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Home My WebLink AboutTR-6460 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghoalo, 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 # 0387C Date December 3, 2008 THIS CERTIFIES that the raising of the existing dwelling 5', construction ofa cellar~ removal/replacement of decking and removal of shed At 1580 Leeton Dr., Southold_ Suffolk County Tax Map #58-2-5 Conforms to the application for a Trustees Permit heretofore f'ded in this office Dated 8/31/06 pursuant to which Trustees Wetland Permit 6460 Dated 9/20/06 and Amended on 11/19/08 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 raising of the existing dwelling 5', construction ofa cellar~ removal/replacement of decking and removal of the shed. The certificate is issued to CHARLES GEITZ owner of the aforesaid property. Authorized Signature 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 November 19, 2008 Mr. Chades Geitz 20 Dogwood Dr. Scarsdale, NY 10583 RE: 1580 LEETON DR., SOUTHOLD SCTM#58-2-5 Dear Mr. Geitz: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., November 19, 2008: RESOLVED, that the Southold Town Board of Trustees APPROVES the Amendment to Permit #6460 to remove the requirement of drywells and gutters on the existing dwelling, and contain the run-off in accordance with Chapter 236-Stormwater Management of the Town Code. This is not a determination from any other agency. Sincerely, Jame .~King, Pre~side~ Board of Trustees JFK:lms 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 Y/' Pre-construction. hay bale line ,,15~1,"). O~ __ 1st day of construction ¼ constructed ~/ Project complete, compliance inspection.to/q/O 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 1st day of construction ¼ constructed Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 6460 DATE: September 20~ 2006 ISSUED TO: CHARLES GEITZ PROPERTY ADDRESS: 1580 LEETON DR.~ SOUTHOLD SCTM#58-2-5 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on September 20, 2006, and in consideration of application fee in the sum of $250.00 paid by Charles Geitz, and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to raise the existing dwelling and construct a cellar, raising the house 5; decking to be removed and replaced after house is raised; and remove the existing shed, with the condition drywells and gutters are installed to contain the roof run-off and a line of staked hay bales is installed prior to any activity, and as depicted on the plan prepared by Joseph Fischetti, Jr. dated January 3, 2006. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. TERMS AND CONDITIONS The pernuttee Charles Geitz, residing at 1580 Leeton Dr., Southold, as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, Of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her Own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. That there will be no unreasonable interference with navigation as a result of the work herein authorized. That there shall be no interference with the fight of the public to pass and repass along the beach between high and low water marks. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Department of Real Properties Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. That the said Board will be notified by the Permittee of the completion of the work authorized. 10. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel Town Hall 53095 Route25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 September 20, 2006 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Charles Geitz 20 Dogwood Dr. Scarsdale, NY 10583 RE: 1580 LEETON DR., SOUTHOLD SCTM#58-2-5 Dear Mr. Geitz: The Board of Town Trustees took the following action during its regular meeting held on Wed., September 20, 2006 regarding the above matter: WHEREAS, CHARLES GEITZ applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated August 31,2006, 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, in accordance with Chapter 268, said application was found to be Exempt from the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on September 20, 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, 2 WHEREAS, the structure complies with the standards set forth in Chapter 275 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 CHARLES GEITZ to raise the existing dwelling and construct a cellar, raising the house 5; decking to be removed and replaced after house is raised; and remove the existing shed, with the condition drywells and gutters are installed to contain the roof run-off and a line of staked hay bales is installed prior to any activity, and as depicted on the plan prepared by Joseph Fischetti, Jr. dated January 3, 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: $100.00 Very truly yours, President, Board of Trustees JFK/Ims 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 reviewed by this Board at the regular meeting of following action was taken: 110 q laolo has been and the ( v"' ) 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: TOTAL FEES DUE: BY: James F. King, President Board of Trustees · . C James F. I~n~ l~'esiden~ Jill M. Doherlry, Vice*Presiclent Pegg7 A. Dickerson Dave Bergen John Holzapfel TOWN OF S01 Southold Town Board o~T~ Field lnsp ection/Works es~io: Name of Applicant: 2~xox t- [c 5 Name of Agent: Property Location: SCTM# & Street I~ ~ ' Br/efDescri;pfion of proposed action: ~ ~i ~ Town Halt 55098 Route 25 P.O. Box 1179 Southold, l~ew York 11971-0959 Telephone (63'1) 765-1892 Fmx (631) 765-6641 Type of a.rea to be impacted: Saltwater Wetland Freshwater Wetland Distance of proposed work to edge of above: Part of Town Code proposed work falls under: __Chapt 97 Chapt. 37 other ustees Report ~ound Front BayFron~ Type of Application: V/~Wetland __Coastal Emergency Info needed: -- 7 Conditions: ' Mailed/Faxed to: Date: Telephone (631) 765-1892 Town 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., September 13, 2006, the following recommendation was made: Moved by Peter McGreevy, seconded by Don Wilder, it was RESOLVED to SUPPORT the application of CHARLES GEITZ to raise the existing dwelling and construct a cellar, raising the house 5'; decking to be removed and replaced after house is raised; and remove the shed. Located: 1580 Leeton Dr., Southold. SCTM#58-2-5 Inspected by: Don Wilder, Jack McGreevy The CAC Supports the application with the Condition the area between the house and the bulkhead is re-vegetated, a drainage plan is submitted, and the use of fiberglass grating on the decking. Vote of Council: Ayes: All Motion Carried SURVE'r' OF PROPERT'r' ~I'FIJA'I'E.' TOPtN: .~2UTHOLi2 5UPI=OLK COUNt, N~ ~YE~ 12-10-0~ FLOOD ZONE REVISION O~-11-2OOg ~FFOLK COUN~ TAX IOOO-~8-2-~ N NOTEE~: · MONUMENT FOUND o PIPE FOUND ELEVATION5 REFERENCE U~ DATUM TIED TO N®VD '2q BENCH AREA = 12,4~4 COASTAL EROSION HAZARD LINE AS ANNOTATED FROM AREA F4AP NO. 56-566-8,:~ ~HEET GRAPHIC, SC, ALE I"= JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 RIVERHEAD, N.Y. 11901 369-8288 Fax 369-8287 REF.\\Compaqservcr\pros\03\03-312.pro SUP. VET OF PP-.OPEP-."I"T SITUATE, PECONIC. TOP'IN: SOUTHOLD 5L~F=t=OLK COUN-FI', NY' SURVEY'ED [2-10-OD FLOOD ZONE REVISION 08-11-200,5 SUFFOLK- COUNTY TAX ~ 1000-58-2-5 Su~u C~itz N 0(% NOTES, · MONUMENT FOUND 0 PIPE FOUND ELEVATIONS REFERENCE US®S DATdNi TIED TO N®VD '2q BENCH AREA = 12,434 .si: or' 0.2q COASTAL EROSION HAZARD LINE AS ANNOTATED FROM AREA MAP NO. 5,~-566-8~ SHEET 8 OF ®RAPHIC SCALE I"= JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 RIVERHEAD, N.Y. 11901 369-8288 Fax 369-8287 REF.\\Compaqserver\pros\03\03-312.pro 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 ~'~retland Permit Application Adminis~xative Permit AmendmenffTrans fer/Extension -'"~.eceived Application:~_L ~-Received Fee:$ ~ ~D _ . - __...C.,omp leted App lic ation __Incomplete __SEQRA Classification: Type I Type II Unlisted __Coordination:(date sent)_ ---LWRP Consistency Assessment Form -C--AC Referral Sent: ~'(~ ~h~te of Inspcction:~2z~o~ Receipt of CAC Report: Lead Agency Determination: Technical Review: ~.4,~blic Hearing Held: Resolution: Name of Applicant Ad&ess Suffolk County Tax Map Number: 1000 - Property Location: I ~,C~)(..,~ ~ mhoneNumber.~{) ~']'~. (~/~¢2,,3r"~,(-'~ C8 (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Ad&ess: Phone: Ooard of Trustees Applica~ 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 o~'~& ~ - (~ocu-o-~ e 1971 __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or susp.enjed by a governmental agency? .~ No Yes If yes, provide explanation: Project Description (use attachments if necessary): ~ ('~.4'~ ~)l,.&ht~ of Trustees Ap~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: _square feet Percent coverage of lot: ~ % Closest distance between nearest existing structure and upland edge of wetlands: [~> feet Closest distance between nearest proposed structure and upland edge of wetlands: I ~ feet Does the project involve excavation or filling? No ~ Yes If yes, how much material will be excavated? 3 (~ cubic yards How much material will be filled? 3~ 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: feet Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): ~oard of Trustees Applica~ COASTAL EROSION APPLICATION DATA Purposes of proposed activity:. Are wetlands present within 100 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) PROJECT ID NUMBER PART 1 - PROJECT INFORMATION :].PROJECT LOCATION: 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 5.1S PROPOSED ACTION: [] New F'--]Expansion [~Modiflcation/alteration SEQR 6. DESC.,.RIBE PROJECT BRIEFLY: 7, AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [~Yes [] No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) J~Residential [~lndustrial [~Commercial [~Agriculture [] Park / Forest / Open Space j~Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) --'-]Yes [~No If yes, list agency name and permit / approval: 11, DOES ANY~Y~..~SPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [~Yes [~No If yes, list agency name and permit / approval: 12. AS A BESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? E~Yes .[~No I CERTIFY THAT THE INFORMATION PROVIDED_. ABOV~E 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 b~4.~ea~d A. DOES AOTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PA~T ~17:~ If yes, coordinate the review process and use the FULL EAF. r~Yes [~No WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency, C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WiTH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, sudace or groundwater quality or quantity, noise levels, existing traffic pattem, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: 02. 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 cemmun y's ex st ng p aris o goa s as off c a y adop ed. o a change n use or nens [y of use of and or other natural resources? Explain briefly: 05. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain bdefiy: C6, Long term, short term, cumulative, or other effects not identified in C1-C57 Explain briefly: C7. Other impacts fincluding chanties in use of either quantit7 or tTpe of energy? Explain bdefi¥: WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA ICEA)? ~lf }/es, explain briefly: [--~ Yes J~No ......... E. IS THERE, O ISTHERE ~-~ Yes ~ LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If)'es ex~lain: No PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reach~dversee~ectidenti~edab~ve~determinewhetheritissubstantia~~~arge~imp~rtant~r~therwisesign~~cant~ 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 la rge or significant adverse impacts which MAY occu r. Then proceed direcfiy to the FU Lt EAF and/or prepare a positive declaration, Check this box if you have determined, based on the information and analysis above and any suppod[ng documentation, that the proposed actjor 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 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) PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: STATE OF NEW YORK COUNTY OF SUFFOLK , being duly sworn, deposes and says that on the ~ day of~, 20t2/a, deponent mailed a true copy of the Notice set forth in the Board oleTrustees Application, directed to each of the above named persons at the 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 ~outhold; that said Notices were mailed at the United States Post Office at ~:X.~s~t'eP "~ Y, , that said Notices were mailed to each of said persons by Sworn to before me this '?/'/~ Dayof 5',-?t,-~,&~ ,2006 Notary Public Com~Ssl~ ~pi~ Board of Trustees Application County of Suffolk State of New York DEPOSES AND AFFIRMS THAT HE/~rlrffi IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/E1J~KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE 1N 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. Signatur~ - ~ SWORN TO BEFORE ME THIS 7'~ DAYOF_re?b/"/ ,20os VINCENT J. KAIN Not.n/Public State of New YOH{ No. 60-4632985 Quldlfled in Westchester Coun~ Oommi$~ion. E~olrel : SEP 18 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 BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of thc Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, C ~k~J~.% (~a'-~T--, residing at ~ being duly sworn, depose and say: That on the {O.day of,~2 , 200~, I pe~onal~ posted ~he property ~om as by placing thc Bo~d of T~stees official poster where it c~ easily be seen, ~d that I have checked to be sure the poster has remained in place for eight da~s prior to the date of~c public being. Date of being noted thereon to be held (I)~/. ~a% ~0, ~Ot~ - · Dated: Sworn to before me this day of yeffl 200g (signature) VINCENT J. FAIN Notar~ Public State of Ne~ ~ No. 60-4632985 Qualified in Westchester Count~ Commi,sslon, Expire~ SEP 18 2006 _ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nmhibits conflicts of interest on the hart of town officem and emolovees. The numose of this form is to nrovide information which can alert the town of nossible conflicts of interest and allow it to take whatever action is neceesarv to avoid same. (Last name, first name, galddle initial, unless you are applying in the name of someone else or other entity, such as a company If so, indicate the other pomon's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (lf"Other'', name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of(or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES ~'~ NO If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Tt~wn o~f Southold ¢~:~ ~O ~J['~- ~,,~ T tlc Or position of that person Id ,, 'l"t'~'¢-(~· O~_~ [~ y,_~o Describe the relationship between yourself (the applicanffagant/mpresentative) 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 own~'r of any interest in a non-corporate entity (when the applicant is not a corporation); __32) an officer, director, parmer, or employee of the applicant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP(~ q~'~"~' ~ ~C + ~'~'"'' x ~__ Form TS 1 Signature Print Name Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its 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, listin~ both sunoortin~ and non- suooortino facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM#_.~- .,~'~ - ")--- ~' P.O CTNAME The Application has been submitted to (check appropriate response): Town.oard Z] Plannin~.oard[--1 ~uilaingOept. [~ ~oardofT~ustees Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: Location of action: Site acreage: Present land use: Present 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: C (c) Telephone number: Area Code~- 7~-~~- ~3,o~'~'''- (d) Application number, if any:_ Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ~ No~rI If yes, which state or federal agency?. C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. 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 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~plicflble 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 ~qot 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 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 $6 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 Peeonie Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ~ Yes ~ No ~xNot Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. ~-~ Yes [] No ~,Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. [--] Yes [] No .~ Not Applicable TITLE DATE