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Home My WebLink AboutTR-7866ANunemaker, Amanda From: Nunemaker, Amanda Sent: Wednesday, April 29, 2015 10:04 AM To: 'Arthur Blenk Jr' Subject: RE: Fence for permit 7866a Hello, Ok, great. There is no problem with the installation on this type of fence. It still complies with the permit specifications as per President of the Board, John Bredemyer. -----Original Message ----- From: Arthur Blenk Jr [mailto:ablenk@aol.com] Sent: Wednesday, April 29, 2015 9:44 AM To: Nunemaker, Amanda Subject: Fence for permit 7866a Hi Amanda- here's the pic. Fence still wood, still 6 ft high, same location and quantity. Only difference is that it looks same on both side. Customer trying to be neighborly, which I applause. Thx - Artie .7 John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee May 21, 2014 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mrs. Sylvia Morandina, Trustee Morandina Living Trust PO Box 1058 Southold, NY 119.71 RE: 1035 CALVES NECK ROAD, SOUTHOLD SCTM# 63-7-32 Dear Mrs. Morandina: • Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 The following action was taken at the Southold Town Board of Trustees regular meeting held on Wednesday, May 21, 2014: RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a Transfer of Wetland Permit #7866A from Patricia Fitzpatrick to Morandina Living Trust, as issued on August 22, 2012, and BE IT FURTHER RESOLVED, that the Southold Town Board of Trustees grants a One - Year Extension to Administrative Permit #7866A, as issued on August 22, 2012. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please contact our office at (631) 765-1892. Sin er ly, John M. Bredemeyer III President, Board of Trustees JMB:amn El John Bredemeyer, President gUFFDl Michael J. Domino, Vice -President James F. King Charles J. Sanders . Dave Bergen oi Date/Time: 0 Town Hall Annex 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report MORANDINA LIVING TRUST requests a Transfer of Administrative Permit #7866A from Patricia Fitzpatrick to Morandina Living Trust, as issued on August 22, 2012; and for a One Year Extension to Administrative Permit #7866A, as issued on August 22, 2012. Located: 1035 Calves Neck Road, Southold. SCTM# 63-7-32 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre -Submission Violation Notice of Hearing card posted on property: Yes Info needed: Modifications: Conditions: Present Were Bay Constable other No Not Applicable J. Bredemeyer M. Domino J. King C. Sanders Form filled out in the field by Mailed/Faxed to: Date: Other D. Bergen John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee e:1r'_1AA pF SO00-11 Uj�o COUNT`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD APPLICATION FOR A TRANSFER OF A WE DATE Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 OWNER //1%% !� /l�//l/G �,�/1i PHONE IJ — F1 MAILING ADDRESS l)— 141-2 AGENT r ADDRESS 7 C PHONE PROPERTY LOCATION '2.�5 C �=� �Jr �C �•/�� / TAX MAP NO: I/We Permit "q from Signed By: , �� request a Transfer of lf_A� • OLJWSK5H I P,,,, H OkAwlb INA 0 LId19G fkusT y. T.ev1Tc--3 ie35v CALVES WIECK RoAb MAILING ADDRESS: f?p. (3ox 1058, souOrHoLe n471 101 Z, James F. King, President Bob Ghosio, Jr., Vice -President Dave Bergen John Bredemeyer Michael J. Domino BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 0 Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631)765-6641 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 VProject complete, compliance inspection James F. King, President Bob Ghosio, Jr., Vice -President Dave Bergen John Brederneyer Michael J. Domino Permit No.: 7866A BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date of Receipt of Application: July 12, 2012 Applicant: Patricia Fitzpatrick SCTM#: 63-7-32 Project Location: 1035 Calves Neck Rd, Southold Date of Resolution/issuance: August 22, 2012 Date of Expiration: August 22, 2014 Reviewed by: Trustee Michael Domino r1 U Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax(631)765-6641 Project Description: To install a 6' high stockade fence along the eastern side yard property line. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the project plan prepared by Patricia Fitzpatrick, received on July 12, 2012 and stamped approved on August 22, 2012. Special Conditions: None Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. James F. ing, President Board of Trustees 0 James F. King, President Bob Ghosio, Jr., Vice -President Dave Bergen John Bredemeyer Michael J. Domino BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: 0 Town Hall Annex 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Please be advised that your application dated T N 12 U 2 has been reviewed by this Board at the regular meeting of lhkjtk44bi2 and your application has been approved pending the cor letion 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) % 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: Final Tnspec-h"ovl Fee=,650.6D TOTAL FEES DUE: $ Sb, M BY: James F. King, President Board of Trustees E .lames F. King. President Bob Ghosio..lr_ Vice -President Dave Bergen John Bredemeyer Michael J. Domino 1-7 LJ Southold Town Board of Trustees Field Ins pection/Worksession Report P.O_ Box 1179 Southold, NV 11971 Telephone (631 765-1892 Fax (631)765-6641 Date/time: Z'Z 2°iZ PATRICIA FITZPATRICK requests an Administrative Permit to install a 6' high stockade fence along the eastern side yard property line. Located: 1035 Calves Neck Road, Southold. SCTM# 63-7-32 Type of area to be impacted: _Saltwater Wetland _Freshwater Wetland _Sound _Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: _Chapt.275 _Chapt. 111 _other Type of Application: _ Wetland _Coastal Erosion _Amendment —Administrative—Emergency Pre -Submission Violation Info needed: Modifications: Conditions: t"1- b -GC Present Were: J. King _B. Ghosio D. Bergen, J. Bredemeyer Michael Domino D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: U a. -.e 1 L,Y•LLy�iiV"`�"� ��'ti+ It.. "-1 F mar' IN V [47v �Vltof /u� "'� ' ro SF ORIy f ERACCE OVER UPLAND AREA _e - 27.M2 .Q. n.) I 6-0-01 V� Lt p0 J 706.7 _ N~ Nucbqr �\ N S, J• IN e f+ Ar \ .•� �� JAW LA ♦ F h � 2 � 6-0-01 V� Lt p0 J 706.7 _ N~ Nucbqr �\ N S, J• IN e f+ Ar \ .•� �� JAW LA fi 1 1 •1+11 {`� •• �•�_ �t. 40 It f Q Y •� i. � �s• ry F � �. 'p J s F: � r e. iha: i SSC, r 6. ':A i Ilmll � VIII VIII I�I�I VIII IIII IIII IIIIII VIII VIII IIII IIII SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DECLARATION Recorded: 07/29/2011 Number of Pages: 6 Receipt Number 11-0084793 At: 09:41:59 AN LIBER: D00012666 PAGE: 902 District: Section: Block: Lot: 1000 063.00 07.00 032.000 EXAMINED AND CHARGED AS FOLLOWS Received the Following Fees For Above Instrument Page/Filing $30.00 Exempt NO Exempt COE Handling $20.00 NO $5.00 NO XrS SRCHG $15.00 NO TP -584 $0.00 NO Notation $0.00 NO Cert.Copies $7.50 NO RPT $30.00 NO Fees Paid $107.50 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A HILL JUDITH A. PASCALE County Clark, Suffolk County auily1R %. VUllly 1\�ylutiiK w L11uVaUvaaavaa� ..�. • • _-s,er of P'agn TORRENS Serial # Certificate # Prior Ctf. # Deed / Mortgage Instrument 4 Page ' Filing Fee Handline 5g. RP T.&A_ Comm of Ed. Affidas it Sub Total 5 QQ_ Deed / Mortgage Tax Stamp I Recording / Filing Stamps 5 Sub Total S --) 5 G GRAND TOTAL I"(-' ! - Beal Annoeriv TaX_Scrvim Aw,ncY Verification _ 1000 06300 0700 032000 Stam CLPJA P Date Initials T Satisfactions/Discharges/Releases List Property Owners Mailing RECORD & RETURN TO: C. riC�Sta.+a, Inc. 12 M, II Pond C. Mo2icwcs. N Y 11540 Mortgage Amt. I. Basic Tax Additional Tax Sub Total Spec. Assit. n, Spec Add TOT. Mf6. TAX ,> _ Dual Town Dual County _ 'f MU Ill AAgortionment Tran,ter I:i, Mansion Tax _ The property covered by% this mortgage :s Lx will be improved bT a one or two famil% dwelling only. YES or NO If NO. see appropriate tax clau,e on oaee - of this instrument. III Community Preservation Fund ' Consideration Amount $ CPF Tax Due S Improved Vacant Land dres TD TD TD U Title Company Information Co. Name Title # Suffolk County Recording & Endorsement Page This page forms part of the attached p el {,ate &P COVL6f�Es * AeYis"I eTr &rLr made b% (SPECIFY TYPE OF INSTRUMENT) i a-�r't r r - ryna r to 4 The prernises herein is situated in SUFFOLK COUNTY, NEW YORK ----- ------------------- — This page forms part of the attached Irc) (SPECIFY TYPE OF INSTRUMENT) The premises herein is situated in SUFFOLK COUNTY, NEW YORK In the Township of SOto7'!+0 In the VILLAGE or HAMLET of mad: r. BOXES 5 TI IRU 9 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. 11 .rnciS loj Xdoa Ieul;,uo ag133ul4a uta I Pue u1 palg uaaq seq aHeDpumiu uu,i.,rj��4= --A • 'iaABdxe,L leaQ DECLARATION OF COVENANTS AND RESTRICTIONS DECLARATION made this �4day of July, 2011, by Patricia Fitzpatrick. now residing at 1035 Calves Neck Road, Southold, NY, as owner, hereinafter referred to as the "Declarant". WITNESSETH: WHEREAS, the Declarant has title to certain land situate, lying and being at 1035 Calves Neck Road, Southold, Town of Southold, Suffolk County, New York, SCTM #1000-063-007-032, said land being more particularly described in Schedule A which is attached hereto: and WHEREAS. the Property is situated in or adjacent to lands activifies upon which are regulated by the Town of Southold Board of Trustees pursuant to Chapter 275 of the Town Code of the Town of Southold, as may be amended, and various activities conducted upon the property are subject to the jurisdiction. regulation and approval or disapproval of the Trustees pnor to being conducted WHEREAS, the Declarant has applied to the Town of Southold Board of Trustees for a Wetland Permit for approval to replace the existing dock wrth a low -profile fixed dock on sixteen 6" diameter piles 12' on center, 3 x 15' ramp and a 6' x 20' floating dock affixed to two 8" diameter piles and in-place replacement of 125' of bulkhead and 37' return landward of high-water on the property described in Schedule A and known as SCTM #1000-063-007-032, and as depicted on the plans prepared by John C. Ehlers Land Surveyor, last dated June 9, 2009: and IOW " V�y X10 uT++ti In the VILLAGE or HAMLET of e r+ 7 N e WHEREAS. the Town of Southold Board of Trustees, as conditions for the issuance of Wetland Permit Number 7050 dated March 18, 2009, required certain covenants and restrictions be placed on the property as shown on the aforesaid plans. NOW, THEREFORE, this Declarant witnesseth: That Declarant, for the purpose of carrying out the intentions expressed above does hereby make known, admit, publish, covenant and agree that the said property herein described shall hereafter be subject to the following covenants which shall run with the land and shall be binding on all purchasers and holders of said premises, their heirs, successors, and assigns to wit 1. The grant of a Wettand Permit for the replacement of 125 of bulkhead and 37' return landward of fNgh.waater shall be conditioned upon portions of the bulkhead being removed and the area being re -vegetated with native species as shown on the above -referenced plan and identified as SUM No 1000-063- 007-032. If any work, repair or reconstruction of the bulkhead is performed, or in the event the bulkhead becomes non- functioning, the portions of the bulkhead referenced as a condition of the permit shall be removed. 2. The grant of a Wetland Permit for the replacement of the existing dock and bulkhead shall be conditioned upon the installation of a non -turf buffer in the area between the two most seaward 1) In the vILLAGE or HAMLET of d o� bulkheads, as shown on the above -referenced plan and identified as SCTM No. 1000-063-007-032. 3. These covenants and restrictions can be modified only at the request of the then owner of the premises with the approval of the Town of Southold Board of Trustees after a duly noticed public meeting. Adjoining property owners shall be entitled to notice of such public meeting by publication or as otherwise deemed sufficient by the Board of Trustees but their consent to such modification shall not be required 4. It is the responsibility of any party having any right, title or interest in the Property to consult Chapter 275 of the Town Code of the Town of Southold. as may be amended and to nota n f orr the Town of Southold Board of Trustees review and such approvals as may be required by Chapter 275 for activities regulated therein on the Property. 5. Declarant grants the continuing right in perpetuity to the Town of Southold or any of its designated representatives to enforce the conditions and restrictions of the covenants. THE FOREGOING covenants and restrictions shall bind the Declarant, its heirs, successors and assigns, and any and all person or persons who shall C) lJ.> h Cif V LT1Vf. I In the VILLAGE or HAMLET of— e o 0 succeed to the ownership of said premises of any part thereof by transfer or otherwise. IN WITNESS WHEREOF, the Declarant has duly executed this Declaration the day and year first above written. WE, STATE OF NEW YORK) ) ss.: COUNTY OF SUFFOLK) On this --� day of vC in the year 2011, before me personally appeared k own to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity and that by his signature on the instrument, the individya{ or the person upon behalf of which the individual acted, executed the inst U k.> r Sep o u a Notary Public SMAWN A. WE" NOMY P,z $'E'9JI'm York No. 01YrE6'.•a'_t Con msaion Expa" G4 4 210 ,(,y A In the VILLAGE or HAMLET of e 7'" a ji, 0 0 5-11838 Amended 5/181, 10 AMENDED DESCRIPTION ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate, lying and being in the Town of Southold, County of Suffolk and State of New York, being more particularly bounded and described as follows: BEGINNING at a point on the northerly side of Calves Neck Road (a private road) distant 958.10 feet easterly as measured along the same from the comer formed by the intersection of the easterly side of Youngs Avenue with the northerly side of Calves Neck Road (a private road); RUNNING THENCE north 15 degrees 38 minutes 40 seconds east along the easterly side of land now or formerly of Holman 195.42 feet to a tie line along the face of a bulkhead on Town Creek; RUNNING THENCE along the said tie line the following 3 courses and distances: 1. south 79 degrees 24' 22" cast 76.23 feet; 2. north 21 degrees 55' 35" east 8.94 feet; 3. south 84 degrees 44' 16" east 43.71 feet to the westerly side of the land now or fo rr:erh o` i3'.erknes. R'�1�TNG PaNCE along sid lard so'..; '4 degrees I? .-mules :24 J_ fee: to :he northerly side of Cal: es Neck Road road RUNND:G THENCE alorg the northerly side of Calves Neck Road ipnva:e road !he `ollowing two courses and distances -. north 69 degrees 01 minutes 20 seconds west 55.15 feet; 2. north 74 degrees 21 minutes 20 seconds west 65 feet to the point or place of BEGINNING. r cc Q 5 o Ln14 wb In the VILLAGE orRAMLETof `Se�T?ior� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM AUG 1 3 2012 D of To: Jim King, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: August 13, 2012 Re: Proposed Wetland Permit for PATRICIA FITZPATRICK SCTM#1000-63-7-32 PATRICIA FITZPATRICK requests an Administrative Permit to install a 6' high stockade fence along the eastern side yard property line. Located: 1035 Calves Neck Road, Southold. SCTM# 63-7-32 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. 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 IACATION: ��Of S0U%yO l� MAILING ADDRESS: Town Hall Annex ,�O P.O. Box 1179 54375 State Route 25 y ./, T T Southold, NY 11971 (eor. Main Rd. & Youngs Ave.) Southold, NY 11971 G C Telephone: 631 765-1938 �0 �1y00UNTY,Nc� Fax: 631765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM AUG 1 3 2012 D of To: Jim King, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: August 13, 2012 Re: Proposed Wetland Permit for PATRICIA FITZPATRICK SCTM#1000-63-7-32 PATRICIA FITZPATRICK requests an Administrative Permit to install a 6' high stockade fence along the eastern side yard property line. Located: 1035 Calves Neck Road, Southold. SCTM# 63-7-32 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. 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 0 James F. King, President Bob Ghosio, Jr., Vice -President Dave Bergen John Bredemeyer Michael J. Domino 0 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application _ Administrative Permit _Amendment/TransfedExtension Received Application C Received FeeS 5 Cs�al� _Completed Application _Incomplete _SEQRA Classification: Type I_Type II_Unlisted_ _Coordination:(date sent) �LWRP Consistency Assessment Form SI II a ECAC Referral Sent: N R _Date of Inspection: AS _Receipt of CAC Repo _Lead Agency Determination: _Technical Review: Public Hearing Held: 101 Resolution: Name of Applicant Address 10 Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 Number:( )j�!j1' J10G ,?7 2,2- Suffolk 2 Suffolk County Tax Map Number: 1000 - n(nz —?::,7 Property Location: �?r,I 7-11 (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: C E W E JUL 12 2012 J� D lown B9W of Trustees Application. GENERAL DATA Land Area (in square feet): .�2 (�� Area Zoning: - Previous use of property: Intended use of property: " " T C= Covenants and Restrictions Yes No If "Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals Yes '-N No If "Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept. Yes '----4 No Does the structure (s) on property have a valid Certificate of Occupancy Yes No Prior permits/approvals for site improvements: Agency Date � 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).1Z.- IIg,5) JPS Wft -cVl �caL . B9W of Trustees Application. WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed M Area of wetlands on lot: koor4 e3b square feet Percent coverage of lot: q .5 % Closest distance between nearest existing structure and upland edge of wetlands: ISP feet Closest distance between nearest proposed structure and upland edge of wetlands: 150 feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): 00a� PROJECT ID NUMBER 617.20 SEQR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PAK11-YKVJtGI INFVKMA I IUN ( to oe completeD Dy Applcant or rrolect aponsor) 1. AAPPLICANT/ SPONSOR 2. PROJECT NAME 'r,k1RI�/N Famicy, .NVujr 3.PROJECT LOCATION: Municipality �V--korL.0 County 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map 102,013 Cis W=114 I&40 � W. 11coI 5. IS PROPOSED ACTI N : - F-nd New Expansion ❑ Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: 1 by a pray ly F-6.Aff 150 T-3mi uaal- M/ 4. vv &P Nay kbGTLA►., va6urpce 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes F No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential F Industrial 11 Commercial Agriculture ❑ Park / Forest / Open Space Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENC (Federal, State or Local) ElYes No If yes, list agency name and permit / approval: A- CURRENTEY__VALID PERMIT OR APPROVAL? Yes No If yes, list agency name and permit / approval: 11I-2.. A ESU LT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? LA"�S Dyes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor ame _ Date: Signature ''Z' tL If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment 0 9 PART II - IMPACT ASSESSMENT To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL FAF. Yes IZI No 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. Yes El No 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 patters, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Longterm, short term, cumulative, or other effects not identified in C1-05? Explain briefly: C7 Other impacts(including changes in use of either quantity or type of energy? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CFA? It yes, explain briefly: Yes 0✓ No 17 . IS THERE, OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es ex Iain: Ves ❑✓ No 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 (1) 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 mustevaluate the potential impact of the proposed action on the environmental characterisfics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the F EAF 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 at WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting determination. Board of Trustees o Name of Lead Agency H HAF-S or 19vG- / D zo/L Date 6- President p agency Title of Responsible Officer Signature of Preparer (If different h ors responsible officer) BqV of Trustees Application County of Suffolk State of New York Irj�j1 �, V ZqA'j2Cy BEING DULY SWORN DEPOSES AND AFFIRMS TH T HE/STHE 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 Notary Public NANCY S BAATOW Public - State of New York NO. 01BA6246841 slified in Suffolk C un j::N40:tary mission Expires S Signature DAY OF JkL,20 1 Z— YOUR NAME: 0 0 APPLICANVAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM 'Last deme, first name, iriddle initial, unless you are al; someone else or other entity, such as a company. If so, person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If"Other, time the activity.) Building \ Trustee Coastal Erosion Mooring Planning t the name of the other 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 than 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 Submittedif day of 200 _ Signature Print Name Form TS 1 Town of Southold 9 • 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. 2. 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). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non - 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 SCTM# PROJECT NAME 1'f r/T�%f (Y Z;�M G&Z The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board ❑ Building Dept. ❑ Board of Trustees Nature 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: andKent of action: Location of Site acreage: Present land use: Present zoning classification:VEFJO—Atwi If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name (b) Mailing address:1, 0 ?2G Q�AiW"s Nr -;r GU �:; (c) Telephone number: Area Code ( ) O'Q • q ZZ (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ❑ NoL! I 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 III - Policies; Page 2 for evaluation criteria. ❑ Yes ❑ No*E] 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 0 Yes 0 No & Not Applicable 0 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 Q Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III — Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III — Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No 0 Not Applicable Attach additional sheets 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 ApAble • Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ NoE] Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III — Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No S] Not Applicable wig 016KV-111%,11Y0311toLoki 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. ❑ YesO No N Not Applicable Attach additional sheets if necessary WORKING COAST POLICIE0 • 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 [I No N Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III — Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ NoE] Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No F1 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 0 Not Applicable PREPARED BY (I _ TITLE DATE . I Z • I2, SURVEY OF PROPEF,_( PROPERTY LOCATED AT SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY. NEW YORK S.C.T.M. x 1000-063-07-32 AREA - 24.679 SF. - 0.5656 ACRES (TO TIE LINES SCALE: 1'-30' NOTE: THE EXISTENCE OF RIGHT OF WAYS. WETLANDS AND/OR EASEMENTS OF RECORD IF ANY. NOT SHOWN ARE NOT GUARANTEED. PROPERTY IS CLEARED IN ITS ENTIRETY — APPROVED BY BOA�R OF TRUSTEES TO "4- FF SOUTHOLD DATE,�uQ L\ Z2 , 7.1)l Z PATRICIA FITZPATRICK LAWYERS TITLE INSURANCE COMPANY ,."A"S' a�n.,VIOLATION I. .aM.. PP3,X,E...1.. TONSES an.. X..,m . M I. .. c so w P.roa cn.w, NOT. m�.P To. X ..u0 ,Pc ro,. NE IGlI IPI SNON E, IS RXRP UO W Nl .wON M X WgRRX,N XmE, XIp {y®p M,ITNY% ,.B,EO IIROa.IP ,0 M I.®QEV M IOYO M,I,Y,M 1N� PmI,.GTY{ ARE IR ,MI9G611E N XDP,buE 2IB5 1 U L JUL 12 2012 / TOWN CREEK Southnoid Town F.CERo. &ILLSTEAP N z s'E Board of Trustees 8.94' 8.94' 4'22 E-[.. S 84.°E\ .R..1 4'444'6 76.23' 1. eroE MOeba Ck y^RFn e O.V S R,1E . R^/ ^"E^ / TIE NET RKL a.. h l f�a z LAND N/F tt / o [ HOLMAN / 21.8' (\• E 7 rRMITE RCB 1 F fti{l l I13.3' W / Y b b 1 LAND N/F BJERKNES i � / s &R /. P) h / pots N 74°Z '20'�y / C A 65.00, .. L 69.01'2 \ 0"W SURVEYED BY: STEVEN l� � C` SS „N°x BARYLSKI 'IS• N.Y.S. LIc. N.. 050453 R 0 41 MEETING HOUSE LANE A Ij SOUTHAMPTON. N.Y. 11960 MAY 14. 2010