HomeMy WebLinkAboutTR-6722
.
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
1 st day of construction
Yo constructed
\~roject complete, compliance inspection.
.
.
TERMS AND CONDITIONS
The Permittee George Guimaraes, residing at Equestrian Avenue, Fishers Island, New York, as
part of the consideration for the issuance of the Permit does understand and prescribe to the
following:
I. That the said Board of Trustees and the Town of Southold are released from any and all
damages, or claims for damages, of suits arising directly or indirectly as a result of any
operation performed pursuant to this permit, and the said Permittee will, at his or her own
expense, defend any and all such suits initiated by third parties, and the said Permittee
assumes full liability with respect thereto, to the complete exclusion of the Board of
Trustees of the Town of Southold.
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 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.
4. 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.
5. That there will be no unreasonable interference with navigation as a result of the 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 Southold require the removal and/or alterations in
the location of the work herein authorized, or if, in the opinion of the Board of Trustees,
the work shall cause unreasonable obstruction to free navigation, the said Permittee will be
required, upon due notice, to remove or alter this work project herein stated without
expenses to the Town of Southold.
8. 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.
9. 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
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
September 19, 2007
Mr. Harold Cook
Harold's LLC
P.O. Box 661
Fishers Island, NY 06390
RE: GEORGE GUIMARAES
EQUESTRIAN AVENUE, FISHERS ISLAND
SCTM# 9-6-4
Dear Mr. Cook:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday, September 19, 2007 regarding the above matter:
WHEREAS, Harold Cook & J.M.O. Environmental Consulting on behalf of GEORGE
GUIMARAES 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, 2007, 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, the LWRP Coordinator recommended that the proposed application be
found Inconsistent with the LWRP, and,
WHEREAS, the Board of Trustees has furthered Policy 5 & 6 of the Local Waterfront
Revitalization Program to the greatest extent possible through the imposition of the
following Best Management Practice requirements: installation of drywells to contain
roof runoff, the area seaward of the house remains non-turf, and
2
.
.
WHEREAS, a Public Hearing was held by the Town Trustees with respect to said
application on September 19, 2007, 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 for the mitigating factors and based upon the Best Management
Practice requirement imposed above, the Board of Trustees deems the action to be
Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5
of the South old Town Code, and,
RESOLVED, that the Board of Trustees approve the application of GEORGE
GUIMARAES for the existing deck, and to remove the Japanese Knotweed and repeat
cuttings over the next three growing seasons, with the condition that the area seaward
of the house to remain non-turf and drywells are installed for the house roof water run-
off, and as depicted on the survey prepared by CME Associates, Engineering, Land
Surveying and Architecture, PLLC, last dated June 21, 2007 and received on August
16,2007.
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
1:::;1r
James F. King
President, Board of Trustees
JFKleac
.
.
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
Gpo~~y"
Please be advised that your application dated Au.
been reviewed by this Board at the regular meeting
and your application has been approved pending the co
following items checked off below.
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
G'u ,'fVloI a.. e "
TO:
has
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Revised Plans for proposed project
Pre-Construction Hay Bale Line Inspection Fee ($50.00)
1st Day of Construction ($50.00)
y, Constructed ($50.00)
2' Final Inspection Fee ($50.00)
Dock Fees ($3.00 per sq. ft.)
Permit fees are now due. Please make check or money order payable to Town
of Southold. The fee is computed below according to the schedule of rates as
set forth in Chapter 275 of the Southold Town Code.
The following fee must be paid within 90 days or re-application fees will be
necessary. You will receive your permit upon completion of the above.
COMPUTATION OF PERMIT FEES:
()o
TOTAL FEES DUE: $ 50----
BY: James F. King, President
Board of Trustees
.
.
Donald Wilder, Chainnan
Lauren Standish, Secretary
Town Hall, 53095 Main Rd.
P.O. Box 1179
Southold, NY 11971
Telephone (631) 765-1892
Pax (631) 765-6641
Conservation Advisory Council
Town of Southold
At the meeting of the Southold Town Conservation Advisory Council held Tues.,
September 11,2007, the following recommendation was made:
GEORGE GUIMARAES for the existing deck and to remove the Japanese Knotweed, and
repeat cuttings over the next three growing seasons.
Located: Equestrian Ave., Fishers Island. SCTM#9-6-4
The CAC did not make an inspection, therefore no recommendation was made.
.
.
MATTHEWS & HAM
ATTORNEYS AND GOUNSELOBS AT LAW
38 NUGENT STREET
SOUTHAMPTON, NEW YORK 11968
PHILIP B. MATTHEWS
(1912-1992)
STEPHEN L. HAM, III
BARBARA T. HAM
631-283-2400
FACSIMILE 631-287-1076
c-rnail: Matthamesq@aol.com
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May 11, 2007
MAY 1.' ~(':J7
Board of Trustees
Town of South old
P.O. Box1179
Southold, NY 11971
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Re: Guimaraes: SCTM No. 1000-9-6-4
Dear Board Members:
I have enclosed a copy of a fully-executed Order on Consent entered into by
my clients George and Mary Elizabeth Guimaraes with the New York State Department of
Environmental Conservation with respect to the deck at their property at Equestrian
Avenue on Fishers Island.
My clients' application to your Board (by Harold Cook as agent) for the same
deck had been denied without prejudice on December 13, 2006. I would appreciate it if
you would advise me of what further action we should take at this time to have the
application granted in light of the settlement with NYSDEC.
Very truly yours,
.btq,~ I~
Stephen L. Ham, III
Enclosure
cc: Mr. George G. Guimaraes
STA~OFNEWYORK - .. vJ'i/
'DEPARTMENT OF ENVIROlWENTAL CONSERVATION
In the Matter of the Violation of
Articles 15, and/or 24 and Titles 1 land/or 23 of Article 71,
as indicated below, of the New York State
Environmental Conservation Law, by:
.............................................................X
(Suffolk County) 'Respondent
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GEORGEANDMARYEUZABETHG~~\,: MAY 1., 7'2J7
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ORDER ON CONSENT FILE NO. Rl- I i-StiI.-.ilGldlt..,.'
.............................................................X F~:',;;' :,.~ ::~_s!rS___
D WHEREAS, Article 15, Title 5 , of the NeWYOrf'State Environmental Conservation Law, (protection of
Waters and Navigable Waters) prolnbits conducting any regulated activities in any of the navigable waters or
protected streams and associated wetlands of the State without the requisite permit, or in noncompliance with
the requisite permit; and
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WHEREAS, Article 15, Title 27 of the New York State, Environmental Conservation Law,(Wild, Scenic and
Recreational Rivers) prohibits conducting any regulated activities within the corridor of rivers so
designated,without the requisite permit, or in noncompliance with the requisite permit; and
WHEREAS, Article 24 of the New York State Environmental Conservation Law, (Freshwater Wetlands Act)
prolnbits conducting any regulated activities on or adjacent to regulated freshwater wetlands without the
requisite permit, or in noncompliance with the requisite permit; and
WHEREAS, the Department of Environmental Conservation (DEe) has documented a violation of said
statutes, specifically Section 24,0701 . Section Part 663.4 ,in that Respondent(s) caused and/or permitted to
be caused,
..........._.....__....................................................................................................nn.........................................................._.................................
. .
: the construction of a deck within the adjacent area of a NYS regulated freshwater wetland without benefit of a :
i permit from the NYSDEC in violation of the Environmental Conservation Law (ECL) at the property located at: j
l.~.~.~~=.~=~:~::.:~.~~=:~.~.~~~.::.............................................................................................................................................1
WHEREAS, Respondent(s) has/have affirmatively waived his/her/its/their right to a public hearing in this matter
in the manner provided by law and having consented to the entering and issuing of this Order, agree(s) to be bound by the
terms and conditions contained herein.
NOW, having considered this matter and being duly advised, it is
10f5
. '. ORDERED, that with.t to the aforesayf;,iolation(s), there is hereiA,osed upon Respondent(s), a penalty
in the sum of two-hundred. fiftv Dollars ($250.00)'Dol1ars, to be made payable ~rtified check or money order, to
the Department upon execution of this Order; and it is further
ORDERED, that nothing contained herein shal1 be construed as preventing the Department from collecting
regulatory fees where applicable; and it is further
ORDERED, that this Order ~hall not become effective until it is executed by the Regional DireCtor on behalf of
the Commissioner, and the date of execution by the Regional Director shal1 be the date of execution of this Order; and it is
further
ORDERED, that in those instances in which the Respondeut(s) desire(s) that any of the provisions, terms or
conditions of this Order be changed, (s)helitlthey shal1 make written application, setting forth the grounds for the relief
sought, to the Commissioner, c/o Craig Elgut, Acting Regional Attorney, New York State Department of Environmental
Conservation, 50 Circle Rd., SUNY, Stony Brook, New York 11790-3409; and it is further
ORDERED, that Respondent(s) shal1 strictly adhere to the terms and conditions outlined in this Order and in Parts
I, II, ill and/or IV of Schedule A, the compliance schedule attached hereto and made a part hereof; and it is further
ORDERED, that any change in this Order shall not be made or become effective, except as specifical1y set forth
by written order of the Commissioner, such written order being made either upon written application of the Respondent(s)
or upon the Commissioners own findings; and it is further
ORDERED, that this Order shall be deemed binding on the Respondent(s), it!his/her/their successors and assigns
. and all persons, firms and corporations acting under or for itlhim/her/them, including, but not limited to those who may
carry on any or all of the operations now being conduCted by Respondent(s), whether at the present location or at any other
in this State; and it is further
ORDERED, that the failure to pay any penalty amounts due under the terms and conditions of this Order may
result in a 22% surcharge in recovery costs and a potential tax refund offset by the Department of Taxation and Finance,
and it is further
Dated: Stony Brook, New York
~,2007
Alexander B. Grannis
vironmental Conservation
By
To: Stephen Ham, Esq.
Matthews & Ham
38 Nugent Street
Southampton, NY 11968
2of5
CONSENT BY RESPONDENT (Individual)
. · Respondent aCknOWledg.e authority and jurisdiction of the Commissi. of Environmental Conservation of the State
of New York to issue the foregoing Order, waives public hearing or other proceedings in this matter, accepts the terms and
conditions set forth in the Order and consents to the issuanc thereof. I ,~
CALIFORNIA
STATE OF NflW""fflftK
CO~'~F (~\),~)
~ ' ~fiar~r~'EY~~~~~fiS
On the ~ day of April 20E, before me personally came Guimaracs
known, who being duly sworn, deposed and said thattheJtesidel at5404 Moonlight Lane, La..J ol1a, CA
the indi1@.-l'....-'1.o.A:E~ ~regoing . t and acknowledged to me thattl"1"xecuted same.
I NoIary NlIIc . California ~
j _ _ _ ~~~~~: NOTARYP LIC
CONSENT BY LIMITED LlABll.,ITY COMPANY
NAME / SIGNATURE !
George G. Guimaraes/Ma' y Elizabeth- Guimaraes
.tome
thatlh't'" -.
Respondent, Harold's. LLC. acknowledges the authority and jurisdiction of the Commissioner of the Department of Environmental
Conservation of the State of New York to issue the foregoing Order, waives public hearing or other proceedings in the matter,
accepts the terms and conditions set forth in the Order and consents to the issuance thereof and agrees to be bound by the
provisions, terms and conditions contained therein.
Harold's llC
Respondent
By:
Name:
Title:
an individual dnally authorized by the Respondent to sign on behalf of
Harold's, llC and whom may bind Respondent to the terms and conditions
contained herein.
Date:
ACKNOWLEDGMENT
STATE OF NEW YORK )
) ss.:
COUNTY OF SUFFOLK )
On the _Day of in the year 2007, before me personally came
to me known, who, being duly sworn did depose and say that he resides at . that he is the
of Harold's LLC, which executed the above instrument; and that he signed his name thereto with full
authority so to do.
Sworn to before me this
_ day of
,2007
30f5
Notary Public
.
.
SCHEDULE A
Compliance Schedule
for
Article 15 and/or 24
1. GENERAL REOUIREMENTS:
Immediately,
Respondent (s) shall cease and desist from any and all future violations of the
New York State Environmental Conservation Law and the rules and
regulations enacted pursuant thereto.
All submittals to the Department required under this Order shall be made by Respondent (s) as follows:
I)
One Copy to the Regulatory Section, Bureau of Habitat, Region One, New Y orl< State Department of
Environmental Conservation, 50 Circle Rd., SUNY, Stony Brook, New York 11790-3409.
II. REMOVAl, REOUIREMENTS:
o TO BE COMPLETED BY:
~..................n..........................''''''''''.''''''''''''''''''''''.....................,
L.~~:~.~.~.?~~~f?::!?:.~?:.~~~~.~.~~:..................j
.....................................................................................................
i Respondent (s) shall submit photographs of the
! completed work required under this schedule, to
i the Department within ten (10) days of its
l..~::.~~~::::...............................................................................
E9 No Removal Required
40f5
S.chedule A (Cont'd.)
.
.
III. RESTORATION REOUlREMENTS:
~ TO BE COMPLETED BY: 10/1/07
SPECIFICATIONS:
..........n.n........................................................................................
. .
. ~, .
i Respondent shall plant 5 trees either red maple or i
! black willow, 6'-8' in height within 10' of the existing i
! shoreline as shown on the revegetation plan prepared !
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.......................................................................................................
. .
. .
i Respondent (s) shall submit photographs of the !
! completed work required under this schedule, to i
! the Department within ten (10) days of its !
i completion. !
. .
.......................................................................................................
o No Restoration Required
IV.NOTICE COVENANT REOUlREMENTS:
o TO BE COMPLETED BY:
lt~~~~~jb~l
Center Drive, Riverhead, NY. A copy of the fi1ing
must be provided to the Department ofEnviromnental
Conservation. The copy of the filing should be sent to:
NYSDEC
Bureau of Habitat
50 Circle Rd., SUNY
Stony Brook, NY 11790-3409
! Attn: Diane Radke .
t.....................................................................................................:
E:J No Covenants Required
5of5
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.
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
Southold Town Board of Trustees
Field Inspection/W orksession Report
Date/Time:
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Name of Applicant:
Name of Agent:
Property Location: SCTM# & Street
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E <1 ve..s 71-14-..-' ;1)<.//5
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Brief Description of proposed action:
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Type of area to be impa0;
_Saltwater Wetland . Freshwater Wetland _Sound Front _Bay Front
Distance of proposed work to edge of above: / /0.1
Part of Town Code proposed work falls under:
i/ Chapt.97 _Chapt. 37 ------,-other
Type of Application: ~etland Coastal Erosion Amendment Administrative
- - - -
_Emergency
Info needed:
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Modifications:
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Conditions:
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Present Were: ~ng _J.Doherty _P.Dickerson _D. Bergen
Other:
Bob Ghosio, Jr.
MailedIFaxed to:
Date:
Comments ofEnviromnental Technician:
.
.
.
OFFICE WCATION:
Town Hall Annex
54375 State Route 25
(cor. Main Rd. & Youngs Ave.)
Southold, NY
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MAIUNG ADDRESS:
P.O. Box 1179
Southold, NY 11971
Telephone: 631 765-1938
Fax: 631 765-3136
LOCAL WATERFRONT REVITALIZATION PROGRAM COORDINATOR
TOWN OF SOUTHOLD
MEMORANDUM
To: James King, President
Town of Southold Board of Trustees
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From: Mark Terry, Principal Planner ~.
L WRP Coordinator
Date: September 17, 2007
Re: Request for Wetland Permit for George Guimaraes
SCTM# 9-6-4
GEORGE GUIMARAES requests a Wetland Permit for the existing deck and to
remove the Japanese Knotweed, and repeat cuttings over the next three growing seasons.
Located: Equestrian Ave., Fishers Island. SCTM#9-6-4
The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review
of the Town of South old Town Code and the Local Waterfront Revitalization Program
(L WRP) Policy Standards. Based upon the information provided on the L WRP
Consistency Assessment Form submitted to this department, as well as the records
available to me, it is my recommendation that the proposed action is INCONSISTENT
with the denoted following Policy Standards and therefore is INCONSISTENT with
the L WRP.
Policy 6. Protect and restore the quality and function of the Town of Southold
ecosystem.
6.3 Protect and restore tidal and freshwater wetlands.
A. Comply with statutory and regulatory requirements of the Southold Town
Board of Trustees laws and regulations for all Andros Patent and other
lands under their jurisdiction
I. Comply with Trustee regulations and recommendations as set forth
in Trustee permit conditions.
~
.
.
The distance to the as built deck from the freshwater wetland boundary is
11 feet; a minimum setback distance of 100 feet from the wetland line is required
pursuant to Chapter 275-3.Findines; purpose; iurisdiction; setbacks. Please require
that the applicant amend the application to meet the above policv to the ereatest
extent practical.
If the action is approved and to further Policv 5: Protect and Improve Water Qualitv
in the Town of South old:
1. Establish a non-turf buffer landward of the wetland boundarv to
protect the water Quality of the pond.
2. Require eutters to drywells on the house to contain roof runoff.
The removal of Japanese knotweed and replanting along the shoreline with freshwater
wetland buffer shrubs is an exempt Minor Action and not subj ect to L WRP review
pursuant to Chapter 268-3; Items A and B of the Town of South old Town Code,
which states:
E. Maintenance of existing landscaping or natural growth, except where threatened
or endangered species of plants or animals are affected, or within significant coastal fish
and wildlife habitat areas;
Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in
preparing its written determination regarding the consistency of the proposed action.
MT /hkc
09/07/2007 09:55
16.85549
HAROLDS LL.
PAGE 01
George G. Guimaraes
1950 Equestrian Avenue
Fishers Island, NY 06390
September 6, 2007
Southold Town Board of Trustees
Attn.: Lauren Standish
PO Box 1179
Southold, NY 11971
Re: Public Hearing, Sept. 19
Dear Ms. Standish,
This letter is to authorize Glenn Just, JMO Environmental COII!Ulting, to represent me at
the hearing on September 19111 regarding the existing deck and knotweed removal plan for
our home on Fishers Island.
Please let me know if anything further is needed for dillCUssion of these matters.
Thanks very much.
~~
fD) ~ ~ .~U1l-lLrnJ
If1lI SEP - 7 ?C07:U,
.__._.~
SOL!thold Town
B0J~rl (If Trustees
By Fax: 631/765--6641
.
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
_Coastal Erosion Pennit Application
.....-'Wetland Pennit Application _ Administrative Pennit
AmendmentlTransfer/Extension
~eceivedApplication:~
--->.J1<eceived Fee:$ ;J'S'\J /'
~ompleted Application~) aJJ c))
_Incomplete
_SEQRA Classification:
Type I_Type II_Unlisted_
_ Coordination:(date sent) ~
~WRP Consistency s ess n Form
~ CAe Referral Sent: >> \0
_..fl'ate of Inspection: I
_Receipt ofCAC Report:
_Lead Agency Deterrnination:_
Technical Review:
/"fYublic Hearing He~
_Resolution:
Office Use Only
f5J fE (G i~ _~ W frUill
UlJ~: .;
L~ 1---
8r~~C.:~---l
-.--__._J
Name of Applicant D-et)'f~:,e
Address f1 U t' 5 TVii III
Ql ) i Wvltla ~ C;
\QU-f
Phone Number:( )
Suffolk County Tax Map Number: 1000 .&-C 7/01/1- tx/f B.1cI < COIJt Lor 00,--/
Property Location:tfOI",<)ifIJCH/\ ~1Ie-' hS~l"rrs ~ ~}()L(,
(provide LILCO Pole #, distance to cross streets, and location)
AGENT:~} ~/Z
(If applicable)
Address:YO 'f3oy (PiP I
~ r1Ji Ot:R3'f1J Phone~3/- ?!f'xr- SSS'O
c!,C\
~~~o
9
. .
Board of Tru8tee8 Application
GENERAL DA T A
Land Area (in square feet):
Area Zoning: ~-e5i&-ej{\H~
Previous use OfProperty:~'fSI.d'f'f\'llaJ
Intended use OfProperty:_~t'g ((1."'11I. rl'O I
Prior permits/approvals for site improvements:
~i kQ, ~~ 1)qJF.
Date ~I...S
9/ J~,1D 5
_._.. No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or sus~ by a governmental agency?
No_ Yes
If yes, provide explanation:
. ... ~-_.::n- ~ ' Ii V1d \YL \(
Q;:'-(~-"-"")\lwinlli ~ ,",X~I i,Jli
~ . I!roD ~ ~ f>>\')-e~... 1\VVJi.li.lt-ed! 6 U\
~dt:a .~ t-f. w,.u b-e .re'MIY-fr)
~(Y\~&. Cl) m~<c ~ D l)[( VleXL
3 (!fDU)\"j .s.~oV\ S
. . .
Board of Trust..s ApplJ.cation
WETLANDffR]WE LANDr~ATION DATA
Purpose of the proposed operations: Wva '-.E\' 51 \'\3 ~-e~{C
~(jJcJ rA ~a~'fS~ ~UlP~
~
')
Area of wetlands on lot: ~- square feet
Percent coverage onot: ('\,~G.... %
Closest distance between nearest existing structure and upland
edge of wetlands: ~ feet
Closest distance between nearest proposed structure and upland
edge of wetlands:. '6 n ~Jeet
Does the project involve excavation or tilling?
-r- No
Yes
If yes, how much material will be excavated? ~. cubic yards
How much material will be filJed?--cl Q... _cubic yards
Depth of which material will be removed or deposited: 11\ \ i2(. feet
L " \
Proposed slope throughout the area of operations: . \
Manner in which material will be removed or deposited: 11\.( Q
.
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):
-. U:, \r'._':J~U.e ~If\,n rnt'\.\""'€'^ ~Q l ~c:;rC.\
. we avt\~ l t ~J.pd
.
Board of Trust..s
.
Applicat.1.on
COASTAl, EROSION APPLICATION DATA
F~151~ "})-eck
\\rw U)f
v-
Purposes of proposed activity:
~f\Yb\Je ~se
Are wetlands present within 100 feet of the proposed activity?
~ No ':I Yes
Does the project involve excavation or filling?
~_No Yes
If Yes, how much material will be excavated? Y\ la (cubic yards)
How much material will be filled?~CI... (cubic yards)
Manner in which material will be removed or deposited: In ( 0.
Describe the nature and extent of the environmental impacts reasonably anticipated resulting
from implementation of the project as proposed. (Use attachments if necessary)
_\ I); V\ ::]cr\"Lue _ 0A-lJi.rr-"^,,,^evv~~l iL4~cls.
_ (ic e... Q~'c CL~aA.el
117.20
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
.
.
PART I . PROJECT INFORMATION To be com letad b
1. APPLICANT/SPONSOR
,
Municipality County
4. PRECISE LOCATION (Streeladdre88 and road Intarll8Cllons. prominent landmarks. ole. or provide map)
e'l/)eSTfla~ . 'i1~\ VIa$-
riS~.efS T5(a.rd\ . C& 'eR ()
5 PROPOSED ACTION IS:
o New 0 Expansion 0 Modiflcationlalteration
5. DESCRIBE PROJECT BRIEFL V.
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
~ Yes 0 No "' No. describe briefty
\ -tee
~
9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
fiZ\ Residential 0 Industrial 0 Commercial 0 Agriculture 0 ParkiForestlOpen Space 0 Oth9r
08S~:
j\~\e-Ja.~\t{ ~~~lVJS
10.
DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING. NOW OR Ul TIMATEL Y FROM ANY OTHER GOVERNMENTAL AGENCY
(FEDERAL. STATE OR LOCAL)?
DYes M No tf Yes, list agency(s) name and penniUapprovals:
11.
DOES ANY ASPEC~ THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
DYes l,!rl No If Yes, Itst agency(s) name and permit/approvals:
,.,
AS A RESULT OF fl POSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
Yes No
OVE IS TRUE TO THE BEST OF MY KNOWLEDG~ I -=?rI 1\ C.
Oats: ~
~
I CERTIFY THAT
Appllcanl1sponw' name:
Signature:
If the action is In the Coastal Area. and you are a state agency, complete the
Coastal Assessment Form before roceeding with this assessment
OVER
1
.....
08/01/2007 10:42
15317154'3
HAROLDS LLC ~
PAGE 02
"
'l "j'
Board of Trustees Application
County of Suffolk
State of New York
c3EOfAo6 G U.I J.1 fA.. ei\ G" S 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 mSIHER KNOWLEDGE AND BELIEF, AND THAT ALL WORK
WILL BE DONE IN THE MANNER SET FORTH IN TIDS APPLICATION AND AS MAY
BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT
AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES
HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING
UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS
APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR
REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.
4~
r ~gnature
SWORN TO BEFORE ME THIS~DAY OF--A({)USt- .20~
~/~
Notary Public
J - - - - :=~~:6- f
i ~ Notary PublIc - catIfomla !
i~~~~~~
5?5?~ {/!L(- {)~qL{
. Board of Trustees Applicattn
AUTHORIZA nON
(where the applicant is not the owner)
l.QfO~ ~.......... s'lljf !ffn~/~ Lw "'-
(print er of property) (mailing address)
~ odk C L ~({57 do hereby authorize
1 (Agent)
to apply for permit(s) from the
~TO;i:mY~1E
A-~ ---
Own signatur~ "'" ~
fJ
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
~ EA~ ~ " ~7 f ~
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
---------------------------------------------------------------
In the Matter of the Application
of
~ ~'
-------_____~-----------(l]~1-~----------------
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
South hOld Town
Board of Trustees
AFFIDAVIT OF POSTING
I, . , residing at
H q t'fJ\5 -:r h VVJ^~ I V1) I }
being ~worn, depose and say: ~
That on the
day of
,200 ,I personally posted the property known as
o~ {~?~
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 C
Dated: 'l(~ /07
Sworn to before me this
,;2(11tday of~. 2007
ri?t(i~~~ ~{;~,I(l?-
Notary Public
ROXANNE SPAULDING
I ,NOTARY PUBLIC. STATE OF NEW YORK
No 01 SPG11:\!142
llUAllllI1I IN SUIIIII K WIIN I Y
M~~Oh1MISSIUN lXI'II\lS AUli.lI, ZDO
I'll.
......,
.
.
CALIFORNIA ALL.PURPOSE ACKNOWLEDGMENT
"':f'5S~4:&{&-::""'X:<:.t<~:<-'<:>~;<:(~";<:i:':S:5;~'-:;:L':<::.t~-;:'~~,!:-.';z:'Q"':<<,,,\;<''<~.'2.<<'S..:{:sX:&<:~~-<<d:<<~~"-.>~k{-,,c ::.:. .....,,~."-~:':.,':..,.;:~Q&'0.:-..<:::~2
State of California
Sat\.. (J,' e. 5v
\?,l \ ,\:)"\ before
~"
County of
On
me,
personally
appeared
ss,
. ~I , ,
<ctl ,C IC<..
t~
,1c1h /. '-
Name and nile of Officer (e.g., "Jane Doe, Nota
G-~~ 6-v.AoUl.r..-<.5
Na e(s) of Slgner(s)
J----~::~---~
_@ CO::::.~3006
i. NoIary PIlblIc - CaIIIamIa I:
t san DllIgo eo.nv -
- - - ~~_~_~I~~
Place Notary Seal Above
ktpersonally known to me
o proved to me on the basis of satisfactory evidence
to be the person(s) whose name(s) is/are subscribed
to the within instrument and acknowledged to me that
he/she/they executed the same in his/her/their
authorized capacity(ies), and that by his/her/their
signature(s) on the instrument the person(s), or the
entity upon behalf of which the person(s) acted,
executed the instrument
WIT ES
my hand and official seal.
.~
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document:
Document Date:
Signer(s) Other Than Named Above:
Number of Pages:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
o Individual
o Corporate Officer - Title(s):
o Partner - 0 Limited 0 General
o Attorney in Fact
o Trustee
o Guardian or Conservator
o Other:
RIGHT THUMBPRINT
OF SIGNER
TOp of thumb here
Signer Is Representing:
Signer's Name:
o Individual
o Corporate Officer - Title(s):
o Partner - 0 Limited 0 General
o Attorney in Fact
o Trustee
o Guardian or Conservator
[J Other:
RIGHT THUMBPRtNT
OF SIGNER
Top of thumb here
Signer Is Representing:
,,^<:/'..',.{::;.>,'/ '
@2004 National Notary Association. 9350 De Solo Ave., P.O. Box 2402 . Chatsworth, CA 91313-2402
Item No. 5907
Reorder: Call Toll-Free 1-800-876-6827
.
JOINT APPLICATION
FOR PERMIT
9S-19-3(I5AlO)pfp
*
f.IIIII!Il
IiIiiI
New Yorl< Stale
United States Army Corps of Engineers
l.c__lIfIlIIodlor.
Applicable to Agftrn:ies <1"0 permit I"'.etegories ti5led In lten' 1. Ph... read an IMlNC:tion& tw1 badt.
2....meof
A1tKtIltdOItlOn~ informltior.. ....eded.
NYS o.pt:. of !nvfronmentlll con_tvdon
o S\re8m Oitturbance (Bed and BankS)
o N8vigebMt Waten (Exce'l'tion and Fill)
o Docks, Mooringe Of P1ettorm~
(('.onsll'tlct or ~laee)
o Dams and Impoundment StNcturea
(Constt'VCt. Reconatruct: Of Repair)
~W8terWetl'nG$
LJ rldaIW.~
o Co8$tal Erosion Contrtll
B Wild. SceniC and Recreational Ri\l8fS
401 Water OtJa!ity Certific8tion
o Potabl. Wa'", s..,.,~
o Long 18llJOO Welle
o """""" v..._ Ccf1trol
R Aqu~ Insect Control
U Fish Cootrot
Mya OfiIee of Generlil ~
(State OWned i..ands Under Water)
Olea",. l.!ceIlH, EasemElnt or
otheI' Real Property lnlefo,t
U(~jty Easement (pipeline!), conduits.
cabl,"-, etc.}
o OOClttS, Moonngs or PlattOfTT1$
(COl1Itruct Of Placei
Ad_ock Pot1<_ey
o Freshwater Wetlands Permit
o Wild. Seenie.l'!lnd Recreationel Ri\-ers
l.eft. George Park Comml.aJon
D DocKS (Cot1$tr~ or Place)
o Mooringo (E.tabllsh)
us Army Corps of Engineers
o Section 404 (Wat9l'Softhe Unlled States)
o SdCtioo 10 (Riv8t6 and Harbors Act)
o Natfonwide Pormit (5)
Identif., Nurnbet'(t)
F'JfAgent;~ Ule 1Jf11y'
DEe APPliCATION NUMBER
.. Appleant is alan: (check 85 m.,y as apply)
o Owoor 0 0I>0nI'''' 0 Las... 0 Munidpalily I GowImmental Agency
!. 11 applIcant Is not the own., iCIenllfy CWlWr here. otherwise, you may pI'O'oIid4 AgentIContact PefSOI'l information,
ApntlCon 0 Owner ~ ,It,Qem ICor1t8lct p~ T Nuftlbrtr \dli'ytlme)
- -SSJ
{J
t.Project/FciHty Loclttan (mlf1t locatlon on Il'IBp, see instructIOn 1a.) l~';;~.-/)(~
TownJCirvNillaGe: riX 710 ~"7Gt Numwt.
8. N_ of USGS -.. M..,:
L_~:
NYT......
NYTM.N 4
I. Protect 0HcrtptI0n and Purpoa.: (Category 01 Activity e.g, new co!'1Slrut.:llon/lnstalatlor\ melr.ttmlilll'\ce or
replacement; Type. .. Sf"Jrlura '" Activity '.g. bu$_. d,.dgmO. filing. dom. doc'. 'okinq" .......; Typo '" "8Ienal. ~
'~~;::l""W~f~~~~;;e: ~noT l~f-eC~
lDe~,~ ~e- ro'..u Lio:-^- wt\l CEk","Ove-
\~jIr ill\\\ \oe ,C-WlCl0fdJ 'tx.t I
feP:o-T-cJ (l()1IW~ 5 Over (/(J)(T AwwuJ I
3 \owi\l'..d S(uJ. &0 seasoVlS ~I\ v1, l.r-' I'
"'..~ \ vt 't' C-. TiS PlJ l I
11, meet ..
s_ Lond?O
Y..
US .A.RMY CORPS Of" ENGiNEER.s
II p .~
~ WOf'i( 8egtnlonPvoJW? ("Y8S, atraeM
I e);planeoon of wtly 'NQl'k was started without permit.)
16. Will ChIs PtojKt Requ.... AddttiorNlI
FeOInt, Statti, 0( Lo,,1 P9m'tIW?
H. tf.p~k.ant ianotthe owner,both multllgnthlotppllcatlon
I he,eby affirm t"lat Information provided on this foml and all attachments submitted
Qtl\o pU\"llanabJe 1M. ClaM" mi,tt.m..nor pursuant to Seetion 2'O.~S of 1111 LlIW.
of wt".atewr ,"\Sture, 11M by ~It"er sufte~, ariSing out of the pre' tea
cmrneoes and CO~5 of evefy name and description resulting from
$10,000 or trrlCrll>onment fOr not more tnan ~ y"af5, or both whe
N u"" 'tiL'(Q""" 0' 'audull.lI_mon,
Oat. ~_~_ 'I 0Signature.. Applicao,___
Date _. __.. Signature of Ow"'" n.__
Tnl. __
.th Is true to the teet of my knmriodge and belief. FM&. mtomol"lta made tl'i~ln
u appliC',al't ecce~ fuir r8l11'pon,ibiilty for aft tHmeg.., dIrecl or lnd1led,
d ag to indemnify and s.we I".armless the Sta1e from $uit'i. adions,
8W. 18 U.S,C, Section 1001 provid&s for.. flne of ~t ~ than
gly fa!s11'l"', conC&6ils. or C<MIM'S up II material hIct, or k:'\OWingiy makes
T~ .--a~~.~~._--
\,
,_..____~______,________.no__.~_~~._.~.
.
.
Town of South old
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
~re Ii: IE I YEW
AUG 3 1 2007 0
I Southhold Town
Board of Trustees
I com lete this CCAF lor
i. All applicants for pennits* including Town of Southold agencies, shal p
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 orooosed action will be evaluated as to its sill.llificant
beneficial and adverse effects uoon 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 exolained in detail. !istin!!: both suooortin!!: and noo-
SUDDOrtinl! 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#
PROJECT NAME
The Application has been submitted to (check appropriate response):
Town Board 0 Planning Board 0 Building Dept. 0 Board of Trustees .~
1. Category of Town of South old agency action (check appropriate response):
Action undertaken directly by Town agency (e.g. capital
construction, planning activity, agency regulation, land transaction)
(b) Financial assistance (e.g. grant, loan, subsidy)
(a)
(c)
Permit, approval, license, certification:
Nature and extent of action:
o
o
~
t-
\ li
Location of action: ftr/ ) !,<:;rf i (A V\
Site acreage: JJ
l're=' """ "" 'R '" s r ~ 1 (g - n
Present zoning classification: i'_ S \ J. 1: ~~ (Y.-{
. . fi th . d action has been filed with the Town of Southold agency, the following
If an applicatIOn or e propose
information shall be provi d:
~\Jt' -
hckr~ ~lc.nLrV~
.
2.
s
(c) Telephone number: Area Code (
(d) Application number, if any:
Will the action be directly undertaken, require funding, or approval by a state or federal agency?
y es ~ No 0 If yes, which state or federal agency?.n..K
tXp3QO
C. Evaluate the project to the following policies by analyzing how the project will further support or
not support the policies. Provide all proposed Best Management Practices that will further each policy.
Incomplete answers will require that the form be returned for completion.
DEVELOPED COAST POLICY
Policy 1. Foster a pattern of development in the Town of Southold that enhances community character,
preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and
minimizes adverse effects of development. See L WRP Section III - Policies; Page 2 for evaluation
criteria.
DYes 0
Vce<-
No ~ Not Applicable
\ J &\STllAtj - \ ~~rO~~
Q,ea
~
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources
L WRP Section III - Policies Pages 3 through 6 for evaluation criteria
DYes 0 No ~Not Applicable
of the Town of Southold. See
. .
D/)r~('~~~)~~1f;-~t~\ sTr5~()U'('~
_ 'Ur')Ps
Attach additional sheets if necessary
b t tb Town of Soutbold. See
. . and rotect scenic resources tbroug ou e
Policy 3. Enbance vls~a~ qUpabty 6 tbr~ugb 7 for evaluation criteria
L WRP Section III - policies ages
DYes 0 No Qg Not Applicable
P~l<"
is
f?\{\<?' Tl-~
Attach additional sheets if necessary
NATURAL COAST POLICIES
Policy 4. Minimize loss of life, structures, and natural r~so~rces from flooding and erosion. See LWRP
Section IIl- Policies Pages 8 tbrougb 16 for evaluation crltena
DYes 0 No ~ Not Applicable
('\OT CX\ ~f\-e Cr::'Y5 I
Attach additional sheets if necessary
Policy 5. Protect and improve water quality and supply in tbe Town of Southold. See L WRP Section III
- Policies Pages 16 through 21 for evaluation criteria
DYes 0 No ~Not Applicable
< \ '))eS Y1m- '\ V\ !Jot IJe. (I 'flj'f'1I So ?fly
Attach additional sheets if necessary
Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including
Significant Coastal Fish and Wildlife Habitats and wetlands. See L WRP Section III - Policies; Pages 22
through 32 for evaluation criteria.
o
o
~
__ __~___",_.__.~___________~.___~______JIl_
.
Yes No Aot Applicable
, ~
W D f) t\r1-f'
.
C(lLtS 1
Attach additional sheets if necessary
Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies
Page~ 32 through 34 for evaluation criteria.
DYes 0 No ~ Not Applicable
, \)oR")
Y'l (1 T
\ 11\\)(')(111'"
.
G \ -r q\n~ \'1 ~---
Attach additional sheets if necessary
Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous
substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria.
DYes 0 No ~ Not Applicable
,\\OIAe ~ ~-P nz~l Je \ V\IJo(lJC'r)
PUBLIC COAST POLICIES
Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public
r~ou~ces of the Town of Southold. See LWRP Sedion III - Policies; Pages 38 through 46 for evaluation
cntena. .
DYeD No ~ot Applicable
f0-r
CQDs,of
0\
~
Attach additional sheets if necessary
-_._~-_.-._-----. -..- .--
-
WORKING COAST POLICIES
.
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See L WRP Section 111- Policies; Pages 47 through 56 for evaluation criteria.
DYes 0 No ~ Not Applicable
. ' l)rlf?'S nOT \I.\\I(,)~IT-e ~ I JUT:-( Q"
DSr>S
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic
Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria.
DYes 0 No ~ Not Applicable
r \)Of'.C,
YlDr
---rll ( n\f)
\ 'fI ()~ll )f' ~I ~ tAd
llYlT~
()\
Attach additional sheets if necessary
Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies' Pa es
62 through 65 for evaluation criteria. . g
o Yes 0 No ~ Not Applicable
=-_~I\ 1)0. T-t'
r~ltr::f
Attach additional sheets if necessary
Poli~y 13. Promote appropriate use and develo ment of .
SectIon III _ Policies; Pages 65 through 68" lP, . energy and mmeral resources. See LWRP
M lor eva uatlon criteria.
o Yes D No ~ Not Applicable
b'\-f'\11 \\- Y~:f'~~ 1r'&1 JIJ:r..e~ o.V'~
'()()t-
PREPARED .{}i?TTiC; i?
UrJ/(
TITLEJvy1. \fYl J '€ 1/
DATE#7
.
.
APPLICANT/AGENTIREPRESENT A TIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of South old's Code or Eilites Drohibits conflicts of interest on the Dart of town officers and emnlovees. The DUmoSi" of
tbiLf2:rm is to nravide information which_!(.an alert the to~ afcossible contlicts of interest and allow it toJ.&ke whatev~Ls:
necessarv to avoid ~.
YOUR NAME:
11 e..-
(last name, Irst name. middle initial, unles8 you are applying in the name of
someone ~eJse or other entity, such I&S . company. If so, indicate the other
person's Of company's name.)
NAME OF APPLICATION: (Check all that apply.)
BuildinS
Trustee
Coastal Erosion
MoorinS
Planning
Tax grie..'aDCe
Variance
Change of Zone
Approval of plat
Exemption from plat or official map
Other
(Jf"Other", name the activity.)
Do you perltOoally (or through your company, spouse, sibling, parent. or child) have a relationship with any officer or employee
of the Town of South old? "Relationship" includes by blood. marriage, or business interest, "Business interest" means I business.
including a pwtnership, 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 S% of the shares.
><
NO
YES
If you answered "YES", complete the balance of this fonn and date and sign where indicated.
Name of person employed by the Town of South old
Title or position of that penon
Describe the relationship between yourself (the applicantlagentlrepresentatt...e) and the town officer or emp!oyee. Either check
the appropria~ line A) through D) andlor describe in the llpate provided.
The town officer or employee or his or her spouse, sibling, paren~ or child is (check alllhat apply):
___.A) the owner of greater than 5% of the sbarels of the corporate stock of the applicant
(when the applicant is a corporation);
_._8) the legal or beneficial owner of any interest in a non-corporate entity (when the
applicant is. nOl a corporation,;
.___me) an officer. dim.'"tOr. partner. or employee uflbe applicant; or
_._D) the Ktual applicant.
DESCRlPTION OF RELATIONSHIP
Fmm TS 1
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XT. SHORELINE
9/11/06
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TITLE
GUIMARAES
RESIDENCE
FISHERS ISLAND NY
D....TE
9/11/06
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-CLETHRA ALNIFOLlA *SWEET PEPPdR iBUSH
P-SALlX DISCOLOR *PUSSY WILLOW ! !
M-HIBISCUS MOSCHEUTOS (PALUSTRI ) :*NATI E
J-EUPATORIUM MACULATUM *JOE EED
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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
December 13, 2006
Harold Cook
Harolds, LLC
P.O. Box 661
Fishers Island, NY 06390
RE: GEORGE GUIMARAES
EQUESTRIAN AVE., FISHERS ISLAND
SCTM# 9-6-4
Dear Mr. Cook,
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday, December 13, 2006 regarding the above matter:
WHEREAS, Harold Cook as agent for GEORGE GUIMARAES 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 28, 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, a Public Hearing was held by the Town Trustees with respect to said application on
December 13, 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 proposal does not comply with the standards set forth in Chapter 275 of the
SouthoJd Town Code, ____ _ ___.
WHEREAS, the Board has determined that the project as proposed will affect the health, safety
and general welfare of the people of the town,
2
.
.
WHEREAS, the deck as proposed does not meet the setbacks for construction proposed on
residential property within the jurisdiction of the Board of Trustees,
NOW THEREFORE BE IT,
RESOLVED, that the Board of Trustees DENY WITHOUT PREJUDICE the application of
GEORGE GUIMARAES for the existing deck and an Administrative Permit to remove the
Japanese Knotweed and repeat cuttings over next three growing seasons.
Very Truly Yours,
~t9(~
/j~~es F. King'- /'
President, Board of Trustees
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-------------.--.--
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Date/Time:
Town Hail
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
John Holzapfel
Telephone (631) 765-1892
Fax (631) 765-6641
Name of Applicant: ( 1<:...0 ()q
Name of Agent: -ft()rv l4
Property Location: SCTM# & Street
Brief Description of proposed action:
Type of area to be impacted:
_Saltwater Wetland '-""Freshwater Wetland i- f-sound Front _Bay Front
Distance of proposed work to edge of above: i .
Part of Town Code proposed work falls under:
_Chapt97 _Chapt 37 _other
Type of Application: _ Wetland _Coastal E si/:m Amendment Administrative
- -
_Emergency
Info needed: 1JQe.dJ (A(\ I ,,5 QC.~"lrjv
Modifications:
.
MailedIFaxed to: .
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.p.. resent Were: I.King J.Doherty P.DickJsoh D. Bergen I.Holzapfel
_Other: - - - H - -
I Date:
I
!
Conditions:
.
.
Telephone
(63 I) 765-1892
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
CONSERVATION ADVISORY COUNCIL
TOWN OF SOUTHOLD
At the meeting of the Southold Town Conservation Advisory Council held Wed.,
September 13, 2006, the following recommendation was made:
GEORGE GUIMARAES for the existing deck.
Located: Equestrian Ave., Fishers Island. SCTM#9-6-4
The CAC did not make an inspection, therefore no recommendation was made.
.
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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
Southold Town Board of Trustees
Field InspectionlW orksession Report
Date/Time:
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Name of Applicant:
Name of Agent:
Property Location: SCTM# & Street
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,
Brief Description of proposed action:
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Type of area to be impa0;
_Saltwater Wetland . Freshwater Wetland _Sound Front _Bay Front
Distance of proposed work to edge of above: Iiv'
Part of Town Code proposed work falls under:
t/ Chapt.97 _Chapt. 37 other
Type of Application: ~land _Coastal Erosion
_Emergency
Info needed:
4IH;~ f-
Amendment
Administrative
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Modifications:
f}F;VY
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Conditions:
/
Present Were: ~ng _J.Doherty _P.Dickerson_D. Bergen
Other:
Bob Ghosio, Jr.
MailedIFaxed to:
Date:
Comments of Environmental Technician:
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southald, N.Y.
CERTIFICATE OF OCCUPANCY
No, Z-30934
Date, OS/26/05
mIS CERTIFIBS that the building
ADDITION
Location of Property:
(HOUSE NO.)
County Tax Map No. 473889 Section 9
EQUESTRIAN AVE
(STREET)
Block ~
FISHERS ISLAND
(HAMLET)
Lot 4
Subdivision
Filed Map No.
Lot No.
conforms substantiall)" to the Application for Building Permit heretofore
filed in this office dated
MAY 18, 2005 pursuant to which
Building Permit No. 31143-2
dated
MAY lB, 2005
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is issued
is DECK ADDITION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR.
of the aforesaid building.
The certificate is issued to PHILIPPE KRAKOWSKY
(OWNER)
SUFFOLK CODNTY DBPARTMENT OF lIBALm APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
PLIlMBBRS CERTIFICATION DATED
N/A
Rev. 1/81
Fo... No. 6
TOWN OF SOUfHOLD
BUILDING DEPARTMENT
TOWN HALL
765-180Z
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APPLlCA nON FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department wllh the following:
A.. For.... buildieg or .ew use:
I. Final survey of properly with accwate location of all buildings, property lines, streets, and unusual natural or
topographic femures.
2. Final Approval from Health Dept. ofwaler supply and sewerage-disposal (S-9 fonn).
3. Approval of electrical installation from Board of Fire Underwriters.
4, Sworn statement from plumber certifying thai the solder used in system contains less than 2/10 of I % lead.
5. Commercial building. industrial building. multiple residences and similar buildings and installations, a certificate
of Code Compliance from architect or engineer responsible for the buildmg,
6. Submit Planning Board Approval of completed site plan requirements.
B. For esisting buildings (prior to April 9, 1957) non-conforming....... or buildings and ~pr..esistiRII" land us..:
I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features.
:! A properly completed application and a consent to inspect signed by the applicant If a Certificate of Occupancy
is demed, the Building Inspector shall state the reasons therefor in writing to the applicant
C. Fees
I. Certificate of Oceupancy - New dwelling S25.00, Additions to dwelling $25.00, Alterations to dwelling S25.00,
SWimming pool S25.00, Accessory building S25.00, Additions to accessory building S25.00, Businesses S50.00.
, Certificate of Occupancy on Pre-existing Building - SIOO.OO
J. Copy ofCertificateofOceupancy - $25.00
4. Updated Certificate of Oceupancy - $SO.OO
S. Temporary Certificate of Occupancy - Residential SIS.OO, Commercial SI5.00
1J'i:-..) ~
New Construction: i) ILcJ.-. (Uld or Pre-e.isting Build~
Location of Property: P-iv...~....."-..... 'lLJ~ F. <;~f>.IlS
House No. Street
Owner or Owners of Property: p", " (;0 ,"X' )<'ho\ \colA .,... ?
"
Suffolk County Tax Map No 1000, Section 60 'f Block
Date.
-6/;:;..~ 105-
(check one)
"C <;.l.ArVD
Hamlet
~ LoI
'I
Subdivision
Filed Map. Lot:
DateofPerrnit S/I!/O S- Applicant F31ri',(l Coc.HPA/J1'
Underwriters Approval:
(ell""')
Pennit No. _-i II 'I.!:.
Health Dep!. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ c:I. ~ .f,f.
Final Certificate:
;.--- (check one)
~--
Applicant Signature
-------
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CO '2.. 30 r 3 'f
OS/23/2005 08;01 FA! 631 768 7798
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71S-180Z
BUILDING DEPT.
INSPECTION
[ ] POUNDAnON 1ST
[ ] POUNDAnON 2ND
[ ] PRAIIING
[ ] PIREPLACE & CHIMNEY
REMARKS: /"U, .1', He d- c:;
,
[ ] ROUGH PLIIG.
[ ] INSULA-nON
[~NAL
DATE --,-iL.7~.~-
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INS"EC.TORA-k/? &b~~
,
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO.
31143 Z
Date MAY
18, 2005
Permission is hereby granted to:
PHILIPPE KRAKOWSKY
90 ROCKLAND AVENUE
YONKERS,NY 10705
for ;
CONSTRUCTION OF A DECK ADDITION WITH COVERED SCREEN AREA AS
APPLIED FOR. THIS PERMIT REPLACES BP 27473.
at premises located at
EQUESTRIAN AVE
FISHERS ISLAND
County Tax Map No. 473889 Section 009
Block 0006
Lot No. 004
pursuant to application dated MAY 18, 2005 and approved by the
Building Inspector to expire on NOVEMBER 18, 2006.
Fee $
150.00
ture
Rev. 5/8/02
ORIGINAL
Fax (516) 765-1823
Telephone (516) 765-1800
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Town Hall. 53095 Main Road
P.O. Box 1179
Southold. New York 1197\
SOUTHOLD TOWN
LANDMARK PRESERVATION COMMISSION
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July 23. 2001
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TO:
Southold Town Building Department
_..--------=--..
Southold Town Landmark Preservation Commja!:ion
. .) )J~i--i
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---------------
FROM:
RE:
Equestrian Ave. -Fishers Island
Tax Map: 1000-9-6-Q
The Landmark Preservation Commission has reviewed the submitted plans
for the addition of a larger deck on the above mentioned residence. The
Commission approves the addition.
Thank you.
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Approved .~0.1 .,cfI!.~ Permit No
FORM NO.1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-180~
311 -+3 rENl.W'c..J
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Disapproved ale
Application No.................
3 .....","'.....,....,
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...........::...~;i........
APPLICATION FOR BUILDING PERMIT
------- ..
INSTRUCTIONS
Dale.................., 19..
FE8 /9 .200 I
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin;
Inspector, with 3 sets of plans. aCCUrate plot plan to sL:ale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public st..'"Cet
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli
cation.
c. The work covered by this application may not be commenced before issuance of Buildin. Pennit.
d. Upon approval of this application, the Buildin.lnspector will issue a Building Pennit to the appUcant. Such penni
shaJJ be k.ept on the premises available for inspection throughout the work.
e. No building mall be occupied Of used in whole or in part for any purpose whatever until a Certificate orOccupanc~
shaU have been granted by the Building l~s'pector.
APPLlCA TION IS HEREBY MADE to the Building Department for the issuance of a Building Pennit pursuant to th,
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances 0
"'...:gulations, for the construction of buildings, additions or alterations, or for removal or demolition, ~ herein described
The applicant agrees to comply wjrh all applicable laws, ordinances, building code, housing code. and regulations, and t.
admit authorized inspectors on premises and in buildings for necessary inspections.
. 10.M [,,'/f"/...7If. .I.m.. .W'w!I~A.p~:/~i-tT
(Signature of ap~cant, or name, /~~~oration)
pc:t3':ll ,3~;O.. f.'.SH~'-'.5.:r.'S~"'-:D./.l!.t. .1('.~:;J9()
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildeJ
4(~P'/t.L. {!.O/J! t!1I.(! !t"':-.. ......... .. .... . .. . . . . . . . .. .. ....... ..... . .. .. ..........
Name or owner orprcmises . ?/~(J. .. ~ ~e.. . . /~'!. !~/.'!./~~. . . ..~ ~.~. ~ ~~s:~~(. .
(as on the tax roll or latest deed)
If applicant is a .;orporation, signatLore of duly authorized officer.
..................
(Name and title of COrporat~ officer)
........................
Builder's License No.
. ;;(t!! . . .11 ~ If '. . . . . .
()':'-" a -p
Plumber's. License No.
.~. .Q. .a.s.. -. .E....
El~ctrician's license No. -r C/
Other Trade's License No.
1. Lociltion of land on which propost:d work wilt b~ done.
. . . F ((.tJ~ !T./</lltJ
House Number
Ily~
................................................
County Tax Map No.
Street
1000 Section. . . ()c; .9. .. . . . .
F/Sfl(~S.. .T5.t.HlUP .'. fIIl..... i)~~ ~ <::.....
Hamlet
b tJ
Block .................. Lot..................
Subdivision. . .
. . . . . . . . .(r.iame) . . . . . . . . . . . . . Filed Map No. .............. Lot...............
2. State existing use and occupancy of premises and intended use and occupa.ncy of proposed construction:
a. Existing use an~ occupancy. . Q~4r:/<. . .9.G.('.Vo-.f.'.E. ,? .. i.r.;>.!. ?<Ft!!/'./;?;..........,...,.
b. Intended use and OCCupancy . XI;J;>.r.~J'-. jJ 17.CC"!.... -'-iF.. .. P.4~C!X... .lJ7T~:j1.t:.t?, X~.. t-Ws.
./-1-< ,J/2vvCt-<f'pr:; Or' ;;<ISTI '-'io LJFC-IC..
, .
9.
10.
11.
12.
13.
14.
3. Nature of work (check which applicable): New Building....... ... Addition...~ . ... Alteration . .~... .
Repair .............. Removal. . . . , . . . . . . . .. Demolition .............. Other Work. .. . . . . . . . . . . . .
Lh I (Description)
,-y t'OO
4. Estirllated Cost. . . . . . . . (. . . . . . . . . . . . . . . . . . . . . . . . . . . .. Fee. . . . . . . . . .. .. . . . . . . . . . . . . . . . . . ... . . . . .
~ X TE~ 1C.e. (to be paid on filina this application)
5. If dwelling, number of dwelling units.! . . . ':?.f~~ . .. Number of dwellina: units on each floor. . . . . . . . . . . . . . . .
If garagc, number of cars ......,....................,............................................
6. If business, commercial or mixed occupancy. specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . .
7. Dimension1 of existing structures, if any: Front. . . . . . . . . . . . . . . Rear .............. Depth...............
Height b.. /JI(~1f. .JJ.Cr~. . Number of Stories. , . . I. . . . . . . . . , , . . . . . . . . , , . . , , . , . . . . . , , . . , , , . . . . . . . . . . . .
Dimensions of same structure with alterations or additions: Front .... J.5. , . . . . . , .. Rear....,...........,.
Depth. . . . . . .~~ . . . . . . . . . . . . Height. . . .. . . . . . . . . . . . . . . . . . Number of Stories. . . . . . . . . . . . . . . . . . . . . .
8. Dimensions of entire new construction: Front. . . . . . . . . . . . . .. Rear,.............. Depth ...............
Height ............... Number of Stories. .. . . . . . . . . . . . . . . . .. . . . . . . . . . . , , , , . . , , , . , . . . . . .. . . , . , , , .
Size of lot: From .' . . . . . . . . . , . . , . . . . . .. Rear..,........,.......... Depth ,.,...................
Date of Purchase ..,..."...,.,..",........., ~er9f Former Owner ."........,.................
Zone or use distnct in which premises ~e siruated . . . . . . . ~ rJ..Q. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Does proposed construction violate any zoning law, ordinance or regulation: ,.,..,............,.............
WHllot be regraded ....... ~O? . . . . . . . . . . . . . '.' . . Will excess fill be removed from premises: Yes No
Name of Owner of premises ~~AI.tpl.{ .J;J?II:~~,K.I, ,Address 8qc.~.".vf, i~~s.J!'1.'Phone No. ~/!I.-.qgfi'.-.t?OI;;. .
Name of Architect ............,......,....,.. Address . . . . . . . . . . . . . . . . . . . Phone No: . , . . . . . . . . . . . . .
Name of Contractor .1.l!~Rt!. ~~A;'~~'!';:~~~......., Address F.~tttl.~l::./~oI'''I'I... Phone No,WI.~.7J3.~:?.7I.f:j..
PLOT DIAGRAM
Locate clearly and distinctly all buildinss. whether existing or proposed. and. indicate all let-back dimensioni from
property lines. Give street and block number or description accordini to deed, and show street namel and indicate whether
interior or corner lot.
STATEOFNEWYORKO SS
COUIITY OF . St!fF.. ?~.. ... .
. () /fAP. . .Ht.~ tu~.I}. . . . . . . . . . . . . . . . . . . . . .. . .
(Name of individual signing contract)
above named,
beins duly sworn, deposes and says that he is the applicant
Heisthe......
(J ().., TIZ A 12 7UR..
....,.......,............
(Contractor, agent, corporate officer. etc.)
of said owner or owners, and is duly authorized to perform ar have perfonned the said work and. to make and. me this
application; that all statements contained in this application are true to the best of his knowledp and belief; and that the
work will be ~~ed in the manner set forth in the application med therewith.
Sworn to bef~ this r- C
.....~... jJ'~~~' .~.A'7"" .... ~~I
NotaryPUbhcTHOM;S.;.~~!~.;..;~~,..,... ....\.. County ~;-l;~ /
Not81ryPubllc Stale 01 Ntlw Vnrlo ..... . .r:;(h. (.('"(-~"""i,"""""'"
No. 4806SSQ . ,
Qualm.a in Sutfolk COUIlI)' . (Signa Ute of applicant)
Tc.tm lO:~pir..12".e..:
/
/
/~
/ / .
/
/
/
/
/ /
/~~
/ /,f\
/;;f///: /!;
/ / /
/ / /
/, Q;~
N/F
ROWLAND OSWALD
ET-AL
/
N/F
HENRY L. FERGUSON
MUSEUM
/
/
N/F
HENRY L. FERGUSON
MUSEUM
(,Yle~'!:~~.~.'."
\:~, ~j)
Q""""""'n m, ,,,,:~
c..... PO~fY K""K;l\Y~K(
P~"'ppE K~'"OWSK'
CII<_NA
~~.o.c~~~ ~~ ;;1{r 'NS"""OC( C;<J~P"",
~~c~~~~YS or THE N[,:"~~ ;~~~o~ igR,
/
/
/
...-.''''''......,
DAlE
RE"SIONS
O(SOl"'~ON
DOT( ........uST ,~, 199$
SC.U, ," ~ 10
5/iaT I (IF I
D"~
""""
g~gr2:~'~U~\T,"'~~~.;,,~~~,;,~'~jjf,~.,~"q~P::) "",,, ~.
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1.)",,-,,,,
,It "'Ph
SUR\lEYW,P
PROPERTY TO BE CONVEYED TO
LISA POSEY KRAKOWSKY
& PHILIPPE KRAKOWSKY
EQUESTRIAN AVENUE
FlSHERS ISlAAO. NEW YORK
C p 1< ~:,::D~::~"~~~:~~ .. KINO
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OCCUPANCY"
'I' USErs UNlAWFUL
I WffiWTCERTlACATE
,IOF~~i
,,-
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_~~__~o.~ ~___ ~
~8!25:2~0; 8?::~
'55i1
30ARD OF TR'_I';;;TEES
.
PAI3E ~)'::::
James F. King, President
Jill 1\1, Doherty, Vice.President
Peggy A Dickerson
Dave Beru:en
John Holzapfel
Town Holl
53C195 Route 26
P,O, Bo~ 1179
Southold, New York 11971-0959
Telephone (6:)1) 765-1892
Fox (631) 765.6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Offi.. U.e Only
Coastal Erosion Pcnnit Application
,....--W.rJ.nd Permit Application _ Administrative Permit
ArncndmentITran3ferlExtenslon
c...Recclv"d Application:~
--.JI.e<eived Fce:$~_
~mploted Application 'l?1~
_Incomplett.
__SEQRA Classification:
Type I_Type I1_Unlisted_
Coordlnation:(dale ..nt}
--UVRP Con.istency Assessment Form &~IQ~\(
-€AC Referral Sent: ~ ~ ~1S.. 'is'1Jk2' -
-1.JOat. afInspeetion: -l'l\C~\.U:e.
_Reeeipt ofCAC Rcport:___
_Lead Aeenoy DctOrminalian:__
Technical Review:
,/Public Hearing HeJd:~1:l\.
__Resolution;
NameofAPPlicantlit'of~e ~)i fv1r.Hq~-S
Address F!for'\c,\\'\OIi\ ~\)P h'sh~fS ~.hwlJ()Lf
Phone Number:( ) fLBi::..2%EL~_
Suffolk County Tax Map Number: 1000..$f("I\rnr\ ocA' - \3 \0Cl< {)o.QiL. loT' ooL{
Property Locatiol1: ru L(
AliI' 2 2 000:;
U<J L\~c),-,
(provide LILCO Pole #, distance to CrOSS streets, and location)
AGENT:~ ~l~
(If applicable)
Address:__ftL
-f~
Wi
/){f 310
Phone: ~ 3/- ?f't ~ 555D
tY~
9;~ t/,\'CJ{f>~
~8!25!2885 ~?::~
755;~4J_
. Board of
SOARD OF TR~STEES
Trusteea APP~iOa~
GENERAL DATA
Land Area (in square feet):
_Zomn, \?>'S\J.-e~~
Previous use ofProperty:~ '\ ~'f' 11\ T~
Intended use ofproperty: '% '^" ..(J .J
Prior pcmlits/approvals for site improvements:
Agency
Date
~~illlj
't~/Ii~
_ No prior peollits/approvals for site improvements.
Has any permit/approval ever been revoked or SUSP~d by a governmental agency?
No_ Yes
If yes, provide explanation:
Project Description (use attachments if necessary):
~t'l^~i y\-e-ed~ ~r
etl.STi~
PAGE 05
~S;'2:;/20?;
~19: :.::
:'~5SS~1
.Board
30ARD OF TRUr::;TEES
of Tru8tees APPlicat~
Pt:.~GE 01;
WETLANDrTRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:
'"'1J e c\( a ~
, '
j?',tj '51 L V\ ~
Area of wetlands 00 lot.
p
square feet
Percent coverage of lot:
%
Closest distance between nearest existing structure and upland
edge of wetlands: p.-- leet
Closest distance betweeo nearest proposed structure and upland
edge of wetlands: n ~ feet
Does the proj eet involve excavation or fi lling?
~ No.
Yes
If yes. how much material will be excavated?n{A-CUbic yards
How lUuch material will be filled? *---CUbiC yards
.Depth of which material wi11 be removed or deposited:~ Ceet
Proposed slope th.roughout the area of operations:~_
Manner io which material will be removed or depositcd:~
Statement of the effect, if any, on the wetlands and tidal waters of the town. that may result by
reason of such proposed operations (use attachments if appropriate):
~{'(>k
4"E',
ekl'S{i~
C8!25j2~~S ~?:~~
7S5~.Scl BOARD OF fRUSTEES
~ Board of Trustees APPlioa"'n
PAGE 07
COASTAL EROSION APPLICATION DATA
Purposes of proposed activity:
~X\f>T"Yl:) u-er(<
Are wetlands present within 1 00 feet of the proposed activity'!
No ).! Yes
Docs the project involve excavation or filling?
~_NO Yes
rfYes, how much material will be excavated? ~(CUbic yards)
How much material will ,be filled? ~ (eubic yards)
MatUler in whieh material will be removed or deposited. Y) J /}.
Describe the nature and extent of the environmental impacts reasonably anticipated resultmg
from implementation of the project as proposed. (Use allachmCllts ifnecessary)
~l'-
E'l ' 6. - ~
\ \, 11\ j
?'~/2S/:;:l:'2S
~~: ..~
?S5S5c.l
30ARD iJ~
TRUSTEES
.
PAGE :0
.
~
f;OJECT 10
~
I ,
61? ),0
APPENDIX C
SiATE ENVIRONMENl'AL QuALITY REV:EVV
SHORT ENVIRONMENT Ai. ASSESSMENT FORM
for UNLISTED ACTIONS Only
{To De completed by Applicant or Project Sponsor)
12')"'!0J>'CT NAME .
" Li! J\ 'iY\fll m *' S
CounLy 8 u~~\ \,
InterseolioM~. Pl'OminQ:nt landmarlC,~ oat.::. or l)/'ovlde map
SEQR
NUMBER
PART 1. PROJl',CT INFORMATION
~:
Munl~PQllty S
~4 PRECISE LOCATION Su~ AO~" .nd Road
Eq\)-e5Tf\~ t\\J
i&hoe(S bb.vJ. yVL{
I 5 I:; pr-:OPOSF;D ACT ON . 0 NeW D Expar:~lIon
CJ~ sq 6
~ification I alteration
- -
3.DESCf<.6E PROJECT BRIEFLY:
U <eC\<- a~ Fx fSri'^1
7, AMOUNT Ol.l.ANO AFrECTED: Ultirnatli'ly -=l
Jnitially 8c;rElO ~ores
tI WlLL PRO?QSe:O ACTION COMPLY WITH EXISTINCI ZONING OR OTHER ReSTFUC110NS?
~Ye' D NO If no, desr;:ribe I:Iriefly~
9, WHft,T IS ~RE8ENT L,~ND USE IN VICINITY OF PROJeCT? (Choose as many as apply.,!
~ ~esldor.t!el Dlndl,lstrilJl D Commercia! DAgnC;.l,ture 0 P.ark I Foresll Opan Space o Other (dl!&ctibe)
SIV\LQle. ct"lJ e..tli \1. fJ
---
10, DOES ACTION INVOLVE A PERMIT APPROVAL, 0" F~NDING, NeW OR Ul TIMATEL.V FROM ANY OTHER GOVERNMEN1 At.
AGEi<CY (Fede..l, State or Local~
Dv" ro:o If Y.'. Iis.t iilgQncy name and permit / I!l'p~Ov81.
f-. --
'1 DOES ANY ASpeCT OF THE ACTION HAVE A CURRENTl.Y VALID F'ER'v1ti OR APPROVAL?
DV" ~~O If yes, list agency name and permit! approval'
lH:' ~~l T 0. PROPOSED ACTION Will ~XISTING PEI'lMIT I ~PPROVAL REQUIRE MOD"ICATION?
etr No
i Ce:"TIFY T~T THE INFORMATIO~~De.D Aa,OVE 1$ TRUE TO THE BEST OF MY KNOWLEOGE
A,ollc.>nL I S,onsor Name \-\f\ ~D l, Dllte: B\~JOC,
SianaitJI'9
If the action 15 a Costal Area, and you are a atate agency,
complete the Coastal Assessmantl'orm bef"re proceedIng with this assessment
~2!2~/2~~S 8q."~
7S5SS41
.
SOARD OF TRUSTEES
.
Pl~;GE ",1
PART II. IMPACT ASSESSMENT (To be completed by Lead Agency)
A_ DOES AC"O~XC~l!O ANY TYi'E I THRESWOLO IN!5 NYCRR, PART 1317.4" If yes, coordinClte the review proc~ss a,-lo U$e the FUll. EAF.
Yes l1! Nl;I
B liVlll f\CTION RECEIVE. COORDINATE;) REVIEW AS PROVIDED FOR UNLISTED ACTIONS iN 6 NYCRR, PAR.T 617.67 l( No. a negra.tiva
decljifl'ltiOr'l fna $uperooded by another invol\,'Qd ~lincy.
o Yo. No
C CCULO ACT!ON RESULT IN ANV ,.,DVF.RSE EFFe.CT$ ASSOCIATED WITH THE FOLLOWING: (AnSWers mi:1Y be handwriLl9n, If lGglble)
C1 Exi:stim; air ql!21lity. 1I1J"'c~ Of grOU"'ldNiltef q'-iality or quantlt-/, nois;lIl0vels, exi$ting traffic p~t~et"', sclld w~ste pn;;JducliOn or dlspoS31,
pohmtial for erosion. drainage Of flooding PrQblema'? ~Iain I)rieOy:
C2. ~. "9,"",lIurol, orol1..oI09leal. 111.00rio, or olhor naM.' 01 cuftur"' '.'0""'." or comn",") or n.!ghborhoo, ,h''''Clor1 e,pi.in bd.ny, 'I
I
C3.
C4.
C7 Or.,erim acts Includin than oHinue0ofeithel' uant! or eorenlil v? x IQlnb~iefl
I
~
o. WlLi_ THE PRO";ECi folAVE AN IMPACT ON THE ENV'RONMeNTA~ CHARACTt;:RISTICS T"'IAT CAUSED THE ESTABLISHMENT OF A C'~IT1CAl
I D'~~~"e~~~r (CEAI' (if ""S, explain ""o.y ]
! E IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO PorENTIA, ADVERSE ENVIRONMENTAL IMPACT$?
l 0 Yo. ~NO r-
PART 111. D~ERMINAT10N OF SIGNIFICANCE (To b. completed by Agency)
INSTFWCTIONS; For each ad....QfSQilffectldentffied above, datarminewhether it is substa.ntial, large, important cr otherwise Qlgnifleiint. Each
effect should be assessed in connectlon with j~ (a) setting (I.e. urban or rural); (b) probablhty or occurring; {c) dt.;ration; ((i; irrevers:bllity; Ie)
geogr!lphic 3'Xlpe: and (1 magnitude. If fieo&$Mry, ~dd attachments or reference Sl.Jpporting meteriais. =nsiJ~e th;lt sKplanation(; ct'ntS!in
sufflcr@!!'ltdet31Itoshowthatallrelevantadverselmpacts hi!!ve been lder,tlfled and liiIdequately ~ddre!S.$ed, If qlJ/~$tlc>n d of p'!.rt Ii waft eheef.~Qd
yes. the determination ofslgniticsnce mustevaluete thepJter'1tier impact Of the prcposed action em the envlronmentai ch,macteristics oftlieCEA,
CheCKl,l,ls bey. ifYOll have identified one or more pctent;ttlly i1)1'9111 er ltilgolflcant advers., Irnpa;ot$ wt'H::h IVIAY Dccur_ Then proceed direetty to ::hG FUl
EAF and/or prepare a posl!j", d8Clarallol'l.
Check thlll bo:< If ~u l'1ave dl!lttrmined. based en the infcnnation and ~naIY$ls :abt;:ve ~nd any liiupportirg documentation, that the PTOpr.::'il!ld S\ctlo
WILL NOT result in 'f"lY signifieDnl adverse erwlronmf;'ntal ImpaeUl AND provide, en attl!lclim.rl1s as rlecesSilry, the fe~=,Qn!1 !H.J"~,):"llng thl
determin1!tion
Ify"."':'i" l
N~me of lead Agency
Do"
I-'rlnt or I ype Name of Relpo,,!uOle onlc6r In Leoo Agency
Title Of R.I~onslb6e omcer
i
i
J
SJgnalUre of Responsll:lle Otfj~r in Lead Ag0~
Signatul'@ of Prep,erer (If different fr(;m tec.ponslbl~ omcer)
.
.
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
John Holzapfel
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
---------------------------------------------------------------
In the Matter of the Application
of
--~~-~-~Qj)~-----------------
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
I,
AFFIDAVIT OF POSTING
residing at C(S~efS -:IB'ro-J, N~_
being duly sworn, depose and say:
That on the l~ay of -Serf"'. , 200 , I personally posted the property known as
by placing the Board of Trustees official poster where it can easily be seen, and that I have
checked to be sure the poster has remained in place for eight days prior to the date fthe public
hearing. Date of hearing noted thereon to be held f. 0
Dated:
Sworn to before me this
N~ay ofY,r. 20a.,
~h4e J,w4cl~
Notary Public
ROXANNE SPAULDING
NOTARY PUBLIC, STATE OF NEW YORK
NO.01SP611~942
aUAWII 11 IN sun 01 K COllNIY
MY COMMISSION IXI'IHIS AUG 9. 2U0'6 I
1J9/25/~'~0S
Cj'::1..'f.:
7S5;5~1
. Board of
BOARD DF ~'F?USTEES
Tru~teos~PPLicatlln
Pt.'1GE 18
~.;
AtJ'l"HORIZATION
('flhare the aPplicant is not the owner)
I. QfO~ ~~~V'Ct1"' S
( pr r owner <5 property)
residing
at S'J.e:'-L ~\I)\iC$hT ~~
(ma ling a dress)
k.:r~CA-.:r~^,37dO
Lt<-
hereby authorize
(Agentl
to apply for permit(sl from the
Southold Board of Town Trustees on my behalf.
lfl A~
~~'S s~gnature)
8
~8/25:2g~; 8~::!
7S5S~.C,1
.
County of Suffolk
State of New York
SOARD DC T9USTEES
PAGE ~,
.
Bo.rd of Trustees Applicat~on
-~QoLT) rcY')~c.... BEING DULY SWORN
DEPOSES AND AFFIRMS THAT HFJSHE S THE APPLICANT FOR THE ABOVE
DESCRIBED PERc\1IT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN .<\RE
TRUE TO THE BEST OF HJSJHER KNOWL.EDGE ANDBELlEF, 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 A;,{Y AND ALL DAMAGES AND CLAIMS ARISING
UNDER OR BY VIRTUE OF SAID PERMJT(S), IF GRANTED. TN COMPLETING nns
APPLICATION, I HEREBY AUTHORIZE THE TRT: S, THEIR AGENT(S) OR
REPRESENTATIVES(S), TOE.. E .NT OP o INSPECT THE
PREMISES IN CONJDl"CTION APPL . nON.
SWORN TO BEFORE ME THIS ;25-1*\
&t~~nuJ~
No ary Public
,2oillL
ROXANNE SPAULDING
NOTARY PUBLIC, STATE OF NEW YORK
NO.01SP6113942
aUAI1111 IlIN sun 01 K GOllNTY
MY COMMISSION fWI'IIIfS ABU. U, 2Ud3'
02!25!~~9S 09::C
7S5~.S'::1
.
30ARD OF TRUSTEES
.
PAGE 1 9
APPLICANT/AGENTIREPRF-SENT ATIVE
TRANSACTIONAL DISCLOSURE FORM
The: Town of~t1ut."n1d~:!l ('ode:. of Ethics nmhibjt~ conflict!! of intotc::st on the nart of1own offi~er!t and emnlq~~~ The rmI'DO!Ie of
thi!l form's 10 nrovide if'lforrnalion wbioh tan a.lert the town of oossiblt! conflicf3 of interest and allow it 10 take wh8.awet ~tion is
!'l t v'd
(uurt n first nam ..qI.id Ie initial. u-ples", you arc applying in the n.stne of
SOml;otle el!;c or other entity.. su'cl1as a company. If so, indicate the: other
person's OJ' company's nam~.) -
YOUR NAMe,
NAME OF APPLlCA 1'ION, (Ch.ck all that apply.)
Building
Trustee
Coasral Erosion
Mooring
Plannins.
TaK grievance
VariMc:e
Change or ZIlne
Approvalorplat
ExemptiOt1 from plat or I)fficial map
Olher
(If "Other-, name thO' fileLivity.)
Do you pCfllIol"llllly (or tllrough your company, ~pouse, sibling, ptlrent, or child) have i1 relatiotlship with any officer or employee
of the Town or SOllthold7 "Rl!:lntionshlp'. inc.ludes by blood, Illarria&l;, Of hUJ:liness intcn::~t. "Bu$iness intc.rcst'~ meil.n~ a business,
including; II partnership, in which lhc town offlc<:r orclnploy" h~ even a partial oWl'\Cr:qhip of (or emplcyrnent by) a corpcntiOfl
in whicn the lown omeer or employee own. more than s~""
YES NO
-~,---- y
lryou answered "YES'" com).')lete the balStloe of this f(iMl'l and date ilnd sign where indicated.
Name ofpcrson ~mptoycd by the Town of St'tl,lthQld
TiUe cr positiot1 of that pcrsOI'1
Describe th~ relationship between yourself (the applicant/l'lgentlreprcscnttfth'e) and the lown officer or employee. Either cbeck
the ilppropriate line A) through 0) and/or descr,bc in the spa.::e provided.
The town officer or employceoT hisor her spouse. ,;ibling. pa,rent, or ch!ld is (cheek all that apply):
A) thc owncrofgrcatcr than S%ofthc sharos of the cotpO:'Qte stock. of the a.pplic~nt
-- (when the applicant is a corporation);
_B) the tegat or bcmfieinl o~ of Rny interest in a non-corporatc cntity (when the
applicant is not p corporation);
~C) 1111 officer. director, pJrtncr, or employee of tho applicant; or
_D) the nctuall\pplic:ant.
DESCRIPTION Or- RELATIONSHIP
form TS 1
Submiltl!d this _day of
SignalUre .
Print Name k\" \Ii11L-n
200
((.0 I<..
~S/25,'2?8S 03::~
7S5S54].
.
SOARD 0" TRiJ.S
PAGE -,..,
,
. ,
Town of Soathold
L WRP CONSISTENCY ASSESSMENT l<'ORM
A. INSTRUCTIONS
1, All applicants for pennits' including Town of Southold agencies, shall complete this CCAr for
proposed actions that are subject 10 the Town of Southold WarerfTont Consistency Review Law. This
assessment is intended to supplement other infonnation used by a TO"lTI of Southold agency in
making a determination of consistency. ,*Except minor exempt actiollS including Building Permils
and other ministerial permits nollocatedwithin thlli Coastal Erosion Hazard Area,
2. Before answering the questions in Section C, the preparer of this fonn should review the exempt
minor action list, polkies and eKplanations of each polley eontained in the ToW11 of Southold Local
Waterfront Revitalization Program. A proposed action will be evaluated as to its siwJificant
beneficial and adverse effects ll00n1he co~l area (which includes all of Southold TO"lTI ).
3. If any question in Section C on this form is jUlSwered "ycs" or "no", then the proposed actiol1 will
affect the aCh.ievement of the L WRP policy standards and conditioJ:1S contained in the consistency
review law. nus. each answer must be cXDlamed in detaiL listin2 both SllDDortin2 aud non-
sUDDortin2 fads. If an action cannot be certified as C<lnsistent with the L WRP policy standards and
conditions, it shall not be UlJ.del1aken,
A copy of the L WRP is available in the following places: online at the Town of Southold ' s
website (southoldtowl1.northforknet), the Board of Trustees Office, the Planning Departmer.t, all
local libraries and the Town Cletk's office.
B. DESCRIPTION OF SITE AND PROPOSED ACTION
SCTM# ~ - c.
<.f
\) e(>\ <. __JJ. ~
fX(S 11i1.3
PROJECT NAME
The Application has been submitted to (check appropriate response):
Town Board 0 Planning Board 0 Building Dopt. ci.. Board ofTru.'tees D
1. Category of Town of South old agency action (check appropriate response):
(a)
Action undertaken.clirectly by Town agency (e,g. capital
construction, plannillg activity, agency regulation, land transaction)
o
o
(b) Financial assistance (e.g, grant, loan, subsidy)
(e)
Pennit, approval, license, certification:
o
-"-~------:----.
Nature and extent of action:
All" "c
UO L ('
'7'lr~
."_'-'_'...1
g8/25/'2805 ?~::c
7S5S5C].
.
SOARD C!F TPU.S
PAGE :3
Location of action: &q D (p 31 ()
Site acreage:
Presenlland use;~ I'Ctf>il\ 1 \ a-l-
Present zoning classification: \\~7( J. P \1'-\ 1.t'V -L
2.
If an application for the proposed action has been filed with thc Town of Southold agency, the following
information shall be provided:
u V\. \x V\o tV V\
(a) Name of applicant:
(b) Mailing address:
(c) Telephone number: Area Code ( )
(d) Application number, if any:
Wii! the action be directly W1.dertakell, require fimding, or approval by a state or federal agency?
Yes 0 NoD
If yes, which state or federal agency?
C, Evaluate the project to the following policies by analyzing how the project will further support or
nol support the policies. Provide all proposed Best Management Practices that will further each poli~y.
Incomplete answers will requin that the form be returned for completion.
DEVELOPED COAST POLICY
Policy 1. Foster a pattern of development in the Town of Soutbold that enhances community character,
pre$erves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and
minimizes adverse effects of development. See LWRP Section 111- Policies; Page 2 for evaluation
criteria.
DYes 0 No LtJ Not Applicable
'\,.he-S nOT ~~u\,cte--~l\c
q (lC~s.s
Attach additional sheets if naca.sary
Policy Z. Proted and preserve hetonc and archaeoloeical resources of the Town of Southold. See
L WRP Section 111- Policies Page.s 3 through 6 for evaluation criteria
D Yes 0 NO~ Not Applicable
08/2S/2l2't3;
l?':l::':::
7S5S5<11
BOARD OF 'RU4ilfS
p,~GE
.
VlI~\ -LLm:~ ~ . ... ~
-1:Joes-_ - ?lP;'~ lo'J 'c~~;i,~
Ot
At'.ach additional ,heets jfneccssar)
Policy 3. Enhance visual quality nnd protect scenic ~csources th~oughoul the Town of Southuld. See
L V\'RP Section In - Policie~ Pages 6 th~ough 7 for evaluation criteria
DYes 0 No EtJ Not Applicable
'V~a('~ ~IJ-f' ~-fu-lJ~ e-
Attach additional sheets if necessary
NATURAL COAST POLICIES
Policy 4. Minimiu loss of life, structures, and natural resources from floodIng and erosion. See LWRP
Section III - Policies Pages 8 through 16 for evaluation criteria
DYes 0 No ct;J Not\APPliCabl[, ,... \\ I r\,.. ('("(::3
-'Oat:: OV\ s .fr) r~ J"~ - fur ~ ~~ L.!""'l"'
Attach additional sh..ts if necessary
Policy 5. P~utect and improve water quality and supply in the Town of Southold. See LWRP Seftion III
- Policies Pages 16 through 21 fo~ evaluation crite~ia
o Ye~ D No ItINot Applicable
. u..c \<-
1.bo.5> .-Yl Cll
Cl+\ec>!
U'tl1'-tl"C,
~<f12IJ
Attach addttiollal sheets if necessary
Policy 6. Protect and ~esto~e the quality md function of the Town of Southold ecosystems including
Slpific:ant Coastal Fish and Wildlife Habitats and wetlands. See L WRP Section IIl- Policies; Pages 22
throngh 32 for evaluation criteria
o D m
r1r::/25/:i~?S
\~?: :c.
7f,55'='C!.
.
No Not Applicable
'l)iC~JJ~Ice~~~tr'L---
30ARD 0' TRU4IIfS
PAGE :5
Yes
Auach additiona.l sheet!; if'noccssary
Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies
Pages 32 through 34 for evaluation criteria.
D Ves 0 No ~ Not Applicable
'1)+>rk- &t'lp:"'J
~e~t'(,T
al~
~~-
Attach additional ,heets if necessary
Policy 8. Minimize environmental degradation in Town of Soutbold from solid waste and hazardous
substances and wastes. See L WRP Section m - Policies; Pages 34 through 38 for evaluation criteria.
D Vcs 0 NI) ijJ Not Applicable
=-~ )0
U )CPs-r r'
, 8SUe S
I
() )/-l)-ecL~~=-=
PUBLIC COAST POLICIES
Policy 9. Provide for public access to. and reereational use of, coastal waters, public lands, and publle
resources of the Town of Southold. See L WRP Section lll- Policies; Pages 38 through 46 for evaluation
criteria.
D YeD NO~ Not Applieablc
=t'l(y, ~Il -pI 110\ )L
OJ'J" "C' S ':>
Attach additional sheets If necessary
~8/25!2~0; 09::~
7S5SS~:.
~~'JARD iJF TPU"S
PAGE :1;
.
WORKING COAST POLICIES
Policy 10. Protect Southold's water-dependent uses and promote siting of Dew water.dependent uses in
suitable locations. See LWRP Section III - Pollcies; Pages 47 through 56 for evaluation criteria.
DYes 0 No ~ Not Applicable
--~~---- Jerr~~~ f^;'~)~~1"~:r
flYlT.....-
Attach additional sheet. if nece..ary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the l'ecoDic
Estuary and Town waters. See LWRP Seetion III - Policies; Pages 57 through 62 for evaluation criteria.
DYes [J No$NotAPPlicable
E'~~T ~-1ne
'\ )/')'>~
'110'
IT': SOIli:Le c::::,
Attach additional sheets if necessary
Policy 12. Protect agricultural lands ill the Town of Southold. See L WRP Section 111- Policies; Pages
62 through 65 for evaluation criteria.
DYes 0 No BlNot Applicable
----------rtOI: Q~Yf ccA-ruroQ a~t""Lt
Att.ch .dditicn.lshCCls ifnecessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Section III - Poli~ Pages 65 through 68 for evaluation criteria.
DYe. 0 Nfl ~ NotApplicahlc
'Vt"C'Kf-p!1r;;!;e J;()-r-~~_ ~~~=-=
:BMilrD BY7Ji~ ~ztTITL' f}n-:~d
DATEJM cp
09!25:2~~S ~9:1~
7555541
.
BOARD OF 411jTEES
PAGE 1 ~
ToWn of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
1. All applicants for pennits' including Town of Southold agencies, shall complete tIris CCAF for
proposed actions that are subj ect to the Town of Southold Waterfront Consistency Revi ew Law. This
assessment is intended to supplement other infonnation used by a Town of Southold agency in
making a determination of consistency. .. Except minor exempt actions including Building Permils
and other ministe1'ial 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, polk.les and explanations of each policy contained in the ToWll of Southold Local
Waterfront Revitalization Program. A orooosed action will be evaluated as to its si!mificant
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 jIllIlwered "ycs" or "no", then the proposed acliol1 "ill
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. Iistinl! both SUDPIlrtln2 alld non-
$UoJ)llrtin2 faets. If an action cannot be certified as cClnsistent with the L WRP poljcy standa.rds and
conditions, it shall not be undel1aken.
A copy of the L WRP is available in the follo\'\ing places: online at the Town of Southold' s
website (southoldtov"ll.northforknet), the Board of Trustees Office, the PlallJ1ing Departmet:t, all
local libraries and the Town. Clerk's office.
B. DESCRIPTION OF SITE AND PROPOSED ACTION
SCTM# q
(p
<(
U e('\ I..
JJ~
fXiStl~
PROJECT NAME
The Application has been submitted to (check appropriate response):
Town Board D Planning Board 0 Building Dept. [)( Board of Trustees D
1. Category of Town of South old agency action (check appropriate response):
(a)
Action undertaken. directly by Town agency (e.g. capital
construction, planning activity, agency reg1.l1ation, land transaction)
o
o
(b) Financial assistance (e.g. grant, loan, subsidy)
(c)
Pennit, approval, license, certification:
o
_."-_._--_.-.~
Nature and extent of action:
ry)-eC\<'
AUG 2 8 2006
---
08/25/2805 89::'
1541
Location of action: li!1.J:f5I!Y_Uf\ ~Il f ,
BOARD OF 411JTEES
PAGE :3
F r Ylli/
()(P 31 ()
Site acreage:
Present land use;~ I'C\-f'Ii\T\ J.
Present zoning classification: ~~ (J e \1'-\ \ t'I) ~
2.
If an appli~ation for the proposed action has been filed with thc Town of Southold agency. the following
information shall be provided:
LJV\. \{ V\O tU V\
(a) Name ofapplicllIlt:
(b) Mailing address:_
(e) Telephone number: Area Code ( )
(d) Application number, ifany:
Will the action be directly undertaken, require funding, or approval by a state or federal agency?
Yes 0 NoD
If yes, which state or federal agency?
C. Evaluate the project to the following policies by analyzing how tbe project will further support or
not support the policies. Provide all proposed Best Manllgement Practices that will further each policy.
Incomplete answers will require thAt the form be returned for completion.
DEVELOPED COAST POLICY
Policy 1. Foster a pattern of development in the Town (If Soutbold that enhances community chllracter,
preserves open space, makes efficient use of infrastructure, makes beneficial use of a eoastllllocation, and
minimizes adverse effects of development. See LWRP Section III - Policies; Page :z for evaluation
criteria.
DYes 0 No "$l Not Applicable
Attach additional sheets if necessary
Policy Z. Protect and preserve historic and arcbaeoloeicaI resources of the Town of Southllld. See
L WRP Section 111- Polides Pagel! 3 through 6 for evaluation criteria
o Yes 0 NO'Q:J. Not Applicable
08f25!2g05 ~g::l
1541
BOARD OF illJTEES
PAGE ~4
Attach additional ,h..ts if necessary
Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southuld. See
L "'RP Section ill - Policie~ Pages 6 through 7 ror evaluation criteria
DYes 0 No Etl Not Applicable
Attach addition-a! ,heets if necessary
NATURAL COAST POLlCIES
Policy 4. Minimize loss or life, structures, and natural resources from flooding and erosion. See LWRP
Section HI - Policies Pages 8 through 16 for evaluation criteria
DYes 0 No rj;J Not Applicable
Attach additional shects if necessary
Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Seftion III
- Policies Pages 16 through 21 for evaluation criteria
DYes 0 No I$bNot Applicable
Attach additiol1al sheet5 if necessary
Policy 6. Proted and restore the quality and lunction of the TOWD of Southold eeo$ystcms including
Significant Coastal Fish aDd WIldlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22
through 32 for evaluation ~riteria.
o 0 1$1
B8/25!2885 0~::4
Yes
1641
Not Applicable
BOARD OF _TEES
PAGE 15
No
Attach additional sheets if noccs!lary
Policy 7. Proted and improve air quality in the Town of South old. See LWRP Section III - Policies
Pages 32 through 34 for evaluation criteria.
DYes 0 NO~ Not Applicable
Alta<;h additional ,hoets jf necessary
Policy 8. Minimize environmental degradation in Town of Soutbold from solid waste and llluardous
substances Rnd wastes. See LWRP Section UI- Policies; Pages 34 through 38 for evaluation criteria.
D Yes D NI) bp Not Applicable
PUBLIC COAST POLICIES
Policy 9. Provide for public access to, and reereational u~e of, coastal waters, public IlI.nds, and publk
resources of the Town of Southold. See L WRP Section III - Policies; Pages 38 through 46 for evRluation
criteria.
D yJ] NOlfJ Not Applicable
Attach additional sheets If necessary
08/25/2885 09::4
_541
BOARD IJF .TEES
PAGE 16
WORKING COAST POLICIES
Policy 10. Protect SouChold's water-dependent Ilses and promote siting of new water-dependent use.! In
suitable locations. See LWRJ> Section III - Pollcie$; Pages 47 through 56 for "valuation criteria.
DYes 0 No ~ Not Applicable
Attach additional sheets ifnece8sl!ry
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the I'econic
Estnary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria.
DYes 0 NO$. Nllt Applicable
Attach additional sheets if necessary
---~_."-_.~~-
Policy 12. Protect agricultural lands ill the Town of Soutbold. See L WRP Section III - Policie,s: Pages
62 through 65 ror evaluation criteria.
DYes D No SlNot Applicable
---~-_._._------~-
Attach additional sheets jf neee,sa!}'
Policy 13. Promote appropriate use and development of ~ncrgy an,d min~nd resources. See LWRP
Section III - Poli~ Pages 65 through 68 for evaluation criteria.
DYes 0 No'bf.l NotApplicahlc
PREPARED BY
TITLE
DATE
Jun 09 06 09:49a
~r~e ~uimaraes
9.951934
p.1
George Guimaraes
1950 Equestrian Avenue
Fishers Island, NY 06390
631/788-7569
June 9,2006
Board of Trustees
Town of South old
PO Box 1179,
Southold, NY 11971
JUN - 9 2005
To the Board,
I'm writing with the urgent request that on your visit to Fishers Island next week you
look at our property and the growing problem we have with the Japanese Knotwood at
the rear of our house. The growth has overtaken the house, is running under and up
through our back porch, into the garage and into the septic system. I don't believe this is
a wetlands protection issue as the water accumulation behind the house is in a rain spill-
off area that has backed up due to the clogging of the drainage under the road. The
highway department has authorized clearing of the drain pipe, which should eliminate the
back-up.
If you will please contact Harold Cook at 631/788-5550 he can take you to the house for
inspection. I'm very concerned about this situation and appreciate your attention to this
growing problem.
My sincere thanks,
4"21 ;(;0///.'0.//1
George Guimaraes
(by fax: 631/765-6641)
g -(rL.[
cc: Harold Cook
.
.
Office Use Only
_Coastal Erosion Permit Application
_Wetland Permit Application / Administrative Pennit
_AmendrnentITransfer/Exte ion
-LReceived Application: ~
~eceived Fee:$ -an;;( ')
~ompleted Apphcatio
_Incomplete
_ SEQRA Classification:
Type I_Type II_Unlisted_
_ Coordination:(date sent)
_CAC Referral Sent:
_Date of Inspection:
_Receipt ofCAC Report:
_Lead Agency Determination:_
Technical Review:
/ Public Hearing He~
~Resolution:
: ~J i
Name of APPlicant~) '.:) E1=f? _ (() P('1fQa.. hl'( ""D fa 0 ')
Address V{) 8QX: {Q(p J - f'i.sh'r"h :rsbwP
l!..l~ - () {(( oq {) Phone Number:( ) fA [if - trr - $ 5 f) ()
Suffolk County Tax Map Number: 1000 4131l[ - Sfr1li'Dn- t.rR 13'1!Y'k tJ~ )...or oo~
Property Location: VU i
(provide LILCO Pole #, distance to cross streets, and location)
AGENT:Ji.~(V '[) frY) l<
(If applicable)
Address: 'Va
FII }1)~
~x {Pro J
(5{(; ?'9()
Phone: If) .-=5)- ?IT - 5S5 ()
ttoard of Trustees Applicatit
GENERAL DATA
Land Area (in square feet):
Area Zoning: ~'t5tJ.'f'V\'~(ilQ
Previous use ofproperty:~'t'SI ~'f'~'l'I(}7 p
Intended use ofProperty:_~'t'S t'cl.fll\. rl'o I
Prior permits/approvals for site improvements:
Date '6'/4/j.E,
911~J() 5
, t
_ No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or SUSP,Ad by a governmental agency?
No_ Yes
If yes, provide explanation:
Qect Description (use attachments if necessary): J
<elYloU/D ~ ~ 0Q fYU '" 1'5"" .. 1<mr 11 ~'A
(~rI"", ""'" ,^f C;);U b.. ';;""""'1
~ru-eJ Cl) m"~ c, D (,It-\'"" \'leX"
'3 BfDU)\\It~~ SeQSOI1 S
~Board of Trustees Applicattlt
WETLANDITRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:
Q-e.\v'\(JlJcJ rA ~CQ.~V\'fSC:
kY\)"tu Jeuf,
Area of wetlands on lot:
-\-
')
square feet
Percent coverage oflot: r'\,~CL %
Closest distance between nearest existing structure and upland
edge of wetlands: ~ feet
Closest distance between nearest proposed structure and upland
edge of wetlands: "8 n~feet
Does the project involve excavation or filling?
-f- No
Yes
If yes, how much material will be excavated? ~ cubic yards
How much material will be filled? Y\. \ CA-
cubic yards
Depth of which material will be removed or deposited: IA \ Q feet
l " \
Proposed slope throughout the area of operations: _ _
Manner in which material will be removed or deposited: V\-\ Q
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):
U, ~T If t? 00 \)1 rl>A.\f'n>("-" kQ I ~q~, "-
We ~tt\; I (~Jpd
. Board of
.
'l'rustee. Applic&t:i.on
COASTAL EROSION APPLICATION DATA
Purposes of proposed activity:
~f\Yb\)e \)~ffi!\e5e
.KooI. U){>'f cf
Are wetlands present within 100 feet of the proposed activity?
~ No ';I Yes
Does the project involve excavation or filling?
~.No_..__ Yes
If Yes, how much material will be excavated? Y\ to (cubic yards)
How much material will be filled?
D:l~
(cubic yards)
Manner in which material will be removed or deposited:. In ( Ct.
Describe the nature and extent of the environmental impacts reasonably anticipated resulting
from implementation oftbe project as proposed. (Use attachments if necessary)
~)n I/I.:]a>-h:ue e.vUJzrT\v-\.II\A.eVV~~lL~S
Oee. Q~,c.L~~l
-----.-
-----.---------
-Board of Trustees Applicat!
AUTHORIZA nON
(where the applicant is not the owner)
I,G~~ GLL~~t'5 residing at SWI JfJMIj/~ Lm ~
(print er of property) (mailing address)
L Jot ~ 1 C \} f{f) IS')? do hereby authorize
~ (Agent)
. 1I.1Is Ck&_to apply for permit(s) from the
~T~~~b~:-
Own signature