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HomeMy WebLinkAboutTR-8008 James F. King, President ~~F ~~VTy Town Hall Annex Bob Ghosio, Jr., Vice-President ,~0~ 54375 Main Road P.O. Box 1179 Dave Bergen l~ ~ Southold, New York 11971-0959 John Bredemeyer Michael J. Domino ~ ~~i~ Telephone (631) 765-1892 ~~y00UNf'l,~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0872C Date: July 8, 2013 THIS CERTIFIES that the rebuild floor southern wall side deck stairs and sanitary stem of existing dwelling in-kind and as per original layout. At 610 Park Avenue Mattituck, New York Suffolk County Tax Map # 123-8-28.6 Conforms to the application for a Trustees Permit heretofore filed in this office Dated November 19, 2012 pursuant to which Trustees Wetland Permit #8008 Dated January 23, 2013 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 rebuild floor southern wall side deck stairs and sanitary system of existing dwelling in-kind and as per origtnal layout. The certificate is issued to MARY DRUM owner of the aforesaid property. 4 Authorized Signature James F. King, President o~g~1fF0(,~co Toum Hall, 53095 Main Rd. Bob Ghosio, Jr., Vice-President t~l (,/j P.O. Box 1179 Dave Bergen ~ = Southold, NY 11971 John Bredetneyer O Telephone (631)765-1892 Michael J. Domino y'y~j ~ Fax (631) 765-f~Ci41 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: ~ 3 Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-constnaction, hay bale line/silt boom/silt curtain 1St day of construction '/2 constructed Project complete, compliance inspection. INSPECTED BY: ~ t ~ ~~i,~ Y COMMENTS: CERTIFICATE OF COMPLIANCE: ~ ~ ~ ~ i Condon Engineering, P.C. New York State Licensed Professional Engineers 1755 Sigsbee Rosd 631-296-1966 Mattituck, New York 11852 Fax 831-298-2651 www.condonengineering.com March 2, 2013 Mr. James F. King Board of Trustees President Southold Town Half Annex 54375 Main Rd. P.O. Box 1178 Southold, NY 11971 Re: drum Residence 610 Park Avenue Ext., Mattituck, NY Dear Mr. King: As requested, we consulted the Suffolk County Department of Health Services Office of Wastewater management regarding the damaged septic system at the above referenced property. I discussed the property with Ed Lyons who is responsible for reviewing permits for residential properties for the Office of Wastewater management Mr. Lyons indicated that the health department was not requiring homes damaged by Sandy to file for permits to repair existing septic systems damaged by Hurricane Sandy. The property owners are permitted to repair the septic systems to their pre storm condition without a<,y involvement with the treaith department Please do not hesitate to call merf you have any questions or require additional information. Very Truly Yours, n ECEBVE' J .Con on, P.E. MAR - 5 2013 out old awn ar 'ru;tres FF James F. King, President ~pp~8~ ~~CpG~ Town Hall, 53095 Main Rd. Bob Ghosio, Jr., Vice-President o ~ P.O. Box 1179 Dave Bergen a T Southold, NY 11971 John Bredemeyer '~,y • Telephone (631) 765-1892 Michael J. Domino ~'Oj ~ .~a Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLO 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 APRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1St day of construction %z constructed Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES ~ SOUTHOLD,NEW YORK PERMIT N0.8008 DATE: JANUARY 23, 2013 ISSUED TO: MARY DRUM PROPERTY ADDRESS: 610 PARK AVENUE, MATTITUCK SCTM# 123-8-28.6 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 January 23.2013, and in consideration of application fee in the sum of $250.00 paid by Bureer Construction and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the Following: ~ Wetland Permit to rebuild floor, southern wall, side deck, stairs and sanitary system of existing dwelling in-kind and as per original layout due to damages caused by Hurricane Sandy; with the condition that a detailed licensed plan that is in accordance with the Health Department for the sanitary system be reviewed; and as depicted on the site plan prepared by Burger Construction, Inc., last dated November 15, 2012, and stamped approved on January 23, 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 Boazd as of this date. o~,~g11fF0(,~c - D Ber en - ent - TERMS AND CONDITIONS The Permittee Mar~Drum residim~ at 610 Park Avenue Mattituck, 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 aze released from any and all damages, or claims for damages, of suits azising 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 rnonths, 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 Peanittee 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 Permi[ by resolution of the said Board. 5. Tlrat 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 Pemilttee will obtain all other pemuts 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 ~~OF SOUryo Town Hall Annex Bob Ghosio, Jr., Vice-President ~ 5437b Main Road Dave Bergen P.O. Box 1179 Southold, New York 11971-0959 John Bredemeyer G Q Michael J. Domino ~ ~O Telephone (631) 765-1892 Fax (631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 23, 2013 Mr. Eugene Burger PO Box 934 Cutchogue, NY 11935 RE: MARY DRUM 610 PARK AVENUE, MATTITUCK SCTM# 123-8-28.6 Dear Mr. Burger: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, January 23, 2013 regarding the above matter: WHEREAS, Eugene Burger on behalf of MARY DRUM 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 November 19, 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 LW RP Coordinator recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policy 4.1 of the Local Waterfront Revitalization Program to the greatest extent possible through the imposition of the following Best Management Practice requirements: the issuance of a permit on existing structures; a detailed licensed plan that is in accordance with the Health Department for the sanitary system be reviewed; and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on January 23, 2013, at which time all interested persons were given an opportunity to be heard, and, 2 ~ • 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 for the mitigating factors and based upon the Best Management Practice requirement imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, RESOLVED, that the Board of Trustees approve the application of MARY DRUM to rebuild floor, southern wall, side deck, stairs and sanitary system of existing dwelling in- kind and as per original layout due to damages caused by Hurricane Sandy; with the condition that a detailed licensed plan that is in accordance with the Health Department for the sanitary system be reviewed; and as depicted on the site plan prepared by Burger Construction, Inc., last dated November 15, 2012, and stamped approved on January 23, 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~ry't~r`u'ly yours, v James F. King President, Board of Trustees JFK/amn ~~~~d51VFfOL.r~PG James F. King, President c - H ~ Town Hall Annex Bob Ghosio, Jr., Vice-President ~ 54375 Route 25, P.O. Box l l79 ' Dave Bergen .(,~y`~ C1' Soutlwld, NY 11971 John Bredemeyer 'K!,(~ .~3 Telephone (631) T65-1892 Michael J. Domino Fax (63l) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: ~I,~ a Q n e I `i Y ~'2 ti~ (,l 1' U ~ I~I~i [M Please be advised that your application dated Z has been reviewed by this Board at the regular meeting of .and your application has been approved pending the completio oft a following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1St Day of Construction ($50.00) / Yz 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: TOTAL FEES DUE: $ S ~ ~ DD BY: James F. King, President Board of Trustees ~ ~ ~ t .,~.'iw~ 1'+ .t i J ; ~ 1 ~ ~ 7 i ~ 4 ' Z•_ ~ ~ . I; _ - ~ ~ ~ r ~ ' . ! u. 1 J • ' M .sir y.,~Y~~.';`~ , .'~r', 1 ~ , + i ~r - + ~ a f S~ ~ ~ YR i . _ F~ ~ F ~ t~ 'r`-'~ ~ ~ri,~t 5 e , ~ 4~ ~ ~ S ` .n ~ ; 4 4 • ~~~~~gpff0(~.cOG ~ Peter Young, Chairman 4 Town Hall, 53095 Main Rd. Lauren Standish, Secretary ti ~ ~ P.O. Box 1 ] 79 Southold,NY 1197] '1~Ql. ~ 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., January 16, 2013 the following recommendation was made: Moved by Audrey Horton, seconded by William McDermott, it was RESOLVED to NOT SUPPORT the Wetland Permit application of MARY DRUM to reconstruct damaged floor and southern wall of existing dwelling, caused by Superstorm Sandy. Located: 610 Park Ave. Ext., Mattituck. SCTM#123-8-28.6 Inspected by: Audrey Horton, William McDermott The CAC does Not Support the application because of the lack of specificity with the proposed actions as well as the need for a sanitary system plan. There was insufficient documentation to make a recommendation. Vote of Council: Ayes: All Motion Carried rl-~` C C C D M~~ ~i(li~ U I` ;AN i 8 2013 souuio~d r~t•,~ Board of liuslr.~s • M gyFFO(M .lames F_ Kine. President CG~ N.O. Rox 1179 bob Ghosio, Jr.~Vice-President d Soutlrold, NY 11971 Dave Bergen ~ ~ Telephone (631 765-1892 .lohn Rredemeyer T Fax 1631)76?-6641 Michael I. Domino ~ 'Z' y~o1 ~ ,~,,a. Southold Town Board of Trustees Field Inspection/Worksession Report ~/i6~~1 Date/Time: Eugene Burger on behalf of MARY DRUM requests a Wetland Permit for the reconstruction of damages caused by Hurricane Sandy; rebuild floor and southern wall in-kind and as per original layout. Located: 610 Park Avenue, Mattituck. SCTM# 123-8-28.6 Type of area to be impacted: -Saltwater Wetland -Freshwater Wetland -Sound -Bay Distance of proposed work to edge of wetland ~rt 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: ;~1JL„f s ~ i Pressere: J King B. Ghosio D. Bergen, J. Bredemeyer Michael Domino D. 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New York State Licensed Professional Engineers 1755 Sigabee Road 631-Y98-1986 Mattituck, New York 11952 Fax 631-296-2651 www.condonerrgtnecan January 16, 2013 t1tr: Mike Verity Building Department Town of Southold Town Hail P.t3. Box 1179 Southold, NY 11971-0959 Re: UrumResidence 610 Park Avenue Ext., Mattituck, NY Dear Mr. Verity: A visit was made to the above referenced property on December 21, 2012 to evaluate the repair work performed at the site which was damaged during Hurricane Sandy. Yo the best of my knowledge, the wall and flrwr replacement on the southern wing of the building is acceptable and in accordance with the current Building Code of New York State. Based on the information provided by the contractor, the cost of the repair work at the site is less than 5t)% the cost of the building as required by the FEMA regulations. Please do not hesitate to call me ff you have any questions or require additional information. Very Truly Yours, . Condon, P.E. ~ - ti I~ iii ~~!I ~,..1 - D j~~j~ JAN 18 2013 < ,~r ~c~;s ~ ~;,n~o JAN 2 22013 authold awn BURGER CONSTRUCTION, INC. o~~~e~~D January 16, 2013 JAN 1 6 20a Southold Town Trustees ~ ~ 54375 Main Road P.O. Box 1179 Southold, N.Y. 11971 Re: Drum Application Mazy Drum 510 Park Ave. Ext. Mattituck, N.Y. 11952 Deaz Board Members, After Will Parks did an analysis of the septic system at the Drum Residence he advised that the system should be replaced in kind and in place. I would like to formally ask permission to add this operation to our trustees application which is up for review at the January 23`d meeting. Thank You, Eugene Burger Burger Construction i>osr ~~rrice H~>x ct:~rciioct:i!. n~.v. ii~~ss rn.irrnon~r.: o;i -;a-sir r,~csi~wn~.: r,ii-_i:,_s,.;.i v OFFICE IACATION: ~ ~~F S~UTjtr ~ MAILING ADDRESS: Town Hall Annex ~p~ P.O. Box 1179 54375 State Route 25 y ~ Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) T Southold, NY 11971 G Q Telephone: 831 765-1938 ~ ~p Fax: 831765-3138 ~~y00UNT'1,Nc~ LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM ~ C~~C~~~~ i~'~ To: Jim King, President JAN 1 8_ 2~13~I~ ~ ) Town of Southold Board of Trustees From: Mark Terry, Principal Planner so,: hold rc; LWRP Coordinator oozrd or rmsfcos Date: January 18, 2013 Re: Proposed Wetland Permit for MARY DRUM SCTM# 1000-123-8-28.6 Note there is no Board of Trustee permit on record for this structure. The structure is located within a FEMA VE Flood Zone (Coastal high-hazard areas). Eugene Burger on behalf of MARY DRUM requests a Wetland Permit for the reconstruction of damages caused by Hurricane Sandy; rebuild floor and southern wall in-kind and as per original layout. Located: 610 Park Avenue, Mattituck. SCTM# 123-8-28.6 _ 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 INCONSISTENT with LWRP Policies 4.1 and therefore, INCONSISTENT with the LWRP. 4.1 Minimize losses of human life and structures from flooding and erosion hazards. A. Minimize potential loss and damage by locating development and structures away from flooding and erosion hazards 3. Move existing development and structures as far away from flooding and erosion hazards as practical. Maintaining existing development and structures in hazard areas maybe warranted for: a. structures which functionally require a location on the coast or in coastal waters. b. water-dependent uses which cannot avoid exposure to hazards. c. sites in areas with extensive public investment, public infrastructure, or major public facilities. • d. sites where relocation of an existing structure is not practical The proposed action does not meet any of the above criteria. The structure is located within a FEMA VE Flood Zone Coastal high-hazard areas defined - "an area of special flood hazard extending from offshore to the inland limit of ....any other area subject to high-velocity wave action from storms or seismic sources." The area is subject to high velocity wave action. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney • ~ James F. King, Preside.• ~~~F S~UryO Town Hall Annex Bob Ghosro, Jr., Vice-Preardent ti~ l~ 54376 Main Road P.O. Box 1179 Dave Bergen t~[ * Southold, New York 11971-0959 John Bredemeyer G Q • ~O Telephone (631) 765-1892 Michael J. Domino Fax (631) 766-6641 ~~'~OOUNTV BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only - oastal Erosion Permit Application Wetland Permit Application Administrative Permit NQ~ ~ 9 202 _ _Amendment/Transf r/E ension i/Received Application: ._T Received Fee:$ Z D , b Completed Application ° Incomplete _SEQRA Classification: Type IType IIUnlisted Coordination:(date sent) 7 WRP Consistency Assess~!e i[ F^orm 1.3 _ CAC Referral Sent 1 ' ~-I l I s Date of Inspection: ~'-tom Receipt of CAC Report: Lead Agency Determination: echnical Review: ~ublic Hearing Held: Resolution: ~ Name of Applicant ~+~Q~~ M Mailing Address 21,0 lrj ~jVrq p,.,~o,.y L_Q_n'~_4.. ~ (~0.~; -fyc Ic ~ 1 ~S2 Phone Number:(lo~„) 2q 4~ - ~q°i 2 Suffolk County Tax Map Number: 1000 - 1 2?j - Q> - 2 f3. CQ Property Location: (D ~ O ~-F}(U~ ~F,- ~;k'~ ~ ~~-r~'CtiLk ~ 11gS2 (p~ro`'vide LILC^^O Pole distance to cross streets, and location) AGENT: W Q,~y~Q ~U f pR,r (If applicable) Address: ~O ~JOX q C,v~CanQ~.e ~ N~ l 1~13~Phone:~ ~ `13+-~ -5-11 ~1~~11~ ~ard of Trustees Applicati~ GENERAL DATA Land Area (in square feet): 2`-~- ~ ~ Qj~ S. F. Area Zoning: ~S, Previous use of property: Q i ~,f, ~ ~Q Intended use of property: ~.PS~ ~j~-~jg Covenants and Restrictions on property? Yes ~_No If "Yes", please provide a copy. Will this project require a Building Permit as per Town Code? ~ Yes No If "Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes ~No If "Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes _~_No Does the structure (s) on property have a valid Certificate of Occupancy? ~_Yes No Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ~ No Yes If yes, provide explanation: Project Dgscription (use attachments if necessary): l~~c~~.__~~_.1-r~-~; o~-, do..n-,o.~e,o ea~.~sp~! b,.,~ uQ.er~-~ror n-, ~-.~-.~t,~ by ~ 1 d l ter ~r`,g-iv,aSi ~av-~-. ' B~rd of Trustees Application. WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Q,~nn S{-1-.~c,}i arm aF C~aNrca~n Cc~.us~d h,.,f ~u~S~m-~ P o h~~, Moor a ~c~u~.e..~,-~ I~uaSL4 i,~r, ~C.yr~~ ~ a.o ~ er or`~ ~.,o~Q ,Q.a...t o.~ ~ . Area of wetlands on lot: ~ 0~ square feet Percent coverage of lot: \ \ Closest distance between Barest existing structure and upland edge of wetlands:-, , r~Q_feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited:~.~~~~ Statement ofthe 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): Board of Trustees Application • • COASTAL EROSION APPLICATION DATA Purposes of proposed actcivity: Q o jP r~~nSC~~rJ~i ~r~ C~~ C~a.vr~a~ A h~ vUQ~rkl'~rm ya.n~c~c.T QSLbu _I~ ~~Y' -t- S'OV~n.Xn WalL~ 'vn a4 (~Q.( 6r ~ p~Q ,Qau-1~,,, Are wetlands present within 100 feet of the proposed activity? No Yes Does the project involve excavation or filling? No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? (cubic yards) Manner in which material will be removed or deposited:____ 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) James F. King, Presiden• ~QF ~l)UTy • Town Hall Annex Bob Ghosio, Jr., Vice-President ~O~ 54375 Main Road P.O. Box 1179 Dave Bergen 1~( # Southold, New York 11971-0959 John Bredemeyer u+ ~r Michael J. Domino ~ ~ ~O Telephone (631) 765-1892 O~y~~UNTI Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 30-YEAR MAINTENANCE AGREEMENT EROSION PROTECTION STRUCTURES CHAPTER 111-15 OF THE SOUTHOLD TOWN CODE I (We) ~ 'T~ 1.~AJ~ The owners of record of property at (o l O ~fl~_~ PcVE, ham. SCTM#1000- ~ Z?J ' ~ ' 2~b • ~ in applying for a Coastal Erosion Permit for an erosion protection structure do hereby agree to a 30-Year Maintenance program for a structure as described: as shown on the attached licensed survey and/or site plan for the approved structure. It is my/our understanding that we are to maintain this structure with materials designed to endure 30 years and/or equivalent to the original approved structure. Any maintenance which involves more than 50% of the length of this structure requires.. approval of the Board of Trustees. We further understand that failure to maintain the structure could result in a requirement to post a bond and/or have the repairs ordered as alien against the property upon a finding by the Board of Trustees that said lack of maintenance would risk life, property or important natural resource features. ~ , /F~~ N~ran'ze signature of owner of record Notary Public CQNNIE D. BUNCH Notay Public, State of New York No. 01 BU6185Q50 Qualified In Suffolk County Commission Expires April 14, 2~/.Io This maintenance agreement shall only be valid upon the attachment of a licensed land -survey/and or site plan made within one year of the original construction and validated to show the final approval of the administrator. , • slzzo ~ SEQR PROJECT ID NUMBER 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. AIP~PLICANT/SPONSO~RL 2. PROJECT NAME Et, rJt>Y l~C-JM ~Z.~S~7EA1ZC,tc ? °ROJECT LOCATIriN~ pp 1 Municipality County V ~-~L__ 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide mao (9 I o 1~~4CZ~C-- A'v~ MKT GIS ~,~„"p ow ~Q- p.~b~~ N 11gs2 , 5. IS PROPOSED ACTION : ? New ? Expansion odification /alteration 6. DESCRIBE PROJECT BRIEFLY: eCor~S~vc-,~ ors of Cyo~.-~(~v ~~SQcr ~`-l S,~xzcs-Ev~m Sa.t-,~ , 2~bu; \c~ a ~'~`!ti-Qrr, I.UaA9- 7.AMOUNT OF LAND AFFECTED: Initially acres ultimately acres 8. W~I/LlL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? I]( IYes ? No If no, describe briefly: I9~WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) I TLResidenlial ? Industrial ~ Commercial Agriculture ? Park 1 Forest /Open Space ~ Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Fetleral, State or Local) 4~Yes ? No If yes, list agency name and permit /approval: L lJ`` 17. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ?Ves ®No If yes, list agency name and permit 1 approval: 12. AS A RE ULT OF PROPOSED ACTION WILL EXISTING PERMIT! APPROVAL REQUIRE MODIFICATION? ?Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE/ Applicant /Sponsor Name Date: Signature 7/ If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II -IMPACT ASSESSMENT o be tom feted b Lead A enc A. DOES ACTION F~CCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 61L4? ayes, coodinate the review process and use the FULL FJ1F. Yes 0 No B. WILL ACTION RECENE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negadw dedaraflon may be superseded by another inwlved agerwy. Yes ~ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Amxvers may be hervhvdtten, H legible) Ct. Existtng air quality, surtace w groundwater qualify or quantity, noise levels, existing traffic pattern, sditl waste production or disposal, pden6al fw erosbn, drainage or flooding problems? Explain 6defly: C2. Aestheflc, agricullurel, arohaeobgieal, Itistod4 w other nalurel ar cultural resources: w community w neighborhood dwredeR Expain briefly: C3. Vegetadwl w fauna, fish, shellfis w wiWfife species, significant habitats, or threatened w endangered spades? Explakt briefly: C4. A wmmunity's existing plans w goals as omdaay adopted, w achange-in use w inten~ty of use of land or other natural resources? Fxplaln briefly: C5. Growth, subsequent development or related adivflies likely to be iMuced by (he proposed action? Fxplain bdefly: C6. Long term, short term, emulative, or other effects not identified in C1-C5? Explain briefly: C7.-Other kn ads indudin than sin use of eflfrer uanet or t of ene ? E sin briefl : _ D. WILL THE PROJECT HAVE AN IMPACT pN THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL - ENVIRONMENTAL AREA CFA 7 Ii s, ex lain briefl Yes Q No E. IS THERE, Oft IS THERE LIKELY TQ COMROVERSY RELATFA TO POTEMIAL ADVERSE ENYIRONMFIiTAL IMPACTS? N in: ? Yes ~ No PART Ig -DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTKiNS: ForeachadverseeBectldentifiedabove,delertninawhelherftissubstaofiai,large,importaMorotherw~esignificent Each effect should be assessed in oonttecdon with its (a) selbng (i.e. urban or rureq; (b) probablAty of ocaning; (c) duration; (d) irravereibifdy; (e) geographic scope; and (f) magnitude. ff necessary, add attachments or reference supporting materials, FJtsure that explanatiorta oonfairt - - suffic'tent defog toshow that afl relevant adverse hnpads have been identified and adequaNly addressed. N question d of part fl was chedred yes, thedeEertnktation ofsignificance mustevaluatelhe potential knpadoftha proposedaMion on the emlronmentalaharar3erisfksoflheCEA. Check tltie box Byou hate Merrflflad one wmore potenflaflytarge wsigMficaMadverse krylads wttkh MAYacax. Tften proceed dkectlyto gte FAF andlw prepare a posfliw dedare6an. Chedr tlrk boz Myduhaw dek~rred, based an the inforntatbn and analysis above and any srtpportlng doameMatlon, drat the proposed a WRL NOT result in arty sigMflcaM adverse erMrommental kneads AND provide, on attactunenis as necessary, the reasons supportktg lh detertninallon. Board of Trustees p J~~rl S/ 2 O ~ 3 ~j / Name of LeaGd Ageruy / / Date U ~K'1 ~f / r / President o ~P ri or Type ame of _e~spyonsi a Offi r in Lead Agency Title of Responsible Officer 6( rgnature of Responsib a Officer in Le Agency Signature of Preparer (If different from responsible officer) i ~~auFFOC,~~, James F. King, President ~ - Town Hall, 53095 Main Rd. Bob Ghosio, Jr. , Vice-President ~ ~ P.O. Box 1179 Dave Bergen Southold, NY 11971 John Bredemeyer '~d1 Telephone (631)765-1892 Michael J. Domino ~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD I ~ ~ ~ u V L, ~~-1 ~i; I In the Matter of the Application of ~ ~ , ~I'~ JAN 1 8 2013 MARY DRUM COUNTY OF SUFFOLK) Sou'hNd?c~.,n STATE OF NEW YORK) Boar" at rue~czs AFFIDAVIT OF POSTING I,'.~~~'~.~~(~prYS~grti ,residing at/dba (~(_;T) ;~4~Unc'1 .{~.V.Q being~rn se and say: That on the '-1 day of Jc,~,,-,~ 2013, I personally posted the property known as by placing the Board of Trustees o Jcial 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 hearingg noted thereon to beheld Wednesday. January 23, 2013. Dated: I l [ ~ I ~ 3 afore) Sworn to before me this ~ dayof~Q~20 t ~j Notary Public Vi i,KI TO i N Nc".ary Pu~I6;, c'.';; of New YorM. n1o. n;-~o1S^696 ~ ~ 5~. ~ ,I§ Gow~ty it ..o j~ NOTICE IS HEREBY GIVEN that a public hearing will be held by the SOUTHOLD BOARD OF TRUSTEES at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. • OWNER(S) OF RECORD: ~Yla~y~r~M SUBJECT OF PUBLIC HEARING: For the reconstruction of damages caused by Hurricane Sandy; rebuild floor and southern wall in-kind and as per original layout. TIME & DATE OF PUBLIC HEARING: M (~~e~~sdo~y, S~u,acy a3, a~~3 -or~~r~+ y.•ooP • If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours o} 8 a.m and 4 p.m. " BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 eo~f~~ Town of So hold ~®g Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM y PROPERTY LxarloN: s.c.7.M. a: 7HE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A y0! )r~ ~ ~ (J~J~ ~~~j ~ 'LG~.ID STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN 'bfa rT,~ ec3 t~ ~$TT T- CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK -PROPOSED CONSTRUCTION ITEM # /WORK ASSESSMEN'T' Yes No a. What is the Total Area of the Project Parcels? ~ Will this Project Retain All Storm-Water Run-Off (Indude Total Area of all Parcels located within ~y~ ~ S ~ Generated by a Two (2') Inch Rainfall on Site? the Scope of Wolk for Proposed Construction) ~YD (This item will include all run-oR created by site ~ ? b. What is the Total Area of Land Clearing fs.F. /Ages) clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed ry Site Improvements and fhe permanent creation of consWdion activity? ~ impervious surfaces) (S.F. / Attea) PROVIDE BRIEF PRO 2 Does the Site Plan and/or Survey Show All Proposed ~ ? TECP DESCRIPTION (ILOrq. Aamuaaa Pagae.. Neeaaa) Drainage Sirudures Indicating Slze & Location? This Item shall include all Proposed Grade Changes and Q p ~r~~U~ 1 - ~n Slopes Controlling Surface Water Flow. ^1,, 1, 3 Does the Site Plan and/or Survey describe the erosion ~C A A/Y~Q O(~ C [l t ) `~Q~ ~c w and sediment control practices that will be used to c control site erosion and storm water discharges. This f~~~(M c X~ r~ ,t D ~U ~ ` item must be maintained throughout the Entire /y^ Q J~ ~T , ' ~ A Construction Period. `OOH C,nt T~ n tJ~-y c~ Will this Project Require any Land Filling, Grading or - \ ~ Excavation where [here is a change to the NaNral .~(-1 yilJYl['V a~ P'CC.~' ~Q-l K ~ Existing Grade Involving more than 200 Cubic Yards ,L~- 1{ of Material within any Parcel? f~ 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? s Is there a Natural Water Course Running through the ? Site? Is this Project within the Trustees jurisdiction General DEC BWPPP Requirements: or within One Hundred (700') feet Of a Wedand Or Submission of a SWPPP is required for all Constmc[ion activities Involving soil Beach? disturbances of one (i) or more acres; incWding disurbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes ? era pan of a larger common plan Nat will ultimately dlsNrb one or more acres or land; which Exceed Fifteen (15) feet of V¢Rlcal Rlse to indud'mg Construction activities invoking sou disturbances of less than one (t) acre where One Hundred (100') of Horizontal Distance? the DEC has determined that a SPDES peonit a required for stone water discharges. - ~ i SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit $ Will Driveways, Parking Areas or other Impervious ? for Storm Water Discharges from ConsWCtion activity -Permit No. GP-0-10-0Ot.) Surfaces be Sloped to Direct Steen-Water Run-Off 1. The SWPPP shall be prepared prior to the submittal of the NOT. The NOI shall be into and/or in the direction of a Town right-of-way? submitted to the DeDedmenl prior to the commencement of constmrAion activity. 2. The SWPPP shall describe the emsian and setliment coned practices and where 9 Will this Project Require the Placement of Material, ? required, pwtconsWClion stone water management practices Nat will be used and/or Removal of Vegetation and/or the OOr15ifUGtiOn of any consWded to reduce the pollutants in storm water discharyes end to assure Item Within the Town Righbof-Way or Road Shoulder y~/t- epmpllanee with the lertn5 and conditions of this pemtil. In addition, Ne SWPPP shall Area? (This Item will NOT induda 1M InabllWen of Ddvewry Aprons.) idenli/y potential sources of pollution which may reasonably be expected to affect the quality of stoma water discharges. NOTE: If Any Answer tp pueations One through Nine is Answered vath a Check Mark 3. All SWPPPS Nat require Me postunstmclion storm water management practice In a Box antl the eons Wedon site disturbanev Is betwvvn 5,000 S.F. 81 Aere In area, component shaA be prepared by a qualified Desgn Professional lJcensed in New Vork a Storm-Water, Grading, D2lnage 8 Erosion Control Plan la Required by Na Town of Thal is knowledgeable in the principles and pactices of Stone Water Management. Southold anti Must be Submitted for Review Prior to lasuancv of Any Building Permit (NOTE' A Check Malik (.r) and/or Answer fa earth WasYon is Required for a rAmpleta App6gaEOn) STA1;v OF NEW YORK, Notary Public, State of New York COUN7Y OF SS No. 018U6185050 Qualified in Suffolk County Commission Expires A ri! 1~, b ?'hat I, ..r~~..i!.~.:°.'!`:.:C:.......... ?pp}}~~v R being duly sworn, deposes and says that lie/she rs the applicant for Permit, (Name of individual sgnMg Document) Md that he/she is the (Owner, Convector g , Comorete Officer, etc.) Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true [n the best of his lutowledge attd belief; and that the work will be performed in the manner set forth in die application filed herewith. Sworn to before me this; \n ....._.....J. day L.V .~~M............. , hlo!a Notary Pub)ic:....`..4?~.~ .~!1.!~~r~~.......................... .....~.~[1..,.,a..~.p7~~'~'-~- _ (Signature of Applicant) FORM - 06/10 ~g11fF0[,~c James F. King, President Town Hall, 53095 Main Rd. Bob Ghosio, Jr. , Vice-President ~ P.O. Box 1179 Dave Bergen ~ Southold, NY 11971 John Bredemeyer d Telephone (631) 765-1892 Michael J. Domino ~1~ Fax (631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD ~ ECEIVE D BOARD OF TRUSTEES: TOWN OF SOUTHOLD JAN 1 02013 In the Matter of the Application of own MARY DRUM COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, ~OOK.Q. ~i[">.Prl'~?~- ,residing at /dba~Fa'~ Q~ SOUna Y--T Vim, ~n kv~l~ being duly sworn, depose and say: That on the ~ day of ~Q„-,~~ , 2013, 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 Wednesday, January 23, 2013. Dated: 1 `"1' 1 ?j (sJgnature) Sworn to before me this da~yof~ka~ r~ 20 Ij lv vLxA/W Notary Public NMry Pi ~ ~~Nwv Yak OwIwnYAoa 6gIrM Oal~~ 13 w • PROOF OF MAILING OF NOTICE D 6 V ~ 11I ~ D ATTACH CERTIFIED MAIL RECEI D JAN 1 02013 Name: Address: IZ3-8-Z8~5 ~x 1312 w , ~ a M0.--1-, t~~1c.., r~ I la s2 i23- ~ -Z~b ~ 1`l ~ \\ah-,a.r~c~a VQ, Av.v, C~llt gnV, ~ ~o ~kr~-I ;?~ec.ca-, , ~r L 3'~~-103 STATE OF NEW YORK COUNTY OF SUFFOLK pn ,residing at Q~SUp O1~ ~J DUt1Cl >~2 being duly sworn, deposes and says that on the -7 day of " , 20~, deponent mailed a true copy of the Notice set forth in the Boazd 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 ~1~, ,that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. ~ ~~j~ ~ v Sworn to before me this Day of -~gy~ , 20 I ~j Notary P~~~uQQbl~~i~~c~~ IIIG1NpL ~f~. .-iU@'i1C. NMry Pu61a, 8MN d Nwu Yak No.4i0g12 OwY4d h 9ullolt Catly r~..oa.», X13 ,I. , M1 ~ . 1 ~ rr r rl Postage s $0.45 ~ ~ ! w` Cedifled Fee f2•°5 fl.l Postmark ~ Reurn Receipt Fee ! ~ (Endorsement Requiretl) 82.35 ~-_y Here ~ Restrictetl Delivery Fee Y - ~ (Endorsement Requiretl) f rl r r9 Total Postage & Faes $ 85.E Ulf 13 O Sent To ~ ~ ~ L r O Srreet. APt. No.: _.J arP09ox Na. ~1 M1 Ci'ry, State, ZlP+~-~~~--------~-~~---- bec,cP~~ 33'-~ 3 . it ~ ~ ~ S M1 a Postage $ $0.45 ~ Cenifietl Fee 8^e.95 ~ f1J Postmark O Return Receipt Fee 8.35 Here p (Endorsement Required) ~ Restdctetl Delivery Fee (Entloreement Regwred) O f5.75 01 ~ ~ 2013 r-R Total Postage & Fees 0 ~ Sent ro i a - ~ Street, Apt Na., ~ ~ ICY 52 Ciry, Stele, 21PV,t ` N, j 1 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: (gyp ; W ~ c_k;Yuw.~ i~o 3~X i ~ i 2 S}cx,ctit Sha.P~a,-~ l/~a#'~~vc.~, N~ I1~152 ~rt CU 1115+aw, ~ A ~ t n-vr,c~~do.. ; V e C, 0 7i axe Je~~-t 17o~ra-~.t ~°`c~-' , F IJ 3'~Y~3 STATE OF NEW YORK COUNTY OF SUFFOLK i nr~f2_ ~ >r ..r ,residing at being duly sworn, deposes and says that on the day of , 2012, ,deponent mailed a 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 aze 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 MAIL/RETURN RECEIPT. Sworn to before me this Day of , 20 Notary Public NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES. TOWN OF SOUTHOLD In the matter of applicant: ~ ~,p~(L~ ~Qa SCTM# @ ~O - 123 - y~- 28 ~ YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: QJt,ccx.~l-r.x~ do..rr•age.o Ca-~~¢e1 bH S"~~5ier`r 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 1.5.1~~ t~c>.~r~ ~Q. Ems{-. ~..lex~:~ (vck~ tJ-~ l 1~t52 3. That the project which is subject to Environmental Review under Chapters 96,111 and/or 275 of the Town Code is open to public comment on: DATE: You may contact the Trustees Office at 765-1892 or in writing. The above-referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. PROPERTY OWNERS NAME: ~ A.n,~~ MAILING ADDRESS: ?tn~~ ~iu ctlrv ~ (n ,r~o ~ au:b~~c, 1\°i52 PHONE ( 2q9~ - Ski 2 AGENT: ~,~~Q Q. .~i_x~4..r` MAILING ADDRESS: two ~o~(. ~l 3~{ Ci~,~~gue t 1°135 PHONE#: ~~o ~ -134- SZ~1 Enc: Copy of sketch or plan showing proposal for your convenience. - _ - Board of Trustees Application • • County of Suffolk State of New York y ,~ig,~~ BEING DULY SWORN DEPOSE AND AFFIRMS YHAT 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 of Property Owner SWORN TO BEFORE ME THIS DAY OF~UUerY~~l >20 l~ Notary Public CONNIE 6. BUNCi~t Notary Public, State of Neer York No. Oi BU6185050 Dual+fied iri Suffolk Counay Cornmissior• expires April ! 4.. ':?Of B~d of Trustees Application. AUTHORIZATION ~ (where the applicant is not the owner) I, IU l ~ '~`((,i~;'l~ residing at lO t O _ \~~~_!~~'EX (print owner of property) (mailing address) ~a~ {vim\~ ~_do hereby authorize (Agent) ~ .~~a f~ to apply for permit(s) from the Southold Boazd of Tows~ )n Trustees on my behalf. J1 ' N (Owne s signature) . , APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the Dart of town officet~ and emnlovces The pttmose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever actwn is necessary to avoid same. YOUR NAME: Las ~ .tn.9. tJU~(~7 ( t name, first name, Middle mrnal, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building _ yy~~ce 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 X 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 [ha[ person Describe the relationship between yourself (the applicantlagenUrepresenta[ive) and the town officer or employee. Either check [he 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 anon-corporate entity (when the applicant is not a corporation); C) an officer, director, partner, or employee of the applicant; or D) the actual applicant. DESCRII'T10N OF RELATIONSHIP Submitted this day of 200 _ Signature Print Name ~,~~y_ ~ _~-i/ Form TS 1 Town of Southold • • LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for pemmts* 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 prepazer 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 si¢nificant 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 standazds and conditions contained in the consistency review law. Thus each answer must be explained in detail, listine both supportin¢ and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standazds and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. _ _ - ,f ~ 1 B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# LAC) - t ~ 3 ~ ~ t NOV 1 9 2012 , PROJECT NAME 1 ~a M capir-~ c Q L~_._-__~__.__~i '~~r'.,,.o1T1P..,i~ r The Application has been submitted to (check appropriate response): ' - _ Town Board ? Planning Board ? Building Dept. ? Board of Trustees 1. Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital ? construction, planning activity, agency regulation, land transaction) ? (b) Financial assistance (e.g. grant, loan, subsidy) (c) Pemvt, approval, license, certification: Nature and extent of action: ~~oiY'S~rn L3DU"~~ Q1L.b~~ ~ ~tonr ~ ~~~axn wd,AS~ ur ~C_,t,v,d co ~ c~r• ~unc~ ~cz.~,~t~v~. Location of action: (DI O ~t o~.r'~ prle, F~c-~. a~a7dC,~jc~c i(q~2 Site acreage: u `moo p~.~~-~ Present land use: ~S ~ ~s,,~-{~ Present zoning classification: K-~CLSi ~ p,~-,-~ 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:_~ (1_,r~a err, ~ ~ , (b) Mailing address: 2 C9 1 S t`;CT i xu~ a ~ r~~ ~~Q ~ ~y~,~/ ~ Ig52 (c) Telephone number: Area Code ( l~ln 317 ZG1~- ~~Iq 2 (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 bow 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 benef?cial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III -Policies; Page 2 for evaluation criteria. ?Yes ? No ~NotApplicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWI2P Section III -Policies Pages 3 through 6 for evaluation criteria ? Yes ? No ~ Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III -Policies Pages 6 through 7 for evaluation criteria ? Yes ? No ~ Not Applicable Attach additional sheets if necessary NATURAI. COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policie~ages 8 through 16 for evaluation criteria ? Yes ? No Not 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 ~ Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LW12P Section III -Policies; Pages 22 through 32 for evalu~ajtion criteria. ? ? ,4~.1 Yes No Not Applic~d5le 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~Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III -Policies; Pages 34 through 38 for evaluation criteria. ? Yes ? No Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LW1tP Section III -Policies; Pages 38 through 46 for evaluation criteria. nn ? Ye9~ No~Not Applicable Attach additional sheets if necessary WORHING 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 Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III -Policies; Pages 57 through 62 for evaluation criteria. ? Yes ? No~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 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~ Not Applicable PREPARED BY TITLE DATE _ _ _ _ _ _ _ _ _ _ _ _ _l ~ _ _ _ Survey for: I MICHAEL DRUM ~.L p/o Lots 7 & 8, AMarratooka Point" E • ~ a2~s Mattituck G~ PP Town of Qo+`~ r<v f~~, M Southampton P Ss?s • 's=°" ~o~ Suffolk County, New York I ~4^ ti 2 p0, Cei O~ IQ ~ ~ ~ St 9h Fo S. C.T,M.: 1000-123.00-08.00-028.006 i Q ,~F, i ~ She fJ0 e~y I I .yo. tirL 6~ \ / / ,OAO~J SCALE: 1"=30' I I C~5 aJ0 i oE~j / i ' d NOTES: I I e~NC _ ~f °~i - 6 _ _ 367j. 1. AREA = 24,184 S. F. ~ L~ 'QO q~Q TE 9 2. ¦ = MONUMENT FOUND, 0= PIPE FOUND, i > ~Q ~ 1 ~ 9•~ 9 3. SUBDIVISION MAP °MARRATOOKA POINT" FILED i ~ - - - - sE - co`•cf„@-O IN THE OFFICE OF THE CLERK OF SUFFOLK o ~ Ssp.'TS aB. _ - aaeso COUNTY ON MAR. 19, 1927 AS FILE N0. 331, j I F ^ I °.1p - 2 P,;,r.+ ~ A• 4. ELEVATIONS SHOWN HEREON ARE REFERENCED I i 9 0 °f ~ N83'oo 40"E a~• ~`EQ 4`a_ „c 6. ;o? S TO N.G.V. DATUM (MSL 1929). I j ~ , ~O. ~a> ~ O~y 5. 4- = EXISTING CONTOUR. ~ ~ 1 ~i olGq a I ~ c ~ s. J ~ 9 o. i r i c c ,yo. ~PUf,by~ S DATE: FEB. 23, 2009 ! ~ FR ~ JOB N0: 2009-027 I O s. e O YW~~~- B PFO 1 ~ ~ 1 I n .'o;%c ~ ' ~ 6 o I ~ a ~ ~ N ~ 564. w , ~ ~ 1 - 53.83' ~ ~rn^ `~_l':,,~ ~ 43 a~, 47"E 585'33'17"W j~" j s_'- N~3.34 _ ~ Z ,y I i lr U; ~ ~ L I - ~ ~~DA D, H!. FOX, L.S. P. C. N. Y. S. L.S. ~'S0234 , j --45. G ~ NE PP~ ~~M. ~ - I iF~X LAND SURVEYING - - 32. ~ - 64 SUNSET AVENUE ~3 1~ PP~yOX~M ' SS4,08~rJ7"N/ ~ P _ K~V ~ 9 2~~2 WESTHAMPTON BEACH, N. Y. 11978 N (631) 288 0022 ~ O ~ Q~G _ _ ` G~~P DwG: 2009-027 WALL REPLACEMENT 39'—, z z 0 F r Z MAJOR ' x a] a PAMAOE 421 mx NEW STAIRS a Z TO REPLACE U ora REPLACE PAIVAc EP U "° EGK JOIST _m__. r�arsr MAJOR PAMAOE 20,_31, ��o SQ.�r. 6' IM,[ o rNl REPLACE FLOOR JOISTS & PLYWOOD / - I m =I MINOR / l PAMAOE 6'-102-"' W �— AP�'ROVED BY J�J 15TIN6 15 I / / / BOARD OF TRUSTEES / / TOWN OFSOUTHOLD — / // / / / / / / / / / // / /// // DATE X1.3" I Z3 3 U ' / / / / / ,10, 3'-6" PAMAOE p7" / / /,MINOR DAMAGE / j z1' 23-9" /MINOR PAM4C�E/ j !!! !! / a /! !/ j /// / / /! , 395 S6 T- j ! , /10-6° 20' Rzaeor LocAnaN: EXISTINC-v LAYOUTA PARK AV E IXl-. 201-611 I. MATTIISx , IVY TOTAL f5UI1-51INO AREA: �3-F- TOTAL RECONSTRUCTION AREA: -700 s.f. TOTAL DECK AREA: 444 s.P. TOTAL DECK RECONSTRUCTION: 03 S.F. DATE l� IJOV VX167 I6. 'taYi NOTE: PRAWINe rm.e: ALL WORK WILL f5E PONE IN KIND AND IN wiLLPIN& PLACE, NOThING 6,flANGES FROM ORIGINAL enwaLOFr-- LAYOUT �a+ie: • MAY REQUIRE MINOR ELECTRICAL REPAIR. # e r d • ALL NEW WOOD STRAPPED TO COPE. • NO STRUCTURAL WORK WILL f5E NEEDED ° W[N6 NO. IN AREAS LA15EL EP "MINOR" DAMAGE Ex - WALL REPLACEMENT ELEVATION