HomeMy WebLinkAboutTR-7440A James F. K/ng, President
Bob Ghosio, Jr., Vice-President
Dave Bergen
John Bredemeyer
Michael J. Domino
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
# 0770C
Date July 12, 2012
THIS CERTIFIES that the reconstruction of the existing shed roof on the south end of the
dwelling changing the configuration to a gable end roof
At 815 Rabbit Lane, East Marion
Suffolk County Tax Map #31-17-18
Conforms to the application for Trustees Permit heretofore filed in this office
Dated 12/8/10_pursuant to which Trustees Wetland Permit #7440A was
issued on 12/15/10 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 reconstruction of the existing shed roof on the south end of the dwelling changing the
configuration to a gable end roof.
The certificate is issued to BRANKO PEROS owner of the Aforesaid property.
Au& SJg~ t~
James F. King, President
Bob Ghosio, Jr., Vice-President
Dave Bergen
- John Bredemcyer
Michael J. Domino
Town Hall, 53095 Main Rd.
P.O. Box I 179
Southold, NY 11971
Telephone (631 ) 765- f 892
Fax (63 I) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
DATE OF INSPECTION:
~ Ch. 275
Ch. 111
INSPECTION SCHEDULE
Pre-construction, hay bale line/silt boom/silt curtain
1st day of construction
¼ constructed
Project complete, compliance inspection.
INSPECTED BY:
COMMENTS:
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 1197t
Telephone (63 I) 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
½ constructed
Project complete, compliance inspection.
Jill M. Doherty, President
James F. King, Vice-President
Dave Bergen
Bob Ghosio, Jr.
John Bredemeyer
Town Hall Annex
54375M~nRoad
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.: 7440A
Date of Receipt of Application: December 8, 2010
Applicant: Branko Peros
SCTM#: 31-17-18
Project Location: 815 Rabbit Lane, East Marion
Date of Resolution/Issuance: December 15, 2010
Date of Expiration: December 15, 2012
Reviewed by: Trustee John Bredemeyer
Project Description: To reconstruct existing shed roof on south end of dwelling
changing configuration to a gable end roof.
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
plans prepared by Garrett A. Strang, Architect dated November 22, 2010.
Conditions: N/A
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 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
TO:
Please be advised that your application dated 10. I ~ ] 10 has been
reviewed by this Board at the regular meeting of ~ ;,.3.1_ I _~"~]10 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)
__ ½ 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: $ ~-(_O. C)O
BY: Jill M. Doherty, President
Board of Trustees
Jill M. Dohegty. President
James F. King, Vice-Presidenl
Dave Bergen
Bob Ghosio, Jr.
John Bredemeyer
P.O Box 1179
Southol& NY 11971
Telephone (631 )765-1892
Fax (631) 765-6641
Southold Town Board of Trustees
Field Inspection/Worksession Report
Date/Time: /°""/dE//~} lq:/'O
BRANKO PEROS requests an Administrative Permit to reconstruct existing
shed roof on south end of dwelling changing configuration to a gable end
roof. Located: 815 Rabbit Lane, East Marion. SCTM#$1-17-18
Type of area to be impacte/¢(
__Saltwater Wetland t/Freshwater Wetland Sound Bay
Distance of proposed work to edge of wetland
hapTOWn Code proposed work falls under:
t.275 Chapt. 111 other
Type of Application: __ Wetland __Coastal Erosion ~Amendment
__Administrative__Emergency Pre-Submission __Violation
Info needed:
Conditions:
/
Present Were: __J.King __J.Doherty '/J. Bredemeyer
B.Ghosio, D. Dzenkowski other
Form filled ou.~t in the field by ~/
Mailed/Faxed to:
Date:
D. Bergen__
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: December 8, 2010
Re:
Proposed Wetland Permit for Branko Peros
SCTM#1000-31-17-18
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:
I1.
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
Jill M. Doherty, President
James F. King, Vice-President
Dave Bergen
Bob Ghosio, Jr.
John Bredemeyer
Town Hall, 53095 Main Rd.
P.O. Box 1179
Southold, NY 11971
Telephone (63 I) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
__Coastal Erosion Permit Application
Wetland Permit Application t,,,~Administrative Permit
Amendment/Transfer/Extension
-.~R-eceiv~d Application; I 0-1 ~ [ ~ ~
~_..R'-eceived Fee:$ ,~%'~ ~'
"C'6mpleted Application~
__Incomplete
__SEQRA Classification:
Type I Type II Unlisted
Coordination:(date sent)_
~[?NRP Consistency Assessment Form-- /.T~ I1~
~--~WAC Referral Sent: ~
-~'Date of Inspection: I ~ ~(!/~c~
__Receipt of CAC Report:
__Lead Agency Determination:__
Technical Review:
~Pablic Hearing Held: I ~
Resolution:
Name of Applicant
Address ~ [ ~ 5-4-- /~ [ ~ r~4
/]~ ~ / / / O Z- Phone Number:( )
Suffolk County Tax Map Number: 1000- ~ ( ,-- /.7
(provide LILCO Pole #, distance to cross streets, and location)
(If applicable)
Address:
Board of Trustees Application
Land Area (in square feet):
Area Zoning:
Previous use of property:
Intended use of property:.
Covenants and Restrictions:
If "Yes", please provide copy.
GENERAL DATA
p-,fO
Yes
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
~No
t~No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspendfld2by a governmental agency?.
t/ No Yes
If yes, provide explanation:
Project Description (use attachments if necessary):
Board of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:
Area of wetlands on lot: d~.f:-~.,~/~.-' .square feet
Percent coverage of lot: ~ frrt,.. ,,~ %
Closest distance between nearest existing structure and upland
edge of wetlands: ~Sv~r~,~.o/~ t/.~ feet
Closest distance between nearest proposed structure and upland
edge of wetlands: t~r~/.~vp feet
Does the project involve excavation or filling?
&'~No Yes
If yes, how much material will be excavated?
How much mater/al will be filled?
Depth of which mater/al will be removed or deposited:
Proposed slope throughout the area of operations:
Manner in which material will be removed or deposited:
cubic yards
cubic yards
feet
reason of such proposed operations (use attachments if appropriate):
Board of Trustees Appl:
County of Suffolk
State of New York
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
PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.
Signature
SWORN TO BEFORE ME THIS ~r/~ DAYOF.~(.~,/~Ct ,20/~
// NotaryPubl~c /
(~F. xr~res July 31,~ o/~,
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
STORM-WATER, GRADING~ DRAINAGE AND EROSION CONTROL PLAN
D~trlct section ,lock Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
SCOPE OF WORK - PROPOSED CONSTRUCYION fFEM# / WORK.ASSESSMENT [
Yes
No
a. What is the Total Area of the Project Pamels?
(Inclede Total Area of all Parcels located wi~in c4~.~' 1 Will this Project Retain NI Starm-Water Run-Off
the Scope of Work for Pmpesed Construction) ¥ ~',~ I ~ Generated by a Two (2") Inch Rainfall on Site?
b. What is the Total Area of Land Cleadng (s.C. / t,~s) ('rhis item will include all run-off created by site
clearing and/or construction activities as well as all
and/or Ground Disturbance for the proposed Site Improvements and the permanent creation of
construction activin/? /f.)/.4/~ impervious surfaces.)
(s.F.,~,,,) 2 Does the Site Plan and/or Survey Show All Proposed
PROVIDE BRIE~ PROJECT DF~CRIFYION 0"m~,,~,~aN~e DminageStmctaras Indicating Size& Location?This
item shall include all Proposed Grade Changes and
/.~ ~'/uj3'7'f-'z ~,( ~- ~ ,'< ( b ~//~ <~ ~',~'/~' Slopes Controlling Surface Water Flow.
//~g~'/~ .~./tJ ~O~J ?'~,Y /~/U.ff ~,z.~ /-f////~',~ 3 D°estheSitePlanand/°rSurveydeschbettmemsi°n
and sediment control practices that will be used to
control site erosion and storm water discharges. This
~/7~x)?~/4/5 (~,.~1 7~./47~***~,~7~.c~ ~'~ itammustbemaintathedthroughouttheEntim
Construction Pedod.
/f.v r- 4 Will this Project Require any Land Filling, Grading or /
/~'t ~ .-'3 ?,4.2/.p~ !(. t/~-/~ ~ /~/~//~ ~r~, Excavation where there is a change to the Natural O V/
Existing Grade Involving more than 200 Cubic Yards __
,' · of Material within any Parcel?
7 ~/~
Encompassing an Area in Excess of Five Thousand
v
(5.000 S.F.) Square Feet of Ground Surface? --
6 Is there a Natural Water Coume Running through the ~
Site? Is this Project within the Trustees jurisdiction
~eneral DEC SWPPPRequirements: ., orwithinOneHundred(100')feetofaWetlandor --
Submission of a SWPPP is required for oil Construction activilies involving soil Beach?
disturbances of one (1) o~ more acres; Inclnding disturbances of less than one acm that 7' Will there be Site preparaUon on Existing Grade Slopes ~
are part of a larger commo~ pla n that will ultimately disturb one or mom acres of land; which Exceed Fifteen (15) feet of Ve~cal Rise to
U
/
Including Construction activities involving soil disturbam:es of ~ than one (1) acm where One Hundred (100') of Horizonta~ Distance?
the DEC has determined that a SPDES permit is required for storm water dlschan:jes.
t. TEe SWPPP shall be fxebared prior to the submittal of the NOI. The NOI shall be into and/or in the direction of a Town right-of-way?
2. The SWPPP shall describe the erosion and sediment contn31 practices and where 9Will this Project Require the P~acement of Matarlal,~
V
constructed to reduce the pollutants In storm water discharges and to assure Item Within the Town Right-of-Way or Road ShoulderL,TU
STATE OF NEW YORK, .,~,,',
COUNTY OF ...:= .~...~.:/-~..c...~ ....... SS
That I, .....~...~.~.r.~.'~...i...~.../..~../.'~..~..~../.~..~:.. being duly sworn, deposes and says that he/she is the applicant for Pcnnih
And that he/she is the .......... .~.....~.C~....(...~..~.Q...~..~......~.....~..]..¥...~.....C~.... .............................................................................
Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have performed the said work and to
make and file this application; that all statements contained in this application are n'ue to the best of his knowledge and belief; and
that the work will be performed in the ~/n~anner set forthjn the application filed herewith.
Sworn to before me this; /"~4.,~ / ~_~'./]
................ ..7...........~'5 ................. day~cJ..r.]..~f/.:..~.../ .¥.¢_~ ..~., 20.../..~ ~/~ __
ll~'bara fi. Stranfl
No~q~y Public NOT;~I~ PUBEIC, New York ~ ,
FORM - 06/10 No. 4730095
Qualified - Suffol~ County
Comm. xpires July
PROJECT ID NUMBER
617.20
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
PART 1 - PROJECT INFORMATION ( To be completed by Applicant or Project Sponsor)
1. APPLICANT / SPONSOR 2. PROJECT NAME
3,PROJECT LOCATION: ,~/~--~,,~.~.~.~://-- K '~
Municipali~ .~'~ ~ d c ~ ~g ~. ~ Coun~ )~/~/~ ~ ~
4. PRECISE LOCATION: S~eet Addess and Road Interse~ons, Prominent landmass etc -or provide map
~. ~S PROPOSED ACT~O~: ~New ~ ~pansion ~ Modi~on ~ alteration
SEQR
6. DESCRIBE PROJECT BRIEFLY:
7. AMOUNT OF LAND AFFECTED:
Initially acres ~e ~ ~*
Ultimately
S. WILL OPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
~Yes [] No If no, describe briefly:
9. WH T IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.)
~Residential ~llndustdal J~]commercial r---IAgriculture i-'--IPark/Forest/OpenSpace J~1Other (describe}
]v1Yes r~No If yes, 1st agency name and permt / approval:
11.UL)I:J5 ,ANY~IY A,'.~A' ECl OF rile ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
~Yes ~o If yes, list agency name and permit / approval:
12. AS A RESET OF PROPOSED ACTION WILL
~iSTING
PERMIT/
APPROVAL
REQUIRE
MODIFICATION?
~ No
I CERTIFY THAT THE '"FO~ATION PROVIDED ABOVE IS TRUE TO THE 8EST OF MY K~OWLED~E
Signature /~~
/
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 ~o be completed by Lead A~enC~ *
~ u~q:u ACTION EXCEED N~rf TYPE I TNRESHOLD IN 6 l%h'(A~, PART 617.47 ff Ye~, cooniinate the review process and use the FULL EN:.
B. V~U-ACTIO~m:~r-wECOORDINATEDREVIEWASPROVIDEDFORUNUSTEDACTIONSiN6~P~617.~ IfNo, anegMive
C. OOULD ACTION RESUCT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Nlswe~ may be ~, If legible)
· ,,~ , Ihmate~dorondangemd ~__.__? briefly:.
C6. Leng tenn, shqd term, cumulative, or other efl~s not ;~iG~ed in C1-C57
C7. Olher, lm~,,~.~indudir~ c~r,a~ in use of either quar~lt~ or I~pe of onef~?
D WIIJ. I~IE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTA'L CHARACTERISTICS THAT CAUSED THE ESTABUSHMENT OF A CRITIC/'
PART III - b~:; r=r~aiiiA'ik,~ OF $iGiiiF~,a, NCE (To be completed by Agency)
INSTRUC110N$: Forsechadvar~eelfectklentifiedabeve, defennlnewhelherl~lssubstanllal, large, lmportont.orolherwtseslgn*E~cant. Ead~
efire~t shouM* be a~sed in oonnec~)n with its (a) setting ('ce. urban or mini); (b) probability of occurring; (e) durab~on; (d) in*mmr~, (e)
geographic scope; and (t) magnitude. If necsesery, add attachments or reference supporting materials. Ensure that explana~ms contain
mA~:lent detail to show that ail relevant adverse Impacts hava been identified and adequately addressed. If quselkm d of part il was checked
WILL NOT result In any slgnBcant adverse em,~ronmental Imlm~ts AND provflJe, on attaeho~rite as nece~____~_ry, the masons sUppo~ ~
determinailon..
Board of Trustees
Name of Lead Agency Date
Jill M. Doherty ' President
Prl~ or Type Name of Responsible Officer in Lead ,~3ency
'rifle of Responsible Officer
Signature of Responsible Ofrmer in Lead Agency 8;Uik~UiU of Preparer (If diltemn~ from respondbte officer)
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE. FORM
The Town of Southold's Code of Ethics vrohibits conflicts of interest on the lrart of town officers and emolovees. The oumoSe of
this form is to orovide information which can alert the town of~ossible conflicts of interest and allow it to take whatever action is
neeessarv to avoid same.
(L~t n~rne, first na~e,~niddle initial, unless you are applying in the name of
someone else or other entity, such as a oompany If so, indicate the other
person's or company's name.)
NAME OF APPLICATION: (Check all that apply.)
Tax grievance Building
Variance Trustee
Change of Zone Coastal Erosion
Approval of plat Mooting
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 Southold? "Relationship" includes by blood, marriage, or buslness 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 t,~ares.
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 applicant/agent/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, parent, or ~hild is (check all that apply):
A) the owner of greater than 5% of the shares of the corporate stock of the applic0nt
(when the applicant is a corporation);
__B) the legal or beneficlal owner of any interest in a non-corporate entity (when the
applicant is not a corporation);
__C) an officer, director, partner, or employee of the applicant; or
__D) the actual applicant.
DESCRIPTION OF RELATIONSHIP
Form TS 1
Submitted this
Signature
Print Name
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
All applicants for permits* including Town of Southold agencies, shall complete this CCAF for
proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This
assessment is intended to supplement other information used by a Town of Southold agency in
making a determination of consistency. *Except minor exempt actions including Building Permits
and other ministerial permits not located within the Coastal Erosion Hazard Area.
Before answering the questions in Section C, the preparer of this form should review the exempt
minor action list, policies and explanations of each policy contained in the Town of Southold Local
Waterfi'ont 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 dctafl~ listing both supporting and non-
su~oortin~ 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# ~( ['2 / ~
PROJECT NAME ~/7~ ~
The Application has been submitted to (check appropriate response):
TowaBoard ~ Planning Board [-] Building Dept. ~ BoardofTrustees
Category of Town of Southold agency action (check appropriate response):
(a) Action undertaken directly by Town agency (e.g. capital
construction, planning activity, agency regulation, land transaction)
(b) Financial assistance (e.g. grant, loan, subsidy)
(c) Permit, approval, license, certification:
Nature and extent of action:
Location of action:
Site acreage:
Present land use:
~'?/c' ~'~ z
Present zoning classification:
If an application for the proposed action has been filed with the Town of Southold agency, the following
information shall be provided:
(a) Name of applicant:
Co) Mailing address: 3/-5~P~
(c) Telephone number: Area Code
(d) Application number, if any:
Will the actio~ undertaken, require funding, or approval by a state or federal agency?
Yes [-~ Nolt~ ifyes, which state or federal agency?
C. Evaluate the project to the following policies by analyzing how the project will further support or
not support the policies. Provide all proposed Best Management Practices that will further each policy.
Incomplete answers will require that the form be returned for completion.
DEVELOPED COAST POLICY
Policy 1. Foster a pattern of development in the Town of Southold that enhances community character,
preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and
minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation
criteria.
[-]Yes
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See
LWRP Section III - Policies Pages 3 through 6 for evaluation criteria
Yes NoApplieable
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 ~NotApplicable
Attach additional sheets if necessary
NATURAL COAST POLICIES
Policy 4.
Section III - Policies Page/s 8 through 16 for evaluation criteria
Yes ~ No la[Not Applicable
Minimize loss of life, structures, and natural resources from flooding and erosion. See LwRP
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
~-~NotApplicable /~ /.~/~/~T~ ~ /~ ~e/~.~/~
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 J~Not~plicflble
Attach additional sheets if necessary
Policy 7.
Pages 32 through 34 for evaluation criteria.
[--] Yes ~ No V~ot Applicable
Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies
Attach additional sheets if necessary
Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous
substances and wastes/See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria.
[] Yes ~--] No~ Not Applicable
PUBLIC COAST POLICIES
Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public
resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation
criteria.
r-] Yes~ No V--~Not Applicable
Attach additional sheets if necessary
WORKING COAST
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.
V-~ Yes ~-] No ~Not 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 ~/NNot 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 ~on criteria.
[] Yes ~ No L~I Not Applicable
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Section III - Polic~ges 65 through 68 for evaluation criteria.
[] Yes ~-] No~L~ Not Applicable
Sep, 13. 2010,d1:18AM ~/_THE IIH~I~I(I: UKUur
BUDDING PLANNING DESIGN CRITERIA
Design Loads Ground Wind Seismic
Live Snow Design
Load Expo,ute Category
Subject to Damage From
Weathering Frost Line Termite Decay
Alteration
Single Family Residence
GENERAL PROJECT DATA
R - 3 21 feet 85 sq. ft,
Construction Type I , Design Criteria
V- b AF&PA WCFM 1995
H ~hWnd Ed t on
Flood
Hazards
AE-eL 6'