX