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HomeMy WebLinkAboutTR-7880A James F.King,President `�QF S0!/TTown Hall Annex Bob Ghosio,Jr.,Vice-President ,`OOl0 54375 Main Road P.O.Box 1179 Dave Bergen Ji Southold,New York 11971-0959 John Bredemeyer ® p� Telephone (631) 765-1892 Michael J.Domino O Fax(631) 765-6641 COU BOARD OF TOWN TRUSTEES V� �TOWN OF SOUTHOLD Permit No.: 7880A t Date of Receipt of Application: June 21, 2012 Applicant: Vito & Dina Moles SCTM#: 54-4-3 Project'Location: 4200 Kenny's Road, Southold Date of Resolution/Issuance: August 22, 2012 Date of Expiration: -August 22, 2014 Reviewed by: Board of Trustees Project Description: To install a post and rail fence along the west side of the property from the concrete walkway seaward, to be no more than 52' seaward of the northwest corner of the existing deck. 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 application prepared by Vito & Dina Moles, received on June 21, 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. 0 s James F. King, President Board of Trustees 0 0 fF James F.King,President pp�� �u'p Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President P.O.Box 1179 Dave Bergen ac Southold,NY 11971 John Bredemeyer • Telephone(631)765-1892 Michael J.Domino y�O1 .�Da 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 Y2 constructed Project complete, compliance inspection James F.King, President sorry Town Hall Annex Bob Ghosio,Jr.,Vice-President ,�0� Ol0 54 Main Road P.O.. Box 1179 Dave Bergen Southold, New York 11971-0959 John Bredemeyer Michael J. Domino '.� �0 Telephone Fax(6 (631) 765-1892 O�y�DUMY,�c� (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7880A Date of Receipt of Application: June 21, 2012 Applicant: Vito & Dina Moles SCTM#: 54-4-3 Project Location: 4200 Kenny's Road, Southold Date of Resolution/issuance: August 22, 2012 Date of Expiration: August 22, 2014 Reviewed by: Board of Trustees Project Description: To install a post and rail fence along the west side of the property from the concrete walkway seaward, to be no more than 52' seaward of the northwest corner of the existing deck. 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 application prepared by Vito & Dina Moles, received on June 21, 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. 044 James F. King, President Board of Trustees i • ��o�giiFFO(�coG James F. King,President o y Town Hall Annex Bob Ghosio,Jr.,Vice-President Q +� 54375 Route 25,P.O.Box 1179 Dave Bergen .j `C Southold,NY 11971 John Bredemeyer 0W J* .�© Telephone(631)765-1892 Michael J.Domino Fax(631)765-6641 BOARD OF TOWN TRUSTEES , / TOWN OF SOUTHOLD TO: V d-o Cb;ma a f r n�✓/1► 6 Please be advised that your application dated Scan a o21, c9aj,), has been reviewed by this Board at the regular meeting of lltjuqu_4 90, 'bld, and your application has been approved pending the cor pletion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1 st Day of Construction ($50.00) % Constructed ($50.00) Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: ramal TOTAL FEES DUE: BY: James F. King, President Board of Trustees 07/26/2012 15:07 63f6-1093 LI FINEST HOMES Bargain ad Sale Deed,with revenants agaimt Grantor's Arb 1' 2 6 2012 I' CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY "' - i ^^ LAWYERS ONLY. THIS INDENTURE, made the 20a'day of October Two thousand and four ---- BETWEEN — JOHANNA TSOURIS,as surviving tenant by the entirety,residing at 25 Maymont Lane,Stonybrook,New York, 11790 party of the first part,and - DINA MOLES,as to one-third interest and VITO R.MOLES,as to one-third interest,both residing at 7 Klannan Court,South Huntington,New York 11746,and CHRISTOPHER KIDERIS,as to one-third interest,residing at 43 Barmarn Avenue,Plainview,New York 11803- - party of the second part, . .. . WITNESSETH,that the party of the first part,in consideration of ten dollars and other valuable consideration paid by the party of the second part,does hereby grant and release utao the parry of the second part,the heirs or successors and assigns of the parry of the second part forever, see Si,edwLe �c"J ALL that certain plot,piece or parcel of land with the but dings and improvem thereon erected, situate,lying and being at Southold,in the Town of Southold,County of Suffol d State of New York; BEGINNING at a point on the Easterly side of Kemtey's distant 225.00 feet - Northerly fro/degrees er formed by the Easterly side of eatery's Road and the Northerly side Sea Drive; RUNNING TNorth 40 degrees 5"s r ' ales 00 seconds West 109.99 feet to the - -- - highwater ma /03 of the Long Ishu Sound; RUNNING TNorth 41 de s 31 minutes 03 seconds 29.85 feet; RUNNING TNorth 3 degrees Ol minutes 47 seconds Ease 88.65 feet; RUNNING TS ith 50 degrees 36 minutes 00 seconds Ease 109.42 feet; RUNNING TSouth 39 degrees 24 minutes 00 seconds West 137.02 feet to apoint on the Ee of Kenny's Road being the point and place of BEGINNING. Said Premises is known as by 4200 Kenneys Road,Southold,New York. Said premises being the same premises conveyed to the party of first part by deed dated 1/27/1971 recorded 1/29/1971 -in Liber 6877 Page 537 in the Office of the County Clerk, - - Suffolk County,New York. - -- TOGETHER with all right,title and interest,if any,of the party of the first part in and to any streets and roads abutting the above described premises to the center lines thereof; TOGETHER with the appurtenances and all the estate and rights of the party of the first part in and to said premises; TO HAVE AND TO HOLD the premises herein granted unto the parry of the second part,the heirs or successors and - assigns of the parry of the second part forever_ AND the party of the first part covenants that the party of the first part has not done or suffered anything whereby the said premises have been carton bered in any way whatever,except as aforesaid. AND the party of the first pan,in compliance with Section 13 of the Lien Law,covenants that the party of the firs[part will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and - --- will apply the same first to the paymenr of the cost of the improvement before using any part of the total of the same for any other propose. _ The word"party"shall be construed as if it read"parties"whenever the sense of this indenture so requires. IN WITNESS WHEREOF,the party of the first part has duly executed this deed the day and year first above written. - IN PRESENCE OF: /1 A6'ei.2r-wra� � .is-s� c\ JO ANNA TSOUR[S �� V 07/26/2012 15:07 6f6-1093 LI FINEST HOMES • PAGE 02 .STATE l)F NEW YORK -STATE OF NEW YORK COUNTY OF golf"ss'. COUNTY OF Suffolk ar. On the 20a day of October 2004 - On the........day of before me,the undersigned personally .before me,the undersipe l parsomlly - - - -appeared JOHANNA TSOURIS appeared personally known to me or proved to me on the personally(mown to AND aleeathe - beds of wry evidence to be the "basis of sebsfiemry indlvidual(s)whose name(s)is(are)subscribed individud(s)whose '" tu.the within kwhr m ew and acknowledged to - to the within iosalaomk .'r . me thatheldWthey executed the same in his/her me that I dshehhey MaN�26 IS 111h, -/their capacky(ies),and that by his/her their - /their capacily(ies),wA*mby bhltterthair sipatums(s)on the instmmem,the individual(s), - sipatums(s)w the imlon4at,dobovidrQs), . or the person upon behalfofwhich the or the pas upon behtl W *kboe. irrd'" ).acted,executed the instrument. _ _-individuaks)acted,elter>fMI�IMii�MYl'itara. TIFFANY ANNUNMTA Nobly Public,Smta of New York No.01AN604WW Qualiffed In Suffolk CwMtr ���/ r Commission mission Expires Seplawnber 26r ,200b _ Bargain and Sale Deed SECTION 054 BLOCK 4 " LOT 3 - COUNTY SUFFOLK - RECORD AND RETURN TO: " Michael Carlomusto,Esq. 1065 Old County Road,Suite 204 Westbury,New York 11590 07/26/2912 15:67 631-6793 LI FIPEST HOMES* PAGE . 63 ALL S'L'ATE ABSTRACT CON Y ' SCHEDULE A 4 ilrY BEGIN14 YCr it a paint on the Eastet3y side of Kane *e corner fisoed by tie Eask*side rMs Ob Sea Drive; RUNNIPir. 1000CE North 40 degrees Si mio�tea ii . the highwater auk oa 11/6103 of the Long Island S - RUNNING THENCE North 41 degrees 31 minutes 03 seconds East 29.55 feet; RUNNING TUDKE North 38 degrees 01 minutes 47 seconds East 88 65 feet; RUNNING 7INDICE South 50 degrees 36 cu lottes 00 secsx,*East t0 .0 teat; RUNNING THENCE South 39 degrees 24 minutes 00 seconds West 137.02 feet to . a point on the Easterly side of Kenaef s Road being the point aad place of BEGINNVG; r , I t '.. be ietaed INIIMr till vekd will i Wb jwMICA 104111164i olid FOR improvslrnerrts erected on the premises which by low somite real property. COWEVAMtiMG ONLY TOLE M with ar the right, title and interest of the party of tits frit pert, of, in and m 4 the lend lyig in the street in front of and adjoining said p a iam Vito& Dina Moles 4200 Kenny's Rd., Southold SCTM#54-4-3 811512012 - Itsp� F� Y E b tag ♦ It mow NOMW ♦ Y suFFo��. James F.King President P.O. Box 1179 Bob Glaosio,Jr..Vice-President . °GZSouthold.NY 11971 Dave Bergen pp "I'elephone(631 765-1892 John Bredemeyer F,1 Fax(631)765-6641 Michael J. Domino Southold Town Board of Trustees Field Inspection[Worksession Report Date/Time: ,l? 416- /J / Z - 3d Rescind Resolution dated July 18, 2012 and Amend Resolution to read as follows: RESOLVED, that the Southold Town Board of Trustees APPROVES the Administrative application of VITO & DINA MOLES to install a post and rail fence on the west side of the property no more than 70' in length beginning from the concrete walkway seaward. Located: 4200 Kenny's Road, Southold. SCTM# 54-4-3 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: Present Were: J. King B. Ghosio D. Bergen, J. Bredemeyer Michael Domino D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: osuFrot t James F.King,President P.O.Box 1179 Bob Ghosio,Jr.,Vice-President G'F2 Southold,NY 11971 Dave Bergen ti Telephone(631 765-1892 John Bredemeyer W T Fax(63 1)765-6641 Michael J. Domino Southold Town Board of Trustees Field InspectionMorksession Report Date/Time: J✓ ' /� J�� VITO & DINA MOLES request an Administrative Permit to install a post and rail fence on the west side of the property no closer than 10' to the mean high water line. Located: 4200 Kenny's Rd., Southold. SCTM#54-4-3 ;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 TyPye of Application: _Wetland _Coastal Erosion _Amendment `Administrative_Emergency _Pre-Submission Violation Info needed: Modifications: Conditions: C? K- S SC'a+,-14-11 6(� i✓i,✓�� I r Cc, – J" •T ��� Present Were: J. King B. Ghosio D. Bergen, J. Bredemeyer Michael Domino D. Dzenkowski other Form file out in th field by cv- Mailed/Faxed to: Date: ko&Dina Moles 200 Kenny's Road, Southold SCTM#54-4-3 111/2012 t '4a dE I .'w'. reixn xey.�O w f y• , I'll 3 r �r D � 'Vayo auim x�a § rI ! EEoos� ��ixn zohrl � 4e ro4y xf'�'q rS c4pry a ry d a % a �°r m • M'g YxjE d of 'if FF_ � I� n COUNTY OF SUFFOLK © IE x°�"" rnx ¢cu xo _ '�•� nr...w.........ee.w.�. o xwraxrvw w.rn '- -...� • 0 OFFICE LOCATION: ��q soyo MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) 41 N Telephone: 631 765-1938 Southold, NY 11971 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM i JUL 17 2012 Southhold Town To: Jim King, President Board of Trustees Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: July 17, 2012 Re: Proposed Wetland Permit for VITO & DINA MOLES SCTM#1000-54-4-3 VITO & DINA MOLES request an Administrative Permit to install a post and rail fence on the west side of the property no closer than 10' to the mean high water line. Located: 4200 Kenny's Rd., Southold. SCTM#54-4-3 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. Ring,President pf SOT, Town Hall Annex Bob Ghosio,Jr.,Vice-President ,�0� ��� 54 Main Road P.O..Box 1179 Dave Bergen Southold, New York 11971-0959 John Bredemeyer - rn cr- Michael J. Domino .'mac �O Telephone(631) 765-1892 lyCOUFax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application D _Wetland Permit Application _Administrative Permit J U N 2 1 2012 Amendment/Cransfer xtensron �Received Application: (01 l� I eceived '�% Sou,hhaid Town // — — Board of Trustees _Completed Application at I l� _Incomplete SEQRA Classification: _ Type IType Ii_Unlisted_ _Coordination:(date sent) aQ�1 ✓LWRP Consistency Assessment Form —,CAC Referral Sent: ate of Inspection: I(((a' _Receipt of CAC Report: _Lead Agency Determination: _Technical Review: Public Hearing Held: 1 1 Y Resolution: \r Name of Applicant Vt�� Address 7 L-hpmkM' ) C DA k-T- ��LTT,� I VM yme ) 1 11L4� PhoneNumber:� '7 /V`34�,/g Ctell W1 744o -32S Suffolk County Tax Map Number: 1000 - 5Y - 'f ,3 Property Location: 42yu k'�-weSyo—nfou Ny <<a-71 )V0er,q OF (,eemj ) D21t/e (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: BqV of Trustees Application GENERAL DATA Land Area(in square feet): 13, S10 S 6z irr Area Zoning: Previous use of property: �tSid c m C-P Intended use of property: a-M,4Lf 4 C-.0— Covenants eCovenants and Restrictions: Yes No If"Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals Yes _ZNo 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 ,� No Does the structure(s) on property have a valid Certificate of Occupancy /Yes No Prior permits/approvals for site improvements: Agency Date Scx rr�lnlA Tpwr1 ---5 4UP Co No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended y a governmental agency? o Yes If yes, provide explanation: Project Description (use attachments if necessary): OF A VGP!>q- S& p!( Pc-nveTq V 60m Nan f�7�/l Ca1'�<-fiteic BoW of Trustees Application• WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): 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 l SPONSOR 2. PROJECT NAME rvm CJ 0 3.PROJECT LOCATION: T� Municipality � I#V W County 4.PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map 5.IS PROPOSED ACTION: Et New ❑Expansion ❑Modification/alteration 6.DESCRIBE PROJECT BRIEFLY: K?iTPt(lf�"Roly 0Ftt, 1c �loo OIC UJSi OF y From tim'-- -M (&I+#- U Q4 7. AMOUNT (O�F. LAND AFFECTED. Initially rt7d acres Ultimately .'4 acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ®Residential ❑Industrial 11 Commercial DAgriculture ❑Park/Forest/Open Space I0ther (describe) �T nn S tet! (We-M5'r S 1 t)E 10. DOES ACTION INVOLVE A PERMIT'APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, Stale or Local) 1V/1Yes n No If yes, list agency name and permit / approval: C 7 -CURRENTLY-VALID-PERMIT OR APPROVAL? -- - - - __- - -- ---- --- ❑Yes IN1.Pro If yes, list agency name and permit / approval: Loex 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? Dyes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / npor ''(n� Date: Signature `' ///�//2' If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment BqW of Trustees Application• County of Suffolk State of New York 670 9005 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. a*-�� 9 - Signature ll SWORN TO BEFORE ME THIS_ DAY OF Jt//1t 120 e Jonas.Justin Wagner Notary P• tate of New York Z " '�VA6213636 N Public in Suffoc County .. —sion Expires 11/16/20 Bled of Trustees Application* AUTHORIZATION (where the applicant is not the owner) / I, Yeo X10 residing at 7fCttfeo" (�'•f�t� l7nYRIVA) (print owner of property) (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. �� (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.'A r/ YOUR NAME: gyas r i (Last name,first name,itiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate theother 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.) 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 a 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_L4! _day of J�/�� 20JZ— Signature a2,& ) Print Name Form TS 1 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. DESCCjR�IPTION OF SITE AND PROPOSED ACTION SCTM# PROJECT NAME �� A L( (�J(p tOSrs�K/tt L l7G The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees Da 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: Location of action: Site acreage: _ p ?� SQ Fr Present land use: /� td-eAL7 Present zoning classification: 4-v,-aet ha 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: ;// TC- A4616;5 „��” (b) Mailing address: >��1�ft & • �M7AXo7DN ST} q j//'so (c) Telephone number: Area Code 0 3�y -&Old (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 UNot Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria 0 Yes ❑ No gNot 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 ❑ Yes ❑ No WNot 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 RfNot 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 1-1Yes1:1ro 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 Ap^le Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes [] No�ot Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No 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. 2(Yeo No❑ Not Applicable Attach additional sheets if necessary WORKING COAST POLICIEO 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 VNot 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 WNot 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 0Not 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. r_1 Yes [:1 No ii Not Applicable PREPARED BY Y l� "a 47S TITLE�w��� DATE PROVED FT BOARD OF TRUSTEES O4-J97 TOWN OF SOUTHOLD DATE ,qvl- z2 zor L l SPUN ISLAND Lo N G 11-6'2D03 WATER- LINE HIGH 8 65' AP.PRO'AMF „E 8 z p3.,E N 3601 47 N CD 0 N 41'9185, �rjc�c(���1C 0 fl)t, jo F I W o 11 tt 0 6? A Z b�L1j b�¢�f' O ; 3� u7 O x CA a O deck z m Orth l m � 7. Porch °' -' A 23.9' t dao 16.1 N v N OWN � 1 p LL R � FR SHED E N , 12'x8' 4) iJ ro C:) 32.5' b sower dareto r w 02 © °� C1 „.' O „W 137 a PP I, S 39.24 00 FORMERLY r� -a 7r- b I NOW OR KAT JOHN N KATHERINE KA' k n Iii JUN 2 1 2012 2 Sou;Phaldiavq board of rustees SEApRIVE ----- NORTH Dia1ROf 07nicroreM,q Ni AOua� moY T&ungmuo m M trM•'aic+M�.4� M JOB No. 03-485 FILE No. 824 F MIO®m'�¢lllf�l�`O RDR4 -MILLI-►CM.t ►NIOL wAiaw wca-AmMM m.raara a ANY a11OP ao,AAiknoK SURVEYED FOR DINA MOLES ,�a, .mni anciwraioa o u SITUATED AT SOUTHOLD an . �' •,weer wo uMAwo�AnnPMr uim,eAa4 vvo m,nc AwoIAA or�c TOWN OF SOUTHOLD, SUFFOLK COUNTY N.Y. wrsls-wna z' arm ar w man we 7w womo nc um Awxmn M®WA m SCALE 1" a 30' DATE 9-21-2004 !e0�SOL OU"filar K9' TO M:A YIP AZ MPP. . FILEDMAP No. DATE CERTIFIED ONLY T0: TAX MAP No.(REF ONLY) 1000-54-4-3 DISK 2DO3 DINA',MOLE,9 ALLSTATE ABSTRACT CORP HAROLD F. TRANCHON JR. P.C. ' FIRST AMERICAN TT1lE IMS. CO. OF NEW.YORK LAND SURVEYOR P.O. BOX 616 >S � 1866 WADING RIVER-MANOR RD. WADING RIVER, NEW YORK, 11792 N. : LIC. No. 048992 631-929-4695 HAROLD F. TRANCHON JR. PENN. LIC. No. 215—E