The URL can be used to link to this page

Home My WebLink AboutTR-7863A James F.King, President ��Of SOUIyo Town Hall Annex Bob Ghosio,Jr.,Vice-President ,�O �� 54375 Main Road P.O. Box 1179 Dave Bergen Southold, New York 11971-0959 John Bredemeyer H Michael J. Domino Telephone(631) 765-1892 CON Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE #0845C Date: March 12, 2013 THIS CERTIFIES that the construction of a 22.3'x 17.5' addition onto the landward side of the existing-26.3'x 20.3' garage At 1665 Mill Creek Drive, Southold, New York Suffolk County Tax Map # 51-6-31.4 Conforms to the application for a Trustees Permit heretofore filed in this office Dated July 26, 2012 pursuant to which Trustees Administrative Permit#7863A 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 22.3'x 17.5' addition onto the landward side of the existin 26.3'x 20.3' garage. The certificate is issued to JAMES WILSE owner of the aforesaid property. )AW" cz'e?,r Authorized Signature Jill M. Doherty, President �F sooryo Town Hall Annex James F.King,Vice-President ,`O 54375 Main Road P.O. Box 1179 Dave Bergen Southold, New York 11971-0959 Bob Ghosio,Jr. G John Bredemeyer Telephone(631) 765-1892 l'C�iJ Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE F INSPECTION: 2�_� C 7 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: 1 COMMENTS: CERTIFICATE OF COMPLIANCE: 6 l ten So vn-fnr2 SCht du iR d -61n2l (n spec i'o 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 James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hail Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7863A Date of Receipt of Application: July 26, 2012 Applicant: James Willse SCTM#: 51=-6-31.4 Project Location: 1665 Mill Creek Dr, Southold Date of Resolution/Issuance: August 22, 2012 Date of Expiration: August 22, 2014 Reviewed by: Trustee Michael Domino Project Description: To construct a 22.3' x 17.5' addition onto the landward side of the existing 26.3' x 20.3' garage. 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 John C. Ehlers Land Surveyor, last dated May 3, 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, King, President Board of Trustees James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bm&meyer 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 TO: Please be advised that your application dated ~-)'-~.IV .2 ~,, .?-DJ.2- has been reviewed by this Board at the regular meeting of ~lz~b( .<;Jr-'.2,2, .-2 bi.2- and your application has been approved pending the ~,n~'pletion of ~he following items checked off below. Revised Plans for proposed project __ Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ Ist Day of Construction ($50.00) __ ½ Constructed ($50.00) 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: $..J~). BY: James F. King, President Board of Trustees # .lames F Krug. President Bob Ghosio. ,Ir. Vice-President Dave Bergen ,John Bredemeser Michael J. Domino PO Box I 179 $outhold, NY 11971 Telephone (631 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: Eileen Santora on behalf of JAMES WlLLSE requests an Administrative Permit to construct a 22.3'x17.$' addition onto the landward side of the existing 26.3'x20.3' garage. Located: 1666 Mill Creek Drive, Southold. SCTM# 51-6-31.4 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Dist/ance of proposed work to edge of wetland Pail of Town Code proposed work falls under: ~/Chapt.275 Chapt. 111 other T~Ae of Application: Wetland __Coastal Erosion __Amendment dministrative__Emergency Pre-Submission __Violation Info needed: Modifications: Present Were: J. King,/ B. Ghosio J. Bredemeyer~ Michael Domino FOLm filled out j~ th~ld by ~ Mailed/Faxed to: Date: __ D. Bergen, D. Dzenkowski other BOARD MEMBERS Leslie Kanes Weisman, Chairperson James Dinizio, Jr. Gerard P. Goehringer George Homing Ken Schneider ¢oard ol '~rustecs .------, http://southoldtown.northfork.net ZONING BOARD OF APPEALS TOWN OF SOUTHOLD Tel. (631) 765.1809 · Fax (631) 765-9064 Southold Town Hall 53095 Main Road · P.O. Box 1179 Southold, NY 11971-0959 Office Location: Town Annex/First Floor. Capital One Bank 54375 Main Road (at Youngs Avenue) Southold, NY 11971 FINDINGS, DELIBERATIONS AND DETERMINATION MEETING OF JUNE 21, 2012 RECEIVED South!Id Town Clerk ZBA FILE: 6569 N A M E OF APPLICANT: James Wi llse SCTM# 1000-51-6-31.4 PROPERTY LOCATION:1665 Mill Creek Drive (adj. to Arshamomaque Pond) SoutholdNY SEQRA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type Il category of the State's List of Actions, without further steps under SEQRA. SUFFOLK COUNTY ADMINISTRATIVE CODE: This application was referred as required under the Suffolk County Administrative Code Sections A 14-14 to 23, and the Suffolk County Department of Planning issued its reply dated May 11, 2012 stating that this application is considered a matter for local determination as there appears to be no significant county-wide or inter-community impact. LWRP DETERMINATION.' The relief, permit, or interpretation requested in this application is listed under the Minor Actions exempt list and is not subject to review under Chapter 268. PROPERTY FACTS/DESCRIPTION: Subject parcel is a conforming 59,287 sq. fi. waterfront lot in the R-40 zone. It is improved with a one and a half story dwelling and accessory garage. It has 175.oo feet of frontage on Mill Creek Drive, 259.51 feet along the northern property line, 274.78 feet on Amhamomaque Pond, and 260.79 feet on the southern property line as shown the survey dated 1-23-2012, revised 5-3-2012 prepared by John C. Ehlers, LS. BASIS OF APPLICATION: Request for Variance from Article Ill Code Section 280-15(B), based on an application for building permit and the Building Inspector's March 14, 20t2 Notice of Disapproval concerning addition to accessory garage at total square footage at more than the maximum code allowable of 750 square feet. RELIEF REQUESTED: The applicant requests a variance to construct a 390 sq. ft. addition to his accessory garage, which will create a total square footage of 924 sq. ft., where the code allows a maximum of 750 sq. fl. on lots 20,000-60,000 sq. ft. FINDINGS OF FACT/REASONS FOR BOARD ACT[ON: The Zoning Board of Appeals held a public hearing on this application on June 7, 2012 at which time written and oral evidence were presented. Based upon all testimony, documentation, personal inspection of the property and surrounding neighborhood, and other evidence, the Zoning Board finds the following facts to be true and relevant and makes the following findings: Page 2 of 3- June 21,2012 ZB^ Filc#6569 - Willse CTM: 1CJ00-51-6-3[ 4 1. Town Law §267-b{3){b~ll). Grant of the variance will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. Accessory structures are permitted in the front yard on waterfront properties. While the applicant proposes to exceed the maximum square footage allowed by code, the Board finds that by adding to the existing structure the applicant will avoid the construction an additional larger building in the front yard area. 2. Town Law §267-b{3}(b}{2). The benefit sought by the applicant can be achieved by some method, feasible for the applicant to pursue, other than an area variance. The applicant has the right to construct an accessory structure anywhere within the principal setbacks established by the town code Article 3- 280-15. In this case, the applicant has the right to construct at least another 750 sq. ft. accessory structure in his front yard as long as he complies with minimum setback set forth in code. 3. Town Law §267-b(3}{b)(3}. The variance granted herein is mathematically substantial, representing 23 % relief from the code. However, by expanding the existing garage, the applicant will avoid constructing an additional larger building in the front yard area and avoid the possible removal of mature trees. 4. Town Law ~267-bO)(b)(4) No evidence has been submitted to suggest that a variance in this residential community will have an adverse impact on the physical or environmental conditions in the neighborhood. By adding to the existing building the applicant will minimize the amount of disturbance to the property including cut-ting down trees. All run off will be contained on site per Chapter 236 of the code. 5. Town Law §267-b(3~}{b)(5). The difficulty has been self-created. The applicant purchased the parcel after the Zoning Code was in effect and it is presumed that the applicant had actual or constructive knowledge of the limitations on the use of the parcel under the Zoning Code in effect prior to or at the time of pumhase. 6. Town Law §267-b. Grant of the requested relief is the minimum action necessary and adequate to enable the applicant to enjoy the benefit of an expanded garage / storage building while preserving and protecting the character of the neighborhood and the health, safety and welfare of the community. RESOLUTION OF THE BOARD: In considering all of the above factors and applying the balancing test under New York Town Law 267-B, motion was offered by Member Dinizio, seconded by Member Weisman (Chairperson), and duly carried, to GRANT, the variance as applied for, and shown on the Survey dated 1-23-2012, revised 5-3-2012 prepared by John C. Ehlers, LS. CONDITION: l) The accessory structure shall remain unheated. That the above conditions be written into the Building Inspector's Cert~cate of Occupancy. when issued. Any deviation from the survey, site plan and/or architectural drawings cited in this decision wiB result in delays and/or a possible denial by the Building Department of a building permit, and may require a new application and public hearing before the Zoning Board of Appeals. ;4ny deviation/rom the variance(s} granted herein as shown on the architectural drawings, site plan and/or survey cited above, such ax alterations, extensions, or demolitions, are not authorized under this application when involving nonconformities under the zoning code. This action does not authorize or condone any current or future use, setback or other feature of the subject property that may violate the Zoning Code, other than such uses, setbacks and other features ax are expressly addressed in this action. The Board reserves the right to substitute a similar destgn that is de minimis in nature for an alteratton that does not increase the degree of tzonconJbrmity. Page 3 of 3- June 21,20] 2 ZBA File#6569 - Willse Vote r!f the Board Ayes Members Wetsman (Chatrperson), Dinizlo. Schnetder, Homing Thl.~ Resolution was duly adopted (4-0) Member Goehringer was absent Leslie Kanes Weisman, Chai~erson Approved for filing ~ /,,~..~'/2012 Board of Town Trustees Town of Southold September 11, 2012 2012 650 Vanston Road Cutchogue, New York 11935 · Phone: 631 -734-2794 EMAIL: EILEENDRAWBLU ~OPTONLINE.NET Dear Trustees, I would like to add a second Drywell on the water side of the exiting garage for rain runoff of Existing gable roof line. Do I need to amend my permit, or will this letter and plan service? My permit # 7863A Job: Willse Home Sincerely, Eileen Santora OFFICE LOCATION: Town Hail Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 M/~ILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: 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 JAMES WILLSE SCTM#1000-51-6-31.4 Eileen Santora on behalf of JAMES WILLSE requests an Administrative Permit to construct a 22.3'x17.5' addition onto the landward side of the existing 26.3'x20.3' garage. Located: 1665 Mill Creek Drive, Southold. SCTM# 51-6-31.4 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 Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office UseOnly Coastal Erosion Permit Application Wetland Permit Application X Administrative Permit AmendmenffTra~sfsr/Extension X Received Application: y. Received )~ Completed Application Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) _~-~LWRP Consistency Assessment Form Referral Sent: __Date of Inspection: Receipt of CAC Report: Lead Agency Determination: Technical Review: ]Lpablic nearing Held: Resolution: \ Name of Applicant Address Phone Number:( ) ~Q;~ Suffolk County Tax Map Number: 1000- '~l - (.P- Property Location:/~O ~ I\{H.--L C[~'~__~ "~f"~ (provide LILCO Pole #, distance to cross streets, and location) (I£ applicable) Phone: /..~! Address: '7&q, of Trustees Application Land Area (in square feet): Area Zoning: ]~- Previous use of property: Intended use of property: GENERAL DATA Covenants and Restrictions: Yes v~ No If "Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals v/' Yes No If Yes , please provide copy of decision. Will this project require anyjL,~nolition as per Town Code or as determined by the Building Dept. Yes / No Does the stracture (s) on property have a valid Certificate of Occupancy /Yes __No Prior permits/approvals for site improvements: Agency Date v,~No prior permits/approvals for site improvements. Has any pemfit/approval ever been revoked or suspended by a governmental agency? Yes If yes, provide explanation: Project Description (use attachments if necessary): A'DDITI 0 ~ TO t bP/TlON 1'7,6' -C ./ST/Z4b' of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~/~t~/~ ]5} ~)] ~'~ 0/~ Area of wetlands on lot: .square feet Percent coverage of lot: ~.~% Closest d~stance Ix/tween nearest emst~ng structure and uplan edge of wetlands: ? ~, L~ feet Closest distance between near_eS proposed structure and upland edgeofwetlands: 'l~l~r/O feet /~. /0/2,6 ' Does th'e project involv~ or filling? No / Yes If yes, how much material will be excavated?~cubic yards How much material will be filled? t~ cubic yards Depth of which material will ~r deposited: ~ feet Proposed slope throughout the area of operations: ~T'x{ / ~ Manner in which material will be removed or deposited: ~3~ 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): PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1. APPLICANT I SPONSOR 3,PROJECT LOCATION: Municipality 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2. PROJECT NAME County~ ~) 4, PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc - or provide map 5. IS PROPOSED ACTION: r-1 New [~xpansion [] Modification / alteration SEQR 6. DESCRIBE PROJECT BRIEFLY: 7 AMOUNT F LAND AFFECTED: Initially ~/~)~) ~/"~cres Ultimately acres 8 WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? r~Yes [] No If no, describe briefly: 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) 10 DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) [~es F-~ yes, list agency name and permit / approval: No 11. uu~:5 ANY ASF~ECT~F-~-A CURRENTLY VALID PERMIT OR APPROVAL? 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? Signature I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE /Sponsor Nam~,j~/. ~"~d) Date:~l~f~.~ If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (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. B. WILL/~CTION 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. E~]TM r~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, ex{sting traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain bdetiy: C2. Aeslhetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain brielty: I C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: c4. ' .... , .... ""¥'"' ': .... A commun ty s ex sting pans or goals as officially adopted or a change m use or mtensf~y of use of land or other natural resources? Exp y C5. Growth. subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, shod term, cumulative, or other effects not identified in C1-C57 Explain bdefly: C7. Other impacts Iindudin~l chan!~es in use of either quantity, or t~'pe of energy/? Explain brier;/: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA/CEAI? tlf ~/es, explain bdefl¥: E. IS THERE, OR IS THERE LIKELY TO BE~ CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: PART Ill - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadvemee~ectidenti~edabeve~determinewhetheritissubstantia~~~arge~imp~rtant~r~therwieesigni~cant~ 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 pmpeeed action on the environmental characteristics of the CEA. Chec~ this box if you have identified one or more potentially laq~e or significant adverse impacts which MAY occur. Then proceed directly to the FUU. 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 aciior WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necasson~, the reasons supporting /hi determination. Board of Trustees N Name of Lead Agency Date President ~ Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) Town of Southold . ~ Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M. #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A GRADING, DRAINAGE AND EROSION CONTROL PLAN S¥O~,m*WATER~ o~mct Section Lot CM~r ~,rmu BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. $CO?E OF WO~[ - ?ROPOSF~D CONSTEUC~ON rrJ~[ fi / V¢O1~ ASSE,~[~FF I Yes No a. What is the Total Area of the Project Parcels? Will this Project Retain AJf Storm-Water Run-Off the(Include Total Area of all Pamels located withinscope of Work for Proposed Construction) 5' t~j s~_/~' 1 Generated bY a Tw° (2') nch Rainfall °n Sitec'(This item will include all mn-off created by site' b. What is the Total Area of Land Clearing /, ;~ ~'~ cleadng and/or construction aclJvities as well as all and/or Ground Disturbance for the proposed ~ ~/C: ~ Site Improvements and the pen-nanent creation of construction activity? impen/fous surfaces.) tS.F.,,~.) 2 Does the Site Plan and/or Survey Show AIl Proposed ?EOV'D)E BRIEF PROJ'~"~ DESCRI]~'T[ON (P.),.u. ~n,~ P~.,.. ~ Drainage Structures Indicating Size & LocalJon? This :./r~ item shall include all Proposed Grade Changes and ~~N~ /f~'~ y ¢z~)/T/~)//~ Slopes Controlling Surfaca Water Flow. ,~Z,¢ t*/~,,'5' T~ iCCk//dT/A,/~, O/z:)O/~/_./~'3 Dcos the Sito Plan and/or Survey describe the erosion and sediment control practices that will be used to contro~ site erosion and storm water discha~jes. This Construction Pndod. 4 Will this Project Requ re any Land Filling, Grading or Excavation where there is a change to the Natural Existing Grade involving more than 200 Cubic Yards of Ma edt wthin any Parcel? 5 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5,000 S.F.) Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction General DEC SWPPP Requirements: or within One Hundred (100') feet of a Wetland or Submission of a SWPPp is required for all Construction act/vt/les involving soil Beach? disturbances of one (1) or more acres; including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes are pad of a larger common p~an that will ultimately disturb one or more acres of tend; which Exceed Fifteen (15) feet of Vertical Rise to F~ including Construction activities involving soil disturbances of less than one (1) acre where One Hundred (100') of Horizontal Distance? the DEC has determined that a SPDES permit is required for sturm water discha~es. SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways. Parking Areas or other Imper~dous for Storm Water Discharges from Construction activity - Pe~it No. GP-O-10-00'I.) Surfaces be Sloped to Direct Storm-Water Run-Off 1. The SWPPP shall be prepared prior to the submittal of the NOI. The NOI sbeJl be into and/or in the direction of a Town right-of-way?~ submitted 1o the Department pber fo the oommencement of conslmction activity. - 2. The SWPPP shall desedbe the erosion and sediment contm~ pmclJces and where 9 Will this Project Require the Placement of Material. constmctedrequired' post-consttuctJonto reduce the storm waterin management pcactices that 'Mil be used andrbr Removal of Vegetation and/or the Construction of any STATE OF NEW YORK, . (3 / t..~'.,-n ,~ ,~--. OONNle u. Notary Public, State of New York COUNTY OF ,....'~/.....%.(...(..~.~.4._~ ..4:~...~ ,,,, SS No. 01BU6185050 Z:~//,~--~--A! ~.z2 A/7-/)/¢" Qualified in Suffolk CouRh, And that he/sba is the ...................... /~....,,~,...~.~...,~'.....~.... ............... Owner and/or representative of the Owner or Owners, and is duly authorized to perforn~ or have performed the said work and to make and file this application; that all statements contained in this application are true to flile best of his knowledge and bel/ef; and that the work will be performed in the manner set forth in the application filed herewith. Sworn to before me this; ................ ~ ........ day o~f ~....~ .......... o ..bli ............................... FORM - 06/10 Board of Trustees Applioation County of Suffolk State of New York ~ ~ E% ~) ~ BEING DULY SWORN 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 TRUSTE.~.S HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING ~UNDER OR BY VIRTUE OF SAID'PERMIt(S), l}r 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 TI{IS APPLICATION. SWORN TO BEFORE ME THIS Notary Public ~ DAY OF c.-~ r ,20/~.. Bo~ of Trustees Application County of Suffolk State of New York ~/~=~/~l ~t~kJ]'~)~ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS DAY OF/"~n'~-g '~7 ,20. Notary Public CONNIE D. BUNCH Notary Public, State of New York No. 01 BU6185050 Qualified in Suffolk County Commission Expires April 14, 2 ~D. of Trustees Application AUTHORIZATION (where the applicant is not the owner) (print owner of proper~y) H Y residingat i&6~ M~£L.U~/~ (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Ow ~gnature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics vrohibits conflicts of interest on the vart of town officers and emnlovees. The oumose of this form is to nrovide information which can alert the town of~ossible conflicts of interest and allow it to take whatever action is necessary to avoid same. [niddle initial, 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.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (1 f "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 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/agen~drepresentative) 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 shams of the corporate stock of the applic0nt {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 Form TS 1 Submitted th~dgy of _ _~. _.~, 200.~ Signature v . ~ff_~ ?~~q ~' Town of Southoid 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" 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- sul~ortin~ facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION scm# PROJECT The Application has been submitted to (check appropriate response): TownBoard ~-] Planning Board [--] Building Dept. [~ BoardofTrustees Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: Location of action: Site acreage:_ (a) Name of applicant: (b) Mailing address: Present land use: ~/~5*~/~/2]/_~ Present zoning classification: ~ -~0 If ~ applicmion for ~e proposed action h~ been filed wi~ ~e Tom of Sou~old agency, ~e folloMng iffo~ation sh~l be provided: (c) Telephone number: Area Code (d) Application number, if any:_ Will the action be directly undertaken, require funding, Yes [] No [~ or approval by a state or federal agency? 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 Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southoid. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria ~ Yes [] No [-~ Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria ~.xYes ~ No [~ 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 [] Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. Yes No Not App~ble Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Sonthold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. r~` Yes ~ No [] Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. ~xYes [] No ~ Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. ~] YeJ-~ No~ Not Applicable Attach additional sheets if necessary WORKING COAST POLICIE~ Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. ~Yes [] No ~ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ~Yes ~ No [] Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III -- Policies; Pages 62 through 65 for evaluation criteria. [] Yes ~ No ~--Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. [] Yes [-~ No'~ Not Applicable SURV'E"f' OF: PROPERTY' 51TUATE-. TOI,~: ~! SUFFOLK C, OUN~, 5UR"ZE"¢~O OI-23-2OI2 I;~E¥1SED O5-O3-2OI2 SUFFOLK CO~ T~ IOOO - 51 - 6 - ~1.4 ~ON ~ ~ -~ APPROVED BY BOARD OF TRUSTEES TOWN OF $OUTHOLD DATE .~<.-~,,,¢ /.9, ~c/~ ~ 8EP 11 2012 ORAINA~F SYE, TEM OALCULATION~: LOT COVERAOE HOUSE AREA I,~-/2 S.F. OR 3.2% OARA6E AREA 534 S.F. OR ADDITION AREA 3qo S.F. 0.7% LOT C, OVERA®E 2,-lq(2 S.F. OR 4.~'% NOT~S: · HONUPIENT FOUND FEHA FLOOD ZONE A~ SHOI'~I ON FIt?J'4 1'4AP NO. ~610~I~H DA~ ~-25-20~ GONT~ ~. ~ '2q PA~H ~eo , I.~ ~res ®P, APHIG SC, ALE I"= .40' // -t os.. -'-- ,~ ,~0¢p JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 RIVERHEAD, N.Y. 11901 REF.C:\Usersgohn~)ropbox\l 1\11-191.pro 369-8288 Fax 369-8287 SIJRVE'r' OF: PROPERTY' 51TUATE: .~2U'THOLD TOI,~: 5OUTHOLD SUFFOLK C, OUNT'I', ~v,r:~ ,:~-~-0~-2o,:[ APPROVED BY ~FFOLK ~ TA~" BOARD OF TRUSTEES I000 - 51 - ~ - ~1.4 ~-,~ ~: TO~ OF SOUTHOLD LOT HOU¢E AREA hSq2 5.F. OR ®ARA®E AREA 53.4 5.F. OR ADDITION AREA 3.clO S.F. LOT COVE:RA®E 2,qq6 S.F. OR 4.8% HONUHENT FEHA FLOOD ZONE A5 .SHO~ ON PIRH HAP NO. ~610~-.OI58H DATE Og-25-2OOq CONTOUI~S F~F. N~xZD '2q DATUM Area = Ar~o I.~ Acre5 ~t~.APHIC SOALE I"= 40' JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 RIVERHEAD, N.Y. 11901 REF.C:\Users~John~Dmpbox\l 1\11-191.pro 369-8288 Fax 369-8287 IEileen ~a.,rrr, ora, Reeident, ial DeeLgner 6~1 734-2794, Cu'~hogue, NY Joseph Fl~h~'~i, ?E 1725 ~ Road · ,%ushold, NY 11971 e31-765-2954. it oF. /I 1950" L4x~4 ¢=~,5T I l t I I , ,r ¥ - ;r,F .I' t' I 72 0" ZO£4_,l Been 5ant, ora. Residential I~skjner 6~1-?"54-Z794 · Cu~ho~ue, NY J~ph Fi~he~, PE 6,~1-765-~'--~