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Home My WebLink AboutTR-7948A Michael J.Domino,President �O�*of SOUryolo Town Hall Annex 54375 Route 25 John M.Bredemeyer III,Vice-President JW_ g P.O.Box 1179 Charles J.Sanders N Southold,New York 11971 Glenn Goldsmith ® �@ Telephone(631) 765-1892 A. Nicholas Krupski O4 'rou Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1336C Date: May 3, 2017 THIS CERTIFIES that repair/replace the existing roofed-over porch attached to dwelling; At 11292 Main Road, East Marion Suffolk County Tax Map#1000-31-13-9.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated November 10, 2012 pursuant to which Trustees Administrative Permit#7948A Dated November 14, 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 repair/re_place the existing roofed-over porch attached to dwelling. The certificate is issued to Kirk O'Ferrall owner of the aforesaid property. a Authorized Signature r r r iti �pF UTH, Michael J. Domino, President O� SO ®� Town Hall Annex John M.Bredemeyer III,Vice-President ~ 54375 Route 25 Charles J. SandersP.O. Box 1179 COO Southold,New York 11971 Glenn Goldsmith ® a� Telephone(631) 765-1892 A.Nicholas Krupski OI�COUI Fax(631) 765-6641 s BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION. �Ch. 275 - Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction Y constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: v y'rG CERTIFICATE OF COMPLIANCE: - -� su James F.King,President �pp� FFu�,r�G Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President o P.O.Box 1179 Dave Bergen A Southold,NY 11971 John Bredemeyer py • !� Telephone(631)765-1892 Michael J.Domino �'Oj .�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 1" day of construction % constructed Project complete, compliance inspection 0 James F.King,President sorry Town Hall Annex 54375 Main Road Bob Ghosio,Jr.,Vice-President h0 l� P.O. Box 1179 Dave Bergen Southold, New York 11971-0959 John Bredemeyer G p Telephone (631) 765-1892 Michael J. Domino '�� Fax(631) 765-6641 �y�OUiJT'1,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7948A Date of Receipt of Application: November 10, 2012 Applicant: Kirk O'Ferrall SCTM#: 31-13-9.1 Project Location: 11292 Main Road, East Marion Date of Resolution/issuance: November 14, 2012 Date of Expiration: November 14, 2014 Reviewed by: John Bredemeyer, Trustee Project Description: To repair/replace the existing roofed-over porch attached to dwelling. 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 Robert O'Brien, P.E., last dated on November 8, 2012, and stamped approved on November 14, 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. Cz James F. King, President Board of Trustees James F.King,President y Town Hall Annex Bob Ghosio,Jr.,Vice-President G L+xi 54375 Route 25,P.O.Box 1179 Dave Bergen .j �� Southold,NY 11971 John Bredemeyer �Oj �'�� Telephone(631)765-1892 Michael J. Domino Fax(631)765-6641 BOARD OF TOWN TRUSTEES i— TOWN OF SOUTHOLD TO: LIQ_ !� -'rf Q C;l Z2 P I'�— ` (�rle v� P. C. Please be advised that your application dated D 2 has been reviewed by this Board at the regular meeting of and your application has been approved pending the completion oft a following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 15` Day of Construction ($50.00) / '/z Constructed ($50.00) V 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: Zn Spe c-l'oln 4e —V5D. DD TOTAL FEES DUE: $ SD• DD BY: James F. King, President Board of Trustees 0 gpFFD(,� James F. King.President CO P.O.Box 1179 Bob Ghosio,Jr.,Vice-President j y� Southold.NY 11971 Dave Bergen y Telephone 1631 765-1892 John Bredemeyer {3, Fax(63 1)765-6641 Michael.I. Domino Southold Town Board of Trustees Field Ins pectionl Worksession Report Date/Time: //1311' Robert O'Brien, P,E. on behalf of KIRK O'FERRALL requests an Administrative Permit to repair/replace the existing roofed-over porch attached to dwelling. Located: 11292 Main Road, East Marion. SCTM# 31- 13-9.1 Typ f area to be impacted: altwater Wetland _Freshwater Wetland _Sound _Bay Distance of proposed work to edge of wetland Part Town Code proposed work falls under: hapt.275 Chapt. 111 _other Type of Application: Wetland _Coastal Erosion _Amendment —Administrative—Emergency _Pre-Submission Violation Info needed: Modifications: Conditions: 04L Present Were: J. King B. Ghosio D. Bergen, ,,-'J. Bredemeyer Michael Domino D. Dzenkowski other Form filled-o t in the field by l�G �h fjt-Cu�I Mailed/Faxed to: Date: r p _ �H f LIrq �s' II p pp 3 M A � �R�$S 9�AA$`• l3�&r.:. n.. •$„ a" Z ., ^i } �'` 7��0. � iw i� F�'� �� `y\�•°t4�yy��T3 �y�� 4 IiFU November i u , i _ y 1 4 f xK f e'er "i k w �e O'Ferrall Residence . u November 8, 2012, 308 PM �. South Elevation WJ OFFICE LOCATION: OF SO(/jyO MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 # # Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 G Q Telephone: 631 765-1938 • i� Fax: 631765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jim King, President Town of Southold Board of Trustees j NOV 14 2012 From: Mark Terry, Principal Planner LWRP Coordinator Date: November 13, 2012 - - Re: Proposed Wetland Permit for O'Farrall Residence SCTM# 1000-31-13-9.1 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 EXEMPT from LWRP review pursuant to: § 268-3. Definitions. MINOR ACTIONS item "B" which states: B. Replacement, rehabilitation or reconstruction of a structure or facility, in kind, on the same site (inplace), including upgrading buildings to meet building or fire codes, except for structures in areas designated by the Coastal Erosion Hazard Area (CEHA) law where structures may not be replaced, rehabilitated or reconstructed without a permit and shoreline erosion control structures (including, but not limited to, groins,jetties, bulkheads, filled piers) located within Great Peconic Bay, Cutchogue Harbor, Little Peconic Bay, Hog Neck Bay, Noyack Bay, Southold Bay, Shelter Island Sound, Pipes Cove, Orient Harbor, Gardiners Bay, Long Island Sound, Fishers Island Sound and Block Island Sound (excluding all creeks); 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, Presiden• �QF so • Town Hall Annex Bob Ghosio,Jr., Vice-President ,�0� Ol0 54 Main Road P.O.. Box 1179 Dave Bergen #f Southold, New York 11971-0959 John Bredemeyer �p� Telephone (631) 765-1892 Michael J. Domino Fax (631) 765-6641 �y00UN' ®' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _ _Coastal Erosion Permit Application _Wetland Permit Application Y Administrative Permit _Amendment Transfe /Ext nsion Received Application: 1 /O �� NOV 10 29?? Received Fee:$ _Completed Application _Incomplete _SEQRA Classification: - - Type ( Type II_Unlisted Coordination:(date sent) �LWRP Consistency Asses ment Form !1 _CAC Referral Sent: N/ _Date of Inspection: _Receipt of CAC Report: __Lead Agency Determination: __Technical Review: _Public Hearing Held: Resolution: Name of Applicant //f/C Q Mailing Address /S W,fST 7S r ,Sr e49YT At?�, Phone Number: 7G7 / Suffolk County Tax Map Number: 1000 - Property 000 -Property Location: /( 2 92 /'7 - (provide LILCO Pole #, distance to cross streets, and location) AGENT: ley" 7— O (If applicable) Address: 20 ;7�r Hlg/r /Lo�aQ ' 1,4�AX4 Phone: 4. / S'2 Ss ard of Trustees Applicati� GENERAL DATA Land Area (in square feet): Irp "47 Area Zoning: Previous use of property: /1.e5, 4'r cr Intended use of property: /I//f Aco. cam' Covenants and Restrictions on property? Yes No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes —1Vo If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes -., No If"Yes", please provide copy of decision. Will this project require 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? /s No Prior permits/approvals for site improvements: Agency --0 G8'.;f-/ Date egU J0, 4w- P'./-IeO INC ¢/�6 2 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?—,ee-Ko Yes If yes, provide explanation: Project Description (use attachments if necessary): 1-2A77P ' B00 of Trustees Application• WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: S /rLP.n.t../ elt, ✓JAS � 'rp / C — Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: lG feet Closest distance between nearest proposed structure and upland edge of wetlands: /z feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? .S cubic yards How much material will be filled? 2 cubic yards Depth of which material will be removed or deposited: .7 feet Proposed slope throughout the area of operations: cl/ 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): �t/arf dP Board of Trustees Application County of Suffolk State of New York K'f 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. ignature of P i)perty O tt-er SWORN TO BEFORE ME THIS DAY OF / t o r/�m�' =t ,20 12- Notary Public PATRICIA A. BOVE Notary NO. 01 O4860753Of w York Qualified in Nassau County Commission Expires May 21,20-414 B•rd of Trustees Application AUTHORIZATION (where the applicant is not the owner) 1, r v 0 t revra—u _residing at_- lS Lu. 7 S (print owner of property) (mailing address) �Uew `Eow l<F �JY 1 0� _ _do hereby authorize (Agent) O t Qr cvt P L% to apply for permit(s)from the Southold Board of Town Trustees on my behalf. ��r (Owner's srignature) .S �J/ Z PATRICIA A. BOVE Notary Public, State of New York No. 01 B048f 0753 Qualified in Nassau County Commission Expires May 27,20.1.;c APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURF,,FORM The Town of u Id f Ethicli piphibits confligiaof interest on the Dag 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 15 necessary to avoid same. YOUR NAME: ��Oa/�,FLT O !S jL/.Fi✓ /- • �� r � `J (Last name,first name,Middle mitral,unless you are applying in the na�tc or 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.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship'includes by blood,marriage,or business interest."Business interest"means a business, including a partnership, in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO / If you answered"YES',complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee. Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); _B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of 200_ Signature Print Name Form TS I PROJECT ID NUMBER 617.20 • 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 3.PROJECT LOCATION: Municipality Grp✓ p Q' County 4. PRECISE LOCATION: Street Access and Road Intersections, Prominent landmarks etc -or Provide map /.291 ^ A-,f 'of O/1-ad - f. ��/1/Ir 5. IS PROPOSED ACTION ❑ New ❑Expansion Ificatlon/alteration 6. DESCRIBE PROJECT BRIEFLY: O.✓ J Iq"C /�fL✓S/. �O�C,f 7. AMOUNT OF LAND AFFECTED: Initially <:> acres Ultimately G acres G� 8.WILLfROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes ❑ No If no,describe briefly: 9. WH IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential ❑Industrial ❑Commercial Agriculture ❑Park/Forest/Open Space ❑Other (describe) 10 DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, ale or Local) F-1 Yes o If yes, list agency name and permit / approval: ----- --f-f-r DI 2�APPROVAL9- _ r-1 Yes o If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTIN PERMIT/ APPROVAL REQUIRE MODIFICATION? Des ❑No I CERTIFY T E I ATION PR IDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sp or Name U� �� r �- F Date: Signatur �`- If the action Is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment 0 QY�' . 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 STORNig ER,GRADING DRAINAGE AND EROSION CONTROL PLAN on - -L-� CERTIFIED BY EA 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? 1 Will this Project Retain All Storm-Water Run-Off (Inciude Total Area of all Parcels located withinS.? Generated by a Two(2')Inch Rainfall on Site? the Scope of Work for Proposed Construction) (S.F.I Awx) (This Item will Include all run-off created by site — ❑ b. What is the Total Area of Land Clearing clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed Site Improvements and the permanent creation of construction activity? (S.F.I A.) impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed — ❑ PROVIDE BRIEF PROJECT DFSCRTPI'fON IPrMde Addllbnal Papeax NeetlM) Drainage Structures Indicating Size&Location?This Item shall include all Proposed grace Changes and R��iT i..,.� G'G, itiol� Slopes ControilinYo r Flow. -�o 3 Does the Site 'Ne scribe the erosion ❑ and sedim coill be used to control site erosiwTT.//er discharges. This item must be maghout the Entire Construction Pe• At[ C LisueuG�C 7-Ti 4 WillthisProjectand Filling,Grading or ❑ — �— Excavation where there is a change to the Natural dX 1Gp4/0jI-i me-�!a-' Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? Fl e'r'000A i"">r o- /.rlJ.w 5 Will this Application Require Land Disturbing Activities ❑ . Encompassing an Area in Excess of Five Thousand �71dai (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 activities 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 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 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 storm water discharges. (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious ❑ for Storm Water Discharges from Construction activity-Permit No.GP-O-10.001.) Surfaces be Sloped to Direct Stomi-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 construction activity. 2.The SWPPP shall describe the erosion and sediment central practices and where 9 Will this Project Require the Placement of Material, ❑ — required,pustconstwiction storm water management practices that will be used andlor Removal of Vegetation and/or the Construction of any constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance Min the terms and conditions of this permit.In addition,the SWPPP shall Area?mals hem wm NOT Include Ire Insadlsean of odwwey APmx.) Identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE: If Any Answer to QuesUona One through Nine Is Answered with a Check Mark 3.All SWPPP3 that require the post-wnstruclpn storm water management practice In a eox and the construction site disturbance is between 5,000 S.F.a 1 Acre in area, component shall be prepared by a qualified Design Professional Licensed in New YOM a Storm-Water.Grading.Drainage L Erosion Control Plan is Required by the Town of that is knowledgeable in the principles and practices of Storm Water Management. (NOTE:Southold and he Must be submitted for Rrviea Prior m is Re ui of My compBuildlete Permit. (NOTE: A rY,eG Mark t.r I erWw Answer for each Weatim is Required for a Complete Appkationl SKATE OF NEW YORK, S U f F-0uL.....,,,,SS COUNTY OF........................... That 1, ......(./64?�....r..J.......AP......................1...:/tTeing duly swom,deposes and says that he/she Is the applicant for Permit, (Name of Individual signing Document) Andthat he/she is the ................ .................................................................................................................. (owner,Contractor.Agent,Corporate Officer,etc) Owner and/or representative of the Owner or Owners,and is duly authorized to plwiform 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 herewith. Sworn to before me this; .. ..................... .....��............. day of...�.M.,vi!..o'`................ ,20..12 . . Notary Public: " ........-ANN CAR ' ..... .... ................................................................ iifryPubli eW ignatureofAppilcant) FORM - 06/10 Qualified in Suffolk County Commission Expires January 19,20 /S Town of Southold • • LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS I. 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. 'phis 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 sign ficant 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 �tiIll 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 SCTMk e eo - ,Y/ -/g —L/ PROJECT NAME (,5 /f%l slit 4-0e 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: Ca'�o,r, s .4,.0 ,cuanbG.I Location of action: //2 ?? — As -4* oM., ✓ Site acreage: .sem Present land use: J'r 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: /Frit .F e--7 (b) Mailing address: /S �✓cs� 7S S'� • /tr°T �/f (c) Telephone number: Area Code ( ) ZZ2 — 92 / 71gr 7 (d) Application number, if any: Will the action be direct undertaken, require funding, or approval by a state or federal agency? Yes ❑ No If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 2. otect and preserve historic and archaeological resources of the Town of Southold, See L7Z, n III — PoliciesPages 3 through 6 for evaluation criteria ❑ No ❑ Not Applicable �/fr G �t /•snd. c /�.vss 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 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 Pagethrough 16 for evaluation criteria Yes 1:1No Not Applicable Attach additional sheets if necessary Policy S. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III — Policies Pages 16 through for evaluation criteria ElYes 1:1 No Not Applicable .Attach additional sheets if necessary Policy 6. Protect and restore the quality and functitki 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 cr' eria. ❑ ❑ Yes No NotA191able 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 33�N ev uation criteria. 1-1 Yes � Noot Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wa stes. See VW 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. �� ❑ YeLl No Not Applicable Attach additional sheets if necessary WORKING COAST POLICI* Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See L Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes F1 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 wale ee LWRP Section III — Policies; Pages 57 through 62 for evaluation criteria. 11Yes ElNo Not Applicable Anach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for3�Not a' criteria. ❑ Yes ❑ No Applicable Anach additional sheets if necessary Policy 13. Promote appro .riate use and development of energy and mineral resources. See LWRP Section III —PoliciesZot 65 through 68 for evaluation criteria. r7Yes ❑ No pplicable PREPARED BY � Q��r ODATE TITLE �2 APPROVED BY � � •,..._/� _ _ __�__ 1-- BOARD OF TRUSTEES --- TOWN OF 50 s �-�..� � , 3,/z „xv%s '4 .�-.s>-• DATE -_ F 2- t % ie-••—•' fir' .e.x �' Sv' frs6I<•' — /F. L.n.� .s</trw+ ji"J f�i', "^ I/I•In �^c�/A`.(+' ,+�1� �/1' � /� . ' /-XIS/. ��li i /f/JD 3/7r 'i� 6�L.r� sc.rt,..� � � � � '`e 4" •6.t.ct. .TT Besse* �r c S /6� ri/t E�rP, Co•6f-f I' � � ' Ca'6Lcc.. �'( ..aC /F/',�.a6 M A vI� x33Lr I l � �-' � �pU.rGG,� it/✓7"" ! Y..} Al J )) \ 1 �t 3. �,..�,FCc..- 6/['4,4,E/�y./} e� ? /:r8'•/1..«•,fwr:^ __--�_. .__._r... w/cs-/6• sn.a. s- SSG � SGL ✓vwN� mw7r..ss ..l�L`'G G' ^G c .VF.✓ L cam..,R•C�C /f C - - - _ - - 2 L• f✓•L s !ri L u.ea'O /R/v0 /�/i�l e,.'Q .� /(un-/S /2 !J G'o•n•r �•../ �v.rteS/q„ /Z ' � G' - - - - - _ - -- 3 A c c sirBs,..- /tea.-GF.cs�.��c.rfs Z—•ry.f x __ O �.�E/?/��L ,G /00E-r/�,@�`.fv e'Ar' fl-eC /e-�rl.6J 7'z !nl/lr�.4-U d✓ Vi-O/STc�L 6'.e/ GAG`..-O C/+/Acfd'� �.✓as �/sr'S/Tr. —��` ,�)�/N. I� 1�"e .F� �/9�G�OAo-' /Q/ - /4-L /° S.t '(PSS OF Nom. � 5 P - --t ROBERT O'BRIEN P.E. 00All 6/� CONSULTINC3 ENC3INEERINO SERVICES TO THE BEST OF MY KNOWLEDGE, BELIEF AND PROFESSIONAL JUDGMENT, THESE PLANS ARE IN COMPLIANCE WITH THE NEW YORK STATE BUILDING CODE NOV 10 2012 Main Road, Laurel, N.Y. 11946 Z� 052P�R DWN S a , SCALE 'ok, // �S DRAWING NO. SHEET DATE LI/��82 ?.::I, Z.7 — 3 1 / 0F d►°