HomeMy WebLinkAboutTR-6745 James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
Town Hall Annex
54375 Main Road
P.O. Box 1179
$outhold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
# 0460C
Date: September 1, 2009
THIS CERTIFIES that the patching of existing bulkhead to prevent soil wash-out~ 10'
non-turf buffer along the bulkhead, gutters to drywells on dwelling~ pipes leading out of
bulkhead capped off
At 1465 Shore Drive~ Greenport, New York
Suffolk County Tax Map # 47-2-28
Conforms to the applications for a Trustees Permit heretofore filed in this office
Dated 9/19/07 pursuant to which Trustees Wetland Permit # 6745
Dated 10/17/07 was Issued and conforms to all of the requirements and conditions of the
applicable provisions of law. The project for which this certificate is being
issued is for the patching of existing bulkhead to prevent soil wash-out, 10' non-turf buffer
along the bulkhead, gutters to drywells on dwelling, pipes leading out of bulkhead capped off
The certificate is issued to JOSEPH & BARBARA DAI owner of the
aforesaid property.
Authorized Signature
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
Town Hall, 53095 Main Rd.
P.O. Box I 179
Southold. NY 11971
Telephone (631 ) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
DATE OF INSPECTION:
V// Ch. 275
Ch. 111
INSPECTION SCHEDULE
Pre-construction, hay bale line/silt boom/silt curtain
1 st day of construction
½ constructed
Project complete, compliance inspection.
INSPECTED BY: (~O~ ~-~.
COMMENTS:
CERTIFICATE OF COMPLIANCE:
James F. K~ng, 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
1st day of construction
¼ constructed
V~Project complete, compliance inspection.
BOARD OF SOUTHOLD TOWN TRUSTEES
SOUTHOLD, NEW YORK
PERMIT NO. 6745 DATE: OCTOBER 17~ 2007
ISSUED TO: JOSEPH & BARBARA DAI
PROPERTY ADDRESS: 1465 SHORE DRIVE~ GREENPORT
SCTM# 47-2-28
AUTHORIZATION
Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of
Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on
October 17, 2007, and in consideration of applicat/on fee in the sum of $250.00 paid by Joseph 8,: Barbara Dai
and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees
authorizes and permits the following:
Wetland Permit to patch the existing 100' bulkhead to prevent soil from
washing from the property into the Bay, with the condition of the installation of gutters
and drywells to contain roof runoff and in accordance with Chapter 236 of the Town
Code-Storm Water Runoff, a 10' non-turf buffer along the bulkhead, and all pipes
leading out of the bulkhead are to be capped off, and as depicted on the project plan
prepared by Costello Marine Contracting Corp., last dated October 31, 2007 'and
received on November 2, 2007.
IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed,
and these presents to be subscribed by a majority of the said Board as of this date.
TERMS AND CONDITIONS
The Permittee Joseph & Barbara Dai, 1465 Shore Drive, Cn'eenport, New York, as part of the
consideration for the issuance of the Permit does understand and prescribe to the following:
That the said Board of Trustees and 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.
That this Permit is valid for a period of 24 months, which is considered to be the estimated
time required to complete the work involved, but should circumstances warrant, request for
an extension may be made to the Board at a later date.
That this Permit should be retained indefinitely, or as long as the said Permittee wishes to
maintain the structure or project involved, to provide evidc~nce to anyone concerned that
authorization was originally obtained.
That the work involved will be subject to the inspection and approval of the Board or its
agents, and non-compliance with the provisions of the originating application may be cause
for revocation of this Permit by resolution of the said Board.
That there will be no unreasonable interference with navigation as a result of the work
herein authorized.
That there shall be no interference with the right of the public to pass and repass along the
beach between high and low water marks.
That if future operations of the Town of Southold require the removal and/or alterations in
the location of the work herein authorized, or if, in the opinion of the Board of Trustees,
the work shall cause umeasonable obstruction to free navigation, the said Permittee will be
required, upon due notice, to remove or alter this work project herein stated without
expeflses to the Town of Southold.
The Permittee is required to provide evidence that a copy of this Trustee permit has been
recorded with the Suffolk County Department of Real Properties Office as a notice
covenant and deed restriction to the deed of the subject parcel. Such evidence shall be
provided within ninety (90) calendar days of issuance of this permit.
That the said Board will be notified by the Permittee of the completion of the work
authorized.
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
October 17, 2007
BOARD OF TOWN TRUSTEES
TOWN OFSOUTHOLD
Mr. & Mrs. Joseph Dai
81-88 Street
Brooklyn, NY 11209
RE: 1465 SHORE DRIVE, GREENPORT
SCTM# 47-2-28
Dear Mr. & Mrs. Dai:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday, October 17, 2007 regarding the above matter:
WHEREAS, JOSEPH & BARBARA DAI 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 September 19, 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, in accordance with Chapter 268, said application was found to be Exempt
from the Local Waterfront Revitalization Program policy standards, and,
WHEREAS, a Public Hearing was held by the Town Trustees with respect to said
application on October 17, 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 the Board of Trustees approve the application of JOSEPH &
BARBARA DAI to patch the existing 100' bulkhead to prevent soil from washing from
the property into the Bay, with the condition of the installation of gutters and drywells to
contain roof runoff and in accordance with Chapter 236 of the Town Code-Storm Water
Runoff, a 10' non-turf buffer along the bulkhead, and all pipes leading out of the
bulkhead are to be capped off, and as depicted on the project plan prepared by Costello
Marine Contracting Corp., last dated October 31,2007 and received on November 2,
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
Very truly yours,
President, Board of Trustees
JFK/eac
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 OFTOWNTRUSTEES
TOWN OFSOUTHOLD
Southold Town Board of Trustees
Field Inspection/Work session Report
Date/Time:
JOSEPH & BARBARA DAI request a Wetland Permit to patch the existing
100' bulkhead to prevent soil from washing from the property into the Bay.
Located: 1465 Shore Dr., Greenport. SCTMg47-2-28
Type of area to be impacted:
Saltwater Wetland Freshwater Wetland
Sound '~B ay
Distance of proposed work to edge of above:
~c]of Town Code proposed work falls under:
__Chapt.275 Chapt. 111 other
Type of Application: t//Wetland __Coastal Erosion ~Amendment __Administrative
__Emergency Pre-Submission Violation Planning
Info needed:
ModificatiOns:
Conditions:
L) Ut9
Present Were: .__J.King ~J.Doherty__P.Dickerson
H. Cusack D. Dzenkowski Mark Terry other
Form filled out in the field by
MailedfFaxed to: Date:
Environmental Technician
Review ~on.
D. Bergen__ B. Ghosio, Jr
Donald Wilder, Chairman
Lauren Standish, Secretary
Town Hall, 53095 Main Rd.
P.O. Box 1179
Southold, NY 11971
Telephone (631 ) 765-1892
Fax (631) 765-6641
Conservation Advisory Council
Town of Southold
At the meeting of the Southold Town Conservation Advisory Council held Wed., October
10, 2007, the following recommendation was made:
Moved by James Eckert, seconded by Don Wilder, it was
RESOLVED to SUPPORT the Wetland Permit application of JOSEPH & BARBARA DAI
to patch the existing 100' bulkhead to prevent soil from washing from the property into the
Bay.
Located: 1465 Shore Dr., Greenport. SCTM#47-2-28
Inspected by: James Eckert
Vote of Council: Ayes: All
Motion Carried
ri s,pp
0 '~ 0 Bl~ 0 Other I .P,~n~c f'l Unk. OYe~ 0 ~'.a~ ~
0 If~dl~n 0 ~ 0 unk~
73.
Stat~Js
DCJS-3205 (2/97J *FALSE
76. COmplainant
Plea by Mail (NOT FOR VTL VIOLATIONS)
TO PLEAD GUILTY:
COMPLETE THIS FORM AND MAIL OR DELIVER TO:
Southold Town Justice Court
53095 Main Road, P.O. Box 1179
Southold, NY 11971-0959
FINE
TO THE PRESIDING JUSTICE AT THE SOUTHOLD TOWN JUSTICE COURT:
][, 6 0' ¢~0 ~/~" ~J ,residing
at ~ ~'j~' ~t,t'~ ,-i¢~,u,,~ I~ , have been
charged with a violation of ' ~ 2,7~' ¢'.~ , under the
Code of the Town of Southold. I hereby elect to dispose of this matter without
appearing in open court. I hereby waive arraignment in open court and the aid of
counsel and understand that a plea of guilty is the equivalent to a conviction after trial.
I hereby plead guilty to the offense as charged and elect and request that this charge be
disposed of and a fine/penalty be fixed as agreed to below. I understand that the
agreed upon penalty is contingent upon the Court's approval, and that my appearance
may be required on a future date if the negotiated disposition is not accepted by the
Court.
Ticket/Summons ff.. 4 L/cO
In Satisfaction of:
Fine/Disposition Recommended:
EDWARD FORRESTER
DIRECTOR OF CODE ENFORCEMENT
TOWN OF SOUTHOLD
Southold Town Hall Annex
54375 Route 25, P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1939
Facsimile (631) 765-6639
e-maih
ed.forrester@town.southold,ny,us
STOP WORK ORDER
TO:
Joseph and Barbara Dai
1465 Shore Drive
Greenport NY 11944
YOU ARE HEREBY NOTIFIED TO SUSPEND ALL WORK AT:
!465 Shore Drive, Greenport NY
TAX MAP NUMBER - 1000-47-2-28
PURSUANT TO SECTION 275-t6A. OF THE CODE OF THE TOWN OF SOUTHOLD,
NEW YORK, YOU ARE NOTIFIED TO IMMEDIATELY SUSPEND ALL WORK AND
BUILDING ACTIVITIES UNTIL THIS ORDER IS RESCINDED
BASIS OF STOP WORK ORDER:
Construction without valid permit Section 275-5A
CONDITIONS UNDER WHICH WORK MAY BE RESUMED:
Issuance of valid permit,from Southold Town Board of Trustees
FAILURE TO REMEDY THE CONDITIONS AFORESAID AND TO COMPLY WITH
THE APPLICABLE PROVISIONS OF LAW MAY CONSTITUTE AN OFFENSE
PUNISHABLE BY FINE IMPRISONMENT OR BOTH.
DATED: October 19, 2007 ~
/ AUT.ORIZEI~GNATURE
I1~1
11. Date 14. Date
73.
DCJS-3205 J2/V7J *FALSESTATEMENTSAREPUNISHABLEASACRIME. PURSUANTTOTHENEWYORKSTATEPENALLAW. .. .,~
Town of Southold
' A- 17 6 6~ Suffolk County, NY
The People of the State of New York vs.
OC~ 2 9 2007
4.,~.
OCt:. 2=1, ~ o 07
ECEB~Ei~
2007
OFFICE LOCATION:
Town Hail Annex
54375 State Route 25
(cor. Main Rd. & Youngs Ave.)
Southold, NY
MAILING 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
From: Mark Terry, Principal Planner X~'
LWRP Coordinator
Date: October 9, 2007
OCT - 9 2007
Seuthhold Town
8oard of Trustees
Re:
Request for Wetland Permit for Joseph and Barbara Dai
SCTM# 47-2-28
JOSEPH & BARBARA DAI request a Wetland Permit to patch the existing 100' bulkhead to
prevent soil from washing from the property into the Bay. Located: 1465 Shore Dr., Greenport.
SCTM#47-2-28
The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the
Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy
Standards. Based upon the information provided on the LWRP Consistency Assessment Form
submitted to this department, as well as the records available to me, it is my recommendation
that the proposed action is exempt from review pursuant to Chapter 268-3, Exempt Minor
Actions, item B which states:
"Replacement, rehabilitation or reconstruction of a structure or facility, in kind. on the same
site, including upgrading buildings to meet building or fire codes, except for structures in areas
designated by the Coastal Erosion Hazard Area (CEHA) law where structures may not be
replaced, rehabilitated or reconstructed without a permit".
MT/hkc
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
Office Use Only
~Cwoastal Erosion Permit Application
etland Permit Application
Amendmentfrrans~er/Extension
eceTved Application:
Received Fee:$.~%"~~ .
~---~C0mpleted Application
Incomplete
~SEQRA Classification:
Type I Type II Unlisted
~Coorchnafion:(date sent).
.~LWRP Consistency Assessment Form
7CAC Referral Sent:
~ate of Inspection:
Receipt of CAC Report:
Lead Agency Determination:
Technical Review:
.~.~Public Hearing Held:
Resolution:
Name of Applicant
Adminislrative Permit
Address
65J-4 ?-Z43o
Suffolk County Tax Map Number:
Property Location:
(provide LILCO Pole #, distance to cross streets, and location)
AGENT:
(If applicable)
Address:
Phone:
SEP l 9 2007
Southhold Town
Board of Trustees
of Trustees Applicatio0
Land Area (in square feet):
Area Zoning:
Previous use of property:
Intended use of property:
GENERAL DATA
Covenants and Restrictions:
If "Yes", please provide copy.
Yes / No
Prior permits/approvals for site improvements:
Agency Date
__ No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspende~d by a governmental agency?
Yes
If yes, provide explanation:
Project Description (use attachments
_ ,,.., .U
~d of Trustees Applicatio0
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:
Area of wetlands on lot:
Percent coverage of lot:
square feet
%
Closest distance between nearest existing structure and upland
edge of wetlands: dJS" feet
Closest distance between nearest proposed structure and upland
edge of wetlands: o'r-~''' feet
Does the project involve excavation or filling?
f No Yes
If yes, how much material will be excavated?
How much material will be filled? cubic yards
Depth of which material will be removed or deposited:
Proposed slope throughout the area of operations:
Manner in which material will be removed or deposited:
cubic yards
feet
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):
of Trustees Ap~licatio0
COASTAL EROSION APPLICATION DATA
Pmp~oses of proposed activity: C~ .-~J_~,,~t5
Are wetlands present within 100 feet of the proposed activity?
No ,/ Yes
Does the project involve excavation or filling?
~'~ No Yes
If Yes, how much material will be excavated? .(cubic yards)
How much material will be filled? (cubic yards)
Manner in which material will be removed or deposited:
Describe the nature and extent of the environmental impacts reasonably anticipated resulting
from implementation of the project as proposed. (Use attachments if necessary)
617.20 SEQR
PROJECT ID NUMBER APPENDIX C
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
PART 1 - PROJECT INFORMATION ( To be completed by Applicant or Project Sponsor)
1. AXPLICANT / SPONS, OR . I2' PROJECT NAME .
3.~ROJE~,T LOCATION:/ , Z~~.~
4. PRECISE LOCATION: SEeet Addess and ~d Inters~tions, Prominent landmarks e~ ~or provide map
5. IS PROPOSED ACTION: [] New [] Expansion [~,'~iflcation / a)teration
6. DESCRIBE PROJECT BRIEFLY:
7. AMOUNT OF LAND AFFECTED:
Initially acres
Ultimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER
E~es [] No if no. describe briefly:
IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.)
dential []industrial []Commercial [~lAgriculture [] Park / Forest l Open Space []Other(describe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal, State or Local)
~ r~]N° If yes, list agency name and permit / approval:
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
[~es []No If yes, list agency name and permit / approvah
12. AS A RES~OF PROPOSED ACTION WiLL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION?
r-]Yes UNo
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant / Spons~-~e /'~ Date:
~he action is a Costal Area, and you are a state agency,
complete the Coastal Assessment Form before proceeding with this assessment
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
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
In the Matter of the Application of
.................
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
at
~ ~sdl~m~;mmit~nl? I'lyes
(Endowment Requi~)
m TO~I ~ge & Fees i $ ~.21
~ ~ ..................................... ~ a c.o.o.
...... ~~ublic ~
CYN~IA M. MANWARING
NOTARY PUBLIC, STATE OF NEW YORK
NO:01 MA61 ~507
QUALIFIED IN SUFFOLK COUN~
COMMISSION
EXPIRES OCT, 20
). as
seen, and that
r to the date of the public
, am'?.
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
SEP 2 § 2007
Seuthhokl Tewa
8oar(I id Tmstee~
Address:
//
,~/,~ ~
STATE OF NEW YORK
COUNTY OF SUFFOLK
_~/)~/~. ~ , residing at / ~ ,~ ~
~, ~ , being duly sworn, deposes ~d says that on the
/ ~day of ~ ,2~eponent mailed a ~e copy of ~e Notice
set fo~. in the Bo~d of T~tees Application, dkected to each of the above n~ed
persons at ~e ad~esses set opposite ~ere respective nines; that the ad~esses set
opposite ~e n~es of s~d persons ~e the ad.ess of said persons as shorn on ~e cu~ent
~sessment ~11 of~e Tom. of ~outhold; ~at said Notices were mailed at the United States Post
Office at ~~ ~, ~at s~d Noti~ere mailed to each of s~d persons by
(ce~ifie~~mail~ ' / ~ ~
Sworn ~efor~ me ~s ~ ~
~ay~3~ , 20~
- I' ~ot~-~u~ 'l ~-' ~
~0:0~ MA01 ~507
~ QUALIFIED IN SUFFOLK COUNt/
~OMMISSION EXPIRES OCT. 20 ~
GREENPORT MPO
GREENPORT, New York
119441644
3548330944-0098
09/24/2007 (800)275-8777 04:19:00 PM
Sales Receipt
Product Sale Unit Final
Description Qty Price Price
NEW YORK NY 10013
Zone-1 First-Class
Letter
0.50 cz.
Certified
Label #:
Issue PVI:
$0,41
$2.65
70070220000245308354
$3.06
PELHAM NY 10803 $0,41
Zone-1 First-Class
Letter
0.50 cz.
Certified $2.65
Label #: 70070220000245308347
Issue PVI: $3.06
HICKSVILLE NY 11801 $0,41
Zone-I First-Class
Letter
0.50 cz.
Certified $2.65
Label #: 70070220000245308330
Issue PVI: $3.06
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
All applicants for permits* including Town of Southold agencies, shall complete this CCAF for
proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This
assessment is intended 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.
Before answering the questions in Section C, the preparer of this form should review the exempt
minor action list, policies and explanations of each policy contained in the Town of Southold Local
Waterfront Revitalization Program. A proposed action will be evaluated as to its significant
beneficial and adverse effects upon the coastal area (which includes all of Southold Town).
If any question in Section C on this form is answered "yes" or "no", then the proposed action will
affect the achievement of the LWRP policy standards and conditions contained in the consistency
review law. Thus~ each answer must be explained in detail~ listing both supoortino and non-
suooorting facts. If an action cannot be certified as consistent with the LWRP policy standards
conditions, it shall not be undertaken.
A copy of the LWRP 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# ¢~" o~_ .
The Application has been submitted to (check appropriate response):
Town~oard ~ Piann~g Board T] Build~gDept. ~ ~oardofT~ustees
Category of Town of Southold agency action (check appropriate response):
(a) Action undertaken directly by Town agency (e.g. capital
construction, planning activity, agency regulation, land transaction)
(b) Financial assistance (e.g. grant, loan, subsidy)
(c) Permit, approval, license, certification:
Nature and extent of action:
Present land use:
Present zoning classification:
If an application for the proposed action has been filed with the Town of Southold agency, the following
o a ions l pro d2¥
(a) Name of applicant:
(b) Mailing address:
b dUT, , I l z o
(c) Telephone number: Area Code (
(d) Application n~ber, iffy:
Will the action be directly undertaken, require funding, or approval by a state or federal agency?
Yes [--] No ~'~ If yes, which state or federal agency?.
C. Evaluate the project to the following policies by analyzing how the project will further support or
not support the policies. Provide all proposed Best Management Practices that will further each policy.
Incomplete answers will require that the form be returned for completion.
DEVELOPED COAST POLICY
Policy 1. Foster a 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 LWRP Section III - Policies; Page 2 for evaluation
criteria.
--]Yes
[] No ~-~Not Applicable
/
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of thc Town of Southold. See
LWRP Section III ' Policies Pages 3 through 6 for evaluation criteria
~] Yes ~ No ~Not Applicable
Attach additional sheets if necessary
Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See
LWRP Section III - Policies Pages 6 through 7 for evaluation criteria
Attach additional sheets if necessary
NATURAL COAST POLICIES
Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LwRP
Section III - Policies Pages 8 through 16 for evaluation criteria
~/Yes F-] No ~ Not Applicable
Attach additional sheets if necessary
Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III
- Policies Pages 16 through 21 for evaluation criteria
~/Yes ~ No ~Not Applicable
Attach additional sheets if necessary
Policy 6. Protect and restore thc quality and function of the Town of Southold ecosystems including
Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22
througJ~32 for evaluation criteria.
Yes
No Not Ap ble '~
Attach additional sheets if necessary
Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies
Pages 32 through 34 for evaluation criteria.
~ Yes ['-] No [--'~Not Applicable
Attach additional sheets if necessary
Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous
substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria.
PUBLIC COAST POLICIES
Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public
resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation
criteria.
[] NoT otApplicahle
Attach additional sheets if necessary
WORKING COAST POLICIE~
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See/LWRP Section III- Policies; Pages 47 through 56 for evaluation criteria.
[] Yes ~ No~l~ Not Applicable
A~ach 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.
[] Yes ~ No ~/NNot Applicable
At~ach additional sheets if necessary
Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages
62 through 65 for evalu/ation criteria.
[] Yes ~ No~l-~ Not Applicable
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Section III- Policies; Pages 65 through 68 for evaluation criteria.
[] Yes ~-~ No ~/NNot Applicable
PREPARED BY
TITLE DATE
Board of Trustees Application
County of Suffolk
State of New York
'1:3 a-cO- % . ,* ,' BEING Dray SWORN
DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK
WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY
BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT
AGREES TO HOLD THE 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 ~3~[gW OF THIS APPLICATION.
SWORN TO BEFORE ME THIS /~ DAYOF ,J_~?O-iVtCt~ ,20~
~ I~otary Public
LAUREN U. STANDISH
Notary Pul~lc, S~te of N~w York
No. 01S16164008
,, O.ual~fied_in Suffolk County
~,ommlssion Lxpires April 9,20/[
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics orohibits conflicts of interest on the Dart of town officers and emnlovees. The nuroose of
this form is to orovidc in forinatiun which can alert the town of nossiblc conflicts of interest and allow it to take whatever action is
necessary to avoid same.
(Last nam~ flint flame, oafddle initial, unless you are applying in the name of
someone else or other entity, such as a company. If so, indicate the other
person's or company's name.)
NAME OF APPLICATION: (Check all that apply.)
Tax grievance Building
Variance Trustee
Change of Zone Coastal Erosion
Approval of plat Mooring
Exemption from plat or official map Planning
Other
(lf "Other', name the activity.)
Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee
of the Town of Southold? "Relatiunship" includes by blood, marriage, or business interest. "Business interest" means a business,
including a partnership, in which the town officer or employee has even a partial ownership of(or employment by) a corporation
in which the town officer or employee owns more than 5% &the shares.
YES NO ~
If you answered "YES", complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself (the applicant/agentJrepresantative) and the town officer or employee. Either check
the appropriate line A) through D) and/or describe in the space provided.
The town officer or employee or his or her spouse, sibling, parent, or Child is (check all that apply):
__fi,) the owner of greater than 5% of the shares of the corporate stock of the applic0nt
(when the applicant is a corporation);
B) the legal or beneficial owber of any interest in a non-corporate entity (when the
applicant is not a corporation);
__.C) an officer, director, parmcr, or employee of the applicant; or
__.D) the actual applicant.
DESCRIPTION OF RELATIONSHIP
Form TS 1
Submitted this ~day of ~- 200,~-
Signature /7~.~-~ ../~-~dd ~ ..~-~-~.' '
PrintNa~'/ ~~ ~.