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Home My WebLink AboutTR-6288 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall Annex 54375 Main Road 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 # 0455C Date:~ THIS CERTIFIES that the construction of a second floor addition with covered porch onto the existing dwelling with a 15' non-turf buffer landward of the retaining wall At 2950 Nllnnehaha Boulevard, Southold, New York Suffolk County Tax Map # 87-3-42 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated 12/2/05 pursuant to which Trustees Wetland Permit # 6288 Dated 2/15/06 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 second floor addition with covered porch onto the existing dwelling with a 15' non-turf buffer landward of the retaining wall The certificate is issued to JAMES & SUSAN SWEENEY owner of the aforesaid property. Authorized Signature James F. King, President Jill M. Dohcrty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (631) 765-1892 Fax (63 I) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: [~ Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction INSPECTED BY: constructed Project complete, compliance inspection. COMMENTS: CERTIFICATE OF COMPLIANCE: James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route25 P.O. Box 1179 Southold, New York11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 January 23, 2008 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. & Mrs. James Sweeney 31 Homestead Ave. Garden City, NY 11530 RE: 2950 MINNEHAHA BLVD,, SOUTHOLD SCTM#87-3-42 Dear Mr. & Mrs. Sweeney: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., January 23, 2008: RESOLVED that the Southold Town Board of Trustees grants a One-Year Extension to Permit #6288, as issued on February 15, 2006. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, President, Board of Trustees JFK:lms JAMES P. SWEENEY 31 HOMESTEAD AVENUE GARDEN CITY, NEW YORK 11530 516-488-5551 ] sweeney~pennmaritime.com January 4, 2008 Board of Southold Town Trustees Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Re: Dear Sir/Madam: Jim & Sue Sweeney, 2950 Mlnnehaha Blvd., SCTM # 87-3-42 Permit No. 6288, dated February 15, 2006 Request for One (1) Year Extension In reference to the above permit I am requesting a one (1) year extension. I unfortunately have encountered delays in obtaining my other required permits that have delayed my accomplishing the work approved by the Board of Southold Town Trustees. I have enclosed my check in the amount of fifty ($50.00) dollars as directed to cover the request for an extension. Should you have any questions please do not hesitate to contact my attorney, Ms. Patricia Moore, or me as soon as possible. Thank you. Sincerely, 2.~D J~nes P. Sweeney ~ CC: Ms. Palricia Moore, Esq., 51020 Main Rd., Southold NY 11971-4616 Mr. Rob Lehnert, Boulevard Planning, 32645 Main Rd, Cutchogue NY 11935 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 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 V/Pre-construction, hay bale line __ 1st day of construction ½ constructed V/Project complete, compliance inspection. Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. ~--~ DATE: Feb.15,2006 ISSUED TO JIM AND SUSAN SWEENEY Ailt'l rizati n Pursuanf to the proVisions of Chapter 615 of ~e ~ws of fha Sta~ of New Yor[, 1893; and ~apfer ~ of ~ ~ws of the Sfafe of New Yore 19~2; and fha Soufhold Toen OrdinanCe f~d ~'~U~TINO AND -~E. P~CINO OF: OBSlRUCI~S IN AND ON TOWN WATERS AND PUBLIC ~DS and ~NDS UNDER TOWN WA~RS;,... and m aCc~dan~ wd~ 'fha Resol~ion of The Board adopfed afa meeting held on 2~06_...._., end in consideration of fha sum of $~.5.0.~.~ ......... pa~d by JSm and Susan Sweene~ ............................................. ................................................................ .....-~ ......................................... , of ....... ~}~ ......................................................... N. Y. and. subjecf fo fhe Terms and ~ndJfions Ilsfed on lhe reveme side ~reof, of ~uthold Town Tr~ees aufhorlzes and permlh ~e following: ~etland PermSt ~o construct a second floor add~tSon wSth cov- ered portch to the ex~stSng single family' dwell~n conditSons of a sSlt *~ ~ ~ ' g ' th~ ..... e anu a ro~ o~ staked haybaies, dry~eI to co,tarn roof runoff and a 15* ~onturf buffer landward?f the a~ in a~ordance wlih the defa~ spoliations es p~nfed m .~e oda]~fln9 app~f]~, ex~st~ng retasnSng wall and the re- moval of Ehe green fencSng along ~he water and all prepared IN WITNESS WHERE', ~e said Board Of Tmsfees ~re- by ~m, i~ ~r~rafe Seal lo be affixed, an~ ~ese presen~ ~.su~ed by ~'m*j~ of fhe sald ~rd .es of ills date. by ~ouzevard ~/ann~ng East dated~/28706. ~ / .__~ave Bergen >stain) . ~eg .Dic,kerson TERIvlS and CONDmONS Jim and Susam Sweeney 1. 'glut ~u~ ~d .Bomi o~ Tn,a~e.s ~ the Toga o~ So.hold ~e ~ele~d ~mm ~ny ~ loc an extea.fion may be made to ~he Board ~t ~ I.~.~ a.~., That ~hl~ pennlt ~hould be retained indefinitely, or ~ long as the said Pe~nlttee wtshe~ ~.~.r.i~ the ~mctu~e or project involve~ to provide evidence to tnyone o0ocemed due ~ ~tion was otlghully ob~ That the wod~ involved witl be s~,ject to t~e ~ a~! app~'ov~ of ~ ~ent~, a~l ~-compl~mce with t~e p~ov~o~ of the or;~,*~ ~plicattoo. may I~ t~cation of d~;.: p,~,~¢ by re~olutioa of the s~id 5. ~ there will be no um~c~x~le intetfe~oe with navigation ~s a ze~lt of the ~ ~t~o~z~d. ' ' ~ d~e ~ot~ to remoye o~ ,lt~ this wo& or project 8. T~at the sald Board will be noth"ied by the Perml~tee ot tt~ ~ul0doo.i~f the work ~ 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 February 15, 2006 Boulevard Planning East 32645 Main Road Cutchogue, NY 11935 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Re: JIM AND SUSAN SWEENEY 2950 MINNEHAHA BLVD., SOUTHOLD SCTM# 87-3-42 Dear Mr. Lehnert: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, February 15, 2006 regarding the above matter: WHEREAS, Boulevard Planning as agent for JIM AND SUSAN SWEENEY 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 January 9, 2006, and WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and 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 February 15, 2006 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, 2 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 JIM & SUSAN SWEENEY to construct a second-floor addition with covered porch to the existing single-family dwelling with the conditions of a silt fence and a row of staked haybales, drywells to contain roof runoff, and a 15' non turf buffer landward of the existing retaining wall, and the removal of the green fencing along the water, and all as depicted in the plans prepared by Boulevard Planning East, P.C. last dated 2128106. 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: $100.00 Very Truly Yours, James F. King President, Board of Trustees JFK/hkc 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 TO: BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated / / ~/Og reviewed by this Board atthe regular meeting of ,~. / / £ ? o~ following action was taken: has been and the ( b~)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 Chapter 97 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: ~ ~(Z) ~% ~te i~s~¢c~¢¢ TOTAL FEES DUE: BY: James F. King, President Board of Trustees James F. K/rig, President Jill M. Doherty, Vice-President Pegg~ A. Dickerson Dave Bergen John HoZzapfel 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 Southold Town Board of Trustees Field InspectionJWorksession Report Date/Time: ~ Name of Applicant: Name of Agent: Property Location: SCTM# & Street Brief Description of proposed action: Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Front Bay Front Distance of proposed work to edge of above: Part of Town Code proposed work falls under: __Chapt.97 Chapt. 37 other Type of Application: Wetland __Coastal Erosion __Amendment __Administrative __Emergency Info needed: Modifications: Conditions: Present Were: __J.King __J.Doherty __P.Dickerson Other: D. Bergen__J.Holzapfel Mailed/Faxed to: Date: Telephone (631) 765-1892 Town Hall 53095 Route 25 P.O. Box 1179 Soathold, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Wed., February 8, 2006, the following recommendation was made: Moved by Don Wilder, seconded by Jack McGreevy, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland. Permit application of JIM & SUSAN SWEENEY to construct a second-floor addition with covered porch to the existing single-family dwelling. Located: 2950 Minnehaha Blvd., Southold. SCTM#87-3-42 The CAC recommends Approval of the application with the Condition of a 10' non-turf buffer landward of the retaining wall. Vote of Council: Ayes: All Motion Carried ~ ~ ~,~ ; ..... 087 Albert J. l~rupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Tox*~ Hall 53095 Route 25 P.O~ Box 1179 Southold, New YOrk 11971-0959 Telephone ($31) 765-t892 F~x (63 D 765~6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD ()ffice Use Only ._._Coastal Erosion Peznfit Application a,~/~/etland pefrmt Application ___ Adminish'atlve Permit AmendmeatdTrans fer/Extension _ __--..-5~R_ ec~-~d Application: Of ~ReceivedFee:$ c~_._- '~ ' - _~ompleted Applicati~~ ~._lnco~lete SEQ~ Classification: 'r~ I_~ II Unlisted C~rdma~on:(~tc sent) ~ 5~ Comistency As~s~e~Fom~ //~O~_ --_ ~AC Refe~ Sent: ~/O¢ _~Rcccipt ofCAC Rcpo~: ____Lead Agency Dcte~nation: TccMical Review: Public Hearing Hei~-] -~- Resolution: ....................... Phone Number:( ) Suffolk County 'Fax Map Number: 1000- _____ff 2 Property Location: ~_.~ ~"~ .~_d/') l J') ~ .J'} ~..~_ (~ovi~ LILCO Pole ~, ~st~ce to ~oss streets, ~d loc~ion) 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 Application _..-"-Wetland Permit Application Administrative Permit Amendment/Transfer/Extension -'-Received Application: --'Received Fee:$ Type I Type II Coordination: ~-'LWRP Consistency Asses: ]0-1TI JCAC Referral Sent: -.-'Date of Inspection: Name Address . ~2 ff f,~-- . Phone Number:( ) Suffolk County Tax Map Number: 1000- ~ Propegy Location: X ~P ~]D] _ (provide LILCO Pole 8, distance to cross streets, and location) (If applicable) (/ Address: -~ 1~/~/' .//)/~'~ /~:,r! c~ Phone:(..~ ~/ ) /'~2~'/' c)O/ / ~rd of Trustees Applicat~ Land Area (in square feet): Area Zoning: GENERAL DATA 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): · rd of Trustees Applicat~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of;vetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: ~ 14' feet Closest distance between nearest proposed structure and upland edge of ;vetlands: feet Does the project involve excavation or filling? /~ No Yes If yes, how much material will be excavated? How much material will be filled? cubic yards Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: cubic yards feet Statement of the effect, if any, on the wetlands and tida[~aters of th~ ~9wn that may result by reason of such proposed operations (use attac~em~ if appropriate): ard of Trustees Applicat COASTAL EROSION APPLICATION DATA Purposes of proposed activity: 0 ~c~ Are wetlands present within ! 00 feet of the proposed activity? No //~ Yes 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? _(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) ,? · PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS STATE OF NEW YORK COUNTY OF SUFFOLK ......... I~ing duly swm'l, doposes and says tl~at on the _dayof J'~r~ R~ ,20~',deponemmailedatmecopyoftheNotice set forth in the Board of Trustees Application, directed to each of the above named persons at thc 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 at ._~v~.9 ,, ~ , that said Notices were m~_ailedjo each of sgid"persons by Office (certified) (registered) mail. ~'~~ 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~~ 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 I, ~6/-~'r/ ~/~'f'xL , residing at ~,,~2"4~~- being duly sworn, dcpose~d say: That on the.~ day oft~t( ,200g, I personally posted.the property knqwn as by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Dated: Sworn to before me this day of ,~-.,~ 200F~, of Trustees Ap~ ALVfHORI ZATION (where the applicant is not the owner) (print owner of/property) (mailing address) ~// ~ /~ do hereby authorize (Agent) /J/~w~J~ ~ to apply for permit(s) from the Southold Board of Town Trustees on my behalf. 8 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) SEQR 3.PROJECT LOCATION: b~ Mun,¢ipality :O"~ ~ ~/~ PRECISE LOCATION: Street Addess and,~ p~Road, In ersections, Prominent landmarks etc -or provide map ~oO,fication/alteration ~ ~ W~,, IS PROPOSED ACTION: ~ New ~ Expansion 6. DESCRIBE PROJECT BRIEFLY:. 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 bdefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply) E~Residential E~lndustdal [~Commercial E~Agriculture E] Park / Forest / Open Space E]Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM,ANY OTHER GOVERNMENTAL AGENCY (Fedoral, State or Local) ~M /~ ]¢! ~¢~C'j,/~l~/"~'rr5 ~Yes E~No If yes, list agency name and permit / approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMit OR APPROVAL? ]Yes [%Z~No If yes, list agency name and permit / approval: 12 AS A RE,~ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? E]Y.s CERTIFY THAT THE JNF~)RMATION/,PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE 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 617.47 If yes, coordinate the review process and use the FULL EAr E]Yes E~No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 61767 If No, a negative declaration may be superseded by another involved agency. EZ] Ye, []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 traff~c pattern, solid waste production or disposal potenfiat 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 briefly: C4. A community's existing plans or goals as o fiiciaiiy ad~piedl oia ~h~nge in use ~; intensity ~ ~se o~ land or other ~atucai resources? ExCain briefly: C5. Growta, subsequent development, or related acfivities likely to bo induced by tho proposed action? Explain briefly: D C6. Long term, shod term, cumulative, or other effects not identified in C1-C57 Explain briefly: WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? I! y? explain: PART III - DETERMINATION OF SIGNIFICANCE (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 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. 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 EAr and/or prepare a positive declaration. Check ihis box if you have determin~dl based onthe ihformation:andan~lysis'aboveand any supporting documentationl that the proposed acfior WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thh determination Name et Lead Agency Date Title of Responsible Officer Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) Board of Trustees Application County of Suffolk State of New York 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~. SWORN TO BEFORE ME THIS { DAY OF 0~'~(... ,20 0 ~ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of to~¥n officer~ add emplo e~s. Tile purpose of this form is to prgvide information which can alert, the town oflx3ssible conflicts of interest and allow it to take whatever action i_s necqssar~ to avoid same. ] ~ //') . ~ (Last name, first name, middle~init~ you~eae applying in the name of someone else or other entiq,, 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 (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 interesf? 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 ~ 1 f you answered "YES"~ complete the balance of this form and date and sign where indicated. Name of persoo 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% oftbe shares of the corporate stock of the applicant (when the applicant is a corporation); 13) the legal or }~eneficial owner of any interest in a non-corporate entity (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 1 Signature__~ . . Print Nam ~r ,e tl et' Town o~ 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 Tovm 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 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 explained in detail~ listing both supporting and non- supporting 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.nortlffork.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 PROJECTNAME FFI~ /'(~,O~C ' f ( d, / // ~ The Application has been submitted to (check appropriate response): Town Board ~ Planning Board ~ 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 ofaction:~ .t,. i ~'//t~,r l~ ~/../i,; Site acreage:_ Present land use: Location of acfion: ff Iff-OX//~/~r'~ /~ Ag 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: (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 ali 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, mikes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III -Poli, cies; Page 2 for evaluation criteria. 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 [~qot 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 A~cable 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 III - Policies; Pages 34 through 38 for evaluation criteria. Yes [-~ No VI 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 Altach additional sheets if necessary WORKING COAST POLICI~ 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 necegsary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. [] 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 energ~ and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. [] Yes [~ No [] Not Applicable PRE.ARED BY~ TITLE ~'g~/¢~¢ DATE SURVEY OF PROPERTY A T LA UGHING WA TER TO WN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK 1000-87-08-42 SCALE: 1"=20' JUNE i5, 2001 Sep/. 25, 2003 fcerfifk:~7!~ons) SEPT. 26, 2005 ~/0/f f~tS6 \ CERTIFIED TO' MERRILL LYNCH CREDIT CORP. NATIONAL LAND TENCIRE 980l - S - O~ Proposed Second Floor Addition · At The Sweeny T~-,o~ o~,~,,e~,,v. ~ °~:~ k~ Residence =_~o~o~,~.~. M'i~eh~a Blvd. 72.5 - ~ISTi~G SPOT E~V. ~ISTIN¢ WATER .m~ ~,~ ~~~ ,,~) ~, S.C.T.M. ~ I000-87-3-42 ~ ~VISIONS DATE; ~OR TRUSTEE5 ~AR - 2 2006 NOTE: , ALL GU~E~ LEADE~ Wl~ DE A~AGHED TO DR~ELD TO CONTA N ROOF RUN-OFF {l,~ BO~EV~ PL~O EAST, P.C. ~C~CTS ENO~EERS 32645 ~ RO~ C~CHOG~, N.Y. 11935 Tel~hone 6~ 1-7~4-2011 6~ 1-7~&2276 htemet: ~blvdplm.com DA~: 12-%05 DR. BY: F~ SC~E: AS NOrD C~: J.~. ,,, 0543 sP- ,SITE,'AND ZOlqllqO DATA TOTAL · BOTH 611~E,~ "3~.O P'T 31, 2 FT 21.2 PT