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Home My WebLink AboutTR-6782 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 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0447C Date: July 20, 2009 THIS CERTIFIES that the construction of first-floor addition and partial second-floor addition to existing dwelling, new patio areas, new sanitary system and new detached garage with a 20' non-turf buffer installed and to be maintained landward of the bnlkhe, ad At 1690 North Bayview Road, Southold, New York Suffolk County Tax Map # 70-12-37 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated 11/9/07 pursuant to which Trustees Wetland Permit # 6782 Dated 12/12/07 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 construction of first-floor addition and partial second-floor addition to existing dwelling, new patio areas, new sanitary system and new detached garage with a 20' non-turf buffer installed and to be maintained landward of the bulkhead The certificate is issued to LAURIE MANDELBAUM 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 l~t day of construction ~ constructed l~r~roject comp~ompliance/~__ . inspection. COMMENTS: / CERTIFICATE OF COMPLIANCE: James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghos±o, 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 1st day of construction ¼ 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 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 Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 6782 DATE: DECEMBER 12~ 2007 ISSUED TO: LAURIE MANDELBAUM PROPERTY ADDRESS: 1690 NORTH BAYVIEW RD. SOUTHOLD SCTM#70-12-37 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 December 12, 2007, and in consideration of application fee in the sum of $250.00 paid by Laurie Mandelbaum ~ subject to the Terms and Conditions as stated in the Resolution, the Southolr and permits the following: Wetland Permit to construct a first-floor addition to the existing dwelling, new flush patio areas and a new partial second-floor, new sanitary system, and a new garage, with the condition drywells and gutters are installed to contain the roof run-off, accordance with Chapter 236-Stormwater Management of the Town Code, a line of staked hay bales is installed prior to construction and maintained until the project is completed, and a 20' non-turf buffer is installed landward of the bulkhead, and as depicted on the site plan prepared by Mark Schwartz, AIA dated December 17, 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, Laurie Mandelbaum, residing at 1690 North Bayview Rd., Southold, NY 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. 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 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. 10. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765~~892 Fax (631) 765-6641 December 12, 2007 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mark Schwartz, AIA P.O. Box 933 Cutchogue, NY 11935 RE: LAURIE MANDELBAUM 1690 NORTH BAYVIEW RD., SOUTHOLD SCTM#70-12-37 Dear Mr. Schwartz: The Board of Town Trustees took the following action during its regular meeting held on Wed., December 12, 2007 regarding the above matter: WHEREAS, Mark Schwartz, AIA on behalf of LAURIE MANDELBAUM 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 November 9, 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 I~WRP Coordinator recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policy 6 of the Local Waterfront Revitalization Prdgram to the greatest extent practical through the imposition of the following Best Management Practice requirements: the installation of gutters and drywells to contain roof run-off, a line of staked hay bales is installed prior to and maintained during construction, and a 20' non-turf buffer landward of the bulkhead, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on December 12, 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, thaffor the mitigating factors and based upon the Best Management Practice requirements 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 LAURIE MANDELBAUM to construct a first-floor addition to the existing dwelling, new flush patio areas and a new partial second-floor, new sanitary system, and a new detached garage, with the condition drywells and gutters are installed to contain the roof run-off, in accordance with Chapter 236-Stormwater Management of the Town Code, a line of staked hay bales :is installed prior to construction and maintained until the project is completed, and a 20' non-turf buffer is installed landward of the bulkhead, and as depicted on the site plan prepared by Mark Schwartz, AIA dated December 17, 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:S100.00 Very truly yours, Board of Trustees JFK:lms 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 /I / el/0') has been reviewed by this Board at the regular meeting 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) i 1st Day of Construction ($50.00) __ ½ Constructed ($50.00) V/ Final Inspection Fee ($50.00) I 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: $ ~ ~, ~0 BY: James F. King, President Board of Trustees Donald Wilder, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-664I Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., December 5, 2007, the following recommendation was made: Moved by Glen McNab, seconded by Peter Young, it was RESOLVED to SUPPORT the Wetland Permit application of LAURIE MANDELBAUM to construct a first-floor addition to the existing dwelling, new flush patio areas and a new partial second-floor, new sanitary system, and a new detached garage. Located: 1690 North Bayview Rd., Southold. SCTM#70-12-37 Inspected by: Don Wilder, Glen McNab The CAC Supports the application with the Condition gutters and drywells are installed to contain the run-off from the dwelling and the patio areas are pitched into the drywells, and a 20' non-turf buffer is installed landward of the bulkhead. Vote of Council: Ayes: All Motion Carried James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 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 Southold Town Board of Trustees Field Inspection/Work session Report Date/Time: /'~'~--ff- O 7 I_AURIE MANDEI_BAUM requests a Wetland Permit to construct a first-floor addition to the existing dwelling, new flush patio areas and a new partial second- floor, new sanitary system, and a new detached garage. Located: f690 North Bayview Rd., Southold. SCTM#70-12-37 ~/y~e of area to be impacted: altwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of above: P~V~C of Town Code proposed work falls under: hapt.275 Chapt. 111 other Type of Application: Info needed: ¢ Wetland Coastal Erosion Amendment Administrative __Emergency Pre-Submission Violation Planning Modifications: Conditions: Present Were: ~ing __J.Doherty__P.Dickerson ~'~. Bergen__ B. Ghosio, Jr /-"/H. Cusack D. Dzenkowski Mark Terry~other Form filled out in the field by Mailed/Faxed to: Date: Environment~ Technician OFFICE LOCATION: Town Hail Annex 54375 State Route 25 (cot. 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 id " To: James King, Pres ent ~' · Town of Southold Board of Trustees Mark Terry, Principal Planner ~/x LWRP Coordinator From: Date: December 6, 2007 Re: Request for Wetland Permit for Laurie Mandelbaum SCTM# 70-12-37 LAURIE MANDELBAUM requests a Wetland Permit to construct a first-floor addition to the existing dwelling, new flush patio areas and a new partial second-floor, new sanitary system, and a new detached garage. Located: 1690 North Bayview Rd., Southold. SCTM#70-12-37 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 Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. The distance from the proposed addition to the wetland line is 56.5 feet; the distance from the proposed patio to the wetland is 43.6 feet; a minimum setback distance of 100 feet from the wetland boundary is required pursuant to Chapter 275-3.Findings; purpose; jurisdiction; setbacks and 275-5. B (2) e. Please require that the applicant amend the application to meet the above policy to the greatest extent practical. If the action is approved the following best management practice (BMP) is recommended: 1. Require a 30 foot non-turf, native vegetation buffer landward of the bulkhead. The BMP will further Policies 5, Protect and improve water quality in the Town of Southold and 6.3 Protect and restore tidal and freshwater wetlands, item D (below). Provide adequate buffers between wetlands and adjacent or nearby uses and activities in order to ensure protection of the wetland's character, quality, values, and functions. 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 Coastal Erosion Permit Application ~qqetland Permit Application Administrative Permit Amendment/Transfer/Extension ece~vved Application: IIik~/O eceived Fee:$ c2b--O 5'" ~Completed Application /[J! __Incomplete __SEQRA Classification: Type I Type II Unlisted __A~oXwRpdinatio n: (dat e sent) Consistency Assessment Form/ l llq [ ~CAC Referral Sent: I Ill'J[ ~.-Bate of Inspection: / ~.~_~.0~ __Receipt of CAC Report: __Lead Agency Deterrrdnation:__ Technical Review: ~blic Heating Held: tO-fig[o') Resolution: Name of Applicant Address / 7~ 5- - &~, 9_3 Phone Number:( ) Suffolk County Tax Map Number: 1000- 70 "" /2 Property Location: ] (.~ ~ O /tX]O/~ T-/~ ~ff 5/7 ~4/~ ~A_CT~ ot~ (provide LILCO Pole ~, dist~ce to cross streets, ~d location) (If applicable) ' Phone: O, rd of Trustees Applicati¢ Land Area (in square feet): Area Zoning: Previous use of property: Intended use of property: GENERAL DATA 72, sz7 ! Prior permits/approvals for site improvements: Agency Date y 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):. O, rd of Trustees Applicati~0 WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~' ~ ]a,4tA/z;> 7~ Percent coverage of lot: t~) % Closest distance between nearest existing structure and upland edge of wetlands: ~ ~ . ~ t feet Closest distance between nearest proposed structure and upland edgeofwetlands: ~ o S ! feet Does the project involve excavation or filling? No ~/ Yes If yes, how much material will be excavated? 4 cubic yards How much material will be filled? (~ cubic yards Depth of which material will be removed or deposited: 3 Proposed slope throughout the area of operations: ~ t~q T'! 0'~¢)t Manner in which material will be removed or deposited: 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): 617.20 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) 3.PROJECT LOCATION: County Municipality 4. PRECISE LOCATION: Street ,~.ddess and Road Intersections. Prominent landmarks etc -or provide map I 0 SEQR 5. IS PROPOSED ACTION: [] New r---~Expansion [~Modiflcation / alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially O. I acres Ultimately O, { acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [] Yes [~ No If no, descdbe briefly: 9. WHAT iS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) [~['Residential ~]lndustrial []Commercial [~Agriculture ~--~Park/Forest/OpenSpace [~Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ]Yes ~No If yes, list agency name and permit / approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [~Yes ~No If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? [~]Yes [--1No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/SponSOrsignature Name~.~/~i ,~.~J~ r~'/"/&~/r'~//"-~t' ~-~b~"7~T"- Date~'~'~', ~& y state agency, complete the Coastal Assessment Form before proceeding with this assessment James F. lfdng, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hail 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (531) 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 ~_..ff~ f~ residing at ]9~ d7 ~),( being duly sworn, depose and say: That on the day of ,200 ,.I personally posted the property known as y p cing the Board 6f 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 (J 1o~_ ~{OPt'./~. cx200~ ,,. Dated: Sworn to before me this \\'~-~ day o f~ctnv~t200'~ Notary Public MELANIE DOROSKI NOTARY PUBLIC, State of New No, 01D04634870 Oualified in Suflotk County-')j-~l Commission Expires September 30ff"~ 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 Sonthold 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 si~dficant 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 detafl~ listing both supporting and non- snooortin~ 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 SCTM# 70 [~- ~7 PROJECT NAME /bgO AJ~7-~ L~/9-7~//~ The Application has been submitted to (check appropriate response): TowuBoar Plann gBoar .u. ingDept. .oardofT stees 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: Location of action: Site acreage: Present land use: Present zoning classification: 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: (b) Mailing address: (c) Telephone number: Area Code ( (d) Application number, if any:. Will the action be directly undertaken, require funding, or approval by a state or federal agency? 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 Ill - Policies; Page 2 for evaluation criteria. Amach 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 [~ Not Applicable Attach add~ttonal 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 [] N° ~ 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 T.J-/ld' /~,~J5~ CT. O~l~.r ,~/OT ,4~7~r'd~'.F.-r ,~.~i,~_ 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 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. 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. 71 Yes ~ No ~ Not Applieable 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. ~-~ Ye~ No~NotApplicable ..r' I.... o Attach additional sheets if necessary 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 ~'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 ~ No'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 r-~ No ~ Not Applicable APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics orohibits conflicts of interest on the oart of town officem and emolovces. The oumose of this form is to orovide information which can alert the town of ~ossible conflicts of interest and allow it to take whatever action is YOURN^M n meof (Last name, first name, rniddle initial, unless you are applying m me 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 j~ Trustee ~ Change of Zunc Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning 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 thc Town of Southold? "Relationshi!~" 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 Y lfyou ansx~,ered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative) and the town officer or employee. Either check the appwpriste line A) through D) and/or describe in the space pwvided. 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% oftha shares of the corporate stock of the applicimt (when the applicant is a corporation); __B) the legal or beneficial ownqr 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 __~) the actual applicant. DESCPdPTION OF RELATIONSHIP Form TS 1 Board of Trustees Application County of Suffolk State of New York 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 AP~_J,~ICATION. Signature/ SWORN TO BEFORE ME THIS ~/~ DAY OF ,/~OO ,20 a7 Notary Public 1690 North Bayview Associates 825 Kimbefly Lane Southold, New York 11971 631-765-6693 November 05, 2007 To Whom It May Concern: I, Laurie Mandelbaum, authorize Mark Schwartz, AIA - Architect, to act as agent for permit applications to the Southold Zoning Board of Appeals, Southold Town Board of Trustees, New York State Department of Environmental Conservation, Suffolk County Department of Health and the Southold Building Department. The proposed residential construction project is located at 1690 North Bayview Road, Southold, New York (SCTM# 1000-70-12-37). Sincerely, Laurie Mandelbaum STRAW BALE AREA: 22,527 SQ. FT. [TO TZE LTNE) EX~ST~IG HOUSE: 2333.2 SQ. FT. PROPOSED ADDiTiON: ~0.0 SGI. FT. (0.4%) PROPOSED GARAGE: 528' SO. FT. TOTAL LOT COVERAGE: 13.05% 100.00' ~ - NORTH BAYVIEW ROAD SITE PLAN SCALE: 1" = 30'-0' OAKWOODDR~E APPROVED BY BOARD OF TRUSTEES TOWN OF,$OUTHOLD REV[SZONS: [ SCTM# 1000-70-12-37 SURVEY OF PROPERTY AT SOUTHOLD TO~N OF SOUTHOLD SUFFOLK COUNTY,. N. Y. 1000-70-12--37 SCALE: I'=30' JUNE 5, 2007 JUL Y 9, 2007 fCER.TIFICA TION) Southhold Town Board of Trustees AREA=22,527 SO. FT. R~nED TO, TO TIE LINE 5.90 BA YVIEtY ASSOCIATES, LI_C )LD REPUBLIC NATIONAL TITLE INSURANCE COMPANY :ITIMORTGAGE, INa, ITS SUCCESSORS AND/OR ASSIGNS ~,ZCONI¢ ,~U~cfl Y ALTERATION OR ADDITION TO THIS SURVEY IS A UOLATION ~.N.~. I$9.$0' (651) 765--5021 ~C~~5~,.,~t,7~7 SECTION 72090F THE NEW YORK STATE EDUCATION LAW. CEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS ~'~D-- '''. ~z~¢ aour~ P.O. BOX 909 eEOJ ARE VALID FOR THIS MAP ANO COPIES THEREOF ONLY IF C~U~,~' _ 1230 TRAVELER S~58 ,o ~P OR COPIES aEAR THE ~RESSEO SEAL OF THE SURVEYOR 'OSE SIGNATURE APPEARS HEREON. .. ®=PIPE SOUTHOLD, N. Y. 11971-'"~