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HomeMy WebLinkAboutTR-8083A Michael J. Domino, President ��OF S0Ury0 Town Hall Annex John M. Bredemeyer III,Vice-President ,`O l0 54375 Route 25 P.O. Box 11 Charles J.Sanders l [ Southold,New York 11971 Glenn Goldsmith GQ � 0 Telephone(631) 765-1892 A. Nicholas Krupskiy00UNT O Fax(631) 765-6641 � `I,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1439C Date: December 29, 2017 THIS CERTIFIES that the construction of a 10'x20' approximate stone slab patio on-grade to replace existing stone patio torn up during Hurricane Sandy, and behind existing bluff retaining wall,• with the conditions that the patio is not to be larger than 200 sq. ft.,• the easterly side of the patio be moved back to the west end of the stairs-, and the westerly side of the patio to be cut back away from propertylne; At 19625 Soundview Avenue, Southold Suffolk County Tax Map #1000-51-1-22.2 Conforms to the application for a Trustees Permit heretofore filed in this office Dated January 24, 2013 pursuant to which Trustees Administrative Permit#8083A Dated February 20, 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 construction of a 10'x20' approximate stone slab patio on-grade to replace existing stone patio torn up during Hurricane Sandy, and behind existing bluff retaining wall; with the conditions that the patio is not to be larger than 200 sq ft • the easterly side of the patio be moved back to the west end of the stairs,• and the westerly side of the patio to be cut back away from property line. The certificate is issued to ROBERT OXNAM owner of the aforesaid property. Authorized Signature r i b *pF SOFT Michael J. Domino,President � y�lO Town Hall Annex John M. Bredemeyer III,Vice-President 54375 Route 25P.O. Box 1179 Charles J. Sanders N Southold,New York 11971 Glenn Goldsmith • �� Telephone(631) 765-1892 A. Nicholas Krupski `+oUffm Fax(631) 765,6641 - BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: ,0 VCh. 275 1 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction % constructed Project complete, compliance inspection. INSPECTED BY: C� 0�y�e l S'� �,,Ld COMIuIENTS: 6J U "n'o � 12et& oX&/\, �- 110 L CERTIFICATE OF COMPLIANCE: James F.King,President ��p�OgOFFOj�cOGy Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President �. P.O.Box 1179 Dave Berges Southold,W 11971 John Bredemeyer tp Michael J. Domino y7j01 p! Telephone(631)765-1892 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 I" day of construction constructed 7 Project complete, compliance inspection 0 James F. King, President �rF SOpTTown Hall Annex Bob Ghosio,Jr.,Vice-President �Q� ��� 54375 Main Road P.O.Box 1179 Dave Bergen # lSouthold,New York 11971-0959 John Bredemeyer y G p� Telephone(631) 765-1892 Michael J. Domino �� Fax(631) 765-6641 �y�OUNTr,Nc� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8083A Date of Receipt of Application: January 24, 2013 Applicant: Robert Oxnam SCTM#: 51-1-22.2 Project Location: 19625 Soundview Avenue, Southold Date of Resolution/Issuance: February 20, 2013 Date of Expiration: February 20, 2015 Reviewed by: Board of Trustees Project Description: To construct a 10'x20' approximate stone slab patio on- grade to replace existing stone patio torn up during Hurricane Sandy, and behind existing bluff retaining wall; with the conditions that the patio isnot to be larger than 200 sq. ft.; the easterly side of the patio be moved back to the west end of the stairs; and the westerly side of the patio to be cut back away from property line. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the survey prepared by John T. Metzger, Land Surveyor, last dated on January 2, 2013, and stamped approved on February 20, 2013. Special Conditions: The patio is not to be larger than 200 sq. ft.; the easterly side of the patio be moved back to the west end of the stairs; and the westerly side of the patio to be cut back away from property line. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. James F. King, President Board of Trustees ��o�,suFF>u�-coG James F.King,President c v� � Town Hall Annex Bob Ghosio,Jr.,Vice-President U. 54375 Route 25,P.O.Box 1179 Dave Bergen cp y Southold,NY 11971 John Bredemeyer �d a0 Telephone(631)765-1892 Michael J.Domino Fax(631)765-6641 BOARD OF TOWN TRUSTEES f TOWN OF SOUTH�OD � L I - ' TO: ��1�� I' �t j)\!Pa� ✓ trvi7.e"4 O AC yla w Please be advised that your application dated 3 has been reviewed by this Board at the regular meeting of Z 2D 3 and your application has been approved pending the completion of thb 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) Y= Constructed ($50.00) Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ D, L)D BY: James F. King, President Board of Trustees K Russell Glover Architect PC box 1031 Shelter Island Heights NY 11965 Re: Administrative permit application,Oxnam Property, 19625, Southold NY Amanda Further to our phone conversation of this morning. As I understand the Trustees were out at the Oxnam property yesterday and according to the owner they took a number of measurements of the existing/proposed patio. I'd like to make 2 points: Firstly when I filled out the administrative permit application 1 listed the patio as 10'X 20'- this was an approximation on my part since I filled out the application prior to the Surveyor coming out and showing the actual size and location of the patio. I assumed that the Survey would be the document that the Trustees would refer to rather than my approximate dimensions. Secondly; there were a number of loose stones laying on the lawn where they were left after the inspector ordered the work stopped and apparently the Trustees measured over these as if they would be laid where they were as part of the patio- this is not the case. The proposed final arrangement is as shown on the Survey and as follows:-a patio in the location of the original ( please see the before photo's )then there are 4 stones to be laid at the top of the beach access stair as a landing so that there will be a gap between the landing and the patio-not a continuous stretch of stone as implied by the surplus stones laying on the lawn. Regarding the blustone sand base for the stones- The patio area was not washed out by Hurricane Sandy- most of the damage came from uprooted trees and shrubs that tore up the base and lifted out the stones along with the wind ripping out the handrails around the beach access landing, not from flooding so I am suggesting that the stonesand base would be correct for the stones in that location plus also allow for any water to drain away through the loose laid joints. Please call me if any clarification is needed Russell Glover 631 332 0517 cell. rouEEIV jEthold Town Board olTid,.,cs Page 1 of I Nunemaker, Amanda From: Rust Glover[rustglover@yahoo.com] Sent: Thursday, February 14, 2013 12:26 PM To: Nunemaker, Amanda Cc: robertoxnam@yahoo.com Subject: Oxnam Property/Board of Trustees. Attachments: Oxnamtrusteeletter..pdf K Russell Glover Architect PC box 1031 Shelter Island Heights NY 11965 Re: Administrative permit application,Oxnam Property, 19625,Southold NY Amanda Further to our phone conversation of this morning. As I understand the Trustees were out at the Oxnam property yesterday and according to the owner they took a number of measurements of the existing/proposed patio. 1'd like to make 2 points: Firstly when I filled out the administrative permit application 1 listed the patio as 10'X 20'-this was an approximation on my part since I filled out the application prior to the Surveyor coming out and showing the actual size and location of the patio. I assumed that the Survey would be the document that the Trustees would refer to rather than my approximate dimensions. Secondly;there were a number of loose stones laying on the lawn where they were left after the inspector ordered the work stopped and apparently the Trustees measured over these as if they would be laid where they were as part of the patio-this is not the case.The proposed final arrangement is as shown on the Survey and as follows:-a patio in the location of the original(please see the before photo's)then there are 4 stones to be laid at the top of the beach access stair as a landing so that there will be a gap between the landing and the patio- not a continuous stretch of stone as implied by the surplus stones laying on the lawn. Regarding the blustone sand base for the stones- The patio area was not washed out by Hurricane Sandy-most of the damage came from uprooted trees and shrubs that tore up the base and lifted out the stones along with the wind ripping out the handrails around the beach access landing,not from flooding so 1 am suggesting that the stonesand base would be correct for the stones in that location plus also allow for any water to drain away through the loose laid joints. Please call me if any clarification is needed Russell Glover 631 332 0517 cell. PS- 1 attached a pdf copy of this letter R ECEIV � [ EB 1 4 2013c�: :.� 2/14/2013 0 OS f FO( lames F. Kind. President O� CpG. N.O. Box 1179 I lob Ghosio.Jr. VICC-Presfdcm ,�-0 as Southold,NY 11971 Daw Bergen y Telephone(631 765-1892 John Bredemeyer p, Fax(63 1)765-6641 Michael J. Domino Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: /ti' l 1 z a p `7 : 'r 11 K. Russell Glover, Architect on behalf of ROBERT OXNAM requests an Administrative Permit to construct a 10'x20' approximate stone slab patio on-grade to replace existing stone patio torn up during Hurricane Sandy, and behind existing bluff retaining wall. Located: 19625 Soundview Avenue, Southold. SCTM# 51-1-22.2 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: hapt.275 _,�--Chapt. 111 _other Type of Application: _ Wetland _Coastal Erosion _Amendment ✓dm _E inistrativemergency Pre-Submission Violation Info needed: Modifications: *7 Conditions: Present Were: "/J. King '13. Ghosio v' D. Bergen, [/J. Bredemeyer Michael Domino D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: Y I Il Y }_ a .r',, fM1. �� �. T( 1� • � afi a " l vyn.y Pre-existing patio at Oxnam/Desai residence, 19625 Soundview Dr, Southold Before Storm Sandy Fn) ECLEovE D D JAN 2 4 2013 Southold Town s Board of Trotees 0 " I ✓ b. Y .S'!}:i �Y fir. + y n Y/ - � a �. rr V 2 4 2013 Board Trmioo g N II SOUND 5 � I,IND ` pry 4 'ONG FO]G { IT 1 Q2) 4� s viF—�_.—uvE COUNT OFSUFFOLK © m v *o SSem:N9enq ._v. .� ....,.va.w.,w...w OFFICE LOCATION: OF souTyo MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 i. * Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) T Southold, NY 11971 G Q Telephone: 631 765-1938 'nc` �AFax: 631765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jim King, President D Town of Southold Board of Trustees FEB 1 3 2013 From: Mark Terry, Principal Planner LWRP Coordinator SoutholdTown oar f Tru ees Date: February 7, 2013 Re: Proposed Wetland Permit and Coastal Erosion Permit for ROBERT OXNAM SCTM#1000-51-1-22.2 K. Russell Glover, Architect on behalf of ROBERT OXNAM requests an Administrative Permit to construct a 10'x20' approximate stone slab patio on-grade to replace existing stone patio torn up during Hurricane Sandy, and behind existing bluff retaining wall. Located: 19625 Soundview Avenue, Southold. SCTM# 51-1-22.2 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 proposal is INCONSISTENT with LWRP Policies 4.1 and 6.3 (below) and therefore, INCONSISTENT with the LWRP. The action is LOCATED WITHIN THE CEHA and does not meet policies 4.1 and 6.3 below. 4.1 Minimize losses of human life and structures from flooding and erosion hazards. The following management measures to minimize losses of human life and structures from flooding and erosion hazards are suggested: A. Minimize potential loss and damage by locating development and structures away from flooding and erosion hazards. 1. Avoid development other than water-dependent uses in coastal hazard areas. Locate new development which is not water-dependent as far away from coastal hazard areas as practical. a. No development is permitted in natural protective feature areas, except as specifically allowed under the relevant portions of 6 NYCRR 505.8. b. Avoid hazards by siting structures to maximize the distance from Coastal Erosion Hazard Areas. The location of the proposed patio is within the Coastal Erosion Hazard Area (CEHA) and will be constructed on the bluff. All development is prohibited on a bluff pursuant § 111-12 unless specifically provided for by Chapter 111, COASTAL EROSION HAZARD AREAS. Pursuant to § 111-6, allowable activities on a bluff may include open timber piles or other similar open work supports with a top surface area of less than 200 square feet and removed annually. Therefore, the patio, as proposed, is prohibited on the bluff pursuant to Chapter 111, COASTAL EROSION HAZARD AREAS. The patio is not an unregulated activity or a specifically allowed action identified in the section. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. 275-11 Construction and operation standards. A. General. The following standards are required for all operations within the jurisdiction of the Trustees: (6) Decks and platforms. No decks or platforms shall be permitted on or near bluffs... Pursuant to Chapter 275 Wetlands and Shorelines the proposal to re-construct 200 square foot patio is not a permissible 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,President • �r4 SOUr9 •Town Hall Annex Bob Ghosio,Jr.,Vice-President `O� �� W75 Main Road P.O.Box 1179 Dave Bergen 41 Southold,New York 11971-0959 John Bredemeyer G • R� Telephone(631)765-1892 Michael J.Domino ',`� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Applicata Wetland Permit Application Administrative Permit Amendment/Trans r/Ex ion t�eceived Application: � Z� 3 eceived Fee:$ i/Co feted A lication 3 � � 'f riW PP rl � (�:� •� ' _Incomplete _ v SEQRA Classification: J Type I Type Il_Unlisted JAN 2 A � 13 oordination:(date sent)_ LWRP Consistency Assessment Form Z I 13 M CAC Referral Sent: 7Dateofinspection: Z - ..'_acs _Receipt of CAC Report: _Lead Agency Determination: _Technical Review: •./Public Hearing Held: 2 3 Resolution: Name of Applicant K06eg'C' oy-N RM Mailing Address I 62 S 5o U tJ C>V I rc W PCV C- 5001Nt L'o t NY, 114371 Phone Number:( > 64(o 322 1850 Suffolk County Tax Map Number: 1000- 'S1 — I — 22-2- Property Location: 10)(62-5 5ootj 0,q tew /kvENUE I soS(lta4-jC>/ N� 1 i 671 20Do1 wC-sT o Cc.Re� �2oAo o(%j .SOL)n1ov%QvJ AEVE. (provide LILCO Pole#, distance to cross streets, and location) AGENT: le. (USSR(,. GLOVC^4t, a'Q<-lkl'7c-'- (If applicable) Address:_ o'3 l 5 KeL-1't-2 t l-F-("s f N y ll'5G$ Phone: 63l 332 oSO Boa of Trustees Application • GENERAL DATA Land Area(in square feet): a S l Z� •F. Area Zoning: R $O Previous use of property: RES , Intended use of property: K S . 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 V✓ No Does the structure(s)on property have a valid Certificate of Occupancy? ✓ Yes No Prior permits/approvals for site improvements: Agency Date RoP1G�oF''ttZ.�S42iS T�2t� 20otfc No prior permits/approvals for site improvements. / Has any permitlapproval ever been revoked or suspended by a governmental agency? V No Yes If yes, provide explanation: Project Description (use attachments if necessary): to ` X 20 ' APf Pee- SioNE 9L-N5 POT-to oN GRADE REr�Ac_� ��1snN� s�an�c P� no 'fa J JP 1�.t2 *JG ( tv221cMVG Board of Truatees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: REP(,A-r-e 6<�15nW-> SibWE Sc-Rf3 PWDO TaieN uP r)oeIpi � IkueC% C-A-0 &(,J 2Y Area of wetlands on lot: 0 square feet Percent coverage of lot: 0 % Closest distance between nearest existing structure and upland edge of wetlands: 0 feet Closest distance between nearest proposed structure and upland edge of wetlands: �<tn _feet Does the project involve excavation or filling? No Yes If yes,how much material will be excavated? O cubic yards How much material will be filled?� O cubic yards 3" Depth of which material will be removed or deposited: A— feet Proposed slope throughout the area of operations: O o Manner in which material will be removed or deposited: $ Y V�At.) v 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): NO e FFG-L-1 617.20 SEAR 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.APPLICANT/SPONSOR 2.PROJECT NAME f90e*:2'C Re5i oe*t 1C.E 3.PROJECT LOCATION: 18625 500NOVtew ArVe Municipality `�avTitiPbp County 5%1FFbL4C1 4.PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide mag) 1 %2.5 SOVf%J.0J(eW AVE "5oV1'#V&P, N Y 20opr WCc5F0FC44+412>-I,&A0 ON S0VNWOVIe*,/ 4Ve--. 5.IS PROPOSED ACTION: ❑ New ❑Expansion CqModiffcation/alteration 6.DESCRIBE PROJECT BRIEFLY: ILS R�_Pc.ACf— 4Q ISZI (QCZ> STVNe sL�1li­-6 P(rilo TaRN v? 0)-( Nvgel c ift(i& SIPOJ Dy — rt- 05', hc(siNta STD toE; Q�J1L�DvP c�nJ 3'1 6AAvE1_, GRSe oN G2AflE . 00 2,E1f3r1WWG WA-Ltr . 7.AMOUNT OF LAND AFFECTED: Initially •005 acres Ultimately 005 acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? LZSIYes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential ElIndustrial OCommercial DAgriculture El Park/Forest/Open Space Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) Yes ®Ne If yes, list agency name and permit / approval: A R VAL? ❑Yes XNo If yes, list agency name and permit / approval: 12 ASA RE ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? es No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Namer�s�l��rj�LL fat-'LJV��� C. -1'1�'t�� Date: l lrsb ' Signature If the action Is a Costal Area,and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART 11- IMPACT ASSESSMENT To be completed by Lead Agency) A DOES ACTION EXCEED ANY TYPE f THRESHOLD IN 6 NYCRR,PART 617'.4? If yes,coordinate the review process and use the FULL EAR - El Yes Q No S. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative dedaralion may be superseded by another khvelved agency. Yes [Z]No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,If legible) C1. Exisflng air quality,surface or groundwater quality or quantity,noise levels,existing traffic pater,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,ardheeOlogical,historic,or other natural or cultural resources;or commurhty or neighborhood character?Ehplaln briefly: C3. Vegetation or fauna,fish,shellfishor wildlife species.significant habitats,or threatened or endangered species?Explain Wiefly: 04. A community's existing plans or goals as officially atlopted,or a changein 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 adion7 _ Explain bnefly: C6. Long term,short.term,cumulative,or other effects not identified in C1-05? Explain briefly: C7. Other impacts Llnducliu than es in use of either uan it or l of ene O. WILL THE PROJECT HAVE AN IMPACT O AREA(CEA)? If s,explain THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL AL lain briefly: ENVIRONMENT Yes Q No E IS THERE,OR IS THERE LIKELY TO 8 CONTROVERSY RELATED No TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? It ves kh: -❑ Yes Q PART Iii-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: Foread"i sidvelse effectidOntillied above,determine whetherit Is substantial.large.importantorotherwisesignificant Each effect should be assessed In connection with its(a)setting(Le.urban or rural):(b)probability of occurring;(C)duration;(d)hieversl�ily;(e) geographic soopw and(1)magnitude. If necessary,add attachments of reference supporting materials. Ensure that explanations contain.. sufficient detat to show that at relevant adverse impacts have been Identified and adequately addressed. If question d of part t was duKked yes.thedetermknaton Ofsignific®nce mustevaluate the potential knpaciofthe proposedaction on the errAronmentaloharacterfl;ftofthe CEA Check rich box Ifyou have Identified one ormore potentially large orsigniflcan(adverse Impacts which MAYoccur.Thmh proceed directlyto the F EAF anEfor prepare a positive declaration. Check this box tyou-have determined.based on the Information and analysis above and any supporting documentation.that the proposed a WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons Supporting pportkg IN Board of Trustees Name of lead Agency �✓ ' ( / Oate .44 r7 f ��,,IA)lr President D Print or Type Name of Responsible Officer in L ad Agency Tolle of Responsible Officer Sgn re of Responsible Officer in Lead A cy Signature of Preparer(If different from responsible officer) ylla'Mt4t-slollTown of Southold Ers $Q"" ntadon & StonwWatw Run-off ASSESEMENT FORM MdpTasftrTAGt7tTik sc7xa TMiFOLMAlA1OAMOMMAY>NGUM1116i{�OFA lffiem WMWFloe - Ter— OT WVMM SCOPE OF WORK - PROPOSED CONS MUMON 1326[N / WORKASMMN[FN'T Yn No a. 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SSELI 6(p J6L A?L(E._.being duly mra,dept.atd says that he/she is Tie aWiant for Fermis, AMthat Wshe is she ..__...__.. _____!7 ..... __ ....._ __... ._.__.._...._ ......__...._..... Niter.com"M AYuL Cnawri aiev.�iej_-�'• Owner and(or repraepsa&e of she Owner or Owoess,and is duly authorized to perform or have petforraed dse said work and to make and fik this appliafto dot all statements contained in th is.appfiafian are n7te to she Deet of his knowk*and heW and that the work will be performed in the manner set forth in the apocabon filed herewith. Swum to before me this, .......... May 20%3 t��.............. Nosy Public: ..._...��G _. tl FORM- 06/10 DOROTHY 5 OGAR Notary Public, State of New York No 52-8200218, Suffolk County Commission Expues August 31,0l0y Board of Trustees Application County of Suffolk State of New York Mai:-i BEING DULY SWORN DEPOSES AND AFFIRMS THAT HFJSHE 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 REV EW OF THIS APPLICAAT QIY Signature o y Owner SWORN TO BEFORE ME THIS I L' __DAY OF TC,, ,,A, 2013- i Notary Pdblic I� f NANCY SBARTOEunt Notary Public .State o1 N NO. 01BA624684 Qualified in Suffolk CMy Commission Expires i I 1 i 0 0 Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) 1 _residing at - (print owner of property) (mailing address) do hereby authorize (Agent) to apply for permit(s)from the i Southold Board of Town Trustees on my behalf. (O ner s signatu I i I i �I i • • is APPLICANT/AGENT/REPRESENTATWE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers Nd entity ea The purpose of this form is to provide information which can alert the to of pn sible conflicts of L terest and allow it to take whatever action is necessary to avoid same. - YOUR NAME: e o sexzr O'X tJ 1j N1 (Last name,first name,iriddle 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.) 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 offiar 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 V If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agpnt/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 Its day of <JWVJ 20Q Signature Print Name Form TS 1 (�. (ZJj5Cx Latft1 PLN tea . Town of Southold • . LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law, This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town) 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail. listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION sCTM# /o oo _S1 — I — 22 . 2 /d d o/51 l t(22.2 PROJECT NAME OXONtA 2EStPekiGE 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) Pemut,approval, license,certification: IX7( Nature and extent of action: �1 RC e44° C^Zc tS'c7NG /o' �2oi A PPiea�c S c Dr/ PRTto - V yc C-c IS17W.--> -T&U ES o oi 2�' C RtRw&L-l td 5rc � fl �tLfL2�S o� PFI i 10 ��02E SHHiVpY Location of action: • • Site acreage: 25, 12"D S? FT Present land use: 9 ot!->I JC71�V Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: 20 bW-T cr-AN" (b) Mailing address: 1 O> 62 5 SO%J h/W(G-N A- /61\A)G 50OT1- LAR N7/ 11 ':�71 (c) Telephone number:Area Code( ) 6" 322 1 aSo (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No K 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. dYes [] No 0 Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III-Policies Pages 3 through 6 for evaluation criteria 0 Yes ❑ No 9Not 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 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 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 1:1Yes ❑ No MNot 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. ❑ ❑ d Yes No Not Applica� • 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 dNot 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 VNot Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. 11Ye9-1n No 2Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES 0 • Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No VNot Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town w}suers. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ElYes ❑ [zNot 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. 11Yes ❑ No I� 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 1:1No I t'/Not Applicable PREPARED BY—K (?—OSS&c t_ G t_a V&2 TITLE ftVe-tjh LEC'-T DATE t IS ( 13 A'�N'� K Russell Glover Architect PC Box 1031 Shelter Island Heights NY 11965 631 7490950 631 332 0517 mobile. C 2 � p p E Board of Town Trustees D LS V L D� Town of Southold Town Hall JAN 2 4 2013 53095 Main Road PO Box 1179 Southold Southold Town NY 11971-1892 Board of1, steel January 24th 2013 Re:- Hurricane SANDY Oxnam Residence 19625 Soundview Avenue Southold NY 11971 Tax Map k 1000-51-01-22.2 Please find enclosed 2 copies of the following- ]- ollowing-1- Completed Board of Trustees Application Form for an Administrative Wetland Permit 2- Pictures taken before and atter Hurricane Sandy of the subject stone patio on grade. 3- Current Survey showing subject patio dated 1/2/13 Please contact me if you need any further information. Yours very truly K Russell Glover N SURVEY OF PROPERTY AT SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y, 1000-51-01-22.2 _ SCALE: 1'= 40' APPROVED BY JANUARY 2, 2013 L BOARD OF TRUSTEES ONGp PD E Q EIV ETOWN OF SOUTHOLD 1S 2 Z c r3 DATE S7,� ��/� JAN 2 4 2013 � 4y 4�J8;F S outholdiewn µv ?9.64• s, QI BoardTrustous BJ zt0 '-� Az :?may. ?p F d+f+I-p C ep SOD S Bpm °g \%04 �✓ �� � � q0 ur � `� s� ��B� ��� >zw `a • kt ��� + UPPER DECK 25.4 OVER LC e ❑ 1-4 WER DECK f ❑ 2 STORY a do FRAME 20,5 j •W HOUSE & GARAGE zo.D' Q O l2 t' \ O N Q. U 2 `21.2' �RETWALLS I� pR1VEWAY � 3 2 Q Z 9B. CUge / z i 1 M f cr, S'pU N� P 1�,d i per. � . 703pp= 4 �P��pF NEIN•J•C ■ = MONUMENT FLOOD ZONES FROM FIRM. NO. J610JC0158H SEPT. 25, 2009 1k yt + h xc� ELEVATIONS AND CONTOURS ARE REFERENCED TO NGVD. ! COASTAL EROSION HAZARD LINE FROM q,0 4�,� ,1p• COASTAL EROSION HAZARD AREA MAP. PHOTO NO. 55-578-83 AREA= 23,526 SQ. F'7 (TO 77E LINES) °pLANO N. .S. LIC. NO. 49618 ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION JCKONIc YORS, P.C. OF SECT70N 7209OF THE NEW YORK STATE EDUCATION LAW. (631) 765-5020 FAX (631) 765-1797 EXCEPT AS PER SECTION 7209—SUBDIWSION 2. ALL CERTIFICATIONS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF P.O. BOX 909 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER STREET 12-307 WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N. Y. 11971