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HomeMy WebLinkAboutTR-7900A James F. King, President OF. soUTyo Town Hall Annex 54375 Main Road Bob Ghosio, Jr., Vice-President h P.O. Box 1179 Dave Bergen Southold, New York 11971-0959 John Bredemeyer Q il` • ~O Telephone (631) 765-1892 Michael J. Domino Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0910C Date: September 27, 2013 THIS CERTIFIES that the removal of permitted deck and reconstruction of it for handicap accessibility; additions on landward side of existing dwelling; addition connecting the main house to the garage, partially converted into living space-, new wood deck off of new master bedroom: and installation of drywell to contain roof runoff At 1020 Ruch Lane, Southold, New York Suffolk County Tax Map # 52-2-33.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated August 28, 2012 pursuant to which Trustees Administrative Permit 07900A Dated September 19, 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 removal of permitted deck and reconstruction of it for handicap accessibility-, additions on landward side of existing dwelling; addition connecting the main house to the garate, partially converted into living space: new wood deck off of new master bedroom; and installation of dawells to contain roof runoff. The certificate is issued to PATRICIA WALKER owner of the afores'a'i`d' property. Authorized Signature • 6 James F. King, President O~(:f0(,rCO Town Hall, 53095 Main Rd. Bob Ghosio, Jr., Vice-President P.O. Box 1179 Dave Bergen Y Southold, NY 11971 John Bredemeyer '>F Telephone (631) 765-1892 Michael J. Domino Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATES OF INSPECTION: V Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction % constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: .6 CERTIFICATE OF COMPLIANCE: gOfFQ( James F. King, President COGS Town Hall, 53095 Main Rd. Bob Ghosio, Jr., Vice-President P.O. Box 1179 Dave Bergen Southold, NY 11971 John Bredemeyer G,y• Telephone (631) 765-1892 Michael J. Domino Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1St day of construction % constructed Project complete, compliance inspection • James F. King, President alaF Sou Town Hall Annex Bob Ghosio, Jr., Vice-President 54375 Main Road P.O. Box 1179 Dave Bergen Southold, New York 11971-0959 John Bredemeyer G Michael J. Domino Telephone (631) 765-1892 ~,YC,OUNVI Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7900A Date of Receipt of Application: August 28, 2012 Applicant: Patricia Walker SCTM#: 52-2-33:1 Project Location: 1020 Ruch Lane, Southold Date of Resolution/issuance: September 19, 2012 Date of Expiration: September 19, 2014 Reviewed by: Michael Domino, Trustee Project Description: To remove the existing permitted deck and rebuild it for handicap accessibility; proposed additions on the landward side of the existing dwelling; proposed addition connecting the main house to the garage, which will be partially converted into living space; proposed wood deck off of new master bedroom; installation of a drywell to contain roof runoff. 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 site plan prepared by Frank Uellendahl, last dated on August 27, 2012, and stamped approved on September 19, 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 ~o`p~uFFOC,~~o James F. King, President Town Hall Annex Bob Ghosio, Jr., Vice-President v~ 54375 Route 25, P.O. Box 1179 Dave Bergen ~.y Southold, NY 11971 John Bredemeyer Telephone (631) 765-1892 Michael J. Domino Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: P( ici'o, ~/1)oAe Y C- 1( k Re-HernkLki Please be advised that your application dated AIMASI 2g1 2012 has been reviewed by this Board at the regular meeting of~mber jq~ 2D12 and your application has been approved pending the c mo p el tion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1s` Day of Construction ($50.00) '/2 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 TnSF' LC4;6V) - $ '50. to TOTAL FEES DUE: $ SO. DD BY: James F. King, President 06, Board of Trustees I IZI 12 gUFFO(~ James P. King, President I'_O_ Box 1179 Bob Ghosio, Jr., Vice-President jZ d Southold. NY 11971 Dave Bergen ? Telephone (631 765-1892 John Bredemeyer ,y Fax (631) 765-6641 Michael .I. Domino °y 71p1 * ~ao~. Southold Town Board of Trustees Field Ins pectionMorksess ion Report Date/Time: l ° Y0 t L T~ Frank Uellendahl, Architect on behalf of PATRICIA WALKER requests an Administrative Permit to remove the existing permitted deck and rebuild it for handicap accessibility; proposed additions on the landward side of the existing dwelling; proposed addition connecting the main house to the garage, which will be partially converted into living space; proposed wood deck off of new master bedroom; installation of a drywell to contain roof runoff. Located: 1020 Ruch Lane, Southold. SCTM# 52-2-33.1 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: tW o g/~ 1 annex OX Present Were: J. King B. Ghosio D. Bergen, J. Bredemeyer___jZMichael Domino D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: e r? pw k Alow o-A 77 72 I Y 11,f w-fir`. i, 1 r fG t ~ - 77 a Y+~' ~~c, w- !b?t ,a *a : f ' f . _ ~ - ,S t i i!F -Yf. u '~'q`~"~ rRL_~ r~~ ~ ~n v~Y~ ~`~~j~~$~z f' •Jy '.1i s•Y'ft, ~.:iai is~."~fi ~~~WC~.~~~.L. TRUSTEES ADMINISTRATIVE PERMIT APPLICATION WALKER RESIDENCE 1020 RUCH LANE, SOUTHOLD, NY PHOTO #1 DATE: 08.23.2012 k"g AUG 2 8 2012 lic Q s Yl - ' r, ~t . may, i Qiw ~ ~7 r 4, .lxk y R TRUSTEES ADMINISTRATIVE APPLICATION WALKER RESIDENCE 1020 RUCH LANE, SOUTHOLD, NY PHOTO #2 - PROPOSED MBR DECK DATE: 08.23.2012 rJ AUG 2 8 ~fi~ .may + ~ ~ 'r ~ ~ - P' r - ~ ~ Sys r y to. s or fly 4 r~ ~f 't~i i l l I t yr Ia 'µp f• • T a~ ' ~ t~ ~ ~ 1 Y k{ .ice{' C . ~ • r y ~ N I~~,IlC ~ 7 tv, VP TRUSTEES ADMINISTRATIVE APPLICATION WALKER RESIDENCE 1020 RUCH LANE, SOUTHOLD, NY PHOTO #3 - VIEW FROM RUCH LN LOOKING SOUTH DATE: 08.27.2012 E n~ i AUG 2 8 2019 i I y 4 ~ F 9'/ m 4 4 n s 4 s a A~ wa N ~i mS A O ,g. A `a`~xoi i e a y , A Ii ' n vyu ~ , I Yin ~n4d d~\~Q 'Pn ~ o I gulp E ~d~! F O9 \ • g I ' \ 4 ~ e C d a I ~ f I \+uwM o d.J• I I +wa / OC+A tq 13 O„ m .N ? iu i \ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - • ~ z:®ia- -NO- = COUNTY OF SUFFOLK © - e Ern x seal vr„cmryrsenmmAw,r `e' - 52 OFFICE LOCATION: ~aOF SO(/ly~ • MAILING ADDRESS: Town Hall Annex to P.O. Box 1179 54375 State Route 25 .If, # Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) T Southold, NY 11971 G, Q Telephone: 631 765-1938 Fax: 631765-3136 LOCAL WATERFRONT REVITALIZATION IZATION PROGRAM MtMUOLD To: Jim King, President $EP g 2012 Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: September 18, 2012 Re: Proposed Wetland Permit for PATRICIA WALKER SCTM#1000-52-2-33.1 Frank Uellendahl, Architect on behalf of PATRICIA WALKER requests an Administrative Permit to remove the existing permitted deck and rebuild it for handicap accessibility; proposed additions on the landward side of the existing dwelling; proposed addition connecting the main house to the garage, which will be partially converted into living space; proposed wood deck off of new master bedroom; installation of a drywell to contain roof runoff. Located: 1020 Ruch Lane, Southold. SCTM# 52-2-33.1 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 denoted following Policy Standards and therefore is CONSISTENT with the LWRP provided that the following Best Management Practice is required: To further Policy 4.2 Protect and restore natural protective features and Policy 6; it is recommended that natural vegetated buffer, incorporating existing vegetation landward of the top of bluff, be established. An example definition follows: NATURAL VEGETATED BUFFER a land area of a certain length and width where existing vegetation occurs prior to the commencement of any grading or clearing activity. Vegetation shall be maintained to achieve a minimum percent ground cover of ninety-five (95) percent. To achieve the percent ground cover indigenous, drought tolerant vegetation shall be planted. Survival of planted vegetation shall be (ninety) 90 percent for a period of three (3) years. Maintenance activities within the buffer are limited to removing vegetation which are hazardous to life and property, trimming tree limbs up to a height of fifteen feet (15') to maintain viewsheds, replanting of vegetation and establishing a four foot (4') wide access path constructed of pervious material for access to the water-body. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney James F. King, President ~oF souls Town Hall Annex Bob Ghosio, Jr., Vice-President ,~0~ Oho 54375 Main Road P.O. Box 1179 Dave Bergen 41 41 Southold, New York 11971-0959 John Bredemeyer CA ac Michael J. Domino ~O Telephone (631) 765-1892 OFax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD - Office Use Only r ~ I~ ~ rf ~ 1 r~ j I fin[ Coastal Erosion Permit Applicati n Wetland Permit Application Administrative Permit I I _AmendmentiTr sf~Ex ension J ; =2' (J~ Received Application: Received Fec:$ ~Q Completed Application o2 Suthho!d Town Incomplete Board of Trustees _SEQRA Classification: Type I -Type IIUnlisted _Coordination:(date sent) _jLWRP Consistency Assessment Form -Cate Referral Sent: l/YA __Dateoflnspectiom tion: qY_ia;~/.1_ -Receipt of CAC Repo Lead Agency Determination: -Technical Review: Public Hearing Held: / Resolution: Name of Applicant P/-1 I D,l<.1 A W 49LIcE2 Address 12W Q.l>Ck-1 L1k)~1 `5L'L "7")r NL~' 45 4 Q. 0o k DICE Sr Rol L- 13 to phone Number:( ) (oi 14~ 63Bc - cil]4 ' ' +0573 Suffolk County Tax Map Number: 1000- Property Location: 102 D C OCkA L~l L) SIT 010 I Ili"( I (73U ~~r?~ o2~'-C~t (TF NISfL"Ctl (provide LILCO Pole distance to cross streets, and location) D17i1.1 l i ~ILF` jyZp~4 ~1~GNL~CT AGENT: (If applicable) Address: '206 34i Phone: ((060 --z6'Z4- BySd of Trustees Application. GENERAL DATA Land Area (in square feet): GAT 1(7,4565 V -tie It U 6 Area Zoning: 2-40 Previous use of property: Qk-S t'9Ecr-p FrL Intended use of property: ~ S k10 cu:n P(L' Covenants and Restrictions: Yes VI/ 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. 5el UL, P)YP U -0 F(71Z 510 l) UCR i-JEl?U 5G~( Will this pro''ect require any demolition as per Town Code or as determined by the Building Dept. V Yes No / Does the structure (s) on property have a valid Certificate of Occupancy Yes No Prior permits/approvals for site improvements: Agency Date -}V 16 i-Totltw rxoC W& A5-VoticT L-MID Nw. TO( I ( CO oils p rwil') w 6vp-ae T Pp puCRTI`ov V eciC 4) i LL 6C 2E" ICJ i ( ~ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspend by a governmental agency? No Yes If yes, provide explanation: Project Description (use attachments if necessary)::Ck7itl~ DL-GL~IV 8E eEl"iCU&V PUD ~~UIL7-IZ~ &E d( 9-01L9P /~LClr i~i[E: P20PtJ6 4LJ9/-770-;t.) e?S Le A,1 JZGT1 ZFJ F120?-r M 91 N kVV6 C 7Z) 6A 21~ ~v 16H ZO LL 6E PA07,RUY Gam, 41eZZ7LW iA--TV ,CSCr)>C,L-)R%~L FLrCZ1j2F,-qC1-167J FRCP. 41- s DEG lC &-FF /'I jO k- B W d of Trustees Application. WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: PTL~'~ ~ G[ 77Zo9A t(~ 6,Ek eAk 677D '-3 /-v MROC 'o9 6C IUL6- L?w&-& eNFJ/Q 1;5e5J Area of wetlands on lot: G~} 4)00 square feet F00- H fiGF1f~&D 1-U&-7Z19 t9 1_-1k)E 7O T/E Lt t~~ Percent coverage of lot: cA 5 5 Closest distance between nearest existing structure and upland edge ofwetlands:e-~ 4~9-/ feet 779 7cP PF T3cvFr Closest distance between nearest proposed structure and upland edge of wetlands: GA feet -m -rop OF xUFF ~ U/Lt TJEG/C~ Does the project involve excavation or filling? No Vex Yes If yes, how much material will be excavated? 4p cubic yards FGL C_iZRVL 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: GA3 2.~ FAT Manner in which material will be removed or deposited: (3Y f 1,,9Cff/k1E 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): 7~E /~~GYl ~.ED r~rJ rr~d~v 4nLc Svc r- 4~FE67- 7ta i TNT TJIS UGC TD -h7+ C- 13c.-UFF N Ct: s! JV LAS 10Z FEET PROJECT ID NUMBER 61720 • SEQR 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 F2<)L1k_' U u~rvD~E r t W? ~e- ~r/L) c Ac~2 2~5<~~-( L~6 3.PROJECT LOCATION: /,J2D eUGH SCTZT eZD,.VY 1 U~FOZfC Municipality County 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map <o Z/~ /1vGN- Lq.vF ~?UT~ipLD~ .V ~ H C7.3 T soy7'~-{ BF /(lT~(ZS~T~r0~1 .Ut1L~7~f l~D.~Di A27 `c 3 5. IS PROPOSED ACTION : ? New Expansion odification / alteration 6. DESCRIBE PROJECT BRIEFLY: ?12~ DYO,~Cp .9PV/71 & 7V ce-.u UT-CT A-i/~I, <.U "OV5P -064&p ~-47LA)4,45 ?Z~ BE P.~q/zi//9a ~~v~rzr~p 7& 2&51D&A-,~t7,9C 'TD CtL&_;47_4~~ <~r75T> 1Z BET~~.crv7L r SU i"TC; ~T/L ~-J~7~n DECt2 TD ~tJ4~E[7 TD 1i-000T~r,.~-is/~HT~ 7. AMOUNT OF LAND AFFECTED: ?O SF .90017-Z!' ek)Z.Y Initially 3$ acres Ultimately .38 acres 8. WILL PROPOSE ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? l~ ?Yes No If no, describe briefly: 1Pj/~ ?/~/lz///•Uli~ ~4W r~Z~ ~ar T~ Plzo~D~EO f'cgU '5AO6 ?s ~}Gl ~<3i.v~P `>/T?E`1~721J/ 22.Z/ 9 W T IS PRESENT LAND USE IN VICINITY OF PROJECT? (Chops as many as apply.) Residential ? Industrial Commercial E]Agricullure Park / Forest / Open Space Other (describe) IV,r?7~IL F2 B7J J- 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGEN (Federal, State or Local) es No If yes, list agency name and permit / approval: -2'aA - THEACTION HAVE A CURRENTLY VALID PERMIT APPROVAL? F-1 Yes o If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? aeS L~TNct 1 IF THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEES[T. OF MY KNOWLEDGE Applicant / SPo s r Na f .V Date: B/2?1/!Z ~ Signature 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 b 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 EAF. Yes Q 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 [ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten. If legible) Cl. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, 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. Long tens, short term, cumulative, or other effects not identified in C1-C5? Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy? Explain briefl - D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA 7 If es, explain briefl : E] Yes ? No 17, OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es a lain: a No F- - - PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether His substantial, large, important or otherwisesigntficant 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 impactof the proposed action on the environmental characteristics of the CFA Check fills box If you have idertified one ormore potentially large orsignlficant adverse impacts which MAY occur. Then proceed directly to the FLIEJAF andfor prepare a positive declaration. Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that ttteyroposed ado WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Board of Trustees o SEp 7 oZ0/z Name of Lead Agency Date J19n~1 L`S President 13 Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Sl alure of Responsible Officer in I -0a gency Signature of Preparer (If different from responsible officer) Town of Southold 5~ Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M. fi THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A 'O1 !'5 - STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN sWet Yecaon hoc - -t CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM # / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? (Include Total Area of all Parcels located within .u~~ 1 Will this Project TwRetain o (2 All Storm Water Site? Run-Off the Scope of Work for Proposed Construction) i ' ~o J`F Generated by a Two (2') Inch Rainfall on Site? (s.F.IH ) (This item will include all runoff created by site ? It. What is the Total Area of Land Clearing clearing and/or construction activities as Well as all - and/or Ground Disturbance for the proposed ~j 9~.. J~ Site Im rovements and the construction activity? ~C/ P permanent creation or impervious surfaces.) (S.F. I Aaea) 2 Does the St Plan and/or Survey Show All Proposed - PROVIDE BRIEF PROJECT DESCRIPTION (arovwa Aaauanm Popes as NeetlW) Drainage Structures Indicating Size & Location? This Item shall include all Proposed Grade Changes and ~ ~~DyV~ G/ GT Slopes Controlling Surface Water Flow. 1 3 Does the Site Plan and/or Survey describe the erosion /1 l'173 TV AFT G G AR,96 and sediment control practices that will be used to Control site erosion and storm water discharges. This Ufa PAd~6~ ~~TL'T/gZl y item must be maintained throughout the Entire Construction Period. 4 Will this Project Require any Land Filling, Grading or Z~~ l~ De-c C L7>/r ~~~l SC117 Excavation where there is a change t0 the Natural Existing Grade Involving more than 200 Cubic Yards of Material within an Parcel? rJ Will this Application Require Land Disturbing Activities ? - ,g r--~ S 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 Welland Or Submission of a SWPPP is required for all Construction activities involving sod 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 El / are part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen (15) feet of Vertical Rise to including Conviction 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 storm water discharges. - (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit S Will Driveways, Parking Areas or other Impervious for Storm Water Discharges from Construction activity -Permit No. GP-0.10-001.) Surfaces be Sloped to Direct Storm-Water Run-Off ? - 1. The SWPPP shall be prepared prior to the submittal of the NOT. The Not shall be into and/or in the direction of a Town right-of-way? submitted to the Department prior to the commencement of conviction activity. 2. The SWPPP shag describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, ? - required, post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any concocted to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the tams and conditions of this permit. In addftlon, the SWPPP shall Area? (this item will Nor Irw 6 t hwuwanan a wwway Ap rwj identity potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine Is Answered with a Check Mark 1 All SWPPPs that require the post Cxmstmction storm water management practice in a Box and that construction site disturbance is between 5,000 S.F. S 1 Acre In area, component shag be prepared by a qualified Design Professional Licensed in New York a sbrm-Watar, Grading, Drainage 6 Erosion Control Plan b Required by the Town of that is knowledgeable in the principles and practices of Storm Water Management. Southold and Must be SubmRSd for Review Prior to Issuance of Any Building Permit (NOTE: A (heck Mark andra Nwwer for each Question is Required fora Complete Appkaw ) STATE OF NEW YORK, COUNTY OF ...?UFlllil......... SS That I, f2 U K. LL B X)IJ... . being drily swom, deposes and sat that he/she is the a licant for Permi (Name of YiditiCunnei signing Document) PP 4 And that he/she is the . ~1.PG N ITCr (Owner, Coniredor, Agent, Corporele OMcer, eta) Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have performed 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 here 'th. Sworn to before me this; . 114 oL. AU('U~................. , 2012- Notary Public:...... ............ValTOTR ..............k ...........IY ary Public State of New York (Signature of Applicant) FORM - 06110 Qualified in Suffolk 0WP v s Commission Expires July 42 t`I l U[ I~rd of Trustees Applicati0o County of SaffeHer K: Aq s State of New York J 1~ PFC CA A,- A I~ 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 ZV DAY OF os+ 20 iZ oZ1~C Notary Public DARELL BROWN Notary Public, State of New York No.OIBR6249671 Qualified in Kings County Commission Expires Oct. 11, 2015 BW of Trustees Application. AUTHORIZATION (where the applicant is not the owner) I, /~ATIZlL=/A l G/~EIZ residing at QUA ( IR'rEl (print owner of property) (mailing address) C,C1jJ LCD U'~ 1P 71 do hereby authorize Ll<?~G~Up~/tr? (Agent) /9 12Cy ilG% to apply for permit(s) from the Southold Board of To n Trustees on my behalf. l ( I~ (Owner's signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. _ YOUR NAME: 79 /G //a (Last name, first name, Middle initial, unless you are applying in the time 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 (If "Other", time the activity.) 2-01--4 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 V 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 z Submitted this day ~fI/ t,b 201111 Signature iu~- Print Name' R`rtZ t C t ? [RLK ~P Form TS I APPLICANTIAGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: ~A.J~ (.lEL.<FAJ (Last name, first name, middle 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 (If "Other", name the activity.) -2 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% o 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 Submitted this Z;;I G+If ,200 1 2 Signature Print Name ~2 <7 C -nJ ~FFL Form TS I Town of Southold • • LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. 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# 1000 - J2 - 02-- 33.1 ~l1aL~~(2 lZE`~ /ZJ~VC-~ PROJECT NAME The Application has been submitted to (check appropriate response): Town Board ? Planning Board ? Building Dept. ? Board of Trustees 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: ~.~bP05~T> L)IjTJ/T/BKJ 7~ Ld'~~LT ~Z~6 7D 6AT'e,- Z3~ C~ lJ~/Z~~ 1 dJ /~1ItZT l.CJTJ~ f~I~ST~lZ_ ~ . Location of action: -/C20 RUcj-4 6k)rc_/E 50U"Tt('b7 dic/ Site acreage: C'4 46090 5F a 3Y oic r~ Present land use: DES Present zoning classification: 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: ) y/c ~/~GG DAI~G , P-4- rcJZ PAT built eck (b) Mailing address: '00 3/4(~ ~ ~De ,y /1 Ql 44 (c) Telephone number: Area Code ( )4~~3 4 -77 - c624 (d) Application number, if any: Will the action bb~edidirectly undertaken, require funding, or approval by a state or federal agency? Yes El No l `~1 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 Southold. See LWRP Section III - Polic' s Pages 3 through 6 for evaluation criteria ? yes[:] No l 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 - Poli 'es 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 from flooding and erosion. See LWRP Section III - Policies Page through 16 for evaluation criteria F1 Yes F1 No Not Applicable Attach additional sheets if necessary Policy 5. Protect and impr ve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 throu 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. ? ? N Yes No Not Apiable 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 a aluation criteria. ? 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 w~Kot See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. ? Yes ? No 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. ? YesF1 No R /Not Applicable 7D ~ - Pion oQ LC 7Z,)Etp Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See WRP Section III Policies; Pages 47 through 56 for evaluation criteria. ? Yes ? No Not Applicable Attach additional sheets if necessary Policy 11. Promote su tamable use of living marine resources in Long Island Sound, the Peconic Estuary and Town wat s. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ? Yes ? No Not Applicable Attach additional sheets if necessary Policy 12. Protect agric Rural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evalu tion criteria. ? Yes ? No Not Applicable Attach additional sheets if necessary Policy 13. Promote app opriate use and development of energy and mineral resources. See LWRP Section III - Policies; P es 65 through 68 for evaluation criteria. ? Yes ? No Not Applicable PREPARED BY ~ 7,UIC 64TITLE DATE fE /Z SURVEY OF PROPERTY N 51TUATE: AR5HAMOMAQUE TOWN= 5OUTHOLD E 5UFFOLK COUNTY, NY SURVEY 10-25-2010 \ - S 5UFFOLK COUNTY TAX u \L \ \ 1000-52-2-33.1 ~p~~ ^UCr7 LAN Z `fr v NTH IED TO: !oa o - o * SSS cHtlsTmaE s®vTls S,UO u° E ~$d) - \ EDH®Uns 1 009 t 11 AUG 28 2012 Southho!d Town P,oard of Trustees /O~O N b• ~aQ s,/- ro 0 0 Q X10 Ln 5/ ry 0 °.3' Z) 0 6 L 0 Q ~O m J Q7 (`L O~ I l OW l12 FRAIy/ 11,4' Uv DECK c Q ~/l l I l ~2.~l tLJQ 0- ~ I r / 0 / o c <a I w C ov TREES G? zr-I O/ o co I V op 'dq F a l E( o m/ /7.3' ,l l9 3 10 p 221 ` NS8021'4S'r.t83°^W ---25.6 ittt it NOTE-5: C~ ro b,...» a e ~ or NEW Y C. ENQ ~•p F MONUMENT FOUND o y p PIPE FOUND NUMBERED WETLAND FLAGS SET BY SURVEYOR USING 'I BACARIIS AS THE WETLAND IDENTIFIER ELEVATION5 REFERENCE N65VD'29 ZONED R-40 JOHN C. EHLE AND SURVEYOR 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 GRAPHIC SCALE 1'"= 20' RIVERHEAD, N.Y. 11901 369-8288 Fax 369-8287 REF.C:\Documents and Settings\Owner\My Documents\My Dropb0x\10\10-184.pro ZONING CALCULATIONS PROPOSED APPROVED BY LOT AREA TO TIE LINE = ca. 16,565 SF CC ADDITION ° BOARD OF TRUSTEES LOT AREA TO T Bluff = ca. 14,250 SF = 100.00% EXIST'G SLOG. COVERAGE = ca. 2,022 SF = 14.19% TOWN OF SOUTHOLD ADDED BLDG. COVERAGE = co. 820 SF = 5.75% TOTAL BLDG. COVERAGE = ca. 2,842 SF = 19.94% DATE liq ALLOW. BLDG. COVERAGE based on 14,250 SF Z R-40: 20% OF LOT AREA = ca. 2,850 SF = 20.00% H EXT'G DECK a CAMERA LOCATION FOR TO BE REMOVED PHOTO VIEW '2 5 RESIDENCE PROPOSED ADDITIONS SOUTHOLD, NY - 1020 RUCH LANE o SURVEY BY JOHN C. FREERS, P.C. 35' w DATE: OCTOBER 25, 2010 FRONT YARD ARCHITECT FRANK UELENDAHL 123 CENTRAL AVENUE EX1'G DECK TO BE REBUILT KITCHEN P 0 BOX 316 III LEVELLED WITH 1ST FLOOR GREENPORT, NY 11944 LIVING RMI 9 FOR WHEELCHAIR ACCESS TI 631-477 8624 iiij! ENCLOSED $ 841 Z~ OWNER PORCH1 PATRICIA WALKER Z I 1020 RUCH LINE W BR 3 SOUTHOLD, W 11971 z BR 2 m 1 r) - -4774 R W N 67, o E , PROPOSED ADDITION a C33 <u G4RDEN R L. 3 1 OOM 1 6x4 DRYW ELL -102, Mi S PROPOSED 6'DIA. XT DEEP DRYWELL w z Q 75 WITH GUTTER LEADERS FOR ROOF RUN-OFF 0 108.7 C-D 3 MBR sroRacE PROPOSED 1'X20' WOOD DECK 1 11h "70 0 i 0 Q PARTIAL CONVERSION d TO RESIDENTIAL SPACE DATE: 6812712012 ~ ~ SCALP 1/16" = I'-0" ( SCALE: 1/16" =1'-0° SITE PLAN SITEPLAN il I HQ. i A UG 2 8 2012 ADMINISTRATIVE SCTM# = 1000-52-02-33.1 15 NAME A-1 WETLAND PERMIT APPLICATION SUFFOLK NCOUNTY, NEWOYORK DWG. NO Sau,hhe!d Town P,oard of Trustees PROPOSED ADDITION 0 3 °i PROPOSED ADDITION ~R' RESIDENCE I SOUTHOLD, NY PROPOSED CRAWL SPACE EXISTING 1020 RUCH LANE FULL BASEMENT SECTION - SCHEMATIC y ARCHITECT FRANK UELLENDAHL 123 CENTRAL AVENUE MUDROOM P,0.80% 316 GREENPORT, NY 11944 TEL: 631-477 8624 oo OWNER 00 PATRK;A WALKER Q 20 RUCH LANE BEDROOM 3 KITCHEN p up `Cf ,11971 GARAGE PROPOSED ADDITION REF. R BEDROOM 2 r, F clearance under beam = 7'-8' athedNG ROOM I BEDROOM 1 CLC.HGT: 7-7 SUNROOM ti T ~ CLG.HGT: 6'-ID' DATE: 08/29/2012 e SCALE: 1/8' = 1'-0' &45EYENi ENiRMICE 8 step ° AS-BUILT 6 step FLOOR PLAN WOOD DECK LG NAME EXISTING A_2 FLOOR PLAN e~9 DWG. ND E PROPOSED ADDITION ST -4 3/4' - F2 - -27 4 - 20'-31/2' 20'-D' ' T-8, 4 1 2 6-0'. 4J12* 9 IO• sA. 807 BARN DOOR 8070 BARN DOOR - - FtP RESIDENCE :STONE RAMP SOUTHOLD, NY STORAGE 1020 RUCH LANE (UNHEATED) / BEDROOM 3 00 ARCHITECT KITCHEN LO•_ i Dir ~ FRANK UELLENDAHL 123 CENTRAL AVENUE 1 o P.0I 316 G - - - - GREENPORT, NY 11944 BATH CLOSET CLOSET q GARDEN ROOM REF. TEL: 631-477 8624 R (CRAWL SPACE) OWNER x' PATRICIA WALKER 1020 RUCH LANE SOUTHOLD, NY 11971 4- 1 980-4714 - - LIVING ROOM _ cathedral ceiling ! MBR Q~ - - - - - - - - - - - - - - - - - rn BEDROOM 2 5 * h Z - J ~ _ -DECK ? . - - - - - - - - - - - - - - - J ~ q r SUNROOM 4 EXISTING DECK TO BE REMOVED +r oN - = WOOD DECK DATE: 08/27/2012 SCALE: 1/8' = 1'-0' 3 PROPOSED FLOOR PLAN 2T-I 1/4' 15' SIDE YARD 10' SIDE YARD DWG. MANE A-3 DWG. NO