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Home My WebLink AboutTR-6793AJames F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. # 0357C Date August 22, 2008 THIS CERTIFIES that the extension of the existing sunroom 4'X 20' and conversion into a four (41 season room At 1775 Mill Creek Dr., Southold ~~oF souryo~ • ,,O BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631)766-6641 CERTIFICATE OF COMPLIANCE Suffolk County Tax Map #51-6-33 Conforms to the application for a Trustees Permit heretofore filed in this office Dated I/11/08 pursuant to which Trustees Wetland Permit #6793A Dated 1/23/08 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 existine sunroom 4'X 20' and conversion into a four (4) season room. The certificate is issued to CHARLOTTE MULLEN owner of the aforesaid property. ash' Authorized Signature r~ .~ James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. ,~~pF SOppyo~ #~ • ~~0,~~ ~~y~DUMV ,~",~'' n Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631)765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR APRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 15t day of construction '/2 constructed / Project complete, compliance inspection. s~'a,1 lea ~ ~,~ ~~ -_~ . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, J r. 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 Y:z constructed ,/ Project complete, compliance inspection. . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6793A Date of Receipt of Application: January 11, 2008 Applicant: Charlotte Mullen SCTM#: 51-6-33 Project Location: 1775 Mill Creek Dr., Southold Date of Resolution/Issuance: January 23, 2008 Date of Expiration: January 23,2010 Reviewed by: Trustee Peggy Dickerson Project Description: To extend the middle of the existing sunroom 4'X 20' and convert into a four (4) season room. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the survey prepared by John T. Metzger last dated January 10, 2008 and site plan prepared by North Fork Drafting & Design last dated November 26,2007. Conditions: Drainage plan to comply with Chapter 236-Stormwater Management, ofthe Town Code. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Jam~g,~~ Board of Trustees r -, IYYI 0:> ~ = ~ - ..... ..... :z: -< -:> r I ~~ Q~ " 4?~~ ~o~ ~At-1'~ APRQXWBLBY _1I>f)FTRU:"'-,~ 3 'v'NlCDf>5<SOUT; : 1ht()8 ~~4 AREA = 79,312 84ft. to tiB lines ~~~ 0~ 00 1.~' N <!' ~6'o , <:". "/0. ~. ~ " " " -y~ ~~ 10- ~ ~ X,' . o lj i,~ 0- -t-' ~ Q.. ;i(\ ~'v'v ~ ~~':J /i~~' SURVEY FOR CHARLOTTE M MULLEN AT ARSHAMOMOQUE TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 1000- 51- 06 - 33 Scale: 1" = 30' June 29, 1993 Sept. 22, 1993 (additions) S,!pt. 28,1993 ( elevations) Nov, 12, 1993 (10 contOur) . JAN. 10, 2008 (prop. addition) w VJ Q 'V ~ ~ \S' .~ ~ 11 J; !] LOT COVERAGE INCLUDES PROP. ADDITION AREA HOUSE 8. SHED ~ 3014 sq.fl. ' 3014/19312 ~ 15.6% 3014/17438~ 17.3% 10 lop 01 bank , Prepared in accordance wilh Ihe minimum slandards lor lille surveys as eslablished by Ihe L./.A.L.S. and approved and adopled for such use by The New York Slale Land ELEVA nONS 8. CONTOUR LINE ARE REFERENCED Tifle Associallon. TO N.G. V. DA rUM. / \0 :.- '<' I ';',!A',). \'i<'~O~ 1/97/ 93 - 223 o L() ~ 5: x u !'::)(lc;TINtc. F(')IJNnATI(')N (/) L() ~ 5: u EXISTIN<.:7 HOUSE NO ~ THIS AREA ~-0 EXIS"IN<.:7 SUNRM UNHEATED CXW15 CXW15 4'-0" ~ ~ ~ ~ .. C1 ~ Iii = ~ ~ C1 J;:XISTIN<.:7 HOUSE " NO I"lORK THIS AREA o Q \ 4'-t;." CXW15 4'-0" (2)2X4 POST (1Yp) ,20'-5" (/) L() ~ EXISTIN6 4"XI2" ~ \ ~UJSH H~/2 ,,~'i._"-";::_(' -" I --,,_, ~~ 8 ":f.~:t: ~ ~ .. ~IL J ~:~ ~- ~I-J N /~I' ====i // // // , / / , // L-$ PROPOSED/EXISTING FLOOR PLAN SCALE: ~" = 1'_0" = = = = = = = = EXIST. TO BE REMOVED I' - :2 G .- 0 7 @ NOTE: HEY( I"4INDOi"'lS 0 EXISTIN6 LOCATIONS I"4IEXIST (2)2"XI2" HDR5 (VIF) ~(c~IW~~ JAN 1 1 2008 l!lJ Soulhbold TOW1I Board of Trus!lles .. Q ~~ .c( Q a Q ~ Q \f) ~ Z C) - en w ON It) ~~ .... C)>- ZZ -~ t-()~ u. ::> co ~~~ 0<(...... :::iE~ ~oC'? NCO 0:::"'" O~ u.m :c~ t- o::: 0 z ?z L () D () -J It () z j!: ::) => \f) ~ . l- n! Ol - D X Y- UJ w () ~ l- \) ~ -J -J X 0 - . . 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 TO: (lhM LO'ttL 1YLu.l." n Please be advised that your application dated II f I f O'? has been reviewed by this Board at the regular meeting of t / a 3/ 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) Y:z Constructed ($50.00) ~inallnspection 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: $ 5l?/OO 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 InspectioniW orksession Report Date/Time: I /;L6 / () y I f Name of Applicant: C:ho.r \a-\-k (Y)v,\ke-J Name of Agent: K e.n PI:> 10 vJb,^"" Property Location: SCTM# & Street ..s ",-,<1)..0\ .A Brief Description of proposed action: S"l-(..-ss jlH /'Yl;11 C(~(k.1Jr. E..... ~-I Si..v,<W",,", Type of area to be impacted: _Saltwater Wetland _Freshwater Wetland _Sound Front _Bay Front Distance of proposed work to edge of above: Part of Town Code proposed work falls under: _ Chapt.. _ Chapt. II _other ~i5 n! Type of Application: _ Wetland _Coastal Erosion _Amendment Administrative _Emergency Info needed: ~~ ~d....{t?~ a-. dft, V d.- ~"-'-" .I-' r c~ -If .:1. ~ (" Modifications: Conditions: Present Were: _J.King _lDoherty ~ickerson _D. Bergen Other: Bob Ghosio, Jr. MailedIFaxed to: Date: Comments of Environmental Technician: In!! '-1-' !;j ; ~ i 'i 1..:.1 \ ~ ' 1 ~ I: I 'I" ! 'II'I , '. : ! . ~ l , ~ . q f! Ilj'i Iii I illS! Ii j ~ f !n ~ i iiiii 111111 '"'' I !iiii; I! ill , i , ~ J f l ~ ,a : iij i' I!!I! iiiii , , 1 ' , iffff:: Irlif:; ~U~,~! j" , .H!e z '1"1 ~ ~ ~H m ~~~f~ ~a:; , e ~an .t~g ~.g :z !I;~~ ~ c '" Xv> ~c ,~ :~.~ o^ ,,- ." 36 D' " .. ,. "< ^. "0 ~ ~ i I~ ~ ~ o ~ o o + . . -+ 5 ~ o h~;;:t. ___- ~~~~~ p~ ~"-r...r }: ...// g /'" ~j. ._-........r=;?' fl~-,:t w~ \ <I, ~~ W ~ ~. '. " \ \ ~~ t o ~ o ~ ~ o "c """"-----,?-Olll: ..I"C.'" \.- J . P , -( j" "'u,,,-t',Ii( eP"'" f\l..J~~ ,....., j-' " ..t )6 :( Lof"';' ;) Co!~;o<; or ,;~Avc 'I ",J .""LlS James F, King, President Jill M, Doherty, Vice-President Peggy A Dickerson Dave Bergen Bob Ghusio, 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 Office Use Only _Coastal Erosion Pennit Application _Wetland Pennit Application 1- Administrative Pennit ~ _Amendment/Trans er! x\E)llion eceived Applicati n: II 0 IS' Received Fee:$ '7 -Completed Application _Incomplete _ SEQRA Classification: Type I_Type II_Unlisted_ _ Coordination:( date sent) _LWRP Consistency Assessment Form CAC Referral Sent: ..-Date ofInspection: I~ 1o/0lS _Receipt of CAC Rep : _Lead Agency Detennination:~ Technical Review: ----.Yt1blic Hearing Held:~ :!JiO'6 Resolution: [6),1E Ii: IE i H ~ l\ru JAM 1 1 2008 ltw Soutbbold Town Board of Trustees d 11l>()'i. ().}.)~'/' Address (HItRlo-N~ /YJ. MwLLE-J PO. /50)( l'IoR, ~!.f-ft,o Id. /J.l/ 119/{ / Phone Number:( ) !-31- 'its - .:l9?O Suffolk County Tax Map Number: 1000 - S I - to - 33 Name of Applicant Property Location: /77S jV!,'U CReeK DR ~~-!l.Q/J / /IN. 111/{ / (provide LILCO Pole #, distance to cross streets, and location) AGENT: /(EAJ H,LlJobJ" .- 1],/" wA-ff<5 (If applicable) D L1 ./ To 00)( 11'17 Address: -5 J .'SS 'n~:,J lx), ~ . Pt-R "",-f~ /Jc >~u.+~i)/d fiN Jlc;)! . J Phone: h 3 I - 3? 9 - 004(, cdl . ~rd of Trustees APPlicati~ . GENERAL DATA Land Area (in square feet): /9. 73/ Area Zoning: K - LfD Previous use of property: 5'Jle <);~ iF {",,",,/,t v ~,.,.{J KF ;;;jc>.uce Intended use of property: i?eS;dl'!A.ve Covenants and Restrictions: If "Yes", please provide copy. Yes /NO Prior permits/approvals for site improvements: Agency Date 199 "3 _ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ./ No_ Yes If yes, provide explanation: Project Description (use attachments if necessary): ;; ')( fe,uJ /YJ,.dj Ie of ex's+:'0 5"N - R....N\ '-1/ X 20' /1/.1<) /!1/iJ<€ If- j.UT,;> L{I-/) 5eASou R<:r>AIl. (j},,'5 e y feN S 'O.lJ fO'/ 1 /JOT e !<rr, ,d AONle6 c 10 s e R. -10 [IJ{1i,AI\Jds -ft.;\jJ r)f ;yf, oUr; J UJE-f- )"AJd <; ) -tnTl>ll.iJJ-r ),';, 7p,N~F --ro I . 411rrd of Trustees APPlicati4lt ; WETLANDffRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: A jj 5,,1J.- RooM , InAJ([ i,v.f 0 t./ / y 20 / -ro fy'5.f;'!J 5t'A.So'u R=M. t.j Area of wetlands on lot: 900 square feet Percent coverage oflol: 5' % Closest distance between nearest existing structure and upland edge of wetlands: So / feet Closest distance between nearest proposed structure and upland edge of wetlands: 5 I. S ' feet Does the project involve excavation or filling? No / Yes .' } -rRE",c i-I foo+'^!J If yes, how much material will be excavated? ~ ~ 3 cubic yard~ How much material will be filled? ),'- 3 / cubic yards Depth of which material will be removed or deposited: 3 feet Proposed slope throughout the area of operations: AJolJ C Manner in which material will be removed or deposited: elf HAAlJ ./ nStatement ofth.e effect, i(any, on thewetlands and tidalwaters of the town thatl11aJ'!~stlltQY reason of such proposed operations (use attachments if appropriate): Nt7rv!. !Ill ,RooF ,RItAJoff 0;U &0 dRIJ;IJI?c! ,AJro DR ,/ we J Is oJ e.""S'1"'0 ~. , PROJECT ID NUMBER 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 PART 1 - PROJECT INFORMATION 1. APPLICANT I SPONSOR Ci-lIH?Lo+fe. 3.PROJECT LOCATION: 2. PROJECT NAME Municipality County 5'" (['o/~ 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks ate - or provide map /17)" /V), LL CRee}/. 5. IS PROPOSED ACTION: 0 New ])/<. ~"-tl..,, Id Al J J~71 [EJ Expansion D Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: [)(1eAJJ e)/15-t':j 5uAJ RoOA if"'x dO' AN) ;nil ~e ,-r iNfO A (Lj)seA50~ POO"1. 7. AMOUNT OF LAND AFFECTED: Initially ~ acres , 00 Ultimately '80 J acres __ 001 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZING OR OTHER RESTRICTIONS? OOves D No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY ~ Residential D Industrial 0 Commercial OF PROJECT? (Choose as many as apply.) DAgricu,ture D Park I Forest I Open Space OOther (describe) 10.' DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) DYes [EJ No If yes, list agency name and permit I approval: ~Y-ASPECrOF-TRl::: ACIIUN HAVE A CUHKENfLY VALID PERMIT OR APPROVAL? DYes [R]NO If yes, list agency name and permit I approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MOOIFICATION? Oves ~ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant I Sponsor Name Signature X Dale: 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 ITo be com Dieted by Lead Aaency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes. coordinate the review process and use the FULL EAF. DYes ONo B. Will ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. DYes ONo C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritlen, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: I No J C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: I No I C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: I~o ~ I C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain brieny: IMO I C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: I NO I e6. Long term, short term, cumulative, or other effects not identified in C1-C5? Explain briefly: I NO I C7. Other impacts (including changes in use of either quantity or type of enerqy? Explain briefly: Lvo I D. Will THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? (If yes, explain briefly: I DYes IXINo I E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: j DYes OONo I PART 111- DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the datefmiooticn ef signific3nse ml:-Jst Elvaluate--tt:le-patefl-tialimf*lGt Elf tRe f.lrepesee-aetien-en-tR6 t..R. imflfl'lt:otal characteri3ti~ of the CCA. Check this box if you have Identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL EAF andlor prepare a positive declaration. CheckTfilsuboxlf you"have-determTiiecf,based -on-Ole Information and -analysis above and-any supporting documeni:ition, fhfifihe"propos-ed-actlo- WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Name of Lead Agency Date Print or Type Name of ResponSible Officer In Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) ~. . Board of . Trustees Application ,. County of Suffolk State of New York (!. tI~R loNe.. /'rJ. /f)" J Ie Ai 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 TillS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. /K G-Ad~!r<a/,~,,-, SIgnature SWORN TO BEFORE ME THIS ---JI1f-DA Y OF ,2011R /0 MELANIE OOROSKI NOTARY PUBLIC, State of New'tblk No. 01004634870 Qualified in Suffolk County ") A CommlssionExpires5eptember30,~ 10 ;......,. eard of Trustees, APPlicate ; AUTHORIZATION (where the applicant is not the owner) ~ I, !: I-I/j!< /"oHp, IYJ. /'{I.I/e,.) (print owner of property) residing at J77S ;n,LI Oee/t! hR, (mailing address) ~..-ItlO Id. Nlf WOI / f.,~,J'lJAtiR5 PUJA:15 UC. do hereby authorize ~j' ~J;~ (Agent) to apply for permit(s) from the Southald Board of Town Trustees on my behalf. 'X ~f~:1C_~.ftJlp,,/ / Owner's sign ure) 8 ,. . . APPLICANT/AGENT/REPRESENTATlVE TRANSACTIONAL DISCLOSURE. FORM The Town of South old's Code of Ethics orohibits conflicts of interest on the Dart of town officers and emolovees. The Durnase of this fonn is to orovide information which can alert the town ofoossible conflicts of interest and allow it to take whatever action is necessarY to avoid same. YOUR NAME: /YJ" 11!.J, CiJM/./oT+e IV\ , (Last name, first name, -Ipiddle initial, unless you are applying in the name of someone else or other entity, such as a company. Ifsa, indicate the other person's or company's name.)' NAME OF APPLICATION: (Check all that apply.) Building Trustee Coastal Erosion Mooring Planning >< Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If '"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? "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 shares. YES NO x If you answered "YES", complete the balance ofthis form and date and sign where indicated. Name ofpers,on employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): _A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); _B) the legal or 'beneficial own~r of any interest in a non-corpomte entity (when the applicant is not a corporation); _C) an officer, director. partner, or employee of the applicant; or _D) the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this_ 10 day of J~''''4~ 1 200 8 ! ~~f:t~:~e Ci~;;;~ f.~;-?: ~ e:~~' Fonn TS I , ,. 1. . J Town of South old LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS I. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of South old Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. * Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the L WRP policy standards and conditions contained in the consistency review law. Thus. each answer must be explained in detail. listinll both suPportinll and non- supportinll 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. SCTM# 1000 fo - 33 o B. DESCRIPTION OF SITE AND PROPOSED ACTION ~I JAN 1 1 2008 PROJECTNAME 51<<lRoolV) l)( I\NS,o".! Soulbb a 1Us!ee$ The Application has been submitted to (check appropriate response): Town Board D Planning Board D Building Dept. D Board of Trustees 5(J I. 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 regulation, land transaction) D D (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: IRJ Nature and extent of action: {XTe-JJ t:'J,,5-t'1 S/AN-8ootVI 1../ ')<:10' ANJ mAX, it IN"", f\ (11) 5<'It'50AJ ~Q?Nl ~ . . . 5o,,+~o Jd. . AJef . 11~71 ;; Location of action: /775 /VJ;{t CR"u< Dk / Site acreage: , '-13 ;!<.,U$ presentlanduse:);NJJ.. IAM'!J K<:5;de.vce Present zoning classification: ;2 - '-I 0 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: CIIARJoN" /no /I1u//eN (b) Mailing address: po Boy I 'f 0 8 , 5o,,-I~o Jd/ IV). /J971 (c) Telephone number: Area Code ( ) b 31 - 76S - P< 970 (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes D 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 L WRP Section III - Policies; Page 2 for evaluation criteria. ~Yes D No D Not Applicable [50: - IJS,?AJ ,. I -r-h",u ~~;>-f""::J HON/rJ IN l'1i2e A 1> ~~.lSe Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of South old. See L WRP Section III - Policies Pages 3 through 6 for evaluation criteria DYes D No [lJ Not Applicable . I 'Th:s a A !?;~.jlp ,....b' ~p<.Jn<.IC~ (N<,.v./.{)slcJ Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See L WRP Section III - Policies Pages 6 through 7 for evaluation criteria DYes 0 No ~ Not Applicable f~tf'''IJ~.olJ t~,'Saf/~ iw;1L )Jur Ic~..,..I'A;AJT . fx.,.eN) /-1."1 p .r.""'n IOwA. ~J" w.,-.f /AA,dS -I (",.-.J 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 0 No 0 Not Applicable A!.t R,;e>F R"NO~ w.n .DRt:>IAJ .'~do ;-":5+".11 J)~"weJl$ \J ./ 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 0 No DNotAPPlicable 'fl.! R'H 1+ 0;: -rh:, E Y j>ANS;O,o f", II SF il'a/ 5j./r.,. Jesj hfl.~. li?",J LIJNd 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 rn flf I, .. Yes No X Not APlable . l>Ve~se R<' be>e,,+eJ 4P:"'AA -ft-r 'I),v5'f)AJ. 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. DYes 0 No~ Not Applicable fig /V'''~t:r+,ve v luR t ~I\I':J 70 Re5<t I~ I..."." ..,..,:., P~".se d' I Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See L WRP Section III - Policies; Pages 34 through 38 for evaluation criteria. DYes 0 No [E] Not Applicable No AZAA.Jo,,~ ~ '5 r;'rNce S ~R UM $7('> ro /?PSv I~ +/"r><o (.-1" r..,-r PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See L WRP Section III - Policies; Pages 38 through 46 for evaluation criteria. DYeD No rn Not Applicable A j>R,v.Ah'! ~'~:.J)p ['#II '!J R~$,Jeo<.Jr:€ -fA;} ;5 Attach additional sheets if necessary I . ... WORKING COAST POLICI' . 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 'J7,:s Pee> .re LT , ;5 PRoD",}" J U ,\ }J'>NJ , I Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See L WRP Section III - Policies; Pages 57 through 62 for evaluation criteria. DYes 0 No ~ Not Applicable 14.5 fX<os!'(~ ." fPObo~pJ "f}II,.;d. 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. DYes 0 No [Xl Not Applicable IJ~-r ,.1f>PI'GA?I,,- 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. DYes 0 No I2J Not Applicable E~;>"'J S':Jk [""';!:J !?ej;Je4ce- PREPARED BY //e.J. ~ 1. taoDA TITLE IJCf,..r( DATE 1- 10-0'6 ~~