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HomeMy WebLinkAboutTR-7869A James F. King, President QF ~Q(/ Town Hall Annex lye 54375 Main Road Bob Ghosio, Jr., Vice-President h~ ~ P.O. Box 1179 Dave Bergen # # Southold, New York 11971-0959 John Bredemeyer H ~ Gs • a~ Telephone (631) 765-1892 Michael J. Domino i~` Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0895C Date: September 3, 2013 THIS CERTIFIES that the construction of a one-story addition to the existins dwellins removal of the deck and construction of a second-story addition At 412 Park Avenue Mattituck, New York Suffolk County Tax Map # 123-7-9.2 Conforms to the application for a Trustees Permit heretofore filed in this ot'fce Dated August 2, 2012 pursuant to which Trustees Administrative Permit #7869A Dated August 22, 2012, 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 a one-storKaddition to the existin¢ dwelline removal of the deck, and construction of a second-story addition. The certificate is issued to DAVID & ANN CORIERI owners of the aforesaid property. Authorized Signature lames F. King, President O~~FF~(,rCO Town Hall, 53095 Main Rd. Bob Ghosio, Jr., Vice-President ~y ~ P.O. Box 1179 Dave Bergen ~ ~ Southold, NY 11971 ,r JohnBredemeyer Gy Telephone (631)765-1892 Michael 1. Domino ~1 * `7~~ Pax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: ,¢?C~ 3 v "Z o 13 / y%~ Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction YZ constructed Project complete, compliance inspection. INSPECTED BY: ~ i~cJ lr COMMENTS: `/a~ ~ I CERTIFICATE OF COMPLIANCE: , g11FF1](,~ James F. King, President ~ ~ ~p~ Town Hall, 53095 Main Rd. Bob Ghosio, Jr., Vice-President ~ P.O. Box 1179 Dave Bergen y ~ Southold, NY 11971 John Bredemeyer 'dy ~ Telephone (631) 765-1892 Michael J. Domino ~ x'01 ~ .~,D~ 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 APRE-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 YZ constructed Project complete, compliance inspection • James F. King, President ~~Of $OUjyO Town Hall Annex Bob Ghosio, Jr., Vice-President h0 54375 Main Road P.O. Box 1179 Dave Bergen ~ ~ Southold, New York 11971-0959 John Bredemeyer G Q • ~O Telephone (631) 765-1892 Michael J. Domino O Fax (631) 765-6641 ~'~OOUNi'1,~~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7869A Date of Receipt of Application: August 2, 2012 Applicant: David & Ann Corieri SCTM#: 123-7-9.2 Project Location: 412 Park Avenue, Mattituck Date of Resolutionllssuance: August 22, 2012 Date of Expiration: August 22, 2014 Reviewed by: Jim King, Trustee Project Description: To construct aone-story addition to the existing dwelling, remove the existing deck, and construct asecond-story addition. 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 survey prepared by Nathan Taft Corwin III, last dated on August 13, 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. v James F. King, President Board of Trustees ~~o~gIVFFO(~cPG lames F. King, President y Town Hall Annex Bob Ghosio, Jr., Vice-President 0 x 54375 Route 25, P.O. Boz 1179 ' Dave Bergen Southold, NY 11971 John Bredemeyer ~dj ~ .~L~ Telephone (631) 765-1892 Michael J. Domino Fax (63I) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: pGtVl~r~ + /-~ni~ brie~l Please be advised that your application dated ~ S~- ,212D12 has been reviewed by this Board at the regular meeting of Ol and your application has been approved pending the comb etion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 15~ Day of Construction ($50.00) '/z 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: 3~-~I~ ~ TOTAL FEES DUE: $ D. Db BY: James F. King, President Board of Trustees pgUf FO(A' James F. King, President QV CO P.O. Box 1179 Bob Ghosio. Jr., Vice-President a Gd Somhold, NY 11971 Dave Bergrn r°n ~ Telephone (631 765-I ft92 John Bredemeyer ~ ~ ~ Fax (631) 765-6641 Michael J. Domino yyor aa~~ ti,} Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: Ao'G- / ? z ~ ~ Z % S'. L DAVID & ANN CORIERI request an Administrative Permit to construct a one-story addition to the existing dwelling, remove the existing deck, and construct asecond-story addition. Located: 412 Park Ave., Mattituck. SCTM#123-7-9.2 Type of area to be impacted: j -Saltwater Wetland -Freshwater Wetland -Sound -Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: ~Chapt.275 Chapt. 111 -other Type of Application: _ Wetland -Coastal Erosion -Amendment /!Administrative_Emergency Pre-Submission Violation Info needed: d l~ 5 5 ~'i3'rr~1'TF~ Modifications: Conditions: Present Were: King B. Ghosio D. Bergen, J. Bredemeyer Michael Domino D. Dzenkowski other Form filled out in the field by J ~ Mailed/Faxed to: V Date: • DONALD G, FEILER •ARCHIT~T 11725 Moin Rd • Box 1692 • Mpttituck, NY 11952 • 6312985453 • Fpx 298.1380 t ~ ~ i ~ ~l / h ` - ` - ~ :f r~ J ~ - --j , rt ; 1 ~ ~ a \ ~ , ~F' I~~~ i~ +1 y ~ .j. ~ t i Il ~ j i 1.1..4 _ . 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Fo ~ pp © ,s' N y; M1 j BPS ~ „49 P~g11L 9 ,/y~ G~t 9 ON e / ~y 9 ~ ~ xorkc COUNTY OF SUFFOLK © s6 zF 23~ ~~-•^•'~m~ ~y_ ReelvmpeM iu Sarvi®P9auy • OFFICE LOCATION: ~~~F $~UjyO MAILING ADDRESS: Town Hall Annex h~ l~ P.O. Box 1179 54375 State Route 25 .If, ~ Southold, NY 11971 (cor. Main Rd. & Youngs AveJ T Southold, NY 11971 G, Q Telephone: 831 785-1938 ,c~ ~ Fax: 631785-3138 ~~y00UNi'I LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD r: - MEMORANDUM jl ~4 h ~ ~ qUG 1 3 2012 ~ ~D To: Jim King, President Town of Southold Board of Trustees s~~~rr,`IOs Town _ 2~'srd of Trustees From: Mark Terry, Principal Planner ~~-~~--4~~ LWRP Coordinator Date: August 13, 2012 Re: Proposed Wetland Permit for DAVID & ANN CORIERI SCTM#1000-123-7-9.2 Donald Feiler on behalf of DAVID & ANN CORIERI request an Administrative Permit to construct a one-story addition to the existing dwelling, remove the existing deck, and construct asecond-story addition. Located: 412 Park Avenue, Mattituck. SCTM# 123-7-9.2 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 James F. King, President ~OF SOUT,y Town Hall Annex Olo 54375 Main Road Bob Ghosio, Jr., Vice-President p.0, $ox 1179 Dave Bergen # ~ Southold, New York 11971-0959 John Bredemeyer G Q ~ _ ~p Telephone (631) 765-1892 MichaeLJ. Domino O Fax (631) 765-6641 ~'~OOUNTI BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland Permit Application ~Adminis[rative Permit _Amendment/Transfer/Extension ?Keceived Application: I ~ ~/Yteceived Fee:$ ~.e"ompleted Application Incomplete _SEQRA Classification: Type IType II_Unlisted_ _Coordination:(date sent) ~LWRP Consistency Assessment Form R 13) _ a, w iZ _CAC Referral Sent: ~N ~ ` ,/Date of Inspection: Receipt of CAC Report: - Lead Agency Determination: Technical Review: - ?1 i~blic Hearipg Held:_$_I _ Resolution: Name of Applicant ~ ~ 1 ~ ~ ~NI4 1 E ~ ~ Address ~I-12 ~a12K P~ , MP 11 ~ iU f.K Phone Number:( ) Z ~ ~ ` ~ ~ 3 1 Suffolk County Tax Macp Number: 1000 - I2 ~ C 7 ` Q • 2 Property Location: Suv T11 S i 0E try ~ ~~K- 1" °~11~ ~1- ~ C, I ~-ltS ~ ©F M ~R R IaTc~o ~ a 120~,~ (provide LILCO Pole distance to cross streets, and location) AGENT: ~tyD~L~ ~il~~- (If applicable) Address: ~ 1'~ 2"J ~4'~ I {~I (~~i I~A~'yATC- 1 R~ Phone: 21~ `54~~ ~rd of Trustees Application GENERAL DATA Land Area (in square feet): I ~ ~ c5 Area Zoning: Previous use of property: S(11~yG~ ~~f ~V 1?'~. i~l t~ Intended use of property: 71~f Y 1l% Covenants and Restrictions: Yes X No If "Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals Yes K 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 Y~ No Does the structure (s) on property have a valid Certificate of Occupancy X Yes No Prior permits/approvals for site improvements: q,~ Agency I~Dgate] ~~'C~GC'i_° ~£iCN`~~'zUC~ ~~~N hl 1 ~U1biClo P~J~ ~l~(~ rctzcN ~)UrpcN ~ ~ ~2ccQ Scir~~i"1-~~::~ z~5v=5w„rom~N4P~~ ~z~~E~~~zu~ 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: Projecpt Description (use attachments if necessary): 1 (ZO P~~~ ~ S 1 ~I' ~`U~ ~ T~U(J bf-~ST~ ~EC~ Tc~ Rev`®~D PR~P~~ 2~~' ~ T ~ `~ot~ B~rd of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~~,,,~~5~ ~D ~ na~sT~ F~ tip 5 ~ ~NPr,UP~a o r ~F- t5 ~ i Nei ~(~JC.TU(~.S Area of wetlands on lot: 'J 1 ~ square feet Percent coverage of lot: I d Closest distance between nearest existing structure and upland edge of wetlands:J~'C~ feet t Closest distance between nearest proposed structure and upland edge of wetlands: ~ feet Does the project involve excavation or filling? No X Yes If yes, how much material will be excavated? C-'~2 cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: 3 feet Proposed slope throughout the area of operations: ~L ~ Manner in which material will be removed or deposited: TR~UCk:~ ©d Statemer3t_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): • sn.zo • SEAR PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANT / SPONSOR ~ 2. PROJECT NAME OLw'+ ~ f AI:,N l.C;(Z? t'1.2 i L~ (LI fi~21 ~S i GE~~iG`E 3.PROJECT LOCATION: 4t2 1'tJE, MainTixtc CJJ-~*, Municipality TC yv P- J O l~ County t' 1 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or orovide map ~ c3Tlt 5 i DE- C~,r PPi'~ C-- ~ c 1 5. IS PROPOSED ACTION : ~ New ~ Expansion X571 Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: ~~I• " I~u`~~'O i SiZr' ~I~Uf`? `mil-~SilnlC~ 2 51~i ~r1?c~.a-tt~VG~ . 7. AMOUNT OF LAND AFFECTED: _ Initially acres Ultimately C? r ~ acres S ~9 SGl. r~j 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ' Yes ? No ' If no, descdbe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential ~ Industrial ~ Commercial ~Agricullure ~ Park /Forest /Open Space ~ Other (describe) i 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANV OTHER GOVERNMENTAL I AGENCY (Federal, State or Local) (~-1Yes ~No 1f yes, list agency name antl permit /approval: ' L~,~ ~O V~1t~ ~J TD W t~ ~l.)11.Q i fJ(a p ~ l` 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ?Yes (~/1 No If yes, list agency name antl permit /approval: Lj~ 1II2~~. llA''S A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? Ures ?No I CERTIFY THAT THE INFORMATION PRO/VIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE~/"' ' Applicant / sor Na ~ ~I r'W/ ~„~2 Date: ~'cc~~2 Signature + 'fl the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II -IMPACT ASSESSMENT To be tom leted b Lead A enc A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.a? If yes, coordinate the review process and use the FULL EAF. Yes ~ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative dedaration may be superseded by another involved agency. Yes ~ 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 pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agdcultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood charadeR Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife spades, significant habitats, or threatened or endangered spades? Explain briefly: Ca. A community's existing plans or goals as officially atlopled, or a change in use or intensity of use of land or other natural resources? Explain bdefly: C5. Growth, subsequent development, or relatetl aclivifles likely to be induced by the proposed action? Explain briefly: C6. Long tens, shot term, cumulafive, or other effects not idenflfied in C7-C5? Explain briefly: C7. Other im ads indudin than es in use of either uantit or t of ener ? E lain briefl D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CFA ? If es, ex lain briefl Yes ~ No E. IS THERE, OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If sex lain: Yes ~ No PART III -DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: Foreachadvelseeffedidentfiiedabove,determinewhetheritissubstantial,large,importantorotherwisesignificant. Each effect should be assessed in cennedion with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irteversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain suffidenldetail to show that all relevant adverse impacts have been ident~ed and adequately addressed. If question d of part ii was checked yes, the determination of sgnficence must evaluate the potential impadofthe proposed actlon on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large orsignificent adverse impacts which MAY occur. Then proceed directly to the FUL FAF antl/or prepare a positive dedareflon. Check this box if you have deternined, based on the Information and analysis above and any supporting dowmentadon, that the proposed acgo WILL NOT result in any signifcent adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi tlelermination. Board of Trustees p ~jlf(t / D Zo/Z- Name of Lead Agency Dale J~/lt ~ S ~ President p Print or Ty a Name of Responsible Officer in Lead Agency Title of Responsible Officer Sign re of Responsible Officer in Lead g Signature of Preparer (If different from responsible officer) eawf~~ Town of So hold ~®g Erosion, Sedimentation 8a Storm-Water Run-off ASSESSMENT FORM PROPEaTr LocgrloN: s.c.T.M. B: THE FOLLOWING ACTIONS MAY REgUIRE THE SUBMISSION OF A 01 ~ ~ STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN is-G tact BecT ~Toc rl- Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK -PROPOSED CONSTRUCITON IT'F.M # /WORK ASSESSMENT' Yes No a. What is the Total Area of the Project Parcels? ~7y 5 ~ Will this Project Retain All Storm-Water Run-O(f (Include Total Area of all Parcels located within j „ 7J bC(~S Generated by a Two (2") Inch Rainfall on Site? the Scope of Work for Proposed Construction) is F I Aqes (This item will include all run-0ff created by site ~ ? b. What is the Total Area of Land Clearing ) clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed ~jrj ,r Site Improvements and the permanent creatlon of `j'' " Q, OI AC construction activity? - impervious surfaces.) (B.F. /Acres) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRff.F PROJECT DFSCRIP'TION (Pmvitla Addidanel Papen as Needml Drainage Structures Indicating Size&Ldcation?This ~ r2 Item shall include all Proposed Grade Changes and - PCzc~G~ ~7 ( Si4' r~ i -r-~tv Slopes Controlling Surface Water Flow. r"V 3 Does the Site Plan and/or Survey describe the erosion ? n ~ '~j-'i (N ~ ~ S~ and sediment control practlces that will be used to Tip y~l control site erosion and storm water discharges. This N item must be maintained throughout the Entire Constructon Period. 4 Will this Project Require any Land Filling, Grading or ? - Excavation where there is a change to the Natural x Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? rj Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand ? n (5,000 S.F.) Square Feet o(Ground Surface? s Is there a Natural Water Course Running through the ~ - Site? Is this Project within the Trustees jurisdiction j( General DEC SWPPP Requirements: or within One Hundred (100') feet of a Wetland or Submission of a SWPPP is required for all Construction activities invoNirg soil Beach? disturbances of one (i) or more acres; inGuding disturbances or less than one acre Nat 7 Wjll there he Site preparation on Existing Grade Slopes ? are part of a larger common plan that will ultimately d'aNrb one or more acres of land; which Exceed Fi(leen (75) feet of Vertical Rise to x including Construction activities involving sot disturbances or less than one (t) acre where One Hundred (100') of Horizontal Distance? - Ihe DEC has determined Iha[ a SPDES permit is required for storm water dischayes. ( SWPPP's Shall meet the Minimum Requirements of the BPDEB General Permit $ Will Driveways, Parking Areas or other Impervious for Storm Water Discharges hom Construction activity -Permit No. GP-0-to-001.) Surfaces be Sloped to Direct Storm-Water Run-Off ? x 1. The SWPPP shall be prepared prior to the submittal of Ne NOI. The NOI shall be info and/Of in the direction of a Town fight-Of-Way? suDmided to the Department prior to the commencement of construction activity. 2. The SWPPP shall describe the eroslgn and sediment contrd practices and where 9 Will this Project Require the Placement o(Material, ? - required, poslconstmction storm water management practices that writ ba used and/or Removal of Vegetation and/or the Construction of any X conswcted to induce the po0utants in storm water dischares and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of this pemlil. In addition, the SWPPP shall Area? ITnls Item will NOT irrcb0! the Irubllation or Dnveway Aprom.l identify potential sources of pollution which may reasonably tre expected t0 a0ec1 Ne gvaliry of storm water discharges. NOTE: If Any Answer to Ouestlona One through Nlne la Answered with a eheclr Mark 3. All SW PPPS that require the poslconstmdion storm water management practice In a Box and Ne codsiruetlon silo disturbance is between 5,000 B.F. 81 Acre in area, component shall be prepared by a qualirred Design Professional Licensed in New York a Stortn-Water, Grading, Drainage 8 Eroaton Congo/ Plan is Required by Ne Town of that is knowledgeable in the principles and practices of Slonn Water Management Southold and Must be Submitbd br Review Prior to bsuance of Any Building PermlL (NOTE: A Check Mark (J I antllor Answer tar each Oueslbn a Required (a a Complete gpgicauon) ST'AT'E OF NEW YORK, COUNTY OF SS That I, ......N.i~..........~?..!-~ ,,t + being duly sworn, deposes and says that he/she is the applicant for Permit, (Name of individual ignirg Document) And that he/she is the .......~G.:p~.. (owner, Conlreclor, Agem. Corporete Officer, etc) Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have perfomted the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed her Sworn to ~b~~e me [his; . L day of.....~!...........................,`lOCa ' Notary Public:..~.~.(.~,.!k. °1+~.'.....:.:+a~CAL1t~ArJY.k _ LAUREN M. STANDISH (Signature or Applicant) FORM - 06/70 IvG.ozsuTSls~oos Qualified in Saffoik Count Commission Expires April 9.20)_ County of Suffolk State of New York D ,fi rJ tom! ~-c~ ~I ~ I-~ BEING DULY SWORN DEPOSES AN 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. ,t ~ Signature ' r SWORN TO BEFORE ME THIS °z 7r~{ DAY OF v~ ~ ,ZU ~L MEUNDA I. TOPPING-NOTARY PUBUC, STATEOFNEWYORK d-~o4 COMAq SS ON~xPiRE3MgY31 ~ ~10/3~ Notary Public i~rd of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, ~i't ~ l-%i2kl~l ~ i~ltip ~c~i,g b'~Fesiding at ~'2 pL~~ ~fE a (print owner of property) ~ (mailing address) j>r 1'}Z~~ do hereby authorize (Agent) ~1t7L~ ~ t L.~, to apply for permit(s) from the Southold Board of Town Trustees on my behalf. 7 ' re APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibit conflicts of interest on the Dart of town officers and emolovees The ouroose of this form i to provide information which can alert the town of oosstble conflicts of inures[ and allow rt to take whatever action is nece rv to avoid soma YOURNAME: p~`*.i ll~ ~ -"`21~ (Last name, first name, ipiddle initial, unless you are applying m the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name) NAME OF APPLICATION: (Check all that apply.) - Tax grievance Building 1C Variance Trustee K Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other', name the activity) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest "Business in[eresP' 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 [he town officer or employee owns more than 5%of the shares. YES NO k if you ansvered "YES", complete the balance of this form and date and sign where indicated. Name of perspn employed by the Town of Southold Title ofposi[ion of [hat person Describe the relationship between yourself (the applicant/agenUrepresentative) 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 he[spouse, sibling, parent, or child is (check all [hat 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 nontnrporate entity (when the applicant is not a corporation); C) an officer, director, partner, or employee of [he applicant; or - D) the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this da of ~ 1 -;!Z AIL Signature - ~ ~~~.~i~; Print Name ~ , ' .r>P; ~ ' Pr"-j Form TS 1 Town of Southold . • LWRP CONSISTENCY ASSESSMENT FORM A. INSTRiICTIONS 1. All applicants for pemuts* 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 prepazer 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 sienificant 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, listine both supporting apd non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standazds 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 PROJECT NAME G~ i >~(Z ( R'E~ I ~ ~C~ I The Application has been submitted to (check appropriate response): Town Board ? Planning Board ? Building Dept. ? Board of Trustees ® II 1. Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital ? construction, planning activity, agency regulation, land transaction) ? (b) Financial assistance (e.g. grant, loan, subsidy) ' (c) Permit, approval, license, certification: ~ ~ Nature and extent of action: '~FZO~St`-T:~ ~ S Tai' ~ t 1lON~ ~`E-1g i ~ 1~ DEcK- To ~ i~-M~J~ p(LO ti~c)c~c~p ~ ~ ~ S i I T1 O is Location of action: ~I 2 ~?laj2 ~ ~ y~ , M a j~y C~. Site acreage: ~ , 3 ~c yt~ Present land use: Si Nei ~ ~l1 t~~ "d~?Vc7-c- ir~C+ Present zoning classification: X40 2. 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: ~pv t~ ~ C~2,t~12 j (b) Mailing address: 9ry'Y Pn'~- ~ ~Yl~l II~tjQ. (c) Telephone number: Area Code (Cc)~ j Z~ rb' ~ ~ ~ ~ (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 III -Policies; Page 2 for evaluation criteria. ? Yes ~ No ©Not Applicable I i I 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 thrc LWRP Section III -Policies Pages 6 through 7 for evaluation criteria ? Yes ? No ~ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources fro 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 -Policies Pages 16 through 21 for evaluation criteria ? Yes ? No ~ Not Applicable Ye~ No Not Applicable • Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southol Pages 32 through 34 for evaluation criteria. ? Yes ? No ~ Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southo substances and wastes. See LWRP Section III -Policies; Pages 34 t6 ? Yes ? No~ Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coas resources of the Town of Southold. See LWRP Section III -Policies: criteria. ? Ve? Nn? Nnt Annli~alilr WORKIP*'OAST POLICIES • Policy 10. Protect Southold's water-dependent uses and promote sit. suitable locations. See LWRP Section III -Policies; Pages 47 througt ? Yes ? No ~ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources ii Estuary and Town waters. See LWRP Section III -Policies; Pages 57 ? Yes ? No ~ Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See 62 through 65 for evaluation criteria. ? Yes ? No ?X Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy ; Section III -Policies; Pages 65 through 68 for evaluation criteria. ? Yes ? No ~ Not Applicable pARE 496' J % N SURVEY OF PROPERTY SITUA TED A T MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-125-07-9.2 SCALE 1"--20' AUGUST 19, 1998 JUNE 4, 1999 ADDED PROPOSED PORCH SEPTEMBER 1, 1999 ADDED PROPOSED POOL SEPTEMBER 15, 1999 REVISED PROPOSED POOL LOCATION OCTOBER 7, 1999 UPDATE SURVEY SHOWING GROINS, LOW WATER MARK & HEIGHTS ABOVE BEACH JANUARY 26, 2000 REVISED PROPOSED POOL LOCATION JANUARY 50, 2005 UPDATE BULKHEAD AREA JUNE 22, 2012 REVISED PROPOSED ADDITIONS AUGUST 15, 2012 UPDATE SURVEY AREA 57,117.45 sq, ft. (TO BULKHEAD) 1.51 1 ac. CERTIFIED TO: FIRST AMERICAN TITLE INSURANCE COMPANY OF EMPIRE ABSTRACT CORPORATION TITLE No. 510-S-3452 (40204) MARINE MIDLAND MORTGAGE CORPORATION DAVID CORIERI ANN CORIERI NEW YORK _NOTES: 1. LOT NUMBERS SHOWN THUS: LOT(~ REFER TO MAP OF MARRATOOKA PARK FILE IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON NOVEMBER 1, 1905 AS FILE No. 450 2. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM EXISTING ELEVATIONS ARE SHOWN TRUS:2Oo EXISTING CONTOUR LINES ARE SHOWN THUS: '- - APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTHOLD Land Surveyor Fax (531)727 1727 WOOD 3 5'E DRAINAOE SYSTEM CALCULATIONS' ROOF AREA (PROPOSED ADDITIONS): 878 sq, ff 878 sq. ft. X 0,17 -- 149,5 au ft, 149,2 cu. ff. / 42,2 = 3,5 vertical fH of 8' dim, leaching pool required PROVIDE (1) 8' dia. X 4' high STORM BRALN POOLS /. PROPOSED BI DIA, X 4' DEEP DRYWELLS FOR ROOF RUN-OFF ARE SHOWN THUS: S 86'04'27" W X~ 171.2_1' GREAT P BAY 99-100(;