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Home My WebLink AboutTR-7258 Jill M. Doherty, President ��OF SOUIy� Town Hall Annex Bob Ghosio,Jr.,Vice-President 43 54375 Main Road #[ l�[ P.O. Box 1179 James F. King Southold, New York 11971-0959 Dave Bergen G Q John Bredemeyer Telephone(631) 765-1892 li�C�U0 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0637C Date: April 21, 2011 THIS CERTIFIES that the demolition of existing and construction of new foundation, dwelling with portico and garage with drainage At 1100 Sound Beach Drive, Mattituck, New York Suffolk County Tax Map# 99-1-4.2 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated February 5, 2010 pursuant to which Trustees Wetland Permit#7258 Dated March 17, 2010 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 demolition of existing and construction of new foundation, dwelling with portico and garage with drainage The certificate is issued to CHRIS CYPRUS owner of the aforesaid property. 1!� P - &'�4 uthorized Signatui 0 • g0FF0( Jill M. Doherty,President �� CD Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President �� P.O. Box 1179 James F. King w Southold,NY 11971 Dave Bergen Telephone(631)765-1892 John Bredemeyert' Fax(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 --L/-/Project complete, compliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7094 DATE: MAY 20, 2009 ISSUED TO: PRUS PROPERTY ADDREF~: 1100 SOUNU Pursuant to the provisions Southold and in accordance with the Resolution, May 20, 2009, and in consideration of a to the Terms and Conditions as stated i: permits the following: Wetland existing dwelling, and as depicted on L.S. last dated October 31, 2008, of the Town Code of the Town of ?rustees adopted at the meeting held on paid by Chris Cyprus and subject outhold Town Board of Trustees authorizes and an enclosed portico to the ~ Kenneth H. Beckman, 17, 2009. Seal to be affixed, IN WITNESS WHEREOF and these presents to be s iority of the said s date. 51TE ~LAN NOTE: / THIS PROPERTY RESIDES INFIRM ZONE AE (EL12) NOTE: ~1~ THE ELEVATIONS SHOWN REFER TO THE NATIONAL GEODETIC VERTICAL SURVEY 1988 DATUM (NGV. D 10PSF 15PS,c 20 PSF 15 PSF 45 PSF 15 PSF for Cathedral cl~ REScheck Soft. are Compliance C ,,..,~.~PPROVED BY .rtifrc~e' ' .... :; VICTOR CUNEO ARCHITECT P.C. NOTE: THIS PROPERTY RESIDES IN FIRM ZONE YE (EL.13) NOTE: THE ELEVATIONS SHOWN REFER TO THE NATIONAL GEODETIC VERTICAL SURVEY 1988 DATUM (N.G.V.D 88) NOTE: AREA OF LOT IS 50,596 S.F. APd~-~P ADJACENT AREA = 15,555 S.F. .--'-"~EA OF HOUSE FOOTPRINT = 2616 S.F PERCENTAGE OF COVERAGE - 19,6% SEA~ARO 2'x16' WOOD WALK WAY 0 O: STEPS FRAME BALCONY TO BE REMOVED (50' W~OE) SITE F~LAN Ba~ed ~ Tab~es R$01.5, R30~,6, R301 Use LJ~ Lo~d Dead 15 PSF 15 FSF 15 PSF 15 PSF 15 PSF 15 PSF RESc/mc/r So~wam Vel'~ion 4.!.o Compliance Certificate ~ Tie: CYl~US ~ VICTOR CUNEO ARCHITECT P.C. F O L,J N ~ A T I O N PLAN K4ALL VICTOR CUNEO ARCHITECT P.C. PLAN .! CEILIN® B~-.ACIN® ~At~LE END!dALL STUD (DPT ON ~ STUD OPT ON HOLD DOP4N E~t~.AC~ET /NALL SHEATHIN® NAILIN® SCHEDULE 120 ~ ,~lNI~ ZONE (3 ~ 1/2' ~,~× ~ ~-!~,~IN~ ~OOF NAILIN® SCHEDULE VICTOR CUNEO ARCHITECT P.C. 5 E C O N ~ F L O O t~. ~ L A N VICTOR CUNEO ARCHITECT P.C. F~..AhdF'E2 O~ENIN~ FLOO~ TO FLOO~ ~ ~. O N T ~ I ~ ~/ A T I O N ~LE~/ATION VICTOR CUNEO ARCHITECT P,C, LEFT ~I~E ELEVATION BB° ~-.I~HT SlOE ELEVATION e FLOOR SHF.~THING TYP. PORCH COLUMN OF=TAIL VICTOR CUNEO ARCHITECT P.C. VICTOR CUNEO ARCHITECT P.C. Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE __ Pre-construction, hay bale line 1st day of construction ¼ constructed I//' Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7258 DATE: MARCH 17~ 20!0 ISSUED TO: CHRIS CYPRUS PROPERTY ADDRESS: 1100 SOUND BEACH DRIVE~ MATTITUCK SCTM# 99-1-4.2 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of Southold and in aeeordance with the Resolution of the Board of Trustees adopted at the meeting held on March 17, 2010, and in consideration of application fee in the sum of $250.00 paid by Chris Cvprus and subjec to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to demolish the middle of the dwelling and construct a new foundation under the newly constructed middle of the dwelling; lift up the second-story portion of the dwelling and add additional blocks to the existing concrete block foundation; add drains to the foundations; add drains to the existing garage and new raised roof to match the rest of the dwelling; construct additions to existing dwelling including an enclosed portico; if necessary, full demolition of dwelling and garage due to conditions during construction phase; all new construction is to be maintained withinithe approved footprint, and as depicted on the site plan prepared by Victor Cuneo~ Architect P.C., last dated FebrUary 15~ 2010, and stamped approved on MarCh 17, 2010. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to bc subscribed by a majority of the said Board as of this date. TERMS AND CONDITIONS The Permittee Chris Cyprus, residing at 1100 Sound Beach 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 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 authorize~d, 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. 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. 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 Fax (631) 765-6641 March 17, 2010 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Chris Cyprus 51 Sunset Boulevard Wading River, NY 11792 RE: 1100 SOUND BEACH DRIVE, MATTITUCK SCTM# 99-1-4.2 Dear Mr. Cyprus: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, March 17, 2010 regarding the above matter: WHEREAS, CHRIS CYPRUS 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 February 5, 2010, 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 Headng was held by the Town Trustees with respect to said application on March 17, 2010, 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 conceming this application, and, 2 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 CHRIS CYPRUS to demolish the middle of the dwelling and construct a new foundation under the newly constructed middle of the dwelling; lift up the second-story portion of the dwelling and add additional blocks to the existing concrete block foundation; add drains to the foundations; add drains to the existing garage and new raised roof to match the rest of the dwelling; construct additions to existing dwelling including an enclosed portico; if necessary, full demolition of dwelling and garage due to conditions during construction phase; all new construction is to be maintained within the approved footprint, and as depicted on the site plan prepared by Victor Cuneo, Architect P.C., last dated February 15, 2010, and Stamped approved on March 17, 2010. 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: $0.00 Very truly yours, Jill M. Doherty President, Board of Trustees JMD/eac Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765 - 1892 Fax (63 I) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., March 10, 2010, the following recommendation was made: Moved by Doug Hardy, seconded by Anne Tdmble, it was RESOLVED to SUPPORT the application of CHRIS CYPRUS to Amend Permit #7094 to demolish the middle of the dwelling and construct a new foundation under the newly constructed middle of the dwelling; lift up the second-story portion of the dwelling and add additional blocks to the existing concrete block foundation; add drains to the foundations; add drains to the existing garage and new raised roof to match the rest of the dwelling. Located: 1100 Sound Beach Dr., Mattituck. SCTM#99-1-4.2 Inspected by: Doug Hardy Vote of Council: Ayes: All Motion Carried Jill M. Doheriy, President James F. King, Vice-President Dave Bergen Bob Ghosio. Jr. John Bredemeyer 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: CHRIS CYPRUS requests an Amendment to Permit #7094 to demolish the middle of the dwelling and construct a new foundation under the newly constructed middle of the dwelling; lift up the second-story portion of the dwelling and add additional blocks to the existing concrete block foundation; add drains to the foundations; add drains to the existing garage and new raised roof to match the rest of the dwelling. Located: 1100 Sound Beach Dr., Mattituck. SCTM#99-1-4.2 Type~of area to be impacted: ~z~5"altwater Wetland Freshwater Wetland c,/Sound __Bay Distance of proposed work to edge of wetland hOchaf Town Code proposed work falls under: pt.275 Chapt. 111 other Type of Application: X.,/~/etland __Coastal Erosion ~Administrative__Emergency Pre-Submission __ __Amendment Violation Info needed: Modifications: Conditions: Present Were: __~J.King __J"'~D. Do herty __~J. Bredemeyer B.Ghosio, D. Dzenkowski other Form filled out in the field by v'~.D. Bergen~// Mailed/Faxed to: Date: APR 2 Chris Cyprus 51 Sunset Blvd. Wading River, NY, 11792 (631) 929-4487 home (631) 262-8115 office For Chris Cyprus home renovations at 1100 Sound Beach Dr. Mattituck, NY, 11952 Cyprus prior permits. NYS DEC permit # 1-4738-03888/00001 Southold Town Trustees pemfit # 7094 The change from the prior permits is to raise the home to meet the FEMA flood requirements as imposed by the Southold Town Building Department. In order to raise the home, the middle of the home will be demolished, there will be a new foundation put in under the newly constructed middle of the home. The 2 story portion of the home will be lifted up and the existing concrete block foundation will have additional blocks added to it to raise the 2 story part of the house to be in compliance with FEMA flood ~luirements. The foundations will have the drains added to them as well to be in compliance with FEMA. The garage will be left alone with drains added to it and a new raised roof to match the rest of the home being raised. Permit Application Application __ Administrative Permit fer/Extension fi/Received Fee:$ ~-~D ~>o~--~-~O Completed Application Incomplete SEQRA Classification: Type I Type il Unlisted Coordinatien:(date sent) LWRP Consistency Assessment Form CAC Referral Sent: __Receipt of CAC Report: __Lead Agency Determination:__ Technical Review: Resolution: Name of Applicant: Chris Cyprus Address: 51 Sunset Blvd. Wading River NY 11792 Phone Number:( 631 ) 9294487 Office (631) 262-8115 Suffolk County Tax Map Number: 1000-099 01 4.2 Property Location: 1100 Sound Beach Drive, Mattimck NY 11952 (provide LILCO Pole #, distance to cross streets, and location) AGENT: Applicant is the Agent (If applicable) Address: Phone: GENERAL DATA Land Area (in square feet): 30,596 Area Zoning: R- 40 Residential Previous use of property: Existing Home Intended use of property: Home Covenants and Restrictions: Yes X No If"Yes", please provide copy. Prior permits/approvals for site improvements: Agency Date NYS DEC Permit # 1-4738-03888/00001 effeefive date March 25, 2009 Southold Town Trustees Permit: # 7094 Date May 20, 2009 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: Project Description (use attachments if neeessary): Current Home is 5 bedrooms, 5 full baths, 2 half baths, kitchen, den, dinning room, fireplace and TV room. After renovations home will be 4 bedrooms, 5 full baths, no half baths, no fu~place, kitchen, study, two TV rooms, den with dining area (see attached plans). The garage will stay as is except the roof will be lifted and re-done to match the renovations on the rest of the home with storm drains added to the lower part of the garage. The middle of the house will be demolished and a new foundation will be put In for the home (see the foundation plan 0-ached). From the original foot print for the middle of the home tbere will be 2 squanxl off areas as shown on the survey. One area is 3.5 ft X 6.5ft and the other area is 4 ft X 12.5 ft. The home will be raised to meet the FEIMA flood requirements as shown on thc elevation plans attached. The existing cinder block foundation for thc 2 story part of the home will also be raised as shown on the foundation plans, existing foundation will be repaired or replaced as necessary along with any interior or exterior walls. The second story deck in the front yard will be removed. The second story deck in the back yard will be mostly closed in as shown on the plans. The home will get new windows, doors and roofs as shown on the plans. Board of Trnstees Application W~TLANDfI'RUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Current Home went thru several renovations and it looks that way. This will improve the appearance of the home Area of wetlands on lot: -17,300 square feet Percent coverage of lot: 34% Closest distance between nearest existing structure and upland edge of wetlands: 26 feet Closest distance between nearest proposed structure and upland edge ofwedands: 26 feet Does the project involve excavation or filling? No X Yes If yes, how much material will be excavated? Only excavating will be for thc new foundation, see foundation plans cubic yards How much material will be filled? Only fill will be backfilling the new foundation cubic yards Depth of which material will be removed or deposited: See foundation plans feet Proposed slope throughout the area of operations: No changes to existing slope Manner in which material will be removed or deposited: Assume digging will be done by machine or a back hoe. 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): There is no effect or impact from this project. The additions are being done over existing concrete and an existing deck. All of these areas are already covered by a roof. Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Current Home went thru several renovations and it looks that way. This will improve the appearance of the home Are wetlands present within 100 feet of the proposed activity? No X Yes Does the project involve excavation or filling? No X Yes If Yes, how much material will be excavated? Only excavation will be for the new foundation as shown in the foundation plans (cubic yards) How much material will be filled? Only fill will be for backfilling the new foundation ___(cubic yards) Manner in which material will be removed or deposited: Assume digging will be by machine or a backhoe _ Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) There are no impacts f~om these changes. The 2 additions are closing in 80 Sq Ft. All of this area is alre?dy covered by concrete and has a roof over it. Closing in the second story deck has no impact as it is already covered by a roof. As we are eliminating 2 half baths and removing the asbestos shingles I would assume this would have nothing other than a positive impact. Board of Trustees A~plication Boar~ of Trustees Application County of Suffolk State of New York 0 h~' ~ J~/O J BEING DULY SWORN DEPOSES TH T. Stm iS Tm APPUC rr FOR OVE 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 CLALMS 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 T~ BE~FOxRE 1V~ THIS ~'-~ Notary Public CUi'~i~!~ L ~ Notany Public, State of New ¥orF No. O1BIJ6185050 Qualified in Suffolk Count'/ Cuinmis,ion; Ex~ires Aerit 14 DAY OF ~e~C~O~ ,20 lO Board of Trustees Application AUTHORIZATION (wh~re the applicant is not the owner) I (print owner of property) (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) PROJECT ID NUMBER PARTI-PROJECTINFORMA~ON 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL A~ESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Pr~ Sponsor) 2. PROJECT NAME PRECISE LOCATION: Sb'eet Addess and Road Intersecllons. PrOminent landmarks Gtc -or provide man ]/0:.'~ -~o~ ~.( _~-.~ ~- t, /)+, I'~/~', t~', {', ~ ~ ~(¥ SEQR Initia~ly acres UlUmately L WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~-------"IYes [] No If no. descfibebrief*y; 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as rtmr~y as apply.) '--'loIhor (ee~bel 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL l~]Yes [--'1No If yes, list agency name and pern~ / approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [~Yes r~No If yes, list agency name and permit / approval: I~AS A Rr~ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT TIlE INFORMATION PROVIDED ABOVE IS TRUE TO 11'tE BEST OF MY KNOWLEDGE PART II - IMPACT A~$F~-~MENT ~o be completed by Lead Agency) A. DOES ACTION EXC~'r,E) ANY 'rYPE I THRESHOLD IN 6 NYCRR, PART 61 ?.47 if ye~, ~ordlnate the mvtew pmoess anti use Ihe FULL EKF. ~ B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IH 6 NYCRR, PART 61 ?,§? If No, a negative declaration may be~raeded by another Involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwdttsn, if legible) C1. Existing air quality, surface or gmundweter quality or quantity, noise levels, existing Iraffic pattern, sotic waste preductioe or disposal, potential for er~icn, drainage or Itoodlng pm~lems? Explain brtafly: ,. C2. Aesthetic, agricuifund, archaeological, htatorfo, or o~er natural or cultural reaecmea; or community or netghbnd-~xl chamctsf? Expte bKefly: C3. Vegetation or fauna, fish. shellfish or wildlife species, significant habitats, or threatened or endangered spec.tea? Explain briefly: Ca.. community's e~lating plar~ or goals aa oiflclMy adopted, or a change In ose or Inten~ly of uae of land m' othe~ eatural tesmlrces? EA°~ t~iel~) C5. ~, subaeq~eni ~evel°Pmeci, or ralated activif]ea iikely to be induced bY tha I~'Opa~eci~on?'Explaln bheflY: D. WiLL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL E. IS THERE, OR IS IHER,~..UKELY TO BE~ CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If ~ e~ato: [] yes ! PART III - [~t i e.~MINATION OF SIGNIFICANCE {To be completed by Agency) INSTRUCTIONS: For each adverse effect identified alcove, determine whether it Is subetanital, large, imlxalant or otha~vise slgniitcant. Each effect should be assessed in connector with ~ (a) setting (i.e. u~ban or rural); (b) prohebility of occurring; (c) duralion; (d) imweralbility; (e) geographic scope; and (t) magnitude. If necessary, add attachments or reference supporting materials. Ensure that exp~anaiions contain sufficient detail to show that all relevant adverse impacts have bean identified and adequately addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental chafe ctedsflcs of Ih $ CEA. Check this box if you have Iden6fled one o~ more potsnf~elly large or aigniflcant adverse Impacts which MAY occur. Then preceed dimply to the FULl FAF and/or prepare a positive declaretlo~, Check tills box if you have determined, based on the information and a~qelyala above and any supporting documentetion, that the proposed actior WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons suppoding thi~ determination. Name of Lead Agency n 9f Type r~a alx~_ <~ ~.~Jency geature of Re~n~le ~n Lead ~en~ Title d Reoponsibte Officer Signature of Preparer (if different from responsible officer) Town of Southold LWRP CONSISTENCY ASSESSMENT FORM 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 deter~nination 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.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 scm#/000-0W- c'// - q, 2 I The Application has been submitted to (check appropriate response): TownBoard [~ Planning Board V-~ BaildingDept. ~ BoardofTrustees [] 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 ofacfion: Site acreage: Present land use: Present zoning classification: If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: (c) Telephone number: Area Code ( ) ~[*- ~(~g-t~-II£ '~- {.(.'~¥14 (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a stat? ?_r federal agency? YeS ~7~' No~ If yes, which state or federal agency?_ C. Evaluate the project to the following policies by analyzing how the project will further support' or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section HI - Policies; Page 2 for evaluation criteria. 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 VI 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 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 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 No Not Applicable Attach additional sheets if necessary Policy 7. Pages 32 through 34 for evaluation criteria. ~-] Yes ~ No ~Not Applicable Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies 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 ~iNot Applicable 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 NotApplicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconie Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. Yes ~-~ No ~Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section IH - Policies; Pages 62 through 65 for evaluation criteria. ~ Yes [-~ No ~Not Applicable , ' Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. PREPARED BY TITLE DATE APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM 1~ To~z of Soulhold's Code of Elhics p~hibils conflicts of i~ ~ ~ ~ of town offi~ ~ ~. ~ ~ of th~ f~ is m omvi~ ~o~ ~ich ~ ~ ~ to~ of ~ible ~fli~ of~ ~ ~w it to ~ w~ ~ ~ m avoid . {~ ~ f~ ~e, mi~ ~fi~ ~ss you ~ ~g ~ ~ ~ of ~n's ~ ~m~y's n~.) NAME OF APPLICATION: (Check all that ~pply.) Tax grievance Building Variaace Truztee Change of Zone Coastal Erosion Approval of plat Mooting Exemption from plat or official map planning Other Do you personally (or through your company, spouse, sibling, parent, or child) have a ~elafionship with ~ officer or ~ployee of the Town of Southold? "Rclalionship~ includes by blood, marriage, or business interest. ~Busincss interc~ mca~s a business, including a pannership, in which thc town officc~ or employee has even a partial ownoship of (or employment by) a corpmafion in which Rac town oflic~r or employee owns more than 5% of lhe sha~s. YES NO ~' If you answered ~YES', complete the I~alanee of this form and d~c and sign where indicaW, d. Name of person employed by the Town of Somhold T~tle or position of fi~at person Describe the relationship between yottrseif (thc applicam/agen~/~ta~iv¢) and the town offi~-r or employee. Either check the appmprinte linc A) through D) and/or describe in the space provided. Thc town offieer or employee or his or her spouse, sibling, imrcnt, or child is (check all that apply): A) ibc owner of gn~ater than 5% of the shares of the corporate stock of the applicant (when the applicant is a coq~y~ion); __B) thc legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); __J2) an oflficcr, director, patmer, or employee of~he applicant; or __D) the acnual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Submitted ~his Signature Print Name day of 200 Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer 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 CHRIS CYPRUS COUNTY OF SUFFOLK) STATE OF NEW YORK) ' CTp AFFIDAVIT OF POSTING , residing at/dba ,~l being duly sworn, depose and say: That on the 'S~day of /k/at,c_ bl ,2010, I personally posted th, e property known as by placing 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 Wed. March 17~ 2010 on or about 6:00 PM. Dated: Sworn to before me this day of)~C,r&200 ~ t Notary Public (~gnature) 60NNIE O. BUNCh Notary Public, State of New No. O18UB18§O§O ' Qualified in Suffolk ¢ounl~,; . Commission rxnims goril 4 ?Glo PROOF OF MAll,lNG OF NOTICE ATTAClt CERTII*IlgD MAIL REC..EIPT~S jp+4 ~n th~s box ' ~t~: ......... ~~ ~'"~ ., being duly sworn, deposes and says on the ~ dayof ~m.~;~. ,20 ~0, deponentmail~atmecopyoftheNotice set fo..in ~e Bo~ ofT~ ~p~ea~o~ directed to each of the above n~ed pemo~ at ~e ~s~ ~t op~site ~ere resp~five ~es; ~at ~e ad~esses se~ opposite ~ nm~ of ~d p~om ge ~e ad.ess of s~d perso~ ~ shorn on the c~ent ~se~sment roll o~e ~o~ 0f Sou~old; ~ s~d Notices were m~led m the U~ted States Post Officeat ~t~, ~ ,~ats~dN~we~mailed~achofs~dpersonsby / )// / Sworn to before me this ~--~ Day of ~ f;~ , 20)_LL~_~ Notary Public MAR -5 2070. l.. .; GONNIE D. BUNGh Notaqt Public. State of New York No. 01BU6185050 Qualified in Suffolk County ,... Commission Expires April 14 20 }oL