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HomeMy WebLinkAboutTR-7983 John M.Bredemeyer III,President "�'OF SO(/J�,O lTown Hall Annex �O 0 Michael J.Domino,Vice-President 54375 Main RoadP.O. Box 1179 James F.King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee G Q Telephone(631) 765-1892 Charles J. Sanders,Trustee Comm��► Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1051C Date: October 6, 2014 THIS CERTIFIES that the repairs and/or replacement of the existing pool and surrounding deck using flow-throughrag ting At 680 Truman's Path East Marion,New York Suffolk County Tax Map#31-12-2 Conforms to the application for a Trustees Permit heretofore filed in this office Dated August 1, 2012 pursuant to which Trustees Wetland Permit#7983 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 repairs and/or replacement of the existing pool and surrounding deck using flow-through grating. The certificate is issued to MARILYN PASIERB owner of the aforesaid property. Authorized Signature 0 John M. Bredemeyer Ill, President ��SUFFO(,4 C Town Hall,53095 Main Rd. Michael J. Domino,Vice-President ��� �Gy P.O.Box 1179 James F. King ti Southold,NY 11971 x Dave Bergen Telephone(63 1)765-1892 Charles J.Sanders y�°1 �a�! Fax(63 l)765-6641 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 1 st day of construction '/ constructed Project complete, compliance inspection: INSPECTED BY: COMMENTS: �� � �� • 04-A 7)6 A --' ?C 101, � L CERTIFICATE OF COMPLIANCE: PATRICIA C. MOORE Attorney at Law 51020 Main Road Southold, New York 11971 Tel: (631) 765-4330 Fax: (631) 765-4643 Margaret Rutkowski D E Q E I V E BetsySecretaries ns July 3, 2013 � 1/ D uu D Southold Town Trustees JUL - 3 2013 P.O.Box 1179 Southold Town Hall uthold own Main Road, Southold, NY 11971 Re: 1000-31-12-02 Parsierb pool fence Dear President King and Board: You issued a trustees wetland permit for the pool and deck. The pool requires a code compliant pool fence which will be placed on top of the deck(deck around the pool). The proposed location&existing location of the fence and existing wall is shown on the attached plans. The fence is located on top of a permitted structure and the existing fence along the side of the house will be re-located. The fence will be of"design rail"aluminum railing system vertical cables on top of the raised platform. Attached is a letter from Meryl Kramer, Architect to Mike Verity with the pool fence details together with the cross section of the design of the vertical cables. Please advise if you need an "amendment to the permit' for the fence details. Th you. tricia C. Moore / � �4 N Infill All infih opt ons regU r a a Cap f(*l Chaanef wW a hl 4"W F$*gy! (foot Raps are optkxutl to, 36'and W high hW""t*# cable infill). These umr the railog lift aM halpmeamait frank structure F u.5 Rails Connect to the pall Aft-a* I C Anscting Bk)cks :RCBs), and Cap fnM Ch&vft mP ba /. I the undersKk of trf 'a;) Rails. Each inlgtypetksispot* - corresponding Foot Rett af-O Cap MINI Chemet dSmWL Foot Rails arts Cap f,f ll Channels are awilaEk in and M ierWS tha :an he CUt to Stile in the tkid. I r —r-- Mob:Clfb�r edsfom jWiu optr w sf au m*& a I Wet1r1 _. laciJ lrel>orlaJ DesignRu7°Q"M aY AMOImaEYs. "• S..ImC . ! 6 pf♦FgY11pe{ AgdY -. 2- I - g�INMk11�t QlYJNW Claw ,,,. j, r. r„rrw.ae. `.,:� • �'IMErMa'oM�lllkgreAMarrxwda .enmmraaoa. ! AMpealor 40 ;WANvow Su0nrtl19 31� Comm 'sw.zoo,:.� osr�rr ear.mr. 1 --a ---- - °z Pray,Y.,.r•+r _r s.u.aao C.� �••i. 1 '� i� it j� ! i9ttlilk�►ilelYFdllglt,l+hrPJr root pal p.ae i I ;� tlMt fiats oaks Mdapupb�llan w.��_ � � +tern i. >ti ass paw-11d 6•e 350 < 'Vrf HOUT FOOT RAIL ) �, ! LS dkvdit 326fatlS SMMSRSMM _ � - 41iM1iaalilaearlfilnilel!d�dlM + { mo0flKid4ilrlgin _— —' +�MIw1l�s an6SlYeer�flaatct M E R Y L K R A M E R Mr. Michael Verity Southold Town Building Dept. Southold Town Hall PO Box 1179 Southold, NY 11971. June 26". 2013 RE. Pasierb Residence Permit N 37984 Dear Mike. .As a follow-up to our meeting this afternoon I am providing documentation for the permit file for the above mentioned property. Enclosed please find a copy of survey with the line of fencing or wall shown in heavy line weight. The barrier will comply with section G105 of the NYS Building Code. Also please find a copy of'Design Rail' Aluminum Railing System Vertical Cables cut sheet for barrier that wilt be used on top of raised swimming pool platform. The existing chain link fencing will be used on the southerly portion of the barrier. The existing masonry wall on the south side of the patio will remain. All sliding doors will be equipped with alarms. Please let me know it you require further documentation regarding this permit application. Best Regards, Meryl KY er,AIA LEED AP Encl. Cc: Marilyn Pasierb 631-477-8736 V,4A V ,r n. Cu%I M-N-ROAD s. R 25 SURVEY OF PROPERTY SITUATED AT NOTES. MARION 7 1. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM r EAST lYlARiON EXISTING EXISTING ECONTOURNIINES AARE RE SSHOWWNTHUS: -- - - - � - `> y{ TOWN OF SOUTHOLD /:n - "'OR"°"l � .2' '''°' " SUFFOLK COUNTY, NEW YORK • - RIVNL °• - IWWW. S.C. TAX No. 1000-31 -12-02 2. FLOOD ZONE INFORMATION TAKEN FROM: J SCALE 1"=20' FLOOD INSURANCE RATE MAP NO. 3610300064 G ZONE AE: BASE FLOOD ELEVATIONS DETERMINED JULY 14, 2004 ZONE X• . AREAS OF 500-YEAR FLOOD: AREAS OF 100-YEAR FLOOD WITH AVERAGE {.`b. NOVEMBER 17 200A REVISED WETLANDS NOTE DEPTH OF LESS THAN 1 FOOT OR WITH DRAINAGE AREAS LESS TIIAN p NOYEIBER 22, 1010 STAKE SOUTH PROPERTY tN♦E 1 SOWRE MILE: AND AREAS PROTECTED BY LEVEES FROM 100-YEAR FLOOD. ADGUST 16. 2012 . 2012OCATE POOL ROFOS D DEfRUCroN ZONE X: AREAS DETERMINED TO BE OUTSIDE 500-YEAR FLOODPLAIN. yA `� NOVEMBER 30. 2012 IDD PROPOSED OELX 3. ANY WETLAND BOUNDARIES SHOWN ARE SUBJECT TO VERIFICATION 65 AREA = 23,405 c. /t. BY NEW YORK STATE AND/OR OTHER REGULATORY AGENCIES. ,3� (TD TR UNE) O.S37 ac. i 0 SA VL .♦ i :.. 1, f1il moo• JIM* yd n{ As, Alt 2. Ak TO 0 '5 ♦ Alk f / 1lr0 k0 '-u AL Ak AL *1 mass A n 6 ar uAimA IATA"s/ne.®/°.♦o \\fi �`B 1\ \ a ra wla n nR a.aN waE ue s V �a+� rm</aRoa ON fO� \ sIA + 1�� \ \ •\�t\`\ J , vW♦Y/lMy�• TEST HOLE DATA 'FST HOU:q1 `` •4 \ \ ` \•: I I�NGY' ( C W,k XIBIL AWSOM M.AAVF.. 200A) \� AL y\ � r 5 6� f a Mrs uc Na. a6a67 FF-DPOSP-D M-4cp, sem:::- �N'""l INK ,"�ell,MR Nathan Taft Corwin 0 \ P @ A -=-lY-F Land Surveyor �Na aa�aa[w aam— kAL M m y A�INDDIo L®r is ElvYa A M u Li A l AND. AP�� RAR Aa1 lwwa. R a+lM-AMwN. - i ITR. - OR1lIfb♦DapA 11�p6111N[ NaI[ (61TTE7-2ao Fm (631)727-1727 � MNA Oil awl WiOAR� 1�6 Y/l�PEAi YW/R Ami MM RW EIORR ARi M°l MYRMR®. ,y�l lyP•Ny I1M Awo/1. as Yakr-' gUFFO(,p James F. King,President �pp� COGS Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President c P.O.Box 1179 Dave Bergen w Southold,NY 11971 John Bredemeyer o Telephone(631)765-1892 Michael J.Domino y�'Oj �Dp� 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 st day of construction / % constructed t/ Project complete, compliance inspection ON I BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD NEW YORK r PERMIT NO. 7983 DATE: OCTOBER 17, 2012 ISSUED TO: MARILYN PASIERB PROPERTY ADDRESS: 680 TRUMAN'S PATH, EAST MARION SCTM# 31-12-2 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 Marilyn Pasierb and subject to the Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits the following: r Wetland Permit to repair and/or replace the existing pool and surrounding deck; with the condition flow-through grating to be used on deck and platform area; and as depicted on the revised survey prepared by Nathan Taft Corwin III, Land Surveyor, last dated November 30, 2012, and stamped approved on January 18, 2013. 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 date. b y Dave Bergen - Nay John Bredemeyer - Abstain 1x1 i i 9 0 TERMS AND CONDITIONS The Permittee Marilyn Pasierb residing at 680 Truman's Path East Marion,New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. 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. 2. 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. 3. 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. 4. 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. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. 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. 7. 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 obstruction 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. 8. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the Perntittee 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. 0 0 James F. King, President �QF so�ly Town Hall Annex Bob Ghosio,Jr.,Vice-President �O �� 54375 Main Road P.O. Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer f/+ an Michael J. Domino O Telephone(631) 765-1892 Z21 COUMv, Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD October 17, 2012 Ms. Patricia Moore, Esq. 51020 Main Road Southold, NY 11971 RE: MARILYN PASIERB 680 TRUMAN'S PATH, EAST MARION SCTM# 31-12-2 Dear Ms. Moore: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, October 17, 2012 regarding the above matter: WHEREAS, Patricia C. Moore, Esq. on behalf of MARILYN PASIERB applied to the Southold 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 August 1, 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, in accordance with Chapter 268, said application was found to be Exempt from 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, 2 0 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 approve the application of MARILYN PASIERB to repair and/or replace the existing pool and surrounding deck; with the condition flow- through grating to be used on deck and platform area; and as depicted on the revised survey prepared by Nathan Taft Corwin III, Land Surveyor, last dated November 30, 2012, and stamped approved on January 18, 2013. 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: $50.00 Ve truly yours, James F. King President, Board of Trustees JFK/amn ��o��SUFFf)t4-cPG James F.King,President y Town Hall Annex Bob Ghosio,Jr.,Vice-President W- eK 54375 Route 25,P.O.Box 1179 Dave Bergen Southold,NY 11971 John Bredemeyer �dj �L� Telephone(631)765-1892 Michael 1.Domino Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Please be advised that your application dated I Z has been reviewed by this Board at the regular meeting of I and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1" Day of Construction ($50.00) % 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: rico 1 �nSpech`av� -(2e- $56 Db TOTAL FEES DUE: $ S D . DO BY: James F. King, President 1 Board of Trustees Inas i �SUFfO(�C James F. King,President 4�p d P.O. Box 1179 Bob Ghosio-Jr_,Vice-President �y A Z q Southold.NY 11971 Dave BerPen k oy4t "Felephone(631 765-1892 John Bredemeyer d ,y Fax(63 1)765-6641 Michael.l. Domino y� a� Southold Town Board of Trustees Field InspectionMorksession Report Date/Time: Ci 1 /0 En-Consultants on behalf of MARILYN PASIERB requests a Wetland Permit to repair and/or replace the existing pool and surrounding deck. Located: 680 Truman's Path, East Marion. SCTM# 31-12-2 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: / �adS % /2F ✓J /ycJ Modifications: Conditions: Present Were: —J. King Ghosio -- D. Bergen, J. Bredemeyery Michael Domino D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: • �o�gpFFD(�.cOG • Peter Young,Chairman Town Hall, 53095 Main Rd. Lauren Standish, Secretary P.O.Box 1179 Southold,NY 11971 A � Telephone(631)765-1892 Fax(631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., August 15, 2012 the following recommendation was made: Moved by Jack McGreevy, seconded by Doug Hardy, it was RESOLVED to NOT SUPPORT the Wetland Permit application of MARILYN PASIERB to repair and/or replace the existing pool and surrounding deck. Located: 680 Truman's Path, East Marion. SCTM#31-12-2 Inspected by: Jack McGreevy, William McDermott Vote of Council: Ayes: All Motion Carried lamu FOL es F_Bing-President 1�� Cp P.O. Bos 1179 Boh Ghosio,Jr.. Vice-president ��� 6y w Southold.NY 11971 Dave Raven oy Telephone(631 765-1892 John Bredemeyar "a 7Fax(63 1)765-6641 Michael 1. Domino Southold Town Board of Trustees Field InspectionMorksession Report Date/Time: 1L i)-- MARILYN PASIERB requests a Wetland Permit to repair and/or replace the existing pool and surrounding deck. Located: 680 Truman's Path, East Marion. SCTM# 31-12-2 Type of area to be impa _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: T iV � s Pre nt Were: /J. King B. Ghosio D. Bergen, v J. Bredemeyer ✓Michael Domino D. Dzenkowski other Form filled out in the field by f /fie aa,��r Mailed/Faxed to: Date: X �,,!80 Truman's Path, East Marion ry A ' 4 4 .d "Ax i1 ,S ey P� .. �f ' :'LMarilyn Pasierb r tgi� ' e rte_ L its ;,`, +. -stt sa .^ e�,` 9F"'y►s.. - . CTM#31� \� jv e* yam+ e/1� N _ l MONO _ t RItt 9+ wow 1g i 4 d �-' .� •,�_^�.� f '-4. {.b d. •f I Di 1 d r1 a? X, _ JE 1,11Z qK d � w r � 7 - « 1 OgUf FO( James F.King.President pV CO P.O. Box 1179 Bob Ghosio,Jr.,Vice-President G'l� Southold,NY 11971 Dave Bergen ti Telephone(631 765-1892 John Bredemeyer Fax(63 1)765-6641 Michael J. Domino Southold Town Board of Trustees Field InspectionNVorksession Report Date/Time: MARILYN PASIERB requests a Wetland Permit to repair and/or replace the existing pool and surrounding deck. Located: 680 Truman's Path, East Marion. SCTM#31-12-2 Type of area to be impac d: _Saltwater Wetland Freshwater Wetland _Sound _Bay i Dis)6nce of proposed work to edge of wetland L } o P 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: rIGZL{ �� urel� rhe�K ti� t� J . �� 6�, !• Gil Present Were: / J. King B. Ghosio D.. Bergen, J. Bredemeyer / Michael Domino D. Dzenkowski other Form fij� qut in t4 fielfi by Mailed/Faxed to: Date: r� � cle6kf cQ�J t 4- t 0.1 � e- -fc9 /t J OUB 0 LA� n du✓�, Cluck Mail I Compose New Moil Addresses I Search Mal I Mal Senrgs I M-A Opfi^nt I vkbwa1 H4 Delete Reply/AII Forward/lnlne All Headers Print Previous/Next Inbox Message 13 of 15 from your Inbox Move Date: Mon Jul 30 23:35:34 EDT 2012 From: "mpasierb@rrcn.com" <mpasierb@rcn.com> Add To Address Book I This is Spam To: mpasierb@rcn.com --- ___ f f-L ✓I 61&S Attachment: photo.JPG (133k bytes) (Clektoopen) r 4r Y� �• a p,. Sent from my iPhone Delete Reply/All Forward/Inline All Headers Previous/Next Inbox Message 13 of 15 from your Inbox Move of 2 7/30/2012 11:37 PM CFieck Mot C.M.Naw Moil I nddiame. 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Sent from my iPhone Delete Reply/All Forviard/Inllne All Headers Previous/Next Inbox Message 14 of 15 from your Inbox Move of 7/30/2012 11:39 PM Ask bad ChKk Moil I Canpwe Nw Mod I Addrrsef I Swrch Moil I Mod Ullings I Mal Opeoro I WAW49 gyp+ Delete Reply/All Forward/Inline All Headers Print Previous/Next Inbox Message 15 of 15 from your Inbox Move Date: Mon Jul 30 23:37:00 EDT 2012 From: "mpaslerb@rcn.com" <mpasierbOrcn.com> Add To Address Book I This is Spam To: mpasierbOrcn.com Attachment: photo.3PG (145k bytes) (Cadctoopen) �e n dc,G V t Sent from my iehone Delete Reply/AII Forward/Inline All Headers Previous/Next Inbox Message 15 of 15 from your Inbox Move )£2 7/30/2012 11:42 PM • i FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. 214287 . . . . . . . . . Date . . March. .1.9. . . . . . . . . . . . . . . . . . . .1 1986. THIS CERTIFIES that the building . . . . AbA,ve. gr.gUnd. .R901. .gn¢, Location of Property . . . . . . . 68.0, .Trumao s. F.4 th. . . . . . . . . . . FA.q , Mar�gp, , , , , , , _ . House No. Street Namler County Tax Map No. 1000 Section . . . 031 . , ,Block 12. . . . . . . . . . .Lot . . , 0.0.2 Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . .Apr'. .l .20. . . . . . . . , 1981 . pursuant to which Building Permit No. . . . .1,1 144,4 , , , , , , I i dated . . KAY . 31. , , , , , , , , , , , , , , , , , , 19 .8 1 , was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is . . . . . . . . . . Above. .gr.ound . p o.o.l . anal .f en.c.e . en.c.l osu r.e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . . JANN. AND . E.T.HEL. KILLIG.AN . . . . . . . . . . . . . . . . . . . . . . . . . . . . towner,YAW4Cdr)tdbk X of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . .N/4, , , , , . . . , . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . .N537186 . . . . . . . . . . . . . . . . . . . . . . . . . Building Inspector Rev. 1/et a _p moo.xo.® LIM 20 `W • w°N q .�µ• v � � • Y ,M41 iy`,Id � � ; jo ' w �I �O � x� � a •/ H� t �k ♦� n�.nm , Q a A O A }bx 81 Q 4 01 <..T n N •�• x n a L b� n b WWOI UKE I r " Tom, ecw � P xance OOUM OFSUFFOLK © ® *wx _�_ __ ft.1 : o s L37 xo PATRICIA C. MOORS, EY W B-4pDm® 51020 Mainin Road Road Southold, NY 11971 LETTER (631) 765.4330 email: pcmoore@mooreattys.com I Date Su DEC 18 2012ASIC- O z0eC4) ,� 2 � ❑ Please reply ❑ No reply necessary Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) war- I, d" 1 fLi �� n f a P /!O residing at Y . � /DaD2. , (print owner of propertp) (malll�ddress) ko �/i„imdn 1 �L �lo�� o., do hereby authorize (Agent) 00/T to apply for permit(s) from the Southold Board of Town Trustees on my behalf. h C i (Ow '9 signature) 09/18/2012 11:08 FAX 63128301fk EN-CONSULTANTS,INC. Z001 EN-CONSULTANTS September 18,2412 James King,Chairmsn Board of Trustees ) E Town of Southold P.O.13ox 1179 1�~ Southold,NY 11971 LI : SEP 18 W '1 Re: Madhn PaslerlI1 — — -- "I TlvVO B ^rg 7r!siees Dear Mr. King: As we would like tl a opportunity to obtain and evaluate additional documents relating to the permitting history of the partially reconstructed deck that was the subject of debate at the August 22nd public hearing and at our on-site meeting with the Trustees on September 12th, we respectfully request that the reopening of the presently adjourned hearing be postponed until your October meetin;;. l thank you for your attention to this request. Re tfully yours, Robert B. Herrmann Coastal Management Specialist cc: Lori Hulse,Assis tart Town Attorney 1319 North Sca Roac Southampton.New York 11968 I p631.283.63601 F 631.283,6136 www,cnconsullanTS.Corn =_ HflvirOfll Tirado f1Uf15Ullr1!-7 f OFFICE LOCATION: fjf soojyo MAILING ADDRESS: Town Hall Annex h0 lQ P.O. Box 1179 54375 State Route 25 # * Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 Gl Q Telephone: 631 765-1938 o�y0pum,a �PS Fax: 631765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM ' To: Jim King, President ' 1 2;12 Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: August 13, 2012 Re: Proposed Wetland Permit for MARILYN PASIERB SCTM# 1000-31-12-2 MARILYN PASIERB requests a Wetland Permit to repair and/or replace the existing pool and surrounding deck. Located: 680 Truman's Path, East Marion. SCTM# 31-12-2 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 "A" which states: A. Maintenance or repair involving no substantial changes in an existing structure or facility; 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 EN-CONSULTANTS E7JTO WHOM IT MAY CONCERN: This letter will authorize En-Consultants to access my property for the purpose of evaluating and/or delineating wetlands and other environmental features and/or making official inquiries on my behalf and/or representing me and acting as my agent for the purpose of securing regulatory approvals and related matters. r ' ignature h/�Pa�s,'� i� P>ty tt N( ame Dated 1319 North Sea Road I Southampton, New York 11968 p 631.283.6360 1 f 631.283.6136 www encr_nuita in-co n environmental consuiting • James F.King,President �0��0F SO Town Hall Annex Ujyolo Bob Ghosio,Jr.,Vice-President 54 Main Road P.O.. Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer AQ Michael J. Domino :% i� Telephone (631) 765-1592 Z07 COMM Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Sioastal Erosion Permit Application Wetland Permit Application Administrative Permit _AmendmenUTransfer/Extension ./,Received Application: I I 1 a' /keceivedFee:$ 5' 70 ' CtS LAkA' Completed Application Q� _Incomplete _SEQRA Classification: - Type IType IIUnlisted Coordination:(date sent) -'fWRP Consistency Assessment FormI► _ ,/C`AC Referral Sent: 1,V _ ,.Bate of Inspection: -t� I1 a' _Receipt of CAC Report: _Lead Agency Determination: Technical Review: ./Public Hearing Held: \a' Resolution: t ton 114 fax t° Name of Applicant er_PA bai &.Y 1 I Address 4-A /q)C &rt;0/L.Y 10eL2-L I'la 4 1 f-3 r/f Phone Number:( Suffolk County Tax Map Number: 1000 -3 — Property Location: 41,0 7/44an4 J PQ76 l� 1193 (provide LILCO Pole#, distance to cross streets, and location) AGENTL (If applicable) —��— Address:_ Phone:_ 03 Bod of Trustees Application• GENERAL DATA Land Area(in square feet): Area Zoning: f e f J p/4 It. a, Previous use of property: o rri V Intended use of property: koM f Covenants and Restrictions: Yes _No If"Yes",please provide copy. 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 any demolition as per Town Code or as determined by the Building Dept. 4 Yes No Does the structure(s) on property have a valid Certificate of Occupancy Yes No Prior permits/approvals for site improvements: Agency Date XNo prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ,?C No Yes If yes, provide explanation: Project Description (use attachments if necessary): Qj,91L C4, cP�� / [Tion, Ae a l #611P IWIU tler - wlrP -4 !(,ry�, /C/ C ec /1�LC..FL6r.f/y! / /��L/17th 13!lir / _, T lin/r � 07 A L/ P/OO // L✓(/�� T/1 C. dG L K wig 4. G1C / r b 0[Y 1 edV 10�d n.04 /YO /1 2✓P� ��� herded s�iu � �u•� � lit /9,1ee S , ��e ,q ✓era ze oz -ll�c �enpvs�ed r��wc�U,r. t,�` /! fie, riynl�tcanf� sr.a//ems ;„ foga /q��u Q /tA, ` AAA 4/,L C/,1:ntl c%GK y90I, Board� of Trustees Application • WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: /e.pcA,�J- /e.ti n «d� of det J24s Area of wetlands on lot: square feet Percent coverage of lot: _% Closest distance between nearest existing structure and upland edge of wetlands: �6' � feet Closest distance between nearest proposed structure and upland edge of wetlands: f 0, (r feet Does the project involve excavation or filling? )k, No Yes If yes, how much material will be excavated? C9 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: q,/ ylP ere d S//if\.q �Ofii � f@Ken o /il r(� �n CL- Statement 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): nnnF Boa of Trustees Application • COASTAL EROSION APPLICATION DATA Purposes of proposed activity: /t fifi 1(� ClJ �i et 4 O hOo lii/t L Ai4f Are wetlands present within 100 feet of the proposed activity? No w'l Yes Does the project involve excavation or filling? No / Yes If Yes, how much material will be excavatte77��d? �( (cubic yards) How much material will be filled? lO (cubic yards) Manner in which material will be removed or deposit/ed: Mtt�M'd zf&O✓f d lNI�11 `( C� 1]iCC_ L /�/06ttj %n �A7frt"tb � aiitr d in d tJa�9���/ �� c� On✓( T� Describe the nature and extent of the environmental impacts to the subject property or neighboring properties reasonably anticipated resulting from implementation of the project as proposed, including erosion increase or adverse effects on natural protective features. (Use attachments if necessary) / /1/Int ��C �.(�T trait�� l�e ✓,`J� Z// e /iD�, e 4a 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 /11101-1:on t County J T-'40 4.PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map d0V 7lu f / Q �7gito r 3 5.IS PROPOSED ACTION: E] New El New 1:7 Modification/alterati 6.DESCRIBE PROJECT BRIEFLY: Idl Re-� ar ' p0 / Q-/ nL ce✓✓di -f*u r 7(u w /ley «,Pa r W /'ep41C °� 7.AMOUNT OF LAND AFFECTED: Initially acres Ultimately acresIf �nC 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTR TIONS?S , ❑Yes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) rrx AJ Residential F-1 Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open Space ❑Other (describe) i 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL i AGENCY (Federal, State or Local) ❑Yes ISI No If yes, list agency name and permit / approval: 11.DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes 10No If yes, list agency name and permit / approval: 113311 i 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 / Sponsor NameDate. t 7-30-/,L Signature If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment 0 0 PART II - IMPACT ASSESSMENT To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL FAF. ❑Yes ❑✓ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. ❑ Yes I✓ 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 problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: C4. A community's existing plans or goals as officially adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly: C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: C6. Longterm,short term,cumulative,or other effects not identified in C1-05? Explain briefly: CT Other impacts(including changes in use of either quantityy or type of energy? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? if yes,explain briefly: ElYes ❑✓ No 17, OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es ex Iain: 0✓ No F- I PART III-DETERMINATION 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 occurring;(c)duration; (d)irreversibility;(e) geographic scope;and (f)magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes,the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur.Then proceed directly to the FUL FAF and/or prepare a positive declaration. Check this box if you have determined,based on fine information and analysis above and any supporting documentation,that the proposed actio WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Board of Trustees tl p Z d/Z_ Name of Lead Agency/ l Date � itis F—s F• l` 1A)t, President Print or ype Name of Responsible Officer in ead Agency Title of Responsible Officer LcO SCr / Sig ture of Responsible Officer in Lead g Signature of Preparer(If different from responsible officer) der Town of Sou I old Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M.#: Ia�O THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A Qf T`Ay_ ���13TORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN D s let – `Lot— CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK SCOPE OF WORK - PROPOSED CONSTRUCTION rrE:M# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? Will this Project Retain All Storm-Water Run-Off theSc(include Total Area of all Parcels located within 'U Generated by a Two(2")Inch Rainfall on Site? the Scope of Work for Proposed Construction) (s F f )Aces (This item will include all runoff created by site It. What is the Total Area of Land Clearing clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed 2f Site Improvements and the permanent creation of construction activity? r (S.F./A.) impervious surfaces.) 2 Does the Site Plan and/or Survey Show AlProposed o ❑ PROVIDE BRIEF PROJECT' DESCRIPTION (PmWd•AdMWnel Pages a•Need•a) Drainage Site Plan slndor tingSur Size&ey Show Al Proposed // Item shall include all Proposed Grade Changes and Slopes Controlling Surface Water Flow. I�_ I 3 Does the Site Plan and/or Survey describe the erosion El and sediment control practices that will be used to .1 control site erosion and storm water discharges. This p item must be maintained throughout the Entire t / Construction Period. / dG _ Ili/ 40 e de 4 Will this Project Require any Land Filling,Grading or Excavation where there is a change to the Natural ❑ Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities ❑ Encompassing an Area in Excess of Five Thousand (5,000 S.F.)Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction )( General DEC SWPPP Requirements: or within One Hundred(100')feet of a Wetland or Submission of a SWPPP is required for all Construction activities involving soil Beach? am part of a of one o or more acres; including ly disturb on of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes ❑ are Dan of o larger common plan that will ultimately antes one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to �/ inducting Construction activities involving soil disturbances of less man one(1)acre where One Hundred(100')of Horizontal Distance? �K the DEC has determined that a SPDES permit is required for stone water discharges. (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious El Storm Water Discharges from Construction activity-Permit No.GP-0.10-001.) Surfaces be Sloped to Direct Storm-Water Run-Off 1.The SWPPP shall be prepared prior to the submittal of me 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 shell describe the erosion and sediment control practices and where 9 Will this Project Require the Placement Of Material, required,post-construction storm water management practices that will be used andfor Removal of Vegetation and/or the Construction of any constructed to reduce the pollutants in storm water discharges and to"sum Item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of this permit.In addition,the SWPPP shag Area?trials Item will NOT intros the Installation ar Driveway Aprwu.) identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine Is Answered wRh a Check Mark 3.All SWPPPs that require the postconstmclbn storm water management practice In is Box and the construction site disturbance is between 5,000 S.F.81 Arse In area, component shall be prepared by a qualified Design Professional Licensed in New York a Storm-Water,Grading,Drainage 8 Erosion Control Plan is Required by the Town of that is knowledgeable in the principles and practices of Storm Water Management. Southold and Most be Submitted for Review Prior to Issuance of Any Building Permit (NOTE: ACheck M.M(4) andlor Answn far eadi question is Requireafora Complete AppliwEm) STATE OF NEW YORK, /// COUNTYOF......ff.I.:F�P(.lC..................SS That 1, -mix"hi ��+" ...........................being duly swum,deposes and says that he/she is the applicant for Pemut, ( me of individual/sigyniing'Document And that he/she is the ......1...:1110. p mer. yyt l✓/.))/.�............. ..................................................................... ✓ (Owner,C�ihaifor,Agent,Corporate Officer,etc.) , Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed die said work and to make and file this application;that all statements contained in this application are hue 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. LAUREN M.STANDISH Sworn to before me th�sj Notary Public,State of New retic ... .L .......clay oi....7 I. . . ......... ..... .20%�— Qualified missomSS t p gihily l ( iat Ein Sufi k C, ,JAJ Notary Publ,r C.4LA.r.1.. .:n..:.... { .. (................ 6jf/jIv{l�• ................... (Signature of Applicant)FORM - 06110 �oy�gyfFO(,�COGs James F. King, President i Town Hall,53095 Main Rd. Bob Ghosio,Jr. ,Vice-President P.O_ Box 1179 Dave Bergen �� • �� Southold, NY 11971 John Bredemeyer '1J Telephone(631)765-1892 Michael J. Domino �`� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD �� �� rl r---- —_._1' In the Matter of the Application of AUG 2 2 2012 I� ul MARILYN PASIERB �_---._^� soutyhD:J rown COUNTY OF SUFFOLK) R9ard of Trustees STATE OF NEW YORK) AFFIDAVIT OF POSTING I, , residing at /dbae6f(CL�(IMQ4 ,r� on�ex being duly sworn, depose an ay: fj'f r✓ �(/� fl/ % � � That on the /`f day of 446uJ 20101 I personally posted the property known as by placing the Board of Trustees official poster where 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 bearing. Date of hearing noted thereon to be held Wed., August 22, 2012. Dated: 8r V3—\2 c I (signature) w�itJV� Sworn to before me this day of R4xa20 tZ n Q c� Notary Vublic LYNDA M MPW- NOTARY PUBLIC,State of New York NO.011306020932,Suffolk Couoy Term Expires March 8,2015, PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: V'1' ( Kt,� Pk�/o� Address: k3 OnU C (e /-,h.n /i.#WC j 1/4.30 it w STATE OF NEW YORK COUNTY OF SUFFOLK L, 1 M'ar" u / u✓ residing at ,j&o 7Q'+Jmej l �W� jam/ /"10ii0� Y being duly swom, deposes and says that on the day of /gym,:20/x, deponent maileda true copy of the Notice set forth in the Board of 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 at that said Notices were mailed to each of said persons by (certified) (registered)mail. t Sworn to eforea this Day of �uJ7 20 i L Notary Public PENNY BEDELL Notary Pudic State of New York No.01_ 609931! comm ais =DOM Sept 29,rL,9-2Q 1 6' �o��g�FFOL�eaG 0 � s James F. King, President ti Town Hall,53095 Main Rd. Bob Ghosio—h, , Vice-President P.O. Box 1179 Dave Bergen Southold,NY 11971 John Bredcmcyer Telephone(631)765-1392 Michael J. Domino 1 * �' Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of MARILYN PASIERB COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, dr;eeL residing at/dba 'pkr C 1 L2—T cc�aa� ��' , a C ✓T / io . I 7Fh t being duly sworn, depose an ay: That on the /f day of Maur f 20 bt I personally posted the property known as by placing the Board of Trustees official poster where 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 hearing. Date of hearing noted thereon to be held Wed., August 22, 2012. Dated: - i3-12— c (�� (signature) Sworn to before me this 6 day of k%xa20 (^-- \ ^ Q 1 ' \ Notary ublic LYNDA M BURR'— NOTARY PUBLIC,State of New York NO.01806020932,Suffolk County Term Expires March 8,20� Bo of Trustees Application . County of Suffolk State of New York �(/, I[.f n �Q✓( f/d BEING DULY SWORN DEPOSES ANO AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN-TO BEFORE ME THIS �F DAY OF ,20 Q-_ Nottary Public Ij P Pkw'1'mk 0 Cnunt 'r APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold'§Code of Ethics prohibits conflicts of interest on the Dart of town officers and employees.The purpose of this form is to provide inforination which can alert the town of possible conflicts of interest and allow it to take whatever action is i necessary to avoid same. // / YOUR NAME: f 14.4. C �� (Last name, t�name,qiiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) I 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 applicantlagent/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 I.. /,. 200%L Signature /ftq `� Print Name Form TS 1 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. 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, listin¢ both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and i conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold 's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# /oua - 31 PROJECT NAME M,4 f,I i Nn Po f i 6 The Application has been submitted to(check appropriate response): i 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: 0 Nature and extent of action: I- IWO r f r G P✓ Location of action: LO J-Q Site acreage: .Z--Y ,-fd y t,,t `-f t T Present land use: c CCK_ Present zoning classification: rt_/j d t n 2�7a 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: (b) Mailing address: (c) Telephone number: Area Code( ) (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 V Not Applicable I 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 eNot Applicable Attach additional sheets if necessary Policy & 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 RfNot 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 ZNot Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No WNot 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. ❑ F] LJ Yes No Not Applwe 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 gNot Applicable i 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 l4J Not Applicable ii PUBLIC COAST POLICIES j 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. { ❑ / Ye�] No 41 Not Applicable I Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No DNot 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 /J Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No® Not Applicable I i Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No eNot Applicable C � PREPARED BY TITLE INn P / DATE )` 31 ? x8" SaysrS 4EDrf.! Aopnp � �"x t6•` Gu�EiC- J-orsrj &u4 I � i )8' 8° 4 i x PDX --•-- 1 � � De k�n� -- i k!s* Kv�6 C) viPn ov _ 14 Fl vw xi0" (rwtd To..sc-Sr n r t � �IA11V O SURVEY OF PROPERTY SITUATED AT NOTES EAST 1 . ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM EAST MARION EXISTING ELEVATIONS ARE SHOWN THUS:sn EXISTING CONTOUR LINES ARE SHOWN THUS: — —s— — — — TOWN OF S O UT H O LD EFL - GFIRST FLOORARAGE S82.17.1G" W SUFFOLK COUNTY NEW YORK GFL - GARAGE FLOOR 1 7 B T.w - TOP OF WALL BW - B070M OF WALL S.C. TAX No . 1000-31 - 12-02 2. FLOOD ZONE INFORMATION TAKEN FROM: SO FLOOD INSURANCE RATE MAP No. 36103CO064 G w IS, SCALE 1 "=2C' ZONE AE BASE FLOOD ELEVATIONS DETERMINED �sw2. JULY 14, 2004 ZONE X{ AREAS OF 500-YEAR FLOOD; AREAS OF 100-YEAR FLOOD WITH AVERAGE ��o: mQ`� NOVEMBER 17, 2004 REVISED WETLANDS NOTE DEPTH OF LESS THAN 1 FOOT OR WITH DRAINAGE AREAS LESS THAN ;er NOVEMBER 22, 2010 STAKE SOUTH PROPERTY LINE 1 SQUARE MILE, AND AREAS PROTECTED HY LEVEES FROM 100-YEAR FLOOD. AUGUST 16, 2012 LOCATE POOL UNDER CONSTRUCTION x NOVEMBER 30, 2012 ADD PROPOSED DECK ZONE X: AREAS DETERMINED TO BE OUTSIDE 500-YEAR FLOODPLAIN. ,,.RNAP 3. ANY WETLAND BOUNDARIES SHOWN ARE SUBJECT TO VERIFICATION 006 o� AREA = 23,405 sq. ff. BY NEW YORK STATE AND/OR OTHER REGULATORY AGENCIES. w°� °eao� �_ (TO TE LINE) 0.537 ac. A9 / 7� I, l 21 / / G a 99 / 9 `°/w� / / / / 20 to p yf D LS &! LS W LS 5SGLB -'o,' D O / °NEaa w'PEs / / / Pmc ,x�_l DEC 1 8 2012 /M2EE 6 /0&0 $off 0 / / / / / / / / / / / T/ SoutM1nitl Tawn d Gq � / aNELnA �LLp ANG nncel / / % /// % / //�P°S/ za° a �jmmcm= A. 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Box 16 ANY. NOT SHOWN ARE NOT GUARANTEED. JomASID.d New York 11947 Jomesport, New York 11947 24— MAI iV ROAD NOTES: 1. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM SURVEY OF PROPERTY EXISTING ELEVATIONS ARE SHOWN THUS:.s.D -+ EXISTING CONTOUR LINES ARE SHOWN THUS: — — — —s— — — — SITUATED AT F.R. - FI ST FLOOR 6 6218.93 " W EAST MARION T.W. - G E FLOOR iB.93 T.W. - TO OF WALL B.W. - B OM OF WALL TOWN OF SOUTHOLD s 2. FLOOD ZONE' INFORMATION TAKEN FROM: 2 FLOOD INSURANCE RATE MAP No. 36103CO064 G ' Sk SUFFOLK COUNTY, NEW YORK ZONE AE: BASE FLOOD ELEVATIONS DETERMINED ZONE X* : AREAS OF 500-YEAR FLOOD; AREAS OF 100-YEAR FLOOD WITH AVERAGE ,�P'0,.,'.o, S.C. TAX No. 1000-31 - 12-02 DEPTH OF LESS THAN 1 FOOT OR WITH DRAINAGE AREAS LESS THAN c` '. 1 SQUARE MILE; AND AREAS PROTECTED BY LEVEES FROM 100-YEAR FLOOD. SCALE 1 "=20' x ZONE X: AREAS DETERMINED TO BE OUTSIDE 500-YEAR FLOODPLAIN. 65 zaa JULY 14, 2004 NOVEMBER 17, 2004 REVISED WETLANDS NOTE 3. ANY WETLAND BOUNDARIES SHOWN ARE SUBJECT TO VERIFICATION �j00' S ' ; NOVEMBER 22, 2010 STAKE SOUTH PROPERTY LINE BY NEW YORK STATE AND/OR OTHER REGULATORY AGENCIES. w • �o AREA = 23,404.55 sq. ft. �0,, ��' (TO TIE LINE) 0.537 cc. /0&1E S0� pP G i� Ea6 \ oq,., a ,It1L c . / / \/ O i 0O, xis.s/ / sD.t•_• / ^Vj zus q' x ATESr HOLE R _ y� �021 xzu °!�.ve �p0.�,ROOF, w `n . ..� e°s` • ..a+` 2y gO�j' - - - •-r -- - �, ,4g '.: F�IGF�y, / & 2 o .AiL F. / / / /y/�//// 5F�J6'�w �/ tie $' So�Pf :� �e,�'��y./ L•°�'w 3� Ny yD / /x / / ////I///I / II °d :a ti. � • �� �I�i. AUG - 1 2012 \ \ ,JIL �Q� 4 `N` I I \\\\ \\ \\\\ I awl 9 o Snutllo,tl Tmml \ \ ``� Pnvrtl ofllusl�Pv L_------ �' \\ AIIIL '4 - �\ ,� 10 10 O \"#� m \ \ \ �\ 17 W-9 E PREPARED IN ACCORDANCE WITH THE MINIMUM STANLs., dV \ \ \ wig \\\ \�\�°� � 0'B ES Eo? ye Her BY THE LI.MR SUCH U55. AND ARPWILE ROVED IEYS AS YORK ESTABLISHED �IIL .,5 & GP LTE LAND ww'" TITLE AssySPt QF"F`�yo \ NT TO O• / \\ \ \ \ \ \\\p\\s\0 '� (TEST HOLE DUTEST 1 BY M pDNALD HOLEDSCIENQ DAT ON JUNE 4, 2004) µ ~�Fr'f` LORP� \ J11L \VX \ a WK EHGWN SLTY. OL ",I? / y0 , �� z WKNN SILT W 0467 V' V�> G 6� � .1111E � O a �'Anros N.Y.S. Lic No. 50467 INNIN RNE TO COARSE SAND UNAUTHORIZED ALTERATION OR ADDITION �) wes �vr GAANEL m TO This SURVEY IS A NOTATION OF \ •, w. BECKON ]309 OF THE NEW YORK STALE E EDUGRON TAW. Nathan Taft Corwin III COPIES OF THIS SURVEY MAP NOT BENING THE LANDSSE SURVEYOR'S U INKED SFAL OR SI Land Surveyor TOSED REAL RUE C NOT BE CONSIDERED TO BE A VALID TRUE COP! CERRFICATTONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED. AND ON HIS BEHALF TO THE Successor To: Stanley J. saksen, Jr. L.S. INE MwMN RNE To oWSE SAND SW TRIP COMPANY, GOVERNMENTAL AGENCY AND Joseph A ngegna L.S. LENDING INSTITUTIONLISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTI– Ti[10 Surveys — Subdivisions — 9[e Plans — Construction Layout TMON. CERTIFICATIONS ARE NOT TRNSFERADIE. y PHONE (631)727-2090 Fax (631)727-1727 THE EXISTENCE OF RIGHTS OF WAY OFFICES LOCATED AT MAILING ADDRESS n• AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P.O. Box 16 ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947