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HomeMy WebLinkAboutTR-6488AJames F. King, President ~~OF SOUTyo Jill M. Doherty, Vice-President ~~ l~ Peggy A. Dickerson l~ Dave Bergen G Q ~ Bob Ghosio, Jr. ~~ AAaaiO I~C~U~,~~`_ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1592 Fax (631) 765-6641 CERTIFICATE OF COMPLIANCE # 0323C Date June 20.2008 THIS CERTIFIES that the first and second-floor additions to the existing dwelling, Butters & drvwells, and 10' non-turf buffer At 405 Private Rd. #3, Southold Suffolk County Tax Map #70-6-15 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 10/12/06 pursuant to which Trustees Wetland Permit #6488A Dated 11/15/06 and Amended on 2/14/07 and 6/20/07 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 first and second-floor additions to the existing dwelling, gutters & drvwells, and 10' non- turfbuffer. The certificate is issued to MARK MELNICK owner of the aforesaid property. Authorized Signature ~J James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. ~o~apF SOGI,~o~ ~y00UNTr,~"~'" 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 APRE-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 '/z constructed Project complete, compliance inspection. f ~I a~' Q~, {~a~ 6N,Q~e ~-s,~{- ~ncA -I-o ~e,N.c,-.... ~..~•~,1 m~ 2~ S;~ . . 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 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 15t day of construction Y, constructed / Project complete, compliance inspection. . . 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 February 14, 2007 Mark Melnick 4 Bluff Circle Hauppauge, N.Y. 11788 RE: MARK MELNICK 405 PRIVATE RD. #3, SOUTHOLD SCTM# 70.6.15 Dear Mr. Melnick: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, February 14, 2007: RESOLVED, that the Southold Town Board of Trustees APPROVE the amendment to Permit #6488A of MARK MELNICK to place new structural supports under the existing deck, and all as depicted on the plans prepared by Ira Haspel dated 1/31/07. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. 510OOle1Y'r G< ~ James F. King President, Board of Trustees JFK/hkc . . 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 Permit No.: 6488A Date of Receipt of Application: October 12, 2006 Applicant: Mark Melnick SCTM#: 70-6-15 Project Location: 405 Private Rd., #3, South old Date of Resolution/Issuance: November 15,2006 Date of Expiration: November 15, 2008 Reviewed by: Board of Trustees Project Description: raise the height of the roof on an 18'x 32 area of the existing dwelling, construct new 9'X 12' addition on first floor, and new 9'X 12' second-floor addition, with the condition of a 10' non turf buffer, gutters and drywells, and all as depicted on the plans surveyed by John C. Ehlers last dated 9/29/06 revised 11/15/06 by Jim King. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth by the Board of Trustees. Special Conditions: Final inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth by the Board of Trustees, a Wetland Permit will be requir~d. This is nOrm~~ any other agency. James F. King, President Board of Trustees ~--'-_..._--._..__....__._----- ---_._--_._....__....._._-------._.._~- . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO:__rh0k Ie- vYle I hi C k.- ,. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 /tJ((';(di, II Ilr /O{, , uJlT>-.. ~ Go".L.'hJV1 I r(__)t-t"<.A~...fo (see below) ~ J n,.." 0 f-~ Please be advised that your application dated reviewed by this Board at the regular meeting of following action was taken: ( \1') Application Approved <--..) Application Denied (see below) <-J Application Tabled (see below) has been and the o~ cA (0 ~ n.,,, -ft.,-+ J. ":J \AI < (;,- --Iv c",,.,--{-:;.,, 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: Ii SD =h/"j ~\\ \,0\ '" s ;J; TOTAL FEES DUE: $ () IW . ~....J.amp.f: F King, Pref:iden1._ Board of Trustees (r>Srec+,.-,...J . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE.CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 151 day of construction Y, constructed t/ Project complete, compliance inspection. . . ~ ..J " C. .......~ ~~ . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Southold Town Board of Trustees Field InspectionlW orksession Report Date/Time: 1/- (O._(],c. Name of Applicant: ~ (\\6{\tcj:, Name of Agent: Property Location: SCTM# & Street 7()- ~--I S- I T~f area to be impacted: i,Paltwater Wetland _Freshwater Wetland ;/ _Sound Front _Bay Front Distance of proposed work to edge of above: Part,..pf Town Code proposed work falls under: t.A::hapt.97 Chapt. 37 other -- - -- Type of Application:..0r etland _Coastal Erosion _Amendment _Administrative _Emergency Info needed: Conditions: ~\"-0-~ -f" ). /11l~ , , C -h 7 GJ..<;~ ~}- Present were0.K.ing\..l'fDoherty j"f'Dickerson L---f5: BergenVrM6 Other: Mailed/Faxed to: Date: Comments of Environmental Technician: I ~ J · l!' ! "lli . ~ '5 H~i!~ H 1 iH ~ in! Hhf 5 1-1- Idn~1 "!l r-~E2.g 'lI ...t'3 ~,-~-5'8~ ~"s:u . r fH 'a nlnl~n~ 'ii Hj.~h'.!!'1 '~ii .~;'pl~l t H~jHqh .g "I' I!~, u nHL 'f I JlH H U [ iiliH :::1 i:c ~ HH H H '" u 'c u ::;; ~ -s 2: ::; ~ ~ . ~~~ o';'ij ~6~ F,.;- .g-~: ~-'" ",H 8:(j ~ <"'... . . .J M_-'.' ----".,... ., NJ~::YO~k State Depar1me~f Environmental conservation.~'~".----- ~ .' , Re~lo,p:1 f:leadquarters " -. ... . if - .. . --. S~~~;iB,~i1dlng 40, Stony Br~ok, NY 11794 DI'.TE: , . (jd/rlr / ~.: . . ..... .', '~,Lclln...4..... tJ. 110- A dJ, Re: '. I . '. -~~'.,''r i,T. /I..' U{f(f" - r-'173J'. CId J..7.J-./ddu'-rlhomas c. J~rllng.. .. IIO.~' , (~jJ./J~ Commissioner . if' _. _:.~~ tI.. .//?.6.."_....' .:" . -.- -_..;J".-= ~~ "... . ... ~' 'r . ( '" - ..."- . . . . ... . ~-~--~"'-~~""'~..I-'~",-,",,,,",:,,,.Jo"o":-~ Delr!."A,... - , -?;;;; '. 1~,'/1 "IL..~ . ..... ,- '. .... :. I .' ,'LLJIC'I ,,~ ~.. ':" ;~ Oa you';;.;;~~L1Ztt;;~:~; ':' . .Ie(. . ;I.,..~_6 r.?-?I,~ ~. ~ .~h.o o-.~~ Based on the information you have stibmitted. the New York State Department of: Environmental Conservation has determined that' the parc'el .xy ~rojeC:t is: I::' , . :;: ',Greater than 300' f r.om 'inventori ed tidal wetl.ands. --:--r .' . ~ ~ . 'Landward of a substantial man-made structure .' "greater than 100' ~n length which was constructed prior to 9/20/77. '~'''' ..' "., . Landward of the l.0' above mean sea'level elevatiOJ:l cont'~ur gradual. natural. slope. on a 'JI Landward oE the topographic crest oE a bluEE. cliff greater~th.n 10' ~n el.evation above mean sea level.~ .! . or dune which is' ~:" . Th~rltfore. no permit is requi'red under the Tidel Wetlands Act. (Article 25 of"'tlie' Environmental. Conservation Law), Please be advised. however. that no;,;construction. sedimentation or disturbance oE any k.'ind may.take place seaward of the 10' contour or topographic crest without :.permit. It is your 'responsibility to ensure thi;lt all necessary prec.autions are taken to prevent any sedimentation or other alteration or dis~urbance to.the grOu"d surEac~or vegetation in thi~ area as a resul.t o~ your project. Such'precautions may incl.ude.prov~ding adequate.work area between the 10" ,'contour or tOPO.9raphi'c crest and the project (i.e. a 15' to 20' w,ide construction areal or" erection.of a temporary fence. barrier. or hay'- bale berm. . . .' ~lease note that any additional work. or modification to the project as described. may require authorlzation by this Department. Please.conl:act, this oEfice if such are co~templated.. '..;. ..... .,. ..~,.. ?... Please be further respon~ibility of agencies. . . advised that this letter does not rel.~eve you of the obtaining any necessary permi ts ,or ..approvals fro.m other .' .'~. t4;.. ';1 . . .'.~. ......:-:...::.: \ ,.::.;".: C" : ,..:' '. -.... ..::. Very truly yours, . :. .., .' CJ~-I:.~ '\. 'L+~~ . . <:....:. Deputy Regional ~rmit'Adm\"ni_str8for .- i'!' I, I ;, " , " 'I' ': .1', . . Mark Melnick 405 Private Rd #3 Southold, NY 11971 Phone: (631)241-4871 cell (631)361-6605 office Email: Marnick@oDtonline.net r~--- I 'M 2 0 2006-' J' ! L __ _, f ~-~'.,,- ' ..: : ," 'p.'. -".-.-----.--. .. '- New York State Department of Environmental Conservation Division of Environmental Permits Region One Building 40 - SUNY, Stony Brook, NY 11790-2356 Attn: Mr. John Pavacic, Regional Permit Administrator Dear Mr. Pavacic, As we discussed, I'm seeking a letter of non-jurisdiction from the DEC for proposed construction on my property in Southold (Suffolk County Tax Map # I 000-70-6-15). I'm enclosing a permit application with the required documentation. As noted on the survey, all construction is to take place above the 10 foot elevation contour. The current house has an existing second floor with a roofline angled to the floor. This limits the usable space on the second floor. We are seeking to remove the roof and extend the walls on the second floor so we have a full 8 foot ceiling height. We are also seeking to expand the existing kitchen on the frrst floor by adding a 9ft X 12ft extension. This is on the east side of the house. Should you require any additional information, please contact me. Thank you for your assistance. Respectfully, Mark Melnick b'.," I~I- "~ I,bi.i, III' li'I:I ~,V:i: IL, II" ~;; I'" ~ f U H2 ~ i' ~~ D '" ~" ~<O 'c "z !~ ;~ x~ U>c: ,,, ~.@ " oE; +, J . c~,,~ UHf 'fir; "If' h~~ ','11 ,I ~ : .' '~ Iii i'IIi'! 'I['i '!; , '''''f'''O'' ';rrmrr' ': t: : . .:.~ .. ," ~ ~ _ ~ " ~w,. ' " ", . , . . ".' '" L..c.J" _". '-,.,e- I~ I , , H I' i /' 'I I I L . ~, ;'-! ! '; 'I I :'191 U I ~ , I'" H~ ;:i ~E ! e:, IIII IOI? ~ "'.~ ~n In ;" IIII " , i'l \ ,\~' 'i. I 1 ,/1 ~ ~ ~ ~;E~::"--~"""~",, j,--~ I _ '-------- 7;-: I I, I +; i i , , ! (<: ! I ! i J . . Board of Town Trustees Town of Southold Town Hall 53095 Route 25 PO Box 1179 Southold, NY 11971 Applicant/property owner: Mark Melnick SCTM# 1000- 70- 6 -15 405 Pvt Rd #3, Southold, NY 11971 February 7, 2007 TRUSTEE PERMlT NO.: 6488A I am seeking a revision to my Trustee Permit. The Building Department has requested us to place new structural supports under my existing deck on the side next to my house. 1 have enclosed the architects drawing and notes which have been verbally approved by the Building Department pending Trustees modification of my permit. The requested modification is not intended to alter any of the previously approved construction, it will not change the footprint of the house or deck, nor will it have any undue adverse impact on the wetlands. The proposed supports are landward side of the existing deck, and we will still be complying with all previous requirements of the permit. Thank you for your consideration in this manner. Respectfully, ! 1 MarkULv/ Albert J. Krupski, Presi. James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson so 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 \ _.9~fice Use O~ Coastal Erosion Pennit A~i(~: ~ _Wetland Permit Applicati ~ Administrative Permit) Amendment/Transfer/Extens' ""'-- ..// _/']{eceived Application: '01 10-1 01<> -'--- ----..---~ _ReceivedFee:$ ~ ~ _.-completed Application---1.Q\J.a.L tlo _Incomplete _SEQRA Classification: Type I_Type II_Unlisted_ OCT 1 2 2006 _Coordination:(date sent) _L~'RP Consistency Assessment Form _ CAC Referral Sent: _Date oflnspection:____ _Receipt of CAC Report: _Lead Agency DetermillatioIl:____ Technical Review: ~ublic Hearing Held:::jlj I~L)" . _Resolution: ____ Name of Applicant /'r) All. K (Y\ c Lf'J I c/< Address 4 6Ll.J~r- c..iltCCG f.I~vPPJ<JUU~ Ny//7'ifg Phone Number43I ) - 2l.( I 4 'is -, I Suffolk County Tax Map Number: 1000 - 70 - b- 1 5 Property Location: 4 0 5 'P Q I\i A T G fL,{ # 3 '50 vie, I J ------------ - ,/)OLI it d 7 C. .. .. ..'(Provide LJLCO Pole #:distance to CJ:oss streets, and location) AGENT: (If applicable) Address: Phone: . Board of Trustees APPliWion GENERAL DATA Land Area (in square feet): ILl,330 , Area Zoning: (le" 0411<\<-- Previous use of property: $'''Jk .L'fI','ly Res:, oelhc..< Intended use of property: S t,I>'\ C Prior pemlits/approvals for site improvements: (CPlCS "1T~CI4( C Agency DE c.. Date 7(30 /q I 7/11/91 10/n/81 3/'3 (84 13", '-~"~T 0", p t g,-",,-o;', I O<{Jt 13 (,.'....0." lk6' t _ No prior permits/approvals for site improvements, Has any permit/approval ever been revoked or suspended by a governmental agency? ~No_ Yes If yes, provide explanation: -- ---..------.----..---- --_..~-_._- Project Description (use attaclunents if necessary): ("fAN!) [";"'1'"'' II: '>Tc,~'/lovl\< tu '2. .,+.. '7 kcvsc 1'8/,,32.' (A<("(lA . , Tc~l~ ,\N:"'\t".. h.cJ....""" ~ vs,.,..b:l..t, 1 e'><";TI^'3 {'Ie....... q'a.c-e. New 9')(\7.' ojt'"';""'o,, I~~ [Iocr to el\lONIQ e1l';s11^<j K,'fck"" Nell-' 9'''11. 2"!.flocr c<U,f,';"'" ~ Board of Trustees APPlilljion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: / /J;JJ/I'O U;,-; 5 /"" j} P <YO r 1 hid 0 1kJJ ~ , /JJe /; ;"7 e 1"1 sri r k/-l-i-.J.-._ /YV>~ &_0..~j{/ll;,jJ ./ / Area of wetlands on lot: Z, square feet Percent coverage oflot: (2/ % Closest distance between nearest existing structure and upland edge of wetlands: ;{.5 feet Closest distance between nearest proposed structure and upland . ,..p "I. edge of wetlands: 39 feet -for stru,-tvr'<. "bc"'- ...",t'_j 2 1,oc.r <:; 2 f<'Ai fe,., ^'''' c1l ~tt,cM Does the project involve excavation or filling? No / Yes If yes, how much material will be excavated? J ~ cubic yards How much material will be filled? y5 cubic yards Depth of which material will be removed or deposited: 3 feet Proposed slope throughout the area of operations: .(/4-t Manner in which material will be removed or deposited: Ao~1( !0<u.vAf;rlV\ .---..-------------- -- -'- ---._- Statementofthe effect, if any, on the wetlands and tidal waters of the town that may resultby u reason ofsudiproposed operations (use afiachnlents ifappropnate): .. -- ------ S""Qi2 nJ7Pcrlt j7 . . Board of Town Trustees Town of South old Town Hall 53095 Route 25 PO Box 1179 Southold, NY 11971 Applicant/property owner: Mark Melnick SCTM# 1000- 70- 6 -15 405 Pvt Rd #3, Southold, NY 11971 I am applying for an administrative permit from the Trustees for modifications to my house. We are proposing a 9' X 12" addition to the landward side of our existing single family house. All new and existing runoffwill be captured on site and the addition is less than 25% of the footprint of the existing structure. In addition we are seeking to remodel and reconstruct a part of the existing second floor of the house which will not change the footprint of the house nor will it have any undue adverse impact on the wetlands. The house is on the south side of Jockey Creek. We are not seeking to change the use of the house but rather to make the house more comfortable for my family. We are planning to raise the height of the roof on an 18' X 32' foot section of the house in order to give us more usable space in the existing bedrooms. The existing ceiling slants from the roof peak to the floor limiting the usable floor space. In addition we wish to make a 9' X 12' first floor addition on the east side of the house as well as a 9' X 12' second floor addition on the same side. The first floor addition is to expand the space in the existing kitchen. The addition will be 62 Y, feet from the water as shown on the survey. This project will not increase the number of bedrooms or the building occupancy and the project will therefore have no long term environmental impact. In order to mitigate any immediate environmental concerns a row of hay bales will be placed between the house and the water during construction. Runnoff of rainwater from the house will be contained in drywells to be placed as indicated on the attached survey. In addition I would like to plant additional spartina on the west side of my existing dock to supplement the extisting spartina on the east side of the dock. This would be done in the spring. My purpose for this is to help improve water quality and the general environment of the waterfront adjacent to my property. Thank you for your consideration in these matters. /\ // / r PROJECT ID NUMBER ~ 617.2. APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only (To be completed by A plicant or Project Sponsor) 2. PROJECT NAME SEQR PART 1 . PROJECT INFORMATION 1. APPLICANT I SPONSOR (Y) AP, K. (YI E. t...N I C Ie. 3 PROJECT LOCATION: ~OJ,I-lCL-D S'UF!=oLI< County Municipality 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks ete _ or provide map qos Pl'-'VA"'~ r-V "* 3 S~vT/.".',!) Ny /19; I 5. IS PROPOSED ACTION: D New o Expansion [gJ, Modification I alteration 6. DESCRIBE PROJECT BRIEFLY: J- r<J'A'.O eXIS,''''''\ I.:~+,."yk."...<: /Vl'uJ q'xl?.' I'! f'1=, AOOli'er-. "" X 12/ 1... --.:. p(....,<- Avo/ TIO~ N('v-J .., ,. h '/ ..( L ~T<-'t7 -Ill X5l. or'-<. 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8 WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? W Yes 0 No If no, describe briefly: 9 WHAT IS PRESENT LAND USE IN VICINITY [id Residential D Industrial D Commercial OF PROJECT? (Choose as many as apply.) DAgricu,ture 0 Park I Forest I Open Space D Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL ~CY (Federal, State or Local) Iaes ~O If yes, list agency name and permit I approval: f",~ - -I)~ v1f.. .IIf] v, fL' ~r-/l.,f NrASPEL.;1 UI- lfit: ACIIUN HAVE- A CUHHI:;NTLY VALID PERMIT OR- APPROVAL?- ~Yes -&lNO If yes, list agency name and permit I approval: "-A~ ~ M" l__l 12. AS A RESULT OF PROPOSED ACTION WILL. EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION? Ges No I CERTIFY THAT THE INFOR e/I :? ! . TION IS TRUE TO THE BEST OF MY KNOWLEDGE Signature Date: Applicant / / ./ If the action Is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment . . PARTII. IMPACT ASSESSMENT /To be comnleted b[Lead ~::J\ A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PAR:L6.17A1 " tfyes, coordinate the review process and use the FULL EAF. DYes DNa 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 DNa C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: I I C2. rhetiC' agricultural, archaeological, historic, or other natural or cultural resources;or community or neighborhood characffi~ Explain briefly 1 C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: I C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or oUler natural resources? Explain briefly: I C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: I C6. Long term, short term, cumulative, or other effects not identified in C1 -C5? Explain briefly: I Explai~ bri~~ I C7 Other impacts (including changes in use of either quantity or type of energy? I I D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)1 (If yes, explain briefly I DYes 0 No I E. IS THERE. OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain .l DYes ONo I PART 111- DETERMINATION OF SIGNtFICANCE (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, thedeterminatign eff:i€lnific3nse must-evalllate-the-petentiaHmpaet-ef-ttle-PfOposea aetioR SR U'16 e:flItirenmcfltal char8,tcri3tic..s ofU,e CCA Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to tile FUl EAF and/or prepare a positive declaration. Chec"kTflTslioxlf youhav'iideteriTiTned, based-on ilie hlformation 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 rype 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 ApPltlltion County of Suffolk State of New York /!Jffll../C fYJEtJ\/lcl<. BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TO,""N OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPEC THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLIC I '1 // SWORN TO BEFORE ME THIS r/\ DAYOF 1I~v.If- 200(, ..~jl tary Public fW;~VU:'!D HOFH\;,\iJ~J Notart' PUblJ:;;, C;L:;.] c~' UtNY York .~!(l. t:2.<o',i'~;~~;>.:!J r: qU~I.1n!L''': m g~tf;'(j!k County ...omm!".;~''';';-1 (-':-i';r ;'- '-'. t' '. ~n. 19 NO<! :3D,:kYDT -. .. . Board of Trustees. APPUWion 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 Southald Board of Tawn Trustees on my behalf. (Owner's signature) -_.,.,.__..,.._-_..._------,--._----~-_._._- 8 : . . APPLICANT/AGENTIREPRESENTATIVE TRANSACTIONAL DISCLOSURE. FORM The Town ofSouthold's Code of Ethics orohibits conflicts ofinterest on the oart of town officers and emolovees. The DUmose of this fonn 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: mELNICk, IYJI'/R-k, 1-1. (Last name, first name, J;Iliddle initiat: 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 APPLlCA nON: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If "'Other", narne the activity.) Building Trustee Coastal Erosion Mooring Planning :>< Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or bus'iness 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% oCthe shares. YES NO ::>< 'fyou answered "YES", complete the balance of this form 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 applic<;1nt (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 Submitted this /6 Signature Print Nam Fonn 1'S ] ~,' ~/) R > ~c ~ ~ -;:z a~ ;g (l) :J:l D l"\"l ~ \J o U\ :-i V ~ w~~_ II! \l1U,~- ';;j 7'1 '''' ~~(\ . - \1)"" ~ - "',:J ,C\,:; "r0",(),,~ ~ . '.- '0 - ~ -,", ij;J '-~ ll\ 'in V\ t.,):..h.( Q (J)~. ;:s: -+- ~~. :z ~ Cl . . (;) ~ ~l_). )>. 1>-,~ ,- V\_~ < \.'\1;-" t-n I L- . I--"n , '-- -- ~ - ~-~t.~ "&-... L- ,- "~ ~ , " 4-0 f>FI/OW Gf:i!ADf ," ,.....,,~;"'< r -DP,). . 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'-=~--------\---- cJ I" 19 , ~t IT ,) 1;Z ~ .J> '< C G> ';1 '" I'" AI J ~;J- ~ I I " , 1'0 rt : I -_of 1- , (p " o ( I :...---= \. -- ~ " 1 14-0 I I \ -:-:31 .. ," \,1 1 "X~ )11/\ .J~ (> ,. '\) \.-,', L J~ 0,\11 :z. .... ", yo )( "" (1) -/ \ i -->---",-':, -~~-_. rbl -I I ~! I tit -1 III .1 tj '1ft (l .s: 1 ! Ij \ ! I \ \: \.,~ SURVEY OF PROPERTY SITUATE: 5OUTHOLD TO}ilfN: 5OUTHOLD SUFFOLK COUNTY, NY SURVEYED 01-04-2005 PROPOSED AGTIONS SHOHN NOT UPDATED 0CI-2'1-2006 SUFFOLK COUNTY TAX II 1000-10-6-/5 Cedifilld To: Mad< MeInid< LOT COVERA6E EXISTIN6 HOUSE 1,512 S.F. OR 10.1'1 % PROPOSE ADDITION lOB S.F. OR 0.13% RESULTANT LOT GOVERA6E 1.020 S.F. OR 10.'11% --- -- - fl..\c;Y\t 50' Y"IId8 Nf)3-54'o4O"E "1.\!' "))\~4' "'.....~ ~ c ~ ~ 1 -l{ 8 NOTES, · MO~NTFOUND o PIPE FOUND ,-, (,_) PROPOSED DRYHELL FOR ROOF DRAINS ELEVATIONS REFERENCE N6VD'2'1 FLOOD ZONE REFERENGES FIRM MAP No. 36103G01666 DID MAY 4, I'I'IB AREA = 14,B30 sf or- 0.34 oGres GRAPHIC SCALE ~ 1"= 30' ~ __I of ---------- ---------- -JOCkey ---------. 1 1 1 1 1 0 I 1 ::J I ~ ---I ~ '" ~. / 1 1 - - - .:.:;- -jj 1 - ~ - =1:0= -jEJ_~ F..- --0- -L) L 1 1 1 1 1 I 1 1 ---------- J>,}'oo <.91',}', .<./ P.>~ 881031' nELI/IE~ ~, --------, J~ --..J N w-tE S 1 E ---------- '" ,..}O.3S' "'''''' R/ , , , , -- -- , . , ~ m ulfj a en' ~ -c cm m~ Em 60. u.~ c. 0, Km 0> z3 ,,'" t52 -"~ c Q CO o 2" -dee, .... .J:: .Q1 Q' 1 I ..--J. ; ,i .. r' -8 r '''''ad ~,' " , 1 f t~ House "I'.I!L.-,..... '" - ~.".~' /00 ~ o "- ~ ---~.... (._-~) I I -f-'~ I L w..1I .1 11 Bil! - , <>.2;, ,-- . .- T , <- ~,~ -,~ I .- ~lr~l -----~~~-2~"',,..-,,~---. i 10' ~ ~ ~=-or- _ _ _ ~t _", -"by- -=~ stone """v""C!lj Jf\/ay -, -'~2~ 64"" \ , , , , , , , 1 N82042'Oo'~ . ,-5,' 0 ~, ' ..-I, -~ ~ -.:.~ . v E a 3 ~.t ! i'5~ t 5& z~ ~~ 3" ~ Q 75.00' . '" Land No", Or F AUdry M trrn~rly of: of hiiJ/iarn - orrIs 0. Norris ~ j",- --.., 8 ir--o;. ~~ __ _10- 150- 13' ~~ . ,~ ... .~ ~s~ -h _ I 1/2 STORY TO BE RAISED TO AA.L 2 STORY PROP. I STaR ADDITION , , F'ROP. 2 NO STORY ADDITION '. 0, F t5 00 ~ o " o '" '€ ~ L . Eo L 0 tPrt 69 ,.2 aU z " , Q -" OCT 1 2 --_...._""..~ ........~.::::::"'~:z::..~....:. -y---~' ~<;:":.~;r..:.~ ~__I"'_loloo__ -' ~-"*-~-- ~.r="~""'- :::-y-",=."'~~ U:~~-_~--==:-*~ ::....... =rr~~ ~tt:=c::::; ......~oI'..........._c..r-.... -----10_- JOHNC. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N. Y.S. UC. NO. 50202 RIVERHEAD,N.Y.11901 369-8288 Fax 369 8287 REF.\\Compaqservm\pros\04\04-347.pro SURVEY OF PROPERTY SIlVA TE: 5OUTHOLD TO}IIIN: 5OUTHOLD SUFFOLK COUNTY, NY SURVEYED 01-04-2005 PROPOSED ACTIONS SHOHN NOT UPDATED Q<l-2Cl-2006 SUFFOLK COUNTY TAX II 1000-10-6-15 CedlIled To: MlIIII: UHnL+ LOT GOVERA6E EXISTIN6 HOUSE 1,512 S.F. OR 10.lCl % PROPOSE ADDITION 108 S.F. OR 0.13% RESULTANT LOT GOVERA6E 1,620 S.F. OR 10.ClI% APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTH OLD HE /cY~{, ..~ gr< ~~ ~ _..r-- -- - f2..\~r.t 50' Y'lld6 N&3"'54'..w"!:ln.Il' ~'J.\\:J.4' ",4~ q) E ~ -{ c ?: CJ :iZ 8 NOTES, . MONUMENT FOUND PIPE FOUND o . , PROPOSED DRYHELL FOR ROOF DRAINS ELEVATIONS REFERENCE N6VD'2Cl FLOOD ZONE REFERENCES FIRM MAP No. 36103G01666 DID MAY 4, IClCl8 AREA; 14,830 sf or 0.34 aGres GRAPHIC SCALE ~ 1"= 30' 1'- I 1 1 I I b 7 I ::! I ---1-~~--~;' ....-} o 1 _ ~ ; ;'C ~!f!r ,- - - - ~ -- -- - --Il -18= """""d<o<-I< ~ 1 . -i}., - r., nli) 't. } ~m L ~ I ~Q) (so. lL~ I 6~ < ~ 1 ~.3 1'Vl 1 aT -Jr J .CO jJ 1 } "I':~ 1 __I Of se2.4.2t20~ 64.&1' , \ N820~2'ix)'~' '. .23/ ? \ .,-J, J" 'O~ ~ c- 0" EO I J!~ ~ ;;S"8 t 6& ,,~ Uo ij~ ~'-l ~ 0:: -" , ~., ~,~ };\lay ~, '\ r, -~. "f] \ ------ ~"~ Uj ------ .JOCkey 1 Creek ------ ------ ------. < ~ J>J"Oo <.9 /J". '<1' p.>~----- 881"31' 1 ------ Tie LINE "'L 'B 50 _ ~ VE 6E'HIGH...".,rlS' ~ " ! ~: c -b- --1 -- l1f--.:'" B -8-0-- "~ ~~ __ _.'0- .... -C .91 ~ 1 } ,.--J, i J.; .. .. , , ~ ~ ~~ ~,' .g' '. o~ 'i; ~ c 0 Eo Co ~ tPrt La ~ a L <-" au 00 z - u ~ c a 0 -' '" t'J /~ 1 :2 story Frame House "'.I!L.-M.6' ~., ,~, ! 00 - o ..... ~ } I (~~~) i) " ...'" , , , ,J ij Elij ...... , "~ , , , , , , , , 1 " ~jT~1 ~ - - - -r;T1.:.---=-9.::.:~,,-~r~~Q~_- rIO'l"4Idedlrt~ , . ~ot.~ "'Ood~----=:: 51""" ~'ye"'OoJ 75.00' " '" Land NoV\i Or F AUdr orrnerly of. ~ 0.iillir5mM. Norris . G. Norris ~ N W-*E S ------ l!f-f P I #O~t~~ I '1J '- I 1/2 STORY TO BE RAISED TO RJLL :2 STORY PROP. I ST ADDITION PROP. :2 NO STORY ADDITION ---....-"'.......... ...b.~~~::.=.~.:.:. .....yc:n._~~. ...=~=:t'..:.-........ .......__bo.-ID_~ -' ~---.....-- ___n___....__ IOIlIIgGiodo...""--,.....-___ ~_1'wk__of~ "'~p;;;.,f...~-=-=:_~ ='c;.:;:::-...._=c:::; to....---:'i:I.-.-g-. ~ ----...-- JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S. UC. NO. 50202 RIVERHEAD, N.Y. 11901 369-8288 Fax 369-8287 REF.\\Compaqservet\pros\04'D4-347.pro SURVEY OF PROPERTY SIlVA TE: 5OUTHOLD TO~: 5OUTHOLD SUFFOLK GOUNTY, NY SURYEYED 01-04-2005 PROPOSED ACTION5 SHOi"4N NOT UPDATED 0<1-2'1-2006 SUFFOLK COUNTY TAX II 1000-10-6-15 Cerlified To: MlIIk u..Jn;d, LOT COYERAeSE EXI5TINeS HOUSE 1,512 5.F. OR 10.1'1 % PROPOSE ADDITION 108 5.F. OR 0.13% RESULTANT LOT COVERAeSE 1,620 5.F. OR 10.'11% ~-- -- ~ ~\f:;'(It 50' Y"lld8 H85~'~ 1l1JI' -e "J.\\'j.4' ......"oolJ q) ;::, co ~ <( co ~ o ~ o o NOTES. · MONUMENT FOUND o PIPE FOUND ,-. \._) PROPOSED DRYI^lELL FOR ROOF DRAIN5 ELEVATION5 REFERENCE NcSVC"2'1 FLOOD ZONE REFERENCE5 FIRM MAP No. 3b103G0166eS DID MAY 4,1'1'18 AREA = 14,830 sf or 0.34 ac.r..s GRAPHIC. SGALE ~ 1"= 30' I ------ ~.~ Eli ------ .JOCk.ey f Creek. ------ ------ ~15~Q~5' ------ ------ i , , , I I <:, 7- I ::J I - - -/- ~~~,o ~ ~1 ~ " ~~'J ~~ j!}r-= - '--::,,- ill - --0-- -17 _.' ..J) t. , , ~rn -c ... ~J! I fh I 6rf ii ~: I ._..1 o c .- " €l , i,.j z~ ~ p'" I ~ 01: ~ -Jr I " p , I r----. __""-air/ - --f':~ I <.I'SOo <.~/s. '<./ .o;>~ ~~,l"lt: 1 E "" u ! ------ 1/: , , , , f.,,-- .... 0 ~t - -,,7.- ti-o - - ~_ _10- ~~ ~" ..[?iV- !ll _ ~. ~- 00 - o ..... ~ ! ! t~ House ...... a..H6' -'?' - I,,~ / I (~~) l ~-' . .~ -" ./ 11 11 B. 9 ~2'.. /' . . , T , , , , , , , , o , . , , '. " 'k>ne ~""''''''''Y , -,~ "",t..c / ........./ == f[~1 fo - - - --l.~9..--=-:::-9-::"!t~.~o_~~Q__ ~ -' ,-,;,- - - i,o' Y<Oc:Ie~~...aq-- - - ~-"'-"by- -= op /'I/ay "0. '\ 5&.2-"'2 "t:: 6-f..&I' , ... N82042'00'1i' '. ~/ ~ ..-1, '," ~ o oj' '0 ~~ Ir- Ill\.) E a I ~.f ~ 6~ t 6& z~ p& -30 . c Q 75,00' . ... Land NOH Or For AUdry M N m~r Iy of, 4- ~llJiam G_ Orns Norris n,r-T lJv o L w o~ ." , , t ~ ~ 00 - o ..... o '" ~, L " Eo , a 0, ll.Q , 0 0, rSJ ou z U c o -" -'- N W+E S ------ I 1/2 STORY TO BE RAISED TO RJL.L 2 STORY F'ROP. 2 NO STORY ADDITION ___.,.._tc>..~ ......~..,..: ~ -.=:%:,:;;'.::- _T......__l.-.. ~"::,=~..:.':.:;:: ~__Fboo_tc>boo__ -' ~---.......-- ----'...~........- IObogCOdlO.~_~"",-"""",,, '\::._TIlr'tr.___.~ to ':-,:c-_s.:..~:--~ :: ..;:=-.:;.~ ~~"'Cc:-::; tc>_-.-.....-.....g_ ~ __....__to__ JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N,Y,S. UC, NO, 50202 RlVERHEAD, N,Y. 11901 369-8288 Fax 369-8287 REF.\\Compaqserverlpros\04\04-347,pro