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Home My WebLink AboutTR-6439A 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 # 0231C Date: July 27.2007 THIS CERTIFIES that the construction of a second-story addition to the existing dwelling. and existing hot -tub and deck At 1700 Oak Drive. Southold. New York Suffolk County Tax Map # 80-5-1.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 08/31/06 pursuant to which Trustees Permit # 6439A Dated 09/20/06. 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-story addition to the existing dwelling, and existing hot-tub and deck. The certificate is issued to John & Linda V oloe owner of the aforesaid property. rp:~ Authorized Signature . . 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.: 6439A Date of Receipt of Application: August 31, 2006 Applicant: John & Linda Volpe SCTM#: 80-5-1.1 Project Location: 1700 Oak Dr., Southold Date of Resolution/Issuance: September 20, 2006 Date of Expiration: September 20,2008 Reviewed by: Trustee Dave Bergen Project Description: To construct a second-story addition to the existing dwelling and for the existing hot-tub and deck. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the survey prepared by Stanley J. Isaksen, Jr. last dated April 18, 2006. Special Conditions: Final inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the South old Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Jal:"g~2 Board of Trustees ,- New York State Deplment of Environmental co!rvation Division of Environmental Permits, Region One Building 40 - SUNY, Stony Brook, New York 11790-2356 Phone: (631) 444-0365 . FAX: (631) 444-0360 Website: www.dec.state.ny.us -J'lQ'l~M;,!"i,..W'~"(.',:;,.". ~ -.. ~ Denise M. Sheehan Commissioner LEITER OF NO JURISDICTION - TIDAL WETLANDS ACT Linda Volpe 1700 Oak Drive Southold, NY 11971 September 8, 2006 Re: Application #1-4738-03599/00001 V olpeProperty, Oak J:>rjve, Southold SCTM: # 1000-80-5-1.1 SEP 1 5 2006 Dear Mrs. Volpe: Based on the information you have submitteathe Department of Environmental Conservation has determined that the property landward of the existing retaining wall and the 22' elevation contour line to the east (top of the bluff) as shown on the survey by Stanley J. Isaksen, dated 2/21/06, last revised 6/23/06, is beyond Tidal Wetlands Act (Article 25) jurisdiction. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 661) no permit is required. Be advised, no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary, as indicated above, without a permit. It is your responsibility to ensure that all precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Article 25 jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and your project (i.e. a 15' to 20' wide construction area) or erecting a temporary fence, barrier, or hale bay berm. Please note that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies or local municipalities. Sincerely, ,/:// /~~~ Mark Carrara Deputy Permit Administrator :c: MHP File t'IOU.~ IJr ., ..;>u V I Il ~ ........ . (V...) -&--v;;>.:- o 'd-S . D(.o II:OD 1A.r-r- WNW l\J jLl '1'" r!,.o /~ ~D u. " .e. \JA.> 10 d(j..A.. S" t;:/ IL ~ c9A K P n~ve. V~ese--.a. ~-h'<.y1 -{-D be- CYl )..e~ {N"er jCt-rTi--J12' 4t?1re-t l"1oD e~ 'Dy, _+haleD ({~- U~'2. 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(fold #2) A NEW YORK STA TE DEPARTMENT OF ENVIRONMENTAL CONSERV AnON W DIVISION OF ENVIRONMENTAL PERMITS NYSDEC REGION I HEADQUARTERS SUNY @ STONY BROOK BUILDING 40 STONY BROOK NY I 1790 JOHN/LINDA VOLPE 1700 OAK DR SOUTHOLD, NY 11971 (fold #1) -- st'lo1e hert' NOTICE OF RECEIPT OF RESUBMISSION The Division of Environmental Permits has received the application referenced below. The material submitted is being reviewed by staff, and you will be advised in writing regarding the department's findings. In all future communications, please refer to the Application ID number. Appliealion ID.. 1-4738-03599/00001 Dale Resubmitted: July 05, 2006 Applicant.. JOHN/LINDA VOLPE Faei/ily.. VOLPE PROPERTY Descripilon: canstr 2nd story addition to exist sfd DEC Contae/C CLAIRE K WERNER JOINT APPLICATION FOR PERMIT Ilea ,::,tates Ann vor s or en meers *m Applicable 10 agend8$ ancI pennII: categories lislBd in Item 1. PIe_ rud all instructions on back. AUachaddltlonal informalioo as needed. Please print legibly orlype. 1. Cheek pennits applied for: NYS Oept. of EnvIronmental Conservation o Stream Disturbance (Bed and Banks) o Navigable Waters (Excavation and FlU) o Docks. Moorings or Platforms (Construct or Place) o Dams and Impoundment Structures (Construct. Reconstruct or Repair) o Freshwater Wetlands [tfTKfal Wetlands o Coastal Erosion Control o Wild. Scenic and Reaeational Rivers o 401 Water Quality Certification o Potable Water Supply o Long Island Wells o Aquatic Vegetation Control o Aquatic Insect Control o Fish Ganlml NYS Office of General Services (State Owned lands Under Water) o lease. license. Easement or other Real Property Interest Utility Easement (ptpetlnes. conduits. cables, etc.) o Docks. Moorings or Platforms (Construct or Place) Adirondack Park Agency o Freshwater Wetlands Pennit o Wild, Scenic and Reaeational Rivers Lake George Park Commisaion o Oodcs (Construct or Place) o Moorings (Establish) us Army Corps of Engineers o Section 404 (Waters of the United States) o Section 10 (Rlv... and Hathorn Act) o Nationwide Pennit (8) ldenllfy Numba<(.) For Agency Use Only; DEe APPUCATION NUMBER US ARMY CORPS OF ENGINEERS Telephone Number (daytime) b3/-7b s-- 2.032- 3. Taxpayer 10 (If applicant is not an indMduaQ Post Office Cod. /Q1/ ~llcanl is alan: (check as many as apply) lJf" Owner 0 Operator 0 Lessee 0 Municipapty I Governmental Agency 5. If applicant is not the owner. identify owner here - otherwise, you may provide Agent/Contact Person infonnatlon. Owner or Agent/Contact Person 0 Owner 0 Agent IContact Person Telephone Number (daytime) Mailing Address Post Office State Zip Code 6. Project J FaclRty LocaUon (mark location on map, see instruction 2a.) County: TownICltyNiBage: .>u f F01-K SouJ.h,oL4 Location (Indud/ng Street or Road) /700 06-k Dr,'1"e.. Tax Map SeclionIB/ock 11.01 Number: I DOO-O!'tJ -Or- {)()/" I Telephone Number (daytime) 631-7{,S- 5333 Post Office Soo-t/.,o/d location Coordinates: , 7. Name of Stream or Waterbody (on or near project site) 5Ot.rn+tJI-D ,8A. 8. Name of USGS Quad Map: NYTM-E NYTM-N 4 9. Complete Narrative of Project Description and Purpose: (Category of Activity; ..g., new constructionl fnallatlon, maintenance or replacement; Type of Structure or Acttvity; e.g., bulkhead, dredging, filling, dam, dock, taking of water; Type of Materials and Quantities; Work Methods; e.g., area isolation, equipment type, phasing; Need or PUrpoH Served) Continue on Separate Page as Necessary ~t>rl ~ exiS+t""j ~;+cJ..en. " A& j+;"", If bej.~ ~ ~ ~ <f,X/Sl"i"J t.W:.1::. Ol(er "lj~' 'R.e:rl~~ 01'\&.. 'oe.dlU"l)yrl o.f\.! aN- YJ~~ JLl(i~Hf1..J' A-Jd,"-I,'On i5 0 bj~ Orij'l1.6./ ~t-rrt'(\+. Gi"o 0: Private Public Commercial 11. Will Project Occupy state Land?D Yos 0 12. Proposed ~art Date: 5-IS-~ 13. Estimated Completion Date: 1;1. - 1- "2.. DOc.. 14. Has Work Begun on Project? (ff yes, attH:h 0 [j.? 15. Ust Previous Pennlt I Application Numbers and Dates: (II Any) explanation of why work was started without e permit Yos No /.l and' work accom l/shed. 16. Will this Project Require Additional 0 ~ 0 If Yes, (ced.I bJjl.ai ((1:-/- Federal, State, or local Pennlts? Unl<nown Yos No Please Usl: 17. If applicant Is not the owner, both must sign the appRcation I hereby affinn that information provided on this fonn and all attachments submItted herewith are true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. Further, the applicant accepts full responsibility for all damage, direct or indireci. of whatever nature. and by whomever suffered, arising out of the project described herein. The applicant. exceotin!:l state orfederal aaancies, also agrees to indemnify and save harmless the State from suits, actions, damages and costs of every nature and description resulting from said project. In addition. Federal Law 18 U.S.C.. SectIon 1001 provides fOf a fine of not more tha 10.000 or imprisonment fornot more than 5 years, or both where an applicant knOlNingly and willingly falsifies, conceals. or covers ur _8 materlal fact; or knowingly makes uses a false, . fraudulent statement Date" ..lll O?Signature of Applicant fA..., Date........ ill Signature of Owner Title _~ill.W _________ Title -.OIJ ~ . . Generallnstructlons Incomplete or inaccurate Information may delay processing and a final decision on your application 1. The applh:ant is responsible for obtaining any other federal, state or local pennits. A separate authorization or letter of No Jurisdiction should be recefved from the Department of Environmental Conservation (DEe), Office of General Services (OGS), Adirondack Park Agency (APA}, Lake George Park Commission (L-GPC) and the Army Corps of Engineers (ACOE)prior to initiation of work In wetlands orwaterways. 2. Type or prfntctearly in ink. Attach FIVE copies of additional infonnation required in A. through C. below. A. A map identifying the location of the project site/area; I.e., a US Geological Survey map or other map with roadways and features suited to accurately depicting a location. B. A sketch plan drawn to scale or with dimensions given or engineering/survey drawings showing: the location and extent of work; the location ofwetlands, streams. ditches and water bodies; and view directions of the photographs required In C. C. At least three (3) representative color photographs of the project area and surroundings with time and date when they were taken Indicated. 3. ApplIcations by counties, cities. towns, and v1Uages must be signed by the chief oxecutive of that municipality or the head of the department or agency undertaking the project. 4. If someone other than the owner is applicant, written consent of the owner to use the property I (acUity must accompany the application. ,5. Locatiof1,Coordinates (section 8) are expressed in New York Transv81'S8 Mereator units or NYTMs (UTM Zone 18 expanded to encompass the entire state). These are based on the North American Datum 1983. If yOu are able to supply accurate coorcftnl!ltes. please do so. Otherwise, the Department witt detennine them. Other Requirements 6. If project is an unlisted action pursuant to the State Environmental Quality Review Act regulations -.6 NYCRR Part 617. a completed Part 1 of a Short Environmental Assessment Fonn must be submitted with the appDcation. 7. lfproject is a Type 1 actiOn pursuant to the State EnvIronmental Quality Review Act regulations -6 NYCRR Part 617, a completed Part.1 of a Full Environmental Assessment Form must be submitted with the application. 8. If project is classified as major pursuant to the Uniform Procedures Act regulations - 6 NYCRR Part 621. a completed Part 1 of a Structural Archeological Assessment Form must be submitted with the application. 9. If project requires a federal permlt and lies within the Coastal Zone. a completed Federal Consistency Assessment Form must be submitted with the application. 10. If projecl.ls within the Adirondack Park, addltionallnfonnation Is required by the APA to fully detennine pennltting applicabltity. SpeCial Requirements for Specific Permit Applications 11. Applications for the construction, reconstruc:lion, or repair of a DAM or other IMPOUNDMENT STRUCTURE must be accompanied by Supplement 0-1. 12. Applications for DOCK, PLATFORM, or MOORING faCility permits must be accompanied by Supplement 0-2. 13. Applications for Water Supply or Long Island We" pennits must be accompanied by Supplement W-1. 14. Appllcattons for a permit to apply a Chemical to control or eliminate Aquatic Vegetation, Fish or Insects must be accompanied by the proper supplemental form available from the department. 15. Applications for a Wlk:I. Scenic. or Recreational Rivers permit must be accompanied by Supplement WSR.1. 16. Applications for a pernllt to disturb a "W9Uand or waterway by placing fill or performing mechanized land clearing, ditching. channeUzation. dredging, or excavation activities under Section 404 of the Clean Water Ad. or Articles 24 and 25 of the Environmental Conservation Law should provide a discussion of practicable alternatives considered to avoid, minimize and/or mitigate the proposed project Impacts. Particular justification should be given as to why the alternatives are not suitable. Contact the Regional Pennit Administrator. Division of Environmental Permits, at the appropriate DEC offICe; OGS. APA, LGPC permitting agent; or the respective Corps District Office. as given below. for assistance regarding any of the above requirements. Consult other available application instruction materials for the appropriate permit types. New York State Agencies: Department of Environmental Conservation Distribution 1ST COPY Pennit Administrator 2ND COPY Corps of Enginser5 3RD COPY Program 4TH COPY NYS Agency 5TH COPY ApplIcant REGION 1 Building 40. SUNY SlMy Brook, NY 11190-2356 (631) 444-0365 REGION 2 1 Hunler's Point Plaza 47-40 21st S1nIet Long Island City,NY 11101.5407 (718)482-4997 REGION 3 21 South Putt Comers Road New Pa1tz. NY 12561.1696 (845) 25603054 REGION 4 1150 North W&Jk:Ott Road Scheneclady, NY 12306-2014 (518) 357-2069 REGION -4 s__ 65561 stale Hwy 10 Stamford NY 12167.9503 (607) 652.7741 REGION 5 Route 86. PO Box 296 Ray Brook NY 12977-0296 (518) 897.1234 REGION 5 Sub-Offlce P.O. Box 220 Wanensburg, NY 12885--0220 (516)623-1281 REGION 6 Slate Office Building 311 Washington Street WatertOYm, NY 1360t.3767 (315)785--2245 R6(Q" G ~",It-Otnlit Slate01l\c85ui1llinll 207 Genesee SlIltet Utica, NY 13501.2885 (315)793-2555 REGION 7 615 Erie Blvd West Syracuse, NY 13204.2400 (315) 42607438 Legend DEe Regional Office DEe Regional Sub-Office Adirondack Park . REGION 7 Sub-Ofllce 1285 Fishel" Avenue Cortland. NY 13045.1090 (607) 753-3095 . . REGION . 6274 E. AVOll . Uma Road Avon, NY 14414-9519 (585) 22ij.2466 ~---l qr' "'-'j .--:.~...__ i a'. . ~ I ./t~. i"- ..J~ REGION 9 270 Michigan Avenue Buffalo NY 14203-2999 (716)851+7165 REGION 9 SuboOfflce 182 East Union Suite 3 Altegany, NY 14706--1328 (716)372--0645 Office of General Services Division of land UtiIlzaUon BureatJ of land Management Gaming Tower. Empire Slam Plaza Albany, NY 12242 (518) 474.2195 United States Armv Coms of Enaineers Department of the Army ATTN: Regulatory Branch New York Ol$biet, Corps of Engineers, 26 Federal Plaza, New York NY 10278.0090 Telephone (917) 790-8511 for DEC Regions; 1, 2 and Westchester and Rockland Counties (917) 790-8411 for DEe Region :3 except Westchestor and Rockland Counties Adirondack Park Agency PO_" Ray Brook NY 12977 (5181891-4050 Lake George Park Commission P.O.9ax749Foil Georg. Road lake Georue NY 12845-0749 (518)668.9347 Albany Field Office 1 Bond Street, Troy NY 12180 Telephone (518) 270.()58B I 0589 - DEC regions 4,5 Buffalo District, Corps of Engineers Telephone (716) 879-4330 - DEC regions 6, 7, 8, 9 1776 Niagara Street, Buffalo NY 14207-3199 Aubum Field OffICe Telephone (315) 255-8090 . 617.20 . Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART 1- PROJECT INFORMATION 1. APPLlCANTISPONSOR :r c.hn a...n.a 1--. 'nU.- V bl 3. PROJECT LOCATION: Municipality ..Yv+h6L.(), don Sh ore.;::. County ~ F FoJ...1G- 4. PRECISE LOCATION (Street address and road intelSections, prominent landmarks. etc., or provide map) nOD l:7a.-k: Dr.'re e.of2.ft.€4 tu~ ~hore. ~ - ~J..t;y, <;h."reo, Sov-f-hcLJ.. 5. PROPOSED ACTION IS: o New 0 Expansion 6. DESCRIBE PROJECT BRIEFlY: UJ...-.J..,'~ of ~ ~ _b#h~ en &:t"-SH,,/ J..uL cr-<f 3<l:.J€. , 12en~'-'Yl ef #15-1-.''1 Jcl~ . ~odificatiOn/atteratiOn 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8, WlLL!5PPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? IJLI Yes 0 No II No, describe briefly _ !:lME- g. WHAT IS RESENT LAND USE IN VICINITY OF PROJECT? Residential 0 Industrial 0 Commercial Describe: o Agricultul& 0 ParklFol&StlOpen Space 0 Other 10. DOES ACTION INVOlVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (~5AAL, STATE OR LOCAL)? l.!::rYes 0 No If Yes, list agency(s) name and permit/approvals: 5ovJ+.-/) '-Ii IBwn BJi L.J.''"1 ~' 11. DOES ANY ASPEC!E,VTHE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? DYes Ltr No If Yes, list agency(s) name and pennitlapprovals: 12. AS A RESULT OF P~~ED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? DYes IJ6 No I; i4- I C RTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWlEDGE Applicant/sponsor na 'O( Date: S - 7- 2-01D Signature: If the on is in the Coastal Area, and you are a state a~ency. complete the Coastal Assessment Form before proceeding with IS assessment OVER 1 . PART" - IMPACT ASSESSMENT be com leted b Lead A enc A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? o Yes 0 No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. DYes 0 No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be ha_n, ff legible) Cl. Existing air quality, surface or groundwater quality or quanli\y, noise levels, existing traffic pallem, solid waste production or disposal. potential for erosion, drainage or flooding problems? Expla.in briefly: . If yes, coordinate the review process and use the FUll EAF. C2. Aesthetic, agricultural, archaeological, historic, or other natural or cuJturaI resources; or community or neighbomood 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 officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: CS. Growth, subsequent development, or related activitiel; likely to.be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other elfects not identified in Cl-CS? Explain briefly: C7. Other impacts (including Changes in use of either quantity or type of energy? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? o Yes 0 No If Yes, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? o Yes 0 No If Yes, explain briefly: PART 11I- DETERMINATION OF SIGNIFICANCe (To be completed by Agency) INSTRUCTIONS: For l!Sch adverse effect identified above, determine whether tt is substantial, large, important or otherwise significanL Each effect Should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probabiltty of o=.Jrring; (c) duration; (d) irreversibiltty; (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 ofsignificance must evaluate the potential impact oflhe proposed action on the environmental characteristics oflhe CEA. o Check this box ffyou have identified one ormore potentially large or significant adverse impacts which MAY occur. Then Proceed directly to the FUL EAF and/or prepare a positive declaration. o Check this box if you have determined. based on the infonnation and analysis above and any supporting documentation, that the proposed actio WILL t:lO~ result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Name of Lead Agency Date Print or Type Name of Responsible Officer In lead Agency Title of Responsible Officer ~l9natllre 01 \\e~ OIIitel in lead ~l:1 Signature of Pfellsrer (II dillerentlrom respons_ officer) . . Vi ~W rr^o~ s.+ru..-r 10 ok~ N"orfh 17>wAAl b~1' 1,11'~f~~1~~~~.~""" '.'. \rte.w ~ 5t~e.t -{a.W) So~ '7 \{(;)(~. 1100 [h,k- I>h\rG{ ~+hl>~ Ny ~ 'irn'F CL~J-; on, bV't.[ 8().Y't., tfdee.'{.. A 'fU- of f"'orose~ O1...Li +i Dn over e)(i~JI(I.J d~d::/qar I1A If I. Ill. 7 f)FJi, . . ~7i.y~, . ~J:P: t:!~i>E;,;'ijt~;;~~ ,>M'. { ()\ F - 11191> OLk- Ddre..-l :)Ovtho~ Ny 1ro fcSed CA dd j ~..()(\ on €l( i sh~ d.ea- t;s('f:.r Cjo.r'--S~ . VI. " ,,1 "_., . , V leN N or}heast V 0\\1\190 Ott/L t>d.ve.} SDlIthold,( Nf .~ (4( '2-00'= L6/1997 12:01 . .516.1309 su-RlSE ~ . PAGE... 05.. " HOUSING CODE INSPECTION November 23, 1973 #1700 Oak Drive & ~8o West Shore Drive R-l Southold, New York Sub-Diy: R~Ydon Shores # 631 Section "A" Lots 25 & 26 Occupied: R. Dordon & family Upon request of the Southold Town Build1ng Department I made inspection of this one story l'ramed dwelling and found no violations of Chapter 52, Housing COde, Town of' Southold. I was admitted to Oak Drive entrance by Mrs. Dordon and began my inspection at approximately 1:25 P.M. Building consists of three bedrooms, living room, dinette kitchen and full bathroom. Heat is furnished to each room from fUrnace located' in full cellar. Inspection qompleted at approximately l:~O P.M. /- ( .~e'Spectrull /'h/ - ~ r1. . '~H1nd . tte~,. t'U-' . . .d;l . &/1997 ~.' .7 .' // .. 12: 131 51&-7.139 SlffiIE'E ~ ,I-'A\:lI:. 1:14 FOIIJl( NO. . TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Oerk's Office Southold, N. Y. .- . Certificate Of Occupancy . No~ ~599g .. . .. . Date .............~~.....?3....., 19.'i:'~. THIS CERTli"1ES that the building located at . .;Jes-t .Shor.a. ;:l;::j,ve.... ... Street . M~p No. ~~.Y.49.r.. .~1).9JBl6ck: No. ..~...... .Lot NO.4~~~...... .~91;1~~+<;l. . .1~ ~!.'. . . . . . ..' '. . requmrements f'or one family dwelling &: housing code conforms Substantially to the ~Rtiip~'m...hi...n,I>..,,"I~ bu:1.l.t f' ': . Certificate of occupancv dated P13. .q:r~. .l\p;-.~..43..:..., 1957.. pursuant to '\VhichJ6m1d!~~"'iiili:N~5662'" - dated..... ~. : ...I.ip.:v:.... Z3.; 19.73, '\Vas issued, and conforms to.all of the ~uire- . . menis of the appp.cable .proviSions of the law. The occupancy for which this certificate is issued is ~. P-Hv-a.t9. one .i'~ly. dweUing...... __...... ................ ....... The certifiCate is issued to . ~!,!~+r;l? .!?C?~C?lt. ~. ~~. .~~~.. . . . . . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. I Suffolk Comity I?epartmerttof Health Approval .... .l?~~:-: . ~~.5;~in.g: . . . . . . . . . . . . . . . 11NDERWRI.TER$ CERTIFl:CATE No. '. P.:r:~7. ~.~;;:t.~g.. .. .. .. . . .. ... . . . . . . . . . . . . HOUSE NUMBER . .!tSQ:....... Street. .West.. .sho;ra .:Jrd..'le... .. .,. ... . ..... . ... 1100 Cak Drive . . _ . . . . . . r. . . _ . _ . ._.' _ . . . . ~ . ~ . . _ . . . . . . . . ,_ . . . . . . . . . . . _ . . . . . . . . . _ . . . . . . . . ~ . . . . . . . ~ . . . d. --~- ...... .~~':':-. <. .l::.~\/~'1.. .. . . ... _ Building Im;pecto.r. I I I I I I /1I2~/1997 ,/ . . 12:1<11 "lb-l.tl~ :;.I.JNl<.L:x.~ rH~ ur I'OIlJll NO. . TOWN OF SOUTHOLD BtlILDING DEPARTMENT Town Clerk', Office Southold. N. Y. -. . . Certificate Of OccUpancy No.z. 8923.' . . . . Date ... F&br.:la't\Y. . . . -3 . . . . . . . . .. 19..78 THIS CERTIFIES that the builc:fing located at . .1700. Oak. Dr,tvQ. . . . . . . .. Street . . Map No. .. :631';'" . BlOck No. ..:it.. ... .Lot No. ... . -2, .&. -26.. .. .. .. .. . .. .. " .. . . Conforms ~bl.-tantiaI:Iyto the Application for Building Permit heretofore filed in this office dated...... 6/6n::,....:. .., 19.... pursuant to which Building Permit No. . 6643Z, dated .' .. . . . 6/61'f'Js . .:. .. . .. ., 19..... was issued. and conforms to all of the r~uire- ments 'of the applicable proyisicins of the law. The occupancy for which this certificate is issued is .......,... ACCl!SSOn'. 3.trac.tura . . . . . . . . .. . .. . .. . . . .. . . .. . . .. . .. 0 .. .. . The certificate is issued to . . . l(ad.~yn. ..A... . .crosde.l.e . . . . . . . . . .. . . . O' .. ... . .. . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County DFPa,rtment of Health Approval ........... NAi. . . . . . . . . . . . 0 . . . . . . . . .' . . . . : . . . . '.' UNDERWRITERS CERTIFICATE No. .... . . . . . . . . . . . . . . . .N/R . . . . . , . . . . . . . 0 0 . . . . . . . . HOUSE NUMBER . .. . 170Q . .0' Street.. ... .Oelt. .D.:t'1y~.... .. .... ........... o' 0 o' : . , '.' . '.' . . . . . 0 . . . ; 0'. . ~ .. . , . "'0 . . . 0 . . 0 . 0 . 0 . . . . .SoutnQlo..... oW. :c... . . . . . 0 . . . . . . .. . . . 0 0 ~f/ ?}~J:j; '-' . . . . . - -. - - . . . . . . . - - - . . . . . . . . . . - . . . . . ~ Builc:fing Inspector /. / :-..........&...:10:1 Sl.NW5E ~ FORM NO.4 - -.",,, PAGE ." 66 . TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFrCE SOUTH OLD. N. Y. '.~ CERTIFICATE OF OCCUPANCY No. ...~... Date ...............~ ..31....1961. THIS CERTIFIES that the building located atoak .111-. 4:.lIeet .SbO". J):!.. Street Map No.Be~~ .Sbm& No. ........... .Lot No. 25 .4:.26.... .southoldt. .N.y..... conf01':lIlS substantially to the Application for Building ;Permit heretofore filed in this office . . dated..... ......;1une.. '28" 1966. PUI'SUaJl.t to which Building.Permit No. 3J,J8.z, dated ~ . . . . . . . .. . . '.Tune . . . 28' 1966" was issued, and confonns to all of the requiiec ments .of the applicable provisions of the law. The occupancy for. which thisceitificate is issued is .h'1vete. one.ffllltUy. ~le:!.:l.';"'g' _................... .._............... _. The certificate is issued to . Doroth:r' }';'U!l2:er' . . . _ . . O!~e=- . . . . . . . . . . . . . . . . . : . . . . . . (owner, lessee Or tenant) of the aforesaid building. Suffolk County Department of Health Approval.......... I'I:..L.................. .\ L r . . ...t~.,L '~l'.""'''' Building Inspector . . . . I . . + I + -<>-Z ~' I " \ , i i e 3_ , # ~--. " , . -, ~~ Ii " Iii ., , ~r 1,1 ii II !' n II I' ,I " II " II, I,,! , i Ie I j. II 1 ~. . df II. /1' .~ ~: II !I, q.l Ii! l " , , , I' , / ~l i -/ / /. I j ,r . I ~I I '1 i I! I, , II!:I/ , I II ~ I , ., I , ,'. 'I' I " , I, ,I r, -I I- I, I., :1 I , I l/ I' 131 1:1 I, I I 'i i! I I I~ r I I I, /'1" I I I-I ,', , , .11. , I , , I~r , I I I I , ''lll""., , I l..f , , I , ", ,-, I,' I I I , ; I I "1 "I ., , I f i ~ i I , I I " " I .' " '1/: 'f , I , I , I I , " , I. , , I I- I I ~)j ~u d, , , I I', '", , "I I '" I, I I I , I , 11'l) I 1'1 I I I I_I I , J I_I ,. , I , I I "Ii~1 I , I II!:/ I I , I I "I J I I' I , I I ("'I I I " ," " I' .1 i I I' , , I , I , " I I I Iii I, I I , e , , , , , , , ~ - ..... -J-- E c ~ " ~ c ~ il u ~ ~ c z 0" w. ~w ~i [~ u -i ~E " ~~ ~~ 2i~ " . NOTE: PROPOSED IMPROVEMENT IS ABOVE EXISTING GARAGE. PERCENTAGE OF LOT COvERAGE: DECK ABOVE BULKHEAD LINE AREA .. 271 S.F. HOUSE AREA -= 1,967 S,,. AREA Of PROPOSED IMPROVEMENT." .381 S.F. TOTAL AREA DECK + HOUSE - 2,0.38 SF 2,0.:38 $,F.;9,4885.F.=21.4? COVERAGE GUARANTEES INDICA TED HERE ON SHALL RUN ONL Y TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TinE COMPANY, GOVERNMENTAL AGENCY, LENDING INSTITUTION, IF LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE TO ADomONAL INSTITUTIONS OR SUBSEQUENT OWNERS. UN),UTHORfZED Ai TERATfON OR ADOIT/ON TO THIS SURVEY IS A VIOLA TJON OF SECTION 7209 OF THE NEW YORK STATE EDUCAOON LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALlO TRUE COPY. GUARANTEED TO JOHN VOLPE LINDA VOLPE FM# 631 DATE FilED JULY 2, 1931 UNDEFINED ROAD LINE SOUTH OLD BAY -- E '-" 2.0' -, 10 o lro <0 I 1.4' o o C'J I'- CJ u 2: w 9 VJ CJ <>: >- <>: o f- VJ ~I e ~ I C'J f- '~l 0 -' y " f'L <0 1- .1' L APPRO""""'" ".. JIEES (() - WEST SHORE D RIVE BEACH AREA (COMMON USE) HIGH WATER LINE AT FACE OF WOODEN BULKHEAO 5 45'39'00"[ 55.15' wo 0 DECK ---.- W/ lUNG '_-.._ .--........... [L24"--- 2 .4'-' , ......,..... ....... n LOT 25 TOWN Or SOUTHOLD '~ATE '1/,91J 'tl6 p: . E 8nv Fereshteh Ghavimi 245 93rd $teeet, Apt 23H New York, New York 10128 2-RAll FENCE .""2'....-- E1 18 .9' SURVEYED FOR: JOHN VOLPE LINDA VOLPE --.--;=::---......, \E:~ 25) ""'-. ....'"'[OT 26 ......f!-<'. HOT TUB ON WOOD DECK GROUND LEVEL WOOD DECK N. 23.0 IE w,,\..~w,.,'( S ~ > ...., ~ o " ............. <. " " " ........., 21.9' (() (() ~ o " MAIN FLOOR ~ o .~ ~ b '<t (J) CONe ~ S OWNERS: JOHN AND LINDA VOLPE 1700 OAK DRIVE SOUTHOLD, N.Y. 11971 TM# 1000-080-05-001.1 5 24 AUG 06 REVISE PROP ADDITION AND SHOW AREA. 4 27 JULY OS SHOW PERCENTAGE OF LOT COVERAGE AND OIST FROM HWl TO PROPOSED IMPROVEMENT J 2.3 JUNE 06 SHOW CONTOURS IN DATUM, FIRST FLOOR ELEv, 2. 11 MAY 06 ADD OWNERS NAME, ADJACENT OWNERS NAME 1A .~~" ,,<': <:...."", ....,,,, ..." CO" "'........" "" <:t"..".I:>" <:,,,t" "C" '''T WEST SHORE DRIVE, OAK DRIVE, AND THE "BEACH AREA" ARE ALL OWNED BY THE REYDON SHORES PROPERTY OWNERS ASSOCIATION, PO. BOX 1693, SOUTHOLD, NY. 11971 ~ <r:: o ,\"J o .'<t 40'11'40"W 5,00' ELEVATIONS SHOWN HEREON ARE IN THE 1929 NGVD SURVEYED: 21 FEBRUARY 2006 SCALE 1 "= 30' AREA = 9,488 SF OR 0.217 ACRES INC. SITUATE SOUTHOLD, TOWN OF SOUTHOLD SUFFOLK COUNTY, N,Y, b STEPS '<t 24,5 2 .3 GARAGE AT.... LOWER LEVEl/ ~ .-:~ct / ~ o ll;f, e 'jJ..# El15.6 : (j ~ > ~ -:<:; EL22/ --.- " "",,/,- ./ 3655 ~t AS PER USER 1 872 ,c , Pg 788 Co SURVEY OF LOTS 25 AND 26 IN MAP OF REYDON SHORES, SURVEYED BY STANLEY J. ISAKSEN, JR. P,O. BOX 94 NEW SUF OLK. 956 631 - 734 58 ./ 06R1475 . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD ~r>,,().. \91{ _Coastal Erosion Pennit Application _Wetland Pennit Application L Administrative Pennit AmendmentlTra fert1'xtension ~eceived Application: 2>I\CYo ~ceived Fee:$ _Completed Application _Incomplete _SEQRA Classification: Type I_Type II_Unlisted_ _ Coordination:( date sent) _ L WRP Consistency Assessment Form ~CReferral Sent:~ ---Pate oflnspection:~ _Receipt ofCAC Report: _Lead Agency Detennination:_ Technical Review: 1'iiblic Hearing He~ _Resolution: Office Use Only 1" r.: l '~ ~~,~.........-- I ~ ' 'TIM..: \ '. ~U. CYJM~ ~~ -t$))r~ AUS 3 1 20C6 Name of Applicant :f" Q""~ l. Yvii:>A VOLya (t)W"'....-rs.) Address I J,l.) 0 ~AV< '017 S..o u.:\\\.o l.~) "'~ II '=\"1 I ~&c; -;;}0:3"2..- Phone Number:(~3} so... \. o4J Suffolk County Tax Map Number: 1000 - 'ire) J;t<o ",..t, ~ Lor LI' It. Property Location: C..~..I!R. "t et:l->< l)ll.lIle. Ii uO \11...1" ~\-\t\'e l:>n.1"e -,(provide LILCO Pole #, distance to cross streets, and location) AGENT:~ A (If applicable itJ..:; n..'t~ I ~\foL$<l. <) Address: Phone: ~oard of Trustees APPlica~ GENERAL DATA Land Area (in square feet): <f)1).}r~ S,'f. ....,..,. Area Zoning: 'R-\ '!. I '::> ~... r I (\.-1... Previous use of property: R.'$ .....~A. r: -A L Intended use of property: ~-'< ~ I I') ...^,I.lK. -7 Prior permits/approvals for site improvements: Agency Date _ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a govermnental agency? V No Yes -- If yes, provide explanation: Project Description (use attaclunents if necessary): (\)~.. ~,^ILr'l \.k"t' Ju.t'; f\.."\" NW CO(2..1J E'~ 0\- \.4o....,Se fOr.:l1 (~) ;:>. ..,P '5'f'''''Pl:>o.lwilll A~o\)tr l:-X,slpl)6- G.AtZ.Ar., e... - t~o Nt-V-:; {<3u,"'QCk.l.m KJU.,.u1Q> of ~) rJo o...'i>f>),T: owe....\... L,,\ (olHD'l..v'\ 6.lr ) pJ", n..\) n,(.m lU. ~A~CClYl cfV ~.Qt>"'CClI1 .,. . ::tl" \'s 0...0\\ \.." po.,;\'t-o ~V_ fu ,?",e~'t- L T ~\\, iS~ll rO lft\. ()~r~Q,~r o~ ~~06 o...,p ~Ln.u~l-'l-l~O VIi'- \)~L"em-<3.~v'"~~OOb- " ~oard of Trustees APPlica4ltn WETLAND/TRUSTEE LANDS APPLICATION DATA ~~"'~l\)\) Purpose of the proposed operations:3o 1\ .f't'"" ~ I So h It. I c,hl! to '1 J ^~\.y.\-t...e.... ~}(.$ \" '''''1 B~ \hNom t1.Y\,) tl &.>>0 >"ooM $ \"A('~ lA.,.L,""'I "'C.I';) lS'j P>< fa....., CAO y;', \~~hO Area of wetlands on lot: C) C square feet Percent coverage oflot: % Closest distance between nearest existing structure and upland edge of wetlands: feet ~) A OJ 0 ~ 5>\ La-v-~ So Closest distance between nearest proposed structure and upland edge of wetlands: feet tJ I A- tJ 0 ~.J\." L~~..s. Does the project involve excavation or filling? V No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: 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): -lJo ~~~....( ~~ o.t.)~ w~rL'A"'D.S l1\)'t, 'OA-L uJU,Tfv'S ~oard of Trustees APPlica4ltn COASTAL EROSION APPLICATION DATA Purposes of proposed activity:---R9v..V' B, :.,:'h ~() -l'.vuL(.t,n '1 ~ \t. ~l..~>l1 I\~<"A~-e 1S~j) ro,wt'\ l).IV\t.l 6Cl.-\h-Room a,c", -eL.AC'.Q 0 ~ ~~1'2..1" 0 \(, \~~.u Are wetlands present within 100 feet of the proposed activity? y/ No Yes Does the project involve excavation or filling? V No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation ofthe project as proposed. (Use attachments if necessary) ~c ~l..IV lrZ-e,,0YV\~IO"'QI lYV1.~<'h.r~ (}~""SOIU~~(~ o IJT. <-, if' ~\.>?h /l~:s. r J..L'l, "-' c..z rYW" I ~ t'1~~"/I(A.;-; M-<- ("} b----.1i-1 ~.,. ~~'...r Cl So ~o t'o:'~ 0- . . NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: So \,.~ ~\..ll'b(')(\ -.{;,\...,,~ YOU ARE HEREBY GIVEN NOTICE: SCTM# Lo~ () - 'ii 0 -~- - I. I 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: ct. c"o...W\ ().... Ce{\ ..\"-' \"U 'l~ iSv.,tl') l.\.e'l" \v...~ o-\H~""1. 1",~"\A,\.....o chu ~\"O\,.Q....r'-1 _ la. -to ~lV ~ c>"1;)\),I,M ()1,).lU...>~ ~')l,!.I.",'1 ~c.~I'L'fMcvr.o 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: .-<If) A'<.y".~...:"", ~^~""IO..........\'t:\'- 16~ pvvX <?""'~ aO"-'\J\~t\D C1lU IS \O..Q.. ~ ~ OA->< ~R."''-) I s: \Cl-'l. Bu \/J....., sho...ll t>~ (}-^-J.. '~','"':l,,- ray ?tl,,~,,~ 0/- .f.~",grhT....h ~"'A\I";,\i 3. That the project which is subject to Environmental Review under Chapters 32, 37, and/or 97 of the Town Code is open to public comment on: . You may contact the Trustees Office at 765-1892 or in writing. The above-referenced proposal is under review ofthe Board of Trustees ofthe Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: ,,?t,)"'~ +L,IUPA ~L" t< MAILING ADDRESS: Ill:' 0 C).q~ ua. 'S -ou...(hoLIO I .., '0 \\ '1..... I PHONE #: b~ I - () 1,,';- _ :l 0 :? ....... Enc: Copy of sketch or plan showing proposal for your convenience. . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK , residing at , being duly sworn, deposes and says that on the day of , 20_, deponent mailed a true copy of the Notice set forth in the Board of Trustees 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 Southold; that said Notices were mailed at the United States Post Office at , that said Notices were mailed to each of said persons by (certified) (registered) mail. Sworn to before me this Day of ,20_ Notary Public PROJECT ID NUMBER . I . 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 1. APPLICANT I SPONSOR 2. PROJECT NAME 3.PROJECT LOCATION: Municipality County 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks ete - or provide map 5. IS PROPOSED ACTION: D New D Expansion D Modification I alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WlLL PROPOSED ACTION COMPLY WlTH EXISTING ZONING OR OTHER RESTRICTIONS? DYes D No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) D Residential D Industrial DCommerCia' DAgriculture D Park I Forest I Open Space DOther (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR UL TIMATEL Y FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) DYes DNO If yes, list agency name and permit / approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? DYes DNO If yes, list agency name and permit I approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION? (]yes D No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant I Sponsor Name Date: Signature If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment . . PART II. IMPACT ASSESSMENT ITa be completed by Lead Agency) A. DOES ACTION EXCEED ANV TYPE I THRESHOLD IN 6 NVCRR, PART 617.4? It yes, coordinate the review process and use the FULL EAF. Dves DNa B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NVCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. o Yes DNa C. COULD ACTION RESULT IN ANV 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 C2. 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 C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: I eG. Long tenn, short tenn, cumulative, or other effects not identified in C1-C5? Explain briefly: I I C7. Other impacts CincludinQ chanQes in use of either Quantity or type of enerQY? Explain briefly: 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 Yes 0 Na I E. IS THERE, OR IS THERE L1KEL V TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: o Yes ONa PART 111- 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 FUL EAF and/or prepare a positive declaration. Check this box jf you have determined, based on the 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 Pnnt or Type Name of Responsible Officer In Lead Agency Title of Responsible Officer Signature of Responsible Officer In Lead Agency Signature of Preparer (If different from responsible officer) . . Board of Trustees Application County of Suffolk State of New York ,<' 0 ",0 L.l\!O A ~ SL BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE I 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 REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. ~~. Signature ~7itt4 ~Pubhc DAY OF Il-u.~lld ,2oob ~~'I~~' .Ai :t ~ SWORN TO BEFORE ME THIS ;:Z ~ SUSAN K TOOKER NOTARY PUBLIC, State of New York No.OlT05078120 QU<:1lified :n Suffolk County Commission Expires May I Q,loo7 GAIL L. ASSmO Notaly PubIlc. State of tlow York NO.Oll\S[o0225<f8 A... 0uaIiO!d in &;;'fuI1< CounIv D "",'MlISSIonExD',,,",JaI. f8.~.L " ~Board of Trustees APPlica~n AUTHORIZATION (where the applicant is not the owner) ... I, (print owner of property) residing at (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (owner's signature) 8 . . APPLICANT/AGENTnREPRESENTATlVE TRANSACTIONAL DISCLOSURE FORM The Town of South old's Code of Ethics nrohibits conflicts of interest on the Dart arroW" officers and eroD.avees. The numose of thi~ fonn is to nrovide information which can alert the town of nossible conflict.; of interest and allow it to take whatever action is necessary to avoid same. - .~ ;) c)\.... ~ L \0 ('ll'l ou.:. -'L (Last name, first name, J1liddle initial, \mless you are applying in the name of someone else or other entity, such as a company. Ifso, indicate the other person's or company's name.) YOUR NAME: NAME OF APPLICATION: (Check all that apply.) v Building Trustee Coastal Erosion Mooring Planning v V Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map 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 South old? "Relationship" includes by blood, marriage, orbuslness 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. NO ./ YES If you answered "YES", complete the balance of this ronn and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself (the 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 own~r 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 FOnTI TS I S-'""B"" ,,",or;;:, r Sl~nature :T. ':;.~ Pont Nam ' 0.... 200 12 . . Town of South old 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 South old 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. listinl! both sUDDortinl! and non- sUPDortinl! 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# t<lDo~ - ~o - ~ -1.1 PROJECT NAME -.f.e,1..~A:... {).c).c:).,l' ~ The Application has been submitted to (check appropriate response): Town Board D PlanningBoardD BUildingDept.0 Board of Trustees [3- 1. 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) D D (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: w Nature and extent of action: cD ~'" tll ~.r e. ~ On tA.~a..II1c.-\~S ~\.lIl~~ T 1.\.& (P g. I.llt V) UJ'T--t ()A lh\, I ,.. ~ ~l') Sll 0 G... 0 0, I, rIY\ . . Location of action: Site acreage: Present land use: 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: ::r ~'y,1\) 'l'"l\N o~ ""o....~ ~ floc OA V; ~ 1'1- (b) Mailing address: S-<::)lL\hoL~ ) M. \ \ 1/1 (;) t..~l -() b"- :;;)032- (c) Telephone number: Area Code (v'[ (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes G'NoD If yes, which state or federal agency? \-\",JJL. o...~f.\'~" ~b€"c. -{.c1'I-" j)Jt TTlU... ---0 "'m - \ l.W ,s. b, J. ClIU 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 L WRP Section III - Policies; Page 2 for evaluation criteria. DYes D No ~otApplicable ~ ~(,~ t:t N<Jr ~~~~~ ~~~~~e~r) ~~\~~S. AJ~ ~Q" ~~ A- TV O.p " ..k <:JY'--' IL.- :A -.. cL;\1o r :-k , " ~ 1 U:S.IL ~ r 0 A-S ,...-yo,. L L ~c V-\n vYI Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See L WRP Section III - Policies Pages 3 through 6 for evaluation criteria DYes D No ~tAPPlicable .' . . tJr? h,~'f'~,~\ till ~t?c:t..c('Q~(""'l"~ ~.!>"'<A"\.4 -2.~'M"1 ~ ~I~() Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See L WRP Section III - Policies Pages 6 through 7 for evaluation criteria DYes D No [g"'Not Applicable kj-" ~U~..:t /lI1J d I ~ \A.V\, L ~u o..llr~ If)~C'{>IUI~ !I,ps. OUV( ..., . 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 DYes D No ~otApplicable ~ ftr;~'" N ~ ~,,\r.. 7~K'l'1\.J J....rl ~ 0 vLl. lO nA-.u.. AN, 1'~ ~ ~t!l ()' N~ _ JVl.(,S!._rl 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 DYes D No Gffi-ot Applicable ----\Vo ,,---,-f.rn I~I"~' j.(~jl) ~ ~~I.LlO -€l=i-D.r- ~ \.'6Lt.a....-.. 9.A v'kl, r i O'V "l..l ~~l"'" 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. D D eM'vlft .' . Not Applicable . Yes No '7.A,~JfA.t,~"{~ t~~N~O~\C~n-!J~ ~1"tl\I~- 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. DYes D No g'Not Applicable ~fl\ Il-'<.~ -t"~K~N \..~ \0oL0~ ",_;JL W ~'1l":>lV So ro, \ r'Z-I'" l1. L'I, --'~o O'^- AAJ '-1 ~ 1+4. .:t Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See L WRP Section III - Policies; Pages 34 through 38 for evaluation criteria. DYes D No ~ot Applicable rJ,; ~"i\-t;u'~; '~~~I ~~ tu"u lVJ h )'t tL.IL rt II' 1 f" j.t4- 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. D YeD NO~APPlicable _tJ~tL::~~ ~ t:;~.i~ S h'& ~~w l- 0 I AJ ~,' J.. ~v \3e.-tu~ ~ cfV Attach additional sheets if necessary . WORKING COAST POLICIES .. .. . Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section 111- Policies; Pages 47 through 56 for evaluation criteria. DYes D No ~tAPplicable IV 0 .Jl t-\- R.- S rN\..J ill o.Ii..t. - L\.a L^ -.AA II ~ e 5:- ~~ (j 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 LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. DYes D No Gl' Not Applicable ~~(..it ~"'~'/UR... Itr2~O~.IC"'f s lJ'c 0::' uA. j fJJu'-'-'-'-\0 ).~,~ \r" (''''110 l'\ ~\a 5.. Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See L WRP Section III - Policies; Pages 62 through 65 for evaluation criteria. DYes D No G-Not Applicable ==:JVo ~. <:u-lfUA. d JcLl\J D~ I~V()LJ.t.'(:) W,''h.(}^" f1J1U\ r\.. "'-....I. 6 ftJ { 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. DYes D No []--Not Applicable -~.~: fttt"/\ll~' ~~c~:: c-Ll,,~..L"~fl\~A.Jr-~ QM..Qy'td t11V~ PREPARED BY j' ,,\.~ .J't)L..~d... TITLE 0u.3 N ~ f'- DATE fj{1'2.~ ~G