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Home My WebLink AboutTR-7142 Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer 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 # 0705C Date: November 22, 2011 THIS CERTIFIES that the construction of dormers, replace existing windows, doors, siding and roof shingles, gutters to leaders to drgwells on the dwelling, and removing or closing off the drainage pipe facing the wetlands At 2345 Mill Creek Drive, Southold, New York Suffolk County Tax Map # 51-6-39 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated June 11, 2009 pursuant to which Trustees Wetland Permit #7142 Dated July 22, 2009 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 donners, replace existing windows, doom, siding and roof shingles, gutters to leaders to drywells on the dwelling, and removing or closing offthe drainage pipe facing the wetlands The certificate is issued to DAVID FUHRMANN owner of the aforesaid property. u~t~orized Si~gnat~u Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (63 I) 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: 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 v/"- Pre-construction, hay bale line st day of construction constructed Y//' Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7142 DATE.. JULY 22, 2009 ISSUED TO: DAVID FUHRMANN PROPERTY ADDRESS: 2345 MILL CREEK DRIVE, SOUTHOLD SCTM# 51-6-39 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 July 22. 2009, and in consideration of application fee in the sum of $250.00 paid by David Fuhrmann 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 dormers, remove and replace existing windows, exterior doors, siding and roof shingles, and construct 453 sq. ft. addition to the existing deck, with the condition of a line of staked hay bales with silt fencing is installed prior to construction, from the top of bank seaward the area is to remain undisturbed, the installation of gutters, leaders and drywells to contain roof runoff and in accordance with Chapter 236 of the Town Code-Storm Water Runoff, and the removal of the drainage pipe in front of the proposed deck area, and as depicted on the site plan prepared by Mark K; Schwartz, AIA, last dated June 4, 2009, and received on June 11, 2009. 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 David Fuhrmann. residing at 2345 Mill Creek Drive, Southold, 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 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 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 &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 aher this work project herein stated without expenses to the Town of Southold. 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 Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 July 22, 2009 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Mark K. Schwartz, AIA P.O. Box 933 Cutchogue, NY 11935 RE: DAVID FUHRMANN 2345 MILL CREEK DRIVE, SOUTHOLD SCTM# 51-6-39 Dear Mr. Schwartz: The Board of Town Trustees took the following action dudng its regular meeting held on Wednesday, July 22, 2009 regarding the above matter: WHEREAS, Mark K. Schwartz, AIA on behalf of DAVID FUHRMANN applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southoid Town Code, the Wetland Ordinance of the Town of Southold, application dated June 11, 2009, 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 July 22, 2009, 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 DAVID FUHRMANN to construct dormers, remove and replace existing windows, exterior doors, siding and roof shingles, and construct 453 sq. ft. addition to the existing deck, with the condition of a line of staked hay bales with silt fencing is installed pdor to construction, maintain the non-turf buffer on the property from the bank seaward, the installation of gutters, leaders and drywells to contain roof runoff and in accordance with Chapter 236 of the Town Code-Storm Water Runoff, and the removal of the drainage pipe in front of the proposed deck area, and as depicted on the site plan prepared by Mark K. Schwartz, AIA, last dated June 4, 2009, and received on June 11, 2009. 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.O0 Very truly yours, F. King President, Board of Trustees JFK/eac James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated ~--(~'q~_. [ [, 'c~(~ has been reviewed by this Board at the regular meeting of .'3'-~ {',~ ~:~c~, and your application has been approved pending the compl~ion of'the following items checked off below, __ Revised Plans for proposed project v'~ Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of Construction ($50,00) ¼ Constructed ($50.00) Final In.spection 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 (631) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., July 15, 2009, the following recommendation was made: Moved by James Eckert, seconded by Peter Young, it was RESOLVED to SUPPORT the Wetland Permit application of DAVID FUHRMANN to construct dormers, remove and replace existing windows, exterior doors, siding and roof shingles, and construct a 453 sf. addition to the existing deck. Located: 2345 Mill Creek Dr., Southold. SCTM#51-6-39 Inspected by: James Eckert The CAC Supports the application with the Condition of a non-disturbance buffer seaward of the deck. Vote of Council: Ayes: All Motion Carried James F. King~ President Jill M. Dohe~ly, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. P.O. Box 1179 Telephone(631) 765-1892 Fax (631)765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report DAVID FUHRMANN requests a Wetland Permit to construct dormers, remove and replace existing windows, exterior doors, siding and roof shingles, and construct a 453 sf. addition to the existing deck. Located: 2345 Mill Creek Dr., Southold. SCTM#51-6-39 ~twf area to be impacted: ater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland ~Chaf Town Code proposed work falls under: pt.275 Chapt. 111 other Type of Application: ~"~etland __Coastal Erosion ._Amendment ._Administrative__Emergency Pre-Submission __Violation Info needed: Modifications: Present Were: ~L~J.King ~t--~.Doherty 2~.P. Dickerson __ __ D. Dzenkowski Scott Hilary__other Form filled out in the field by(/'~,~, v Mailed/Faxed to: Date: ~ Bergen~d ..Ghosio, OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. 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: Mark Terry, Principal Planner LWRP Coordinator Date: July 16, 2009 .y' Re: Proposed Wetland Permit for DAVID FUHRMANN. t~ \"~ SCTM#1000-51-6-39 Mark K. Schwartz, AIA on behalf of DAVID FUHRMANN requests a Wetland Permit to construct dormers, remove and replace existing windows, exterior doors, siding and roof shingles, and construct a 453 sf. addition to the existing deck. Located: 2345 Mill Creek Dr., Southold. SCTM#51-6-39 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 with the denoted following Policy Standards and therefore is CONSISTENT with the LWRP provided that the following recommendations to further the below listed policies are implemented. Poficy 6. Protect and restore the quafity and function of the Town of Southold ecosystem 6.3 Protect and restore tidal and freshwater wetlands. E. Maintain buffers to ensure that adverse effects of adjacent or nearby development are avoided: Maintain buffers to achieve a high filtration efficiency of surface runoff. Avoid permanent or unnecessary disturbance within buffer areas. Maintain existing indigenous vegetation within buffer areas. If the action is approved it is recommended that a perpetual natural veqetated buffer be required landward, to the Top -o f - bluff (bank) line; preserving the existing vegetation. NATURAL VEGETATED BUFFER -- a land area of a certain length and width where existing vegetation occurs prior to the commencement of any grading or clearing activity. Vegetation shall be maintained to achieve a minimum percent ground cover of ninety-five (95) pement..To achieve the percent ground cover indigenous, drought tolerant vegetation shall be planted. Survival of planted vegetation shall be (ninety) 90 percent for a period of three (3) years. Maintenance activities within the buffer are limited to removing vegetation which are hazardous to life and property, trimming tree limbs up to a height of fifteen feet (15') to maintain viewsheds, replanting of vegetation and establishing a four foot (4') wide access path constructed of pervious material for access to the water-body. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney FUHRMANN PROPERTY BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only ~9>asml Erosion Permit Application --..~etland Permit Application Administrative Permit Amendment/Transfer/Extension ~R~ce~-ved Application: ~ompleted Application ,{~1~ __Incomplete SEQRA Classification: Type I Type 11 Unlisted__ Coordination:(date sent) ~/CAC Referral Sent: r~ ~.l~lt~ of Inspection: __Receipt of CAC Report: __Lead Agency Determination: _ Technical Review: Resolution: JUN 1 Name 0fApplicant David Fuhrmann Address 69 Kensinqton Avenue Norwood, NJ 07648 Phone Number:( ) 201-294-8554 Suffolk County Tax Map Number: 1000 - 5 ;1, - 0 6 - 3 9 Property Location: 2345 Mill Creek Drive Southold (provide LILCO Pole #, distance to cross streets, and location) AGENT: Mark Schwartz - Architect (If applicable) Address: DO Box 933 Cutchoque 11935 Phone: 734-4185 of Trustees Applicati~ Land Area (in square feet):_ Area Zoning: R 40 GENERAL DATA 1000-51-06-39 Previous use of property: Sinqle Family Residence Intended use of property: Prior permits/approvals for site improvements: Agency Date Buildinq Dept #34499 03/13/09 interior alterations __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: ~oje~ Description(useattachmentsifnecessary):construct two dormers, remove and replace existing windows, exterior doors sidinq and roof shinqles. There will be no expansion of the existinq house footprint. We are proposinq an addition (453 sf)to the existinq deck as shown on plans bard of Trustees Applicati~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose oftheproposed operations: To expand the second floor to create a loft area and a bedroom with full bath. An addition to the existinq deck is also proposed Area of wetlands on lot: 2. 270 square feet Percent coverage of lot: 13.6 % Closest distance between nearest existing structure and upland edge of wetlands: 19 feet Closest distance between nearest proposed structure and upland edge of wetlands: 21 feet Does the project involve excavation or filling? X No Yes If yes, how much material will be excavated? N/A cubic yards How much material will be filled? N/A cubic yards Depth of which material will be removed or deposited: N/A Proposed slope throughout the area of operations: flat Manner in which material will be removed or deposited: N/A 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): Positive effect. Project limiting haybale line will be installed to contain site disturbance during construction. A drainage system of drywells will be installed to capture and recharge roof runoff and =ii up~idd=d ~=~Liu ~y~t=m wall b= CUlluLiucL=d ~iid lucdted more than 100' from tidal wetlands PROJ£~T I.D. NUMBER 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only ~PART I--PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPUCANT/SI=~NSOR 2. PROJECT NAME David Fuhrmann by Mark Schwartz Fuhrmann Property 3. PROJECT LOCATION: mun~.ty Southold c~,ty Suffolk 2345 Mill Creek Drive, Southold, NY (SCTM#1000-51-06-39 5. I$ PROPOSED ACTION: r-~ New [] EJ(~anslon [] M~lfl~tlo~all~al~n Construct two new do~ers, remove and replace existin~ windows, doors, siding & roof shingles. ~ expansion of the existin~ deck is also proposed. 0.1 0.1 g. WHAT IS ~UENT ~ND ~E IN V~N~ OF ~E~? SEQR exterior 11. ~ A~ ~ OF THE A~N ~ A ~RR~Y V~D PE~ ~ ~AL? ~y~ ~ ~f~im~~ Southold Bld~ Pe~it for interior alterations 12. ~ A A~LT OF ~ A~ION ~ ~ P~Mm~VAL ~lnE ~ON? ~y. ~ Bldg Pe~it Slgnalurm If the sctloa is in Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment I OVER WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABUSHMENT OF A CEA? I$ THERE, OR tS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? [] Ye~ [] NO il Yes, explain bl~fly PART Ill--DETERMINATION OF SIGNIFICANCE (TO be completed by Agency) INSTRUCTIONS: For each aclverse effect tclentlflecl above, determine wl~ether il L~ substantial, large, important or otr~erwise significant. Each effect snOUlCi be assessed in connection with its (al setting (i.e. u~ben or rural); (1~) probability o! occurring; (c) duration; irreversibility; (el geograpr~ic scope; and (fl magnitucia. If necessary, add attecl~mante or reference supporting materials. Ensure that exDlanations contain sufficient detail to sRow that ell relevant adve~'se imgacts have been identlfiecl anct a~Cluately adclressecl. question D of part II was cP. ecked yes, the cletermination and signitica~lce must evatuate the potsntlat iml~act et the [0roDosed action on the environmental characteristics Of the CEA. [] Check this box if you have identified one or more potentPally large or significant adverse inf~i?cts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. [] Check this Pox if you have determined, 10ased on the information and analysis above and any supporting documentation, that the proposed action ~NILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this cletermination: 4 .P CHITECT MARK SCHWARTZ & ASSOCIATES 28495 Main R ac · POBox 933 · (~utclloguc, NY 11935 631.734.4185 I ~ww. mksarchilccl.cOln July 18, 2009 Southold Town Board of Trustees 53095 Route 25 P.O. Box 1179 Southold, New York 11971 Re: Fuhrmann Property 2345 Mill Creek Drive Southold, New York Dear Trustees: The Owners have reviewed their property deed and have stated that there are no covenants or restrictions for residential construction. Please call this office ff you have questions or need any additional information. Mark Schwartz · James F. King, President Jill M. Doher~, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (63 I) 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 DAVID FUHRMAN COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, /f~)I~'/F_...~/'/t4/~/~t"~ residing at/dba Z ~.~ ~J" ~trt being duly sworn, depose and say: That on thd~ day of ~J b~( y, 200 ,~I personally posted t~h~e property known as__, . by placing the Board of Trustees official post~ wh~e it c~ easily be sero, ~d that I have check~ to be sure the poster h~ remained in place for ei~t days prior to the date of the public hemng. Date of heating noted thereon to be held Wed.~ Jul~ 22, 2009 on or about 6:00 PM. Dated: ~ ~ ( Sworn to before me this ~,,~ dayo~200 ti Notary Public CONNIE D. BUNCH Notary Public. State of New York No. 01BU6185050 Qualified n Suffolk Coun tv Expires Aoril ~4~ ~'0 ~, .... !looo -- S') - o& - ~ & I County of Suffolk State of New York DEPOSES AND AFFIRMg 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 1N THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. SWORN TO BEFORE ME THIS ~'~ DAYOF cJ~/A./~ ,20 a~ CONSTANCE LISOWY Notsry Public,, Stat~ of New York No. 01LI6110900 Q~lifi~t in Suffolk County Commi~ioll Expil~ Slal~ 01, 2012 Mr. and Mrs David Fuhrmann 69 Kensington Avenue Norwood, New Jersey 07648 201-294-8554 March 08, 2009 To Whom It May Concern: I, David Fuhrmann, authorize Mark Schwartz, AIA - Architect, to act as agent for pe.tdt applications to the Southold Town Board of Trustees, New York State Deparlsnent of Environmental Conservation, Suffolk County Department of Health and the Southold Town Building Departmenlx The proposed residential construction project is located at 2:545 Mill Creek Drive, Southold, New York (SCTM# 1000-514)6-39). Sincerely, David Fuhrmann date: APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM Thg Town of Southold's Code of Ethics prohibits conflicts of interest on the tmrt of town o fficm's and emdiovees. The otlrm~e of this form is to orovide information which can alert the town of unssibte conflicts of interest and allow it to take whatever action is necessary to avoid same. YOURNAME: Schwartz, Mark, Kevin (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 X Change of 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 telmionship 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 ~xtployment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO X If you answered "YES", complete the balance 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 applic~mffagenffrepresentative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parenh 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 ~oq~omtion); 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, pa~er, or employee of the applicant; or ___D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 Submitted th Signature Print Name FUHRMANN PROPERTY 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). lfany question in Section C on this form is answered "yes", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. 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 SCT~I# 31 16 2.2 The Application has been submitted to (check appropriate response): TownBoard [] PlanningOept. [] Building Dept. ~-~ BoardofTrastees [] 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 e~ent of a~ion: Con~truEt two new dormers, remove and replace existing windows, exterior doors, siding & roof shingles. An expansion of the Location of action: Site acreage:. Present land use: 2345 Mill Creek Drive Sou,hold 0.58 acres sinqle family residential Present zoning classification: R40 If an application for the proposed action has been filed with the Town of Sou,hold agency, the following information shall be provided: (a) Name of applicant: David Fuhrmann (b) Mailing address: 69 Kensington Avenue Norwood, NJ 07648 (c) Telephone number: Area Code ( ) 201 - 294 - 8554 (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?. 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 IH - Policies; Page 2 for evaluation criteria. ~-] Yes ~ No [] (Not Applicable - please explain) This project entails additions and alterations to a sinqle family dwellinq on a previously developed site in a heavily developed neighborhood. Policy 1 is not applicable to this project. 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 - please explain) This project does not contain nor does the project affect historic or archeoloqical resources; nor is the project located in a historic maritime area. Policy 2 is not applicable to the project. 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 - please explain) To the extent that this policy is applicable to the proposed project, visual quality and scenic resources will be protected at the site through the protection and maintenance of the well-vegetated embankment buffering the developed portion of the site from Arshamomoque Pond. Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. MinimiTe loss of life, structures, and natural resources from flooding and erosion. Sec LWRP Section III - Policies Pages 8 through 16 for evaluation criteria [] Yes [] No ~-~ (Not Applicable - please explain) This oro~ect does not address nor affect erosion control ~tructures or other erosion/floodina control intitiatives. Policy 4 is not applicable to the project. Attach additional sheets if neeessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP SeCtion 1H - Policies Pages 16 through 21 for evaluation criteria [] Yes [] No [-~ (Not Applicable - please explain) The proposed project is consistent with P~icy 5 via 2 major ~mp~nents: 1. installation of drywells to control and recharge stormwater runoff, 2. retention of the existing vegetation on the embankment buffering the project from tidal wetlands, which is to be preserved permanentely and also protected from site disturbance during construction by a project-limiting f~nce and staked haybales. Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Signhqcant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. [] Yes [] No [] (Not Applicable - please explain) This project will be consistent with Policy 6 for the same reasons as Policy 5. 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. See Section III - Policies Pages; 34 through 38 for evaluation criteria. [] Yes [] No [] (Not Applicable - please explain) The project will neither affect nor have an impact on air quality in the Town of Southold. Policy 7 is not applicable to this project. Attach additional sheets if necessary Policy 8. MinimiTe environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section HI - Policies; Pages 34 through 38 for evaluation criteria. [-~ Yes [] No ~ (Not Applicable - please explain) The project will neither create nor require the handling of solid waste or hazardous substances. Policy 8 is not applicable to the project. 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. [] Yeff-] No [] (Not Applicable- please explain) As the project is limited to the upland portion of the property, landward of an embankment, public access and recreational use of the adjacent coastal waters and public lands and resources will not be affected by the project. Policy 9 is not applicable to the Project. Attach additional sheets if necessary 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 ~ (Not Applicable - please explain) The project neither proposes nor affects the water-dependent uses. Policy 10 is not applicable to the project. 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 - please explain The project neither proposes nor affects commercial or recreational fisheries or other uses associated with the living marine resources of Long Island Sound. Policy 11 is not applicable to the project. Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section HI - Policies; Pages 62 through 65 for evaluation criteria. [] Yes [] No ~ Not Applicable - please explain The project is neither situated on nor adjacent to agricultural lands. Policy 12 is not applicable to the project. 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- please explain The project affects neither the use nor the development of energy and mineral resources. 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