The URL can be used to link to this page

Home My WebLink AboutTR-7309 Jill M. Doherty,President ��F soar O� y0l Town Hall Annex Bob Ghosio,Jr.,Vice-President h O 54375 Main Road James F. King 41 lx[ P.O.Box 1179 Southold, New York 11971-0959 Dave Bergen G Q John BredemeyerO • �� Telephone(631) 765-1892 l�CnUNV Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0642C Date May 10, 2011 THIS CERTIFIES that the second-floor dormers onto the existing dwelling and autters, leaders & drywells At 3050 Minnehaha Blvd.- Southold Suffolk County Tax Map #87-3-41 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 4/22/10 pursuant to which Trustees Wetland Permit#7309 dated 5/19/10 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 Second-floor donners onto the existing dwelling and gutters leaders &drvwells The certificate is issued to ALLISON TUPPER owner of the aforesaid property. A torized Signature Jill M. Doherty,President �D �6' Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President tiy'� P.O. Box 1 179 James F. King p y Southold,NY 11971 Dave Bergen Telephone(631)765-1892 John Bredemeyer y�0 �a� Fax(631)765-6641 111 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: k CERTIFICATE OF COMPLIANCE: 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 (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 V/ Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD; NEW YORK PERMIT NO. 7309 DATE: ~ ISSUED TO: ALLISON TUPPER PROPERTY ADDRESS: 3050 MINNEHAHA BOULEyARD, SOUTHOLD SCTM# 87-3-41 AUTHORIZATION ' Pursuant to the provisions of Chapter 2'/5 and/or Chapter 111 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board °fTrastees ad01~d at the meeting held on May 19. 2010. and in consideration of application fee in the sum of $250.00 paid by Allison Tu~l~er and subject to thc Terms and Conditions as stated:in the ResblutiOtl, the Southold TOWn BOard, of Trustees authorizes and: Pe~it~ the following: Wetland Permit to construct second-floor dormers onto the existing dwelling, with the condition of the installation of gutters and leaders to drywells to contain roof runoff and in accordance with Chapter 236 of the Town Code-St6i'm Water Runnoff, ang! as depicted on the site plan prepared by ~Peconic Permit Expediting, last dated April 22, 2010, and stamped approved on May i9,2010. IN WITNESS :WHEREOF, the said Bo~d of Trustees h~reby cause~ its Corporate Seal to be affixed, and theso presents to be subscribed by a majority of the said Board as of this date. TERMS AND CONDITIONS The Permittee Allison Tupper, residing at 3050 Minnehaha Blvd., 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 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 authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. 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 f~ilure 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 May 19, 2010 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Robert Lehnert Peconic Permit Expediting 32045 Main Road Cutchogue, NY 11935 RE: ALLISON TUPPER 3050 MINNEHAHA BOULEVARD, SOUTHOLD SCTM# 87-3-41 Dear Mr. Lehnert: The Board of Town Trustees took the following action dudng its regular meeting held on Wednesday, May 19, 2010 regarding the above matter: WHEREAS, Peconic Permit Expediting on behalf of ALLISON TOPPER applied to the Southold Town Trustees for a permit under the previsions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Towri of Southold, application dated Apdl 22, 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, in accordance with Chapter 268, said application was found to be Exempt from the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on May 19, 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 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 approve the application of ALLISON TUPPER to construct second-floor dormers onto the existing dwelling, with the condition of the installation of gutters and leaders to drywells to contain roof runoff and in accordance with Chapter 236 of the Town Code-Storm Water Runnoff, and as depicted on the site plan prepared by Peconic Permit Expediting, last dated Apdl 22, 2010, and .stamped approved on May 19, 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: $50.00 Very truly yours, President, 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 1179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (63 I) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: 11;5o,', ff,er Please be advised that your application dated I~t9¢'; [ a,~,~ cO, O/E) has been reviewed by this Board at the regular meeting of t~/9. ,6201t3 and your application has been approved pendin9 the completid'n of'the following items checked off below. __ Revised Plans for proposed project __ Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ Ist Day of Construction ($50.00) __ ¼ Constructed ($50.00) V// Final inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above, COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ ,-~ o9- BY: Jill M. Doherty, President Board of Trustees Peter Young, Chairperson Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (631) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., May 12, 2010, the following recommendation was made: Moved by Greta Schiller, seconded by Peter Young, it was RESOLVED to SUPPORT the Wetland Permit application of ALLISON TUPPER to construct second-floor dormers onto the existing dwelling. Located: 3050 Minnehaha Blvd. Southold. SCTM#87-3-41 Inspected by: Greta Schiller, Peter Young The CAC Supports the application with the Condition gutters, leaders, and drywells are installed contain roof run-off. Vote of Council: Ayes: All Motion Carried Jill M Dohelty, President James F. King. Vice-President Dave Bergen Bob Ghosio. Jr. John Bredemeyer 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: Peconic Permit Expediting on behalf of ALLISON TUPPER requests a Wetland Permit to construct second-floor dormers onto the existing dwelling. Located: 3050 Minnehaha Blvd. Southold. SCTM#87-3-41 ssaOf area to be impacted: Itwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Town Code proposed work falls under: t.275 Chapt. 111 other Type of Application: [~Wetland __Coastal Erosion __Administrative__Emergency Pre-Submission __ __Amendment Violation Info needed: Modifications: Conditions: Present Were: __~J.King __J~_'_~.Doherty __"~J. Bredemeyer __ B.Ghosio, D. Dzenkowski other Form filled out in the field by t'~D. Bergen~ Mailed/Faxed to: Date: NEW YORK STATE DEPAR~ENT OF ENVIRONMENTAL CONSERVA~ON Facility DEC ID 1-4738-03576 PERMIT Under the Environmental Conservation Law (ECL) Permittee and Facility Information Permit Issued To.'. MARK FRIEDMAN 585 WEST END AVE APT 12F NEW YORK, NY 10024-1715 (917) 601-9992 Facility Application Contact: PECONIC PERMIT EXPEDITING INC 32645 MAIN RD CUTCHOGUE, NY 11935 (631) 734-8361 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Facility: FRIEDMAN PROPERTY 3050 M1NNEHAHA BLVD]SCTM# I000-87-3-41 SOUTHOLD, NY 11971 Facility Principal Reference Point: NYTM-E: 716.207 NYTM-N: 4546.147 Latitude: 41°02'16.3" Longitude: 72°25'40.3" Project Location: WATERCOURSE: COREY CREEK Authorized,Activity: Construct two second floor dormer additions. All work must be in accordance with the 2 page plan prepared by Boulevard Planning P.C. Architects dated 10/21/09 last revised 2/25/10 and stamped NYSDEC approved 4/5/10: Permit Authorizations Tidal Wetlands - Under Article 25 Permit ID 1-4738-03576/00002 New Permit Effective Date: 4/5/2010 Expiration Date: 414/2015 NYSDEC Approval By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, and all conditions included as part of this permit. Permit Administrator: JOHN A WIE.,L~D, Deputy Region~strator Address: NYSDEC P~,G'ION 1 HEADQU/MLQ'ERS / SI.~ ~t~/ONY BROOKI5~IRCLE RD / STQNY/B, ROOK, NY 117.90 -3.4o09 ./ Auth°rized Signature: ~////k..~/ ~~_~. J// Dat~//60~ [ ~ Page 1 of 5 View of Existin~ House from Dock View From House Towards Creek Friedman Residence .~0_ 0 Minihaha Blvd. Southold, N.Y. OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cot. 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: MarkTerry, Principal Planner ~ LWRP Coordinator ' \- Date: May 14, 2010 Re: Proposed Wetland Permit for ALLISON TUPPER SCTM# 1000-87.-3-41 Peconic Permit Expediting on behalf of ALLISON TUPPER requests a Wetland Permit to construct second-floor dormers onto the existing dwelling. Located: 3050 Minnehaha Blvd. Southold. SCTM#87-3-41 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 LWRP review pursuant to' § 268-3. Definitions. MINOR ACTIONS item "11" 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 Cc: Lori Hulse, Assistant Town Attorney OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cot. 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: From: Leslie Weisman, Chair Members of the Zoning Board of App.~s MarkTerry, Principal Planner ~ LWRP Coordinator MAY 17 2010 Date: May 17, 2010 Re: Coastal Consistency Review for ZBA File Ref. ALLISON TUPPER #6377. SCTM# 1000-87-3-41. ALLISON TUPPER #6377. Request for Variance from Code Section 280-116B, based on an application for building permit for additions and alterations, and the Building Inspector's November 19, 2009, updated Mamh 1, 2010 Notice of Disapproval concerning additions and alterations to existing dwelling, at less than the code required setback from bulkhead of 75 feet; at 3050 Minnehaha Blvd., (adjacent to Corey Creek) Southold, NY. SCTM#1000-87-3-41. 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 determination that the proposed action is EXEMPT from LWRP review pursuant to: ,268-3. Definitions. MINOR ACTIONS item "11" 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; The parcel is not located within the Coastal Erosion Hazard Area. Cc: Jennifer Andaloro, Assistant Town Attorney Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Brederneyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application ~Wetland Permit Application Administrative Permit RcR__AmendmentFFrans f~r/Extension eceived Application:~[/a~Q eceived Fee:$ O~5'O ~o, ompleted Application q ] Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) ~ Consistency Assessment Fora ~.'CAC Referral Sent: '31 | ,-~ate of Inspection: Receipt of CAC Report: Lead Agency Determination:__ Technical Review: ~,/Public Hearing Held: ~ }l ~. ] I L~ Resolution: Name of Applicant Address Phone Number:( Suffolk County Tax Map Number: 1000- b"~ Property Location: ~tg~~a''t9 /~ / Dor~ (provide LILCO Pole #, distance to cross streets, and location) (If applicable) Address: Phone: 73 Lrd of Trustees Ap~ Land Area (in square feet): Area Zoning: ~ - 4 ~7 Previous use of property: Intended use of property: GENERAL DATA Covenants and Restrictions: Yes )~ No If "Yes", please provide copy. Prior permits/approvals for site improvements: Agency Date 7 __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? )< No__ Yes If yes, provide explanation: Project Description (use attachments if necessary): of Trustees Ap~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose ofthe proposed operations: Area of wetlands on lot: O .square feet Percent coverage of lot: ] 3-, ~ % Closest distance between nearest existing structure and upland edge of wetlands: '3 7. ~ feet Closest distance between nearest proposed structure and upland edge of wetlands: ~ttg. ~ feet Does the project involve excavation or filling? X No Yes If yes, how much material will be excavated? A///9 cubic yards How much material will be filled? /lY/~ cubic yards Depth of which material will be removed or deposited: /V/t~ feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: 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): ~rd of Trustees Ap~ COASTAL EROSION APPLICATION DATA Purposes of proposed activity: fJft~-t~ ~don~,~ Are wetlands present within 100 feet of the proposed activity? No /~ Yes Does the project involve excavation or filling? )( No Yes If Yes, how much material will be excavated? /~/,~ How much material will be filled? /~, ?~t} Manner in which material will be removed or deposited: (cUbic yards) (cubic yards) Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) ~oard of Trustees ApplicatiOn County of Suffolk State of New York ]~t~ ~ .~r-¢ ~ .~ ~ //~r- ~L BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH 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), I~ GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE SWORN TO BEFORE ME THIS ,~(-5q7~ DAYOF t/~F'~,c_ ,20/0 PI=CONIC PERMIT EXPEDITING E~u~ldmcj / DEC / Variance / Marine 32645 Main Road · Cutchogue, NY 11935 E-Mail peconicpermilsS*loptoalin¢.nct Ph 631.734.8361 · Fx 631.734.2276 March 19, 2010 Board of Town Trustees Town of Southold P.O. Box 1179 Southold, NY ! 1971-0959 To Whom It May Concern, This letter is to authorize employees of"Peconic Permit Expediting Inc." to act as my agent in obtaining a permit from the Southold Town Trustees. If you have any questions, please feel free to call me at any time. Respect fu, J~ yours, Marl Fried~n & '~ Allison Tupper - Property Owner Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Brcdemeyer Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (631) 765-1892 Fax (63 I) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of ALLISON TUPPER COUNTY OF SUFFOLK) STATE OF NEW YORK) I, /Qa~'t't~ 7L //'t't~'t'.'p , residing at /dba being duly sworn, depose and say: AFFIDAVIT OF POSTING That on the/] ,2010, I personally posted the property known as day °f/l~nfi/JoS-O mtrt t }1~ ~6 n~ ~f ) ,/~ 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.~ May 19, 2010 on or about 6:00 PM. Dated: Sworn to before me this day of/Tt~ 20~ ~ Notary Public NO. ~ in ~ c:o~nty MY Commission Ixgkel August 0~, PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL ~ Greenlawn, N.Y. 11740 ~Doliveu esconset, N.Y. 11767 Hempstead, NY, e, Garden City, NY, Total Postage & Fees $ $5.54 05105/2010 ~;~i~;"'"~ ......................................................................... i~ (~ ~) D y~ ............ E~6 Domestic Return Receipt 102595-02-M-1540 4 , : _ ~:~.~,* Cutchoque Ps For~ 3811, February 2004 , being duly sworn, deposes and says that on the 5 _ day of May ,20 10, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at Cutchogue (certified) (registered) mail. that said Notices were mailed to each~M persons by Sworn to before me this Day of P-"[r~c~ , 20/O Notary Pu,~ic PETER R. MCOREEVY NOTARY PUBLIC-STATE OF NEW YORK NO. 02MC6131514 Qualified In Suffolk County My Commission Expires August 0~, 20~ /~' 11550 11530 PROJECT ID NUMBER 'ART 1 - PROJECT INFORMATION 1. APPLICANT / SPONSOR 3.PROJECT LOCATION: 617,20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2. PR.~.OJECT NAME 4, PRECISE LOCATION: Street Addess and Road Intersections, Prominent landman~s etc -or orovide mae SEQR 5. IS PROPOSED ACTION: [] New [] Expansion ~ Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: r/cc," 7. AMOUNT OF LAND AFFECTED: Initially #~ acres Ultimately '* ~-~'~* acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [] Yes [] No If no, descdbe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as manyas apply.) r~Residential []Industrial [--]Commercial DAgficulture r~Park/Forest/OpenSpace r-]other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) r~Yes No list agency name and permit / approval: ] If yes, 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ]Yes []No if yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ~]Yes ~[]No I CERTIFY THAT THE/INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/ Sponsor Namej~;.~.,) ...,,¢'~-- ¢t~ --~.~. / ~ ~,~ ? Date: ,~ ~-,?.,~.. If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL FAF. []Yes []No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwdttan, Jf legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, exis§ng traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain bdefly: C2. Aesthetic, agdc~ltaml, amhaeslogicel, histodc, or other nataml or cultura~ resources; or oommuntiy or neighborhood eharactaff/~plain C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or thmatanad or endangered species? Explain briefly: C4. A community's existing plans or goals as ofr~ially adopted, or a change in use or intensity of use of land or other natural resources? Explain bdefly: C5. GraPh, subsedu~nld~¥elopm~nt, or mtstad acti~ties likaly to be inducad by tbs proposed action? Explain bdofl¥: C6. Long ten% short term, cumulative, or other effects not idestified in C1-C57 Explain briefly: C7. Other impacts {inciudin~l changes in use of either ~uanffi~ or t~pe of ener~}/? Explain bdefl}/: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITrCA[ ENVIRONMENTAL AREA (CEAI? (If ~,es, exptsin bfiefl}/: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If }/es explain: r~Yes j~]No I I PART Ill - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (al setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irrevemibility; (el g~3grephic scope; and (fl magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been 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 characteristics of the CEA. Check this box if you have identified one or mom potentially la~ge or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or pmpem a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actio~ WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporlfog thi determination. ~--- /~ ~,-,--/~ Name of Lead Agency ~-~ ~'"~/r?'~-~-D~a~~ /~ature of Responsible Officer in Lead~,.~ncy Title of Responsible Officer Signature of Preparer (if different from responsible officer) Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended ~o supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus~ each answer must be explained in detail~ listing both supporting and non- suooortin~ 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 SCTM# '~- 7 I - 30 PROJECT NAM~ "~t/ ~' /~'¢~ / ~ The Application has been submitted to (check appropriate response): TownBoard [-~ Planning Board ~ Building Dept. [] Boardofirustees 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) [--] Co) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: p£~ ~ ~1~ ,~r~ t~ Location of action: 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 ofapplicant: ~ II t (c) Telephone number: Area Code (). (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? C. Evaluate the project to the following policies by analyzing how the project wffi further support or not support the pOlicies. Provide aH proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. Yes [] No ~ Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section HI - Policies Pages 3 through 6 for evaluation criteria ~ Yes [--] No ~ Not Applicable Attach additional sheets if necessary Policy 3.- Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section IH -Polieies Pages 6 through 7 for evaluation criteria Yes ~ No ~. Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III -Policies Pages 8 through 16 for evaluation criteria ~ Yes ~ No ~ Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria Yes ~ No I.~. Not Applicable 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. Protect and improve air quality in the Town of Southold. See LWRP Section IH - Policies Pages 32 through 34 for evaluation criteria. [] Yes [] No .~_ Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. ~ Yes [] NO .~- Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section IH - Policies; Pages 38 through 46 for evaluation criteria. ~-~ Yes~ No~ Not 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 [-~ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peeonie Estuary and Town waters. See LWRP Section IH - Policies; Pages 57 through 62 for evaluation criteria. [-~ Yes ~-~ No V-~ Not Applicable AVach 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. [] Yes ~ No ~ Not Applicable APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethins nrohibits conflicts of interest on the nart of town officers and emulovees. The ouroose of ~is form is to m-ovide inforination whLh can alert the town of ~ossible conflicts ofll~st and allow it to rake whatever action -- -t void ,e. (Last name, first name,~iddlc initial, unless you am applying in the name of someone else or other entity, such as a company. If so, indicate, the other person's or compeny's name.) NAME OF APPLICATION: (Cheek all that apply.) Tax grievance Building Variance Trustee ~ 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 thmngh your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or bu~inass interest "Business intere~ means a business, ineinding a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a coq0oration in which the town officer or employee owas 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 persoo employed by the Town of Southoid Title Or position of that person Describe the relationship between yourseff (the applicunt/ngent/representative) 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, paint, or child is (check all that apply): A) the owner of greater than 5% of the shares of the corporate stock of fha applicont (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a ann-corporete entity (when thc applicant is not a corporation); __.C) an officer, director, partnei', or employee of the applicant; or __D) fl~ actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Sonthold's Cod~ of I~thlc~ orohibits conflicts of interest on the ~art of town 0fficors and emnlovee$. The nomos~ of this form is to orovide information which can alert the town of nossible conflic'ts of interest and allow it to take whatever action is {Las~aff~ first anm~. ~niddi~ initial, unless you ~ applying in me name o~ sumennc ¢is¢ or other entity, such as a company. If $o, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all fliat apply.) Tax grievance Building Variance Trustee -~ Change of Zone Coasad Erosion Approval of plat Mooring Exemption from plat or official map Planning Other Of"Other-~, nan~ the nctivity.) Do you pemonally (or through your company, spouse, sibling, parent, or child) have a relationship ~:ith any officer or employee of the Town of Southold? "Relationship" includes by blond, marriage, or bu.dmss interest "Business in tmv,.nt~ means a business, including a parmership, in which thc town officer or cmployc~ has even a partial ownership of (or employment by) a corporation in which thc town officer or employee owns more than 5% of the shares. YES NO X If you answenM "YES", complete the balance of this form and date and sign where indicated, Name of person employed by the Town of Sonthold Title Or position of that person Describe the relationship he.ann youtseff(the applicant/agent/representative) and the town officer or ernployus. Either check the appropriate line A) through D) and/or describe in the space progid~d. The town officer or employ~ or his or her spouse, sibling, parent, o~ ~hild is (chnck all that apply): A) the owner of grea~r than 5% of the sha~s of the corporate stock of the applicant (when the applicant is a cotl}orotion); __B) die legal or bencfi¢inl owner of any interest in a non-corporate entity (when the applicant is not a corporation); __C) an officer, dither, partner, or employee of the applicant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I . S u bmitted 'thi~,-,/Jt~9 d~,*A 9~ ~ / 5UR%4E¥ OF PROPER'I"' 51TUA"I'~: ~IN~, IqATER. TOI,~IN, 5~gUTHOLD .SUI=t=OLK C.,OUN'r'K, .50t~'vlE"f'ED, AU®. II, 200q SUFFOLK C. OUN'r'f TAX # IOOO - ¢"'/ - ~, - 41 AL1LI'SOI~ NOTES= · MONUMENT FOUND ~ ~ ~t, 0 PIF~ FOUND ~ ~ Fq~,OF~ERT¥ LIES INSI~ FLeD ZO~ AE (EL~') ~ ~ TIED ~0 THE ~ CONTO~ ~ k~ FLOOD ZONE LI~ A5 ~FE~N~ TON~ 2q ~A~M - ~ ~ ELEVATIONS .FE.NCE N~VD ~ ~ 5 5 ®P, APHIC, E~C.,ALE I"= 20' 5.0 x 5>k5 5A5 ,4 5.3 3 6 EAST MAIN STRHET N.Y.S. [1(. NO. 50202 RIVERHEAD, N.Y. t 1901 369-82,58 Fax 369-8287 REF.\\Coml aqscr~ er\pros\09\0 ¢- 146.pro 5.5 x X 6,5 X PP..OF'OSED SECOND PLOOP-. DOP-.MEP-. ADDITION CHANGES, EXCAVATION, PROPOSAL. LEGEND TG-TOP OF GRATE ELEV. PLOT PLAN <CATCHB^SN; SCALE I" = I0'-0" TC - TOP OP CURB ELEV. 72.5 - EXISTING SPOT ELEV. 5,1 .I X X ELF' ELP x UNPAVED 5TONE / X 5.5 , ~ . NOYR: YBRRE WiLk 5B NO Q~DE C~ FILLI~Q, OR CLEARINQ IN NST - NEW SEPTIC TANK NLP - NEW LEACHING POOL NDW - NEW DRYWELL 72.5 FD(ISTING CONTOUR~ --W W EXISTING WATER SERVICE NEW GAS 5EP-,.VICE -- E E NEW U,G. ELECTRIC 5EP-,,VICE SITE AND ZONING DATA ZONING REQUIREMENTS R-40 ~I~TING CONDITION5 pROPOSED CONSTP-.UCTION AS PER I 00-244 LOT AP-.~A MAX 40,O00B.fi I I, 154 B.P. I I, 154 5.F. FRONT YARD SETBACK 35.0 FI- I 8 .G PT 18 .g PT REAP. YARD SETBACK 35.0 FT 37. g PT 40. G FT SIDE YARD SETBACK I 0.0 FT I 3. ~ FT I 4. 5 FT TOTAL ~ BOTH SIDES 2D,O FT 47. 7 PT 47. 7 FT MAX. GROSS FLOOR AREA 20% I 7G8 55 I 5. 8% 1768 BP I 5. 8% LOT COVERAGE AS PER 230g 5F 20. G% 230g SF 20. ~% NEW YORK STATE D.E.C MAXIMUM H~IGHT 35.0' PT! 20.0' PT 20.0' FT NEOJ B'-~)" DIA. 5TORJ'I DP. AIN SUBJECT PROPERTY 1DS m KEY MAP PROPOSED SECOND FLOOR ADDITION AT THE FRIEDMAN / TUPPER RESIDENCE 3050 M1NNEHAHA BLVD. SOUTHOLD, NY S.C.T.M. # 1000-87-3-41 REVISIONS AB PER N,Y.5. DEC 2-25- I 0 FOR BOUTHOLD TRUSTEED 4-22- I 0 DATE; APPROVED BY BOARD O1: TRUSTEES TOWN OF SOUTHOLD BOULEVARD PLANNING P.C. ARCHITECTS 671 FRANKLIN AVENUE GARDEN CITY, N.Y. FECONIC PERMIT EXPEDITING PHONE: G3 I .734.83G I TI-iESE PLANS AND SPECIFCATION S ARE INSTRUMENTS OF SERVICE AND ARE THE PROPERTY OF PECON[C PERMIT EXPEDITING INC INFINNGEMENTS WiLL BE PROSECUTED, DATE: 10-21-09 DR. BY: RWL SCALE: AS NOTED CHKD: 0911 A-1 ri n 26'-3" EXISTING BATHROOM E,~ISTING BEDROOM fliP-.ST FLOOR PLAN SECOND FLOOR PLAN J 41 i . iLO. SCALE,, = iLO,, SCALE 4 = PROPOSED SECOND FLOOR ADDITION AT THE FRIEDMAN / TUPPER RESIDENCE 3050 M1NNEHAHA BLVD. SOUTHOLD, NY S.C.T.M. # 1000-87-3-41 REVISIONS DATE; A5 ?EI~ N.Y.5. DFC 2-25- I 0 FOP-, 50UThlOLD TRUSTEE5 4-22- I 0 BOULEVARD PLANNING P.C. ARCHITECTS 671 FRANKLIN AVENUE GARDEN CITY, N.Y. 50UTH ELEVATION I . iLO. SCALE e, = P..E A P-.. ELEVATION SCALE e, = I N 0 P-,.TH ELEVATION SCALE eI "= I'-0" PECONIC PERMIT EXPEDITING PHONE: 43 I .734,83G I THESE PLANS AND SPECIFCATIONS ARE INSTRUMENTS OF SERVICE AND ARE THE I ROPERTY OF PECONIC PERMIT EXPEDITING 1NC, INFRINGEMENTS WILL BE PROSECUTED.~ ~ DATE: 10-21-09 DR. BY: R W L SCALE: AS NOTED CHKD: PRO~ECT NUMBER 0911 I