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Home My WebLink AboutTR-6879Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town HallAnnex 54375MainRoad 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 # 0599C Date: November 5, 2010 THIS CERTIFIES that the construction of a second-story addition and deck onto the existing dwelling, new windows & doors; gutters to leaders to drywells to contain roof runoff; maintain the 10 ft. wide non-turf buffer along the landward side of the existing bulkhead At 3600 Deep Hole Drive, Mattituck, New York Suffolk County Tax Map # 115-17-8 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 4/9/08 pursuant to which Trustees Wetland Permit #6879 Dated 5/21/08 was issued and conforms to ali 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 a second-story addition and deck onto the existing dwelling, new windows & doors; gutters to leaders to drywells to contain roof runoff; maintain the 10 ft. wide non-turf buffer along the landward side of the existing bulkhead The certificate is issued to JOSEPH ZITO owner of the aforesaid property. ~/uthorized Signatu~ Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fsx (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: ~ ~'/' Ch. 275 Ch. 111 INSPECTION SCHEDULE __ Pre-construction, hay bale line/silt boom/silt curtain __ 1st day of construction ~ constructed / Project complete, compliance inspection. INSPECTED BY: ~ COMMENTS: CERTIFICATE OF COMPLIANCE: COUNTY CLERK'S OFFICE STATE OF NEW YORK COUNTY OF SUFFOLK CC #: C10-40520 I, JUDITH A. PASCALE, Clerk of the County of Suffolk and the Court of Record thereof do hereby certity that I have compared the annexed with the original DECLARATION recorded in my office on 1110812010 under Liber D00012642 and Page 373 and, that the same is a true copy thereof, and of the whole of such original. In Testimony Whereof, I have hereunto set my hand and affixed the seal of said County and Court this 11108/20'10 SUFFOLK COUNTY CLERK JUDITH A. PASCALE SEAL SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE T~pe of Instrument: DECLARATION N~m~er of Pages: 5 Receipt N~m~er : 10-0130103 District: 1000 Recorded: At: 11/os/2olo 10:05:36 AM Page/Filing COE TP-584 Cert. Copies LIBER: D00012642 PAGE: 373 Section: Block: Lot: 115.00 17.00 008.000 EXAMINED AND CHARGED AS FOLLOWS Received the Following Fees For Above Instrument Exempt Exempt $25.00 NO Handling $20.00 NO $5.00 NO NYS SRCHG $15.00 NO $0.00 NO Notation $0.00 NO $6.25 NO RPT $30.00 NO Fees Paid $101.25 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk County Number of l}ages ~ This document will be public record. Please remove all Social Security Numbers prior to recording. Deed / Mortgage Instrument Deed / Mortgage Tax Stamp FEES 31 Page / Filing Fee Handling 20. 00 TP-584 Notation EA-52 17 (County) Sub Total EA-5217 (State) R.P.T.S.A. Comm. of Ed. Affidavit Certified Copy NYS Surcharge Other ,/ crc) 5. O0 15. 00 Sub Total Grand Total I 4 [ Dist. Real Prope~ Tax Servio Agency Verificatio~ I lO00 11500 1700 008000 Satisfactions/Discharges/Releases List Property Owners Mailing Address 6 RECORD & RETURN TO: -ets4 -/- z,, I,~y a~ F~ 8 Mail to: Judith A. Pascale, Suffolk County Clerk 310 Center Drive, Riverhead, NY 11901 www. suffolkcountyny, gov/clerk This page forms part of the attached '2./'/o Reco[ding / Filing Stamps Mortgage Amt. 1. Basic Tax 2. Additional Tax Sub Total Spec./Assit. or Spec./Add. TOT. MTG. TAX Dual Town __ Dual County Held for Appointment Transfer Tax Mansion Tax The property covered by this mortgage is or will be improved by a one or two family dwelling only. YES or NO If NO, see appropriate tax clause on page # of this 5 Community Preservation Fund Consideration Amount $ CPF Tax Due $ Improved Vacant Land TD TD TD Title Company Information Suffolk County Recording & Endorsement Page /~O CJ._A~ ~l'(.,gJ"t ~- ~.0/,/'~/,0,/~/.,~'/~ made by: (SPECIFY TYPE OF INSTRUMENT) The premises herein is situated in SUFFOLK COUNTY, NEW YORK. TO In the TOWN of ~r) ~/¢~/O/~ In the VILLAGE or HAMLET of BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. (over) DECLA3%ATION OF COVENTkNTS ~' ~£//~ /~, by , ~ OF THIS DECLAkATION made this day of - 20 ,~ '~2~ ~ '/, ZI~ residin~ at ~ ~ ~ ~'~ , hereinafter referred to as' "bEC~T(S)": W I TNE S SETH on WHEREAS, DECLAPJ~NT(S) is/are the owner(s) of certain real property located D,e/L e, Town of Southold, County of Suffolk, State of New York, Tax Map as District 1000, Sectionl/~ Block described in the Suffolk County / / , Lot 0 ~ which is more particularly bounded and described as set forth in Schedule "A" annexed hereto, hereinafter referred to as the Property; WHEREAS, the Property is situated on lands within the jurisdiction of the Board of Trustees of the Town of Southold (hereinafter the "Trustees" pursuant to Chapter 275 of the Town Code of the Town of Southold or its successor, and various activities conducted upon the property may thus be subject to the regulation and approval of the Trustees prior to being conducted; WHEREAS, the DECLARA/qT(S) therefore made application to the Trustees for a permit pursuant to the Wetlands Law of the Town of Southold to undertake certain regulated activities; and WHEREAS, as a condition of the granting of a Wetlands Permit to undertake such regulated activities, the Trustees required that a ~[~ NOW, THEREFORE, the DECLAPJINT(S) do/does hereby covenant and agree as follows: SCHEDULE A Continued Commitment No. 03-18157A LB Name(s): Joseph T. Zito All that certain plot, piece or parcc] of laud, situate, lying nmi being at Mattituck, in the Town of Southold, County of' Suffolk and State of'New York, bounded and described as follows: BEGfNNING at a point on the Easterly side of Deep Hole Drive, which said point is where the division line between the premises herewith described and land now or formerly of Ma[n Sit~s. Inc. intersects the said Easterly side of'Deep Hole Drive; and which said point is distant 1372.96 feet Southerly from the corner formed by the intersection of,he Ensterly side of Deep Hole Drive with the Southerly side of'New Suffolk AYenuc; RUNNING THE1VCE North 4 degrees 52 minutes 50 seconds East along the We~tedy side of Deep Hole Drive. 100 fcct to a point; RUNNING THENCE North 79 de.ecs 00 minutes East 130 feet more or less t~ the creek or gutter and land now or formerly of ri. Alvin Smith: RUNNING THENCE Southerly along said creek to land now or formerly of Mnin Site{ Inc., 100 fcct more or less; RUNNING THENCE South 79 degrees 00 minutes West along land now or formerly of Main Sites, Inc. 120 feet more or less to the En.mtcrly side of Deep Hole Drive, the point or pisee of BEGIIVNIN~.-= ~ Property Addcess: ~ 3600 Dcpho{n Dr~e \ Southold, NY \ -2- MFtR-~7 gE] LG:E~4 FRtiN:l(~!~'Et, l C NRi-~OI._ITRNQ 7~?-3575 TO:SDS~9~4~14 PRGE:01"O! TO?~N OF SOUTHOLD BUILDIi~G AND ZONING DEPARTMENT In ~h~ Matter of the Application of Jozeph Zito Pre-,existing Certificate of Occupancy. STATE OF NEW YORK ) )s.s.: CO[rNTY OF c , · , · .,U~ FO~_,K ) ROSE~NN GUITTARD, being duly Sworn, d. eposer ,J sa 1. Your deponent is the Administrator of the Estate of Arthur Guittard, record owner of the premises known as Deephole Drive, Mattltuck, New York, Suffolk County Tax Map No, 1000- 115.00-17.00-008.000, fully familiar with the fac~s and circumst at%ces herein. 2. A]thur Guittard purchased the premises 3. Om the ~ day of~ , 19~ Art~u.- ~,.: ......... f ~mllzar with the structures which are located existence prior ~o 1957 and iq the same form as shown on 7. qbe single family residence described above az~d shown on 8. That there ~s at least one mingle station smoke de~ection alarm devise is installed on or near the ceilin~ and that ~,uch device is in good workin9 order. ' 9. I make tzh]s 5ffJdavit ~t k~%owin9 full well that the Town of Southold Buildin~ and gonin9 Department will rely upon the facts as stated herein to issue a pre-existing certificate of occupancy for said structures for the above premises. Sworn to before me this ROSEANN GUITTARD 1) Upon the substantial completion of the aforementioned permitted activities there shall be established and subsequently maintained ~/~,"non-turf buffer" as defined by Chapter 275 of the Town Code; and 2) These covenants shall run with the land and shall be binding on the DECLARANT(S), his/her/their heirs, assigns, purchasers, or successors in interest and may only be modified after a public hearing and upon resolution of the Trustees. IN WITNESS WHEREOF, the owner(s) day of //- ~ -'/ '20 / O has/have duly executed this instrument this OWNER'S SIGNATURE STATE OF ~ ~zl~f ss: COUNTY On the ~77/ day of A/~/~WF~ ~/~' in the year 20 ~ , before me the u~dersigned, a Notary Public in and for s~id State, personally appeared ~J~/~ ~ ~/~ personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity, and that by his/her/their signature(s) on the instrument, the individual or the persons on behalf of which the individual(s) acted, executed the instrument. ,,/ Notary Public Ruth $. Van Alien Notary Public, State of New York No. 01VA6139157 CommMion ExptFes Jmmmry 3, 20/~ James F. King, 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 (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 /2roj°nstructed ect complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 6879 DATE: MAY 21~ 2008 ISSUED TO: JOSEPH ZITO PROPERTY ADDRESS: 3600 DEEP HOLE DRIVE~ MATTITUCK SCTM# 115-17-8 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 Ma,/21, 2008, and in consideration of application fee in the sum of $250.00 paid by Joseph Zito 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 construct a second-story addition and deck onto the existing dwelling, and install new windows, and doors, with the conditions of the installation of gutters, leaders and dryweils to contain roof runoff and in accordance with Chapter 236 of the Town Code-Storm Water Runoff, maintain the 10' non-turf buffer, and as depicted on the site plan prepared by Allied Builders, last dated February 28, 2007, and received on April 9, 2008. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. TERMS AND CONDITIONS The Permittee Joseph Zito, residing at 3600 Deep Hole Drive, Mattituck, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide 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 caus6 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. 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 May 21, 2008 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Richard Feehan P.O. Box 364 Orient, NY 11957 RE: JOSEPH ZITO 3600 DEEP HOLE DRIVE, MATTITUCK SCTM# 115-17-8 Dear Mr. Feehan: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, May 21, 2008 regarding the above matter: WHEREAS, Richard Feehan on behalf of JOSEPH ZITO 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 April 9, 2008, 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 issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on May 21, 2008, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of JOSEPH ZlTO to construct a second-story addition and deck onto the existing dwelling, and install new windows, and doors, with the conditions of the installation of gutters, leaders and drywells to contain roof runoff and in accordance with Chapter 236 of the Town Code- Storm Water Runoff, maintain the 10' non-turf buffer, and as depicted on the site plan prepared by Allied Builders, last dated February 28, 2007, and received on April 9, 2008. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: $50.00 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 To: :: oSepk Please be advised that your application dated ]~/9¢,~ I (¢, c~OO(~f' ha~s been reviewed by this Board at the regular meeting'of /7"]~,.,t ,..,31;,.3c0,.¢¢'' and your application has been approved pending the ¢omple~on 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) __ ½ Constructed ($50.00) v// 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 Donald Wilder, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (63 I) 765-664! Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., May 14, 2008, the following recommendation was made: Moved by Glen McNab, seconded by Don Wilder, it was RESOLVED to SUPPORT the Wetland Permit application of JOSEPH ZlTO to construct a second-story addition and deck onto the existing dwelling, and install new windows and doom. Located: 3600 Deep Hole Dr., Mattituck. SCTM#115-17-8 Inspected by: Peter Young, Glen McNab The CAC Supports the application with the Condition gutters and drywells are installed to contain the roof run-off. The CAC also recommends an engineer's report to determine whether or not the first floor can accommodate the additions. Vote of Council: Ayes: All Motion Carried James F. King, President Jill M. Doheriy, Vice-Presidem Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. P.O. Box I 179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: JOSEPH ZITO requests a Wetland Permit to construct a second-story addition and deck onto the existing dwelling, and install new windows and doors. Located: 3600 Deep Hole Dr., Mattituck. SCTM#115-17-8 Type/~f area to be impacted: ~z~'altwater Wetland Freshwater Wetland Sound Bay Dist)ance of proposed work to edge of wetland P~)~t of Town Code proposed work falls under: '~.Chapt.275 Chapt. 111 other / Type of Application: ~,,~Wetland __Coastal Erosion __Amendment __Administrative__Emergency Pre-Submission Violation Info needed; Modifications: ~'r~u~-~ ~..~ ~_~,I~_~__ ~ ~L./ /X~ ~- ~,'~.~. Conditions: Present Were: JKing CDoherty __P.Dickerson __ __ D. Dzenkowski Mark Terry__other Form filled out in the field by D. Bergen__ B.Ghosio, Mailed/Faxed to: Date: Environmental Technician Review- 115 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 June 23, 2008 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Joseph Zito 3600 Deep Hole Dr. Mattituck, NY 11952 Wetland Permit #6879 3600 Deep Hole Dr., Mattituck SCTM#115-17-8 Dear Mr. Zito: In connection with the above-referenced, enclosed is a check in the amount of $50.00, which is your refund for over-payment of the application fee. Please contact our office if you have any questions. Very truly yours, Lauren M. Standish, Secretarial Assistant Board of Trustees Eric. TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES P.O. BOX 1179 SOUTHOLD, NY 11971 1003 50-666-214 0 5000 ~ 5 ?0 I,,' O~ICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY M~ILING 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: Scott Hilary, LWRP Coordinator Planner Date: May 20, 2008 Re: Chapter 268: Waterfront Consistency Review Wetland Permit for JOSEPH ZITO SCTM#115-17-8 Richard Feehan on behalf of JOSEPH ZITO requests a Wetland Permit to construct a second-story addition and deck onto the existing dwelling, and install new windows and doors. Located: 3600 Deep Hole Dr., Mattituck. SCTM#115-17-8 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 CONSISTENT. In the event that the action is approved, the following best management practices (BMP's) are recommended: 1. Require the installation of gutters, leaders and drywells to control stormwater. The BMP's will further Policies 5 Protect and improve water quality in the Town of Southold and 6.3 Protect and restore tidal and freshwater wetlands. Pursuant to Chapter 268, the Boards shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route25 P.O. Box 1179 Southold, New York11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only we astal Erosion Permit Application tland Permit Application Administrative Permit dR Amendment/Transfer/Extension eceived Application: --'-Completed Application q..//(n[O~ __Incomplete __SEQRA Classification: Type I Type II Unlisted Coordination:(date sent). ~----'L'rWRP Consistency Assessment Form CAC Referral Sent: ~_~l~te of Inspection: ~Receipt of CAC Report: __Lead Agency Determination: Technical Review: ~Public Hearing Held:~t]~_ __Resolution: Name of Applicant ~S~ fE Address Phone Number:~$1) Suffolk County Tax Map Number: Property Location: I'L -) ~. . cig APR - 9 2008 Southhold Town Board of Trustees (provide LILCO Pole fl, distance to cross streets, and location) (If applicable) Address: ?~ 0t Phone: Bo~ of Trustees Application Land Area (in square feet): An-ea Zoning: GENERAL DATA Previous use of property: Intended use of property: Covenants and Restrictions: Yes No If "Yes", please provide copy. Prior permits/approvals for site improvements: Agency Date __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? l/No Yes If yes, provide explanation: Project Description (use attachments if necessary): of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: / ~ ¢A~3 "~ /~t at,~d- ~Jc~ Area of wetlands on lot: I) ! q 3, } ~ square feet Percent coverage of lot: q, o'''/'r % Closest distance between nearest existing structure and upland edge of wetlands: q~ ' feet Closest distance between nearest proposed structure and upland edge of wetlands: 2-7' feet Does the project involve excavation or filling? No Yes If yes, how much material wilt be excavated? ~ cubic yards How much material will be filled? ~13 ~/- 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: feet Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are wetlands present within 100 feet of the proposed activity? No / Yes Does the project involve excavation or filling? No Yes If Yes, how much material will be excavated? p0~f How much material will be filled? ~O ~r Manner in which material will be removed or deposited: (cubic yards) (cubic yards) Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: ;,4'. Y I1 '-1o2 ys that on the py of the Notice ~o~.~-,~.~'~bove named persons at me aaare~ses set opposite mere respecuve names; mat m~ 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 O/(t ~ (certified) (registered) mail. Sworn to before me this /q/'- Dayof ~7'lq~/ ,200t Notary Public , that said Notices ,~er~mailed to each of said persons by LAUREN M STANDISH Notary Public, ~l~te of New York No. 01ST6164008 ClualifJed n Suffolk County uommission Ex~ires April 9. 20_L/ Bo~ of Trustees Application AO'I'nORI ZATION (where the applicant is not the owner) owner of property) residing at 36~6 ~eC~fd~ (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. 8 PROJECT ID NUMBER PART l - PROJECT INFORMATION 1. APPLICANT / SPONSOR 617.20 APPENDtX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT I::NVlRONM£NIAL ASS£SSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2. PROJECT NAME county KK SEQR 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map 5.1S PROPOSED ACTION: [] New [-~,,~pansion I~Modification/alteration DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? IS PRESENT ~ND USE IN VlCiNI~ OF PROJECT? (Choose as many as apply.) ,dent/al ~,ndustrial ~Commercial ~Agdculture ~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 Lo~l) ~es ~No If yes, list agency name and permit / approval: IL DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ~Yes ~ 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/Signature ~ 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 Agency) 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. E--~ Yes [~o B 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. 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 flood!n~ problems? Ex?lain brielly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: D3. Vegetation or fauna, fish, shellfish or wildlgo species, significant habitats, Or threatened or endangered specie~? Explain briofiy: C4. A community's existing pians or yea s as officially adop ed or a cha~ge in C5, Growth, subsequent development, or related activities likely to be induced by the proposed aefion? Explain briefiy: C6. Long term, shod term, cumulative, or other effects not identified in CI-C57 Explain briefly: C7. Other imp,acts (including_. chanties in use of either q uantit,,/ or type of energ. I¥? Explain bdefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? (If yes, explain bdefl¥: IS THERE, OR IS :THERE LIKELY TO BE: C?NTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadVersee~ectidenti~edab~ve~determinewhetheritissubstantia~~~arge~im~~rtant~r~~herwises~gni~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 (0 magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficierd detail to show that all relevant adverse impacts have been identified and adequately addrassed. If question d of part ii was checked yes, the determination ofsignificsnce must evaluate the potential impact of the 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 file nformat on and aha ys s above and any supporting documentation, that the proposed actio~ 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 Tifie of Responsible Officer Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus~ each answer must be explained in detail~ listing both supporting and non- supporting 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.nortlffork.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# q?$?'U/- II.F, - PRO C __ The Application has Ween submitted to (check appropriate response): TownBoara [] Planning Board [~] BuiidingDept. 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: 3~°° fle-~]M' PX. ]~l(f~O0,.~{ Siteacreage: , 9.5 ~ Present land use: 0 ~'~ 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 ~pli~afft: ;~0 ~C f// ~ / 7'~ (b) Mailingaddress: fO, ]~0~ .~[q O~l~g4)["- It)-/ . I/qff"} (c) Telephone number: Area Code {;~ 3Y,~ ~ ~¢.f'O (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [~No~] Ifyes, which state or federalagency? $5)e ~;~ 0_~ C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide ali 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 ~ot 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 ~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 ~Not Applicable t° 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 Southoid. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. ~ Yes ~ No ~/~ot 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 f~ WORKING COAST POLICIES ' 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 [~ot Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waJ~'rs. 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~n criteria. ~-] Yes [] No~l-Z-I Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. ~ Yes [-~ No ~Not Applicable DATE 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 1N 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. [ /Signat/ure ~ SWORN TO BEFORE ME THIS DAY OF ,20Cg '~ lqotary Public AUTHORIZATION (where the applicant is not the owner) owner of property) residing at ~0 ~-~f O/~ (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM _The Town of Southold's Code of Ethics emhibits conflicts of interest on the hart of town officers and emelovees. The tmmose of this form is to omvide information which can alert the town ofl~ossible conflicts of interest and allow it to take whatever action is ~cessarv to avoid same. YOURNAME: f4 ,o /t4 (Last name, first name, Middle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change &Zone 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 &the Town ofSouthold? "Relat ansMp' mc udes by bood, marrmgn, or bus ness ntemst. Bus ness 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 mom than 5% of the shares. YES NO If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title Or position of that person Describe the relationship between yourself(the applieanffagent/repmsentative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space progided. The town officer or employee or his or her spouse, sibling parent, o; ~hild 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 ega or beneficial owner of any interest in a non-corporate entit~ (when the applicant is not a corporation); C) an officer, director, parlne?, or employee of the applicant; or __D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 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 OTHER POSSIBLE AGENCIES YOU MIGHT HAVE TO APPLY TO N.Y.S. Dept. of Environmental Conservation (DEC) SUNY, Bldg. 40 Stony Brook, NY 11790-2356 (631) 444-0355 Mon., Wed., Fri., 8:00 AM-3:00 PM Suffolk County Dept. of Health Services 360 Yaphank Ave. Yaphank, NY 11980 852-5700 U.S. Army Corp. of Engineers New York District 26 Federal Plaza New York, NY 10278 917-790-8007 N.Y.S. Dept. of State Coastal Management 99 Washington Ave. Albany, NY 12231 518-474-6000 § 58-1 NOTICE OF pUBLIC HEAi~INO Chapter 58 NOTICE OF PUBLIC H~IARIHG § 68-1 § 58-1. Providlngnotlce ofpnblie hear}rigs. [HISTORY~ Adopted by the Town Board of tho To~cn of Southold 12-27-1996 as L.I.~ No. 2§-1996. bmaeucknents noted where applicable,] § 58-1. Providing notice o[ pub]in hearings. ~rhenever the Code calls for a public hearing, this section shall apply. Upon determining tha~; an application Is complete. the board or commission reviewing the same shall fix a time Ired place for e public hearing thereon. The ,%ard or commlssi~m reviewing an applicatlon shall provide for the giving of notice: A. By causing a potlce giving the tbne, date, place and nature of the hearing to be published in the official newspaper within the period prescribed by law. B. By requiring the applicant to erect the sig~ provided by the town, which shall be prominently displayed on the premises facing each public or private s~reet which the property involved in the application abuts, giving notice of the application, the nature of the approval sought thereby and the time and place of the public hearing thereon. The sign shall be set back not more. than ten (10) feet from the property line. The sign shall be displayed for a period of not las~ than seven (7) days /mmediately preceding the date of the public hearing. The applicant or his/her agent shall file an affidavit that s/he has complied with this provision. C. By requiring the applicant to send notice to the owners .of record of every p/'operty which abuts and every property which is across from any public or private street § 58-1 souTHOLD CODE § 58-1 from the property included In the application. Such hotic~ shall be made by certified mail, r~urn receipt rsquastod, posted at least seven (7) day~ prior to the date of the in ~ial public hearing on the s. pplicatioh and addressed to the owners at the addresses Ii,tod for them on the local assessment roll. The applicant or agent shall file an affidavit that s/he has cornl;lied with this provision. RIGHT SIDE APPROVED BY 8o^RD OF TRUSTEES _ TOWN OF SOUTHOLD REAR LEFT SIDE FRONT NEW SUFFOLK AVE. h S 79'00'£ N/F FABRY I00' 130' STAKE SET 20. 3' I STORY WOOD ' FRAME RES. 1.4XI.4 CHIMNEY ' ENCLOSED PORCH WOOD STEPS STEPS N 79'OO' w Southhold Town Board of Trustees TAX MAP NO. 1000-115-17-08 Guarantees indicated here on shall run (-~ PICKET OVER 0,6' GUITTARO 100' STAKE SET 120' SURVEY OF DESCRIBED PROPERTY S! TU A TE N//F SMITH OF DOCK SURVEYED 30 NOK, 98 SCALE 1"=20' AREA= 1~022.928 SF OR ~276 ACRES only to the person for whom the .,.~,¢/IA TTITU'CA; TOWN OF SOUTHOLD is pnpqred, and on his behalf fo the '~:~' ~'.~,~,:,, c:ovo~.,~,t~ ,~f~,,~y, SUFFOLK COUNTX N. ~ Gu~rc. ntees (:re net Ircnsf~rc. bJe 1o SURVEYED BY SURVEYED FOR: JOSEPH ~ Z/TO STANLEY J. ISAKSEN, JR. ~mc ...... seal sha/~ GUARANTEED TO JOSEPH T. ZITO TOWN OF SOUTHOLD Unauthorized alteration or addltbn to thi~ P.O. BOX 29# ~r~ey is r: violation of Section 7209 of NEW SUFFOLK, NY ~1956 the New York 5tczte Education Law, /LICEN~D LAND SURVEYOR NY~ LIC. NO. 4~,., 5 98R761