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Home My WebLink AboutTR-7374 Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0698C Date October 25, 2011 THIS CERTIFIES that the extension of the existing bedroom and adjacent deck, enclosure of the exiting porch, and installation of gutters, leaders and drvwells At 100 Dean Dr., Cutchogue Suffolk County Tax Map #116~4-3.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 7/28/10 pursuant to which Trustees Wetland Permit #7374 dated 8/18/10 was issued and conforms to ali of the requirements and Conditions of the applicable provisions of law. The project for which this certificate is being issued is for Extension of the existing bedroom and adjacent deck, enclosure of the existing porch, and installation of gutters, leaders and drywells. The certificate is issued to RONALD & EILEEN BREUER owners of the Aforesaid property. A h~riz~ Sig~natur~e Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (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 ~? Project complete, compliance inspection. INSPECTED BY: ff~- ~'J~-.~_~ COMMENTS: CERTIFICATE OF COMPLIANCE: Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY II971 Telephone (631) 765-1892 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 Project complete, compliance inspection. INSPECTED BY: COMMENTS: 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 I 179 So~thold, 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 V/ Pre-construction, hay bale line __ 1st day of construction ½ constructed ~/' Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7374 DATE: AUGUST 18 2010 ISSUED TO: RONALD & EILEEN BREUER PROPERTY ADDRESS: 100 DEAN DR.~ CUTCHOGUE SCTM#116-4-3.1 AUTHORIZATION Pursuant to the'provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meedng held on Aueust 18.2010 in consideration of application fee in the sum of $250.00 paid by Ronald & Eileen Breuer and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to extend the existing bedroom and adjacent deck; enclose the existing porch; and provide gutters, leade~ and drywells, with the condition a line of staked hay bales is installed prior to construction activities and maintained throughout construction, and as depicted on the survey last dated February 3, 2010 and stamped approved on August 18, 2010. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. TERMS AND CONDITIONS The Permittee, Ronald & Eileen Breuer, residing at 100 Dean Dr., Cutchogue, NY, as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released 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 Pennittee 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 [o 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 thc 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 $outhold. 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 ma~ 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 Hail Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 August18,2010 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. & Mrs. Ronald Breuer 100 Dean Dr. Cutchogue, NY 11935 RE: 100 DEAN DR,, CUTCHOGUE SCTM#116-4-3,1 Dear Mr. & Mrs. Breuer: The Board of Town Trustees took the following action dudng its regular meeting held on Wed., August 18, 2010 regarding the above matter: WHEREAS, RONALD & EILEEN BREUER applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance, application dated July 28, 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 Hearing was held by the Town Trustees with respect to said application on August 18, 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, 2 WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, and, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, and, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees has found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees APPROVES the application of RONALD & EILEEN BREUER to extend the existing bedroom and adjacent deck; enclose the existing porch; and provide gutters, leaders and drywells, with the condition a line of staked hay bales is installed prior to construction activities and maintained throughout construction, and as depicted on the survey last dated February 3, 2010 and stamped approved on August 18, 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:S100.00 Very truly yours, Jill ~'Doherty~ Board of Trustees JMD/Ims 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 Please be advised that your application dated ")/0-~/IO has been reviewed by this Board at the regular meeting of ~J~//~'//0 and your application has been approved pending the completion 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) 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: BY: Jill M. Doherty, President Board of Trustees Peter Young, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 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., August 11,2010, the following recommendation was made: Moved by Doug Hardy, seconded by Greta Schiller, it was RESOLVED to SUPPORT the Wetland Permit application of RONALD & EILEEN BREUER to extend the existing bedroom and adjacent deck; enclose the existing porch; and provide gutters, leaders and drywells. Located: 100 Dean Dr., Cutchogue. SCTM#116-4-3.1 Inspected by: Greta Schiller, Doug Hardy, Peter Young Vote of Council: Ayes: All Motion Carried Jill M Dohe~gy. 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 RONALD & EILEEN BREUER request a Wetland Permit to extend the existing bedroom and adjacent deck; enclose the existing porch; and provide gutters, leaders and drywells. Located: 100 Dean Dr., Cutchogue. SCTM#116-4-3.1 Type of area to be impacted: j.~.Saltwater Wetland __Freshwater Wetland Sound __Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: Jc_C, hapt.275 Chapt. 111 other Type of Application: c-'~Wetland __Coastal Erosion __Amendment __Administrative__Emergency Pre-Submission __Violation Info needed: Modifications: Conditions: Present Were: __J.King L/J.Doherty__J. Bredemeyer B.Ghosio, D. Dzenkowski other Form filled out in the field by D. Bergen__ Mailed/Faxed to: Date: A C OFFICE LOCATION: Town H~lAnnex 54375 State Route 25 cor. MainRd. & YoungsAve.) Southold, NY11971 MAILING ADDRESS: P.O. Box 1179 Southold, NY11971 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: August 16, 2010 Re: Proposed Wetland Permit for RONALD & EILEEN BREUER SCTM# 1000-116-4-3.1 RONALD & EILEEN BREUER request a Wetland Permit to extend the existing bedroom and adjacent deck; enclose the existing porch; and provide gutters, leaders and drywells. Located: 100 Dean Dr., Cutchogue. SCTM#116-4-3.1 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the denoted following Policy Standards and therefore is CONSISTENT with the LWRP provided the following: If the action is approved, to further Policy 5: Protect and Improve Water Quality in the Town of Southold and Policy 6; Protect and Restore the Quality and Function of the Town of Southold Ecosystem it is recommended that a minimum 30 foot natural ve.qetated buffer be required landward from the edqe of wetlands, where existinq ve.qetation occurs, includin.q re-ve.qetated areas. NATURAL VEGETATED BUFFER -- a land area of a certain length and width where existing vegetation occurs prior to the commencement of any grading or clearing activity. Vegetation shall be maintained to achieve a minimum percent ground cover of ninety-five (95) percent. To achieve the percent ground cover indigenous, drought tolerant vegetation shall be planted. Survival of planted vegetation shall be (ninety) 90 percent for a period of three (3) years. Maintenance activities within the buffer are limited to removing vegetation which are hazardous to life and property, trimming tree limbs up to a height of fifteen feet (15') to maintain viewsheds, replanting of vegetation and establishing a four foot (4') wide access path constructed of pervious material for access to the water-body Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney Jill M. Dgherty, President James F. Kit{g, Vice-Presldcnt Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095Main Rd. P.O. Box 1179 Southold, NY II971 Telephone(631) 765-1892 Fax(631) 765-6641 BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD Office Use Only .~wOaStal Erosion Permit Application etland Permit Application Administrative Permit ~'Completed Application~_~ Incomplete SEQRA Classification: Type 1 Type Il Unlisted Coordination:(date sent) .,/'~ILWRP Consistency Assessment Form Q ~"CAC Referral Sent: c} [ ~ate of Inspection: ~__!1[ [ Receipt of CAC Report: Lead Agency Determination: Technical Review: ..~ublic Hearing Held: ~! IR !l ~ Resolution: JUL 2 8 2010 S0uthh01d 10wfl Board 0t Trustees Name of Applicant Address Suffolk County Tax Map Number: Property Location: IO 0 7lA\ (provide LILCO Pole #, distance to cross streets, and location) AGENT: -- /~//~ (If applicable) Address: Phone: of Trustees Applicat Land Area (in square feet): Area Zoning:. '~ L ~ GENERAL DATA Previous use of property: Intended use of property: Covenants and Restrictions: If "Yes", please provide copy. Yes v'~ No Does this project require a variance from the Zoning Board of Appeals If "Yes", please provide copy of decision. Prior permits/approvals for site improvements: Agency Date Yes V~ No __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspenOed by a governmental agency? ~/ No Yes If yes, provide explanation: Project Description (use attachments ifnecessary): (,.see. of Trustees Applicatio~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose ofthe proposed operations: ~ ~'¢ ~c[ ~ ~ec~ V-O,~',-"- (.~'~' Area of wetlands on lot: Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands: I ~ O feet Closest distance betwee.!/n.&arest proposed structure and upland edge of wetlands: ~ ~ (11 feet Does the project involve excavation or filling? ~ No Yes If yes, how much material will be excavated? /v .~ .~.c cubic yards How much material will be filled? /,/.'~ cubic yards Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: ~ }*, Manner in which material will be removed or deposited: feet Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): PROJECT ID NUMBER SEQR PART t - 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. PROJECT NAME 4. PRECISE LOCATION: Street .Addess and Road Intarsecfiom Prominent landmarks etc -or provide mad I OD -b~,~v~ ~-~¥~z ~ C~c~5~~ ,AJ~' r~o¥~' ~ ~ ~lvz IS PROPOSED ACTION: ~ New ~Expansion ~ M~ifi~tion / .l~ration DESCRIBE PROJECT BRIEFLY: 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 bdefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) E~"~esidential []Industrial ~]Commercial r~Agriculture [~Park/Forest/OpenSpace [~Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) E~es r~No If yes, list agency name and permit / approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ]Yes ~ If yes, list agency name and permit / approval: 12. AS ARES~ESJ~_T OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ~as [3?No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant ,~I~Nz~ ~_~(~.~_~ Date:/ Signature 7 2..g / Z',3 / ~ 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. [X3E$ ACTION EXCEED ANY TYPE I THRE.~,'IOLD IN 6 NYCF~,R, PART 6t 7.47 if YeS, ~;~dbt~e the reMew p~-~_ _ _ _~ sr~l ~,e the FULL EAF. I--'1 Ye, B. WILL ACTION RECEIVE COORDINATED REVIEWA8 PROVIDED FOR UNU8TED ACllONS IN 6 NYCRR, PART 617.6? if No, a nega6ve C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED VtlTH THE FOLLOWING: (Ar~wers may be harch~d~mt, if leglfale) poten~d k~ ereskm, drainage or IkxMing probtems? Explain b~. I I C5. Growth, subsequent ~e~i,~,L o~ related ac~, likely to be Induced by ble propeaed m? ;: .-T~ bdefly: C6. Long term, short talin, cumulative, o~' ofllor e~b, not Ident~ed kl C,!-C57 F_~ln IMelly: ° '1 C7. ~ ;,T,i~,, Ilr, c;~;, ,,d ~;,.,,~,~ ib use o; e;~,~ quantity or t~oe of eneegy? ~:~!n ~ D. ¥~IU.'~"IE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICA]_ E. IS T'~;~.~ OR IS THERE UKELY TO BEt CONTROVERSy RELATED TO'POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? if PART ~1 - ~l =~mlINATION OF SIGNIFICANCE (To be completed by Agency) INS'IRUCTIONS: F~reach~dvarseeffect~denb~ed~b~ve~detenn~newhether~t~ub~tant~aL~n~n~ Each effect should be ass,=_,~,d_ in connection with Jte (a) setting (i.e. Urban or mini); (b) pmhabliity of o<~untng; (C) duration; (a') In'evar~biiity; (e) geographic agape; and (t) magn~de. If neeessmy, add al~:hments o~ reMmm~ supporting rrmter'mls. Ensure that exp~naUons contain md~::lent detail to show Ihat all relevant adverse impacts have been Identit~d and adequately addressed. If quesho~ d of part Il was checked yes. the determinatlo~ of significance must evaluate the potential Impact of the praposed action mi the envilxalrnmltal chare~ndsflc~ of the CEA EAF and/or prepare a posltl~.de~m'atlen. ~. Check this box ff you hava detemdned, based o~ the informaOon and analysle above e~ ~y ~ d~, ~t ~ ~ a~ WILL NOT result In any significant adw efwironmental Impacts AND pro,de, oft attac~ as necessaly, the masons euppo~ng 811= de{ermlnallon.. Board of Trustees Name of Lead Agency Jill M. Doherty ~dnt or Type I~me ~f Respo,n?:)l~ Officer in Lead Agency President Date Title of Responsible Officer Slgnatere of Preparer (If different from respons/ble officer) Jill M. Doherty, President Jamcm F. King, Vicc-Presidcnt 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 BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of RONALD & EILEEN BREUER COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING , residing at/dba /00 So~'thhold Town Board of Trustees being duly swum, depose and say: That on the q day of ~c>qt' , 2010, I personal.l~( posted !_he 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 heating. Date of hearing noted thereon to be held Wed., Aus, ust 18~ 2010 on or about 6:00 PM. Dated: (signature) Swum to betbre me this ! (49 day ~c~cafy Public tory Public - SI~'O of New York No. Ol S~33454 ?aiMed in Na~au Coun~ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS ~ Soard of T~rUstee$ NaTne: Address: STATE OF NEW YORK COUNTY OF SUFFOLK , residing at '00 ~,Lr~ )r O~,t3tChOh~d ~t{ , being duly sworn, deposes and says that on the ~' dayof ~/. ,20 / O, deponent mailed a tree copy ofthe Notice set fo'.in the'Board of ~/rustees 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 ~ '¢~,3 ~ N"/ , that said Notic~e,t.were mailed to each of said persons by (certified) (registered) mail. y /) . ~ Sworn to before me this. [ ~ Dayof~:~-.., ~ ,20_g° r[~P:;:V Public S,ate of New York 'qo 015133454 i~ooiified in Nassau Coun~ m c~.~i~ Fe~ 12.80 06 =[ ............. .C=.~_::~ ....... ~S...~.:.:~_.._.~ n ru Po~ $ $0.~ O~M? Board of Trustees Application County of Suffolk State of New York ¢ OW[l,, ~>T~D,_~r 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), 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 WITHW OF T PLICATION. co c ioN Signature SWORN TO BEFORE ME THIS HAY OF h ,20. r O x't~i6~dr~ ~ublic LAUREN M. STANDISH Notary Public, StBte of Nm ~ork No. 01ST6164008 Qualified in Suffolk County Commission Expires April 9. APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM · The Town of Southold,s Code of Ethlos v, ohibits conflicts of interest on tbe oast of town officers and emalovees- The n~se °f ~his form is to nrovide inforination which can alc~ the town of oossible conflicts of interest and allow it to take whatever action is necassarv to avoid same, (Last name, first name, ~alddle initial, unless you are applying in me mu,,¢ or someone e se or other entity, such as a company, lfso, indicate the other person's or company's anme.) NAME OF APPLICATION: (Check 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 through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Sonthold? "Relationship" includes by blOOd, masdage, or business interest. "Business interest'? means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO & If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself (the applieantJagent/represe nt ative) 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, parent, or ~hild is (check all that apply): A) the owner of greater than 5% of the shams of the corporate stock of the applic,~nt (when the applicant is a corporation); ___B) the legal or beneficial ownqr of any interest in a non-corporate entity (when the applicant is not a corporation); __.C) an officer, director, pastoei', or employee of the applicant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Signature Print Name"g-cn~'~ & Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A O O O I J (> ~ I~ ~L [ STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN }istrict section BlOCk o~tt CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION l'll~t~# / WORK2t~'SS~-aSSM~iT I Yes No a. What is the Total Ama of the Project Parcels? (IncludeTotalAreaofallPamelslocatedwithin ~t~ ~ ~j,1= I WillthisProjectRefeinAJlStorm-WaterRun-Off Generated by a Two (2") Inch Rainfall on Site? the Scope of Work for Proposed Construction) ('~is item will include all run-off created by site (&F. I Acres) b. What is the Total Area of Land Cleedng cleadng and/or construction activities as well as all -- and/orGroundDisturbancefortheproposed ~ g6 SiP Site lrnprovements and the permanent creation of consbection activity? impervious surfaces.) (s.F. t Aces) 2 Does the Site Plan and/or Survey Show NI Proposed PROV]I)E BRIEF PROJECTI' DESCRIPTION {pro,de Add,tonal Pages as Needed) Drainage Structures Indicating Size & Location? This Item shall include at/Proposed Grade Changes and __ 6 h ..I 5 4 S,opesCo.t o,,.gSu.aceWate F,ow. ,/~ t4 .,~ e,l ~C,¢, ,Jr . (j~O) 3 Dee' the ORe Plan and/°r Survey describe the er°si°n practices 4~- (-'~, ~ control site erosion andstorm water discharges. This -- and sediment control that will be used to ~'y~. ~qr~O_ II, XI~i'~I~ ~O~{C-~ II "P,,¥o.~.!,(~(~ Constructi0nitemmustbemaintainedthr°ugh°uttheEntlrepedod. c[~'¼m0 [{ '{..~r ~'~3 'l{ .d~g/~'c~,n qbZ., 4 Will this ProJect Requiro any Land Filling, Gradingor · E-I gll ,~'oi J v~,:~ ,w ~ Sr,-~eI w~ ii Excavation where thore is a change to the Nater*l · ~ . Existing Grade Involving more than 200 Cubic Yards __ of Matedal within any Parcel? m O, % 'V~.Tq , V~ -~ I O1' ~. I n~'(~ 3¥ j-~_~) , 5 Will this Application Reduire Land Oisturbing Activities ?'e,~'~ldE (, I'~'~. *'~ hC'r3 b,l~'..~ Encompassing an Area in Excess of Five Tnousend (5,000 S.F.) Square Feet of Ground Sun'ace? 6 Is there a Natural Water Course Running through the Site? IsthisPmjectwithintheTrusteesjudsdiction~ __V General DEC SWPPP Requirements: or within One Hundred (100') feet of a Wetland or Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one (1) or more acres; including disturbances of tess than one acre that 7 Will there be Site preparation on Existing Grade Slopes ~ / are pad of a larger comrne~ plan that will ultirnate~ disiu~ one or more acres of land; which Exceed Fifteen (15) feet of Verlical Rise to including Construction activitiss involving soil disturbances of less than one (1) acre where One Hundred (100') of Horizontal Distance? -- the DEC has determined that a SPDES permit is required for storm water discharges. SWPPP'~ Shall meet the Minimum Requirements of the SPDES General permit 8 Will Driveways. Parking Areas or other Impervious r~ ,/ for Storm Water Discharges from Construction activity. P.nait NO, GP-O-tO~0t.) Sur[aces be Sloped to Direct Storm-Water Run-Off V 1. ~e SWPPP shall be prepared prior to the submittal of the NOI. The NOI sha~l be into and/or in the direction of a Town fight-of-wa.y?[~J -- submitted to the Department prior to the commencement of construction activity. 2. lhe SWPPP shall describe the erosion and sediment control practices and where 9 Wit/this Project Require the Placement of Matedal, required, post-constoJction stem water management practices that will be used and/or Removal of Vegetation and/or the Construction of any I I constructed to reduce the po[~utents In storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder identify potential sources of po~ution which may reasonably be expected to affect the STATE OF NEW YORK, COUNq~Y OF ........................................... SS That l ......... ..~......0~.......~....~.....~.~...~.~ .......................... being duly sw6m, deposes and says that he/she is the applicant for Permit, (Name of individual signing Document) And that he/she is the ~ Owner and/or representative of the Owner or Ovmers, and is duly autho45,ge, i~t,O ltel: ~ar~[ have performed the said work and to make and file this application; that all statements contaioed h, this apR~_~l~ ~o£his knowledge ~md belief; and that the work will be performed in the manner set forth io the applicati9,n' ..f..~d~..O!EI~_~_. I1~00~ ' · uuamed in Suffol Sworn to befo me this; · - .............. d -~--. ..................... day of.-~/.~..~.t,':-]. .......................... 20./.~ / / 2'/ /~ ~ Notaly Pub~(,Z~ ...fL ......~.......~..~..~TLI ....................... ~ '~,t'~[; .......................... FORM - 06110 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 Wateffxont Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Sonthold 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 supoortin~ 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 scm# ! g q - 7, ] PROJECT NAME /~ efi ~ ~ ¥ I I,* e The Application has been submitted to (check appropriate response): TownBoard [] PlaaningBoard~ Building Oep,. ~] BoardofTrustecs Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital (b) (c) construction, planning activity, agency regulation, land transaction) Financial assistance (e.g. grant, loan, subsidy) Permit, approval, license, certification: [~ Nature and extent of action: LSat, ~,~q t~3i~ ~c~ Site acreage: ], ~ q ~¢Ve Present land use: ~J~e~ ,d 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) Nameofapplicant: ~'~<[d ~ Et'l~dld '~'~'weLt~V" (b) Mallingaddress: I 0 0 '~{~tlv,,. "-~rlV-q j C.~Ce~[-,~t~e! Mx/ IIq'2~'-~ (c) Telephone number: Area Code ([g~ 14 ~1 q - "7/~ ~g (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 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 I. 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 A~ach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria [] Yes [] No ~/Not Applicable 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 HI - 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 throu~/~ 21 for evaluation criteria [] Yes [] No~/NmNot 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; eval~eriteria. Yes No Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. ~'~ Yes ~ No ~/~ot 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 III - Policies; Pages 38 through 46 for evaluation criteria. ~ Yes~ No ~Not Applicable Atlach 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 ~3/~ot Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ~-] Yes ~ No ~Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - 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 enerIo' and mineral resources. See LWRP Section HI - Policies/Pages 65 through 68 for evaluation criteria. I lYes ] INop'l Not Applicable DATE "7/~-'7 NEW ADDITION TO CEILINO CLOSET BATH JUL 2 8 .'.'~ 3 Southhofd Town Board of Trustees EXISTING LIVING ROOM q EXISTING BEDROOM WEST ELEVATION DEAN DRIVE Project 100 Dean Drive, Cutchogue, NY ~11935 Ronald & Eileen Breuer Event # 1 2 3 4 5 6 7 8 9 10 11 12 Proiect Activities Develop conceptual design Develop Drawings & plans Bid out project with Contractor File for permits with DEC and obtain approval File for permits with Southold Town and obtain approval Select Contractor & develop contracts for Dean Project Construction Phase Monitor and inspect prospect by agencies and owner Complete Construction Restoration of site DEC & Southold Town final Inspection of site Ready date June July Au.qust X ........ X X-----X × ............ X × ............ × ............ × Sept Oct Nov X X--X X X SURVEY OF PROPERTY SITUA T£D A T CUTCHOGUE TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-116-04-3.1 SCALE 1"=30' AUGUST 24, 1993 SEPTEMBER 14, 1995 (WETLANDS AREA) FEBRUARY .3, 2010 STAKE 75' WETLAND SETBACK LINE AREA DATA WETLANDS 22,099+ sq. ft. AREA 0.506+ ac. UPLAND 62,463.77± sq. ft. AREA 1.434~ ac. 84,562.'77 sq. ff. TOTAL AREA 1.941 ac. °/ / / / / APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTHOLD DATE Project: Dean Drive Ronald & Eileen Breuer Notes: 1) Proposed extension = 672 sq/ft Existing house = 2,200 sq/ft Existing Driveway = 1,900 sq/ff Total 4,772 sq/ft Or 7.6% of Upland area 2) All soil left on site 3) No grading required 4) .,,.,. Indicates proposed extension ( 16 x 41 5) Existing porch enciosed front