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Home My WebLink AboutTR-7234AJill 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 (63 I) 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 ½ constructed v/'/ Project complete, compliance inspection. James Vavas 3085 Bay Shore Road Greenport, NY 11944 (30) x Suntech 175w Panels = 5,250 Total DC watts (30) x Enphase M190 Inverters Shuco Mounting System PV PANEL: INVERTER: MOUNTING RAIL: SUNTECH 175 WATt STP175S-24/AB-1 ENPHASE ENERGY M190 MICROINVETER (1 PER PA SHUCO W RAILS r~Y 1530 Rock Point Rd. Middle Island, NY 11953 1 888-350-SOLAR 1 S0uthh0H 7ow~ ~oard of ~rustees SHUCO "ezL" STANDOFFS CONNECTION TO RAIL 18'-11" ROOF STANCHION NONE NO. LAYERS OF EXISTING ROOFING: ONE SIZE OF EXISTING RAFTER: 2" x 8" RAFTER SPACING: 16" O.C. RAFTER SPANS: 18'-11' ROOF PITCH: 3.5/12 PITCH (16 DEGREES) ADDITIONAL SUPPORT PROVIDED: NOT REQUIRED TYPICAL DETAIL FOR PANEL MOUNTING ON RAILS, SHOWING OVERHANGS Length of mounting rait 1 31.8" · CONNECTI~)N TO-/ RAFTER ROOF PLAN SCALE 1/4" = 1'-0' 454 LBS. UPLIFT PER CONNECTOR TOWN ur ~,,JuI ..... DATE m - 54 ATTACHMENT POINTS The existing roof rafters at this residence can adequately support the proposed Solar PV panel assembly (5 Lbs PSF) and the snow loads (25 Lbs PSF). In addition, the 5/16" x 4" lag screws installed at 4'-0" o.c. meet the uplift requirements of 4 screws minimum per assembly, 6 screws are provided. This installation meets the requirements of the Residential Code of New York State and has been found to be acceptable by my office. PROJECT JAMES VAVAS 3085 BAY SHORE RD. GREENPORT, N.Y. 11944 TITLE SOLAR PANEL DETAILS SCALE 1/4" = 1 '-0' DATE 05-07-10 DRAWING NO. R-1 MCCRAY ARCHITECT P.C. 73 KENDRICK LANE DIX HILLS, NY 11746 TEL: 631-427-0171 FAX: 631-782-2666 TABLE R301.2(1) CLIMATIC AND GEOGRAPHIC DESIGN CRITERIA I SUBJECT TO DAMAGE FROM ICE SHIELD ,," COMMENTS GROUND WIND SEISMIC WINTER ' UNDER- DEPTH OF 3" LAG SCREW 2 IN ~ ASSI~ME 1" LOSS THROUGH ROOFING SNOWLOAD~ SPEED* DESIGN Frost line DESIGN LAYMENT FLOOD AIR FREEZING TOTAL UPLOAD CAPACITY PER LAG SCREW (mph) CATEGORY~ Weatherlnga depth~ Termitec Decay~ TEMP~ RE~QU1RED~ HAZARDS~ iNDEXi 454 Las E~.SE CODE R EQ UlR EMENTS NY STATE RESIDENTIAL CODE 2007 ForSI: I pound per square foot =0.0479kN/m2, I mileperhour= 1.609 km/h. shall be filled in with tile weathering index (i.e., "negligible;' "moderate" or"severe") for concrete as determined from the Weatherin~ Probability Map [Figure ROOF HEIGHT < ON ~ 30 FEET R301.2(3)]. The grade of masonry units shall be determined from ASTM C 34 C 55 C 62 C 73. C 90, C 29, C 45 C 2 6 et C 65~2 R301.2(6) depending on whether there has been a history of local damage. mined on a site-specific basis in accordance with Section R301.2.1.4. h. The jurisdiction shall fi fi J n this part of fl~e table '~dth Ia)the date of fl~e jurlsdiction's enwy into the National Flood Insurance Program (date of edoption of the first i. In accordance with Sections R905.2.7. I,R905.4.3,Rg05.5~3,R905.6.3,R90~.7.3 and R905.8.3. for areas wheretheaveragedaily lemper.~toreln Januwy is 25~F UPLOAD CALCULATIONS (-4°C) or ess. or where there has been a h s ory of ocs damage from the effects of ice damming, the jurisdiction shall fill in this part of the table with "YES." Oth- j. The jurisdiction shaJl fill in this part of the table with the 100-year return period air freezing index (BF-days) from Table R403.3(1). k. The ground snow loads to be used in determining the design snow loads for roofs ~tre given in Figure R301 .?.(5) for sites at elevation s up to 1000 feet. Sites at PROJECT TITLE SCALE DRAVVlNG NO. MCCRAY ARCHITECT P.C. JAMES VAVAS SOLAR PANEL DETAILS 118" = 1'-0" 3085 BAY SHORE RD. DATE ~[-~' 73 KENDRICK LANE DIX HILLS, NY 11746 GREENPORT, N.Y. 11944 05-07-10 TEL: 63%427-0171 FAX: 631-782-2666 on 0 &OT55 / I I I I SURVEY OF LOTS 52, 55, 54 t~,IENDED MAP 'A' PECONIC BAY ESTATESS ARSHAMOMAQUE, TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. SURVEYED FOR: DANIEL VAVAS URSALA VAVAS JUN - 3 2010 OR 0.602 ACRES ~URVEY£D BY STANLEY j. ISAKS£N, JR. P.O. BOX 294 N~ SU~LK. N.Y. 1955 651 ~73 5855 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 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7324A Date of Receipt of Application: June 3, 2010 Applicant: James Vavas SCTM#: 53-6-6 Project Location: 3085 Bayshore Road, Greenport Date of Resolution/Issuance: June 16, 2010 Date of Expiration: June 16, 2012 Reviewed by: Board of Trustees Project Description: To install (30) Suntech solar panels and Enphase inverters totaling a system size of 5,250 watts onto the roof of the existing dwelling. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the project plan prepared by New York Solar Solutions, LLC, received on June 3, 2010, and stamped approved on June 16, 2010. Special Conditions: None. Inspections: Final inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Jill~1. Doherty, Presid~/nt Board of Trustees ' JMD:eac 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 TO: ~"~('~.~ Please be advised that your application dated ,_~'~'~.m~ ..~, ~3/O has been reviewed by this Board at the regular meeting of .LT,,,,,,~ J~;. ~O/O and your application has been approved pending the completion o-f~he following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1st Day of Construction ($50.00) Constructed ($50.00) Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southoid Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE:$ BY: Jill M. Doherty, President Board of Trustees Jill M, Dohelly, President James F King, Vice-President Dave Bergen Bob Ghosio, Jr John Brederneyer PO. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: ~-~ New York Solar Solutions, LLC on behalf of JAMES VAVAS requests an Administrative Permit to install (30) Suntech solar panels and Enphase inverters totaling a system size of 5,250 wafts onto the roof of the existing dwelling. Located: 3085 Bayshore Rd., Greenport. SCTM#53-6-6 Type of area to be impacted: _~¢affWater Wetland Freshwater Wetland Distance of proposed work to edge of wetland haf Town Code proposed work falls under: pt.275 Chapt. 111 other Type of Application: 'v'~etland __Coastal Erosion ~Ad ministrative__Emergency __ Sound ~Bay __Amend ment Pre-Submission Violation Info needed: Modifications: Conditions: Present Were: ~King ~J.Doherty r~J. Bredemeyer ~D. Bergen B.Ghosio, ~ D. Dzen-~wski -~ther -- Form filled out in the field by Mailed/Faxed to: Date: SUNTE H Solar powering a green futureTM 175 Watt MONO-CRYSTALLINE SOLAR PANEL Suntech Black LabelTM modules are exclusively designed and engineered for homeowners who seek a rooftop solar solution that combines visual aesthetics with excellent efficiency. Features · High conversion efficiency based on innovative photovoltaic technologies · High reliability with guaranteed +/-3% power output tolerance · Withstands high wind-pressure and snow load, and extreme temperature variations Quality and Safety · 25-year power output transferable warranty · Rigorous quality control meeting the highest international standards ISO 9001:2000 (Quality Management System) and ISO 14001:2004 (Environmental Management System) certified factories manufacturing world class products · ULlistings:UL1703, cULus, ClassCfirerating, conformitytoCE Recommended Applications Residential roof top systems · On-grid utility systems On-grid commercial systems ~oar~{ Trusteel, ~ ,~. . Suntech's technology yields improvements to BSF structure and anti-reflective coating to increase conversion efficiency Unique design on drainage holes and rigid construction prevents frame from deforming or breaking due to freezing weather and other The panel provides more field power output through an advanced cell texturing and isolation process, which improves Iow irradiance performance Suntech was n(]med Frost and SulfivQn's 2008 Solar Energy Development Company of the Year Solar powering a green future Electrical Characteristics Characteristics STP175S-24/Ab-1 STP170S-24/Ab-1 STP165S-24/Ab-1 STP160S-24/Ab-1 Open - Circuit Voltage (Voc) 44.2V 43,8V 43.6V 43 2V Optimum Operating Voltage (Vmp) 35.2V 35.2V 34.8V 34.4V Short- Circuit Current (Isc) $.2A $.14A $.04A $A Optimum Operating Current (Imp) 4.95A 4.83A 4.74A 4.65A Maximum Power at STC (Pmax) 17$Wp 170Wp 16$Wp 60Wp Operating Temperature 400C to +85°C ~0°C to +85°C -40°C to +85°C -40°C to +85°C Maximum System Voltage 600V DC 600V DC 600V DC 600V DC Maximum Series Fuse Rating 15 AMPS 15 AMPS 1S AMPS 1S AMPS Power Tolerance -+3 % -+3 % -+3 % ±3 % STC: Irradiance 1000W/m~, Module temperature 25~C, AM=1.5 Ground holes ~ ~ Mechanical Characteristics Solar Cell Mono-crystalline 125x 125mm (Sinch) No. of Cells 72 (6x 12) Dimensions 1580x808x35mm (62.2x31.8x 1.4inch) Weight 1 $.$kg (34.1lbs.) Front Glass 3.2 mm (0.13inch) tempered glass Frame Anodized aluminium alloy Junction Box IP65 rated ^IW (12AWG), asymmetrical lengths (-) 1200mm Output Cables (47,2inch) and (+) 800mm (31.5inch), MC Plug Type IV connectors Current-Voltage & Power-Voltage Curve (170W) Temperature Coefficients Temperature Coefficient of Pmax -0.48 %/°C Temperature Coefficient of Voc -0.34 %/°C Temperature Coefficient of Isc 0.017 %/°C Temperature Dependence of Isc, Voc, Pmax lei ENPHASE SOLUTIONS The Enphase Energy Micro-Inverter System improves energy harvest, increases reliability, and dramatically simplifies design, installation and management of solar power systems. The Enphase System includes the micro-inverter, the Envoy Communications Gateway, and the web-based Enlighten monitoring and analysis website. PRODUC TIVF Maximum energy production Resilient to dust, debris and shading Performance monitoring per module RFI:ABLF - MTBF of 365 years System availability greater than 99.8% No single point of system failure SMART - Quick & simple design, installation and management - 24/7 monitoring and analysis MICRO-INVERTER TECHNICAL DATA Input Data (DC) Recommended input power (STC) 230W Maximum input DC voltage 54V Peak power l~acking voltage 22V- 40V Max. DC short circuit current 12A Max. input current 10A Output Data (AC) Maximum output power Nominal output current Nominal voltage/range Extended voltage/range Nominal frequency/range Extended frequency/range Power factor Maximum units per branch Efficiency Peak inverter efficiency CEC weighted efficiency Nominal MPP ~'acking Mechanical Data Operating temperature range Night time power consumption Dimensions (WxHxD) Weight Cooling Enclosure environmental ratin9 Features Communication Warranty Compliance 230W 54V 22V- 40V 12A 10A 190W 190W 920mA 800mA 208V/183V-229V 240W211V-264V 208V/179V-232V 240V/206V-269V 60,0/59.3-60.5 60.0/59.3-60.5 60.0/59.2-60.6 60.0/59.2-60.6 >0.95 >0.95 21 15 95.5% 95.5% 95.0% 95.0% 99.6% 99.6% -40°C to +65°C -40°C to +65°C 30mW 30mW 8" x 5.25" x 1.25" 4.4 lbs Natural Convection - No Fans Outdoor - NEMA 6 Powedine 15 Years UL1741/IEEE1547 FCC Part 15 Class B Enphase Energy, Inc. 201 1st Street, Suite 300, Petaluma, CA 94952 8777974743 New York Solar Solutions LLC ;[530 Rocky Point Rd. Middle Island, NY 11953 1-888-350-SOLAR www.newyorksolarsolutions.com 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 MEMORANDUM To: Jill Doherty, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: June 9, 2010 Re~ Proposed Wetland Permit for JAMES VAVAS SCTM#1000-53-6-6 New York Solar Solutions, LLC on behalf of JAMES VAVAS requests an Administrative Permit to install (30) Suntech solar panels and Enphase inverters totaling a system size of 5,250 watts onto the roof of the existing dwelling. Located: 3085 Bayshore Rd., Greenport. SCTM#53-6-6 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 EXEMPT from coastal consistency review pursuant to § 268-3. Definitions, item II which states: II. Additions to an existing building or rebuilt residential structure which results in no net increase in ground area coverage, except where the parcel is located in a coastal erosion hazard area; 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 All M. Doben'y' President james F. King, Vic~-Pr~sident Bob Ohosio, Jr. John B~icm~cr Town Hall, $3095 Main Rd. P.O. Box ! ! 79 Southold, NY li97! TeJRohon e (631 ) ?65-1892 F~ (631) 7r~-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Oaly ..__Coastal EroSiOn Pr, trait Applicago.~ __Wotlaad Permit Application ~/ Admimshativ¢ P~'mit / Amendmimlc/"l'r a~ f:p-I F~x IADsio n __~,Received Appticatien: ~ /~] /O ~__Received Fee:$ ~'~ ~ t .~Completed Applicatien~ __..lncomplc~ __SBQRA Classification: ~ l~Typc II U~lis~cd Coordixm~ion;(d~c sent:) · ._~CAC Referral S~nt:, . ,Date of lnsp~fioa: ~Rec~p~ of CAC Rcport:.· ~Lead Agency Determiaaden: Tccl~ical Review: ~ublic Hearing HeM: .__~olution: dUN - 3 20~0 =~ Southhold 1own Boqrd of T~u~tees 'Name of Applicant ~'/r~ler~ Suffolk ~tytax Map N~b~: 10~- Y3 - ~ - 6 (pre,dc L~CO Pole ¢, ta~ ~ ~oss s~cc~, ¢ (If applicable)" t / 1-5/~ - qq6- 00¢3 ~B 39~d S33£~ai 30 (]~t~'0fl IPgB§gz. IE :9I Land Arca(~uluarc~): Area Z0~ng: GENERAL DATA Previous use of property: Intended use of property: Covenants ~nd Restrictions: If"Yes", plcase provide copy. Yes / No Docs this project require a variance from the Zoning Board of Appeals __ If"Yes", please provide copy of decision. Prior permits/approvals for site impwvt~n~nts: Ago.,~cy ' Dat~ '~ No __ No prior permits/approvals for site improvements. Has any perm/t/appwval ever been revoked or susp~gd~ed by a governmental agency? ,/No Yes If yes, provide explanation: Project Description (usc attachments if necessary): E0 39~'d S331S~1 ~0 ~0~ I~99S9Z. Ig:0I Board of Trustees Application 'WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the pr°posed operation: ~bblT-t~J OF / Area of wetlands on lot: square feet Percent coverage of lot: 0 % Closest distance bctween nearest ~xisting slruct[tre and upland edge of wetlands: .A./33, 5' feet Closest dis 'lance between nearest proposed structure and upland edgeofw~qlands: 75'/l" feet 7~ Butg-ttotO Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? ?J/~ cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: A//,,$ Proposed slope throughout the area of operations: ,A/~ feet Marm~' in which material will be removed or deposited: reason of such proposed operatiom (u~e attachments if appropriate): ~0 "49Td SSBISR~I .:lO (~OB I~'99§9/ Ig:OI O[OZILII§O PROJECT ID MJMBER )ART 1 - PROJECT INFORMATION 6t7.20 ' :" APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( 'ro ~e completed by A ~lk;ant or Project Sponsor) 2. PROJECT NAME Cm]nty 1. APPLICANT I SPONSOR 3,PROJECT LOCATION; 4. PRECISE LOCATION: ~et Adde~ ~nd~d ~S, IS PROPOSED ACTION: SEQR $, DESCRIBE PROJECT BRIEFLY: ~9 ,,v,/P,.. $ inlllally ultimately ' ac~es B, WILVPROPOSED ACTION CO WITH EXISTING ZONING OR OTHER RESTRICTIONS? IS PRESENT LAND USE JN VLCINI'FY OF PROJECT? (Choose as many as ap~ly.) [~]O[her (descriDe) enUal E~]h~lustrla, E~commerclal E~Agrlcullur. E-~Park/Fomsl/Op~nSpac. 10. DOES ACTON NVOLVE A PER~T APPROVAL. OR FUNDING: NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGE Y (Federal, StMe or Local) ~Yes ~]No If yes, ~ist egenw na~ and pe~it I approval: ~Y~ ~ If ~s, Iisi agency n~e a~ ~ I a~roval: ......... -~ ........ ~p~ ..... /~-p~ ................................................. 12,~esAS A ~T OF PROPOSED A~ION WILL ~IS~NG PERMIT/ ~PROV~ REQUt~ MODiFI~TION? , CERT,FY TNAT/ F ON PROV, DE0 . 0"': T AeOVE iS TRUE TO THE 6ES¥ OF MY KNOWLEDG~ If ~e actien ~ a Cos~i ~ea, an~ yea are a s~te complete the Coas~l Asse~ment Fo~ before ~ceeding with ~is assessmenl cO _RgVd S331SA~± ~0 Q~Oa [bgB§gL [~:0[ OZO~/L[/§O PART I! - ,IMPACT ASSESSMENT ~TD be completed by L~d Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If ye~, ~ordinate the review proc=~ and use ~he FULL FAF. [] Yes [] Ne B. WIlL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, P..,d:~T 61 ?.67 If No. a negative do~daration may be superseded hy another Involved agency. r-lY- C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be ban~written, if legible) C1, Existing ak quality, surface or groundwater quality o~ quantity. ,-,oise levels, oxJstJnl~ traffic paUem, s~d wasle production or dlepo~al, poterfi~l fix' erosion, drain~3e or fk~dlng problems? Explain briefly: I' I Ca. vegetation or fauna, f~.h, ~ho~ir, h er wildlife ap.;i~, ~ni~;r~i ho~al~ ~ ~hreaio~,~-~ e~:langweb splice? Explain brlelty:,. C4. A com~nmlty'a, e)defln,g p~n~ ?r,.goaIs as officially a~opted, cra change, in uea or Imea~dty e,~ uee OI laflci o~ omar neural resource*? ~xplaln briefly: D, WILL THE PRO.AECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAl. ENVIRONMEN"rAL AREA (CEA}? I[[f,~. s, ?x~la in b. riall~: E. iS THERE. OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONME,NTAL IMPACTS? II y~s explain: PART Ill - DETERMINATION OF StGNiFICANCE (To be comf)lete~t by Agency) INSTRUCTIONS: F~re~ch~dversee~ectidenti~ed~b~ve~de~ermine~hetheri~iesubst~n~ja~ge~mp~rta~t~r~the~#i~e~i~nificanL EaCh effect should be assessed in connection with its (a) setting (i.e. urban or rural); (bi probability of occurring; (c) duraUon; (d) irreversibility; (e) gengmphic scope; and (f) magnttude~ if necessary, acid otlachmento or re~[arence supporfincj mater[als, En~ure ~hat explana~10r,$ co. rain su~clent detail t~ show that ali relevant adverse, impacts have been identified and adequately add~. If question d of part ii was checked Name of Loed AGency Dal~ '/"Title of Responsible OffiC~,r Signature of Preparer (tt different from Board of Trustees Application County ofS~f~ ~l'~ Sta~e of New York BEING DULY SWORN . DEPOSES AND Al;FIRMS THAT HE/SM IS THE APPLICANT FOR THE ABOVE DESCR1BED.PERIvtlT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/H~R KNOWLEDGE AND BEI.rI~.~, AND THAT ALL WORK W~LL BE DONE IN TI-~E MANNER SET FORTH.IN THIS APPLICATION AND AS MAY ~o~,~ ~o ~o~ ~ow~ o~ ~o~o~ ~ ~ ~o~ ~.~s _ ~/ Signature SWORN TO BEFORE ME Tills o~-~g~' DAY OF /do.-/ ,20 Ic~ Public, Sta~e of New ¥or~ No. 1,1 -- 4880731 N0tsry ~ubli~om)nissio. Exp. Dec. 1 fi, ~0~/.~ ~,~lifi~d ~n Kin~s Count~ .~ LO 39Vd S3'~IS{~!tl AO (IBV0fl I1~99~ IZ:0I OIOglLl/§O ~oaxd of A~THOI~XZA_~ION (where the applicant is not the owner) "('print owner of property) (mailing address) do hereby authorize (Agent) to apply for permit(s) from'the Southold~oard of Town Trustees on my behalf. Owner's signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE. FDRM The Town of Southold's Code ofEthlcs nmh~bir; conflicts oir inter~t on the oar~ of lo~vn 6flicors and ~molov=es. Thc ma'nome of t~i$ ~rm l; rio ~ovide in fo~'n ntion which a~n alert tho ~own at'~sihl~ ~on~ic~s ofiotom~t and allow it ~n ~d/e whnt~ver a~tion is t~a i . (L~t name, £~nl n~r~,m~kile initial, unl~ :y'o~ ~ q~lyiog imi lt~ nnm~ of ~r~n's Or ~m~y's n~c.) NAME OF APPLICATION: (CJ~eck all that apply.) T~x D'i~vanc~ Building V~-ianc~ Tms~e Chmn$~ of Zone Coastal Erosion Ap~wl 0l'pla~ O~r ~ you ~na{ly (or Ih~0uSh yo~ comfy. ~. ~61{~. ~ o~ child) ~ a ml~p wi~ ~y officer or ~pioyee Name often ~mployed by lhe Town of Sou~oid T}~e br ~sifion of ~h{i D~i~ ~he mlafio~h}p ~lweea yours~[f(~ ~ppli~n~rcpm~n~ve) ~d ~c town o.ffi~r o~ employe~. Either ch~ck ~; appm~m~c linc A) ~hrou~ D) ~or dc~ in ~hc A) ~ owner of ~a~r ~ ~% o~ sh~ of ~e ~c stuck uf~ a~l~A ~) ~ ~al app{imnL DE~R~I~ OF ~LATIONSH~ ' Form TS i ~,- 6~ BDVd S331sn~i Ho GMVO8 I~99§9Z Ig:OI OlOg/LI/SO Town of $outhold LWRP CONSISTENCY ASSESSMENT FORM A, INSTRUCTIONS All appl~caa~ £or permits* including Town of Southo[d agencies, shall compl~ ~s CC~ for ~o~ acfiom ~t ~ subject ~ ~e Town of Sou~ld Wa~om Con~st~cy Renew Law. T~s ~ses~nt i~ ~ m s~l~t o&er ~fom~ion ~ by a To~ of Sou~ld ~eney ~ ~ a de--on of ~i~y. *~cept mi~r exempt actiom i~l~ing Buildi~ Permi~ a~ other min~terial ~mits not located within the Corn?al Emsion H~d ~rea. Before answe~ving the questions in Section C, lira preparer of this form should review the exeml~ minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A urovosed action will be evalu_-~zd as to its ai~ifieant beneficial and adverse effects uvon the con. al area (which includes all of Southold .Town). Ifm~y question in Section C on this form is at~vered "yes" or "no", that the pro~d ~n ~1 ~ect ~e a~ev~ent of ~e L~ policy st~d~ ~d condifio~ ~n~d ~ ~ co~s~ ~cw law. Thru, ~ch ~er must be exgl~M h dq~ l~g bo~ SUOOO~g and non* SUDDO~ hC~ ~ ~fion ~ot ~ e~fi~ m comi~t ~ ~e L~ ~licy ~ md ~n~fion~ it s~t not ~ ~de~. 'A copy of thc LWRP is available' in the following places: online at ~he Town of Southold ' s wcbsitc (southoldtown.norflffork.net), the Board of Trustees Office, the Plamfing Department, all local libraries and the Town Clerk*s office. B. DESCRIPTION OF SITE AND PROPOSED ACTION The Application has been submi~ed to (check appropriate response): TownBoard [] Planning Board ~-] Building Dept. [] BoardofTrustees ~ Catego~ of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by ToTM agency (e.g. capital [] consnxacfion, planning activity, agency regulation, land transaction) [~ Co) Fi~ncial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: [~ Nature and extem of action: ti 399d S331S~1 30 ~0~ I~99§9L I~:OI 010~/£I/S0 l-~alion o faction: Site acreage: Present land use: Pr~cnt zoning classification: If an appUcation for thc proposed avfion has been filed with th~ Town of Southold ag~cy, the following information shall be provided: (a) Nameofapplicant: · ~e~ (c) Telephone number: Area Code ( ) (d) Application number, if any: Will the action be directly undertaken, require limding, or approval by a state or federal agency.* Yes [~ No ~ If yes, which stat~ or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not $upport the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form bc returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of S0uthold that enhances community character, preserves open space, makes effident use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III- Policies; Page 2 for evaluation criteria. [] Yes [] No ~Not Applicable At.ch additioaal ~b. ect~ if nece~ary Policy 2. Protect and pr~e~e h~toric and a~ha¢olo~c~ r~ources of the Town of Sou~old. S~ ' LW~ Section HI - Po~ies Pag~ 3 through 6 for ev~uation criteria ~ Yes ~ No~ Not Applicable Attach additional sheets ifne¢¢ssar~ Policy 3. Enhance visual quali~y and protect scenic resources throughout the Town of Southoid. See LWRP Section H/- 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 IH - Policies Pa~ges 8 through 16 for evaluation criteria [] Yes [] No[-~ Not Applicable A~ach addigonal sheets if nceessary Policy 5. Protect and improve water quality and supply in the Town of $outhold. See LWRP Seefioa Ill - Policies Pages 16 throu~gh 21 for ~valuation criteria ~ Yes [] No~l---I Not Appheable" Atlach additional sheets if neeessary ' Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems includi~ Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section ~ - Policies; Pages through 32 for evaluation criteria. Yes No Not Applicable PolitY 7. Protect and improve air quality in the Town of Southold. See LWRP Section HI - Policies Pages 32 through 34 for evaluation criteria. Yes [] Non-~ Not'Applicable Attach additional sheets if necessary Policy 8. Min~m~e environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP. Section IH - Policies; Pages 34 through 38 for evaluation criteria. [] Yes ~ No ~Not Applicable PUBLIC COAST POLICIES PolitY 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 HI ~ Policies; Pages ;38 through 46 for evaluation criteria. ~-~ yz_J~ No ~/Not Applicable Attach additional shccts 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 Ill- Policies; Pages 47 through 56 for evaluation criteria. [] Yes [] No ~Not Applicable A~tach additional shoe~ if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the PcconJc Estuary and Town waters. See LWRP Section IH - Policies; Pages 57 through 62 for evaluation criteria. [] Yes [] No ~/Not Applicable Auach additional sheets if necessary policy 12. Protect agricultural lands, in the Town of Southold. See LWRP Section I~ - Policies; Pages 62 through 65 for eva~uation criteria. ~ Yes [] No ~'~ Not Applicable An~ch 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 PREPARED BY TITLE §~ 39Vd S331sn~i 30 68~0fl IPggGBi IE:0I 0~08/lI/g0