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Home My WebLink AboutTR-7634 Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town HallAnnex 54375MainRoad P.O. Box 1179 Southold, New York 11971-0959 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 ~ constructed Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7634 DATE: AUGUST 24, 2011 1SSUED TO: 8925 LLC PROPERTY ADDRESS: 8925 BAY AVE., CUTCHOGUE SCTM#104-3-15 AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold with the Resolution of the Board of Trnstees adopted at the meeting held on Au~,nst 24.. 2011 application fee in the sum of $500.00paid by 8925 LLC 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 for a 4'X 24' open-grate catwalk, seasonal 3'X 20' ramg 20' floating dock, electric and water, and with the condition of a 30' non-turf buffer landward of the wetland boundary, and as depicted on the survey prepared by John T. Metzger dated February 22, 2011 and stamped approved on September 21, 2011 plans prepared by Peconic Permit Expediting last revised September 6, approved on September 21, 2011. IN WITNESS WHEREOF, the said Board of Trnstees 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 Thc Permittee, 8925 LLC, 8925 Bay Ave;, Cutcllogu¢, 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 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 Pennittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Towx~ of Southold. The Permittea is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covema~ and deed restriction to the deed of the subject pamel. Such evidence shall be provided wilhin ninety (90) calendar days of issuance of this permit. That the said Board will be notified by the Permittee of the completion of the work authorized. 10. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. Jill M. Doherty, President Bob Ghesio, 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 August24,2011 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Robed Lehnert Peconic Permit Expediting 6700 Alddch Lane Mattituck, NY 11952 RE: 8925 LLC 8925 BAY AVE., CUTCHOGUE SCTM#104-3-15 Dear Mr. Lehnert: The Board of Town Trustees took the following action during its regular meeting held on Wed., August 24, 2011 regarding the above matter: WHEREAS, Peconic Permit Expediting on behalf of 8925 LLC 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 7, 2011, 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 recommended that the proposed application be found Inconsistent with the Local Waterfront Revitalization Program policy standards, specifically with Policy 6 - Protect and restore the quality and function of the Town of Southold ecosystem, Policy 6.3 - Protect and restore tidal and freshwater wet/ands, and, WHEREAS, the Board of Trustees has furthered Policies 6 and 6.3 of the Local Waterfront Revitalization Program to the greatest extent practical through the imposition of the following Best Management Practice requirements: the removal of the flood light, the existing decking on the catwalk to be removed and replaced with open-grate decking, and a 30' non-turf buffer landward of the wetland boundary, and, 2 WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on August 24, 2011, 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, 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, NOW THEREFORE BE IT, RESOLVED, that for the mitigating factors and based upon the Best Management Practice requirements imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, RESOLVED, that the Board of Trustees approves the application of 8925 LLC for a 4'X 24' open-grate catwalk, seasonal 3'X 20' ramp and 6'X 20' floating dock, electric and water, and with the condition of a 30' non-turf buffer landward of the wetland boundary, and as depicted on the survey prepared by John T. Metzger dated February 22, 2011 and stamped approved on September 21,2011 and dock plans prepared by Peconic Permit Expediting last revised September 6, 2011 and stamped approved on September 21,2011. BE IT FURTHER RESOLVED, that the removal of the flood light and replacement of the catwalk with open-grate decking must be completed within 60 days from the date of this permit. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees:S806.00 Very truly yours, Jill Iyl'J Doherty, President BoaYd of Trustees JMD:lms 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 SOUTHOLI) Please be advised that your application dated r~/r) I1~ has been reviewed by this Board at the regular meeting of Ill and your application has been approved pending the com'pl~tion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1st Day of Construction ($50.00) ½ 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 (631 ) 765-I 892 Fax (631) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., August 17, 2011, the following recommendation was made: Moved by Doug Hardy, seconded by Jack McGreevy it was RESOLVED to SUPPORT the Wetland Permit application of 8925 LLC for the as-built 4'X 24' catwalk, 3'X 20' ramp and 6'X 20' floating dock. Located: 8925 Bay Ave., Cutchogue. SCTM#104-3-15 Inspected by: Audrey Horton, Jack McGreevy, Doug Hardy The CAC Supports the application, however, recommends a violation issued for the as- built. Vote of Council: Ayes: All Motion Carried Jill M Dohe~ly. President Bob Ghosio, Jr, Vice-President James F King Dave Bergen John Bredemeyer P.O. Box 1179 Southold, NY 11971 Telephone (631 765-1892 Fax (63t) 765-6641 Southold Town Board of Trustees Field Inspection/VVorksession Report 8925 LLC requests a Wetland Permit for the as-built 4'X 24' catwalk, 3'X 20' ramp and 6'X 20' floating dock. Located: 8925 Bay Ave., Cutchogue. SCTM#104-3-15 area to be impacted: ater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: 4,,~pt.275 Chapt. 111 other dof Application: ~Wetland __Coastal Erosion ministrative__E mergency Pre-Submission __Amendment Violation Info needed: Modifications: Conditions: Pr vt/ ~J. King 'res/ent Were: J. Doherty B. Ghosio V" J. Bredeme~'~r D. Dzenkowski other -- Form filled out in the field by D. Bergen, Mailed/Faxed to: Date: Lynda Lomangino Little Creek Cottage 8925 Bay Ave Cutchogue, NY 11935 June 6~n~ 2011 Board of Trustees of Southold Town I have recently purchased the property at 8925 Bay Ave and would like to transfer the dock pemfit into my name: 8925 LLC Enclosed is a cop3' of thc original permit. Thank You. Lynda Lomangino Manager of 8925 LLC LLT ~ , .... 0~li/20il 14:22 F~ $~15144089 SWC INC. Ro~ $&'Jv&COret Ctminot:ta S~'TH J :L04-03~015 1~003 ~::~ regular mleting"o£ ~y 30, 1992s ' lte. SOl:,'vZ.D tha~ 'abe Southold ~ow~2 ~]:d I~ ~ Mve ~ ~o~o~, pl~ give Very truly Presid~nt,- Bc~cd of Trus~es oc. Bui2d2ng Dept. ~ OOi BOA,ID OF TO~'T~Ur~ JoN - 6 ~ Trust~e$ Jill M Doherty, President Bob Ghosio, Jr, Vice-President James F King Dave Bergen John Bredemeyer P.O. Box I 179 Southold, NY 11971 Telephone (631 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/VVorksession Report Date/Time: Inspect the property of ANTHONY LOMAGINO for possible additional wetland code violations. Located: 8925 Skunk Lane, Cutchogue. SCTM#104-3-15 salOf area to be impacted: twater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: ~...Gfi'apt.275 __Chapt. 111 other Type of Application: /....--'~etland __Coastal Erosion __Amendment __Administrative__Emergency Pre-Submission Violation Info needed: Modifications: Conditions: Prese/nt-Were: b'/~l. Doherty t.--'f3. Ghosio ~ J. Bredeme'~r L./'/D, D~enkowski -- Form filled out in the field by C~ing __ other ~DcBergen, Mailed/Faxed to: Date: ~ MARTIN D. FINNEGAN TOWN ATTORNEY m ar tin.finnegan@town.southold.ny.us JENNIFER ANDALORO ASSISTANT TOWN ATTORNEY jennifer.andaloro@town.southold.ny.us LORI M. HULSE ASSISTANT TOWN ATTORNEY lori.hulse@town.southold.ny.us SCOTT A. RUSSELL Supervisor Town Hall Annex, 54375 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1939 Facsimile (631) 765-6639 OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD Mr. Peter Larson 89-25 Skunk Lane Cutchogue, NY 11935 October 19, 2010 RE: People vi Peter Larson Ticket No. A 5402 Dear Mr. Larson, Regarding our last conference in the above-referenced case, it was my understanding that you were considering submitting an application to the Office of the Trustees for a permit for the as-built deck. The Trustees indicated that they would accept hand-written drawing depicting the deck on a survey if you were not inclined to get a new survey done for the purposes of making an application to the Board. The Justice Court matter has been adjoumed to November 15, 2010. Please submit your application to the trustees by that date if you are opting to have the deck legalized, or remove the structure and contact my office so that a compliance inspection may be scheduled. Please find enclosed an additional form requiring your signature from the court to dispose of the matter with a conditional discharge in lieu of a fine. Please return the signed document to my attention. Please contact my office if you have any questions. Regards, Assistant Town Attorney Enc. Cc: Board of Trustees ~ Justi Court FORM NO. 2~ 6317G53898 p. i STATE OF HEW YORK : COt~NTY OF 'T~TI C~'COURT TO~ OF ROI]q~ROT,D of On the day of , you were convicted in tl~ Court Pursuant to Sections 65.05 and 65.10 of the Penal Law, this Court placeS Defendant on a conditional dischar!te for a period of . '. Irom the dap of 19__ The Court imposes the following conditions on Defendant: GENERAL CONDITIONS (Section 65.10-2-a-h Penal Law) 1. Refrain h~ra frequenting unlawful or disreputable places or consorting with disreputabla persons; l}Vork faithfully at a suitable emploFment or faithfully pursue a course of studl~ or-vocational training; ' ' 3, Support hl~ dependants and meet other family responsibilities; 4. Make restitution ut the fruits of his offense or.make reparation fo~' the loss or damage cabser] thereby. B. SPECIAL CONDITIONS (Section 65.10-24 Penal Law) In its discretion, the Court may modi[y or enlarge the conditions, lfyou commit an additional offense other than a triffflc ir~raction cir. violate one or more ol the above conditions at any time before this conditional discharge expires, the Court may revoke this senten~:e and return you to court for resentencing. ,200 Dated: BRlll~a'stice 80UTHoLD; NEW YORK RUDOLPH H. ,TOWel JUSTICE ] haue read 6r had read to me the abo.e conditions imposed and I thoro~nhiy understand the conditions imposed. I acknowledge that ] have receh;ed a copy of this order and the conditions irnpo~ed Dated: -'A-5402 Town of Southold Suffolk County, NY The People of the State of New York vs. COUNTY 0~: SUFFOLK (~ I~e~l Properf~ Tax Service Agency 104 January l4,2011 Ms. Lauren Standish Board of Town Trustees Town of Southold Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Dear Lauren, '~/OP O~O~toS~ q As per our telephone conversation on ~ursday J~u~ 13m, enclosed please find copies of the plus and requests by Salvatore ~d Else-Ma~ CuccinoRa to build a dock at 8925 Sku~ L~e in Cutchogue in 1977. Eve~hing was submi~ed and approved by the Tom. However, we do not ~ow ifa ceffificme of completion was ever issued for ~is dock. The dock was built ~d in place when we purchased the home in 1997. Based on our conversation, I am enclosing the copies of the plans, permits, and town approvals along with a check in the amount of $50.00 to get a certificate of completion in our names: Peter and Patricia Larson. Please send all correspondence to: Peter and Patricia Larson 21 Hunt Court Brookville, New York 11545 516 621 7509 (home) 516 639 3726 (cell) Please let me know if you need any additional information. We plan to sell this property and want to make sure all the proper documentation is in place. Thank you for all your help in this matter. Sincerely,~ Patricia A. Larson Peter D. Lam'on TRUSTEES - :2, John M. Brcde, meycr, II1, President Albert J. K..upski, Jr., Vice Pr~iden! Henry R Smith Jolm B. Tuthill William O. Albcrtson Telephone (5t6) 765-1892 Fax (516) 765-1823 BOARD,OF~WI~ TRUSTEES A~U~.., 12~ 1992 SUPERVISOR SCOTT L HARRIS Town Hall 53095 Mah Road P.O. I~X t179 Southold. New York 11971 Oostello Marine sus..an E. Long P.'~i'~x 2124 Gree~%port NY 11944 Re: Salvatore Cucinotta SCTM % 104-03-015 Dear Susan: The following actfon was taken by the Board of Trustees at their regular meeting of July 30, 1992: RESOLVED that the Southold Town Board of Trustees approve the request for a waiver to remove 4 existing 2-pile dolphins an~ replace with two 2-pile dolphins. If you have any questions, please give us a call. Very truly yoLLrs, John M. Bredemeyer, III President, Board of Trustees JMB/jmt cc. Building Dept. DOCK BUILDING CONTRACTING :, RPO ION L &' WOO~'~PIUNG. FLOATS 423 FIFTH STREET, P O BOX 212~1. · .GREENPORT. NEW YORK 11944 · (51,6;) 477-1199/477~1393/477.,0682 July 14, 1992 Board of Trustees Town of Southold Nai~ Road Southold, NY 11971 Re: Salvatore Cucinotta Bay Avenue, Cutchogue Dear Members of the Board: A permit to construc='a dock facility at the above referenced was issued by the Board of Trustees in 1977. Mr. cucinotta hired Costello Marine to remove four existing 2-pile dolphins and relocate two 2-pile dolphins in a position that would better secure his float. The N¥S DEC did not require a permit for this work and issued a "No Permit Necessary" (NPN ~1-4738-00352/00001-0). For this reason, and because the size of the protect'was being reduced in size, we did not think it was necessary to apply for Trustee approval and subsequently completed the work. Before closing our files, we called your office for confirmation and were advised by your secretary that we should have filed a request to emend the existing permit. Enclosed please find sketch of the proposed modification that was sent to the DEC. Also enclosed is a check in the amount of $35.00 representing the fee you require for an amendment. We apologize for any inconvenience this may have caused and res- pectfully requ/est your favorable determination. Thank you for your time and attention in this matter. Very truly yours, Susan E. Permit Manager Enc. BOARD OF TOWN TRUSTEES Town of Southold Main Road Southol& New York ] 1971 1. Your application, dated ..~.~....~..~..L....~..~....~.. .............................. has b,en reviewed by this Board. at a meeting of th, Trustees held on ....... ..F.e..~...l~....~.-.6.~....~.~....~. ........................................... and resulting in the ac~iort, as indicated below: (...~..,.) Application approved ( ............ ) Application denied. ( ............ ) Appllcatio~ tabled. 2. Comments and remarks~ P,~SOLVED t,o appro~ the app]..toat:Lon of Salvathx-~ Cuctnotta to oonst, ruct a dock, r,emp mid f'].o~t; off p~,opef-l,y of the applicant at Little C~eek with e_~9~_~v~sion that the dock not be moz~ ~han~ feet(~_~ '.]~gE~_~fz~m b/Eh water end at app~ox~ate ri~L2 an~les with~e ~ho~e. 3. If your ppplicatio~ is approved above, A Permit Fee is now due, and should be made payable to the order of the Board of Southold Town Trustees. This fee is computed below according to the Schedule of Rates as set forth Jn the Instruction Sheet (Form I/1). If the Permit Fee is paid in person t~ the Secretary of the Baard, The Permit will be obtainable at the s~me time. If the fee is paid by mail, the permit will be mailed in reply. Computation of Permit lee: 6 x 20 foot flont (120 s.f.) 0.10 ,, 12.00 16 foot ~ (6~ s.f.) Total Fee for this application ................ ~ ........................................... $ ...~...~.:.~..0. ......................... Signed Philip O. Ho~'t;o~ Chin. ~aard of So~thold Town T~ustees. Re:: S~lvatore C~otta ~ar '~ fo~tng ao~6n Was t~en re~ler ~e~ng"of j~y ~0, 1992; ' ~ ~U ~e So~thold. X~ ~o~d of' ~es a~r~e ~he replace Wt~ two 2-pile dolp~. ,' ~regld.'en=,. 9oa~cl of Tr~ees cc. ~Lldin~ Dept.. BOARD OF TOWN TRUST~:s:~ Town of Southold Main Road $outhold, New York ]1971 l. Your appllcatio~o dated ....... ~Q.'9~'~R~,...2,.~...~.~.TZ ...................... has been reviewed by this Board at a mee~ng of the Trustees held on ....~...~, ~.~ ........................................... ~nd resulting in the attic, os indicated below: ( ........... ) Application approved, ( ............ ) Application denied. L,.....~.....) Applicotion tabled, Please attend the next meetJ~E of the Bo~ of Town Trustees on Februaz~ 6, 1978 to discuss this ma~cer with +.,be bo~.cl.. 3. I;~ your applieatio~ is approved above, A Permit Fee is now due, and should be made payable ~f~eth~e. or~..r of, ~ Board of* .~x~o. ld Town Trustees. This ~e is computed below according to =e~ule or 1~3tee as set tort~ In the Instruction Sheet (Form I/1). if the Permit ~ is paid in person to the Secretary of the Board, The Permit will be obtair~ble at the some time. f the fee is pak~ by mail, fhe permit w[l| be mai~ed in ~eply. Computotion of Permit Fee: Total Fee for this application ........................................................... $ ........................................ Chin. Board of ~outhold Town Trustees BOARD OF TOWN TRUSTEES Tovrn of Southold Main flood $outhoI~, New York 11971 1. Y~ur application, dated ..~9..~.~..~..~...e.~....~..~.=..,.~.~.7..~. ............................ hasbeen reviewed by this Board, at a meeting of the Trustees held on ....~..q~.~.~...~...:~.7..~.~ .......................................~ ........ and resulting in the action, as indicated below: ) Application approved ) Application denied. (.......x~.....) Application tabled. 2. Comments and remarks: A meeting is requested with you to determine the question of the necessity of the angle of the dock. The next meeting of the Board of Town Trustees will be held January 3, 1978 at 7:30 p.m. 3, If your application is approved above, A Permit Fee is now due, and should be r~e payable to the order of the Boorcl of Southold Town Trustees. This fee is computed below according to the Schedule of Rates os set forth in the Instruction Sheet (Form I/1). If the Permit Fee is paid in person t~ the Secreto~/of the Boar~, The Permit will be obteinable at the same time. If the fee is paid by mail, the ~errnit will be moiled in reply. Computation of Permit Fee: '~otal Fee for this application ............................................................ $ ........................................ Chin. Board of Southeld T,~wn Trustees. by ~,~ ...... Secret. / BOARD OF TOWN TRUSTEES Town Of $outhold Main Road $outhold, Now York 11971 APPLICATION FOR ~'IXED and/or FLOATING DOCK~ I. Applicant's nome and address: ............... ..~..C-.L~....~. ................. .... ........... .... 2. Cant recto r's name a nd address: .......~...~. ~./~.~.~........C~...//..~....~.'..d~.. ................................... ....................................................... 3. Briefly explain the purpose of this application: ........................................................................ ....... ........ .......... ............. ..... /..~.......~.~...~.~.~...~.~.~ .......................................................................................................... After issuance of a Permit, I expect to: (mark by an X~ (o) Commence work -- AT ONCE ............ ; ASAP ......~....; UNKNOWN ............. (b) Complete work In -- I DAY ............ ; 1 MO......~.....; I YE ............. ; FUTURE ............. 5. Secure the correct Area Map from the Secretary of this Board, ond by using an X WITHIN A CIRCLE indicate as closely os possible the idcotio~ of this dock. On the reverse side of this map, provide a SCALE DRAWING which wilt show Ordinary High Water Mark, the shape and size of the dock and any supplemental pilings which ~re needed to hold a floating dock or tm-up a boat. Give all dimensions necessary to determ ne the area of the dock surface which extends offshore from the O. H, W. M. 6. Will any portfon of this construction extend offshore into To~m Waters beyond c~ imaginary line or boundary formed by other similar structures along the are~'s shoreline? ~ or NO. If It does extend beyond this so-called dock Pine indicate by how far, approximately, .......... ft. 7. Provide the following documents: (a) A Licensed Engineer's Su,rve~/~ of the property involved. (b) A copy of the Contractor s Plans and Specifications. W'ill this construction require the Filfing of any /and offshore of the Ordinary High Water Mark or the Dredging of any material from Town La~ds under water? ~l~or NO. If it does, Form ,6,/4 (Application for Dredging/Filling) must be completed and attached as port of this Accepted by: 9. In requesting approval of this application, I submit that: the information presented herein is true and correct to the best of my knowledge and belief; I am the person accountable for the performance of the work in accordance with the plans and specffications attached; I have read or am familiar with the provisions of any Southold Town Ordinar~e pertinent to the work involved; and further, I intend to adhere to and abide b~, the Terms and Conditlo~s of the Permit, when and if issued to me. BOARD OF TOWN TRUSTEES Town of Southold Main Road Southold, New York 11971 INSTRUCTIONS PERTINENT TO T]tE FILING OF AN APPLICATION 1. All applicants should read and hecame familiar with the Town Ordinances which govern the use of WETLANDS or PUBLIC LANDS OF THE TOWN. Extracts and complete Ordinances are available from the Secretary of this Boc~ Or from the Town Clerk's Office. 2. A completed application will normally mcluire a SINGLE COPY of each of the following items: (c~) An applJcatic~n FORM A/I, A/2, A/3, A/4, or A/5) with all the questions answered. (b) An Area Map to show location of project. (supplied by Secretary). (c) A Licensed Engineer's Survey of the property involved. (d) A copy of the Contractor's Plans & Specifications. This may be supplied after approval of the opplicotic~ but a Permit will r~ be issued until the Secretary of this Board receives this item. (e) An applicant's diagram drawn to SCALE or the reverse side of the AreaMap, showing the size, shape, and overall dimensions of the structure or work as well as its relation to Ordinary High Water Mark. 3. A completed opplicatios~ must be filed with the Secretary of this Board, before it can be reviewed by the Board at the earliest meeting after it~ date of fi~ing. 4. In complicated cases, or at the request ofthe Secretary, it rn~y be necessary for the applicant to p~esent the completed applicatJo~ in person in order to supply a(~dJtionol or more complete formation than the Forms provide for. 5. After review by the Board, the applicant will be notified of the action taken, and if approved, such notice will also include ~ amount of the Fee reciuJl'ed for the issuance of the Permit. 6. The following schedule of charges will apply: (o) A minimum fee of $$.00 will be charged against all applications ~ · ~a~. This fee is payable at time of filing and is not returr~ble regardless of action token. (b~ Fee for Mooring (Form A/I) -- at the rate of $1.00 per piling, stake, or other anchor- ing device. (c) Fee for Docks (Form A/2) -- at the rate of 10c per Sc[. Ft. of dock surface offshore af Ordinary High Water Mark plus $1.00 per piling used to secure a float or boot. (d) Fee for Bulkheads (Form A/D) -- at the rate of $1.00 per lineal foot of construction offshore of Ordinary High Water Mark. (e) Fee for Dredging/Filling (Form A/4) -- at the rate of 10c per cu. yd. based on the estimated maximum from computing the application. (f) Fees for Special Purposes (Form A/5) -- at a rate depending on the type of work. 7. The Permit Fee, rhode p=~o[e to the Board of Southold Town Trustees, must be paid either in person or by mail prior to the issuance of the Permit. IF PAID IN PERSON, THE PERMIT IS OB- TAINABLE AT THE TIME PAYMENT IS MADE. 8. NO'[IFICATION OF APPROVAL of an application ?s NOT a PERMIT. 9. A Permit is usually issued for a period of construction to cover 12 mos., but may be for a shorter or a longer ~eried of time as the case may warrant. The Permit should be retained, however, for as long as the cons~ructlon will be rn~intained, as a proof of original autharizotion: 10. A Permit may be extended by request to the Board, or it may be revoked by subsequent re~olu- lion of the Board. ~' '~ 1'9~2 .' - Y ~D Y for Tr~t~ Page of ~ , t~e :~xJef uft~ Bc~rd ef So~thold ToWn'Tru~aas Thi~ flee ~ cofll2uced below T~ Of ~lthohl ,/~'P¥,IC4'~ION ~g ~ arad/~ ~O,4.'I'I~G, I30CY~ 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: August 24, 2011 Re: Proposed Wetland Permit for 8925 LLC SCTM#1000-104-3-15 Peconic Permit Expediting on behalf of 8925 LLC requests a Wetland Permit for the as-built 4'X 24' catwalk, 3'X 20' ramp and 6'X 20' floating dock. Located: 8925 Bay Ave., Cutchogue. SCTM#104-3-15 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 INCONSISTENT with the denoted following Policy Standards and therefore is INCONSISTENT with the LWRP: Policy 6. Protect and restore the quality and function of the Town of Southold ecosystem 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions The structures were constructed without a permit pursuant to Chapter 275 Wetlands and Shorelines of the Southold Town Code. Additionally, if the action is approved and to further Policy 4.2 Protect and restore natural protective features and Policy 6; it is recommended that natural vegetated buffer incorporating existing vegetation (trees) landward of the wetland, An example definition follows: 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. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Seuthold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD Office Use Only Coastal Erosion Permit Application ~x_Wetland Permit Application __ Administrative Permit Amendment/Transfer/Extension ~_Received Application: 7/7]1 ! ~_Received Fee:* ~J~(2r)~i ~e ~Completed Application qlq I l[ ~complete __SEQRA Classification: Type I Type 1I Unlisted C00rdination:(date sent) --.~WRP Consistency Assessment Form ~CAC Referral Sent: ~t~ ~ ~ II ~/Date of Inspection: ~ !TQ! t( Receipt of CAC Report: __Lead Agency Determination: Technical Review: ~--/l~blic Hearing Held:_ ~ ! ) ~. ! [! Resolution: $~uthhold lown Name of Applicant ~29q 2 .~ ~-L ~' Address Phone Number:( Suffolk County Tax Map Number: 1000 - Property Location: ~:~ 5?2- ~'~ /~,~7~ (provide LILCO Pole #, distance to cross s~eets, ~d location) (If applicable) Address: dTffO /4/;4~ i~ ~?r~ ~ /~J y ) l/ a]5'.2 Phone: '7 4- 5,fid.a- ard of Trustees Applicat Land Area (in square feet): Area Zoning: ~- 40 Previous use of property: Intended use of property: Covenants and Restrictions:__ GENERAL DATA 26 l: ?o Yes /~ No If "Yes", please provide copy. 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 fi( No __ 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): trd of Trustees Applicat WETLAND/TRUSTEE LANDS APPLICATION DATA Purposeoftheproposedoperations: ]~ ~4 ~ / [ ~. .~ ~ X I 5 Area of wetlands on lot: ~/'- ~- ffff 0 _square feet Percent coverage of lot: , t9 ! % Closest distance between nearest existing structure and upland edge of wetlands: ~ O feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? X No Yes If yes, how much material will be excavated? /V/,]0- cubic yards How much material will be filled? /I//~ cubic yards Depth of which material will be removed or deposited: /~/~ feet Proposed slope throughout the area of operations: AJ /~ Manner in which material will be removed or deposited: A//tDr 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): Town of Southold ~ ~ Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATIOH: S.C.TAL #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER, GRADING, DRAINAGE AND EROSION CO~iT~OL PLAN District Section BloCk Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK, SCOPE OF WORK - PROPOSED CONSTRUCTION I't'ISM# / WORKASSESSlVI~AWF I Yes No a. What is the Total Area of the project Parcels? 1 Will this Project Retaia All Storm-Water Run-Off Generated by a Two (2") Inch Rainfall on Site? ~l of Work for proposed Constmclion) (S.F. t,~s) Crhls item will include all mn-off created by site the Scope b. What is the Total Area of Land Clearing cleadng and/or construction activities as well as all -- and/or Ground Disturbance for the proposed /fi//,~ Site Improvements and the pe~Tnanent creation of impervious surfaces.) construction acl~ tS.F. / ACres) 2 Does the Site Plan and/or Survey Show All Proposed r---'l ; I'ROV]DE BRIF~ PROJECT DES~ON 1~,"~ ~ ~"* "~} Drainage Structures Indicating Size & Loca~3n? This ~ I [ item shall include all Proposed Grade Changes and -- ~.. ~__~'~/1 '~:'~-.'~ ~X}.~ ~"! ~'")"~ Slopes Controlling Surface Water FIow. ~'~ 'IL'- w/~/]'~' ~ ;1 ~'/l, ~'"' 3 D°es the Site Plan andJ°r Survey desedbe the er°si°nwill de used and sediment control practices that to ~ control site erosion and storm water discharges. Tbis ~ ~' item must be maintained throughout the Entire ~ ~' ~'\ ' Construction Period. 4 Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural I./I Existing Grade Involving more than 200 Cubic YardsL~U -- of Material within any Pamel? 5 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand~ __ (5,000 S.F.) Square Feet of Ground Surface? 6 is there a Natural Water Course Running through the Site? ls this Project withth the Trustees jurisdiction or within One Hundred (100') feet of a Wetland or -- General DEC SWPPP Requirements: Beach? SubmiSsion of a SWPPP is required for all Construction actiones invoMmj soil distudmnces of one (1) or more acres; including disturbances of less than one acre that 7Will there be Site preparation on Existing Grade Slopes are part of e larger common plan that will ultimately distunb one or more ac*es of hand; which Exceed Fifteen (15) feet of Vertical Rise to including Construction activities im, olving soil d~ud)ances of less than one (1) acne where One Hundred (10ff) of Horizontal Distance? -- STATE OF NEW YORK, COUNTY OF ........................................... SS That I, ......~..O....~....~....~.....~.... ......... ..~....~...b...~......~....tT....~... being duly swbrn, deposes and says that be/she is the applicant for Permit, And that he/she ............................................ ('~;:;55g~go;;X~'~, ~'t; Oth~r:~i Owner and/or representative of the Owner or Owners, and is duly authorized to perform or bare perforated the said work and to make and file this application; that all statements contained in this applica~on are true to the bes~s~. ~ll~t~ft belief; and that the work will be performed in the manner set forth in the application fried herewithNOTARY I~JSLIC.$TATIi OF NEW YORK Sworn to before me this; / ~1~ ~ ! $ ! 514 ~'~"<- 20 t/ Notary Public: ..l.~/,,~ad...~......ff..~../-~'~¢~ ................................. ~, ~,,i ......................... FORM - 06110 PROJECT ID NUMBER PART I - PROJECT INFORMATION APPLICANT / SPONSOR 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 County SEQR 3.PROJECT LOCATION: 4. PRECISE LOCATION: Street Addess and Road IntersecUons. Prominent landmarks etc -or ~rovide mad 5. IS PROPOSED ACTION: [] New [] Expansion [] Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially 4'~ acres Ultimately 4'~ acres 8. VVtLL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [] Yes [] No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Chooseasmanyasapply.) [~Residential []Industrial E~]Commercial r-~Agriculture E~]Park/Forest/OpenSpace []Other(describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, Stata or Local) ]Yes [] No If yes, list agency name and permit / approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? E~]Yes []No If yes. list agency name and penni[ / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? C3Yes [~No I CERTIFY THAT THE INFORMATION PI~VIDED ~__OVE IS TRUE TO THE BEST OF MY KNOWLEDGE ,,,..- ._ 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 ITo be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes. coordinate the review process and use the FULL FAF, I--lYes 17i"o B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. r-lYes r~No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answem may be handwditen, if legible) C1. Existing air quality, sudace or groundwater qualtiy or quantity, noise levels, existing traffic patiem, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: I CZ Aesthetic. agricultural, archaeological, htstudc, or other natural or cultural resources; or cornmu~tty er neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shelltish or wildlhe species, significant habitats, or threatened or endangered species? Explain briefly: I, C4. A community's existing plans or goals as officfially adopted, er a change in use or intensity of use of land or other natural resources? Explain bdefiy: I C5. Growth, subsequent development, or related activities likely to be induced by the proposed action?Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in Cl-C57 Explain briefly: C7. Other impacts lincludin~ changes n use of either ({uantit;/or ~pe of ene~},9 Explain briefl;/: D. WILL THE PROJECT HAVE AN iMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA ICEAI? IIf }/es, explain briefly: r--lYes i'71.o I E. IS THERE, OR IS THERE LIKELY TO BEI CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If)'es explain: [ Yes []N°l PART III - DETER.~INATIGN OF SIGNIFICANCE (To be completed by Agency) . INSTRUCTIONS: F~reachadversee~ectidenti~edab~ve~determinewhetheritlesubstantia~,~arge~imp~rtant~r~therwisesigniticant~ Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) 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 significanco must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have ideniffied one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. Chad( this box if you have determined, based on the information and analysis above and any supp~rflng documentation, that the proposed actior WILL NOT result in any significant adverse environmental Impacts AND provide, on attachments as necessary, the masons supporting thi.~ determination. Board of Trustees Name of Lead Agency Date Jill M. Doherty President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) Jill M. Doher~, President Bob Gbosio, Jr., Vice-President James F. King Dave Bergen 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 8925 LLC COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING 1, g~-o'~ ~-e~r~er7L , residing at /dba being duly sworn, depose and say: That on the 16 day of t~,~/ ,2011, I personally posted the property known as by placing the Board of Trustees official poster'where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wed~ August 24~ 2011 on or about 6:00 PM. Dated: Swom to before me this day of-/~ 201 / Notary Public CONNIE D. BUNCH Notary Public, 8tale of New York No. 01BU6186050 Qualified in ~kJffolk Courtly Commission Exptre~ ~ '14. 'D2~ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTi Name: Address: Rene LeCren P.O. Box 158, Cutchogue, N.Y. 11935 9105 Skunk Lane LLC c/o Total Personal Services 623 Stewart Avenue, Garden City, NY, 11530 Cutchogue/New Suffolk Park Dist. P.0. Box 311, Cutchogue, N.Y. 11935 STATE OF NEW YORK COUNTY OF SUFFOLK Robert Lehnert , residing at 6700 Aldrich Lane Matt ituck , being duly sworn, deposes and says that on the 9 th day of Auqust ,20 11, 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 , that said Notices were ma~d to each of s~/~persons by Sworn to before me this Dayof % Notary Public CONNIE D. BUNCH Notary Public, State of New York No. 01BU6185050 Qualified In Suffolk County Commission Explrss April 14, PECQNIC PERMIT EXPEDITING Building / DEC / Variance / Marine 6700 Aldrich Lane · Matiituck, N.Y. 11952 E-Mail peconicpermits(~optonline.net Ph 631.734.8361 · Fx 631.734.2276 June 23, 2011 Board of Town Trustees Town of Southold P.O. Box 1179 Southold, NY, 11971 - 0959 Re: Trustees Authorization Letter To Whom It May Concern, This letter is to authorize employees of"Peconic Permit Expediting Inc.' to act as my agent in obtaining permits from the Board of Town Trustees of the Town of Southold. If you have any questions, please feel free to call me at any time. Lrd of Trustees County of Suffolk State of New York /~R b ~r.-/~ //~ ~]/.9 ~'£'"]~ BEING DULY SWOKN 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. SWORN TO BEFORE ME THIS {7"/.f DAY OF '~"~ ,20l/ Notary Public No. · ua#fl~cl in ~ ¢ounN .Ur ~ ~ 4ugu~ 0~,~N, :;0/2.. APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM Thc Town of Southold's Code of Ethic~ ~rohibits conflic~ ofinter~st on ~c ~ of to~ bffi~ ~ mv]o~s. ~ ~u~ of ~ fo~ is ~ ~ inflation which ~ ~ ~ ~ of ~ible ~i~ of~ ~d ~tow it ~o ~ whoever a~ion is W avoid . (~ n~c, ~ n~c,~id~c ~, ~ y~ ~ ~ply~g ~ ~e n~c of ~nc el~ or o~ cnfiW, such ~ a ~mp~y. If ~, ~di~. ~ o~cr ~n's or ~m~y's n~e.) NAME OF APPLICATION: (Check ali that apply.) Tax gricvencc Building Variance Trastcc Change of Zonc Coasta~ Erosion Approval of pint Mooring Exemption from plat or official map Planning Other (If"Other", name tbe activity.) Do you personally (or through your company, spouse, sibling, parcnL or child) have a relationship ~vith any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business intcm~ '~Busines~ interesf' me. as 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 moro than 5% of the shares. YES NO X lfyou answcrod '~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 rolationship between yourself(thc applicant/agent/reprosentative) and the t~wn officer or employee. Either check the appropriate linc A) through D) and/or describe in the space provided. Thc town officer or employee or his or her spouse, sibling, parent, o~ Child is (check all that apply): __A) the owner of groater than 5% of the shares of the corporate stock of the applicant (when tim applicant is a corporation); __B) tbe legal or ben*ficial owng' of any interest in a non-corporate entity (when thc applicant is not a corporation); __C) an offieer, director, partner, or employee of the applicant; or __D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 Sa brniited this ~.~ay~or J"~,~ 2~/_ PrintName A~er"-~ ~'~/nt'~' ~" APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Eflfics orohibits conflicts ofinte~ on the hart of town Officers and emvlovees. Tho rmroosc of this form is to orovide information which can alert the town of vossthle confhcts of mterest and allow rt to take whatever actmn ~s necessary to avoid same. (Last na~e, first name, ~iddle initial~ tmless yon ~ applying in ~ ~ame of someoo¢ else or other eotity, snch as a company. If so. iadicate the other pe~on's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee a~ Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If "Other", name thc 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 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 coq)oration in which thc 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 Snethold Title or position of that person Describe the relationship between yourseff (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, o~ child is (check all that apply): A) thc owner of greater than 5% of the shares of the corporate stock of the applicon? (when the applicant is a corporation); ___B) thc legal or beneficial owner of any interest in a non-corporatr entity (when thc 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 I .t/~ SubmRted this Signature ...~,~ 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 rninisteHal 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 Waterfrom 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, listinfl both supporting and non- supporting facts, If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold ' s website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION scm# PROJECT The Application has been submitted to (check appropriate response): To uBoar. [] P anningBoara[] Bu.aingOept. Boa ofT ustees [] 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: Location of action: ~::'q,), ~r- Site acreage: Present land use: t~¢ 5! ~-~,n ~'~- 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: ~O d~ ~-- ~ ~ ~ Co) Mailing address: ~q9 :~'" (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 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 IH - Policies; Page 2 for evaluation criteria. [] Yes ~ No ~fi~ Not Applicable 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 ~-~ 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 HI - Policies Pages 6 through 7 for evaluation criteria 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 through 21 for evaluation criteria [-~ Yes ~ No []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 HI - Policies Pages 32 through 34 for evaluation erlteria. ~ 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 IH - Policies; Pages 34 through 38 for evaluation criteria. Yes ~ No ~l 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 HI - 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 Peconic Estuary and Town waters. See LWRP Section 1H - Policies; Pages 57 through 62 for evaluation criteria. ~-~ Yes ~-~ No ~ Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section IH - Policies; Pages 62 through 65 for evaluation criteria. ~ Yes [] No [] Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. [] Yes [--] No [] Not Applicable PREPARED BY - ~/~/~/~ TITLE DATE ~-7" ]) DOCK PHOTOS 0 0 LOCATION OF ' ,SUBJECT PP-,,O?ERTY KEY OF 50TM) ~ 00 EXISTING DOCK PLAN I. = I LC)" SCALE 4 G-O x 20 0 PLOATING DOCK MAP O0 6" DIAMETER DOLPHIN FOR FLOATING DOCK LEGALIZE EXIST1NG CATWALK & FLOATiNG DOCK AT 8925 LLC 8925 BAY AVENUE CUTCHOGUE, NY S.C.T.M. # 1000 - 104 - 3 - 15 REVISIONS DATE; APPROVED BY BOARD OF TRUSTEES TOWN OF $OUTHOLD .~ ::'ECONIC PERMIT EXPEDITING PHONE G31.734.83GI EXISTING DOCK SECTION SCALE h" = ~'-0" 1106 SP- 1 N 310.00' N77'o2'OO"E.~ fl78'10 lu 144-.28' S87~1~0'W -- I BUFFER SURVEY OF PROPERTY A T PECONIC TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. 1000-104-03-15 SCALE: 1~ 50' FEB. 22, 2011 $75.00' CERTIFIED TO~ 89-P5 BAY A VENUE~ LLC THE KELSEY COMPANY CONESTOGA TITLE INSURA~ COMPANY BAY AREA - 201,270 SO. FT, or 4.6205 ACRES (TO TIE LINES) "PI-CeNIC '~ P.O. BOX 909