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HomeMy WebLinkAboutTR-8159A James F. King, President ~~Of SDUly~ Town Hall Annex Bob Ghosio, Jr., Vice-President ~ 54375 Main Road P.O. Box 1179 Dave Bergen # ~ Southold, New York 11971-0959 John Bredemeyer H ~ Michael J. Domino ~ ~ ~O Telephone (631) 765-1892 ~~io~ ~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0881 C Date: AllQUSt 2, 2013 THIS CERTIFIES that the replacement of the deck boards on the existin 4g 75 sq ft deck and 4'x4' staircase to Qround• and construction of a 2'x20' staircase on southerly side of deck At 1 110 Cedar Point Drive East. Southold New York Suffolk County Tax Map # 90-2-20 Conforms to the application for a Trustees Permit heretofore bled in this office Dated Apri130, 2013 pursuant to which Trustees Administrative Permit #8159A Dated Mav 15, 2013, was issued and conforms to all of the requirements and conditions of the applicable provisions of taw. The project for which this certificate is being issued is for the replacement of the deck boards on the existing 475 sa ft deck and 4'x4' staircase to ground: and construction of a 2'x20' staircase on southerly side of deck. The certificate is issued to PAMELA J. WILLIAMS REV. LIV. TRUST owner of the aforesaid property. rW o~ uthorized Signat re i ~ James F. King, President ~g~fftK,r Town Hall, 53095 Main Rd. Bob Ghosio, Jc, Vice-President P.O. Box 1179 Dave Bergen ~ ~ Southold, NY 11971 John Bredemeyer Gy ~>F Telephone (631) 765-1892 Michael J. Domino ~4j * Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: (/t~U,c ~ ao/a Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction ~/z constructed Project complete, compliance inspection. INSPECTED BY: ~I . ~ ~k COMMENTS: CERTIFICATE OF COMPLIANCE: ma.l cry cr~c I2a-~Sey Con s-Iv~rf~"on James F. King, President O~4S11FFQ(,(-C y, OG Town Hall, 53095 Main Rd Bob Ghosio' h, Vico-President ~ y Datro Bergar. ~ ~ - P.O: Box l (79 JohnBtedemeyer phZ. Southold,I~ L197k . Michael J. Domino y?/P p!~ Telephone (631) 765 1892 1 ~ ~ Fax (631) 765-664 f BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLO YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PR10R TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR APRE-CONSTRUCTION INSPECTION. FAILURE TO` DO SO SHALL BE COMSIDEREO A VIOLATION ANO POSSIBLE REVOCATION OF THE PERMiT. INSPECTION SCHEDULE Pre-construction, hay bale line 1~ day of constuction censtructed Project cemplete, compliance inspection James F. King, President ~pF SOUK, Town Hall Annex Bob Ghosio, Jr., Vice-President ,~0~ 54375 Main Road Dave Bergen P.O.Box 1179 Southold, New York 11971-0959 John Bredemeyer G ~ Michael J. Domino ~ ~O Telephone (631) 765-1892 (~-~,QU~'~~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD Permit No.: 8159A Date of Receipt of Application: April 30, 2013 Applicant: Pamela J. Williams Revocable Living Trust SCTM#: 90-2-20 Project Location: 1110 Cedar Point Drive East, Southold Date of Resolution/Issuance: May 15, 2013 Date of Expiration: May 15, 2015 Reviewed by: Board of Trustees Project Description: To replace the deck boards on the existing 475sq.ft. deck and 4'x4' staircase to ground; and to construct a new 2'x20' staircase on southerly side of deck. 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 project plan prepared by Ratsey Construction, received on April 30, 2013, and stamped approved on May 15, 2013. Special Conditions: None Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. James F. King, President Board of Trustees gyFFO(,~ James f. king, President CQG P.O. Hox 1179 Hob Ghosio. Ir_~Vice-President ~ 1~ SoWhold.NY 11971 Dave Bergen ~ ~ Telephone (631 765-1892 .bhn Rredemeyer ~ ~ Fax (631) 765-6641 Michael I. Domino ~ 'F ~'~Of # ,~aa. Southold Town Board of Trustees Field InspectionNVork Session Report Date/Time: 5 ~ ~ Ratsey Constru tion n behalf of PAMELA J. WILLIAMS REVOCABLE LIVING TRUST requests an Administrative Permit to replace the deck boards on the existing 475sq.ft. deck and 4'x4' staircase to ground; and to construct a new 2'x20' staircase on southerly side of deck. Located: 1110 Cedar Point Drive East, Southold. SCTM# 90-2-20 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: Modifications: Conditions:- a.? ~r Pre~nt Were: ? J. King Ghosio ~ D. Bergen, J. Bredemeyer~_ Michael Domino D. Dzenkowski other Form fill d o the field~by~ Mailed/Faxed to: Date: f, ~r-.~,~ ~ e~~~g'Y.fT~~'ir.' ~ ~,lAs~e~ k _'w^ s ,`4°{'ht~:ry~y - fi si>--- e~ P -~I~§ 'y~~ - ~~iki it 7 ~ - i. 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WILLIAMS REVOCABLE LIVING TRUST SCTM#1000-90-2-20 Ratsey Construction on behalf of PAMELA J. WILLIAMS REVOCABLE LIVING TRUST requests an Administrative Permit to replace the deck boards on the existing 475sq.ft. deck and 4'x4' staircase to ground; and to construct a new 2'x20' staircase on southerly side of deck. Located: 1110 Cedar Point Drive East, Southold. SCTM# 90-2-20 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney James F. King, President ~QF S~U)y Town Hall Annex Bob Ghosio, Jr., Vice-President ,`O~ 54375 Main Road y P.O. Box 1179 Dave Bergen T ~ Southold, New York 11971-0959 John Bredemeyer G ~ p~ Telephone (631) 765-1892 Michael J. Domino ~ Fax (631) 765-6641 ~~OOUNT'1,Nc~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only __Coastal Erosion Permit Application/ Wetland Permit Application ? Administrative Permit _Amendment/Transfer/ xte ron ~eceived Application: ?JD j ~~P(eceived Fee:$ ae ~~`ompleted Application ~ 3 D G C ~ ~ ~ ' -Incomplete SEQRA Classification: Type IType IIUnlisted APR 3 0 2013 C~oordination:(date sent) WRP Consistency Assessment Form ~ 3 CAC Referral Sent uthold own Date of Inspection: Receipt of CAC Report: Lead Agency Determination: Technical Review: Public Hearing Held: Resolution: Name of Applicant ~~~29C ~ [/~J//~~/'' S Mailing Address~~N1\\ ~ ~ Phone Number:'1~ - ~~~lO Suffolk County Tax Map Number: 1000 l~~" nOZ ' ZG Property Location: (`~c~t~ yam,- ~~y ~Vl~ln (provide LILCO Pole dtstance to cross streets, and location) `tl (If applica-bhe~) Address: ~ L ~ ~1r15 Phone: ~9~1~''-C"f~" V`t-t"l Bo>• of Trustees Application • 1 GENERAL DATA Land Area (in square feet~):~~~G -~-1~-r Area Zoning:~~y G~-~~ Previous use of property: JC~.r'(~ Intended use of property: 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 requi e 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 126 ~Z.aR 'C1~K~,~Yj, JE'ti''(`1~.1 ~ No prior permits/approvals for site improvements. Has any penmit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: Project Description (use attachments if necessary): 'LP C~ J1'~ L~-} S ~ _ ~ Boar•f Trustees Applicatioa • WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Ili ~a~ ~ c ~r~~ r7.~.R~S C~N~C'~_.- ~~~V~~ Area of wetlands on lot: square feet Percent coverage of lot:,__~__% Closest distance between neazest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: ~ feet Does the project involve excavation or filling? No Yes ~l If yes, how much material will be excavated? V cubic yards How much material will be filled? V cubic yarld~s Depth of which material will be removed or deposited: feet Proposed slope throughout the azea of operations:-- Manner in which material will be removed or deposited: ~ a VY~~'1(`~ C1.~~ ~~Q ~w1 C~i,.~n~~R~ 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): X~t • sn.zo • SEAR PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART t • PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME 3.PROJECT LOCATION: Municipality s County 4. PRECISE LOCATION: Sheet Addess antl Road Intersections. Prominent landmarks etc -or provide map ~ ~ ~(\-lc \ b \ ` 5. IS PROPOSED ACTION : ? New ? Expansion IC7~Modifcation /alteration 6. DESCRIBE PROJECT BRIEFLY: L~y ~ ~n`~ ~ ~e~~ac-e d~ ~ ~ bcaRc~ can ~ - l1tLL a~ u~ sve~ I. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WIWI/LIL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? 17~I Yes ? No If no, describe brieFly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential ? Industrial ~ Commercial Agriculture ? Park !Forest /Open Space ? Other (describe) 1O.~DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) Yes AMINO If yes, list agency name and permit /approval: L~J Y ERMIT APPROVAL? OYes 14~No If yes, list agency name and permit /approval: 1I2~. LA'S A R t U~LT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? LJres No I CERTIFY AT THE INFOR ATION PROV(I~,D~ED ABOVE IS TyR,,U~E~ T`O THE BEST OF MY KNOWLEDGE Applicant /Sponsor M\\~ ~ Date: Signature I the a ion is a Costal Area, and you are a state agency, complete he C astal Assessment Form before proceeding with this assessment PART II -IMPACT ASSESSMENT To be tom feted b Lead A eoc A DOES ACTION EXCEED ANY TYPE f THRESHOLD IN 6 NYCRR PART 61T.4? If yes, coord'male d,e review process and use the FUII EAF. - Yes Q No 8. YYILL ACl10N RC-CEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACT70NS IN 6 NYCRR, PART 617.6? If No, a negative Qedamdan may be srgrerseded by arrotfier inwlved agency. Yes ~ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED MATH THE FOLLOVNNG: (Answers may be harMwritten, illegible) Ci. Existing ah quadty, surface w groundwatw quafity or quantity, noise k+veis, eidsting traffic pattern, safid waste produdion er disposal, potential for erosion, drainage w flooding problems? F~tlain ixietiy: C2. Aesihedo, agricultural, ardieedogMal, fdstorie, w oilier natural ar Guttural resburces; ar mriimundy w neigliboriiood charade(I F~ylain briefly: C3. Vegetation or fauna, fish, shellfis 'or wildlifespedes, sgnifipnt habitats, or Ihmatened or endangerr.W spades? Explain briefly: C4. A oommuniry's ezisdrg plans ar goals as o~daay adopted, or a change in use or inlensiry of use of land w other natural resources? Explain briefly: C5. Growth, subsequent development, or related adivities likely to be induced by the proposed adion? Fxplain briefly: C6. Long term, short term, amulauve, or other effects no( identified in Ct C5~ Ezplam brefly: C7. O(her impacts fndudin than es in use of either uantil or t e of ener ? Ex lam briefl : - D. WILL THE PROJECT HAVE AN IMPACT pN THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED TH£ ESTARLISHMENF OF A CRITICAL ' ENVIRONMENTAL AR64 CF1i ? If es, ex lain briefl : - Yes Q No E IS THERE, OR IS THERE LIKELY TQ 8 CONTROVERSY RL-7.AlED TO POTFMIAL ADVERSE ENVIRONMENTAL IMPACT'S? If ki: -Q Yes Q No PART IN - DETERMINATION OF S'KiNIFICANCE (To be completed by Agency) INSTRUCTIONS: Fweachadverseettedidentifredabove,detenninewhedierdissubstaotial,large,importanlwatherwisesignificank Eedt aged should be assessed in edlulecdon with iW (a) setting lie. urban w ruraQ; (b) probatiidly d occurring; {c) duretien; (d) irreversbd'dy; (e) geographic tawp~ and (f) magndude. If necessary. add attachments w reference supporting materials. Ensure that explanations contain - . _ and(iciard dated to show that ad relevant adverse Mlpads have been Mendfied aM adequately addaessed. ttQuestion d of part d was dledced yes, the detertnina(ion of sign lfiwnoe must evaluate dre potential impadof the proposed adbn on ilia erKirwsnental oharaderisdcs of the CEA Cfiedcdlfsboxdyou here Werlflfied onewmore potwitiaflylargewsignificantadverseimpadswMch MAY occur. then proceed dheWylo the FJ1F andfw prepare a positive dedaralion. Check tlds box dyou~have delermhied, based an ilia Mfomiation and analysis afore and any supporting daamterdadon, drat the proposed a WILL NOT result M any sigriiflprd adverse emiironmental impacts AND provide, on attachments as necessary, the reasons suppordrg till determination. Board of Trustees ~ S/3~3 Name of lead Agency Date ~A H9 f ~ ~~/N lr President is Pnnt or T Nype ame of Responsible Officer in Lead A envy Title o(Responsible Officer Sgn re of Responsible O~cer in Lead A nq Sgnature of Preparer (If different from responsible officer) ~d of Trustees Application . County of Suffolk State of New York ~ r~ . ~~v V ~ ~I 1~tN.S BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE TS 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 TN THE MANNER SET FORTH IN.THIS APPLICATION AND AS MAX BE APPROVED BY THE SOUTHOLI' TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF FOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNAER 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 ENT1;R ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION W[TH REVIEW OF THIS APPLICATION. ~ Q` rgaatwre of Property Owner SWORN TO BEFORE ME THIS ~3. DAY OF 20~ r•. s ` .one ~r~~-zola Notary P blic ' 1°" t~d of Trustees Application AUTHORIZATIO~i (where the applicant is not the owner) ` ` ~ ~ ~ ~ ~~~fr vwS zesiding at ~~s:s ~ l~Z~ti t~o~T , l\1 1 l I ~ ~ ~'j (print owner of pzoperty) (mailing address) do hereby authorize (Agent) `Z~-~zti ~c,~~~~o-t ~ ~ to apply foz permit(s) from the Southold Board of Tawn Trustees on my behalf. ner's signature) APPLICANT/AGENT/REPRESENTATI VE TRANSACTIONAL DISCLOSURE, FORM The Town of Southold's Code of Ethics prohibits conFlicts of interest on the Dart of [own officers and employees. The putvose of rhi~ form is to ttrovide information which can alert the town of possible conFlicis of interest and allow it to take whatever action is necessary to avoidrr~same. 1 - YOUR NAME: ll\\h ~.:~tl ~~L1'(J'~~C'Tl~n (Las[ name, first name, middle initial, un ess 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 J 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 ot~cial map Planning Other (If"Other", name the activity.) ~~Y1~i~~~ 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 [own 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 fTTOrmTand~~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 applicanUagent/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 rnrporation); 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. DESCRIPTION OP RELATIONSHIP Submitted this day of 200 _ Signature Print Name Form TS 1 ! • dark Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM ~ ~ PRDPERTY LocanoN: s.c.T.M. p: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A ~Jpj .L ~ STORM-WATERr GRADING, DRAINAGE AND EROSION CONTROL PLAN 'i' a~~ set on ~ cr ~t CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NFIN YORK. SCOPE OF WORK -PROPOSED CONSTRUCTION ITEM # /WORK ASSESSMENT Yes No a. What is the Total Area of the Projed Parcels? ~ Will this ProJed Retain All Stone-Water Run-0If (Indude Total Area of all Parcels bcaled within ~ Genereted by a Two (2') Inch Rainfall on Site? the Scope of Work for Proposed Construction) (This item will include all runoff created by site (S.F. /Aces) b. What is the Total Area of Land Cbadng deadng andlor constmction activitles as well as all andlor Ground Disturbance for the proposed ~ Site Improvements and the pemranent creation of censtrudbn activity'? impervious surfaces.) (s.F. / Apes) PROVIDE BRIEF PROIECI' DFSCRIPTION (P~owm Aaamow Fayes nNeaMtl) 2 Does the Site Plan andlor Survey Show All Proposed ? Drainage SWctures Indicatlng Size 8 Location? This Item shall Indude all Proposed Grade Changes and L>\„~ ,.l,ry. 1~ MC Slopes Controlling Suface Water Flow. 1~,~~, M AJ 3 Does the Site Plan andlor Survey describe the erosion `r ~ (~Q'1 C~~aS ~ ~ and sediment control practices that will be used to control site erosion and storm water discharges. This (~iCXI z ~jry;t~m,0o h)~,~~ (a;Jl~,wn~.~L4 item must be maintained throughout theEnfire a.~sary-~k `I~ ~ ~0. Conshudion Period. c~~ ~ Y ~~e_\~ YC 1\Q~Y- ~f ~U 4 Wiii this Project Require any Land Filling, Grading or ? ~4^1^ - , i Excavation where there is a change to the Natural C%- lam' Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? ~j 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 Nrough the ? Site? is this Projed within the Trustees jurisdiction w General DEC SWPPP Requirements: or within One Hundred (100') feet of a Wetland or Submissbn o(a SWPPP h required br all Construction activities invdving soil Beach? d'atuNances of orre (i) or more acres; inducting disturbances of less Nan one acre mat 7 Will there be Site preparation on Existing Grade Slopes ? em pan of a legler comnan pan roar wiN ulgmarety disturb one or more acres of IarM; which Exceed Fitteen (15) feet d Vertical Rise to Inducting Canswction activities InvWing soN disludbances of less than one (7) acre where One Hundred (100') of Horizontal Distance? - ma DEC has determined that a SPDES permit is requirect for stone water discharges. (SWPPP'a Shall meet me Minimum Requlramems of the SPDES General Permit $ Will Driveways, Parking Areas or other Impervious ? ~ for Storm Water Discharges eom Consmuckon activity -Permit No. GP-0-10401.) $urface3 be Sloped t0 Diced $tdRfl-Water Run-Off w 1. the SWPPP shaA be prepared prior to the submittal of the NOI. The NOI shah be Into andlor in the directlon Of a Town right-of-way? - subMketl tithe Department prior to me comnanoemenl of constmctlon activity. 2. The SWPPP shall desaibe ttte erosbn and sedMent cemra practices arM where 9 Will this ProJed Require me Placement of Material, ? required, p0stconsbuctbn storm water management Drectices met wAl be used anNOr Removal of Vegetation andlor the ConstrOCtien of any construc4d to reduce the poAmams h storm water dscharges and w assure Item Wimin the Town Right-of-Way or Road Shoulder compliance with the terms end candtians of th5 pemrk. to addttbn, me SWPPP shall Area? (Thb tmm Mn xoT Inclose me Inmletlan a grlrewey Apwu) bentlry potential sources of poAUtion whlU may reaconebly be expected to enact me quality of sloxn water dlsdlarges. NOTE: x My Mower b Ougtlga One mrough Niq la Mswarlld wkh a Click Mark 3. AA SWPPPS mat requke me postconstmclbn storm water management practlce In a Box qd Uw corgtructlan aka diaturbana b batvnah 5,000 S.F. 8/ Acre In eru, corrlporxmt sheA t>e prepared try a qualified Design Professkxlal Licensed in Newyork a Sbrm-Water, OradlnA oralnaga • Erosbn Cam,ol Plea is Raquked by U,e Town of met b knowtedgeeMe in the pdndples end pmdbes of Stone Water Management. Soumold aM Mwl be Submkbd far Review Pdorto bewrlw of My BuiMirg Pamk. (NOTE: Atllxk Mark(~)anNar A,rewerbr eadi Guestion'w Requmd fore Carpk4 App&etlon) S1'A1'E OF NE ORK, ~ C v That I . . being duly sworn, deposes and says that he/she is the applicant for PertDit, ( of bdrvitlual signi t) And that he/she is the h 7'"E~'Q " (QHtrer~ Contractor, Agent, Corporate Officer. etc.) Owner and/or representa ' e of the Owner or Owners, and is duly authorized to perform or have performed the said work and to make and file this appli tion; that all statements contained in dtis application are true to the best of his knowledge and behef; and that the work will be performed in the manner set forth in the application filed herewith. Swom to befor~ m^e. this; .........................1(J....... day f .~.1 /e ~ L-'......r...... , 20.W~ KU - -~S%R~~ V L KLA Notary Public a s-CTAT6- (Sgnewre d Apptian FORM - 06/10 cuann•d fn Suffolk County My Commlulon ExpheN November 06. 4015 Town of Southold • • LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for pemuts* 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 'fgm scant 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, IistinE both supportin¢ and non- supportin¢ 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. ~~n B. DESCRIPTION OF SITE AND PROPOSED ACTIO IU) ~ ~ ~ ~ ~ ~ D ~IJn~I SCTM#~_- OZ -~Q_ APA 3 0 X013 PROJECT NAME r f Tru ; ^s 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 duectly by Town agency (e.g. capital ? construction, planning activity, agency regulation, land transaction) ? (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of ac~tio~ny: ,~i~ C~Cd1VY~ 1"JY~.~S f' ~'Y~(`C4!~~~ ~l ~-1 ~ ~ gi G~- C~c~h S~,er~t('~ ~1o'~P~~~!'~ ~-fr~~p} C~xv'# CiV~5~P46`~ Y,P4~J ~QCC1S44P ~f ~ C~ ~ ~ ..LVJ~K- lYC ~ ' Location of action: t ~ \p p~42 ~~tlk ~t:~1'1~~\~ Site acreage: ~ a aj+-4 Present land use: ~~(1Qy~4~(^+L~ Present zoning classification:_~,y(~~~,1(~ Q 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be prov(i~ded: (a) Name of applicant: lad\~ f\ I~~Q;~?p ~ Q~j,~'~t(p (b) Mailing address: ~ '~i`~~- ~~j ~\A~-~. (c) Telephone number: Area Code Q I'>~` 1-~~~- (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 ~ 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 - Pfo},licies 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 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 ? 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 LWRP Section III -Policies; Pages 22 through 32 for evaluation criteria. ? ? Yes No Not Applic~ • 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 was~tjes. 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 LWRP Section III -Policies; Pages 38 through 46 for evaluation criteria. ? Ye~ 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 (b~~11 ~ TITLE C~LYI~ DATE i SURVEY OF LOT 101 APPROVED BY SUBDIVISION MAP OF BOARD OF TRUSTEES CEDAR BEACH PARK TOWN OF SOUTHOLD FILE No. 90 FILED DECEMBER 20. 1927 SITUATED AT DATE 51513 BAYVIEW TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-90-02-20 SCALE 1 "=20' AUGUST 14, 2007 nanrc AREA = 26,344 sq. it. WapD DDCK\ (TO TIE UNE) 0.605 a0. nOAnNc ' 7� WWp ppCK ME1 CEDA K p °.Unl,y oi l ° . - b OI.N • T°TDL rlI VE p .a ASPH,LT P/yEMEM • EA (� I°%PE EOS 81-S 40aa 4A .'EA 4lJlLI101.8 p I °• ,y NO I ;0 300.0' . I • • °' N r ISI j e' C , jm I^ I 4 . Zi hl , • 4, p i 0 I, I : p qcl 9k I • A $ O WAV 0 'PS wCo0 DECK •A • ° •. •° q I O�g' 'n7 IWOD WOOD PECK TVv ML r� SRPS • , •° , A FlLL DM' 14.6' WOOD DEC, CHIMNEY WaOp OfOH PkHiER • CONIC, ° ♦ .. �O FENCE ,n 0.3'W 1A.4' ;: : .,,.:I, Wa00 WAS y es n (aARAGf UNDER! IroOa \~ uHli n 1 ¢ 2 ShPs o e °4 STORY FRAME HOUSE KEY & GARAGE cTC rz^ E F I U Q 1 1e.0' WANc °e¢I, x.N` 4 WOOD DECk \ CONC 6 21.0' EORZLD,1EP5 W WOOD DECK � NOTE: THIS PARCEL ALSO BEING KNOWN AS LOT 10 ON MAP No. 1 OF PART OF PROPERTY OF EDWIN H. BROWN I � FILE OFFICE106 AS THE C ERK OF No. 802 SUFFOLK COUNTY ONJANUARY , 92FILE �y ITOP OF SLOPE E NC T. Fp E.E O G� Wln nl Pap Ca a9KEE y\WjDW 2 I WOOD BU(AHE,,D WOOD OEC' p 3 STANDARDS I FOR CTIRE ORDANCE SURWITH S AS ESTABLISHED O BY THE LIA.LS. AND APPROVED AND ADOPTED sWO BE1CH� \ O FOR SUCH USE BY THE NEW YORK STATE LAND_ I WOOD 1TILE AS N. N 79. <0 �' q' Tr 37'50" �/ WATER MARAL"ON APPA4ENi NIaH00> � � (n J" t,l • o, � AUGUST y, 4 101.08' u H0 G LAND NY.S. Lic. Na. 50467 1 1 UNAUTHORIZED AIIERATION OR ADDITION CpNIc BAYJ A -r TO THIS SURVEY IS A VIOLATION OF Nathan Taft Corwin III SECTION 7209 OF THE NEW YORK STATE EDUCTION UW COPIES OF THIS SURVEY MAP NOT BEARING Land Surveyor THE LAND SURVEYORS INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALL TO THE Title Surveys — Subdivisions — Site Plans — Construction Layout TRE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON. AND TUITION CESRTIFICATIONS ME NOT ITRANSFFEEMBLE. PHONE (631)727-2090 Fax (631)727-1727 OFFICES LOCATED AT MAILING ADDRESS THE EXISTENCE OF RIGHTS OF WAY 322 ROANOKE AVENUE P.O. Box 1931 AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. RIVERHEAD, New York 11901 Riverhead, New York 11901-0965