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HomeMy WebLinkAboutTR-8178A James F. King, President ~QF ~~Ury Town Hall Annex Bob Ghosio, Jr., Vice-President ~0~ Old 54375 Main Road P.O. Box 1179 Dave Bergen ~ ~ Southold, New York 11971-0959 John Bredemeyer G • ~O Telephone (631) 765-1892 Michael J. Domino ~O Fax (631) 765-6641 ~y~QU~fI'1,N~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0871 C Date: July 8, 2013 THIS CERTIFIES that the reoulaz maintenance of established foot oath which includes spreading out of woodchins along the path At 12400 New Suffolk Avenue Cutchogue, New York Suffolk County Tax Map # 116-6-12.1&12.2 Conforms to the application for a Trustees Permit heretofore filed in this office Dated Mav 1, 2013 pursuant to which Trustees Administrative Permit #8178A Dated Mav 15, 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 regular maintenance of established foot path which includes spreading out of woodchins along the path. The certificate is issued to TODD FREED owner of the aforesaid property. ,u t~ uthorized Signal re James F. King, President O~~tff0(,rCO Town Hall, 53095 Main Rd. Bob Ghosio, Jr., Vice-President ~(y P.O. Box 1179 Dave Bergen Southold, NY 11971 John Bredetneyer ~ Telephone (631) 765-1892 Michael 1. Domino ~1* ~,y0 Fax (631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE F INSPECTION: 7 1 / Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 15t day of construction '/z constructed Project complete, compliance inspection. INSPECTED BY: ~ ~ es- • - COMMENTS: CERTIFICATE OF COMPLIANCE: O T c 09/07 '15 TUE 15:27 FAX 891 785 8145 SOUTHOLD TOtYN,CLER%- Trustees f~001 07/09/2013 14:59 6317656641 ELIZABCaTHA. N.EVILCE TOWNBAGL, 53095 MAIN ROAD 7ClWN CLJrs'.R.rf ,P.O. BOX 1179 .R.E'GI~TBAR OXa VITAL STA77SX"ICS SOfTI'ITOLD 1X971 ~sARKIsfGE OX*FICER +FA.~ 63X-76S--.6145 FLCO,RI7SM.rl1VAGClId`Xs"NT O.CI'ICL`R T~ERXs,P,KO1t1E: 631-7GS~X800 FR~L'X7014f0(G'INFORA~fATlON014'FCCE[i sautkoldtown.norlkforknet O>ir+TCL OF TAE TOWN CI,ETikC TOWN OF.5014J'I'I~IOLD APPLICr~'I'IOI~I I+'OR PUBLIC ItCCL+ SS TO.L~ECORAS TNSTRi[7G°CxO.NS: Prase contp(ete scetion i of this forDt aad give to Tburct Clerk's Oft'CCe (agency Freedoat of In£oianation OCfiicer). qne copy will be returned to you in response to yow• rcquest,or as an interim response, ?i?4•~~l+a?•aaff•aaaa.+.ffafa•?aae~++!?+f i+a?+?lH fa1la4•aafal a+aa•all.• s~cczorr z. To: i Ry STQe~ (Departu~enl, or Uf6cer, if[<nown,•thal has the information you are. requesting), 1ZECOT2U XOU G'4~CSI{ TU [NSPCCT: (Describe the record' sought. [f possible, sigi~~ly dnPe, tile. title, tax map nuGVher, and any other pertinent infermation). Signaxute ofAppl~icaynt: /1 u •Prttlted (dame: "L~l- t>1eTi • Mailing Address (i£different Front above): [ APPFt.OV;F-Q . - I ) DENI6D+ [ P.PPItOVED ~+I'CEi 17ELAX+ ~Q ItEC;E1VED I3lizabeth -Neville Date Freedom of InfotYtlation OfficeF Band carry to department? dUL 9 ~ Accepting Clerk's Initials Yes_____ No^ Applicant's initials,~_ wothotd Town ~lerlt "`If delayed or denied, see reverse side for exp[analia2. i • James F. King, President O~gUfFO(Mco Town Hall, 53095 Main Rd. Bob Ghosio, Jr., Vice-President = fly P.O. Box 1179 Dave Bergen ~ i Southold, NY 11971 D ~ John Bredemeyer .p n~~ Telephone (631) 765-1892 Michael J. Domino ~1 ~ 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 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 151 day of construction '/2 constructed Project complete, compliance inspection James F. King, President ~~Of SD('/Ty0 Town Hall Annex Bob Ghosio, Jr., Vice-President l~ 54375 Main Road P.O. Box 1179 Dave Bergen ~ ~ Southold, New York 11971-0959 John Bredemeyer G ~ ~ • ~O Telephone (631) 765-1892 Michael J. Domino O~~,COU~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8178A Date of Receipt of Application: May 1, 2013 Applicant: Todd Freed SCTM#: 116-1i-12.1 & 12.2 Project Location: 12400 New Suffolk Avenue, Cutchogue Date of Resolution/Issuance: May 15, 2013 Date of Expiration: May 15, 2015 Reviewed by: Dave Bergen, Trustee Project Description: For regular maintenance of established foot path which includes spreading out woodchips along the path. 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 Todd Freed, received on May 1, 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 gpFFO(~ James F. King, President 0~ C P.O. Box 1179 Bob Ghosio. Jr., Vice-President ~ ~ Southold, NY 11971 Dave Bergen ~ ? Telephone (631 765-1892 John Bredemeyer T Fax (631) 765-6641 Michael J. Domino y 'yol ,~aor Southold Town Board of Trustees Field I/nspection/Work Session Report Date/Time: ~ ~ r~~,~ TODD FREED requests an Administrative Permit for regular maintenance of established foot path which includes spreading out woodchips along the path. Located: 12400 New Suffolk Avenue, Cutchogue. SCTM# 116-6-12.1&12.2 Type of area to be impacted: -Saltwater Wetland -Freshwater Wetland -Sound ~C 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: `-LO-- rc ~ ~'TrcC' , Present Were: J. King B. Ghosio ~D. Bergen, J. Bredemeyer Michael Domino D. 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OFFICE LOCATION: ~~OF SO(/jyO MAILING ADDRESS: Town Hall Annex ,~O l~ P.O. Box 1179 54375 State Route 25 # ~ Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) Telephone: 631 765-1938 Southold, NY 11971 ~ ~ ~O Fax: 631 765-3136 o~~,COU~,N~ LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM ff~~~ Ire To: Jim King, President U Town of Southold Board of Trustees MAY ~ 4 20i3 From: Mark Terry, Principal Planner LWRP Coordinator soucnom r~; r Board a irusCZCS ~ Date: May 14, 2013 Re: Administrative Permit for TODD FREED SCTM#1000-116-6-12.1 &12.2 TODD FREED requests an Administrative Permit for regular maintenance of established foot path which includes spreading out woodchips along the path. Located: 12400 New Suffolk Avenue, Cutchogue. SCTM# 116-ti-12.1&12.2 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed actions are CONSISTENT with the Policy Standards and therefore 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 ~~F SQUry Town Hall Annex Bob Ghosio, Jr., Vice•Preeident ,~0~ O~ 64376 Main Road !I P.O. Box 1179 Dave Bergen l~l J~ Southold, New York 11971.11969 John Bredemeyer Michael J. Domino ~ ~ i~ Telephone (631) 786-1892 O~~,CO ~ Fax (831) 786-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only -Coastal Erosion Permit Applica ion -Wetland Permit Application ~ Administrative Permit D ~ ~ ~ ~ . Amendment/Transf r xtension ~ m • _ Received Application: 5 / 3 ' ReceivedFee:$ /L1J-~ ~AY _ D i Completed Application S/ ~ 203 -Incomplete ~ _SEQRA Classification: Southold Town t Type I Type II_Unlisted f _Coordination:(date sent) / Tr LWRP Consistency Assessment Form,{ 3_ -CAC Referral Sent 17" I Date of Inspection: r / 3 Receipt of CAC Report: _Lead Agency Determination: ~ -Technical Review: 'F Public Hearing Held: ~ Resolution: Name of Applicant F~ Mai)ingAddress_ ~`~a~6fa w~hl R~o.~,~r.uS.~~foh_A7ev~i rk ~IRSb Phone Number:(IlL?) ~3~-.3'71 Y o/ q 14-566 "I2 ~ ~ i_ Suffolk County Tax Map Number: 1000 - ///P - ~ ~ / £ Property Location: 460 AJew S„-~,/~Ik Auen ~~e ~,.-fd.o~c~;.~rK IIg3~ (provide LILCO Pole distance to cross streets, and location) AGENT: F~ I R _ (If applicable) Address: Phone: I Board of Trustees Application i" GENERAL DATA Land Area (in square feet):~~~p~p..~a.(~ DO ~ Sq,.,o,e-ref Area Zoning: Qe C I ~ r`~1~. ~ i Previous use of property: ~ ~ ~ `~a ~ Intended use of property: ~~S ; ~o „'VJu ~ 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 j If "Yes", please provide copy of decision. j Will this project requir y 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 u1~ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes iI If yes, provide explanation: ~ Project Description (use attachments if necessary): 1'~9.rlar .nafn'~enen~P. on cma~/e~ryJon of t'n~ ~HJ~ inr ~.i.lo.i Slrt a,lJnna lw+3l~Q wo n'~O'F Wood C~'~~, I 8• d of Trustees Application • WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Q.- l.~ R~ ~.r ~ ~n 1 l ~ Y.~, ry 0-~-(ae~T~, W~-+.Sn `~,~t.,d.. ~cc ~.,r~ of rail ,z--<..~'.rF "e°.AcL.~~~ I is i boon t Area of wetlands on lot. square fee Percent coverage of lot: l o % j i Closest distance between nearest existing structure and upland edge of wetlands: 130 feet Closest distance between nearest proposed structure and upland edge of wetlands: hJ ~ feet i Does the project involve excavation or filling? No Yes ~ If yes, how much material will be excavated?cubic yazds How much material will be filled?~ cubic yazds 1~otia..a.~'ofu°oalc.L~lprsp~.,( Depth of which material will be removed or deposited: feet / I Proposed slope throughout the area of operations: F~4 f Manner in which material will be removed or deposited: r. ~l G .,o v~ f o~ ~.ao~l~7 f Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of sMU~ch proposed operations (use attachments if appropriate): /~On_T 4ula( Me1n~Ic/lA/iC0 n~oiodo~ PROJECT ID NUMBER 617.20 SEAR , APPENDIX C STATE ENVIRONMENTAL QUALfTY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Onty RART 1 -PROJECT INFORMATION (To be wmpleted by Applicant or Project Sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME i. N 3.PROJECT LOC//ATIOttN: Municipality l~.t T~, County ~4 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc •or provide map ~ 1 ~f n ~ 1.7e..a S.,-(fo~l~ ~en l,e 5. IS PROPOSED ACTION ; I Jew ~ Expansion ? Mod~catlon / aReraUon i u 6. DESCRIBE PROJECT BRIEFLY: JJ~~,,,, / I u-~GF MOJr>~nQ/r re O~S`^Ct« 8/M"n ~y" r / / 5 P Tm Oft 4>~y G?~ l.-M IALI.ae~/ SP+eodt.~ q sti.cU ~..o4,P"mf ~~oo~cGlrf j t 7. AMOUNT OF LAND AFFECTED: InitiallyQ Q L acres Ultimately 0). acres I 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? es ? No if no, describe briefly: L. 9. WHA PRESENT LANG USE IN VICINITY OF PROJECT? (Choose as many as appy.) esidenfial ?Industrfal Commercial ?Agriculture ?Park/Forest/Open Space ?Other (describe) 10.' DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGEN Y (Federal, State or Local) ~s ~ No IF yos, list agency name and permit I approval i /'1d..rnr I P ~ ~o.,. o7~f.. A R VAL7 Yes o If yes, list agency name antl permit /approval: 12 AS A R LT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? es No 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MV KNOWLEDGE Applicant /Sponsor Name...~~~~{///~~,~~,t~1I' .p7 ,t / Date: Signature `r°v°~r li, ~WSL~/ 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 ~com leted b lead A enc A. DOES ACTION F~CCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. Yes ~ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? K No, a negative deGaration may be superseded by another involved agency. Yes ~ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) Ci. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not ident~ed in C1-C5? Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CFA)? Yes a No If Yes, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? Yes ~ No If Yes, explain briefly: PART III -DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part II was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics ofthe CEA. Check this box if you have ident~ed one or more potentially large or significant adverse impacts which MAY occur. Then proceed direGly to the FUL FAF and/or prepare a positive deGaration. Chedcthis box rfyou have determined, based on the infomration antl analysis above and anysupporting documentation, that theproposed action WlL NOT result in any significant adverse environmental impaGS AND provide, on attachments as necessary, the reasons supporting this determination Board of Trustees ~ 3 Z ~ i 3 Name o ead Agency h Date lT't ~ f President Print or T Name of Responsible cer Ip Lead Agency Title of Responsi le cer .L/,lam/'r*1K~_ SrglrAiure of Responsi6 cer m e gency gnature of Preparer ( i rent om respond e o icer) • • Oak d Town of Southold Erosion, Sedimentation & Storm•Water Run-off ASSESSMENT FORM ~ PROPatTY LOCATION: s.e.Tll. a: THE FOLLOWING ACTIONS MAY REgU1RE THE SUBMISSION OF A ~`AII" STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN -!F'-iron '65cTt' -'CT- CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW ORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM # /WORK ASSESSMENT Yes No j a. What R the Total Area of the Project Parcels? ~ WIII this Projed Retain All Storm-Water RulrOtF i (Include Total Area of aA Percale boated within ~ Generated by a Two (2') Inch Rainfall on Site? ? I the Scope of Work for Proposed Consinlctlort) l= rpaas) (This Item will include a0 run-oN created by site / b. What Is the Total Area of Lantl Clearing ~QOp sR~ deadng and/or wnsWdlon aetiviges e5 well as ell l~ andror Ground Disturbanw for the proposed l~lAe.1 ~ Site Improvemenb entl the pennerrent rxeatbn M wnsttuctbn actNhy7 '~t~~T^~ Impervious surfaces.) (S.F.IAaes) I PROVIDE BRIEF PROIF.t'I' DESCRIPI•ION lP~owa•Amtiwr Farm.. NestlsN 2 Does the Site Plan and/or Survey Show All Proposed ? I Drainage Strudures Indlcatlng Size 8 Location? ThN / Item shall Include all Proposed Grade Changes entl LL / r' ~I~ Slopes Contrdling Sulfaw Water Flow. ~l Mee 9A~w[n rg on Sy..4(/ nor TEA r 3 Does the S(te Plan and/or survey descdbe tlta erosion O-~ utll•t.M• It n [ ~..e~f rtl,~ s•(/n e A and sediment woad practl~s that wrll be.used fo '~J"' wnOrol stte erosion end stone water discharges. This Svfu t ~..F• ~(pJ • Item must be maintained throughout gte Fstlre Construdlon Pedod. 4 Will thb Project Require any Land Fiping, Grading or Fxcavagon where there is a change to the Nahlral Existing Grade Involving more than 200 Cubic Yards a ~ _ of Maledal within any Parcel? i rj Will this Application Require Land Disturbing Activities I Encompassing an Area in Excess of Five Thwsantl ? (5,000 S.F,) Square Feet of Ground Surfew? s Is there a Natural Water Course Running through the ? SIte1 Is this Protect within the Trustees judsdidlon General DEC SWPPP Rewiramenb: or within One Hundred (700')feet ofa Wetland or Submhsbn ole SWPPP brequked for ell COnsWetlon edwltkfs FvoMng eaA $aaCh? dhturbancea ofone (1) p mwa aaea; bxiuding ebturhancee o! lase then one ape tlut 7 WIII there be Ske preparation on Ezisting Gade Sopes am pertorelaryeroonanpt plan that wa Utl(metelydlalurbaneormwe erxes oflend; which Exceed Fifteen (15)feet of Vertical Rlse to bdud"ag CansW ctbn edivlUes 1rvoNirg saA tlbWNencea d less then one (1) ape whwe V too DEC nee tlamrmhetl thataaPDES pematb requlretl mratorm wemrdischmgae. One Hundred (100')of HOdzontai Distance? - (aWPPPY Shall moot the Mlnlmum RequlrennMS of the aPDEB Gamral PamUl 8 WIII Driveways, Parking Areas Or Other Impervious for emmt Water Obohargea hom CrxmtrucUon actlNty-Parmil No. GP-0.10-001.) $UrfeCa9 t1aS1OpedWDlred $IORII-Water RUll-Gff 1. Tha SWPPP shell be preperetl Ddp to ma eubmOtal of the NOI. The NOI ghee be Into and/or in the direction of a Town Itghl-of-way? subrrulled b Itw Departmanl prior to the commerxenwM d oonsWdbn edivky. 2. The SWPPP shat dewdbe the erasion entl sedlmont contrd practices and wham 9 WIII this Profed Require the Placement W Material, required, postcunstmctlon abrrri watarmanagemant prxtlcea that wit be used end/p Removal of Vegetation and/or the COnshuCtiOn of any coMhtlded m reduce tea polutenm pt atormvreter dktluysa and b assure Item Within the Town Right-of-Way or Road Shoulder wmpllarwe with the tams end mnditlarw d this permit. In adtlNOn, the SWPPP shall identlly pdxr0ai spumes d poAUtlon wldcli may re96onedy be axpecte0 N aOeU the Areal lTtu• lErw wm xorewww tlr ewnn.m. orom.wv Apam.l qualty of storm walor0lacherge6. NOTE If My Mewerta Guaatlwu Onetlrrough Nirw NAnewan0 wah aChaek Marty 3:M SWPPPa that require Ne poat•cariabudion sNrm wetermenegemant pradlre ins BOx and BrewnsfractlanaW dlamrWnw is Mtwesn 6,0003F,81 Mnln ens, component aha4 be properetl by a quMibd Deapn Profeasbnel Cleansed b New Vod a atvm•Watar, Oradkia. Dninaga a Fsosbn Crawl Plan la Ibqubed by tM Town d f Sleumdtl and Mwtae SUpmMed for Revtaw Prier to dsuannd aiAldi PamN I that kknowledgeablenMe pdndplea and precacecd SbmrWatp Management. A^Y n9 I MOTE Aped Nalt(~)eMrp Aruww fp zed CUesUOn MRawNN brs Cwrwbre Appbdan) i S7'A1'E OF NEW YORK, ~~~`Q ok C-O7U~NfTY OcF ..r SS That h ••1•`it>,I~+••••bs•..i:,fr~rt being drily sworn, deposes and says that he/she is the applicant (or Prmti[, (Name d IndvMual a~ning DparmeM) And that he/she is the Ln,e•f , ~(Owner, CanOadp, Agent, Carppate Glifreq ate.) Owner and/or representative of the Owner or Owners, and is drily authorized to perform or have performed the said work and to snake and hie this application; that all statements contained in this application are true to the best of his knowledge and belief, and that the work will be performed in the manner set forth in the application filed herewith. Sworn to before me this; ....................1~~ day of ....~Q.f.>.~............................. 20a..~ / Notary PubU1.4.:IM1A...._C.._~...r. ~!f+7`~V/...r......................... ISguturedApplkanU FORM - 06/10 Notary Public, State of New or No. Ot CE0606965 I Qualified in Richmond County My Commission Expires July 31, 2013 • • ~ Board of Trustees Application I County of Suffolk State of New York I T.~r~ E ~x.~ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE ii 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 i ; REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJiJNCTION WITH REVIEW OF THIS APPLICATION. Signature of Property Owner i SWORN TO BEFORE ME THIS a~~' DAY OF n 20I ~ j ; Notary Public PAULINE C. CELLA Notary No I01CE0606986 w York Qualified in Richmond County My Commission Expires July 37, 2013 • I . 1 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE,FORM i. Tti T ^ c ~olda Code of Ethics prohibits conflicts of interest on the van of town officers and emnlovces The numosti of I Ibis form rs to vrovlde information which can start the town of possible conflicts of mterast end albw d to take whatever action L ~ neces5arv to avoiLd same. 1 1 - YOUR NAME:1 rT<cE T`o d-~ F~ j, (Lest name, first name, ipiddle initial, unless you aro applying id the name of someone else or other entity, such as a company. If so, indicate ttre.other person's or company's name J NAME OF APPLICATION: (Check sll that apply.) ~ - - ~ _ j i Tex grievance Building ~ - j~ Vaziance Trustee _ Change ofZone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (]f"Other', name theactiviry.) /F~-~t^k'6e`~S.-;?~~~n~~~(br , 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, mazriage, or business iMerost "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 corpomtion in which the town ot£cer or employee owns more than 5%of the shares. YES NO If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or positlon of that person - i - Describe the relationship betwcen yourself(the applicanUagenUtepresentative) and the town officer or employee. Either check the appropriate Tine A) through D) and/or describe in the space provided. The town omcer or employee or his or her spouse, sibling, parent, or child is (check all that apply): _A) rho owner of greater than 5%of the shares of the corporate stock of the applicant ~ I . (when the applicant is a corporaton); - _B)the legal orlxneficial owner of any interest in a non-corpornce 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 __a._...._...-.-. Submitted this 1 q/'~day of /~nr~2~ /_3 Signature. ' Print Name o d ~ ' Form TS I Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for I 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. i . 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 I Waterfront Revitalization Program. A proposed action will be evaluated as to its si iig~ ficant beneficial and adverse effects upon the coastal area (which includes all of Southold Town1. I 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 exulamed in detail, listme both suaUOrtine and non- supaortin¢ 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 j local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION scrM# t I b - l~ - 11,1 PROJECT NAME N ~ A- The Application has been submitted to (check appropriate response): Town Board ? Planning Board ? Building Dept. ? Board of Trustees I 1. Category of Town of Southold agency action (check appropriate response}: (a) Acton undertaken directly by Town agency (e.g. capital ? construction, planning activity, agency regulation, land transaction) ? (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certificafion: Nature and extent of action: ~ My l ~ a)n~PG W O~[rval' P 1Go0 CST ~m an1~-fn ~ , w4e~^ ~pc\a.fsJ tl~oh~e a tnal~ n -3f o-Fwoo~e~,'p f Location of action: 11~1b'~ ~~w 1„ffslK A-.F...Q (.,~fc(.of~~U.a.,~York(1~31 i Site acreage:~~DpT1,~Q~ `t~~00 ~;.ta,e ~ 1.7Sac,.rA- Present land use: ~ s 1 do ~ ~ n! j~ I; Present zoning classificafion: Q.3 . ~b n1Jal 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: TmdcQ ~r~eJ j (b) Mailing address: ].t(0`~ (ora'{Q+wolnl ~oo.~y l~.,o ~..~n14Cr rl.7ev11olKl(~/~ i l (c) Telephone number: Area CodeQ13) ~3r'3~1Y of ~!~',~G6-I~`(S 'I i (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? i Yes ? No ~ If yes, which state or federal agency? I C. Evaluate the ro'ect to the followin olicies b anal m how the ro'ect will further su ort or P J g P Y Yz~ g P J PP not support the policies. Provide all proposed Best Management Practices that will further each policy. I 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 LW)2P Section III -Policies; Page 2 for evaluation criteria. Yes ? No ? Not Applicable Q... a )n'lc ,Q bn un4D r iA, Attach additional sheets if necessary Policy 2. Protoct and preserve historic and archaeological resources of the Town of Southold. See LW)3P 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 ' ~q l r ~..c~.,k .Ae end b7kmT e-T~~1~"~ ~d~~ I Attach additional sheets if necessary l NATURAL COAST POLICIES i 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 I i 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 ~NotApplicable ~ i I I I Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems includmg I' Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III -Policies; Pages 22 through 32 for evaluation criteria. ? ? Yes No Not Applicable i 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 i' i I Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III -Policies; Pages 34 through 38 for evaluation criteria. I' i ? Yes ? No ~ Not Applicable I PUBLIC COAST POLICIES I 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. i ? Ye~ No ~ Not Applicable I I Attach additional sheets if necessary +i I f M w 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 i i 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 IIT -Policies; Pages ~ 62 through 65 for evaluation criteria. ? Yes ? No ~ Not Applicable I I Attach addttOnal sheets if necessary L Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP ~ Section III -Policies; Pages 65 through 68 for evaluation criteria. it ? Yes ? No ® Not Applicable PREPARED BY hod d Frerd TITLE n w n c t DATE ~'i 2of j Todd Freed 2400 Grathwohl Road New Suffolk, New York 11956 Apri129, 2013 lanai D MAY - 1 2013 Board of Town Trustees Town of Southold Southold Town 54375 Main Road tT Southold, New York 11971-0959 Re: Administrative Permit Application - 12400 New Suffolk Avenue, Cutchogue Deaz Trustees, Enclosed please find one application packet and one photocopy of the application packet. I will send the photos on April 30, 2013. I look forward to this application being on the May 15, 2013 heazing agenda. If you have any questions, please call me at 212-735-3714 or 917-566- 1245. Sino rel~y,~J ~ Todd Freed enclosures Todd Freed D ~ ~ 2 2400 Grathwohl Road ~ tS D New Suffolk, New York 11956 fdAY - 1 2013 Apri130, 2013 outsold own T Board of Town Trustees Town of Southold 54375 Main Road Southold, New York 11971-0959 Re: Administrative Permit Application - 12400 New Suffolk Avenue, Cutchoeue Dear Trustees, Enclosed please find the labeled pictures to complete the application packet. If you have any questions, please call me at 212-735-3714 or 917-566-1245. Sincerely, "su~vec~ Todd Freed enclosures vy~y- V APPROVED 3Y ~ s ,~zaE ~ BOARD OF TRUSTEES TTa.~s• ~a' _ _ TOWN OF SOUTHOLD ~ PqR~ T R DATE ,~,~y ~ 5 z ~ ~3 s ~ I, " ~ q a y ~ x 3 ~ ~ ~ ~ o ~ ~ ~4r sae a:. N ~ Na 2 yTy, a ~ fR. Ng. ~ O °~~a u xa R 7 ~ ? Q} .tl (rp Cy i 3 4~ y' 1 ~i 4b 711 tli l~ F W ~'ab, ~e9r,.l„ra.Min'~cn 1 ® ~t2 O~lMy`1Pe ,.1. na~ n Ne * z~ ~ d Ct ~ w~.~el•, l,,d„d1,J f~,o~~7'b' J II " ~ C ~ I V ~ ~ ~CFPVti-~.~ Ct mod. ~ a a ,»n V^1{u' ~ +PS~ w a ~'s MAY - 1 2013 F~~C N~'sz. DTDDD FREED ~!y q w EDITH w~sTErt da ADVDCATES ABS STEWART TITLE I old Town