The URL can be used to link to this page

Home My WebLink AboutTR-6443 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 # 0297C Date February L 2008 THIS CERTIFIES that the deck, stone wall and fence At 1200 First St., New Suffolk Suffolk County Tax Map # 117-7-30 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 8/25/06 pursuant to which Trustees Wetland Permit #6443 Dated 9/20/06 was issued, aud couforms 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 deck, stone wall and fence. The certificate is issued to WILLIAM GRELLA owner of the Fd~; Authorized Signature . . James F. King. President ,Jill M. Doherty, Vice-President Peggy A. Dickenwn Dave Bergen John Holzapfel Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (6311 765-1892 Fax (6311 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 1 st day of construction % constructed --d Project complete, compliance inspection. . . TERMS AND CONDITIONS The Permittee William Grella, residing at 1200 First St., New Suffolk, NY, as part ofthe conside:cation for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of South old 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. 2. 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. 3. That this Pem1it 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. 4. That the work involved will be subject to the inspection and approval of the Board or its agcnts, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result ofthc work herein authorized. 6. 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. 7. That if future operations of the Town of South old require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustccs, the work shall cause unreasonable obstruction to frce navigation, the said Pennittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. 8. The Permittee is required to provide evidence that a copy ofthis Trustee pern1it has been recorded with the Suffolk County Department of Real Properties Office as a notice covenant and deed restriction to the deed ofthe subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. 9. That the said Board will be notified by the Pennittee of the completion of the work authorized. J O. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subjcct to revoke upon failure to obtain same. . . .James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel ....\\\ \W SOU/it D ~.~~ " .::>~ .... .... c/> ::.c ~. ~ ~ ~ r,f COUN1'l ,,,~ Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971.0959 Telephone (631) 765.1892 Fax (6:3 1) 765.6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 20, 2006 Mr. Anthony Portillo 495 Riley Ave. Mattituck, NY 11952 RE: WILLIAM GRELLA 1200 FIRST ST., NEW SUFFOLK SCTM#117-7-30 Dear Mr. Portillo: The Board of Town Trustees took the following action during its regular meeting held on Wed., September 20,2006 regarding the above matter: WHEF<:EAS, Anthony Portillo on behalf of WILLIAM GRELLA applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the South old Town Code, the Wetland Ordinance of the Town of Southold, application dated August 25, 2006, and, WHEF<:EAS, said application was referred to the South old Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHER:EAS, in accordance with Chapter 268, said application was found to be Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEF<:EAS, 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, 2 . . WHEHEAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEHEAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEHEAS, 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 WILLIAM GRELLA to repair the existing deck, remove lattice fence on both sides of property, construct a new stone wall on north side of property and a new mahogany fence with concrete columns and stone veneer, and as depicted on the plan received on September 18, 2006 and survey received on August 17, 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: $50.00 Very t"uly yours, 1~07~ Jarrl; F. King - ;/ President, 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 (6~1) 76!i-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: W l(J.J. Ot v), v..lLn I rJ. ('to- Please be advised that your application dated 6' I.s.~ /5110 reviewed by this Board at the regular meeting of '1 ~ 0) 0), following action was taken: has been and the C vj-Application Approved (see below) C_) Application Denied (see below) C_) 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: '1L (t'\clJ I 1\Jl~ C'Ltin, - -t SO, 00 ~\ ~ct \,.(\ ~.~ ::f<!\P TOTAL FEES DUE: $ <0.') ,a.') BY: James F. King, President Board of Trustees . . \I1-1-~ . - . . .Tames F. King, President Jill 11. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Jon:c. Holzapfel Town Hall 53095 Ronte 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (6J1) 765-6641 i BOARD OF TOW!j< TRUSTEES TO\VN OF S01jJTHOLD Southold Town Board otTtustees Field Inspection/W orkses ioh Report OatefTlme 411'/(;(;, Y;C:;fn., . Name of Applicant: ( .:,.,e I \ U\ ivJi r ( '0L i '---" , n i Na:neofAgent: Ar)"o,o\ ~ o.~t,\loi I Prcperty Location: SCTh1# & Street_I 17 -17 -r 3,0 1200 rS'< .'>+) r\}("J J~(~(:, ~k i Brief Description of proposed action:YL-0ri"~ tr, ~ .\-,,) decl iT'",,"'-C khxy -0-<\'-1 ~'."'. ''cUI>., \:vU-, '~ ((~,' 14>sllw,l;"'''' N0 ,'~ Vei\1 ,"-''' "~-"" "O-t: 't: I'~ ~ C1 N.i.Ji "...""he> ')"""-1 -P'~l/ (_.J:~, '.0r.,A.,M,r)i,^,", }- S~ u~ .- I T::r>e of area to be impacted: .. Saltwater Wetland _Freshwater Wetland I / _,_Sound Front ~Bay Front ! Dis':ance of proposed work to edge of above: h~ of Town Code proposed work falls under: ~Chapt(F _Chapt 37 _other T::pe of A,pphcatlOn JWetIand _ Coastal Etbs16n _Ampndment _Emergency _Administrative Tnfn needed: .1..", ;.-'U-A.lK S""~ (Ie, iL. "A (k7 S, >Ww, "> f,2U l\..t J . (+,;" Lv.> ,ie ,; \I Modifications: Conditions: Present Were: Other: ,,;j,King JrDoherty _P.Dicketsoh_vb. Bergen viHolzapfel I I 'Date: I I MaikdlfiL'led to: . . Telephone (631)"'65-1892 Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTIIOLD 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 NOT SUPPORT the application of WILLIAM GRELLA to repair the existing deck, remove lattice fence on both sides of property, construct a new stone wall on north side of property and a new mahogany fence with concrete columns and stone veneer. Located: 1200 First St., New Suffolk. SCTM#117-7-30 Inspected by: Don Wilder, Jack McGreevy, Peter Young, James Eckert The CAC does Not Support the application because the impervious driveway should removed and replaced with a pervious driveway or develop a drainage plan. Vote of Council: Ayes: All Motion Carried . . ,James F. King, President ,Jill M. Doherty, Vice-Pn~sident Peggy' A. Dickerson Dave Bergen Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 1l971-0959 Jolm Holzapfel Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6419A Date of Receipt of Application: August 17, 2006 Applicant: William Grella SCTM#: 117-7-30 Project Location: 1200 First St., New Suffolk Date of Resolution/Issuance: August 23, 2006 Date of Expiration: August 23,2008 Reviewed by: Board of Trustees Project Description: To remove existing driveway and replace with stone driveway. Fi'ndings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the South old Town Code. The issuance of an Administrative Permit allows for the operations as indicated in the application dated August 17, 2006. Special Conditions: None If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. a Wetland Permit will be required. This is not a determination from any other agency. Jal:;:in::r:2nt Board of Trustees . . August 7, 2006 Code Enforcement Officer Town of Southold PO Box 1179 Southold, NY 11971 Doar Sir or Madam: PI'38se be advised that waterfront construction is taking place at 1200 First SI in New Suffolk. There an3 no permits displayed for the Trustee's, DEC or Building Departmenl In addijion to the construction in the back yard a masonry planter was buill in tront of the house on the R;~h1 of Way. This planter along with the one next door severely restricts 2 way traffic on First Street especially when the occupants park their vehicles in tront of the houses These planters need to be removed and no parking signs need to be placed. Sincerely, Concerned Cijizen CG Highway Supl Trustees AliI' - Uv ' /i'i- 1 J .3 () WI \ \ (0-G'" (j((?\lQ . a /, - I~J 2 ;~ ~ 9 1: ~~ c-k_" 'i \'::~C~_ /-'! ~-"t:",;~*,,-"" .':;' ~,'.~ ,___"kl~dlc f ,;-~~ : ,.! ,i}~I ",,~:j, E :G-:~f:'E(~ ~0\ ~_::=J \ ' e 1, :( !~(~\t;" :\' ~~ ld, . i~tiH \~~,::~~ ~ih'~\ ' \ ;~l\1\i;)~1< i1l\~:;\~~~\ . ' /~ ' \ \', \ ,f P:, '1 'E=J]Cr~i1!t:n:1' J - \ . I'~ '~_ll~_LI~L.:""i...J,\,'_\i" '\ ~'" \:~;f.]J'C:~J - ,\ -' ' -' I, 'T1-r']T"~T-~Fn"- '- . \ r', (T~' "~ \ I ' ".o', , I ~ i -- !,' ! I : . l j ~,' t: ' ',..\,. ~"l 1 r-~ -,t:JJ:r~ ~ \\ ;" ~' r:! 1,' 8::! :)'" -- I': 1 : : ' lilt \:\~,~~,'i.;, ,1 \ .i{~)~;fi~LJ,::; ;~I ::~ L.~_:~l"f, :,\')~ln' "I j r\, '. Y(j':'I:'l."I" j :jf-:iJ r"- ,-.-1\'" ,c,---~" ;;, . Ie -=:,A. '\i . ~~ 'i; - - L ~ 1 -~ -: ,--'~ ;-T-' - , I, / ]."" _ ~ _ _ ,. :" 0 , ' ~,,~;'./~ f 1--; , ,,_;. \ \'" : - ~ - ,I :.] I \_ ."_ , ,5 ., ' ' '" ] ; . _', ,,:. /'" "e"2~: \ ,,'" r' .. ~ 0 , . ',' "\ ' . .: .~-~- r ''" J') I " _---.:::-----..-J'-, '- 1\- m , ]VIIII'n ~ 1"11'-' I" I'" I I I I I i, I Ii I ! --.----..- 11'llil! I m'Tl-~-'1 I '!I !Ii' - I 'I ,'i f'- "I ~I :~ rl '-:-I 31 I >-= ,. ~ e co 1 !e ," io I; ~ ~ . -=--1~ II s"id 8~~f '''',0 ~/~"" \~, '<w' I III I@,!: I Iii ., ~'J "', ~""; , I I; KENNETH L. EDWARDS M/I.RTTN H. SIDOR GEORGE Ll. SOLOMON ,JOSE["JH 1.. TOWNSr-::-.rD ~ <t.~' \'If SOlll;s-~~~ f.. : ~ ~ r,f COUIITi :~~ . MAltiNG ADDRESS: P.O. Box 1179 Southold, NY 11971 . PLANNING BOARD MEMBERS ,mRILYN B. WOODHOUSE Chair" OFFICE U)CATlON: Town Hall Annex 54:375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY Telephone: 631 765-1938 Fax: 631 765-3136 PLANNING BOARD OFFICE TOWN OF SOUTHOLD To: James King, President Town of South old Board of Trustees From: Mark Terry, Senior Environmental Planner . 1',/ L WRP Coordinator \" Date: September 15, 2006 Re: Request for Wetland Permit for William Grella SCTM# 117-7-30 Anthony Portillo on behalf of WILLIAM GRELLA requests a Wetland Permit to repair the existing deck, remove lattice fence on both sides of property, construct a new stone wall on north side of property and a new mahogany fence with concrete columns and stone veneer. Located: 1200 First St., New Suffolk. SCTM#117-7-30 The proposed action has been reviewed to Chapter 95, Waterfront Consistency Review of the Town of South old Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is generally CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. Pursuant to 9 275, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency ofthe proposed action. CC: Sean Kiernan, New York Department of State Division of Coastal Resources . ,lameH F. King, President .Jilll\/.. Doherty, Vice-President Pegh'Y 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) 76;'-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application ~ etland Permit Application _ Administrative Permit AmenclmentlTransfer/E tension ......ll.eceivcd Applica 'on: 04, __~cceivcd Fee:$ __ .~mpleted Application ___[nc()mpletc__"_~~_ __ __ SEQRA Classification: Type I_Type 1I__Unlisted~ __ Coc'rdination:( date sent) _.....;..wRP Consistency Ass ssmentForm~ -eAC Referral Sent: "" _~ak of Inspection: '0 _ __Receipt of CAC Report:__ ____Lead Agency Determillation:~ Tec1nical Review: =:::'::!>lll\'rlc Hearing Hcl'~ __Resolution:___ __ q~'-~~ Address (lCO ru" 51 ^~-' ~1.A' I ~ ~O(; flU?Y Av€.- M'f\i1TlJcl\. t ~^J'-( U~.) 0 Phone NumberJI(') Lis (o-1ozc1 Suffolk County Tax Map Number: 1000 - J\l-- 07-- ~ Ilru 1st 51." N~ SuPFD\LI rJ( (provide LILCO Pole #, distancepross streets, and location) AGENT: 4vvTI-\O.v--f (O~\AJ ([fapplicable) Address:--.!-/-9 )' -----._-- ..~-----------~--"--_. Name of Applicant '0\\\\~ Proper! v Location: -~ ~\~~\d\\~" dl' U'iy' Avri (l\Ri(ltlUU<- fWf1f; L Phone:l7il 572.- Y7LLL.... . Board of Trustees APPlic.on Land Area (in square feet): GENERAL DATA S ) 1\ C. 71 ~k Area Zoning: (1/) 7~ Previous use ofproperty:~~~ \ DnN'l\4t- Intended use ofproperty:__rlS:::,\ ~Av Prior permits/approvals for site improvements: Agency Date _~ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspel),ded by a governmental agency? ../ No Yes If yes, provide explanation: (Jf- Co,,~.') Qd Project Description (use attachments ifnecessary):_KlZ.~_~ ~'h.T ~-\~(, CWiJ ~~\<ff-D (\.}rE.'-^/ ~('U 1V\\6 - ~'Lr--"vfL\) ~~'"\ \f)~LV\:L4 rU\ N~ ~Av~() ~vfZ'-{,i ~€(I--~Vih--0 lM\\~ B---uvc.R- UN ~\\T Sl,l)f;...') of- ~fvR'l {K.\ f.j1- Mj0 ~\O~~ ON fV'JFJlt ~r:y:- f9(Z(L)1 Av--;~ fJr N?-vJ{; ~ ~PH\OJ'A1J'( 'fit.n/C~_ wf ~'--. tt'>- Iwj 6~ V\~~ . Board of Trustees APPliCeon WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: '&;;.Ct.,:'f5_ '~'",Ii"'~ w.,,-, I-J:\l(.).N"") ~:h.-- LlrJ2>A~fz.- AvJ'\:) (v)A-TlL()--\d't""- ON \~ --ft~\L--Yi ,p.,..,fi. O\t) Qr/"\J ~t<--\J I ~ .~ ~t..{,-f\2,..~ Lvtl'>. Cf\u\.,06-t \ Y\I . Area ofwetIands on lot: C> square feet Percent coverage oflot: % Closest distance between nearest existing structure and upland edge of wetlands: () feet Closest distance between nearest proposed structure and upland edge of wetlands: 0 feet Does the project involve excavation or filling? 1/ 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 ofsuch proposed operations (use attachments if appropriate): ~l-~ ~4ThfJh (1--\:~ {l-vv-Jo~F o.N~ V\XZ..!?J l:X4\/~Z.~ off~~ To ~Ay~ It:~~v~ IS Sj\-~(L.- ~ .~ '2NUI~ . Board of Trustees APPliCeon COASTAL EROSION APPLICATION DATA Purposes of proposed activity:_t ~(b.-r: to l\Ju l\I (J/\J") ~ u~ S~<-.-/ Are wetlands present within 100 feet of the proposed activity? _-'L...~ No Yes Does the project involve excavation or filling? _~_ No Yes If Yes, how much material will be excavated? o (cubic yards) How much material will bc filled? () (cubic yards) Manner in which material will be removed or deposited: Dcscribe the nature and extent of the environmental impacts reasonably anticipated rcsulting from implementation of the project as proposed. (Use attachments if necessary) '~k\~k ----fL1)O(\Jf; _ 't>v\{AA'C' , C(Z~ ~T\0L- ':J- 'TtJ-m \~I'2-h..- \"> ..--0\ I~ ..I.... l:1Ji& C-.ov"-.lUI..\ll2Y" ~ c- O rJ \~'- -~V\ivlR-c~'L.^,-1\, . . . PROOF OF MAILING OF NOTICE A TT ACH CERTIFIED MAIL RECEIPTS Name f( A\cIJtc:- f-o/\N>t 6f'/oli Address: po f t-hL- L.u0.J\- Cv.p ~ Ivt4'zt1j ') ~K<T M~~ ~~ <1.~T~\\~0 w.. It ~ t,N iLL...) "':::::.ll~ tN'( (l ~ ~10 po ~)'- \ ~ ('\Jc t.A_) o ~~LL , ~ ~)'- ~~'i III ~Clo N ~t..,J :::::'v~,"-L l t ~r;t, J STATE OF NEW YORK COUNTY OF SUFFOLK ~~~~\ \)~residingat L\~( {.~ ~~___ Jl-']m~ (l "1(2.. , being duly sworn, deposes and says that on the _______2'5- day of uti , 20 0<", deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons atthc 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 asscs,mcnt r~~fSouthold; that sai Notices were mailed at the United States Post Office at ~ l-Z. , that said ot ees w~mailed to eaeh of said persons by (eerlilied) (registered) maT V _ Sworn to before me this ;J \ ~ Day of (~';n-Ld.f', 20 ~ "-~ l/t WI otary pUbliec1.1 LINDA S. TAGGART Notary Public. Stale of New York No. 4948506 7 Com !lu~liIied i~ Suffolk County /) ^.. mission Expires Marc/) 20 ,L-V</ '- . I PRO,IECT ID NUMBER I . PART 1 - PROJECT INFORMATION 61720 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) SEQR 1 APPLlCAN;~ ~PONSOR ~~\7~ 2. PROJECT NAME r v'\J\1l()~ 3PROJECT WCATION \2;.):) ,".c>, S\ N\7 (;IJ .s ui;fCL-v'-j tV--( County "S.~~ Municipality 4 PRECISE I_OCATION Street Addess and Road Intersections, Prominent lan~J etc - or provide map I2cr.:> 1:':>\ 5\ ~ -Svtt&- I \ 5 IS PROPOSED ACTION o New D Expansion 0MOdification I alteration 6 DESCRIBE PROJECT BRIEFLY ~~"-\l\."7.-P l>~V\Z.'^^t I ~ Ol......J ~0\t\ ~t~'::, J~ p(Li~~t\ ( f\v0\) 'T~ \::>fC,-e-U-.,fV~ oN h.J-'-~' UfV)--'-. f'-\:"-f'1 ~ D /'Iv--- of '(tt~ .sTV~ (~D 7 AMOUNT (iF LAND AFFECTED' Initially acres Ultimately acres 8~PROI'OSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes I~o If no, describe briefly: rn:AT IS 'RESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) . Residential D Industrial D Commercial DAgriculture D Park / Forest I Open Space D Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Fe(~I. State or Local) DYes ~ No If yes, list agency name and permit I approval' 11 DOES !\~SPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? D Yes No If yes, list agency name and permit I approval: 12. AS A Rj~LT OF PROPOSED ACTION WILL EXISTING PERMIT / APPROVAL REQUIRE MODIFICATION? DYes Q No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant 10:~Nc( . f~ \ArU DateY("Z.~ I liD 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 11- IMPACT ASSESSMENT ITa be comnleted bv Lead Aoencv\ A DOES ACTIO~~EED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. o Yes No B. WILL ACTIO~EIVE COORDINATED REVIEW AS PROVIDED FOR UNliSTED ACTIONS IN 6 NYCRR, PART 61767 If No, a negative declaration may e superseded by another involved agency. c=J Yes No C COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLQWJNG: (Answers may be handwritten, if legible) CI Exislilg air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential fOf erosion, drainage or flooding problems? Explain briefly: ] [ C2 Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: [ j C3 Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly' [ J 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 rP-SQlJrces? Explain briefly [ ] C'- Grow:h, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly , [ ] C6. long term, short term, cumulative, or other effects not identified in C1-C5? Explain briefly: [ ] C? l:: impacts (iceluding changes in use of either quantity or type of energy? Explain briefly: ] D. Will THE:JROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? ,If yes, ex~lain brieflt 1 DYes 0 No I E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? jf yes explain: DYes ONO I ] PART III - DETERMINATION OF SIGNIFICANCE (To be compleled by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otnerwise 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) geographk; scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient (letaH 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 if you have determined, based on the information and analysis above and any supporting documentation. thai the proposed actio WIU_ NOT result in any significant adverse environmental impacts AND provide. on attachments as necessary. the reasons supporting thi dete~mination Name of Lead Agency Date Print 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) . James F. King, President .Jill M. Doherty, Vice-President Peggy A. Dickenwn Dave Bergen John Holzapfel . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone 1(31) 765-1892 Fax 1631 I 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter ofthc Application of ---l,l.ll-L-!.L1Jl~ll~--~~_~~ll______________________ COUNTY OF SUFFOLK) STATE OF NEW YORK) n AFFIDA VIT OF POSTING !, l1\J\t\Ovrv~ \<-a\l~~iding at ySr ~ l-E- c! it\) ~- _ht'tT\\u Lt--- iA/1 ( l ~ ~ 'L_ being duly sworn, depose an~ say: That {l:'~~b daFf 5>\fp ~,200~ I)V~~IY p(de~ the pr~erty'k yrn as__ by placing the Board of Tmstecs official poster wherc it can easily b seen, and that I have checkcd to bc 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 U jp()p Jp1 Qb, aDlYr .-____ th,\ ' /0"\ (l60Ll-f (C. dO {arn Dated: . iC!f Sworn tob\ f5: day 0 lJ)/;~ : (~pu lic REB.^. S. MacDONALD Notary Public, State of New York No. 4974783 Qualified ;n Suffolk c~ . Signature on File in Nassa C V k:3 Commission Expires Nov. 19. ' . . Board of Trustees Application County of Suffolk Stah~ of New Yark ~,~,t\o J{ ~l U..D HETNG DIns SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRLE 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 APPLICA TlON, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENT A TIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PRE\lISES IN CONJUNCTION WI EVIEW 0 THIS APPLICATION. ( l/ Signature SWORN TO BEFORE ME THIS _2 ~ /). . .. DAY OF _~ ? ,2oJ2j" ~/' . /', . (' .' LJc /' .J Notary Public lINOl\ S. TAGGART Notary Public. State of New York No,4948506 ,.........~f!IId in Suffolk County" 7 100 _...0-.,.. ExpiIes March 20, --,t.::;, 7 Town of Southold . . L WRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS I. 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, Iistine: both supportine: and oon- supportine: facts. If an action cannot be certified as consistent with the L WRP policy standards and conditions, it shall not be undertaken. A copy of the L WRP is available in the following places: online at the Town of Southold 's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# ~:bo ----11l- rn ......-:u PROJECT NAME The Application has been submitted to (check appropriate response): Town Board! D Planning Board D Building Dept. D Board of Trustees dJI 1. 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) D D (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: [21 Nature and extent of action: _--1--~,.r,,-'vAL- u~ fi?,r'w:;.. t ~~. {JrrJ'V:J -\Of 1:+...l.l-\V\i6 ,LhoJ~ ~ 8\. 0 ~ ~tA~ ~ " ~ -1J'i..'^- ,'VC(\Th..~M.--S. Site acreage: . C2uJ )';5\' ~ .0)\ . M" vJ ~u ffo \ t.<-- (('J( Location of action: Present land use: ~~'::>, ~t\\ 4'v Present zoning classification: (V\'f..... 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 ofapplicant:1$\~ '1 <~:'\LuJ (b) Mailing address:~q'6 0lJ"- J. ~'I(1_ ~\A'\i\"\$UA-l II.){ ~-I \ I~'L--- (c) Telephone number: Area Code (T\~ 57'2-l.\.{~ (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [J No0 If yes, which state or federal agency?_ C. Evaluat.? thc project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Managcment Practices that will further each policy. Incomplete answers will require that the form bc returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of South old that enhances community character, preserves open spacc, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes advcrse effccts of dcvelopment. See L WRP Section III - Policies; Page 2 for evaluation criteria. DYes [] No 0 Not Applicable Attach additiof1al sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - PoJicies Pages 3 through 6 for evaluation criteria DYes [J No [3' Not Applicable . . Attach additional sheets ifnecessary 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 [J No ci 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 DYes [J No 0 Not Applicable Attach additional sheets if necessary Policy 5. Pmtect and improvc water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria DYes [J No [{JNot Applicablc Attach additiOl'al sheets if necessary Policy 6. f'rotect 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 [J QJ Yes No . Not Applicable . Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 thmugh 34 for evaluation criteria. D Yes~ No G 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 L WRP Section III - Policies; Pages 34 through 38 for evaluation criteria. DYes [J 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. See L WRP Section III - Policies; Pages 38 through 46 for evaluation criteria. D y c[J No 0 Not Applicable 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 loc~ltions. S? L WRP Section III - Policies; Pages 47 through 56 for evaluation criteria. DYes [] No [Z] Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See L WRP Section III - Policies; Pages 57 through 62 for evaluation criteria. DYes [] No CZI Not Applicable Attach additional sheets if necessary Policy 12. IProtect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through (,5 for evaluation criteria. DYes [] 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; rages 65 through 68 for evaluation criteria. DYes [] No ~ Not Applicable PREPARED BY \~ t TITLE DATE~Ij06 Albert J. Krupski, PreSiden. .James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson . Town Hall 53095 Route 25 P.Ci Box 1179 Southold, Nl!w York 11971.0969 Telephorw (631) 766.1892 Fax; G:n) 766.6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD ---------~_..,---- ---'--------._-- Ornee Use Only __ Coastal Erosion Permit Application _____Wetland Permit Application ~ Administrative Permit Amendment/Trans ter/'Extcnsio n ..6e"~ived ApplicatlOn:)Z II'')~ .r-:~e"eived Fce$~~\:L'Yfi':,.'0_rd ' ~ompleted AppltcatlOll__'i>' )\ '11 S:lo _ .___ Incomplete _.______ ___ _ _ SE:.)RA ClassltilatlOIl Type I_..Type II _Unltstcd_ Coordination:{date sent) :-~__ L \\'RP Consistency Assc.~~;;cI;tI~;-nl1 _--eU-itt)~ __ CAe Referral SeIlt: - -. ___Dale ofTnspection: _Receipt ofeAC: Rcport.___ ____Lead Agency fkterminat!{)ll:_ Technical Revic\v: _Public Hearing Ilcld: Rc~olution: I: - --- ---- -- --- ---- Name of Applicant. t,di\\\Ai"^'- C\(C-\LI..--\.A/\- -----,.~------------ ---- --- ----- ____n___ -----__________ ______~___ __ __ n_____ Address --!ri~~~ (\ ~ V=-\ , A.,iV<-. .. ~~\~ \ lTl{'-h. :AlC _Jl~~~z--__ _ _ __ _Phonc Nutltbcr(5/b) -tJ.5.12 -90 Z y.-. ___ _ Suffolk County Tax Map Number: 1000 - --I11~ (n. :'X.3~_. ["I,......... \':,\ - , " c- I~,l_i Property Loc'\tion:_ _L~~~~ ,'S\. V\JvJJ l)L I \-'=---'-~ +-_ t'l' J q --6 . . . J-._J.__. tiJ..J_~__ (provide L1LCO Pole II, distancc to cross streets, and location) AGENT:__fu~-n+wJ~_~ L-LO __~_______ (If applicable) ~ 9~ A >&~ ~U Ad""~'_ ~~__L>Z-'l'l!V\L _"'t'tI ([1!C}/C11L7 -Jf)f~___..______~_Phone 2{fJ 572 ---lJ1L{( ~oard of Trustees APPlicat~n Land Area (in square feetL GENERAL DATA 3, \ V. l \ O't1='T Area Zoning:___.y\.- '2--. /; Previous use of property: ----'=-'E-S iiJl; IV.TI&____ -------------.---- Intended use of properly:. ./\Z..;c':' ,\:r.,,'vn (\1 _____________.__ -- .-- ---.'.--.------.- -_._._----~-------.._._-- ----.-----.------- Prior permits/approvals for site improvements: Agency Date ----------.------.-- ----._-- -.'--..---- -'--.- --------- ----------...-----.--- --..-----.-----..--------- ---.- -- ---.. _.,,----- -- --.. ------ -.--------..--- ------- --- ---- __ __. No prior penn its/approvals for site improvements. Has any peIlnit/approval ever been revoked or suspended by a govell1rnental agency'! _L No___ Yes Ir yes, I}rovide explanation: --...---.--.--------..-- - -- --.---.-------...-.-.--- ---'---,-..- --...- - -----..------------- i2-.o.i'>\tR,.-J6 . f\)I-"'; D.E.(_V'--\"J G-I Project Description (use attachments if necessary): .J:),"':---,:,?~;<, :"'T (\ '-.\ (1 0--Q.c\<:-- " I r- c..,-", '"c\'--.. L A-\T\ ~ _J--JLctC&2 __CL.."-J '2--,:J--n-\-- ~ \~ '::') 01= ~~ p~l__LnI_ ~)~ Go.'\J(.. LDl\LA.... ~1 ~\l>"0t ~.t:C iC v\JFc.l---.J , (~,'^-''::.. (..)\""'-'-"; s.....-~.:d SID"E L \; /'ll&h.. ,.\Jf: 1.;-' (Y\A\-\-0C\f\-y" / ,) I l' .-r ,'-.- ',- h-: L '"'-_._ ~ c"~~)\^(~ '-'-' ,:,..~.'vT.SD,,-.,,.vz, y~:;~'V,-,,? -~~_ .""'1..1\, \._ Z~lb.-, l-XLA...'--'h.' r _ jI--'l '- I <;''''-( ~oard of Trustees APPlicatilr WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: '~J'--l'-'\1{v(, (:.o.-v~" u,".Y::. C-~--::.__f'cc('~ -iT~;~~. (jf'l[J2-I\'f'u'~~---.l\::i'-~_ v'Jf'fD,-;:;D , -r$_u:Q~'\.""J-A\~7 _ I':> CA,-,\.V"(-l... 1V"l n_f\I('-'I:L~~- 1\/li'fi{:>f0 '6_.,\,i~)\--;':> <. \\/-),.. ,::,S'i..O c.']\. .--, \ ~'1 I ,"rea of wetlands onlot:____=:>.':'.:_~ J_square feet Percent coverage oflot__._~_% Clos,",>:t distance between nearest existing structure and upland edge efwetlands:___-D_ ____fect CloseE-t distance betwecn nearest proposed structure and upland cd"c of wetlands: D feet b _.__.....__. _____,,_ Docs the project involve excavation or tilling? ( 1/ No Yes rCyes, how much material will be exeavated'!____cubic yards How much material wi II be filled? cubIC yards Depth of which material will be removed or deposited:__ feet I'ropo,ed slope throughout the area of operations:_______ Manner in which material will be removed or deposited:__C-I2-v-~rlKC) ~k:'/hCit<hV;-,__ -J?_J;"'i;-,J?_l^' _ "Dfl--\V~ Uf\J\)1;.1L ~tD~r<- pq'~I2,~ 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): . ~D NUMBER r . APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 617.20 SEQR PART 1 . PROJECT INFORMATION 1 APP~CAW / SPONSOR 2. PROJECT NAME 11".....~h>--\..1'\ ~ c.(~"(l\.-L.v 3,PROJECT i_OCATION < :"Ci Municipality County _)l iF- oL-k.. 4 FJRECISE _OCATIO~~ Street Addess and Road Intersections, Prominent landmarks etc - or provide m;lD 1"Z.~u bT c:':>,. (JE LJ ,:::>,-,~~-Yt-",1.L- I rJ "-.L--.' :;;J(1"<-,v'-<-. AvE:. 5 IS PROP(j;;ED ACTION 0 New D Expansion EJ Modification" altemtion G DESCRIUE PI\OJECl ORIEFL Y tV,. '~\v';;;vV-~ ' {Lot -- t::y:rLLj,,:.........."'7 \)LC~ (,0 \T1..:>/\...i'-?-i::- Kr;~(l\^'-V~ ","'~J( ( I , L\...-i1LI.- r L"" t,,/.--.tJ.> /VVriW "Hi.NUL. 7 Nv10Ui~T UF LAND AFFECTED Ultimately I~ 1'1 71 ~i ,< IrliliClllyl&lj ," 1(r Llcres acres 8 V'JllL !'RCWOSED ACT ION COMPI. Y WITH EXISTING ZONING OR OTHER RESTRICTIONS? DYec [2] No If no, describe briefly: 6~,L \2T c~~~t,"I'Ctl,_ / ;;:A^~CtL(",( k-\~"t"\ (-~ ";..,j)\=; ,- ~ Il_,- .,~ ''') 9 WHi\T IS )RESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as Llpply,) o Hec;iLlentiClI Dlndllstrial D Commercial DAgriCUllure o Park I Forest I Open Space [] O!hl~f (:Iuscribe) 10 DOES ACTIO,'-~ INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMA TEL Y FROM i\N't crn-IH< C~OVERNMENT AL AGENCY (Federal, State or Local) DYes [~NO If yes, list <:lQency name and permit / approval: 11 DOES PNY ASPECT 'OF THE ACIION HAVE A CURREnTLY VALID PERMIT OR APPROVAL? DYes [JNO If yes, list agency name and permit / approval: 12. AS A R(~SULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICA r IO~J? Ges []NO I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF r,.1Y KNOWLEDGE Applicant r::~~nh"V\ r0::':'\1~ Dafe 11 II Ie"" 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 (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF DYes BNO 8. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 6176? If No. a negative declaration may,be superseded by another involved agency. DYes CJ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten. if legible) C1 Existing air Quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: ~' ] r~' \..1 C2 Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain brieny ~J) ] C3 Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Expl"in briefly' GJJ ] C4. A conmunity's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other l1aturClI rese-urees? Explain briefly [\J~ . ] C5 GroVlth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly C.~,~ - ] C6. Long term, shari term, cumulative, or other effects not identified in Cl-C5? Explain briefly' [f~l,- ] C7 Othe' impacts (including changes in use of either quantity or type of energy? Explain briefly: I,\!_ ] 0 WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONJV1ENTAL CI-I.A.RACTERISTICS THAT CAUSED THE E::STAf3LISHMF.NT OF A CRITiCAL ENVIROf'Jr,1ENTAL AREA (CEA)? {If yes, explain briefly ] DYes [JJNo I E is TI1ERE O~THERE L1K~LY TO BE, CONTROVERSY RELATED TO fJOTENTIAL ADVERSEENVI~()NMENTAL.lrV1PACTS? If yes explain DYes No I ] PART 111- DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, importantorolherwisesignificanL E:ach 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 ji was checked yes, the dotermination of significance must evaluate the potential impact of the proposed action on the environmental characteristies-oHhe-GEA-:---- 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 determfned, based on the information and analysis above and any supporting documentation, that the proposed actior WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi detErmination Name of Lead Agency Dale Print or Type Name of ResponSible Officer In Lead Agency Tille of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Pre parer (If different from responsible officer) County of Suffolk State of New York 4ItBoard of Trustees APPlicJlton __~____ JJvvTl--to"V":" t;10T1 t-t..l?__BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR TIlE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEI'vIENTS 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 TillS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE /,PPLICANT 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 T[[[S APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATlVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PRI'l'vlISES IN CONJUNCTION WIT ,'VIE OF THlS APPLICATION Signature SWORN TO BEFORE ME TIIlS__L:::L ~c'-' ( ,. ~ N;"taryI>ublie _DAYOF~jn ,20 QlD M11IIaA WARlIIER IloIIry PuIlIIc Staa of New 'toft< No.01WA6140448 Qualified in Suffolk County Commission Expires lanua!)' 30e,? 0\ n Au~ 17 06 03:13p 111:1/1,f/:lEm& 82: 51 V.L MEDICAL FORCES 97.9 153 1759 THEINKSPOT -PUG.L\.I. U~ .L:J..l&tIi t.t::e~ ^pp..1....l.Ca'C~on 3106 p.2 PAGE 02 AtI'1'BORl:ZA'l'ION (where the applicant is not the owner) .. I, WJi..l lam f""- ~~W1 . (print owner 0 property) residing at /).,U 0 Ftlh1T (mailing address) hereby authorize ArAJrJtcAAl ( Agen~ l to apply for permit(s) from the Southold Board of Town Trustees on my behalf. J!i:..1#i -.---_._..._...._--..~-_......_.- ..-.-,.._.~----_.__.,. ",. .---.--------.-----.... .'.-." ",~-,-.- 8 l . . APPLlCANT/AGENTIREPRESENTA TlVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics orohibits conflicts of interest on the Dart of town officers and emolovees. The Durnase of this fann is to orovide information which can alert the town of DOssible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: ___~~\\t1.l-LI'1 .~IC.-..IL,'-O (Last name, first name, lpiddle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Building Trustee Coastal Erosion Mooring Planning \/' Tax gri,~vance Variance Change of Zone Approval of plat Exemplinn from plat or official map Other (If''Other--. name: the activity.)_ Do YOll personally (or through your company, spouse, sibling, parent, or child) have a relationship \vlth any officcr or cmployce oftht: Town of SOlltholJ? "Relationship" includes by blood, 111<miage, or business interest. "Business intGrest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employmcnt by) a corporation in which the tOWll officlT llr l'mployee owns more than 5% of the shares. YES NO J lfyoll dns\\crcd "YES', complete Ihe balance of this fOrol and datc and sign where indicated. Name of per SOil employcd b)' lhe Town of South old Title 01 position of lhat person _________ Describe the relationship between yoursc1f(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. rhe to"m officer or emploYl'e 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 appliqmt (when the applicant is a corporation); _____13) the legal or beneficial O\vner 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 _p) the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this _.day of Signature Print Name 200 Form TS I 4-~ z '1 >-; z >-; (/) :r: u ,- ]> z o o o o o o o (/) n l> , fTl W '-.. ~ Ci' . II ~ 61 .... . I - . o D o 0----0- '-,') J BLUESTONE TOP "- BLUESTONE TOP I 6' 4' " ~ I' STONE VENEER STONE \JALL cco u,.! BLUESTONE TOP BLUESTONE TOP J "- 6'-6' S TONE VENEER LOUVERED MAHOGANY FENCE STONE VENEER SECTION OF LOUVERED FENCE /, ' U.i ;.J \ ,,0 "- .,. z- j T~ 1'# '2 ~ I '" --' oii; t ~~ ~~ ~ .,. :'l " '" 50..5.3~ _ i1! '~ ~ro'~ ___ k_ ~ ~ l{"),j 2-E IKlOO OCCK~ li-]]" 7' '~:\.; - ~D"t4 ;r ()~ --' cp v~.v<' I" >:>/ ,. ., H.j "-""""~ C).- 1 0'" I .3 , I r-.eL<.. ,~ J) 36.5' rP L/N{j~~ 6 0 0 010 CU TCHOGUE " o o SA Y 5 08" 08' 20" _ _ _ _ _ W SIra SHEETING UNDER FACE OF DECK "'" , ~I -I I I I ~}~ ,."" ~~ .fl ("~~ ; ,~, '" ul rJ. 1,::) \,1 I ,j \1.1 )" \',; ~ ? n,H~ \\I \,'}-\o) I \. J !-...1 I .,) {, ~sl '- I I I , I I I I I <0 N/F ROMAGNOLI }-...: (I) Lw Cl Cl::: '<:( ::r:: u Cl::: .() - Cl Cl - I<) l!) " C\J OJ V:J HPE FOUNO--.. 2.7 C> ..; c FeNce, <0 c:i . 2.3' 2,0' , \ \ [1' I-l . ~ \[~ ~ \~ 0. ~ ~ ffJ;:iQ. 1- \il !J V'd ,J -5 ') [" n...J '} ... n 1;J " "'" r /<-- 2 STORY WOOD FRAME RESIDENCE '0 <ci '" 32.3 nE 50' N aT 50' E ..; GUARANTEES INOICATW HERE (X<l SHALL RUN ONt Y ro mE PERSON FOR MHOU 'THE: SURVEY IS PRU'ARE:D. ANe) ON HIS BEUALF 10 THE nTlE cavPANY. G'OlC/lNIIEHTAL AGfHCY. LENDINC INSn1U11I.'X'I. IF USTED HEReON. AND TO THE ASSIGNEES OF THE LENOING lNS"nJTrON. CUARAN1ffS ARC Hor TRANSFERABLE ro ADOlnONAI. INSnTIJTK>>rIS OR ~OOfNT o)ltt/fJl5. UNAUTHORIZED ALTERAnON OR ADf)InON TO THIS SURVEY IS A KOLA TlON OF SEC1KJN 7209 OF mE HEW yORK S;~1E EDUCA1IlNi LAw.: COPIES OF TH,S 5UR\'["Y MAP Nor BEARING 50,53'.: "! ;) ,<:; ....._'-.., 'T l - ..~ J ~ l. t t- o<: ..:-.;n o '..J FIRST STREET o ~ :1 vi 7. ]<1- c.1 Y ~ ;) \1.1 v :> ---:: J <: SURVf:YW 3 MA r. 2000 SCALE /"=/0' AREA= 3,11/.382 SF OR 0.07/ ACRES SURVEY OF DESCRIBED PROPER TY S/TUA TE ! \ ,,0 "- " z- --~----- .~ :,-1 ~~I ~I -I I I I '" -J 0;iJ t ~~ ~~ tI " ii " :;; .'jD..5.J~ _:i! " ',: ~ro<\l!' .i v __ L,. ~ _--- ,lI"),j e.E...~ OCCJ(~--------- 11'1]7' ~\; - . '-----<-D't P-. ;; ()~ -' cp P-~-ve "'f' . i:> . .' ;. ., 1+1 '=-"-"~ i:) 1 C"J , .3 ., t E.et<- ; J) ~ 36.5' rP LINb~"'y 6 0 0 010 CUTCHOGUE" o o BA Y 528. 08' 20" W '" ~1~ ,,3' ~ ~ ~ (''->I < ; \\1. ~ \1.1 \11 r-J ~ .:;) \'J \ du.l ) ~ ~ ? HJe ~ V)-"') I ..) ;; !.--1 17, f .~ l' ~ I '- I I I <.0 N/F ROMAGNOLI I I I I t-.: I lr) lu " . Cl Cl Cl Q:: - 'C I'<) I() G . C'J Q:: CQ J::) V) 2.7 Cl /~PE rouND...... o-j STffL SHEETINC UNDER FACE OF DECK " FENCE, <0 cj . 2.3' ~ 2,0' J ~ _\ 1- ~ gl~ n,,'Al \J~~~ $0 r.. '.t r !J '~'J '"~) 'J ('>l n sJ " -<:~) r <. /~ 2 STORY WOOD FRAME RESIDENCE '" <ci '" 32,3 77E 50' N OT 50' E .., GUARANTfES /NO/CAW HOlE ON SHAll RUN {)Nt Y 10 mE POISON FOR ttHOU THE SURlIF:Y IS PREPARED. ANfJ ON HIS BEHAJ..F 10 mE "1U Cl.MIPANY, GOlDlNllCNTItL AGf"NCY. L.ENOINC /NSnwm:w. IF USTEO HCREON. NID TO THE A~GNffS OF THE LENOING INSlI1UflON. CUARNiTCES ARE NOT TRANSFERABLE ro A0DI1lOHAL II'ISnTlJDONS OR SUBSEQUENT oKNE:R5. UNAumORlZED At IFRI. new OR ADDmON TO THIS SURVCY IS A HotA 1ION OF SECTION 7209 OF THE NEW YORK stA TE EDUC.A 11DN LAW. COPIES OF THIS SURVf:Y MAP Nor BEARING - -- -_.~-- ........ .....'''., 50.53'; 0 ~ ' J ~ -..:.-3 ,. i, , p~ l. \ t ~ .J.;/I o v FIRST STREET o ,i 1 ~ f ~ :1 u! '2 "- ....1 ],,/ ... '1 ~ 3 ~ / ? III lY .? :s:: 2[ ""' Xl CQ <: SUR~'f:y[O J MA Y. 2000 SCALE /"=10' AREA= 3,/11.382 SF OR 0,071 ACRES SURVEY OF DESCRIBED PROPER TY S/TUA TE z I ,c . (1~'h~51\o CUTCHOGUE' o 0 BA Y ~ 08' 08' 20- W STElLSJfaIW'C WtlOflt FAlX OF 0(l;K QI).~3' ~ ~ - ~ CO N/F ROMAGNOLI \'j ;: ~ S ~ ,. ,. ~ I ~ . t-.: V) lu a Cl:: <l; G gs , c::. c::. ~ ~ tI) 2.1 <> FfI"E fOWC)--. t1 lIE- 50.' .... --------- -~ 36.5" 2 STORY WOOD FRAME RESIDENCE 1-~ J~ \ 2.J' 2.0' o --8 ~ ~ 3 .. ~ ~~ -;; t: . . i '" ~ r" h;,) It~ ~) Ig ~ ~ IJ d" N/F LORIA ;" k ~ i{ '" ~ ~ Cl ~ C) ~ "l, I)j .,., ~ ~ ~ .. <: 50.53' STREET N or 50' E Q./MM1ED.MllCAJfD ~ tIN .5NM.L ,.., eM. Y 10 .. /IQS(1II ,... ...., lHE aAnll' 'slWfP~IINDOIfHlSf/EHllLF1OH" JllIE QWMr; QMM'lIIDI'I'Al 4Gl!NCY. 10lWllQ MJm,IJICIJ(, ~ usa tlP!Oll. ANl) m .c AUJCIIIIfD" OF ..c IDIIJMG ._RIJIQIt QIAIlMlEES'lIIIJElfOr ~ IV MlPlJlOMt ..sD.IUJDd tJII ~r o.NfJIS IMII!AUINC:IWlW ALIlJt.UION III' MlItlfrJdW 10 DtrS SlMha'''''' WCllA.......sl'I:1JQIf 1ZfIIIOF 'IHE~l1MJ(SrAIFUlIIOI_LA" coPrES OF Dd StltKY 11M' NOr I/EMIJNC 1HE1.Af<<)~~SCAl5HAU. NfJT BE t:a4IDDIED 10 IIC A v.u.o IRtC" cw< FIRST SUR\If"rw J If A 1'; 201J0 SCALE ,~-'O' ME"'. J,rnJB2 sr OR 0071 ACReS SURlE'Y OF o.ESCR/BED PROPERTY Sl1UArF: NEW SUFFOLK, TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. SURVE:YEO FOR : BYTE:S BY THE BA Y TM # 1000-117-0.7-30. GUARANTEED TO. BYJ'E"S BY 1l1C BAY CCAoIuCNI\('Al TH LA'JO nnf II'S co I. SURVEYf:D BY STANLEY J. ISAKSEN, JR. po. Bo.X 294 .~~UFFOLK' NY 11956 i 631 734-5835 /. I ,,~4t2) /I / ~I / U~~D"J$::,-D! !,'.D 5 'I' '...~"I' fes lV'r' I,f; 4'J2:'J" ,". I.. . " , C> C> ~ ~ lI) 2.1 " APE 1OlAMJ-.. ..-j 71E:- 50' N or 50' E z ~ ~ ~ - , <0 N/F ROMAGNOLI tl ~ ... :\ li l- I I g . f-.: V) ..... a Cl:: ~ ~ AWWfIlD .NllC4D M!1ft tJN JfMU. _ fM. 'f JD ... POt!IDII ". awJIf IN( SlInEY IS 1'ftJ"ARID. AND lJII Jf$ IEHMF KI IN" "1lE CCUWfr: ~ AGEWCr. UICWIIC wswrul10t "USIED HOIfDJl AMI ro H A$:M:iNUS OF N" I.DfDWG 1lISIf~ GllAltAN7lE'!I1IIIL1IOr~1I) ADDIIIQItJU. ~"JUJDd" 0It Sl85RUDf'r CWlDrS. LWAUINCHlE'D .u.IEbDCW CJR AIJIJlllt1II to .. ~ IS A WQlAJDW '" src1taJf natI OF 'lHENOI JOIlJr $r'All"tt:lflC:AlDflAll. C/JPICS(T1HfSst.I'hI"'fMAl'HOr~ THE l.MV ~s 08)5S(D .!E4L SJMU. NOr tIC cadDDIlD m BE: A V.u.G lRt€ "",y. \ ~ Ii " ~ ~ a ... a ~ ~ "l, IJ, ""', " <... ~ <: t c I'"P'LI~GS....... boo b \0 CUTCHOGUE" 8/1 Y o 0 ... .. S 08" 08' 20. _ _ _ _ W S!fl!...S!!f1IWC~'ACEOF/JCQf Sf).Q.J' -------- ;>- -c-- .16.5' "'!!!::1. '" ~ 2.,]' 2.0' 2 STORY WOOO FRAME RESIDENCE ;" '" .. ... 50.53' FIRST STREET o 1\ ~ k ~ OJ J. I&.~ \ o~ .;; ~ .. .. i ... ~ r' h;,) th, Ie., ~) ,@ .. ~ IJ a" N/F LORIA SURI.€YEO J UA Y, 2000 SCALE I~""O' AREA- J,rnJB2 51" OR 0071 ACRES SURloEY OF DESCRIBED PROPERTY Sl1t/Aff: NEW SUFFOLK, TOWN OF SOUTHOLO SUFFOLK COUN TY. N. Y. SURVf:YEO FOR , BYTES BY THE BA Y TJ./ # 100D-11 7-07-JD GUARANTeED TO BYT(S BY l11E BAY CC",U(jNI\'[Al m LAUD one /tIS co f. SUR.vE:YfIJ BY sTANLey J. ISAKSEN, JR. po. BOX 294 I (;jNEI.V. SUFFOLK, NY 119..56 631 731-5835 ? I , ' . jt}.f4 .~ ..~. .-- ./ .U~~D./'~~;b ! ;.,.0 S "/~ ,'..}....~ fJ/S ltk.' f,(; .1'i:!;'.., ,'" I,