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Home My WebLink AboutTR-7850 James F. King,President �pf soojy Town Hall Annex Bob Ghosio,Jr.,Vice-PresidenthQ� OlO 54375 Main Road P.O. Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer G p Telephone(631) 765-1892 Michael J. Domino Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0848C Date: April 18, 2013 THIS CERTIFIES that the construction of second-floor additions and alterations to existing single-family dwelling,• and drainage is in compliance with Chanter 236 Stormwater Management of the Town Code At 8225 Nassau Point Road Cutchogue New York Suffolk County Tax Map # 118-4-10 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 6/20/12 pursuant to which Trustees Wetland Permit#7850 Dated 7/18/12, was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the construction of second-floor additions and alterations to existing single-family dwellin • and drama e is in compliance with Chapter 236-Stormwater Management of the Town Code. The certificate is issued to VINCENT& CAROL MANAGO owners of the aforesaid property. 0 77 Authorized Signature 0 James F. King,President o�o$oFFat 4, Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President �@ P.O. Box 1179 Dave Bergen = Southold,NY 11971 John Bredemeyer �y '� Telephone(631)765-1892 Michael J. Domino 'y4j �`�� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: `410 (b 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: n / � O k CERTIFICATE OF COMPLIANCE: U Lincjci I3e��nt Called n Apr 02 13 11 : 37a Bertani Builders 6317653916 p. l • John Bertani Builder Inc. 1380 Oakwood Drive Southold, N.Y. 11971 (631)765-1594 FAX(631)765-3916 � EQEIVEIQ APR - 2 2013 April 2,2013 Re: Carol and Vincent Manago Permit#7850 Southold Town Board of Trustees Mr. James King, President Southold Town Trustees P.O. Box 1179 Southold, NY 11971 Dear Mr. Feng: We are requesting a project complete, compliance inspection for the Carol and Vincent Manago Residence,8225 Nassau Point Road, Cutchogue, NY 11935,permit#785a Thank you. Sincerely, �u1d4 �) . de,-4an,c_' Linda D. Bertani Vice President James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION, FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE __ Pre-construction, hay bale line __ 1st day of construction ¼ constructed __ Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTItOLD, NEW YORK PF.~'~0, ~8~ DATE: JULY 18,~2012 ISSUED, TO: V[~CF~NT,&~CAROL MANAGO PROPERTY ADDRESS: 8225 NASSAU POINT RD.~ CUTCHOGUE SCTM4q'18"4~I 0 I, AUTHORIZATION Pursuant to the provis ohs of chap[er 275 and Chapter 111 of the ToWn Code of~e ToWn of Southold and in accordance with the Resolution of the Board of Trustees adopted at the m~eetil/g held (>ti July t 8~ 2012 in consideration of application fee in the sum of $250.00 paid by and C6nditions as stated in the Rcsoltition; the Southold Town Board of Trustees authorizes and permits the foll~w'ing: Wetland Permit to construct second floor additions and alterations to the existing single'family dwelling, with the Condition the drainage is - Stormwater Management of the Town Code, and as depicted on the site plan prepared by ~rk K. Schwartz AIA dated May 31, 2012. , IN WITNESS WHEREOF, the said Board of Trustees hereby causes its C0~°rate Seal t° be affixed, an~l~ ~ ~r ~e ~seflts to b~ subsc,ri.'bed B~ fi mai 6fi~) Of the said BOard as Of this dfi~. {r' TERMS AND CONDITIONS The Permittee, Vincent & Carol M~mago~ ~esidin~ at 8225 Nassau P0int. Rd,, Cutchogue, NY as part of the consideration for the issuance of the P~rmit d0es 99derstand 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 ~ges, of suits arising directly or indirectly as a~result of any. operation performed pUrSuant to this permit, and the said eermittee wi[l~trhi~ expense, defend any and all such suits initiated bY third parties, and the said Permittee assumes full liability with respect thereto', t0 the complet¢ogxC~l~x.~c~!of ~ BoMd 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 wan'ant, ~uest 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.~r 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 ~ no unreasonable interference with navigation as ~ result of the work herein authorized.~ That there shall be no interference with the right of the public to pass and repass al6tig the beach between high and low water marks. That if futUre Operations of the Town of Southold require the removal and/or alterations the location of the Work herein authorized, or if, in the opinion of the Board oi~Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due not/to0~ ~o remove or alter this work project her.ein, stated without expenses to the ~To~ri l~$o~l~thol~. That the said Board wilt be aotified by the Pennittee of tho co~] ~ Work That the Permittee will obtain all other permits and consents t~ supplemental to this Permit, which may be subject to revoke upi ~'faitllre t° }~)'%ain same. James F. King, 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 July 18, 2012 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mark K. Schwartz, AIA P.O. Bo'x 933 Cutchogue, NY 11935 RE: VINCENT & CAROL MANAGO 8225 NASSAU POINT RD., CUTCHOGUE SCTM#118-4-10 Dear Mr. Schwartz: The Board of Town Trustees took the following action during its regular meeting held on Wed., July 18, 2012 regarding the above matter: WHEREAS, Mark K. Schwartz, AIA on behalf of VINCENT & CAROL MANAGO applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated June 20, 2012, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, in accordance with Chapter 268, said application was found to be Exempt from the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on July 18, 2012, 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, 2 WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees APPROVES the application of VINCENT & CAROL MANAGO to construct second floor additions and alterations to the existing single-family dwelling, with the Condition the drainage is in compliance with Chapter 236 - Stormwater Management of the Town Code, and as depicted on the site plan prepared by Mark K. Schwartz AIA dated May 31,2012. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, Jame .~King, Presii~ Board of Trustees JFK/Ims James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall Annex 54375 Route 25, P.O. Box 1179 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 (~ I ~ I I~ has been reviewed by this Board at the regular meeting of ' '-/I i~, II;} 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) 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: James F. King, President Board of Trustees Peter Young, Chairman Laurcn Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (63 I) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., July 11, 2012 the following recommendation was made: Moved by John Stein, seconded by William McDermott, it was RESOLVED to SUPPORT the Wetland Permit application of VINCENT & CAROL MANAGO to construct second floor additions and alterations to the existing single-family dwelling. Located: 8225 Nassau Point Rd., Cutchogue. SCTM#118-4-10 Inspected by: William McDermott, John Stein, Jack McGreevy The CAC Supports the application with the Condition gutters, leaders and drywells are installed to contain roof run-off. Vote of Council: Ayes: All Motion Carried James F King, President Bob Ghosio, Jt, Vice-President Daw Bergen John B~edemeyer Michael J. Domino P.O. Box 1179 Southold, NY 11971 Telephone (631 765-1892 Fax (63 I) 765-6641 Southold Town Board of Trustees Field Inspection/VVorksession Report Date/Time: 7/////~---~ VINCENT & CAROL MANAGO request a Wetland Permit to construct second floor additions and alterations to the existing single-family dwelling. Located: 8225 Nassau Point Rd., Cutchogue. SCTM#118-4-10 Type of area to be impacted: ~ltwaterWetland Freshwater Wetland Sound .~Bay Distance of proposed work to edge of wetland P~ha Town Code proposed work falls under: pt.275 C h a ,~,~1._1 other Type of Application: ' Wetland __Coastal Erosion__Amendment __Administrative__Emergency Pre-Submission Violation Info needed: Modifications: Present Were: "--- J. King *'"'"B. Ghosio ~ D. Bergen. ¢,,--J. Bredemeye[__ Michael Domino D. Dzenkowski __ Form filled out in the field by Mailed/Faxed to: Date: other .e;w,. York State Depart~t. of EnvironmentalConservati~ ...... i~aing 40 -SUNY, Stony Bro~[INew York 11790-2356 I~ Telephone {$$$) 444-0355 Facsimile (516) 444-0373 Vincent Manage 10 Bellows Lane Manhasset, NY 1030 August 29, 1997 Re: Application #1-4738701~07/00002 Mah~go Property, 8225 Nassau Point Road, Cutohogue John P, Cahlll Commissioner 'JUN 20 2012 S0uthh01d Town Board of Trustees Dear Mr. Manage: Based on the information you have submitted, the New York State ..Department~ of Environmental COn~ervation has determined that: All the property landward of the top of bluff as shown on the plan prepared by Thomas C. Samuels dated 7/21/97 last revised on 8/26/97 is beyond the Jurisdiction of Article 25 (Tidal wetlands). Therefore, in accordance with the current Tidal Wetlands Land Use · RSgulat'tons (6N¥cRR Past 661)'no permit is required under the Tidal W~lands Act . Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take Place seaward of the tidal wetlands Jurlsdictional boundary, as indicated above, without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any eediNentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands Juri~diction which may result from your project. Such precautions may include maintaining adequate work area between the~ tidal wetland Jurisdl?~Lignal boundary and your project (i.e. a 15' to 20' wide construction area) or ereotin~; a temporary fence, barrier, or....hay bale berm. ' Please be further advised that this letter does not relieve you of the responsibility of obtaining any n.eceseary perml.%s..er approvals fro~ other agenci~ ..... cc: Samuels & Steelman BMHP File Sincerely, George W. Ilammarth Permit Administrator PHOTO No. 06 PHOTO No. 11 PHOTO No, 07 PHOTO No, 12 PHOTO No. 08 PHOTO No. 13 PHOTO No. 09 PHOTO No. 14 pHOTo No. 05 PHOTO No. 10 PHOTO No. 15 REVISIONS: PHOTO No. ]6 PHOTO No. t7 PHOTO No. ;~ A-- 1 N 118 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cot'. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 To: Jim King, President Town of Southold Board of Trustees LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM 1 7 2012 S0,~hti0!d T:wn From: Mark Terry, Principal Planner LWRP Coordinator Date: July 17, 2012 Re: Proposed Wetland Permit for VINCENT & CAROL MANAGO SCTM# 1000-118-4-10 Mark K. Schwartz, Architect on behalf of VINCENT & CAROL MANAGO requests a Wetland Permit to construct second floor additions and alterations to the existing single-family dwelling. Located: 8225 Nassau Point Rd., Cutchogue. SCTM#118-4-10 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 "Ir' which states: II. Additions to an existing building or rebuilt residential structure which results in no net increase in ground area coverage, except where the parcel is located in a coastal erosion hazard area; Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney Office Use Only Coastal Erosion Permit Application ~-Wetland Permit Application __ Administrative Permit Amendment/Transfer/Extension Rece~ved Application: [a]~O/],~ Received Fee:$,~5-~)~' ' ~~' Completed Application {;~ !o~Z~)l 13- _Incomplete __SEQRA Classification: Type I Type II Unlisted __Coordination:(date sent). ~'LWRP Consistency ,Sssessment Form/')I0C] It ~- ~-CAC Refe.~ Sent: (e I ~q II ~' · ~D~e oflnspection: r} j 11 113-- _Receipt of CAC Report! ' ' __Lead Agency Determination: __Technical Review: ~--4~i51ic Hearing Held: "~ ! icl I ~ __Resolution: JUN 2 0 2012 $0uthh01d 10wn ~oar8 of Trustees Name of Applicant Vincent and Carol Manago Address P,O. Box 933, Cutchogue, NY 11935 Phone Number:( ) 734-4185 Suffolk County Tax Map Number: 1000 - 118-4~-10 Property Location: 8225 Nassau Point Road, Cutchogue, NY (provide LILCO Pole #, distance to cross streets, and location) AGENT: Mark K. Schwartz, Architect (If applicable) Address: p.o, Box 933, Cutchogue, NY 11935 Phone: (631) 734-4185 ffc r Bo~ oE T~us~ees Application GENERAL DATA Land Area (in square feet):.1.3084 acres Area Zoning: R-40 Previous use of property: Residential Intended use of property: Residential Covenants and Restrictions: -- Yes ~ No If "Yes", please provide copy. ~-~ Does this project require a variance from the Zoning Board of Appeals [~/[ Yes If"Yes", please provide copy of decision. Will thi~2I~oject require a~emolition as per Town Code or as determined by the Building Dept. ~ Yes ~[~_[~No Prior permits/approvals for site improvements: Agency Date No ~ No prior permits/approvals for site improvements. Ha~ any permit/approval ever been revoked or susp~l by ~[-,~lvemmental agency? I~ INo L._l Yes If yes, provide explanation: Project Description (use attachments if necessary):. 2nd floor additions and alterations forl bedroom and master bedroom. Master bedroom proposed to have new office on west side. All proposed work to be contained within existing building envelope (no expansion of footprint) of Trustees Applicatio0 WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 2nd floor additions and alterations proposed to stay within existing building envelope Area of wetlands on lot: J 05 0 square feet Percent coverage of lot: I. ~ % Closest distance between nearest existing structure and upland edge of wetlands: ~:~ feet Closest distance between nearest proposed structure and upland edge of wetlands: ~ feet Does the project involve excavation or filling? V1 No Yes If yes, how much material will be excavated? 2 cubic yards How much material will be filled? 1.s cubic yards Depth of which material will be removed or deposited: 3 feet Proposed slope throughout the area of operations: */- 5% Manner in which material will be removed or deposited: Excavated shall be used for final grade, new fill for septic shall be contained on property. 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): The proposed work sha~l have a positive impact on the wetlands and tidal water through the installation of drywells to control water runoff, a pervious driveway for natural drainage James F. King, Plcsldcnt Bob Ghosio, .h'., Vice-Prcsldcnt Dave Bergen JoJll/ Brcdcmcyer Michael J. Domino Town ttall, 53(}95 Main Rd. P.O. Box I 179 Southold, NY 1197l 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 VINCENT & CAROL MANAGO COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING J'~,~'ff/.~Q residing at/dba 'Z-~d(~?lJ~-,~,~l, being duly sworn, depose and say: That on the ~day of ,201~1 personally postcd the property known as by placing the Board of Trustees official poster where it can easily be seen, and tbat 1 have checked to be sure the poster has remained in place i-bt eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wed, July 18, 2012. Dated: ~,Z'~~] (signature) ~ Swam to bctbrc mc this day o%~201~ Notary Public CONNIE D. BUNCH Notary Public, State of New York No. 01 BU6185050 Qualified in Suffolk Commission Expires April ~llt 14.I~d (9;95)~Text 12 I PROJECT I.D. NUMBER I 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only .PART I--PROJECT INFORMATION (To be completed by Applicant or Project sponsor) - "1. APPLICANT/SPONSOR 12.PROJECT NAME Mark Schwartz, Arch tect ~incent and Carol Manaoo SEQR 3. PROJECT LOCATION: Mufll¢lplllly Southold c,o~Aly Suffolk 8225 Nassau Point Road, Cutchogue, NY S. IS PROt~3SEC ACTION; [] New [] Expansion ~"""~ Modification/al/oration 6_ DESCRleE PROJECT BRIEFLY: 2nd floor additions and alterations forl bedroom and master bedroom. Master bedroom proposed to have new office on west side. All proposed work tO be contained within existing building envelope (no expansion of footprint) 7. AMOUNT OF LAND AFFECTED: 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER GIGS'TINe LAND U~E REb'TRICTIONST [--v7]Ya$ [] No I! NO, Giesertbe I~-iof~y 9. WHAT IS PRE~ENT LAND USE IN VICINITY OF PROJECT? ~Z]Agrlcultutl 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE OR LOCAl.)? [~No If yes, flit aglac*/(s) arid DEC nonjuristdction approval, ZBA "11, 0OES ANY ASPECT OF THE ACTION HAVE A CURRENTLy VAI.ID PERMIT OR ~AL? [] No If yes, lilt RESULT oF PROFosED ACT,O~ ~LL EX~.~- p~RMrr/Ammv. L ~ ~=~? ~. ~.o I C~ ~AT THE INF~ P~D~ ~E IS ~ ~ ~E B~ OF MY ~E ' . , / -~ / / ......... C/ I If the action is in the Coastal Ama, and you am a stats a~flW, ~plete the Coastal ~sessment Fo~ before p~lng with fils assessment OVER PART II - IMPACT ASSESSMENT (To be completed by Lead A~lency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. [~Yes [~'1 No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, flistoricl or other naturai or cultural re~e~; or community or neighborhood character? Explain briefly: I C3. Vegetation or fauna, fishl shellfish or wildiife sped~sl ~i~nifi~nt habitatsl or threatened or endangered spades? Explain briefly: I C4. A community's existing plans or goals ~'offi~iaily'~dopt~d, or a ch~n~"in use Or intensiiy of use of land or other naturai resources? Explain briery: I C5. Growth, subsequent development, or reiated activities likely to be induced by the proposed action? Explain bfieflyi I C6. Long term, snort term, camulati~i or other effects 'not id;ntifl;d 'i~'~i ~C57 Explain briefly: ......... I D. WILL THE PROJECT HAVE AN ~MPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA ICEAI? Ill )'es, explain briefl~,: [~Yes [Z]NoI E. IS THERE, OR IS THERE LIKELY TO BE~ CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If ~/es explain: r-'l Yes r~lN° I PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (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 significance must evaluate the potential impact of the proposed action on the environmental characteristics of the C EA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUU FAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actio~ WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons suppoding thi: determination. Board of Trustees Name of Lead Agency f. Print or Type Name of Responsible Officer in Lead Agency S~ature of Responsible Officer in Lead ~ Da~ President [] Title of Responsible Officer Signature of Preparer (If different from responsible officer) Town of Southold Erosion, Sedimentation & Storm.Water Run-off AUESSMENT FORM PROPERTY LOCAl]ON: $.C.T.IiL #: THE FOLLOWIN~ ACllON~ MAY ~QUI~ ~ SUBM~N OF A B~m GE~ ~ A ~ ~8~ IN T~ ~A~ OF N~ YO~ ~OPE OFWO~ - PRO~S~ CON~i'KUCrlON z'l'~ ~ / WO~S~ [ Ycs No (~ T~] ~ ~ ~1Pa~b I~ ~ /. ~ ~n~ by ~ T~ (29 I~h ~i~ ~ ~? the 8~ of Wo~ ~ P~ ~) ancot ~ ~n~ fm~e pmp~ ~'e'/~) 2 ~ t~ S~ ~ an~ ~ ~ ~ ~ ~O~E ~ ~ D~IION ~~ ~{n~m~l~&~?T~ I~ shall In~ a~ Pm~ ~ ~ ~ ~m must ~ m~}~ ~gh~t ~ E~ ~ Pe~. , ~g G~ I~Mng m~ ~ ~ Cu~Y~ E~ ~ ~a h ~ ~F~e~ (5,~ S.F.) S~m F~ ~ ~u~ ~?~ -- 6 Is ~ a ~1Wa~ ~u~ ~nl~ ~ ~e ~ ~ ~pP ~: ~ ~ln ~e Hu~ (1~') ~ ~ a W~ or ~,~~~P~~ R~l~V~e~a~r~~a~ ~ ~ : ....... ?~. ~;~;i~:~ ................................................................ 0~ m~or ~p~n~ve of ~e ~r or ~, ~d ~s dul~ au~o~ m p~o~ ~ ~ ~ff~d ~ ~d wo~ ~d m ................. ......... ............ No~ hb~ ......~/~;~.~.~..~%:~~ FORM - 06/10 of Trustees ApplicatioO 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. SWORN TO BEFORE ME THIS c~ 0 d~ DAY OF ~"~e ,20 / '2_- Board of'~o~h~ Aooc~h Aoo~catjgo (V~n~ thc Appffcmtt [5 not t~c Owner) (Agent) to apply for variance(s) on my behalf fi'om the Southold Zoning Board of Appca.ls. AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of $outhold's Code of Ethics prohibits conflicts of interest on the parg of (own officers and employees. The purpose of this form is to nrovide informotion which can alert the town of poesible conflicts of interest and allow it to take whatever action is necessary to avoid same. (Last name, first name, nljddle~nltlal, unless you are applying In the name of someone else or other entity, such as a company. If so, Indicate the other person's or company's name.) TYPE OF APPLICATION: (Check all that apply) Tax grievance Variance Change of Zone Approval of Pint Other (activity) Building Permit Trustee Permit Coastal Erosion Mooring Planning 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 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 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 child is (check all that apply): __ A) the owner of greater that 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation) B) the legal or beneficial 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 APPLICANT/OWNER TRANSAC~fIONAL DISCLOSU]~E FORM ]'he Tuw~ of So~old's Code of ~(l~t,~ orohib{~ couflict~ of hter~ on the Dirt of tov;n o f~c'~s iud ecsolovHs. Tb~ ~, ~..~ ] ~ of Ibis (m.m is to orovkl~ Inform.rims w~kh Cnn aler~ the town of IMssible Cpn..fll~_ of-' ;. ~-;~-; ~t~d OIJ~w it ~o toke ~;~., T¥1~ OF APPLICATION: (Check all that ~pply) Tex grJevloee BuiMtug permit // Variaacc ~ -- Trustee Permit ~/ ~nun~e of Zone Co~til EFOSIOn Approval of Plat Moorin~ Other (uct~vity) Planuin~ Do you per'hilly (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or mldo~ee of the Town ofSouthold? #lt~.lafloosb¥' blciade~ by bJoodp umtT~e, or Imiinen lateresL "Bus/nt~s ht0co~q menm u buineH, hchiding a t~srtuorshtp, h which the town offie~ or employee has even t partial owuerskip o((or employment by) a corlmration in which the town offteer or employee owns more than S% of the share~ No ~ If yo~ answered 'YES", compleCe file balance of ~his form and dote and sifn wheFe iadJceted. Name of person employed by tile Town of Southo/d Title or po~tio~ of that pe:3on Describe the ndatJomldp between yoorJetf (the applicant/agent/representative) and the town oflScer or employe~ Either cheek the approprbite line A) througis D) nd/or ducribe bx the space provided. The t~wn o~c~ m- eatploy~a o~ hh er ba~ spouse, sthlbtf, parent, or cA(id is (check all ~bat apply): . A} the ewae~ orgralter that $% ortho share~ of the corporate stock ef tho applicant (whcn the sppllunt h a corportt~ou) B) the legal or besiefichtl owner of &Ky intere~ h a non~corlMt-ate entity (when the nppfienn¢ is nO! a corporation) C) sn oHIcer, director, Imrtner, or employee of(he appRcant; or __ D) the 8ctu~l appliciot DESCRIPTION OF RELATIONSHIP £jo £ a~ud 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 Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. 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#// _ The Application has been submitted to (check appropriate response): TownBoard [] Planning Dept. [] Building Dept. [] Board of Trustees [] 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 ac~tio~: Site acreage: Z.-~ g:~at~'/~.~ Present land use: t~ 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) Nme of applicant:~'~'//[ (b) Mailing address: ~/~J/ qc~ 52~ _~//~¢~]0~ff. ff, Al] //qd5 (c) Telephone number: Area Code ( ) -7 ?)4 '~4/?~ (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 agencyT DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. [] Yes [] No [] (Not Applicable - please explain) Anach additional shee[s 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 - please explain) 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 - please explain) Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III- Policies Pages 8 through 16 for evaluation criteria ~[4~ Yes [] No ~ (Not Applicable - please explain) At~ach 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 --L~ Yes [] No F-~ (Not applicable - please explain) 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 - please explain) 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. See Section III - Policies Pages; 34 through 38 for evaluation criteria. Yes [] No [] (Not Applicable - please explain) At~ach additional shee~s 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- please explain) 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. ~ Ves~ No [-~ (Not Applicable - please explain) 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. IT Yes R No [] (Not Applicable - please explain) 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 - please explain Atlach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southoid. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. ~] Yes [] No [-~ Not Applicable - please explain At~ach 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 - please explain CERTIFIED TO' LAYIYERS. TI?LE INSURANCE COMPANY ABSTRACT REPORTS, LTD.' VINCENT MANAGO CAROL MANAGO ANY AL TERA TION OR ADDITION TO THIS SURVEY IS A VIOLA TION OF SECTION 7~.03 OF THE NSF/ YORK .gTA TE EDUCATION LAW, EXCEPT AS PER SECTION X2Og-SUBDIVISION 2. ALL CgR~ICA TION5 H~R~ON ARE VA~ FOR T~S MAP AND COPIES T~REOF ONLY tF ~DDI~ALLY TO COMPLY ~TH SA~ LAW T~ T~M 'ALTERED MUST BE USED BY ANY A~ ALL S~VEYORS UTILIZING A COPY OF ANOT~R SURVEYOR'S MAP. TERMS SUCH ~S '~SPECTED' AND 'SROUGHT-T~DATE' ARE NOT IN CO~LIANCE WITH T~ LAW. SU7,~"7 OF LOT 64 L' LOT 65 "AMENDED MAP" ' D,: iVASSAU POINT" FILED AUC. ' ~22 F!gENO. 156 A T NA,. 2AU POINT TOWN G? SOUTHOLD SUFFOLK COUNTY, N Y. AREA = 1.30,84 Acres to tie lines ELEVATIONS AND CONTOUR LINES ARE REFERENCED TO N.C.V.O. FLOOD ZONE LINES DETERMINED FROM CONTOURS & FIRM. 1000- 118- 04 - 10 Scale, 1" = 30' Feb. 16, 1996 APRIL 4, £001 t update MARCH ET~ SO01 Inew bulk~eed ) L ~9618 / ~ECONIC $UN~EYQRS~ t631) 765 - 5020 FAX t631) 765 - 1797 P. O. BOX 909 1230 TRAVELER STRggT SOUTHOLD~ N.Y. 11971 N. 82'00'00' E. plO L 0 T SPLIT S. 82'00'00' Vl. plo LoT 6~ CER T/FlED TO, LAWYERS. TITLE INSURANCE COMPANy ABSTRACT REPORTS, LTD, ~ VINCENT MANAGO CAROL MANAGO AREA = 1.3084 Acres to tie lines LoT ANY AL1'ERA170N OR ADD/T/ON TO THIS SURVEY IS A VTOLA 770N OF SECTION 7'~09 OF Th~ NEW YORK STATE E'DUCAT'ION LAY/, EXCEPT AS PE~ SECTION 7209-51JBOIVISION 2. ALL CERTIFICATIONS HEREON ARE VALID FOR THIS I~tP AND COPES TheREOF ONLy IF SA~ MAP OR COPIES BEAR ~ ~Jc~SS~D 6'~4L OF THE SURVEyoR WHOSE SIGNATURE ~4PPEAR$ ADDITIONALLY TO CO~PL y FITTH SA~ LAW 7'FE ~ 'ALTERED BY' MUST BE USL~D BY ANY AND ALL ~VEYOR$ UFI~IZIN~ A COPY OF ANOTheR SURVEYOR'S MAP. FERMS SUCH AS '~S~.CT~D' AND 'BROUGHI--TO~DA TE. ARE NOT IN COMPU~4VC~ ~TH ~ LAW, ELEVATIONS AND CONTOUR LINES ARE REFERENCED TO N.G.V.D. FLOOD ZONE LIN~S DETERMINE~ FROM CONTOURS & FIRM. 558.99' SUPVEY OF LOT 64 &, P/O LOT 65 "AMENDED MAP 'A' OF NASSAU POINT" I~ED AUG. 15,1922 FILE NO. 156 A T NASSAU POINT TOWN OF SOUTHOLD SUFFOLK COUNTY, N Y. 1000- 178- 04 - 10 Scale.. 1" = 30' Feb. 16, 1996 April 4.. 1996 (CER7~CA T/ONE ADDED) oc~' gl .,5~'~7 Apr;/ 6 19~ ,"J~x 2 0 2072 - Sor!~hho!d Town of ~r!~stees E~CON/ 4 C P.C. (651) 765 - 5020 FAX [6311 ?65 -I P. O. BOX 909 1230 TRAVELER STREET 96- 113 REVISIONS: WE~'I' ELEVATIQN SCALE: 1/8" = 1' EXISTING WEST EI_FVA'rION SCALE: 1/8" ~ 1' 2 0 20]2 So,thho]~i tow~ Beard o! lnlstees APPROVED BY BOARD OF TRUSTEES TOWN OF $OUTHOLD DATE A-1 SOUTH ELEVATION .~--N..E: 1/8" = 1' EXISTING SOUTH ELEVA'I'[ON SCALE: 1/8" -- 1' REVISIONS: I m EAST ELEVATION SCALE: 1/8" = 1' EXISTING EAST ELEVATION ,.~:ALE: 1/8": 1' OPRO.1ECT NORTH 1ST. FLOOR PLAN SCALE: 1/8" = 1' i REVISIONS: A-4 OPROJECT NORTH 2ND. FLOOR PLAN SCALE: 1/8" = 1' / '\ / \ / \ / / \ ==;__ REVISION A-5