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Home My WebLink AboutTR-6446 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0396C Date: Janu~ THIS CERTIFIES that the construction of a second-floor addition to existing dwelling with gutters, leaders and drywells At 275 Watersedge Way, Southold, New York Suffolk County Tax Map # .88-5-58 Conforms to the application for a Trustees Permit heretofore flied in this office Dated 8/16/06 pursuant to which Trustees Permit # 6446 Dated 9/20/06 and was issued, and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the construction of a second-floor addition to the existing dwelling with gutters, leaders and drywells The certificate is issued to JAN1NA CASEY-DITTMAR owner of the aforesaid property. Authorized Signature Jmnes F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (63 I) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction ½ constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: 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. 6446 DATE: September 20~ 2006 ISSUED TO: JANINA CASEY-DITTMAR PROPERTY ADDRESS: 275 WATERSEDGE WAY~ SOUTHOLD SCTM#88-5-58 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 b) 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 construct a second-floor addition to the existing dwelling and provide drywells for leaders and gutters, with the condition a line of staked haybales is placed down landward of the bulkhead prior to construction, and as depicted on the survey prepared by Pat Seccafico dated August 2, 2005. 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 Permittee Janina Casey-Dittmar, residing at 275 Watersedge Way, Southold, NY, 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 ihe 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 right 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 heroin 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 Route 25 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. Dan Collins 924 Newbridge Rd. Bellmore, NY 11710 RE: JANINA CASEY-DITTMAR 275 WATERSEDGE WAY, SOUTHOLD SCTM#88-5-58 Dear Mr. Collins: The Board of Town Trustees took the following action during its regular meeting held on Wed., September 20, 2006 regarding the above matter: WHEREAS, Dan Collins on behalf of JANINA CASEY-DITTMAR 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 16, 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, 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 JANINA CASEY- DITTMAR to construct a second-floor addition to the existing dwelling and provide drywells for leaders and gutters, with the condition a line of staked haybales is placed down landward of the bulkhead prior to construction, and as depicted on the survey prepared by Pat Seccafico dated August 2, 2005. 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: $50.00 Very truly yours, Ja es~F. King '~ President, Board of Trustees JFK/Ims James F. King, President Jill M. Doherty, Vice-President Peggy A~ Dickerson Dave Bergen John Holzapfel Town Hall 53095Route 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 Please be advised that your application dated reviewed by this Board at the regular meeting of following action was taken: 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 Telephone (631) 765-1892 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 At the meeting of the Southold Town Conservation Advisory Council held Wed., September 13, 2006, the following recommendation was made: Moved by Peter Young, seconded by Jack McGreevy, it was RESOLVED to SUPPORT the application of JANINA CASEY-DITTMAR to construct a second-floor addition to the existing dwelling and provide drywells for leaders and gutters. Located: 275 Watersedge Way, Southold. SCTM#88-5-58 inspected by: Peter Young, Don Wilder The CAC Supports the application with the Condition of an additional 10' non-turf buffer to what exists. Vote of Council'. Ayes: All Motion Carried James F. FAng, President Jill M. DoherW, Vice-President Peggy A. Dickerson Da'~e Bergen John Holzapfe} Town Hall 53095Route g5 P.O. Box 1179 Southold, NewYork 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD office Use Only __Coastal Erosion p~rmit Application _~__Wetlaud Permit Application . Administrative ?¢rmit Amenchncnt/Transfer/Extensiot~ ~ceiv~d A~lica~on: ~(~ [~ ~ompleted A~catJon~ . Inco~t~ SEQ~ ~assifica~on: T~e I T~ II~nlistcd Coordina~on:(datc ~c ~ef~al Sent: ~ t~ .. ~ of In~pecfi~:~ ~cceipt ofCAC Re~ ~ ~ ~ad Agency Dcte~na6on: T~c~c~ R~view: ~solation: ~ AUG ] 6 2006 Name of Applicant, '~"t~2~J'H Dr. (7~t_,fi. CU -- O' ·. _ Phone Number:{ Suffolk County Tax MapNumber: 1000- ~¢~> - ~3- -~J~, (provide LILC0 Pole #, distance to oross streets, and location) AGENT: ~ c.oc.t.~ ,..'g - (If applicable) Adctress: '~ffe ,._~.~ac~.a6~- FO3. Phone: ~'-tr.. - 7~ BO~D OF TI~i~TEES ~oa~ o~ Trus~e~s Applica~ion P~GE 05 Land Area (in square feet):. Area Zoning:., Previous use of property: Intended usc of property: GENERAL DATA Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever becn r~voked or suspended by a governmental agency? Yes If yes, provide explanation; Project Description (use attachments BOARB OF TRUSTEES ~oar~ o~ Trustees ApDli~Won RAGE 06 WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: Percent coverage of lot: square feet Closest distance between nearest existing structure and upland edge of wetlands: c~(o. feet Closest distance betwceat nearest proposed structure and upland edge of wetlands: { O..~o feet Does the project involve excavation or filling? .~)~ No Yes If yes, how much material will be excavated? How much material will be filled'? C) Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: 0 cubic yards cubic yards May_ncr in wkich 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 oper~tions (use attachments if appropriate): 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 the Application of ..... .... COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, 0[C_.[/~t '-['-crr¢~ , residing at C4~5 being duly sworn, depose and say: That on the [[ day of '~3~L. , 200~, I personally posted the property kuown as by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held tl b,w~, _-,~.L?"I c~O, ~ 0"0 t~ .-. A · .... ' or} a00ue6,,.q3 Dated: (signature) C>~ ~?~f ~efc r e20m(~his No~-ary Public DEBORAH A. IQ~IO Notary Public, State of N~ York No, ('? 07/13/2006 ]_3:28 BOARD O~ T~U~S . PAGE PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Address: STATE OF Nt~W YORK COUNTY OF SUFFOLK . b~g duly ~o~ d~os~ ~d sa~ that on ~e ~ day of ~ ,20d~, depon~t mai.l~ a ~e copy of ~e Notice ' set fo~, in ~e Bo~of~St~s App~cafio~ ~ted to ~h of ~e above named persons at the addresses set opposite thee resp~five ~es; ~at the addresses set opposite ~e n~,of s~d pe~o~ ~ ~e ad.ess of sEd persons ~ sho~ on the current ~ses~t mil of the To~. of Southold; ~at s~d Nodces we~ reeled at the Unit~ States Post O~ce at ~ ~o, ~ . that s~d Notices w~d to each of said p~ons by Notary Public 5_~ o ~?o 07/13/2006 i3:20 7656E BOARD OF PAGE 08 NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRU..STEES, TOWN OF SOUTHOLD Ia the matter of applicant: YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Pen-nit from the Board of Trustees to: ~___O,..3.~'T--R,.)c.,~ 2..~.~:3 ~ ,~::~';~ tTre)O 2. That the property which is the subject of Environmental Review is located adjacent to yourpropcrtya~disdescribedasfollows: ~7'5 I,,)~T~_/7-~r~& 3. That the pxoj¢¢t which is subject to Environmental Review u~der Chapters 32, 37, and/or 97 of thc Town Code is open to public comment on: ~ot~, o~O: dZCXS~ . You may contact the Trustees Office at 765-1892 or in writing. The above, referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal, MAIIJNG ADDRE < 3[ e _ I ,JlPL/-/ Eno: Copy of sketch or pla~ shoMng proposal for your convenience. BOARD OF T~TEES PAGE 10 IPROJECT ID NUMBER '1 §t?.20 APPENDIX C STATE ENVIRONMENTAL QUALITY RE'VIEW SHORT ENVIRONMENTAL ASSESSMENT FORM PART '1 - PROJECT INFORMATION 1'i APPLICANT I SPONSOR 3,PROJECT LOCATION; ~..~.a~' ~ ~ pRECISE LOCATION; S~et Addess and Ro~d for UNLISTED ACTIONS Only ( To be completed by ,licant or Project Sponsor) , PROJECT NAME County SEQR Prominent landmarks otc-or oro¥1de ma[~ ~?"~ 4,.-J,~,~'r'~-/t~~Ij~ 5, IS EROPOSEO ACTION: [] New [] Expansion ~odiflcatio. / alteration ?. AMQUNT O~' LAND AFFECI'ED: Irlitially o~.~:)~..aere. Ul[Imetely .'~-4';~'~- eom. 8,~POSED ACTION COMPLY WiTH EXISTING ZONING OR OTHER RESTRICTIONS? I~lYas [] No If no, desc~be brleW: PRESENT LAND USE IN VICINEDf OF PROJECT? (Choose aemeny es apply,) .,,,, •Co.,me, ,el []p..,.,Fo,..,,O.e...aea 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Fe~leral,~Siate er Local) -7'lYes [-~o If yes, list e, gency name and pan.it / approv,~l; 11. DOES ANY ASP~E, CT Of THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [~]Yes [~ If yes, list agency name and permit ! ll~8esA RE~Uo~,~'~PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE If the action Is a Costal Area, and you a~ a s~te agency, complete the Coastal Assessment Form before proceeding with this assessment 07/13/2006 13:23 )3CARP DF TOTEES PAGE 01 ~'ART II. IMPACT ASSESSMENT (To be completed by Lead A. DOE~ ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART Bt 7,4? If ye~, c, oordln~te the mview pmee~s and use the FULL EAF, B. WlLLACTIONRECEIVECOO~DINATED RL=v~EVVA$ PROVIDI-"DFOR'U~ILISTED~CTiON$1N B NYCRR, PART617.67 IfNo, snegstJvs declaratian may be supemeded by snottier thvolve~ agency, r-~ yes r--]No : C. COULD ACTION R~SULT IN ANY ADVERSE EFFECTS A~SOCIATED WiTH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or gmLmdwater quality Or quarit~[y, noise levels, existing traffia pattern, aefid waste produC~on ur disposal, )oton~ial fqr erosion..d?in~ge or floodln? prob!em~;? Explain bltefly! C2. esthetic, agr~cu ~ml, archaaol~3g~cel,,h~atodc, or Other natural or eulttlml mSoumes; or community or neighbomood character? Explain briefl~ C3. V.geiatlon or [aun., fish, shailfl;h'or wildlife species, =lgnificent,habi~is~ or C§. Growth, subsequent development, or ~eleted activities llke~y to bo In¢Jused by the pmpo~ed action? Explain bdafly; Other ii. soLs (includin~ cha,'~ss in use of elii~or quesse/ar ~e O~ ene~? ~piai~ b.efly .... D. ~ THE PROJE~ HAVE AN IMPACT ON ~E E~RONMENTAL C~C~RISTICS T~T CAUSED THE ESTABLISHMENT OF A CRITIC[ E. I~ THroE OR IS THE~g LIKELY TO BE CO~ROVER~ RE~TED T0 ~!E~IAL ADVERSE ENVIRONMENTAL IMPA~T$?_ ~s expiate: , PART III - D~ERMINATION OF 81GNIFICANCE (To be mm~e~ ~ ~en~) INS~UCTIONS: F~e~chadve~e~t~ti~a~ve~de~newhet~ritissu~an~ia~ia~ge~im~nt~r~the~ise~ign~n~ Each e~ect should ~ assessed in ~nne~tion wi~ i~ (a) s~g (i,e. u~n ~ ~ml); (b) p~b~li~ of occu~ng; (c) duration; (d) irrevarslb~l~; (e) ge~mphic ~pe: and (~ magnitude. If n~e~a~, add aEachmen~ et m~ran~ sup~thg martials. Ensure that expla~atio~ ~Bin Sufficient detail to show ~at all mle~t sdveme, impa~ have been Men~ a~ ad~uately addressed, If question d of pa~ il was c~eck~ yes, the dete~mlnatbn ofsig nl~n~ m~t evaluate ~e ~nt~al im~ of~e p~s~ a~n on the envi~nmental eham~er~tl~ of the C~ Cbe~k ~is ~x if you have Idana~ one ~ m~ ~nt~[ly ~e or s~n~nt adve~ impac~ which ~Y o~r, The~ pm~ed dlmct~ to the FUL[ ~F and/ar papas a posltl~ WILL NOT result in any slgnl~nt a~rse en~mnmen~l Impa~ ~D pravide, on sffa~men~ as ne~a~, the reasons suppo~ dete~lnafi~. Name of Lead Agency Date' Pdnt or I yl~ Name of Nasponsibte Omoer in Lead Agency Tiffs of Responsible Officer Signature of Rssp~nsibla'Offl~r II~ Lead Agent'/ Signature 0f P~eparer (if dilferer'~ from reep0n$ible officer)' 07/13/200~ 13:23 75555 BOARD OF TRUSTEES Board of Trus~ee~ At~pli~ation County of Suffolk State of New York DEPOS~.S AND AFFmUS ~ ~S~m ~S u",~ ~emC~ ~O~ ~ ~O~ DES~ED PEK~T(S) ~ T~T ~L STA~NTS CO~D ~ ~ ~ TO ~ BEST OF ~S~K ~O~EDGE ~ BELmF, ~ THAT ~L WO~ ~L BE DO~ ~ T~ ~K SET FOR~.~ ~S APPLICATION ~ ~ MAY ~E ~Pgo~D ~ ~ SOlOeD YO~ ~O~ O~ ~gUS~S. Ym ~[IC~T AGeS TO HOLD ~ TO~ OF SOUTHOLD A~ ~ TO~ TRUSTS u~ss ~D ~ mom ~ ~ ~ ~s ~ c~s ms~o ~ O~ BY ~ OF S~ PE~T(S), ~ G~D, ~ CO~LET~G ~PLICATION, I ~BY AUTHO~E T~ ~US~ES, ~ AGENT(S) OR ~SENTATI~S(S), TO EN~ ONTO ~ PKOP~WY TO INSPECT ~ .P~SES 1N CON~CTION ~ ~W OF T~S mPLICA~ON, Silage SWORN TO BEFOKE ME THIS "z? ^vo, .., ooc 07/~3/20B6 13:23 7G~i~,~ ~OARD OF TR~TEES I ~onr~ .o~ TruS'be'eS PAGE AUthORIZATION (where. the applicant is not the owner) . (Print ~wner of property) (mailing address) hereby authorize (Agent) to apply ~or permit(s) from the Southold Board of Town Trustees on m~ behalf. owner's slg3zattLre) 07/13/2006 13:23 7651 BOARD OF APPLiCANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM PAGE hi its fli~t ofin~res'~o the ns, The ' fnori~atianWhichc al ]bl¢ i t . andall cracuonts nece,.~ea~' to avoid same. .... Uare"' i'i. in the [~,, '- of ('1..~ name, fir~ nMr.,c,.~tdd|c initial, anless yo ~ y g . ~mann~ ¢l,'~ or ~ther cnHty~ such ~ ~-~omP~Y, If so, lndica~h4: other ]qAME OF APPLICATI°N: (Check all that apply.) ' ' ,, Building , . Vn~nnee Coastal £msian Ch~ or 7.,one Mooring Approval of plat Exemption from phi or official map Planning 0f'~Othc~', name the activity.) Do you personally (or through your company, spouse, sibling, pamnt~ or child) havn a ralation~ip w~th My offianr ot cmployee " ionsb{ '? includes b blond, marring~, or bus'ness interest. "Busineas interest" mean,~ a bosines~% efthcTownqfSoutholcr?, Relat p · Y ' inclufling a pm~ership, in which thc town officer or cmployce bas cyan a partial ownership of (or ampl0ym~nt by) a corporation in which the town officer or cmployce owns more then $% of thc shares, YES NO ~ If you ans~vcred "YES". complete thc helanc~ ofthi:~ form and date sad ~ign wl~re indicate. Name of porsqn employed by the Town ol-$outhnld Title bt position or'that person Detain'the the relation~ip between yout~if(tbe applicant/agent/ropresantative) and the town officer or emplo);ee. Either cheek the appropriate lin~ A) through D) and/or describe in ~hc space provided. The town offigr or employgc or hb or her spouse, sibling, parc:pt, or ~hild is (check all'that apply): A) the owner o f greater than 5% ef ~be shores of thc corpOrate stock of th~ appli~nt -- (when the applicant is a corporation); B) the legal or ber~ficial owner of any interest in a non-corporate entity (when the applicant is not a coqmratioo); ~C) an officer, director, partner, or employee cf thc applicant; er D) the actual applicant, DB~CRIPTION OF RELATIONSHIP FOITrt ~ I 09 87113/2886 13:23 76~ ~OARD OF P~G£ 82 Town of Soutltold .LWRP co ,N, SISTENCY ASSESSMENT FO.R~ 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 lo 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.4rea. Before answering the questions in Scion C, the preparer of this form should review the exempt minor action list, policies and explanafons of each policy contained in the Town of Southold local WoXerfront Revitalization Program. A vrooosed action will be ewl,,m~d as.. to its ~ifican* _..beneficial and adverse effects upon the coastal area (which includes all of Somho!d Town)_ If any que. stion in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail~ listing bo_ih suooortln~ and non.. sun0ortin~ facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of fl~e LWRP is available in the following places: online at the Town of Southold's website (southoldtown.norttffork.net), the Board of Trustees Office, the Planning Deparmaent, all local libraries and the Town Clerk's office. B, DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# ~), - ~ ~-~ The Application has been submitted to (check appropriate response): Town Board ~'~ Planning Board [] Building Dept. [] Board of Trustee., 1. Category of Town of Southold agency action (check appropriate response): Action undertaken directly by Town agency (e,g. capital eonsln~un, planning activity, agency regulation, land mac'dun) (b) Financial assistim, ce (e.g. grant, loan, subsidy) (c) Permit, approval, license, eertilication: Nature and extent of action: 07/~3/208B 13:23 765 BO~ OF PAGE 03 Lo~ation of action:...'~?'X' Si~ acreage:. Pmsentland use: ( ~.~--~, Present zoning classification: If an application for the proposed ~ction has been filed with the Town of Southold agency, the fbllowing information shall bc provided: (a) Nameofapplicant: ~rodlfflD.~ ~.q,~J-~ ]~(..~¢Yit~YL~.. d (c) Telophone number: Area Code ( .~, , _ (d) Application number, if any:. Will the action be directly undertaken, require funding, or approval by a 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 pattcro 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 o(develepment. See LWRP Section HI- Policies; Page 2 for evaluation criteria. [] Yes [] No ~-~ Not Applicable Attach additional sheet~ if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section HI - Polic~s Pages 3 through 6 for evaluation criteria ','es [] po F, 1,,o, Applicab,e Attach additional sheets if necessary Policy 3, Enhance visual quality and protect scenic resources throughout thc Town of Southold. See LWRP Section ]III - Policies~ages 6 through 7 for evaluation criteria [] .Yes [] No D Not Applicable Attach additional shem if n~c~ssary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III-]Policies Pag~8/through 16 for evaluation criteria ~ Yes [] No ~ 'Not Applicabl Attach additional sheets iftlecessaW Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section IH - Policies Pages 16 through~4~r evaluation criteria [~ YeS [] NO [ J Not Applicable (x JI /0 .... Pohey 6. Pro~ snd ~store the quali~ and func~e~ of the Town ef Southold ecosT~tems i~clud~ Si~fficsat Coas~l Fish and Wffd~fe Habiia~s and wetlands, Se~ L~P Secgoa ~ - Po~cies; Pa~es ~ throa~ 3~ for ~al~a~oa ~te~a. X Yes No Not Applicable A~ach additional sheets ifnecessat~ Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section 11I - 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 ,vastcs. S~e LWRP Section IH - Policies; Pages 34 through 38 for evaluation crite~fia. ~-] Yes [] No ~ Not Applicable , PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. Sec LWRP Section Ell - Policies; Pages 38 through 46 for evaluation criteria. [] Ye~~'~ No [] Not Applicable A~tach additional sheeL~ if ~ecessary 07/13/2006 i3:23 ?6SB~ BOARD OF TRUSTEES WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses suitable locations. Sec ~L~0/RP Section III,- Policies; Pages 47 through 56 for evaluation criteria. Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town watel~. See LWRP Section IH - Policies; Pages 57 through 62 for evaluaiion criteria. F~ Yes [] No ~ Not Applicable A~ach additional ~he~ts if n~cessa~ Policy 12. 62 through 65 for evaluatig, u~riteria. ~ Yes [] NO [-'Il Not Applicable, ~ - Protect agricultural lands in the Town of Southold. See LWRP Section HI - Policies; Pages AUach additional sheets if necessary Policy 13. Promote appropriate use and development o.f en. ergy and mineral resources. See LWRP Section IH - Policies; Pa~ through 68 for evaluation criteria. ~-~ Yes [] No ~l ]Not Applicable OL LOAM -0.5' SUR~ OF CERTIFIED TO: ~RRY WATERS FI~ NO, 50510 DEC. 29, 1958 MAP NO,: 2901 / = 20' OATE: AUGUST 2, 2005 &C.~M. OlS~ lO00 SEC. 88 BL~ 5 LOT 58 se~ ~ ~o u~ ~ ~ ~ ~ ~m m ~a~ ~ I 07-~ W. Montauk Highboy J2~ Main Steer ~ t~om~ ~;~r~t~s PHON~' (651) 728-5330 PHONE: ~631) 878-0120 FAX: ~630 728-6707 F~: ~6~) 878-7190 k Je.z' -8.7'. ~ ~ATER IN ~ ~ / k ~OT ~/ rm~ ~N r.~ , voo~ co~c. ~o~. ~v~ .z.o,~ ~ ~ ~ ~oor~ ~. r~ ~ ~ ~ e ~,e'~ SUR~ OF CERTIFIED TO: ~ er~c~ss LOT 5 ~ ** - MAP OF ........... -- SITUATE AT R~ISIONS: M~N HIGH FAT~R BA~IEW I~ ~ ~ ~ .......... ~ -- ~ - -- ---- TOWN OF 50UTHOLD ' l ~ N 6~$~'IO"F 100.00' ~ SUFFOLK COUN~ NEW YORK ~' ~ S.C.~M. OIS~,OOO SEC.~ BL~S LOT58 PECONIC BgY ~ ~~u~~.~.~ PROFESSIONAL ~ND SURV~OR, P.C. u~o ~ ~.,o~. ~ ~ su~ ~ ~ ~ ~ N. KS. LIC, NO. 049287