HomeMy WebLinkAboutTR-6931 James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghos±o, Jr.
Town Hall
53095Route 25
P.O. Box 1179
Southold, New York11971-0959
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
¼ constructed
J Project complete, compliance inspection.
BOARD OF SOUTHOLD TOWN TRUSTEES
SOUTHOLD, NEW YORK
PERMIT NO. 6931 & 6931C DATE: July 23,2008
ISSUED TO: KEVIN FAGA
PROPERTY ADDRESS: 12580 MAIN RD., EAST MARION
SCTM#31-14-8.2
AUTHORIZATION
Pursuant to the provisions of Chapter 275 and/or Chapter 11 ! 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
Julv 23. 2008 in consideration nf application fee in the sum of $500.00 paid by Kevin Fana and subject to the
Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and
following:
Wetland Permit and Coastal Erosion Management Permit to renovate and
construct additions to the existing single-family dwelling and upgrade
with the condition of a 10' non-turf buffer, the addition of gutters and drywells to
roof run-off in accordance with Chapter 236-Stormwater Management of the Town
and the installation of a line of staked hay bales and silt fence prior to construction
activities, and as depicted on the site plan prepared by Jeffrey T. Butler, P.E. last dated
October 29, 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, Kevin Faga, residing at 12580 Main Rd, East Marion, 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 fi.om 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 ail 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 cimumstances 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 Office of the Clerk of the County of Suffolk 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) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
July 23, 2008
Jeffrey T. Butler, P.E.
206 Lincoln St.
Riverhead, NY 11901
RE:
KEVIN FAGA
12580 MAIN RD., EAST MARION
SCTM#3t-14-8.2
Dear Mr. Butler:
The Board of Town Trustees took the following action during its regular meeting held on Wed.,
July 23, 2008 regarding the above matter:
WHEREAS, Jeffrey T. Butler, P.E. on behalf of KEVIN FAGA applied to the Southold Town
Board of Trustees for permits under the provisions of Chapter 275 of the Southold Town Code
the Wetland Ordinance, and Chapter 111 Coastal Erosion Management, applications dated
June 25, 2008, and,
WHEREAS, said applications were referred to the Southold Town Conservation Advisory
Council and to the Local Waterfront Revitalization Program Coordinator for their findings and
recommendations, and,
WHEREAS, the LWRP Coordinator recommended that the proposed applications be found
Inconsistent with the LWRP, and,
WHEREAS, the Board of Trustees has furthered Policy 6.3 of the Local Waterfront
Revitalization Program to the greatest extent practical through the imposition of the following
Best Management Practice requirements: the Board of Trustees did not find it practical to
relocate the existing dwelling 100' from the wetland boundary, however, requires the installation
of a 10' non-turf buffer, the addition of gutters and drywells to contain roof run-off in accordance
with Chapter 236-Stormwater Management of the Town Code, and the installation of a line of
staked hay bales and silt fence prior to construction activities, and,
WHEREAS, a Public Hearing was held by the Town Trustees with respect to said applications
on July 23, 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 these applications, and,
WHEREAS, the structure complies with the standards set forth in Chapter 275 and Chapter 111
of the Southold Town Code, and,
WHEREAS, the Board has determined that the project as proposed will not affect the health,
safety and general welfare of the people of the town,
NOW THEREFORE BE IT,
RESOLVED, that for the mitigating factors and based upon the Best Management Practice
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 approves the applications of KEVIN FAGA to renovate
and construct additions to the existing single-family dwelling and upgrade the sanitary system,
with the condition of a 10' non-turf buffer, the addition of gutters and drywells to contain roof run-
off in accordance with Chapter 236-Stormwater Management of the Town Code, and the
installation of a line of staked hay bales and silt fence prior to construction activities, and as
depicted on the site plan prepared by Jeffrey T. Butler, P.E. last dated October 29, 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: $100.00
Very truly yours,
JamE :. King,
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
COASTAL EROSION MANAGEMENT PERMIT
Permit #6931C
Date: July 23, 2008
SCTM#31-14-8.2
Name of Applicant/Agent: Jeffrey T. Butler, P.E.
Name of Permittee: Kevin Faga
Address of Permittee: 12580 Main Rd., East Marion
Property Located: 12580 Main Rd., East Marion
DESCRIPTION OF ACTIVITY: To renovate and construct additions to the existing
single-family dwelling and upgrade the sanitary system.
SPECIAL CONDITIONS: The installation of a 10' non-turf buffer, addition of gutters and
drywells to contain roof run-off in accordance with Chapter 236-Stormwater
Management of the Town Code, and the installation of a line of staked hay bales and
silt fence prior to construction activities.
The Coastal Erosion Management Permit allows for the activities as indicated on the
site plan prepared by Jeffrey T. Butler, P.E. last dated October 29, 2008.
Inspections are required at a fee of $50.00 per inspection. (See attached schedule.)
James . K~ing, Preside~
Board of Trustees
JFK:lms
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
Town Hal!
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: ~(~Ji?/ 'Fo, c~o~
Please be advised that your application dated f~ ! 2 ~-I0 ~
been reviewed by this Board at the regular meeting of q ! ¢33~0 ~
and your application has been approved pending the completion of the
following items checked off below.
Revised Plans for proposed project
has
Pre-Construction Hay Bale Line Inspection Fee ($50.00)
__ 1st Day of Construction ($50.00)
½ Constructed ($50.00)
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
~et 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: $ lot), O0
BY: James F. King, President
Board of Trustees
JUL-22-2008
18:~0
Sofia Antoniadis
12500 Main Road PO Box413
East Marion, New York 11939
1646-201-3560
P.O02
July 22, 2008
$outhold
Board of Town Trustees
Town Hell Annex Building
54375 Route 25
P.O. Box t179
Southold, New York 11971
Re:
'/2,580 Main Road
East Mar/on, New York 11939
SCTM~ 1000-031.14-008.2
Kevin Fage
JUL 2 3 2008
Sor. thold Town
Bear~ of Trustees
Gree§ngs:
I am in receipt of the Notice To Adjacent Property Owner and as the owner of 12500
Main Road I have concerns with the renovation and upgrade to the sanitary system.
I respectfully request that in my absence of the scheduled hearing on July 23, 2008 at
6:00pm that my concerns be documented and made public.
Although I did not have adequate time to review the site plan provided with
knowledgeable authorities. I am concemed that the proposed three pools shown close
to the proper~y line are too close to my existing ddnking water well.
Thank you and should you have any questions please do not hesitate to contact me.
TOTAL P.O02
JUL-22-2008 18:40
P.O01
1990 Coney Island Avenue
Brooklyn, New York 11223
(718) 998-8437
(718) 627-3585 fax
1~ Town Tmslees From: Sofia Antoniadis
Fax: 631-765-6641 ~ 2
elmae~ 631-765-1892 Oaf~e: 7/22/2008
Re: Kevin Faga 1000-031-14-008.2 CC:
~ Usgen~ i-I For Re,view rl Please Comment C] Ple~e ReSdy I-1 Please Rec,~le
Kindly include the attached letter in regards to the headng scheduled for
July 23, 2008 at 6:00pm:
Kevin Faga
12580 Main Road
East Ua~n, New York 11939
1000A)31-14-008.2
Thanking you inadvance for your assistance.
~O0/ZO0~ ~N¥8 3~¥~$ [SS[J ~ZSg ~8 ~08 XWJ 8~:80 800~/~/LO
I:IR II'I; IMNK
Kay Largo Bt. erich
97670 Overseas Highway
Key Largo, Florida 33037
Phone: 305-$52-2070
Fax: ~05-852-~922
www.kcysba~zk, com
Company Fgom
$OUTHOLD TOWN HALL AMELIA HuKTr
A~d. om Date
BOARD OF TKUSTEF, S 07/22/2008
631-765-6641 2
__ Urgent __ For Review
KEF:
KEV1N FAGA
SCTM 1000-031-14-008.2
..-- please Comment
__ Please Reply
dUL 2 ~~
gOO/LO0~ ~N¥8 31¥1~ ISSIJ ~8~ g~8 §0~ XYJ 8g:60 800~/gg/ZO
Donald Wilder, Chairman
Lauren Standish, Secretary
Town Hall, 53095 Main Rd.
P.O. Box 1179
Southold, NY 11971
Telephone (631 ) 765-1892
Fax (631) 765-6641
Conservation Advisory Council
Town of Southold
At the meeting of the Southold Town Conservation Advisory Council held Wed., July 16,
2008, the following recommendation was made:
Moved by Don Wilder, seconded by James Eckert, it was
RESOLVED to SUPPORT the Wetland Permit application of KEVlN FAGA to renovate
and construct additions to the existing single-family dwelling, and upgrade the sanitary
system.
Located: 12580 Main Rd., East Marion. SCTM#31-14-8.2
Inspected by: Don Wilder
The CAC Supports the application with the Condition the proposed addition is relocated
away from the water as far as possible, and drywells and gutters are installed to contain
roof run-off.
Vote of Council: Ayes: All
Motion Carried
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
P.O. Box 1179
Southold, NY 11971
Telephone (631 ) 765-1892
Fax (631) 765-6641
Southold Town Board of Trustees
Field Inspection/Worksession Report
Date/Time: '"7~ I~-D ~
K£¥1N FAGA requests a Wetland Per'nit to renovate and construct additions to
the existing single-family dwelling, and upgrade the sanitary system. Located:
12580 Main Rd., East Marion. SCTM#31-14-8.2
Type 9f area to be impacted:
~fl'twaterWetland Freshwater Wetland Sound ~
Distance of proposed work to edge of wetland
.~cOf Town Cc~Je/l~'oposed work falls under:
hapt.275 ~/Chapt. 111 other
Type of Application: _~Wetland b~Coastal Erosion __Amendment
~Administrative__Eddergency Pre-Submission Violation
Info needed:
Modifications:
Conditions:
Present.,Were:/~/.'.~ing ~oherty L/~..Dickerson
~/O. Dzen~z"~wski Mark Terr~ ~<rt~er.~¢~. -
Form filled out in the field by
J..~. Berge n~&~B.G hosio,
Mailed/Faxed to:
Date:
Environmental Technician Review-
OFFICE LOCATION:
Town Hall Annex
54375 State Route 25
Main Rd. & Youngs Ave.
Southold, NY 11971
MAILING ADDRESS:
P.O. Box 1179
Southold, NY 11971
Telephone: 631 765-1938
Fax: 631 765-3136
LOCAL WATERFRONT REVITALIZATION PROGRAM
TOWN OF SOUTHOLD
To: Jim King, President
Town of Southold Board of Trustees
From: Scott Hilary, LWRP Coordinator
Date: July 16, 2008
Re: Proposed Permit to Wetland Permit for KEVIN FAGA
SCTM#31 - 14-8.2
Jeffrey T. Butler, P.E. on behalf of KEVIN FAGA requests a Wetland Permit and Coastal Erosion Permit to renovate
and construct additions to the existing single-family dwelling, and upgrade the sanitary system. Located: 12580 Main
Rd., East Marion. SCTM#31 - 14-8.2
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 Southoid ecosystem.
6.3 Protect and restore tidal and freshwater wetlands.
Comply with statutory and regulatory requirements of the SouthoM Town Board of Trustees laws and
regulations for all Andros Patent and other lands under their jurisdiction
I. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions.
The distance from the bulkhead to the proposed action is approximately 24 feet; a minimum setback distance
of 100 feet from the wetland boundary {bulkhead) is required pursuant to Chapter 275-3. Findings; purpose;
iurisdiction; setbacks. Please require that the applicant amend the application to meet the above policy to the
~,reatest extent oracticable.
Further the proposed action may require a variance from the Zoning Board of Appeals pursuant to § 280-116.
§ 280-116. Building setback requirements adjacent to water bodies and wetlands.
B. All buildings or structures located on lots upon which a bulkhead, concrete wall, riprap or similar structure
exists and which are adjacent to tidal water bodies other than sounds shall be set back not less than 75feet from the
bulkhead.
§ 268-5. Review of actions.
F. Upon recommendation of L WRP Coordinator, the designated agency shall consider whether the proposed
action is consistent with the L WRP policy standards summarized in 3~ 268-1 herein. Prior to making its determination
of consistency, the designated agency shall consider the consistency recommendation of the £ WRP Coordinator. The
agency shall render a written determination of consistency based on the CAF, the L WRP Coordinator
recommendation and such other information as is deemed necessary to its determination. No approval or decision
shall be rendered for an action in the coastal area without a determination of consistency. The designated agency will
make the final determination of consistency. The Zoning Board of Appeals is the designated ageno, for the
determination of consistencF for variance applications subiect to this chapter. The Zoning Board of Appeais shall
consider the written consistencF recommendation of the L WRP Coordinator in the event and at the time it mahes a
decision to grant such a variance and shall impose appropriate conditions on the variance to make the aetivitF
consistent with the objectives of this chapter.
If the action is approved the following best management practice (BMP) is recommended:
1. Require a minimum 10' non-turf, permeable buffer landward of the bulkhead.
The BMP will further Policy 5, Protect and improve water quality in the Town of Southold and 6.3 Protect and
restores tidal and freshwater wetlands
6.3 Protect and restore tidal and freshwater wetlands.
D. Provide adequale buffers between wetlands and adjacent or nearby uses and
activities in order to ensure protection of the wetland's ~, values,
Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written
determination regarding the consistency of the proposed action.
Office Use Only
~Coastal Erosion Permit Application
~..,4(/elland Permit Application Administrative Permit
A mcndment/Trans f~r/F.,xtension ~'-
-~Recci'~dApplication: ~0~ ~.
~ecelvcd Fcc:$ ~
' ~,npleted Application ¢~O~ ~
Incomplete
SEQRA Classification:
Type I Type I1 Unlisted
Coordination:(date senl)__
~AC Refc,-ral Sent:
Receipt of CAC Report:
Lead Agency Determination:
Technical Review:
Resolution:
Namc ot'Applicant
2008
Address
"(~'<,,A. .....
Sufl'olk County Tax Map Number:
Property Location:
(provide IJI.CO Pole #, distance to cross streets, and location)
(1 f applicable)
Board of Trustees Application
GENERAL DATA
Land Area (in square feet):
Area Zoning: ¢ -t-tO
Previous use of property:
Intended use of property:
Prior permits/approvals for site improvements:
Agency Date
__ No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspende~y a governmental agency?
I,/No Yes
If yes, provide explanation:
Project Description (use attachments ir necessary):
Board of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:
7'0
Area of wetlands on lot: O square feet
Percent coverage of lot: O %
Closest distance between nearest existing structure and upland
edge of wetlands: ~ '~. feet
Closest distance between nearest proposed structure and upland
edge of wetlands:. /~ ~ feet
Does the project involve excavation or filling?
No ~ Yes
If yes, how much material will be excavated?,20~:~ubic yards
How much material will be filled? O 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):
Board of Trustees Application
COASTAL EROSION APPLICATION DATA
Purposes ofproposedactivity: ~ ,~')."~{ J/~O0)~
Are wetlands present within 100 feet of the proposed activity?
No ~ Yes
Does the project involve excavation or filling?
No
If Yes, how much material will be excavated?~/,~(:~, bic yards) I
How much material will be filled? O (cubic yards)
Manner in which material will be removed or deposited:~a~_~
Describe the nature and extent of the environmental impacts reasonably anticipated resulting
from implementation of the project as proposed. (Use attachments if necessary)
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Ir.
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
In the Matter of the Application of
...... ...............................
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFiDAVIT OF POSTING
I, ]~,~-.///~/4( ~dY'-~-f~_,residing at ~)~
being duly sworn, depose Md s~y:
Tha?n the 2~d-~day of :J'cd ¥ ,200~, I personally posted the property known as
by piecing the Board of Trustees official poster where it can easily be seen, and that I have
checked to be sure the poster has remained in place for eight days prior to the date of the public
hearing. Date of hearing noted thereon to be held [l~r2d...-~Ll.l_J r,).~, oO00~" .
Dated:
(signature)
Sworn to before me this
day of ,.Tv~, 2008
Notary Public
GINA A. LOCKE
No. 01 LO6057960
Notary Public, State of New York
Qaalified in Suffolk County
My Commission Expires 04/30/201'/
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name/Address/SCTM:
William Hukill
1770 Stars Road
East Marion, NY 11939
SCTM# 1000-031-14-8.1
Maria Xefos
P.O. Box 413
East Marion, NY 11939
SCTM# 1000-031-14-7
William Clayton
12832 Route 25
Ea~Marion, NY l1939
SCTM# 1000-031-14-15
STATE OF NEW YORK
COUNTY OF SUFFOLK
Melissa C. Butler, residing at 206 Lincoln Street, Riverhead, NY 11901, being duly sworn,
deposes and says that on the 30t~ day of June, 2008, deponent mailed a tree copy of the
Notice set forth in the Board of Trustees Application, directed to each of the above named
persons; that the addresses 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 Shoreham, NY, that said Notices were mailed to each of said persons by
certified return receipt mail.
Sworn to before me this
Day of ~, y ,2008
Notary Public
GINA A. LOOKE
No 01 LO6057960
Board of Trustees Application
AUTHORIZATION
(where the applicant is not the owner)
(pfini owner o~'prt(Perty)
residing at /~/29 0_)q/3£$ iS/.
(mailing address)
do hereby authorize
(Agent)
to apply for permit(s) from the
SouSes on my
~ signature)
behalf.
Board of Trustees Application
County of Suffolk
State of New York
DEPOSES AND AFFII~MS 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. 1N COMPLETING THIS
APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR
REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.
SWORN TO BEFORE ME THIS ~ ~, _ DAY OF _
,20oF'
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics vrohibits conflicts of interest on the Dart of town officers and emvlovecs. The purpose of
this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is
necessaw to avoid same.
(Last name, ~ir.qt 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 of Zone Coastal Erosion
Approval of plat Mooring
Exemption ,Crom plat or official map Planning
Other
(If"Other", name tim 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 employ~nent by) a corporation
in which the town officer or employee owns more than 5% of~.~hares.
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 thc relationship between yourself (the applicantJagentIrepresentative) and the town officer or employee. Either check
thc appropriate line A) through D) and/or describe in the space provided.
The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply):
A) the owner of greater than 5% of the shares of the corporate stock of the applicant
(when the applicant is a corporation);
B) the legal or beneficial owner of any interest in a non-corporate entity (when the
applicant is not a corporation);
C) an officer, director, partner, or employee of the applicant; or
___D) the actual applicant.
DESCRIPTION OF RELATIONSHIP
Form TS I
Submitted n~u{. ~'~ day of' ~ 200
Signature
Print~ame ,~'g~--~-~--~-~ f'_ ~.~ "~ ~
Butler Engineering
Architectural and Engineering Services
206 Lincoln Street
Riverhead, NY 11901
Tel: (631) 208-8850
Fax: (631) 727-8033
LETTER OF TRANSMITTAL
DATE: 6/23/08 PROJECT NO.:
TO: Lauren Standish
Town of Southold Trustees
FROM: JeffreyT. Butler RE: FagaApplication
WE ARE SENDING YOU: [] Attached [] Under Separate Cover Via
The following items:
[] Prints [] Sample [] Specifications
[] Plans [] Document [] Shop Drawings
[] Letter [] Change Order
COPIES DATE NO, DESCRIPTION
3 Copies of site plan
3 Applications
1 Check for $250.00
~,.,,, 5 2308 [~
THESE ARE TRANSMI'I-FED AS CHECKED BELOW:
~. ~0~r.¢ of ~rus e~,s
[] For your use [] Resubmit__ copies [] Subn'~ osp~ ,u~ ui~i. flbutlon
[] As requested [] For signature [] Return __ corrected prints
[] For review and comment [] For bids due__ [] Returned for corrections
[] Prints returned after loan to us
REMARKS: Lauren,
Please review application packet and call with any questions.
Thank you,
Jeff Butler
COPY TO
SIGNED ~
,r cnc,osurcs arc not as noted, kind,y noti~as aet ~cy T. Butler
LWRI CONSIS FENCY ASSESSMEN I FORM
, INSTt,ll I(!TIONS
All apl>lie:mis lbr permits* including Town of Southold agencies, shall complete Ihis
Imqmscd ~ctions that arc sulk]eot to the Town ol'Soulhold Waterfi'ont Consislency
il~qst;sslnclll is inlcndcd to supplement other infommtion asecl by a Tovw~
miflqing a determination o[' consistency. *~k'Cel)l minor exempt
I lcfi~rc ;mswcring thc questions in Section C, the preparer of this lbrm should
minCer m.:lion list, policies and explanations ofcach policy contained in the Town
Witlc~lionl I.}cvilaliTalion Progranl. A~proposed action will bo ewllualcd as
bcnclk:ial filial adverse efl'ects upon the coastal area (which ~.l_q(!os
I1' mty question in Section C co this l'orm is answered "yes" or "no", then thc
;tl'llzcl thc achievement of the LWR? policy standards and conditions contained
review law. Thus~ each answer nmst be explained in detail~ listinI2, both
SUplmrtinl4 fi~cts. I1' an action cannot be certified as consistent with the LWI,~P policy
c{mditions, il shall not be undertaken.
A ~_:~q)y o1' thc I.WRI' is availahlc io the following places: online at Ihe Town ul' ~;oulh~fld
wchsilc (stmlho/dlown.norlhl'(n'k.net), the Board of Trustees Office, the Planning I)cp;H Inh'nl
Il>cai libraries and the Town Clerk's off'ice.
PlqS( :I~IlI'TII)N ()Ii' SITE AND PROI+'OSED ACTION
J i~,_, Applicalion has I'mcn submitted to (check appropriate response):
i,~,~, ~;,,:,,',l [ii~] I'lan,,ingBoa,-d~ Buildingl)ept. [] Board ol' Trustees
( ';}lcgory el'Town ol:Southold agency action (check appropriate response):
Action undertaken directly by Town agency (e.g. capital
conslruction, plmming activity, agency regulation, land transaction)
I"inmlcial assistance (e.g. grant, loan, subsidy)
Pcrmil, appl'owfl, license, certification:
9
II un Ul~plicaliun Ibc the proposed actbn has been flied with the Town of S¢t thc Id agency,, thc
]nlb~nlution shall be provided:
lb) Maili~lgaddrcss: ~ ~_~ '~'~
id) Al)lflicalbn number, il:any:
Wilt thc adion be directly undertaken, require lh~ding, or approval by a stale or l~dcral agone} ?
N,,ITI If yes, which state or lkderal agency?
~' iq'ahmic ihe project to thc following policies by analyzing how tl~c project will further support
md snppol'| lhe policies. I'rovide all proposed Best Management Practices that will ftn'lhc4' each
h,tuinpkle answers will require that the form be returned for completion.
Pi, :v'FL¢ilq,',l) (~OAST POLICY
Ih}slot a pattern of development in the Towu of Southohl thai cnhauees cnllllllnuity dlflF;~d~'? ,
open si)acc, makes cflicieut use of iufrastructure, makes beneficial usc of a coaslal I.calioa, ;:,k
ud,imizes adverse effects of development. See LWRP Section III - I'olieies; Page 2 for cv:duati~at
Iii N. :] Not Applicable
caicy 2. Protect and preserve historic and archaeological resources of the Town of
i ',V R p Ncc tion I I I - Policies Pages 3 through 6 for evaluation criteria
Enhance visual quail .ty and protect sccoic resources throughout ~l~c Town of Somh~ hi. :.;c~,
,qcclion III Policies Pages 6 through 7 for evaluation criteria
~':~'cs Iii No [~ NotApl)licablc
i i, Ii :lddi/i{m:d :dlccls ii ncccssm'y
COAST I'OLICIES
¥ 4. Mimmizc loss of life, structures, aud natural resources from flooding and erosion. ;:,cc ~.,~
:~.ibm Ill - Policies Pages 8 through 16 for evaluation criteria
,'
Vcs No Not Applicable
J ;ii[I ;Mdilmnal shouts il IIcccs~qal'y
~'~licy 5. Protect and iml)rove water quality and supply in the Town of Southold. See i,WRP Scdhm ;[,~
i'~>]hScs Pages 16 Ihrongh 2 [ fin' evaluatioo criteria
.[;d[ addilio[ml ~;ht ds if ncccssmy
~'~ik'y 6. I'rolcct and restore thc quality and function of the Town of Southohl ccosyslcms c [i~i~
qig~J~'icanl ¢ 'oastal Fish and Wihllife itabitats and wethmds. See LWRP Section II I - Politics; Pages
~'~,gh 32 for c¥;Ihmlion criteria.
;'c'; No dicable
and iml)rnve air quality in the Town ol S{ nth >hi. Ncc [.Will' Set'lion
34 fro' cvalnation criteria.
[~] Not Apl, hcablc
!g,iic~' ~. Nlilmnizc environmental degradation in Town of Southold from solid waste ami ha:~ac,%as
s~,:~:mccs and waslcs. Sec LWRP Section 111 - Policies; Pages 34 through 38 for evalualim~ crime %.
I R:s E I N,,[~,tAl,l, licablc
]qqil,]{'(;()ANT ) " ~ ~
I ()Li(/IcS
. ,.%y I'rovidc for i)nblic access to, and recreational rise of, coastal waters, phi)lie lands,
i'c,;~t~r.ci:s of ~l~e Town of Soulhold. See LWRP Section I11 - Policies; Pages 38 thrnugh 46 for
i Yc~ ]l No[~otApl, licable
/
,~,. h i,,Iditit>lli~} shccis it ncccssaly
l'rntccl Suulhohl's water-dependent uses and I)romotc siting of new watcr-dcpcmlcnt ~s~':':
h~cathms. S{~c I,WRP Section I!i- Policies; Pages 47 through 56 for ewtluatiolt crilcria.
h'omolc sustainable use of living ]narine resources in Long isJaml Souml, Ibc
Town w~tlers. Sec LWRI Section Ill - Policies; Pages 57 through 62 I~}r cvalu:tli~m ~:~'~:[: ~.
J~i,Ji~)i¥ i.~. J)I'UUIUtC apprul)riate use and development of energy and mineral resources.
~';~,iim~ ~ti - Politics; Pages 65 through ~8 for evaluation criteria.
J JY,s I~:}] N,, ~t Applicable
h'olccl agricultural lamls in the Town of Southohl. See LWRP Section III for cvalualion crileria.
Nu [~0t Apl, licaJ, Je
LAUNDRI~
ROOH
DATHROOh'i
KITCHEN
DINING
ROOh4
6L~
LIVING
ROOM
DEDROONi
(2)2650 g~9'10 (2)2650
LAV 0
C, LOSRT AP. EA DEHINP KNEE HALL
A~EA BRHIN~ KNEE HALL ~
A~EA
~EHtN~
KNEE
HALL
LINE
SITE
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. ' ' ' ~ ~EP *25.00 ~.PT. *25.00 ~.PT.
UT[LIT~ POLE ~ ' "' , '"
TOTAL [IVIN¢ ARE~, ~,OO SO.FT. I¢5S.82 ~.PT. 2~¢.00 ~.FT. 5~.12 ~.FT./NOT TO
"XISTI~ ~ILOI~ COVB~eE, ADDREVIATION5~AN
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~ ,~ ~LINE OF P~PO~P t 126~2 HAIN ROAP
~_ ~ ~ JN ~ BALD5 AND GILT ~ ,~, ....... EADT MARION, NY
~'~ ~ /V=" ~ /~u~
, ~ 15' RI~T ¢ ~ 5~P5 W ~ILI~ ~ ~ ~ CALL US TOLL FREE 1~06~2-7962 ,.
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q J , .. ~ I ~ ~ ~ ~
*~,. ~ .... .L.. % *Xa~ ""'"'" =~ '~~:~% V//~%~ X ' ¢ , RESIDENTIAL DISTRICT
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I '~ ~ ~ '~.. ~ "'...'".. %~ ~'~ ~/ / / ~ ~ ~'~ m '~ PROVIDED: ~17532.5S SO.~.
, bX ~ ' /'..~. ~ISTI~PH~T ..... ~~~,S~/~O~g~ . ~.~ ~ ' MNIMUM ~LOWED 1~0'
I/ ~ ~ ~ ~ / 'J ~~%n~,~ / ~ PO~H ~ ~ ~ ~ M N MUM mo~ S~K:
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I- ~ e2~' % %~ ~ ~' ~'"" ~/ J ~ ~ / / /A~/ ,¢ ~ ~ PROVIDED. 65-6
8 _ , %, =., (/ ~% ; ~'~~ ~~ ~ ~ MINIMUM REQUIRED: 850
~ ~5.0' %%X%%/,%%%~q~ r' '. % : ~ ~~ / / ~ ~ ~ / EXI~ING: 1ST:. 1 088.62
* XX ~Xt ~ X .' ~/ ~ ~~/ / / A/ ~ / ~ PROPOSED' ~ST: 288 SQ.
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EXISTI~ 5TOO ~ ~ ' -- __ t -- ~ EXISTINe'~
~DE FENCE ~ ~ ~ CONC~ NUMBER OF ~ORIES.'
_ J M~. ALLOWED. 2.5
J~ ~ ~ EXI~ING 2.0
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