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Home My WebLink AboutTR-6754 James F. K~ng, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town H~l 53095Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0380C Date November 5, 2008 THIS CERTIFIES that the extension of the existing roof on east side of dwelling 10' to cover portion of existing deck, 12'X 22' swimming pool, and installation of gutters & dr~wells At 1165 Old Harbor Rd., New Suffolk Suffolk County Tax Map gl 17-3-8.4 Conforms to the application for a Trustees Permit heretofore fried in this office Dated 9/24/07 pursuant to which Trustees Wetland Permit 6754 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 extension of the existing roof on east side of dwelling 10' to cover portion ofexistin~ deck, 12'X 22' swimming pool, and installation of gutters & drywells. The certificate is issued to SANFORD & ELIZABETH FRIEMANN owners 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 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 0_~.~ 1st day of construction ¼ constructed "~Project complete, compliance inspection, f,/,/~zE~F V ~ ~ ~ ~ -I-~ ~ b~ p~y~E~.c$ i~wc,"-rTEP o~ 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 1st day of construction ½ constructed ~Project complete, compliance inspection. V BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 6754 DATE: OCTOBER 17, 2007 ISSUED TO: SANFORD & ELIZABETH FRIEMANN PROPERTY ADDRESS: 1165 OLD HARBOR ROAD, NEW SUFFOLK SCTM# 11%3-8.4 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 application fee in the sum of $250.00 paid by Sanford & Elizabeth Friemann 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 extend the existing roof on the east side of the dwelling 10' to cover a portion of the existing deck, and to install a 12' x 22' swimming pool, with the condition of the installation of gutters and drywells to contain roof runoff for the entire dwelling and proposed addition in accordance with Chapter 236 of the Town Code- Storm Water Runoff, a line of staked hay bales to be installed prior to construction 10' landward from the top of the bluff, and as depicted on the survey prepared by John C. Ehlers Land Surveyor, last dated October 23, 2007, and received on October 24, 2007. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affrxed, and these presents to be subscribed by a majority of the said Board as of this date. TERMS AND CONDITIONS The Permittee Sanford & Elizabeth Friemann, residing at 1165 Old Harbor Road, New Suffolk New Yorl~, 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 evidence to anyone concerned that authorization was originally obtained. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. That there will be no unreasonable interference with navigation as a result of the work herein authorized. Thai 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 furore 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. 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 OFTOWNTRUSTEES TOWN OFSOUTHOLD Mr. & Mrs. Sanford Friemann P.O. Box 968 Cutchogue, NY 11935 RE: 1165 OLD HARBOR ROAD, NEW SUFFOLK SCTM# 117-3-8.4 Dear Mr. & Mrs. Friemann: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, October 17, 2007 regarding the above matter: WHEREAS, SANFORD & ELIZABETH FRIEMANN 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 24, 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 gutters and drywells to contain roof runoff for the entire dwelling and proposed addition and in accordance with Chapter 236 of the Town Code-Storm Water Runoff, a line of staked hay bales to be installed prior to construction 10' landward from the top of the bluff, and 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 Southold Town Code, and, RESOLVED, that the Board of Trustees approve the application of SANFORD & ELIZABETH FRIEMANN to extend the existing roof on the east side of the dwelling 10' to cover a portion of the existing deck, and to install a 12' x 22' swimming pool, with the condition of the installation of gutters and drywells to contain roof runoff for the entire dwelling and proposed addition in accordance with Chapter 236 of the Town Code- Storm Water Runoff, a line of staked hay bales to be installed prior to construction 10' landward from the top of the bluff, and as depicted on the survey prepared by John C. Ehlers Land Surveyor, last dated October 23, 2007, and received on October 24, 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 ~nspection. (See attached schedule.) Fees: $100.00 Very truly yours, James F. King 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 OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated ,~~2/--~/ been reviewed by this Board at the regular meefin¢ of and your application has been approved pending the completion of the following items checked off below. __ Revised Plans for proposed project '/Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of Construction ($50.00) Constructed ($50.00) I/'/' 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: TOTAL FEES DUE: $. //-- BY: James F. King, President Board of Trustees 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/Work session Report Date/Time: ]'0 ]/ca /o'q SANFORD ~,'ELJZABETH FRIEMANN request a Wetland Permit to extend the existing roof on the east side of the dwelling 10' to cover a portion of the existing deck, and to install a 12'X 22' swimming pool. Located: 1165 Old Harbor Rd., New Suffolk. SCTM#117-3-8.4 Type of area to be impacted: Saltwater Wetland Freshwater Wetland __ Sound ~Bay Distance of proposed work to edge of above: ~c.~of Town Code proposed work falls under: __Chapt.275 Chapt. 111 other Type of Application: '/Wetland __Coastal Erosion __Amendment __Administrative __Emergency Pre-Submission __Violation Planning Info needed: Modifications: Conditions: Present Were: ~/J.King __J.Doherty__P.Dickerson ~q3. Be g __ . Ghosio, Jr V/ H. Cusack D. Dzenkowski Mark Terry other Form filled out in the field by Mailed/Faxed to: Environmental Technician Review Date: 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 Don Wilder, seconded by James Eckert, it was RESOLVED to SUPPORT the Wetland Permit application of SANFORD & ELIZABETH FRIEMANN to extend the existing roof on the east side of the dwelling 10' to cover a portion of the existing deck, and to install a 12'X 22' swimming pool. Located: 1165 Old Harbor Rd., New Suffolk. SCTM#117-3-8.4 Inspected by: Chris Kempner The CAC Supports the application with the Condition the pool is relocated no closer than 50' from the top of the bluff and gutters and drywells are installed to contain the roof run- off and the pool backwash. Vote of Council: Ayes: All Motion Carried 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 ¢'~' LWRP Coordinator Date: October 9, 2007 Re: Request for Wetland Permit for Sanford H. Friemann SCTM# 117-3-8.4 SANFORD & ELIZABETH FRIEMANN request a Wetland Permit to extend the existing roof on the east side of the dwelling 10' to cover a portion of the existing deck, and to install a 12'X 22' swimming pool. Located: 1165 Old Harbor Rd., New Suffolk. SCTM#117-3-8.4 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 INCONSISTENT with the denoted following Policy Standards and therefore is INCONSISTENT with the LWRP. Policy 6. Protect and restore the quality and function of the Town of Southold ecosystem. 6.3 Protect and restore tidal and freshwater wetlands. 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 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. The distance to the proposed pool from the bluff is 20 feet~ a minimum setback distance of 100 feet from the bluff line is required pursuant to Chapter 275-3.Findings~ purpose~ iurisdiction~ setbacks. Please require that the applicant amend the application to meet the above policy to the greatest extent practical. If the action is approved and to further Policy 5: Protect and Improve Water qualit~ in the Town of Southold: 1. Require hay bales I0' landward of top of bluff during construction. 2. Require a drywell for pool drainage. 3. Require a nonturf~ native vegetation buffer landward of the top of bluff. 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 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 ~wOaStal Erosion Permit Application etland Permit Application Administrative Pernfit R Amendmentfl'rans fedExtension Rece-Tved Application: eceived Fee:$ f~'_'. Completed Application ~ !hq [ ~ __Incomplete __SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) ~ Consistency As~ssment Form q ~--C>AC Referral Sent: q[~tl ~O3 ' ~---"IJate of Inspection: |C~}~[ll~~} __Receipt of CAC Report: __Lead Agency Determination: Technical Review: ~blic Hearing Held: ~Resolution: Name of Applicant Address /J ~.ff'~ 0 ~,~ ~,~-,~-~,~ .~O. & ~ ~/ ~~,~hone N~ber:( Suffolk Co~ty T~ Map Number: 1000 - Property Location: ~'/S (provide LILCO Pole #, distance to cross streets, and location) AGENT: /I///4 (If applicable) Address: Phone: of Trustees Applicati~ 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 V/No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspende, tt by a governmental agency? I,"' No Yes If yes, provide explanation: of Trustees Applicati~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot~l[~l~ square feet Percent coverage of lot: A]/,~t % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No / Yes If yes, how much material will be excavated? /2-0 cubic yards 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: 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 A~plicati~ COASTAL EROSION APPLICATION DATA Axe wetlands No Does the proj No Yes If Yes, how much material How much material will be filled? Manner in which of the proposed activity? filling? y~ds) Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) ~d of Trustees Applicati~ AbT~ORIZATION (where the applicant is not the owner) I, residing at (print owner of property) (mailing address) do hereby authorize (Agent) to apply for permit(s from the Southold Board of Town Trustees on my behalf. (Owner's signature) PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1. APPLICANT / SPONSOR 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) SEQR 3,PROJECT LOCATION: //ar' Municipality 4. PRECISE LOCATION: Street Addess/and'/Road Intersections, Prominent landmarks etc -or provide mae 5. IS PROPOSED ACTION: ,~ New ~-~ Expansion r~ Modification / afleration 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~3'Yes [] No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as manyas apply.) [] Residential []Industrial []Commercial [~Agriculture [] Park/Forest/Open Space r~ Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) r~lYes r--']No if yes, list agency name and permit / approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? r-"~Yes ~Jo if yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/Sponsor Name .~'~.~.~ ~o ,~l~i..,~/~ Date: If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead A~lenc~/I A. DOES ACTION EXCEED ANY TYpE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. F--] Yes [~No WiLL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. I C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resoumes; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wild~ife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A commundg's existing plans or goals as officially adopted, or a change in uso or intensity of use et land or other natural resources? ~xplain hrietl¥: C5. Growth, subsequent development, or related activities Jikely to be induced by the proposed action? Explain briefly: Cfi. Long term, short term, cumulative, or other effects not identified in C1-C57 Explain briefly: C7. Other impacts (includin~l changes in use of either cluantity or type of ener~l}'? Explain bfiefl}': WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ~-~I'~eCsNMEj~°AREA/ICEAI? IIf}'es' explain bfiefl}': E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTtAL ADVERSE ENVIRONMENTAL IMPACTS? If },es explain: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadverseeffectidenti~edab~ve~determinewhetheritissubstantia~~Iarge~imp~rtant~r~therwisesigni~cant~ Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude, if necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination of significa ncc must evaluate the potential i m pact of th e proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULl EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actior WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the masons supporting thi~ determination. Name of Lead Agency Date Title of Responsible Officer Signature of Preparer (If different from responsible officer) Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency 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 being duly sworn, depose~md say~.' That on the;~v~y o,e $~;~ITr~ ~ 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 of the public hearing. Date of hearing noted thereon to be held I,J,3~, (3C('IX~ n . ~(X53 - oh. ox a(,x: k 1i 05 Dated: -(sig~ature(ff Sworn to before me this day of~00~ Notary Public PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Ce~ifled Fee ~2. G5 ~ (E~o~m~t R~uir~) ~0.00 / ~ postage $0.41 0956 r'-I (Endorsemer~ Required) $0.00 0~ r-R Total Postage & Fees $~.06 nj 5qto~,/e~ /ff. ~-~/~'~,,~/q~/,residingat //ha'~ 04~ /-X'/~ga~ ~r) N~,~ .~oF~e...~ ~/.,X~, Itq.;'~, being duly sworn, deposes and says that on the ~ ~ day of 5~r~;.4'~ ,20o~7_, deponent mailed a tree copy of the Notice set forth in the Board of Trnstees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at/u~',o ~,~-~e~../~..,, #~.~, that said Notices were mailed to each of said persons by (certified) (registered) mail. ~~ /~f~ ... Sworn to before me this Day of _~s~__, 20%-X Notary Public Town of Southold C 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 supporting and non- suooortiw, facts. If an action cannot be certified as consistent with the LWRP policy standards and 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 The Application has been submitted to (check appropriate response): TownBoard ~ Planning Board ~-~ Building Dept. ~ Board of Trustees ~ 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: Locafionofaction: 1/[~A~ Or4> ~P~f.~o~ l~odO) / ~ ~ ~ //~ Site acreage: Presem l~d use: Present zo~g cl~sification: 2. If ~ application for ~e proposed action has been filed M~ ~e Tom of Sou~old agency. ~e follo~ng i~omation sh~l be provided: (a) Nme ofapplic~t: ~ ~. ~ ~Z~W~ (b) M~l~g ad,ess: (c) Telephone nmber: ~ea Code (). 7~-- (d) Applicmion nmber, iffy: Will ~e action be dkectly ~de~en. req~re ~d~g. or approvfl by a state or federal agency? Yes ~ No ~ If yes. w~ch state or federfl 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 the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria ~ Yes ~ No [5~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 Yes ~ No [] Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for evaluation criteria ~ Yes ~ 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 NotApplicable 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 LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. Yes 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. [] Yes ~ No [] Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. ~ Yes~ No ~Not Applicable Attach additional sheets if necessary WORKING COAST POLICIESC Policy 10. Protect Southoid'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 ~ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. [] Yes ~ No ~ Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. Yes 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 ~ Not Applicable PREPARED BY ~',pa/I:DP-~ ~. ff~/,~n~J TITLE Ot-e.)~ DATE Board of Trustees Application County of Suffolk State of New York ~'~A,//'~/'/. / ~a4'Z~-rJ /~l .~.nn~/-~q-BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE 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. SWORN TO BEFORE ME THIS ~q/'"- DAY OF.~.n-/~ an{~ -~ ,2009 c"~Notary Public AUTHORIZATION (where the applicant is not the owner) (print owner of property) residing at (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nrohibits conflicts of interest on the anrt of town officers and emnlovees. Thc ouranse of this form is to on)vide information which can alert the town of oossible conflicts of interest and allow it to take whatever action is YOUR NAME: ~/~) ~-~ D ////. (Last name, first name,~aiddle 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 ali that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Emsinn Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other", name the activiiy.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or 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% of the shams. 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/agant/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): __A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); __B) the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); C) an officer, director, parmer, or employee of the applicant; or __D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 Submitted this x:a~day of S ignat ur e.~'"fi~o*~-,~ Print Name E~RV"~-T~D .~=PT. 12, 200'/ F:~.OP. POOL OGT. 22, 200'I, OC, T. 2~, 20O7 .S(,FF-OLK COt~Tf TAX I000 - IFf - · I'.'k2NUHENT FOUN~ PP-.OPOSED DR'r' P~ELL ~1 I~IA. 4' DEEP' TO CONTAIN 2" RAINFALL ON ROOF EXTENSION AND POOL BAOF~!,iASH ELEVATIONS ~EFERENCE N®VD '2q E)ATUNi LOT AREA = 1~,~12 S.F. OR 0.452~ ACRF: ~RAPHIC, 5C, ALE..I": ~:;~' 0 ~E C EI] ~ Ei~ llllJ ,0Ci 24 2007 $outhhold Town I~ard of Trustees JOHN C. EHLERS LAND SURVEYOR EAST MAIN ~l' N.Y.S. LIC. NO. 50202 R1VERHEAD,N.Y. 11901 3(~-8288 Fax 369-8287 RI~. D:UOBSq)Tq)'/-199 SEP 27 2007 Southhoid Town Board of Trustees EXISTING 3T'-10 3/4" 7'-0" 7'-0" ~-6~ 7'-0" 16" DEEP TREADS (1 TO RECESS IN AS SHOWN) 4'-3" 4'-3" 16" DEEP TRE~DS (1 TO RECESS .DJ AS SHOWN) 4'-5 1/4" 3'-11 1/2" (3) 2Xg DFe2 w/(2) 1/21STL, FL. PLT, HEADER- TO MATCH NEW -- (2) 1/2" FL. PLT. HEADER L COLUMN w/CAP ~ BASE F, ONTR~CTOR TO VERITT STAIRS (CENTER W1TH DOORS)