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Home My WebLink AboutTR-6335A 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 # 0288C Date Januarv 7. 2008 THIS CERTIFIES that the single-storv addition to the dwelling At 1825 Truman's Path, East Marion Suffolk County Tax Map # 31-13-3 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 3/24/06 pursuant to which Trustees Wetland Permit #6335A Dated 4/19/06was 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 single-storv addition to the dwelling. I The certificate is issued to JENNIFER GOULD owner of the aforesaid property. r-~~ Authorized Siguature . . 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 Permit No.: 6335A Date of Receipt of Application: March 24, 2006 Applicant: Jennifer Gould SCTM#: 31-13-3 Project Location: 1825 Truman's Path, East Marion Date of Resolution/Issuance: April 19, 2006 Date of Expiration: April 19, 2008 Reviewed by: Board of Trustees Project Description: Construct a single-story addition to the existing dwelling; with removal of "stoop" deck and cellar entrance and all as depicted on the plans surveyed by John Ehlers revised 3/21/06. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth by the Board of Trustees. Special Conditions: Final inspection If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth by the Board of Trustees, a Wetland Permit will be required. This is not a determination from any other agency. J,me, F ~:.;;i Board of Trustees . . 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 Pre-construction, hay bale line 151 day of construction '12 co nstru cted vi Project complete, compliance inspection. . . 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 Southold Town Board of Trustees Field InspectionIWorksession Report Date/Time: Y - 12 - 0 0 Name of Applicant: Jg,." "0- GnJWJ Name of Agent: ~ Brief Description of proposed action: A-cU ,+. <5Y' T 11A~ f tA1h t t>>-f (YlcA/\..Ml,N A-J,"-""""Mhv<. f~f Property Location: SCTM# & Street 3) - 13 - 3 Type of area to be impacted: v< _Saltwater Wetland _Freshwater Wetland ~Sound Front _Bay Front Distance of proposed work to edge of above: P3}i of Town Code proposed work falls under: .L.Chapt.97 _Chapt. 37 _other Type of Application: ./ W etland _Coastal Erosion _Amendment _Administrative _Emergency Info needed: ~ kJ O\c-t Ih. ~ IhA \ e Modifications: Conditions: "Present Were: _I.King _I. Doherty _P.Dickerson _D. Bergen_I.Holzapfel Other: " MailedJFaxed to:' Date: I I ,I' :1 4-- + ...." 4- ~ I rl n o I -c=.-----z I ~ ~ ~'" "''''12 "-0 ; i Po .' < Ii ": lllj ~p. 'l ~ I it ~i ~ ", ,I . ej ~ ! a.!:;)~ ~~i, i!5-1. >-~.~ -~~ ~~~ G !d w w II' ~ is i~ ~ ~~i III " li! '", "lir, ,'I I 11111 ~i t m M.I (jjl Iii p~ .q II. I" ,II I ~ . III ,,, III III !l::!' . dl !L I~i Ii .I, 'J' id f, . 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: 'S e.v., \u- BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD ~l"" Please be advised that your application dated reviewed by this Board at the regular meeting of following action was taken: 31;).4/0(" '-1/19/0(, has been and the ( /) Application Approved (see below) L-) Application Denied (see below) L-) 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: r ~ So L. "0'\ '0'1~"'~ ~~\~i\O B1 TOTAL FEES DUE: $ S'D j,> BY: James F. King, President Board of Trustees SURVEY OF PROPERTY SIlVA TE: EAST MARION TOWN: SOUTHOLD SUFFOLK COUNTY, NY SURVEYED 03-30-2005 TOPO ADDED 01-21-2006 PROPOSED ACTIONS 03-21-2006 SUFFOLK GOUNTY TAX # 1000-31-13-3 CBRTIFJIlD TO: Jaime. ~ leImifer B. GoaId O-....--.~...JIhLlmd 'l1de Il.u._ C'"""I""'Y <Q~ ~ %C?. 16"t Qr;!' r'!:Tf: ,..,..""'1. APPROVED rw BOARD OF TRUSi ::,:3 TOWN OF 50UTHOlD :( /9?-tXJ& p:, N W4-E S / , ..1. / 00 ~~~ ~. 00' ~ ~.,. ry ~ / (:, \ ,,'<'" / """'~ c...:Vd00 ">,J \ ~" /oq~ "l /(.1] ~~ '".~ - 4P' \ o...X" ~ ~/ T 7/ / /~-- --- / / / / 0 all / - , , , ..." '" ~ <..P 'Q ~ '=1 \I:~"" 0 u P-: \1::, (1':. f~~ "b ~ <: ~ 9- 7-'6 \S>i- ,., co ~..., o '" \S>q" s..~ ~~ ~J. ~ , , , , , , "-?9'. PROPOSED ADDITION (,~~ ~ #- LOT GOVERA6E TABLE ~ o CJ' /f/)~ // EXISTING HOUSE 14'l 5G FT EXISTING 6ARA6E 253 5G FT EXISITNG DEGK IB3 5G FT EXISTING DEGK 31 5G FT CELLAR ENiRANGE 21 5G FT EXISTING TOTAL 1,243 5G FT OR 16.11% EXISTING HOUSE 14'l 5G FT EXISTING 6ARA6E 253 5G FT EXISTING DECK 31 5G FT PROPOSED ADDITION 325 5G FT TOTAL EXISITNG AND PROPOSED 1,35B 5G FT OR IB.33% ;;; ;:D ~ L."...) // NOTES, . MONUMENT FOUND !"'" i ~.....,,\ . '. . -.-.... .'.' ;'Jit.':' "'''1' ",' . ',' i , .,~ , "~r1'; ..'0:~'~' . .. -. 'CfY:;,(<il " J~.,\---~~'\J,'ry ''''''''''l'''''''zed ",k.ot"~,,,,, "" oddlt'oo ,,, " "'~""~ rn<.>p t>e<r""l" ,><~"',.,,' k>>d ""'-V"'P'" "",,,, ;, 0 ~"""~""" of "'c';"" '20<'. ,vb-dl,I.I= 2, of lhe "",,,Y,,,. <.Ial" ",*,ca!IOO I.",,' FLOOD ZONE AS SHOHN ON FEMA FLOOD MAP "'-!MBER 36103c.0064 6 EFFECTVE DATE MAY 4, 1'1'1B 11/2 STORY FRAME HOUSE ROOF PEAK AT 20.5' ABOVE AVERA6E 6RADE ELEVATIONS REFERENCE N6\/D'2'1 C.E.HL AS ANNOTATED FROM GOASTAL AREA HAZARD MAP, TO""'N OF SOUTHOLD PHOTO No. 48-640-B3 SHEET 28-0 OF 4'1 AREA = 1,410 S.F. or 0.11 ACRE '00"J cop;.,,; '",m ''''' o.-I')rol o' lh', ."'"V~~ ...,..-""""lth~O<'91r<>'Df''''''''''''_v'''I'''-'' ~1""'P"d ""al """" "" ~"",,;de'ecl \0 be v(>Hd tn", "opl~~" GRAPHIc.. SCALE ~. .---- 1"= 20' ..- .~ I i ~~~~;~~ERS LAND ~~~;:.~;:~! i ~'3~~8~~~~.\\Compaqser\'~r\proS\O~5~1~~05-147!fI)_ .c.J ..c"cl;j~.o"o"" 'cd',Qt"" '''''''0'' ~iq"'~ '''<>\'0''' .,.."v"~...,,, peep"'''''''' ",,,.c,,,h..,c,,, ....~" ''''' e,,_ "''''g C"de 01 f'c.x"'.e 'or L"""'''''''_"" (>dop'"'' "'J 'he ~~" ~"'~ '?l.xe "",,0""'''''' of P,-a,,,.~k""" Leo,'" ""'veo;nr.. Said ,,~d;H~ot""'" """" ,,'" """l lot""pe"onlm."."''''ihe"....-v~l.pr..""....O. """'00 hi,,,,,,,,,,,, to 1M l'"'" <Dn'f'<"'j.9",....."""". '''''''l''''''4CO''d 1~"";"'J;"";'"';a"J""~"'_"""",""d Co lhR a&6"""~~ of !he "'od'"':l.....Hl"""'. ,-",Ulka_ "=",.,,,"oll"""'BCablet"~""""""""""""" James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel Town Han 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 'J"e.v.. ~ ~lA' Please be advised that your application dated reviewed by this Board at the regular meeting of following action was taken: 31-;).4/0(, t..{/lq/o, has been and the LL) Application Approved (see below) L-) Application Denied (see below) L-) 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 rnust be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: .,- ~ So \i06-' \,.-, s'f=-\--."'" " JENNIFER B. GOllLO ATTORtiEY AT tAW P.O. BOX In'' GREENPORT, NY 11944 7054 PAY ~~~~ OF .~Vo rd . "Tow/) -:r11.l'Sk:l>.s' -F ;+f,,/ OI^,d 00 !ie?; -". . . .~ North:Fork Ba'nkv' I . www.nortbforkb8nk.com. . .: FOR om -?"I- )3,- 3.--rl:(/~ p'YJ7,t---(,t..lOf/ lYJ~I'IIUJJ ....~j) 11"0010'51<11'" ':'0 C ~..O 1 q Ii c.:llrl C:i!."'''00 r1l:." "II" DATE 4. -22:- Ola .7911214' I $.50:6b-~: . ". .:- i</'. .. l?QI;A~ ffi =- --- ~64 ... ..., KENNETH L. EDWARDS MARTIN H. SIDOR GEORGE D. SOLOMON JOSEPH L. TOWNSEND . MAIliNG ADDRESS: P.O. Box 1179 Southold. NY 11971 . PLANNING BOARD MEMBERS JERILYN B. WOODHOUSE Chair OFFICE WCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold. NY Telephone: 631765-1938 Fax: 631 765-3136 PLANNING BOARD OFFICE TOWN OF SOUTHOLD To: James King, President Members of the Board of Trustees AP R 1 i. LvJ From: Mark Terry, Senior Environmental Planner L WRP Coordinator Date: April 17, 2006 Re: Request for Wetland Permit for Gould/Williams SCTM# 31-13-3 GouldlWiIliams request a Wetland Permit to construct an addition on the north side of the dwelling. SCTM#31-13-3 The proposed action has been reviewed to Chapter 95, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (L WRP) Policy Standards. Based upon the information provided on the L WRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the L WRP. Pursuant to Chapter 95, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. . . , Albert J. Krupski. President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson . . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application /' Wetland Permit Application ~Administrative Permit AmendmentITransfer/Extension --e:Received Application: ,~(ri-I./I ~ ~eceivedFee:$ SO ~ ~ompleted Application :", \~ Lt I ~ _Incomplete SEQRA Classification: Type I_Type II_Unlisted_ 't101~ _Coordination:(date sent) lWltf' _LWRP Consistency Assessment Form '>11\1 ~ CAC Referral Sent: -"'Date ofInspection:~ _Receipt of CAe Report: _Lead Agency Determination:_ Technical Review: ~blicHearingHe~ Resolution: MAR 2 4 2006 Name of Applicant JPnflifer ~. t90c..tcJ Address P.D. l!.D~ I" @re~(lporl. 1..)'/ /1C,q..4 Phone Number:(b'l.. 4T7' r,.foO, Suffolk County Tax Map Number: 1000 - 3 1 - J 3 - 3 Property Location: IS :;1.0 o...r k./a.- 1 'is "5 -rruWlll VI' ~ Pct+~ ECI!Jl- VY1a~,'Ov\... tlS;l,S' ffot>1 'll-tE'r.sec-t.oYl (.0..>...,.", .s~ fou-k. ~~ n _(provide LILCO Pole #,distance to cross streets, and location) AGENT: ()D()~ (If applicable) Address: Phone: ~ Board of Trustees APPli~ion GENERAL DATA Land Area (in square feet): I,LlIO 5.F Area Zoning: ~t) Previous use of property: re,:>i d-f'rJ+,'o.l 5,'/) 9 'of ~ vYl'/'J rl 11)(>1111'15 c:. U)'jtD -fa1'l1,1" ot well l'll~ Intended use of property: (F~ 1 d-e >1+,' Q I Prior permits/approvals for site improvements: Date I ~'2 fro Cj '; (; (M<t{Q-/i,1~r fll'rl)l,'+ -+0 r.f>pl(lC~ Ioe. ItkQC(d.. cl a Y>'lCtCj'f'& 10'1 .s+orvv> -it- 2 -IQq-:;'1 So<.rth::>lclTo"",,, &hld,nl;t ~. 5-?'4-<!1 c1orlY}('rD.dd,~.,oV) --/-0 f",t..''':>f,'y1(1 ooe-0YY1,(y dWl'/IlflS 50ut1IYl'd b""" &.{d,";"l ~p+ 11- I-'ls~ 'PIP (',0 -11- Z - '~~11o f:, r . s'(Ic;lL-f'C4,,"I'j c1welll"CJ, a(C~s!o",,'f ~C>""'c;,e; ~f'5-fO J.oIarl-t . Agency Sou-/-t,nlrl Tow 11 /{'u <.J<<J .... _ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ----y..- No _ Yes If yes, provide explanation: Project Description (use attachments if necessary): s; (l~ la. .!:sTar" Q d d ,-{," on -to Pf-i's+..ng dl..'-Hlr'r1lj} L0...tit1 r~vY'l~\lal of "s-fa1f" rlPr(c. C I 'is~ ~,F.) a~d (-erlo,- e>'lfm;1C-e (27 $.F) 7,opo:.<'cl a-ddrt-.l>1I I'~ ~~h S,t:, roWf'Vl'r. ,'f7c,.eCl~ IV) lei (b1K',-o.~e. S. F_ ;:, o{)I'f 115 S.~. E'lC.,t'~I'I1'j b-t covero.c;,e ,. ':l 1,2.43. S,F. j>'opo5?J Io-t COV'fltlge .'::. () ~!;'i5 oS, f. 5ef2- SlI'\)f'9 \.D-+ (O\X',o'}f' -tClhle.. ~ Board of Trustees APPli"'ion WETLANDrrRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: S,'flq(e 9+or~1 aclc!.--I,D>'1 -+-0 I V)(rfl1~e .. Si'U. of .e'f-i5-h'fl~ k:-tt:'1.w >'1 QAd I !>f-floor ~tiro()Nl. ee r~IOt1 0-1' ~Cl~e e~\':.t.n~ 1*-[100, .bf'drooM I E'~l'o;rl,ll~ bttf/tlrooolYl Odld f'rtt,,!WCl\, +D dl.Vf'III"~_ Area of wetlands on lot: app{D-J... 2nD square feet Percent coverage oflot: 3 % - we-t-IClflcl ~ Closest distance between nearest existing structure and upland edge of wetlands: ~ D feet Closest distance between nearest proposed structure and upland edge of wetlands: 59 feet Does the project involve excavation or filling? y. 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: feet t0b+ aff '.('Cob\.c.... Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlllllds and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): 'Pf-::>POPd Cldd'-/I'on i':> lat1d\~)ord Ql'1d ~U){lf'{) ~'kIS-f"Ilca- dwel/l(}S at1a t1CC-eC,SO{!y BUdd'lllj.. 'l'f~fE'pt~ na~ ~ bulKheaded -6, appr()~/(y)IA*"j bD <--I-ears_ . 617.20 PROJECT 10 NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 - PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) SEQR 1. APPLICANT I SPONSOR 2. PROJECT NAME T..f'fllI .;Ji> r P-., OOu I cl.. Gould f l.Od','arns Adtl,.4-,'o IJ 3.PROJECT LOCATION: Municipality SJ u-Itbl cl TOwV') County of S"fful Ie. 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks ete - or provide map 1'ls?S In.lWlc.ly1l!, p~, t:a!,-t Man'Ov'l, ~'1 SCTlM -# 1000- '31- I ~- '3. l'll-Wr~ef.b.... - s-toJe I?ocrl€. .?!> 5. IS PROPOSED ACTION: 0 New ~ Expansion o Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: "P r 0 rose cl S..,J '":l'~ s+o f '-/ a.dd,-I,O{) ,.? ICilt'ld WOrc/ ~ tx>-I-wep V'- e~I'Sh'(19 dw.eIl'flS - ~Vl tt a rc'P,l,S u r'i loud d IVl'Cj 7. AMOUNT OF LAND AFFECTED: .11 Initially . II acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? DYes ~ No If no, describe briefly: '1' r Djec-t I1"Glll,r{>.J, Q{I a r-eC\. vCl n'tVle(.. -r~ r S,'do(' 'I().rcl s..ffba(~ r._ 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ID Residential D Industrial Dcommercia' DAgricu,ture D Park I Forest I Open Space DOther (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) U ~ ~Yes DNa If yes, lisl agency name and permit I approval: IV'iSO-EC,> AIM'! rOt/,$ of f'JI)'?JI;1+('r'll.0Gl,,,..r 00{ ju,,'~d,ctlo" k'4lPr) 5:>~ld 'Pu..>1l BUdd'll" 'D4>p-t ,).. &:'00,,01 of ilffeCA.Ls 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? DYes ~NO If yes, list agency name and permit I approval: - 12. AS A ~ULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION? Ges No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant I Sponsor Name ::Tf'v')t'l": ~6:>(Jld Date: 3-;)'4-l00b Signature ut 7V1/VV1 f\ A A v ~ J I 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 comoleted by Lead Agency) A. DOES ACTION EXCEED ANV TYPE I THRESHOLD IN 6 NVCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. DVes ONo B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NVCRR, PART 6176? If No, a negative declaration may be superseded by another involved agency. Dves ONo 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: I I CZ. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: I I C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: I I C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: I I C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: I ^ ~^^ I C6. Long term, short term, cumulative, or other effects not identified in C1-C5? Explain briefly: I including ch.maes in use of either uantitv or type of enerQY? Explain briefly: I Cl. Other impacts I I 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: I o Ves 0 No I E. IS THERE, OR IS THERE L1KEL V TO BE, CONTROVERSV RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain DVes DNo I I PART 111- DETERMINATION OF SIGNIFICANCE (To be campleled by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effecl 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, thedetermination 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 FUL EAF and/or prepare a positive declaration. ___ ___ n_______ _ __ ____n__ Check this hoiTfyou-have -delermlne-d~ based ordhe -information and analysis above and any supporting documentation, that the proposed actio 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 rypa Name of Responsible Officer In Lead Agency Title of Responsible Officer Signature of Responsible Offk..er in Lead Agency Signature of Preparer (If different from responsible officer) . . Board of Trustees Application County of Suffolk State of New York ::Jhlr'l,f€'r P->_6'otllcl 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. SWORN TO BEFORE ME THIS [). Lt ~ DAY odv{ Q ('~ 200\0 '- On Notary Public UNOA M. rotMs NOT~RY~. STATE OF NEWYllIlK TERM~'RES~~~~ . . APPLICANT/AGENTIREPRESENT ATIVE TRANSACTIONAL DISCLOSURE FORM The Town of South old's Code of Ethics orohibits conflicts of interest on the Dart arroW" officers and emolovees. The numose of this fonn is to nrovide information which can alert the town ofoossible conflicts of interest and allow it to take whatever action is neces.c;arv to avoid same. YOUR NAME: ~ y) I~r B. ooulJ (Last name, first name, -I;11iddte initial, unless you are applying in the name of someone else or other entity, such as a company. Ifsa, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Varianee Change of Zone Approval of plat Exemption from plat or official map Other (If"Other'., name the activity.) Building Trustee Coastal Erosion Mooring Planning )<.. 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, rnarriage, Of 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 x , If you answered "YES", complete the balance of this fonn and date and sign where indicated. Name of person employed by the Town of South old 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 applicant (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, partner, or employee of the applicant; or _D) the actual applicant. DESCRIPTION OF RELATIONSHIP Fonn TS 1 . . JENNIFER B. GOULD Attorney at Law 210 Main Street - P.O. Box t 77 . Creenport, New York t 1944 Telephone 63 t -477-8607 . Fax 631-477-2601 March 24, 2006 Southold Town Board of Trustees 53095 Main Road PO Box 1179 Southold, NY 11971 MAR 2 4 2006 RE: Application for Southold Town Trustee Administrative Permit Premises: 1820 a1k/a 1825 Truman's Path. East Marion. NY 11939 SCTM # 1000-31-13-3 Dear Board of Trustees: I am the owner of the above referenced premises and submit the enclosed Application for an Administrative Permit, along with an original survey prepared by John C. Ehlers, dated 3/30/2005, with topographical data added 1/27/2006; and data regarding proposed addition added 3/21/2006. The proposed construction is a single story addition landward and between the existing functional single-family dwelling and accessory building. As depicted on the enclosed survey, the footprint/lot coverage of the existing structures is 1,243 S.F; the proposed lot coverage/footprint will be 1,358 S.F, an increase in total lot coverage of 115 S. F. Should you require any further information, please do not hesitate to contact me by telephone at 631-477-8607 or at the above address. Hand - delivered JENNIFER B. GOULD Attorney at Law 4- I~-W()lc /I.Q'. '3,1'1~-S 1& 2. <;' -r NvvlUvl' <, POJ In> t rYl. L0 l.I rfVl- ('lJ{Y)pla,pJ. L. LV R-P 0 lid So Ur-.R~ I ()rJ"Cof,t? c.y. COAstAl eeos/o/) h~ (7iIM . ~~ 210 MAIN STREET P.G. BOX 177 GREENPORT, NEW YORK 11944 TELEPHONE 631-477-8607 fax 631-477-2601 Town of Southold . . LWRP CONSISTENCY ASSESSMENT FORM A, INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of South old 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. 2. 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). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the L WRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, Iistine: both supportine: and non- supportine: facts. If an action cannot be certified as consistent with the L WRP policy standards and conditions, it shall not be undertaken. A copy of the L WRP 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# 3 I I ~ - 3 Gould {Wt'I/"Oms. fld1Jrfl'o/l-to APR \ 3 2006 ~lder1C€... PROJECT NAME The Application has been submitted to (check appropriate response): Town Board 0 Planning Board 0 Building Dept. 0 Board of Trustees ~ I. Category of Town of South old agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) o o (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: ~ add,t,'o'iU dW~lIi tI ((pro u~ j:..:-rct?f>" ) W.p~ &::rI roo","". fScrlWroom e.j..l!>+>()~.::>t? l~+ flOor,' Dv1d -:Me!.f- ill I Location of action: I. TrUYY)(.Il'l' ~ Pa-tlh . & mcu,'o fV. (Q (ll Ifs-20) Site acreage: 1410 .s.~. Present land use: sl'n~l~ fOwl, h., r1WP/l"(1) ~- 4 () Present zoning classification: 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: JPf>(),' fl'r 13>. Gnul C/ P. O. 8:.0'1.. 1,7 Gr~"'~d. tv'( 11'14-4 (b) Mailing address: (c) Telephone number: Area Code (b~( - 417 - St, 0 I (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes D No [i] If yes, which state or federal agency? \,JCl,'IJE'r o.f j ur,'.sd f'c-f,'O~ I'f"f<<>r frot'Y'J tJ '/5> Dee oM,'C. t'~cJ aI!. pro~t.-i'f i'::. bill K/.tQodE"" tit'! cl ero~ cO,.1!5truC:t,tlvf Crl Irs I e(-evCt'/.o..., CO(jTO\J.r..,. londV>fu.rel of 0<.;~dl!!J LR,9QJ .$fra::t~ c, Ev-aluate 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 L WRP Section III - Policies; Page 2 for evaluation criteria. ~Yes D No D Not Applicable ~ IA ~;-t~~ d~~lr~:w;tl);~~~..~~/~'/:t rJ~~~l'tl~~.. -f,'~~,t\~Q{'~n 1'tY1ff~ ~~~\~~~I;'~~CJ:" rp~~I:r~~~r~; ~~~N~,'rl~\~J ~ii~,!3fSOS. (,... or.' , -, I V>o +In . 0 /J "rI Attach additional sheets If necessary ~o.r/..1 Clo1 01 I CJ(C{J-ff"::)I'1+ "I v..H'If,rl1S. 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 D No D Not Applicable ~,.s I'~ 0- ~d~ -t~~.? ;7<.I'~? t:rt1-fr~M D=t: w.1f ,'nr,.~ ('JIM' e b " S. T+ ,'~ Q SI .:.9br""l ndcl,.J,o.ll .bMIIW'OVl e^"~:()('1 dwell,,'J~ d- ~0V't1('~~ VIIn,r)" wdl ~O.,. '/,w t"WlADJ...... -t-IILD SLlbJp,,", 10+ ~;yJ pr-PSPe.ve<" -H.u1 rlAara.cJ.er 04- -t~ 1\W"Cjl.1ln...rh'noL 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 Iil Yes 0 No 0 Not Applicable ~;fb~'i\1) ~h/r ~Ylt1~~ ~,,~~ lfj~ri~ ~ G~ + t-le~hb:l{~ol c.., d ,-t'll .'~ Co ,hi . . " .II c. '9;(hftz;j;J~~';t. .fie,. ~d f-r~v.(;IoJ''''''lJ (ldd.-t..",1I'I tXlI/l ...,0.{ <.!:><J€~lAolvYI _____~ ___ ,1/}jP~"'-Il. ,..,rl-~ c::;./"'ovliC- (lr v"~u..cJ 't;'Mt'""'f ".., s."IoJ~d '101 .or 11 rI ,- (JCfl ,oM ~ ,.p I'CI In knr I 0+" ~dditional 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 6U Yes 0 No 0 Not Applicable A ~1?U(,f(Jrc'-I {)(O'S, C.A Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See L WRP Section III - Policies Pages 16 through 21 for evaluation criteria DYes 0 No [i]NotAPPlicable i'rli'SPN 1A?" tuO+ C'nrl a lie! ..f'ONa, bpd rO~MS ~r /o~;'~D~d:'jS. _ ~ .f I') Q~ I ..."1 IV) ~ d uH'\ t, r'l 'j -rJ1rr-P,' 50 p II b /I' C A')(J-/(> _ ltr-n __ _ ___ -tiN) _ 1St'<- ". "'0 ntld..h/)~l burda.... -1-0 -f'~IM.17!1 !i.f'p-t,c. S~sdoVlA. 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 L WRP Section III - Policies; Pages 22 through 32 for evaluation criteria. o o r~ !\Jot oPF I,cttb\t.. No 'XNotA.able . .~ ~ J}';i;':E~/;~' f~~ f{}";;;;,,;--n;;~:rt.:; ~~~ y. ro <=.J r- Clml>o?-l fa (DC II.. ~ ;l~ ~ /Cl i ~ I:Dv ~ ~~ <;paro I'- 1\.)0 P..t\~M,o..,~. Pr,?fW lA'''' ,,)0-{ "_-PL-r_ I ~_ prn_l.~~t~ rone,J-rd -(.'sh C>r ""'clll.{D Ho.h.<(aJsl fI, Ivri(:y~", '^"~ +,ri~1 ;A""T.r.;~ P('....~/ ('OIl<>rlr'Ar.,l..'"", ,. '], '\+ Ig.' p((>\Jrr{r04 (ltJrll).<_ Yes Attach additional sheets if necessary Policy 7. Protect and improve air quality in tbe Town of Soutbold. See LWRP Section III _ Policies Pages 32 through 34 for evaluation criteria. DYes 0 No ~ Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of South old from solid waste and hazardous substances and wastes. See L WRP Section III - Policies; Pages 34 through 38 for evaluation criteria. [$! Yes 0 No 0 Not Applicable f4'nova.~d /c.'1'rlAOIJ ,..),'/1 ,nc/ucla.. ~ allrl -AVl ~+.(?..c...."~ r-eC'~('/'r15 <:"f'~tPVo~ I - -rlQ c. /_ lo.rcllJ (,/~+ ~+-::: f!.; ,,,>, h ./S'ft.J/,L 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 L WRP Section III - Policies; Pages 38 through 46 for evaluation criteria. o YeD No~ Not Applicable . to (~ \. d\J t-JO W,;) . "/N(>("~r-€. LO.+L<. PlJbl.C QC'~ s.~ -{C\ ~Ch additional sheets if necessary clUl~III"Hr 0 rlcl LL',/( tvo+ hloet tV{' "Cjhtnn.' V,fw 0{ W~ r- Or bxt.0k.. * W:D-t\ll 0{ ~1~b(.>Cj dw~u,I)'1 ~/t?5 21 fc.oi . ~O~NG COAST POUCIi . P~licy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in 'suitable locations. See L WRP Section 111- Policies; Pages 47 through 56 for evaluation criteria. @ Yes 0 No 0 Not Applicable ~ro~~ ,'~ ~~~~ r'~ ~~ ~9~ ~~I~ 'h~~~ ~1:':, D.~I ( I '--:J "f f'YiJc>'''","v"" ::l::IAo \AJGbler.... ~(I~t' n-f Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See L WRP Section III - Policies; Pages 57 through 62 for evaluation criteria. DYes 0 No [i] Not Applicable \." SoD' P(bj~N =.tl "',..... of- \lv,,,,'::l vYlQr,vLR. o \Il1PQr-f, re So lLrt'O " ro,'YIY>'l{lt""(.O'cU .1. r9f rPr1J .11 'L lCM I Attach additional sheets if necessary Policy 12. Protect agricuIturallands in the Town of Southold. See L WRP Section III _ Policies; Pages 62 through 65 for evaluation criteria. DYes 0 No ~ Not Applicable Pr6'SPc-t ',,,, 1l0+ /;;:)('Chk>r1 01 (OihU'No.,.,,,, O.(J 1I t},.,'('ul-f:::~~ land... -fO("r""!J<lCq ,)'I -f"M"J. ~l-P,rlln__L<"Orl. CI >'l (] r 7/)'li ~r ;~:.... 0'''' ~vt)' .'-" +:> o.+rAOr ,ail.. us."". -rtw"" 's ~I:l 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. I)U Yes 0 No 0 Not Applicable PREPAREDBY~ QJA.TLE () W lotQ.r DATE 4 - f?:,-Zl)Cf..o