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HomeMy WebLinkAboutTR-7925 John M. Bredemeyer Ill, President ,o�cJllffOL���G'- ' Town Hall Annex Michael J. Domino, Vice-President , la\ 54375 Route 25 James F. King r ; P.O. Box 1179 Charles J. Sanders Southold, NY 11971 Dave Bergen �S 600 Telephone (631) 765-1892 Ol 4i,, Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0958C Date: March 10, 2014 THIS CERTIFIES that the ret val ofthesouth wall of kitchen and foundation; kitchen to be extended 7'7"x16' on south side 4 j 12 expansion on northwest corner for bath; replacement-of existing bilco entry; replacement''of opening, interior alterations to house,and porch; replacement of septic system and"itnstallation of drywells;and new driveway At 40 South Lane, East Marion,New York Suffolk County'Tax Map# Conforms to the application for a Trustees Permit heretofore filed in this office Dated September 10, 2012 pursuant to which Trustees Wetland Permit#7925 Dated October 17, 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 the south wall of kitchen and foundation; kitchen to be extended 7'7"x16' on south side; 1 l'x12' expansion on northwest corner for bath; replacement of existing bilco entry; replacement of opening, interior alterations to house and porch; replacement of septic system and installation of drywells; and new driveway. The certificate is issued to ELLEN BRENNER 2007 TRUST owner of the aforesaid property. dr,"•-• 41P°N &Ayr;.XL. Authorized Signature • • -- James F. King,President ✓` OFF t1(k Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President O- Co , �� l/y P.O. Box 1179 Dave Bergen y Southold,NY 11971 John Bredemeyer `4� .:sy it `■ Telephone(631)765-1892 � Michael J. Domino \-70.? at. `773 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DAT:7 INSPECTION: 3 /A-/ Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction 1/2 constructed Project complete, compliance inspection. P P INSPECTED BY: Y6 s COMMENTS: --r )� Art e_, /7A CERTIFICATE OF COMPLIAN A James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall, 53095 Maia Rd. P.O. Box 1179 Southold, lqY 11971 Telephone (631) 765-1892 Fax (63 t) 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 Ist day of construction ¼ constructed Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7925 DATE: OCTOBER 17, 2012 ISSUED TO: ELLEN BRENNER 2007 TRUST PROPERTY ADDRESS: 40 SOUTH LANE~ EAST MARION SCTM# 37-6-4 AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on October 17~ 2012~ and in consideration of application fee in the sum of $250.00 paid by Mark Schwartz and subject to the Terms and Conditions as stated in the Resolution, the Southotd Town Board of Trustees authorizes and permits the following: Wetland Permit to remove the south wall of kitchen and foundation and set within setback; kitchen to be extended 7'7"x16' on south side; an ll'x12' expansion on northwest corner for bath; existing bilco entry to be replaced; replace openings, interior alterations to house and porch; replace septic system and install drywells, and new driveway; and as depicted on the site plan prepared by Mark K. Schwartz, AIA Architect, PLLC, last dated September 25, 2012 and stamped approved on October 17, 2012. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this dal~. TERMS AND CONDITIONS The Permittee Ellen Brenner 2007 Trust, residing at 40 South Lane, East Marion, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. That there will be no unreasonable interference with navigation as a result of the work herein authorized. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstmction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. That the said Board will be notified by the Permittee of the completion of the work authorized. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hail Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 October 17, 2012 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Mark K. Schwartz PO Box 933 Cutchogue, NY 11935 RE: ELLEN BRENNER 2007 TRUST 40 SOUTH LANE, EAST MARION SCTM# 37-6-4 Dear Mr. Schwartz: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, October 17, 2012 regarding the above matter: WHEREAS, Mark K. Schwartz on behalf of ELLEN BRENNER 2007 TRUST applied to the $outhold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated September 10, 2012, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on October 17, 2012, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of ELLEN BRENNER 2007 TRUST to remove the south wall of kitchen and foundation and set within setback; kitchen to be extended 7'7"x16' on south side; an 11'x12' expansion on northwest corner for bath; existing bilco entry to be replaced; replace openings, intedor alterations to house and porch; replace septic system and install drywells, and new driveway; and as depicted on the site plan prepared by Mark K. Schwartz, AIA Architect, PLLC, last dated September 25, 2012 and stamped approved on October 17, 2012. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: $100.00 Very truly yours, James F. King President, Board of Trustees JFK/amn James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Brederaeyer Michael J. Domino Town Hall Annex 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (631 ) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD reviewed by this Boam at the regular mee~ino of ' - I D/17/[ L and your appli~tion has been approved pending the completioWof the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1~t Day of Construction ($50.00) ½ Constructed ($50.00) Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE:$_~._,_t~, BY: James F. King, President Board of Trustees Peter Young, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY I 1971 TeJeaahmae~ 6JLD765 - 1892 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., October 12, 2012 the following recommendation was made: Moved by John Stein, seconded by William McDermott, it was RESOLVED to SUPPORT the Wetland Permit application of ELLEN BRENNER 2007 TRUST south wall of kitchen and foundation to be removed and set within setback; extend kitchen 7'X 16' on south side, 11'X 12' expansion on north-west corner for bath; existing Bilco entry to be replaced; replace openings, interior alterations to house and porch; replace existing sanitary system; install new drywells; and new driveway. Located: 40 South Lane, Southold. SCTM#37-6-4 Inspected by: Audrey Horton, Peter Young, William McDermott, John Stein, Doug Hardy Vote of Council: Ayes: All Motion Carried James F King, President Bob Ghosio, .Ir. Vice-President Michael J. Domino PO. Box 1179 Southold. NY 11971 Telephone (631 765-1892 Fax (6311 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: Mark K. Schwartz, Architect on behalf of BRENNER ELLEN 2007 TRUST requests a Wetland Permit for the south wall of kitchen and foundation to be removed and set within setback; kitchen to be extended 7'7"x16' on south side; an 11 'x12' expansion on north-west corner for bath; existing bilco entry to be replaced; replace openings, interior alterations to house and porch; replace septic system and install drywells, and new driveway. Located: 40 South Lane, East Marion. SCTM# 37-6-4 Typ~f 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: Pre ntWere ~J.K' z"'~B. Ghosio ~' ~J. Brede~ney~-r '~J~J~Micha;I Domino D. Bergen, D. Dzenkowski Form filled out in the field by other Mailed/Faxed to: Date: RE'vISIONS: PHOTO -A- PHOTO -D- PHOTO -B- PHOTO PHOTO -C- PHOTO < © < OFFICE LOCATION: Town Hail Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) $outhold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jim King, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: October 12, 2012 Re: Wetland Permit for BRENNER ELLEN 2007 TRUST SCTM# 1000-37-6-4 ., OCT 1 2 2012 Mark K. Schwartz, Architect on behalf of BRENNER ELLEN 2007 TRUST requests a Wetland Permit for the south wall of kitchen and foundation to be removed and set within setback; kitchen to be extended 7'7"x16' on south side; an 11'x12' expansion on north-west corner for bath; existing bilco entry to be replaced; replace openings, interior alterations to house and porch; replace septic system and install drywells, and new driveway. Located: 40 South Lane, East Marion. SCTM# 37-6-4 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney _~..oastal Erosion Permit Application ~W. etland Permit Application ] Amendment/Trans fer/E~ensio~ 3~ARece~ved Application:__~/~0]~ ~Received Fee:$ ..~-J~/~ ,'/~D ~/Completed Applicatio~ -O.- __Incomplete __SEQRA Classification: Type I Type II Unlisted ccOOrdination:(date sent) WRP Consistency Ass~s~mealt~orm AC Referral Sent: __Date of Inspection: r __Receipt of CAC Report: Lead Agency Determination: ~Technical Review: Public Hearing Held: I~h~/ Resolution: Office Use Only Administrative Permit 1 O 20]2 Name of Applicant Brenner Ellen 2007 Trust Address 27 Clubhouse Court, Jericho, NY 11753 Phone Number:( Suffolk County Tax Map Number: 1000 - 37-6-4 Property Location: 40 South Lane, (provide LILCO Pole #, distance to cross streets, and location) AGENT: Mark Schwartz, Architect (If applicable) Address: P.O. Box 933, Cutchogue, NY 11935 Phonei 631-734-4185 GENERAL DATA Land Area (in square feet): 10535 sq. ft. Area Zoning: R40 Previous use of property: single family residence Intended use of property: single family residence Covenants and Restrictions: [-~ Yes ~-~ No If "Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals If "Yes", please provide copy of decision. Will thi~a~r~ject require a~v~emolition as Dept. I ¢ I Yes l~ No Does the structure (s) on property have a valid Certificate of Occupancy Prior permits/approvals for site improvements: Agency Date --] Yes ~ No per Town Code or as determined by the Building [~ Yes ~-] No ] No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or su¥~[ded by la_~vemmental agency? I~1 No_J.~[_ Yes If yes, provide explanation: Project Description (use attachments if necessary): South wall of kitchen, and foundation, to be removed and sot within _~etback. K!tchen to be e×tended 7'-7"x!6'-0" on so-th s!de. ! !'-0"x!2'-0" expansion on north-west corner for Bath. Existing bilco entry to be rc~nl=e-=rl I:~¢=nl~=r,= nn=ninn= inf=rir~r =lf=r~flnn= fn hnH~= ond nnr~h Replace septic system and install d~ells, New driveway of Trustees Ap~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Additions and alterations to house, replace existing septic system and install new drywells, ddveway 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? 137 cubic yards How much material will be filled? 208 cubic yards Depth of which material will be removed or deposited: 6 feet Proposed slope throughout the area of operations: +/- 5% Manner in which material will be removed or deposited: Excavated shall be used for final grade, new fill for septic shall be contained on property. 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): The proposed work shall have a positive impact on the wetlands and tidal water through the installation of drywells to control water runoff, a pervious ddveway for natural drainage and install new septic system. PROJECT ID NUMBER PART1-PROJECTINFORMA~ON 617,20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2. PROJECT NAME Brenner Ellen 2007 Trust cou. SEQR 1. APPLICANT I SPONSOR Mark Schwartz, Architect 3.PROJECT LOCATION: Manlclpa~y Southold 40 South Lane, Southold, NY IS PROPOSED ACTION: [] New [~ Expansion N ModlflcatJo~ / alteration $. DESCRIBE PROJECT BRIEFLY: South wall of kitchen, and foundation, to be removed and set within setback. Kitchen to be extended 7'-7"xl 6'-0" on south side. 1 1 '-0"xl 2'-0" expansion on north-west corner for Bath. Existing bilco entry to be replaced. Replace openings, interior alterations to house and porch. Replace septic system and install drywells, new driveway ?. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WiTH EXISTING ZONING OR OTHER RESTR,CT,ONB? [71Yes ~ No Ii~ no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~"~ResktenUal [~lndusbtal r~commemial ~Agdc~l~ra [----]Parl(/Fore$,/OpenSpace ~] Other (describe} 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. AGENCY (Federal, Ste~e o~ Loc. at) [~]Yes r"]No If yea. list agency name and permit I approval: DEC, Health Department, Building Department NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [--']Yes F~No If yes, liat agency name and permit / approval: il~A.S A iB~ULT OF PROPOSED ACTION WILL EXISTING PERMIT / APPROVAL REQUIRE MODIFICATION? · IVeS MNo I CERTIFY THAT THE tNFORMATION~ROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWt. EDGE Applicant/ Sponsor Name ~ ~d~ C ~/~L~ f Date: Signature.. ~ If the action I~----~C'~ooatal Area, and you ara a state agency, completa the Coastal Assessment Form before proceeding wlth this assessment PART II - IMPACT ASSESSMENT {To be completed by Lead A~lency) A~ DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR. PART 617.47 If yes. c~ordinate the review proceas and use the FULL EAF. I--I Y..s 171.o WILL .~CTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative deelamtiofl may be superseded by another involved agency. E]Yes [~]No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding pmbtams? Explain bdefly: I C2. Aesthelic, agdcultural, archaeological, htstodc, or other natural or cultural resources; or community or neighborhood character? Explain bdefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain bdefly: C4. A community s existing plans or goals as officially adopted or a change ~n use or intensity of use of land or other natural resoumes? Explain bde~y Cfi. Gro~h~ subaoquent development, or related acti~Ues likely Ia be induced b~ the proposed actinn? fixptain I ........... C6. Long term. shod term. cumulative, or other effects noi id~nii~ed;i~"(~l~C5? Explain briefly: C7. O_thor impacts linc~ndinfll chan~es in use of either quantit;/or t;/pe of ene~/? Explain bri~fl}~: / / D. VVlLL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEAI? (If)'es, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BI~ CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If ~es explain: PART III - Dr: t ~.RMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of o~:coning; (c) duration; (d) irreversibility; (e) geographic scope; and (t) magnitude, if necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that ail relevant adverse impac~ have been identified and adequately addressed. If question d of part ii was checked yes, the determination of slgnilicance must evaluate the poten rial impact of the proposed action on the e nvimnm entel characteristics of the CEA. ~ thts box if you have Mentitied one or more potentially ladle or significant adverse Impacts which MAY occur. Then proceed directly to the FULl EAF and/or prepare a pnsl6ve declara~on. Check this box If you have determined, based on the information and analysis above and any suppo~ng documentation, that the proposed ac~ol WILL NOT result in any slgniticant adveme environmental impacts AND pravide, on attachments as necessary, the reasons supperting thi: Board of Trustees Name of Lead Agency ~ PHnt or Type Name of Responsible Officer in Lead Agency Si~atb~ 'of ~espo~tble Omar ~n Lea~n~ [] 7- a'- 2.0/Z Date President Title of Responsible Officer Signature of Preparer (If different from responsible officer) Jmnes F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michacl J. Domino Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of BRENNER ELLEN 2007 TRUST COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, A~r~d~ C~~-c.~ , residing at /dba ~P4~f being duly swom, depose and say: That on theq///~ day of O¢~,~'/~ ,201Z-, I personally posted the property known as by placing the Board of Trustees official poster wi{ere it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public heating. Date of hearing noted thereon to be held Wednesda¥~ October 17~ 2012. Dated: Sworn to before me this [7 day of ~ 20/~- Notary ~ICHELLE DISTASIO Not~ Public, State of New York /_ .~ U?: 4_99.4.7~3_ ,t, lJ Quahfled in Suffolk County [ ~' Commission Expires May 22, 20__~ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address~ STATE OF NEW YORK COUNTY OF SUFFOLK ("~'TJ/-~ ~ 6/~ ' , being duly sworn, deposes and says that on the °fTq~' ~la~, of ~ ¢"/~xI'~'/Y ,20/L, deponent mailed a tree copy of the Notice set forth in the Board ol~ Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office a~ (/9 t~ t6/~Sr4~' , that said Notices were mailed to/each of said perso, ns by CERTIFII~D I$1AIL/RETURN RECEIPT. S~o~too~e_fojefore me this / 7 NO. 4994753 Qualified in Suffolk County Commission Expires May 22, 20_._/ o~ c ~ ~,'~'t /I 9.3 2 Town of Southold ~~) Erosion, Sedimentation & Storm-Water Run-off ~ =----~ .... NT FOR & ~ti~eT~a ~ ~ p~? (l~u~ To~l~ ef all Pa~ I~ ~ln ~ ~ 8~ ~W~k ~ p~ ~) 10535 sq. ff. ~ ~a ~ (2~ I~ ~ ~ S~? b. What~ T~I~C~ (~'~'/~) (~~eaa~ffc~by~ an~ O~nd D~n~ ~ ~ ~ a~~ ~$~ ~1~ ~ ~ ~ 2500 Sq. ~. S~ Im~me~ ~d ~e pe~a~ ~ of (~F. ~ ~) ~ ~') ~O~ ~ ~O~ D~Y~ON ~.~ 2 ~eSi~a~l~Su~y~pm~ ~i~e S~. Ind~ ~ & ~? ~ I~ ~1 ~ude ~ P~ G~e Additions and alterations to house, repla~ existing ~ ~ ~ Wa~r F~. septic system and install new d~ells, new driveway 3 ~~S=~d~me~ ~ ~ e~n and ~ ~ ~m ~ be ~in~d ~ ~ MmdM ~ any P~ 5 ~, .is ~pB~on ~ulm ~ DI.~ ~ E~ng an ~a in ~ ~ (5.~ S.F.) ~u~ Fe~ ~ ~ .... 6 Is ~ a ~ml Wa~ ~ ~n~ng S~? Is ~is ~Je~ ~ ~e T~ ~ ~(1)~a~; ~~1~~ ~ ~C hm ~n~ ~ a S~8 ~ ~ ~ ~ ~ ~ ~. O~ Hun~ (1 ~) ~ ~l D~? ~ ~ ~n~um ~~8p~ ~ 8 ~11 ~ ~ ~s or ~1~ ~ ~~ b~ ~- ~ No. ~0~.) ~ be ~d ~ ~ b.W~ ~ 8ub~ m~ ~ ~ ~~ ~. }~ ~in ~ ~ ~a T~ ~ Z~PPP~II~ ~~~ 9 ~ ~ ~ R~ ~e Pl~nt ~ ~e~, ~'~I~O~N~W~O~ ~,, ~ ~ CONNIE ~ O~ ............. ~.,.; ......................... ~ No~ Public, ~;te of New York · · ~ No. ~1BU6185050 __ . ~A~ ~ ~..A~ ~ Qualifi~inSuffolkCoun~ (~:-~:~*~.~f ............................................................... 0~ ~or ~pms~m~ of ~e ~er or ~, ~ A d~ aufl~o~d to ~o~ or have p~o~ · at ~e ~ ~R be ~o~ in &e m~l~ ~t f~ ~ ~e ~p~on ~ed h~d&. S~m ~ before me ~; ........... ............ ....... .................... . ........... of Trustees Application County of Suffolk State of New York 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 T I ICATION. SWORN TO BEFORE ME THIS Notary Public CONNIE D. BUNCH Notary Public, State of New York No. 01BU6185050 Qualified in Suffo k Coun~ ~ Commission Expires ApriJ 14, 22/~:~ AUTHORIZATION (where the applicant is not the owner) Brenner Ellen Trust 2007 (print owner of prop~y) 27 Clubhouse Court, Jericho, NY 11753 residing at. (mailing address) do hereby authorize Mark Schwartz, Architect (Agcnt) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nrohibits conflicts of interest on thc hart of town officers and employees. The purpose of this form is to nrovide information which can alert the town of omsible conflicts of interest and allow ig g~ g#l~ W]t~g~ycr action is necessary to avoid same. YOUR NAME: (Last name,~firs~t na~me,~,~.d~dle i~nitial~, units you are ~pply~he~name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) TYPE OF APPLICATION: (Check all that apply) Tax grievance i,/~ Variance Change of Zone Approval of Plat Other (activity) Building Permit Trustee Permit Coastal Erosion Mooring Planning 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 ~lich the town officer or employee owns more than 5% of the YES NO I~' 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 that 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_7~ day of__~, 20 f ~ Print Name ~,~ ~ -~C'~/bt~/~ f~_ APPLICANT/OWNER TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics orohibits conflicts of interest on the oart of town officers and emolovees. The ouruose of this form is to orovide information which can alert the town of oossible conflicts of interest and allow it to take whatever action is necesmrv to avoid same. YOUR NAME: ~:~ ~ ~]/L] ~ ~, ~'~,'~ff. ~ (Las[ name, fi~t 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.) TYPE OF APPLICATION: (Cheek all that apply) Tax grievance Variance k/'~ Change of Zone Approval of Plat Other (activity) Building Permit Trustee Permit Coastal Erosion Mooring Planning 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 that 5% of the shares of the corporate stock of the applicant (when the applicant is a corp~ratlon) 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 Print Name Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfxont Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. If an action cannot be certified as consistent with the LWRP policy standards and conditions, jt 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# 37 6 4 The Application has been submitted to (check appropriate response): 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: South wall of kitnhnn: and foundation: to b~. r~.mnv~.d and set within setback Kitchen to be extended 7'-7"x16'-0" on south side. 11 '-0"xl 2'-0" expansion on north-west corner for Bath. Existing bilco entry to be replaced. Replace openings, interior alterations to house and pomh. Replace septic system and install arywells, new driveway Location of action: 40 South Lane, Southold Site acreage: 10535 sq. ft. (.24 acre) Present land use: single family residential Present zoning classification: R40 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: Brenner Ellen Trust 2007 (b) Mailing address: 27 Clubhouse Court, dericho, NY 11753 (c) Telephone number: Area Code ( ).631-766-0796 (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [~] No r~ if yes, which state or federal agency? 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 - please explain) This project entails relocating, additions and alterations to the existing single family home in a heavily developed neighborhood. Policy 1 is not applicable to the project. Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria ~-~ Yes ~ No ~ (Not Applicable - please explain) The subject property does not contain nor does the project affect histodc or archeological resources; nor is the project located in a histodc madtime area. Policy 2 is not applicable to the project. Attach additional sheets if necessary Policy 3. Enlumce visual quality and protect scenic resources throughout the Town of Southoid. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria ~ Yes ~] No ~] (Not Applicable- please explain) To the extent that this policy is applicable to the proposed project, visual quality and scenic resources will be protected at the site through the protection and maintenace of the well vegetated area buffedng the developed portion of the site from the tidal wetlands of Gardners Bay. 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 HI - Policies Pages 8 through 16 for evaluation criteria ~ Yes ~-] No ~] (Not Applicable - please explain) The project does not address nor affect erosion control structures or other erosion/flooding control initiatives. Policy 4 is not applicable to the project. Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria [~ Yes [--] No ~] (Not Applicable - please explain) The proposed project is consistent with Policy 5 via (3) three major project componenets; 1 - upgrade and relocation of the existing septic system to ensure effective treatment of sanitary waste; 2 - installation of a drainage system of drywells to control, manage and recharge stormwater runoff; and 3 - retention of the existing vegetation on the westerly portion of the site to be protected from site disturbance dudng construction by a project-limiting fence and staked haybales. 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 ~-~ NoN (Not Applicable - please explain) This project will be consistent with Policy 6 for the same reasons described for Policy 5; because there will be no loss of wetlands and because the statuto~ regulatory requirements of both the Sound Town Trustees and the New York State Department of Conservation will be complied with, Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southoid. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. See Section III - Policies Pages; 34 through 38 for evaluation criteria. Yes ~ No ~ (Not Applicable - please explain) The project will neither affect nor have an impact on air quality in the Town of Southold, Policy 7 is not applicable to the project. 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. ~l ] Yes~l I No [~ (Not Applicable - please explain) The project will neither create nor rrequire the handling of solid waste or hazardous substances. Policy 8 is not applicable to the project. 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 Ill - Policies; Pages 38 through 46 for evaluation criteria. ~ Yeti No~] (Not Applicable - please explain) The project is limited to the upland portion of the property, public access and recreational use of the adjacent coastal waters and public lands and resources will not be affected by the project. Policy 9 is not applicable to the project. Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's wal~llr2dependent uses and promote sitingn~r new water-dependent uses in suitable locations. See LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. -]Yes ( ot Applicable- please explain) The project neither proposes nor affects water-dependent uses. Policy 10 is not applicable to the project. Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. [-~ Yes ~] No ~] Not Applicable - please explain The project neither proposes nor affects commercial or recreational fisheries or other uses associated with the living marine resources of Long Island Sound. Policy 11 is not applicable to the project. Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section Ill - Policies; Pages 62 through 65 for evaluation criteria. ~Yes ~-] No[~ Not Applicable-please explain The project site is neither situated on nor adjacent to agricultural lands. Policy 12 is not applicable to the project. Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. ~ Yes N No ['~ Not Applicable - please explain The project affects neither the use nor development of energy and mineral resources. Policy 13 is not applicable to the project. EL. 9,3' , , I IN I~' .,a,~_p6' deep 8' dia-~' cJeep I EL. 3.3' 3' CLEAN SAND COLLAR GROUND '~/AT ER: EL 0.1' EL. 0.1 SITE DATA: ~ED BY : TRUSTEES SOUTHOLD , I , PHOTO SHOT HaY BaY w/SILT FENCING PROPOSED ADDITION SOUTH LAN E 58"58' HOUSE FF 12.6' EX. 1 STY. HOUSE FF 12.6' .~. ~ATIO )I*L~RADE 94.88' LIMITS OF LIMITS OF CLEARING CLEARING FLOOD ZONE LINE FLOOD ZONE LINE : 8EP 2 6 2012 N/O/F THORP ; AND BOUNDS BY: SURVEYORS NYS UC.: 49618 MAY 2.2012 RETAINING '~X/ALL S 58058'30" W SITE PLAN N/O/F VAN RIDER :lNY'l / HOUSE No. 1: ~x,x 37¢ _ __HOLL~ No. HOUSE No. 5: ~ HOUSE No. 6: 4-.2.' AVERAGE SETBAC K:,~,.~' ,-,1ti (IlO P~VISIONS: ill S-la