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HomeMy WebLinkAboutTR-6256 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 # 0220C Date: July 25,2007 THIS CERTIFIES that the construction of a first and second story porch addition and a two- stOry garage At 7055 Indian Neck Lane, Peconic, New York Suffolk County Tax Map # 86-6-26.1 Couforms to the application for a Trustees Permit heretofore filed in this office Dated 10/28/05 pursuant to which Trustees Permit # 6256 Dated 12/21105. Was issued, and conforms to all of the requiremeuts aud couditions of the applicable provisious of law. The project for which this certificate is being issued is for the construction of a first and second stOry porch addition and a two-stOry garage. The certificate is issued to Janet Carrus owner of the aforesaid property. ~c;?~ Authorized Signature James King, Vice-Presic' Artie Foster Ken Poliwoda Peggy A. Dickerson I'own Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 .....UJ1VI." lJ. 1.:>..1 ""1-'01\.1, .l1t:01Ul;::UL- Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTH OLD 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 Iine1!)-<,jcb O~ J- ~ 1 st day of construction -:7 Y, constructed Proj'ct compl",. oompH,"" loop,ctloo. 1/4!n/,,~ James King, Vice-Presi Artie Foster Ken Poliwoda Peggy A. Dickerson BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 53095 ]{oute 25 P.O. B~x 1179 Southold, New York 11971-0959 Telephono ~631) 765-1892 Fax1631 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. Board Of $outhold Town Trustees SOUTHOLD, NEW YORK ~ER~T NO. ~2~G DATE: Dec. 21, 2005 ~SSUED TO JANET CARRUS Pursuanf ia the provisions of Chapter 615 of the the SteLe of New York, 1893~ and C;hapier 404 of the ,L~, ws of the SfaLe of Now York 19~2: and fha Southold To~n Ordinance en- titled ."REGUL:ATING AND -11-1E.,PLACING OF OBSTRL!C~LOHS IN AND ON TOWN WATERS AND PUBLIC LANDS end lite REt~iOVAL OF SAND, GRAVEL'OR OTHER MATERIALS~F~J~OM LANDS UNDER TOWN WATERS;~?. end in a~¢o~dance wi~h 'the Resolution of The Board adopLed et a meeting hold on ~07.~....i, and in consideration of the sum of $..~.-~.O~._O.q .... pald by Janet Carrua o~ Peconic ............... N. Y. aed s~ioc~ ~o the Terms and Conditions (isled on the reverse side hereof, of Southold Town Trudees authorizes end permlfs the following: ~e~and Permit ~o co~$t~c~ E±rst ~and seco~ s~or¥ porch add± and a ~o-~tory ~ar~e, ~±th ~he co~dit~o~'dry~eZl~ ~re in~tallec to contain the race r~n-oE~, a line cE ~ta~ed h.~y b~le~ ±~ ~n~t:a~ pr±or ~o co~str~ctio~, a~d ~11 ~s depi~,l~ed,.o~ the s±te p~a~ ali in accordance with the defailed ~l?ecmca~.ons as presenf~a m · the odglnati~g prepared by Garrett A. Strang, Architect la,~t dated 1/24~06o IN WITNESS WHEREOF, The sald Board of Trustees here- ~ causes ifs Corporate Seal to be affixed, and these ~.resents ia sul~scdbed by ~'majorRy of the sa~d Board .as of TEP~S ,nd C~NDITIONS ~[~p~¢~ Janet Carrus 7055 Indian Neck Lanes Peconic , .~. N.¥~'~ a. ~t ~h.'.~dlot~of : 24: ~. That this Pen-it ~oald be t-et~tt~d indefinitely, or as loag as the said P~ax¢ w~h~s ' to' uutl~'aln the ~uct'~e or project involved, to provide evtd~mce to anyone coa~rtted Chat sud~- .,~l~tloa ~ odb, tnally obtdncd. 4. That dxe work involved will I~ ad,jeer to the iasl~tton ~ ~pproval of d~ ~ m That ~ ~ ~ no unteaso~ble tntecfex*e~e with n~vtg;ttto~ ~ · te~dt of the w~k affthodzed, ' ' 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 December 21,2005 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Garrett A. Strang, Architect P.O. Box 1412 Southold, NY 11971 RE: JANET CARRUS 7055 INDIAN NECK LANE, PECONIC SCTM#86-6-26.1 Dear Mr. Strang: The Board of Town Trustees took the following action during its regular meeting held on December 21,2005 regarding the above matter: WHEREAS, Garrett A. Strang, Architect on behalf of JANET CARRUS 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 October 28, 2005, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator 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 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 JANET CARRUS to construct first and second stow porch additions and a two-stow garage, with the condition drywells are installed to contain the roof run-off, a line of staked hay bales is installed prior to construction, and all as depicted on the site plan prepared by Garrett A. Strang Architect last dated January 24, 2006. 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:S100.00 Very truly yours, President, Board of Trustees JFK/Ims Albert J, Krupski, 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 TO: BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Oanc Please be advised that your application dated (~.(. · ¢.~¢ 2ZbJ' reviewed by this Board at the regular meeting of ~. ~ following action was taken: (~) Application Approved (see below) ( )Application Denied (see below) ( ) Application Tabled (see below) has been and the 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 (631) 765-1892 To,a~a 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., December 14, 2005, the following recommendation was made: Moved by Jack McGreevy, seconded by Don Wilder, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH CONDITIONS of the Wetland Permit application of JANET CARRUS to construct first and second-story porch additions and a two-story garage. Located: 7055 Indian Neck Lane, Peconic, SCTM#86-6-26.1 The CAC recommends Approval of the .application with the exception of the addition on the east side and there is no change to the natural vegetation on the north and east sides of the house. Vote of Council: Ayes: All Motion Carried SITE DATA SITE AREA 7.37 ACRES - 320,963 SQ. FT. TAX MAP # ZONING 1000 - 86 - 66 - 26,1 R - 801RESIDENTIAL FLOOD ZONE WATER SUPPLY USE EXISTING PROPOSED "VE" (elevation 8) "AE" (elevation 8) and "X" PRIVATE WELL ON SITE SINGLE FAMILY DWELLING SINGLE FAMILY DWELLING BUILDING AREA EXISTING PROPOSED 2 stop/porch addition I story porch addition 2 story garage TOTAL LOT COVERAGE TOTAL EXISTING PROPOSED 2,340 SQ. FT. 260 SQ. FT, 884 SQ, FT. 768 SCI, FT. 4,252 SQ. FT. 0.74% 1.34% OWNER JANET CARRUS 52 Wast Ardsley Ave. Irvington, NY 10533 PLANNING BOARD MEMBERS JERILYN B. WOODHOUSE Chair WILL/AM J. CREMERS KENNETH L. EDWARDS MARTIN H. SIDOR GEORGE D. SOLOMON PLANNING BOARD OFFICE TOWN OF SOUTHOLD MAILING ADDRESS: P.O. Box 1179 Southold, NrY 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 Janet Carrus SCTM# 86-06-26.1 JANET CARRUS requests a Wetland Permit to construct first and second-story porch additions and a two-story garage, 7055 Indian Neck Lane, Peconic, SCTM# 86-6-26,1 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 Attic 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 Application ~---~etland Permit Application __ Administrative Permit ~ Amendment/Transfer/Extension iv--id Application: I 01 k~-~O x~ _~:Received Fee:$~ ~,~---'Completed App lic ation~X~ t~- ~ 113~ __Incomplete __SEQKA Classification: Type I__Type II Uniisted Coordination:(date sent) : ' ~ Consistency Assessment Form_ I ~1 q [ 0 F -¢~C Referral Sent: g / / qlIY~- ~-~Date of Inspection: 1~3~-/! t~[0\ ~ __Receipt of CAC Report: __Lead Agency Determination: Technical Review: __Resolution: C, '3 [ Name of Applicant Address /~Pl//~T'O~/~'y ]O~f'~$~} Phone Number:~{) ~/-//~0 Suffolk County Tax Map Number: 1000- ~-d~' ~'/ Prope~yLocation: ~o~C /~0 '~ ~e~ ~ _~rovide LILCO Pole ~, ~st~ce to cross streets, ~dloc~ion) - AGENT: ~' ' ' *~ ~. ff~ ~ ~ (If applicable) Address: Phone: '~6 $'"' ,-VV '..C'J''~ of Trustees Applicati Land Area (in square feet): Area Zoning: Previous use of property: Intended use of property: GENEI~L DATA 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? ~/ No Yes If yes, provide explanation: Project Description (use attachments if necessary): _ ,rd of Trustees Applicati WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: Z~'~ gg~__ _square feet Percent coverage of lot: ~'~ % Closest distance between nearest existing structure and upland edge of wetlands: ,..q(~ feet Closest distance between nearest proposed structure and upland edge of wetlands: .~'~ feet Does the project involve excavation or filling? 'v/ No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: t~ - F~, ~ Manner in which material will be removed or deposited: feet S_tatem~n~ of the effect~ if any~ On the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attac~unentg if appr0priate): PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1. APPLICANT / SPONSOR 3.PROJECT L~O~ATIO N: Municipality 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 County 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map SEQR 5. IS PROPOSED ACTION: [] New 6. DESCRIBE PROJECT BRIEFLY: J~Expansion [] Modification / alteration 7. AMOUNT OF LAND AFFECTED: Initially ~.~, acres Ultimately '~o ~ ~)"~ acres 8. WILL PROPOSED ACTION COMPLY WiTH EXISTING ZONING OR OTHER RESTRICTIONS? ~]Yes [] No If no, describe bdefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply,) ~ Residential ~-~ Industrial [--] Commercial [~Agriculture [] Park / Forest / Open Space E~ Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ~;~Yes r"--~No If yes, list agency name and permit/approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID I~ERMIT OR APPROVAL? [~Yes t~No If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? [~Yes r'-~ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/Sponsor Name ~---~,~¢?r ~,~..jl~./~'~ ~,~lr~,,/~' Date: Signature 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 completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAR 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, I--lYes [ 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, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain bdefly: C3. Vegetaiion or fauna, fish, ~hetlfi~h or Wildlife species, Significant hat}tats, or threatened o¢ ~ndangered species? Explain briefly: C4. A community's existing plans or goals as officially ~dopted, or a Change in use or intensily of use of land or other natural resources? Explain Criefly: C5. Growth, subsequent development, or related activities iikely to ~e induced by the proposed action? Explain briefly: C6, Long term, shod term, cumulafive, or other effects aot id0ntified in o1-c$? Explain briefiy: C7 Other impacts (inCluding changes in use of either ~uantit~ O~tTpe'o~ energy? Explain briefly': D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA~? /If yes, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If)'es ex~olain: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it ia 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 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 environmenta~ characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ~heck t~is ~ox if you have determin~dl based onthe info~ma~iou and a~aly~ts above and any supporting documentation, that ~he proposed actior WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi~ determination. Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAlL RECEIPTS Name: Address: SCTM #1000-86-06-26.2 Carol Freda SCTM #1000-86-07-09 Barbara Adams SCTM #1000-86-07-7.2 Patricia Dawson 47 Robin Lane Alpine, NJ 07620 PO Box 1642 Soutboid, NY 11971 92 Begen Street Westward, NJ 07675 L GARRETT A. STRANG, residing at 1230 Traveler Street, Soutbold, New York, being duly sworn, deposes and say that: On the/~ th of December, 2005, deponent mailed a true copy of the Notice set forth ia the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite their respective names; that the address set opposite the name of each person is the address of said person as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at Southold, NY, that said Notices were mailed to each of said persons by (certified) mail. ..~' Signature / Sworn to before me this /2 th day of December, 2005. {,Notary Public) ' // NOTARY pUBLiC, New York No, 4730095 ualified - Suffolk county QU~ Ex'ires July 31 ,~o?__~..-- comm. ~' 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-~ ~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 ,residingat IL3o t ~_~u~ being duly sworn, depose and say: That on the F3~day of ~o~, 200~,, I personally posted the property..l~nown as by placing the Bo~d of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in plac~for eight days prior to the dateffthe public he~ing. Date ofhemng noted thereon to be held ~.~ ~p(., ~t, ~ · Dated: /~p~/0( Sworn to before me this /,r~day of hc 200(' Nota y~Pub~ic ~' /~ Barbara A. Strang NOTARY PUBLIC, New York No. 4730095 Qualified - Suffolk County Comm. Expires July 31, ~ LETTER OF AUTHORIZATION RE: PREMISES, iNDIAN NECK LANE, PECONIC, NY SCTM # 1000-86-06-26.1 I JANET CARRUS, HEREBY AUTHORIZE GARRETT A. STRANG, ARCHITECT TO ACT ON MY BEHALF WHEN MAKING APPLICATION TO THE UNITED STATES OF AMERICA, STATE OF NEW YORK, SUFFOLK COUNTY, TOWN' OF SOUTHOLD OR ANY OTHER GOVERNMENTAL AGENCY IN CONNECTION WITH THE ABOVE REFERENCED PROJECT. Sworn to before me this ,2005 ~oard of Trustees Applicati6n County of Suffolk State of New York ~,~/t.~m( ~' fr~a Ma 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 ~ ~"/",q DAY OF t~¢ ra~ ,20~,.f"' Barbara A, Btrnng NOTARY PUBLIC, New York No. 4730095 Qualified - Suffolk County Comm. Expires July 31, ~ oo APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Towa of Southold's Code of Ethics t>mhibits conflicts of interest on the part of town officers and eml>loyees. The puroose of this form is to ~rovide information which can alert the town of oossible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: "~'~ ~' ~ '~' ~ ~' ~ °' S (Lost name, first name, ~aidd[e initial, unless yoo are applying in the name of someone else or other entity, such as a company. If so, indica~ 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 (If"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 applicm~ffagenffrepresentative) 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 applicant (when the applicant is a corporation); __.B) the legal or beneficial owner of any interest in a non-corporate entiB, (when the applicant is not a corporation); ___C) an officer, director, partner, or employee of the applicant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Submitted this ~,67'#day of ~9¢ Yo~'tC 200 ~ Signature~ Print Name ,.T'~0nt*'.r C~ ~_~_~__ To~vn 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 To~vn 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 significant beneficial and adverse effects ur)on 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 exlAained in detail, listing both SUl~l)ortin~ and non- supporfin~ facts. If an action cannot be certified as consistent with the LWRP policy standm'ds and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# /~ ~ PROJECT NAME The Application has been submitted to (check appropriate response): TownBoa,d 7] Plaun g Board 5] uilding,ept. 5] .oa,dofTrnstees 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) Finoncial 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 zoning 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: .5"~. ~J. (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, m~kcs efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. [] Yes [] No ~ Not Applicable Xttach 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 throngh 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 ~ Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. Yes No Not Ap~l~ble 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 ifnecessaO' Policy 8. Minimize environmental degradation in Town of Southoid from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. Yes [-~ No I~3 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 ~ Not Applicable Attach additional sheets if necessary 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 ~ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconie 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 evaination criteria. [] Yes ~1 No ~ Not Applicable Garrett A. Strang Architect 1230 Traveler St., Box 1412 Southold, New York 11971 Telephone (631) 765-5455 Fax (631) 765-5490 October 28, 2005 Mr. A1 Krupski, President Southold Town Board of Trustees PO Box 1179 Southold, NY 11971 Re: Application for Carrus, 7055 Indian Neck Lane, Peconic, NY SCTM # 1000-86-06-26.1 OCT 28 200D . [ Dear Mr. Krupski and Members of the Board Enclosed please find original and two copies of completed application and required fee in connection with the above referenced application for your consideration. If, at~er reviewing this matter, you have any questions or comments, please feel free to contact us at the office. Thank you for your courtesy and cooperation in this matter. Very truly yours, ~ett A. Strang, R.A. Architect Encs.