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TR-8209
z SOFF04 Glenn Goldsmith,President ����� COGy� Town Hall Annex A.Nicholas Krupski,Vice President c < 54375 Route 25 Eric Sepenoski W ,? P.O.Box 1179 Liz Gillooly �y • O�� Southold,NY 11971 Elizabeth Peeples ��l �a t Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: L411,51 IH Completed infield by: •C9� '��� David Bergen on behalf of JAMES & VICKY VAVAS requests a Transfer of Wetland Permit#8209 from Edward Jurzenia to James &Vicky Vavas, as issued on June 19, 2013; and for an Administrative Amendment to Wetland Permit#8209 for the existing 4'x11' wood stairs to the beach in lieu of originally proposed 3.5' wide aluminum , retractable steps to beach. Located: 3165 Bay Shore Road, Greenport. SCTM# 1000- 53-6-7 Type of area to be impacted: o Saltwater Wetland Freshwater Wetland Sound >e Bay Part of Town Code proposed work falls under: x Chapt. 275 Chapt. 111 other Type of Application: X Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No 0 Nof Applicable Info needed/Modifications/Co ditions/Etc.: %j aam� 6M& c� QfA ( e el a joy-�� i o Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly E. Peeples 3/5-/:P -)—rcvt S Peo— N,2-N-d- M d vtck C-�)�O11cl ,due- 6 /)oil- Corn Vdri-xoance of- .54nt4vre. . Pb-rrA S 1-i 1 l can d er f �- ��dw� TV f zen i ol. Box 1008 Cutchogue, NY. 11935, March 22, 2024 ® E C E v Southold,Town Trustees LIAR 2 2 2024 Southold Town Annex 54375 Rt 25 Southold, NY. 11971 Southold Town Board of Trustees Trustees, We are requesting a transfer of Trustee permit#8209 issued June 19, 2013 from Edward Jurzenia to James and Vicky Vavas. We are also requesting an amendment to permit#8209 to reflect the stairs to the beach as exists. Project description: amend Permit#8209 to include: replace proposed 3.5 ' wide aluminum retractable steps to beach with existing 4 'X 11' wood stairs to the beach. The project is located at 3165 Bayshore Rd, Greenport, NY. You will find an original packet with one copy of the following: -Color pictures -Affidavit -Authorization -Transactional Disclosure Forms -Property Survey -Property Site/Construction Plan -Copy of Permit#8209 -Copy of location map -A check in the amount of$200. Please let me know if you require any additional information. Sincerely, David Bergen Agent for James and Vicky Vavas SURVEY OF PROPERTY LOT 55 & PART OF LOT 56 m AMENDED MAP"A"OF �0 PECONIC BAY ESTATES rz 50.0'WIDE RESIDENCE-PUBLIC WATER FILED: MAY 19, 1933-MAP NO. 1 124 n m PUBLIC LOT 54 SITUATE D RIGHT OF WAY I175.00 TO M.H.W.AS PER FILED MAP 145.38 TO CURRENT M.H.W. ARSHAMOMAQUE (GREENPORT) UTIL. kg 9$ N66°o9'oo"E ghh I BULKHEAD NAIL TOWN OF SOUTHOLD g IZ 10g1xMO D: POLE MON.FND. U N{0 ,O,.L 5 5 x g$9 �01 RETURN G� SET U SUFFOLK COUNTY, N.Y. D - o e (31 ASPHALT DI21VEWA.X•� ��.. ..—. �ARA .. U* 3 �. ZJ f 0 WITH CONCRETE CURB Z G.FL.=10.96 N 1 Z N TAX MAP NO.: 1000-053.00-06.00-007.000 I O N 100 z5.o'R.vsB. = W 35.0'F.Y.SB. 1 J m LOT 55 = ° 1 J LOT AREA TO M.H.W: 10,888.24 S.F.(0.250 ACRES) 0 g6 WATER E g `� Ln I ! W O a DATE SURVEYED:JAN. 27, 2021 Z g F W—W METER x �N a In io I M m i p N ADDED FLOOD ZONE:JAN. 29, 2021 m O I f ERVIC x PL. to N ° ' < A Z N W SERVIC� .D F m0 BOA 20.0 :I m 2 x1 f.lX g2"r m ,n m ^~ N C m 1 STORY A I 9' 6 o n J � ! -ELEVATIONS REFER TO NAVD88. _� �2 h1 of SANITARY 57 w FRAME I D rr-- m Ul � -NO WELLS WITHIN 1 50'OF SUBJECT PROPERTY. n g' gh I m CONCRETE A C O m N covERs I RESIDENCE 10.o I m O f mz - #3165 I D � _ --1 WD D 1 Ul ` I s�s 44.3 G g9 I D r o 0 30 60 I °� g' _PA T OF ° r Feet 'TI f �� �L..�. G.32L..j1RFNTR7ANCE ZR— I LOT56 N m0 °� �0 I SCALE: 1 INCH= 30 FEET I - �o� 00 L.P.OIPE FND. J / x0 TANK Nkg� l xg00 x6$0 x0,1h x 00 h �g�i U�ga, PILLAR �° STAKE HEDGE ROW ON LINE STAKE BULKHEAD NAIL FND. w OF NIPS $� m� z� �,°�S66°O9'OO"W FND. FND. t� ,► _ & 175.00 TO M.H.W.AS PER FILED MAP rn ^" y O N POLE o�` PART OF I 145.00 TO CURRENT M.H.W. y m LOT 56 o I n 0 O �z m RESIDENCE-PUBLIC WATER 0 0 r o ?I° MAR 22 2024 m cn "�m o o&0990 n w cn of Southold Town o LAND Board of Trustees mIn m LEGAL NOTES: m N I.COPYRIGHT 2019 AJC LAND SURVEYING PLLC.ALL RIGHTS RESERVED. 2.UNAUTHORIZED ALTERATION OR ADDITION TO THISSURVEY MAP BARING A LICENSED LAND LD SURVEYOR'SSEALISAVIOATIONOFSEGTION7209,SJBDIVISION2.OFNEWYORKSTATEEDJCATION LAW M 3.ONLYBOUNDARY SURVEY MAPS WITH THE SURVEYOR'S EMBOSSED SEALARE GENUINE TRUE AND / CORRECT COPIES OF THE SURVEYOR'S ORIGINAL WORK AND OPINION. U 4 CERTIFICATONS ON THIS BOUNDARY SURVEY MAP SIGNIFY THAT THE MAP WAS PREPARED IN Q ACCORDANCE WITH.THE CURRENT EXISTING CODE OF PRACTICE FOR LAND SURVEYS ADOPTED BY THE / I�ID SURVEYING PLLC NEWY MITEDT STATE ERSOSSFOR TION WHOM THE BOUNDARY SURVEY SURVEYORS.PREPARED. THETI LECON IS MPA S LIMITEDRK PERSONS FOR WHOM PROFESSION LLAND UR ISPRS.INC. HE TERTIFI ECOMPANV TO > C THE GOVERNMENTAL AGENCY.AND TO THE LENDING INSTITUTION LISTED ON THIS BOUNDARY SURVEY �/-'- a-�.:n.. I[� MAP. m 1 ^'^^-" 1 ✓ 11\J I 5,THE CERTIFICATIONS HEREIN ARE NOTTRANSFERABLE, d LAND SURVEYING &�PLA`NNINGk 6THELOCATION OF UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS ARE NOT ALWAYS KNOWN 2 AND OFTEN MUST BE ESTIMATED IF ANY UNDERGROUND IN,PROVEMENi50R ENCROACHMENTS EXIST OR ARE SHOWN. ENTS OR ENCROACHMENTS ARE NOT COVERED BY THIS �-^- `� 1'm� d A/� �/I 7..THE OFFSETS E(OR DIMENSIONS)SHOWN HEREON FROM THE STRUCTURES TO THE PROPERTY LINES ARE d 77_ S COLEMAN ROAD, GENTEREACH, NY � 1720` r I FORASPECIFIC PURPOSE AND USE AND THEREFORE ARE NOT INTENDED TO GUIDE THE ERECTION OF 3 i■ :,M Q 7 .W [ FENCES RETAINING WALLS.POOLS.PATIOS PLANING AREAS,ADDfTIONSTO BUILDINGS.AND ANY OTHER n�s«�es=PHONE,,6�as �� m✓�I ;7 ,1 , rI'GG~� vv B.ONLY SURVEYS B ARNG THE MAKERS EMBOSSED SEAL SHOULD BE RELIED UPON SINCE OTHER THAN N L:"r.--�-` EMBOSSEDSEAL COPIES MAY CONTAIN UNAUTHORIZED AND UNDETECTABLE MODIFICATIONS. � DELETIONS.ADDITIONS.AND CHANGES. EMAIL: AJ-C246 T N @OP ONLINE.NET 9 PROPERTY CORNER MONUMENTS WERE NOT SET AS PART OF THIS SURVEY UNLESS OTHERWISE NOTED D 10 ALL MEASUREMENTS REFER TO U.S.SURVEY FOOT. / U I 8'-0"EXISTING NON TURF BUFFER LOCATION PLAN EXISTING I 75 E .00 S23°31'49" 0 BULKHEAD iNx 9 �IELINE o _ REPLACE PROPOSED 3.5'WIDE ALUMINUM 8'-0" V� RETRACTABLE STEPS TO BEACH =� 69.. GRAY ARE Oy WITH EXISTING 4'X 11' rc a *e. WOOD STAIRS TO THE BEACH. m N w s I wti ;�... 3168yB/�j1 SHORE RD c w O w $. `,►* y fQ � GRE N Of1RT N.Y HEIGHT OF Ty/7.q' - _ - I IHIj 11 r 10. ----------------- — — — - - - - - - BULKHEAD I I II I 11 IEzIll I I 11�1 T II D - --- •-a "°�` 111 111=111- F-111 -lll-ll1= - - =W= _Wll w - d� -III-II IHII-I _ILHL�II IT - ���I��IHI II ss. e I IIII I I IFII Jf I I�II�I IJI �Z'zo ,.9'HIGH 18.2' I I I-I I III-I =III' s m o W66D DECK � � HII �IF�I I 1 1 1 I ILLq =1II=1I m ' Y Tf - HTi= _ _ II-111=T(- za.7 • as =11�11 I I T I Ik�l I�IFII N o DECK y ^+ C-�=III= F.F =12.55 I r 5 Goa91e Q H -III-III Fil �1�I11 11 1 -ITI- I III-I 4 e. _ '1 AHW 2.4' 1Tf -ll�l 1 F= ifl=_III=III=�= =1111i-T-I =1i11 1 =III- =1= I- u Y U m } t11 �Itt ry} =11� Ik�llIl-l�lr�ll L -ILA I 7 in 27.9 w Z[n a I w �1 1 v ETkE9I n�II I MI IHI III a-I II 1I�IlI=1 -IHTiJ II�IL I IH F O 2 w� ' ¢Z PROJECT SCOPE -jT�=1 I- l EMI I�I 11=HI�I i9TI�k��I I c Nc. a F Q ... a I _ L -I �I�1� 1 1 I- -III-III-I 1I-I -I -III-I I I- m-f0 w ALW o.0 - 1 _I -II II=11-I -II-III-I=III-I -III-II -III- I ]j - 111 I� - -III BRICK o �'I, W Nw AMEND PERMIT#8209 TO INCLUDE: _ T�t hI ICI I TH�I I-I -I I-III-I I I I-III-III-I H H I I - wAuc n ^ I y��... 1= T1,11 IP'ljy� ���I WU 25-TOTA 11 - I 1 I I _I I T�II IFII 11R-uTH-11m-IIIHn-III-Iur-ulm-In��IHII1rII- -u—I-I n-u-ul- uz REPLACE PROPOSED 3.5 'WIDE u ll—ll O 23.a I 11-II ICI -I II II IFI-I IILJI IIHII- HI-III-IIHI 111=III-IIHI H �T_I -�ri�Ir��I1�T� �r I T� I��ri i�li �w ..Y. I "�.,a.o' ALUMINUM RETRACTABLE STEPS TO �LI II 1 1F�1gIHI IpI�I I I I II I Irl IPI H I-III II-III-u1 Ili I II=II-IIrI II-InII�u= as (2 ' FO�H BEACH WITH EXISTING 4 'X 11'WOOD - -1�11=IIE =1 III=W= =1 �I�l�� �l� ��i111 � ��T�Il o u y VV LT-III=1 I H I- d1 CHI rCl l ITi-I -I I IIH H T I- hI -ITi- H1-III=III-I -I I I-III-III-li- ,� - �m�-r r�rr�Fr I_$ 1�1��r��iH��r HI�I-�I�I�ILitt�r � �i-��r l� T� 1���H��t ° I � STAIRS TO THE BEACH. m- =0=1I I_Mal I- =1I1=1I II I Ti III I IS�IWE 100. �1 lll�ll= =ll1=W- H I1= =11I_ Ia1-111=IIHI I-IIHI 1 1 -I ---IIIII -IIHI=1111�11 II�T_I I II-IIHI L LIII "emu �II�1 1CLL1I lL1l= lI� � HI- _III- gI' III- H�I�-��-I III O��11I 1--�I1I I-1I 1 H�H I IIH-TI 1 1 =-1I 1_1 II--_T IIIII1II-1n-=IIIIII ll-it-lF 1I 1I�1BI1�uI l-1-_1-uI IlI--1T1�nI I l�I TII I-1-JTl1i=I-III�H_llam l III-- _II LIll-1-�_I�I H1 H-II��C 11 lI 1�I q-IIIHT T_III�III TIIH�II-I H-IIH I-IH 1_IIF L-=III��IIJII-I�1-I1I 0 � yb�o° All as per plans dated MARCH 18, 2024 } - \ ' R li�lll. ��I. .I. ..11-II�ITIF�TIF�Tr��Ik�-T�R�II�iT1�ll�~il�llll�l-��I�I-"II I II .I�.IIl ... 1-1-, fill-�ll,� -11- -111. = Z mum o 1 EXISTING STAIRS m LL 3 AD e 0 �3 Uu _ I Al75.00 I N23°51'00"W o• ; EDGE PAVEMNEf w O s _ s 3 Site Survey Al SCALE 1"=20'-0" 0' 20' 40' REPLACE PROPOSED 3.5'WIDE ALUMINUM RETRACTABLE STEPS TO BEACH WITH rill EXISTING 4'X 11'WOOD STAIRS TO THE BEACH. z I a z_ I I � O O O Q-0 O CLLI N_ //// // // /, //,, // ,/,, ///,/ //,,, -// James & Vicky Vavas N - Permit Transfer/Revision Stairs N a / 3165 Bayshore Rd, Greenport, NY o SCTM - 1000-53.-6-7 Ji MAR 2 2 2024 Prepared by: Ken Quigley+ Dave Bergen W W Site Plan Southold Town � 2 Site Plan i Board of Trustees Date: MARCH 18, 2024 Drawing: Al Ex1sr1NG _ Scale:AS NOTED W SCALE 1"=5'-0" o+ 5' 10, 20' BULKHEAD RETURN 1co Q U t-%,f-14 R rIR 0 - :L• _- -_ - - _� -- sue„, , Board of `trustees Application A IDAVIT ` ,cc { L4� BEING DULY SWORN x DEPOSES AND AFFIRMS THAT HE/SIDE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN a ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANLIER 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 k BOARD OF TRUSTEES HARMLESS AND FREE,FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY-VIRTUE OF SAED PERAUT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S)OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN C®NJI NCT'ION WITH THIS AInPLICATY®N, c INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE TIDE BOARD OF TRUSTEES TO ENTER ONTO My PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL, EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. : a ignature of Property Owner Signature of Property Owner' F 3 SWORN TO BEFORE ME THIS DAY OF ��� �, r ,20 z� `Y L ELAINE STAMAS Notary Public ( NOTARY PUBLIC STATE OF NEW YORK KINGS COUNTY LIC.#OIST ES 71 3 COMM.EXP u a 1 � l f Board of Trustees Application r F 3 f AUTHORIZATION f (Where the applicant is not the owner) IIWe, J c=L -3 7 owners of the property identified as SCTM# i 000-= 3 in the town of 4 New York,hereby authorizes to act as my agent and handle all 3 necessary work involved with the application process for permits)from the Southold Town z Board of Trustees for this property. a P perty Owner's Signature Property Owner's Signature u s 4 s s SWORN TO BEFORE ME THIS . J DAY OF �e_=�� ,ZO ' S Notary Public FZiLIC.9#01ST4880 OF NEW YORK Y i 31 COMM.ESP ! S' 8 t. x s r Y r. v _ 1 5 . i t 1 A]PPLICANTIAGENT) EPRESENTATIVE TRANSACTIONAL DISCLOSURE FOB t Y The Town of Southold's bode of Ethics prohibits conflicts of interest on the part of town officers and emylo ees The nuroose of t this_fotm is to provide information which can alert the town of passible conflicts of interey and allow it to take whatever action is necessary to avoid same. i YOUR NAME: J C C S Ljc" � (Last name,first name,.q»ddle initial,unless ydu are applying in the name of s 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.) r 1 Tax grievance Building 4 Variance Trustee Change of Zone Coastal Erosion Approval afplat Mooring Exemption from plat or official map Planning g (if"Other•,narpe the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any otficeror employee s of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, s 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, i YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. 3 Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the appiicandagent/representative)and the town officer or employee.Either check f 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): 12A)the owner of greater than 5%ofthc shares of the corporate stock of the applicant 12 (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 I n Submitted this 5 d of Signature___ PrintNarne FFonn TS l ' i 9 f , APPLICANT/AGENTBEPRESEN'TAT'I VE TRANSACTIONAL DISCLOSURE FORM The Town ofSouthold's Code.of Eihics arohibits conflicts.of.Interest onahe oerf oftown otxicers and employees.The purpose of_ this form'is to provide information which can alert rile town of oossibie conflicts of itdenest am dw i10 take whatever adtion is necessary to avoid same. YOURNAME: David Bergen (Last name,fast name.-Middle 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,spousei sibling,parent or:child)liave a reationship with any officer or employee of the Town of Southold? "Relationship"includes by blood;marriage,or business interest:"Business intermr.means a business, including a partnership;.in which the town officer or employee has even a partial ownership of(or employment by)a cowration in which the town officer or employee owns more than.5°lobf the shares. YES n NO n.. If you answered"YES".complete the balance of this form and date and sign where indicated. Name ofperson employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicantlagenthepresentadve)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 EL (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a nowcorporate entity_ (whenthe applicant is not a corporation); E[ C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this P ay,of 20Z(F Signature Print Name David BerggM Form IS 1 '� James F. King, President O~~e~FQlA,co Town Hall, 53095 Main Rd. Bob Ghosio, Jr., Vice-President h~ G~ P.O. Box l l79 Dave Bergen ~ ~ Southold, NY 11971 John Bredemeyer °y ~ Telephone (631) 765-1892 Michael J. Domino ~Ol ~ y~ 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 1 day of construction YZ constructed Project complete, compliance inspection ~i ~ _ _ _ _ _ _ _ ~ 3:. y ~ , BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK j ~ j> f PERMIT N0.8209 DATE: JUNE 19, 2013 [ ISSUED TO: EDWARD JURZENIA PROPERTY ADDRESS: 3165 BAYSHORE ROAD, GREENPORT SCl'M# 53-6-7 AUTHORIZATION Pursuant to the provisions of Chapter 275 the Town Code of the Town of Southold and in accordance t with the Resolution of the Board of Trustees adopted at the meeting held on June 19.2013, and in consideration of application fee in the sum of WAIVED as per Town Board Resolution# 2013-280 and subject to the Terms ~ and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit for the existing +/-75' long bulkhead to be replaced in-place; add up to 250 cubic yards of fill; insta113.5' wide aluminum retractable steps to beach; and to establish and subsequently maintain a 5' wide non-turf buffer landward of bulkhead, and as depicted on theproject plan prepared by Darline Duffy, received on May 28, 2013, and stamped approved on June 19, 2013. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. O'• s ~O~~F~~cO ~ ~ _ TERMS AND CONDITIONS The Permittee Edward Jurzenia residing_at 3165 Bayshore Road, Greenport, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board.. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. 8. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. 9. That the said Board will be notified by the Permittee of the completion of the work authorized. 10. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. James F. King, President ~QF SQUry Town Hall Annex Bob Ghosio, Jr., Vice-President ,`Q`~ 0/_ 54375 Main Road P.O. Box 1179 Dave Bergen Southold, New York 11971-0959 John Bredemeyer H ~ Michael J. Domino ~ • a0 Telephone (631) 765-1892 ~~~QUMV,~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 19, 2013 Mr. Edward Jurzenia 3165 Bayshore Road Greenport, NY 11944 RE: EDWARD JURZENIA 3165 BAYSHORE ROAD, GREENPORT SCTM# 53-6-7 Dear Mr. Jurzenia: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, June 19, 2013 regarding the above matter: WHEREAS, EDWARD JURZENIA applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated January 31, 2013, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policy 6.3 of the Local Waterfront Revitalization Program to the greatest extent possible through the imposition of the following Best Management Practice requirements: the issuance of a permit on structures; and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on June 19, 2013, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, 2 • • WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that for the mitigating factors and based upon the Best Management Practice requirement imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, RESOLVED, that the Board of Trustees approve the application of EDWARD JURZENIA for the existing +/-75' long bulkhead to be replaced in-place; add up to 250 cubic yards of fill; install 3.5' wide aluminum retractable steps to beach; and to establish and subsequently maintain a 5' wide non-turt buffer landward of bulkhead, and as depicted on the project plan prepared by Darline Duffy, received on May 28, 2013, and stamped approved on June 19, 2013. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: $ 50.00 Very truly yours, James F. King President, Board of Trustees JFK/amn • ~~~~g~F~~c~''t James F. King, President ~ y ~ Town Elall Annex Bob Ghosio, Jr., Vice-President w 54375 Route 25, P.O. Box 1179 ' Dave Bergen ~,fi~ ~ Q}, Southold, NY 11971 John Bredemeyer j ~ ~ Telephone (631) 765-1892 Michaek J. Domino Fax (63l) 765-6641 BOARD OF TOWN TRUSTEES _I TOWN OFSOUTHOLD TO: Cd I,IJGi~d ~lt_~Z~(r11 t~ Please be advised that your application dated 13 has been reviewed by this Board at the regular meeting of 3 .and your application has been approved pending the completion of the ollowing items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1st Day of Construction ($50.00) / Yz Constructed ($50.00) Final Inspection Fee ($50.00). Dcck 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 accorcling 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 tie-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ tS_ . ~Q BY: James F. King, President Board of Trustees • ~~~~gpFFO(,~~ ti ~ Peter Young, Chairman ~ ~ Town Hall, 53095 Main Rd. Lauren Standish, Secretary ~ T P.O. Box 1179 'F Southold, NY 11971 y'~/Q rb~~ Telephone (631) 765-1892 y' Fax (631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., June 12, 2013 the following recommendation was made: Moved by John Stein, seconded by William McDermott, it was RESOLVED to SUPPORT the application of EDWARD JURZENIA to repair 75' bulkhead, as needed. Replace approx. 15' of sheathing, new cap, waters and stringers. Install aluminum retractable steps to beach and add 120 cy. fill and 50 yds. of topsoil Located: 3165 Bayshore Rd., Greenport. SCTM#53-6-7 Inspected by: John Stein The CAC Supports the application with the Condition of a 25' non-turf buffer. The application should include an as-built site plan depicting the location of the non-turf buffer. Vote of Council: Ayes: All Motion Carried ~:f I_-~ ? 4 .•r- ~ - ~ ~ , r_ _ ! _ Y` _ may; _ - - - - ~ i~'~ Er'Jwarr~;urzenia - ~ ' 3165 Bay Shore Road, Greenport ,d' i `,n' j-4' y1 - ~ CS/12/13 _ - v~ 4 - gUFFO(R James F. King, President Cp~ P.U. Box 1179 Bob Ghosio, Ir., Vice-President y'y Southold, NY 11971 Dave Bergen ~ l'elephone (631 765-1892 .lohn Rredemeyer ~ Fax (63q 765-6641 Michaell Domino ~ 'r' y~of # ,~aor. Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: [7~ I~13 EDWARD JURZENIA requests a Wetland Permit to repair the existing ±75' long bulkhead; replace approximately 15' of bulkhead sheathing using untreated lumber; replace ±75' of bulkhead cap, waters and stringers; install 3.5' wide aluminum retractable steps to beach; add approximately 120 cubic yards of lost fill, and approximately 50 cubic yards of lost topsoil. Located: 3165 Bayshore Road, Greenport. SCTM# 53-6-7 Type of area to be impacted: -Saltwater Wetland -Freshwater Wetland -Sound e~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: ? I~Vetland -Coastal Erosion -Amendment _Administrative_Emergency -Pre-Submission Violation Info needed: ~ f n J ~ q.~5 /j Modifications: ~ ~1:~rrn ~,~j.~~,.? rvf- ~ ~g,,,. N to Conditions: i ~ Present Were: '~J. King ~B. Ghosio D. Beirgen, LJ. Bredemeyer L~Michael Domino ?D. Dzenkowski other Form filled out in the field by ~c~~ Mailed/Faxed to: Date: °1G" S'~ 'l+~l~!'.~~,ri 'i4~,s„ • ~ 4 , rt qtr Cl.. r' ~ ' i . F, # uua _ t., ~3 n, ii,• ~f Cf~, G :fit ~~~W'+t'r'- J ~ ?I Y ~ J'i~ ~ ~ ~ r ~ 1.L ~.~_.rs F,*. 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F R~ n ,p ~ r a~~ s. v f J- rw rtL w. a.• wv ~ • ~ ~ l I m*amwo. raw S Sq.? e ~ ~ _ _ ' r wmi ~ -`z uz w~c~ u'z ~ O as vc ruw afe vs.~nm ee. w.m ~ ~ - rorce COUNTY OF SUFFOLK © ~ e secnox°o e n,~ _ z _ _ _ E" -O- ~ - _ _ Rso1~~MM1r TU Saks /WS~' v 53 a OFFICE LOCATION: o~~OF SO(/lyOl MAILING ADDRESS: Town Hall Annex ~ O P.O. Box 1179 54375 State Route 25 * * Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) H Southold, NY 11971 G~ Q Telephone: 631 765-1935 ~ Fax: 631765-3136 ~~y00UNN,~~ LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM lUl ~ ~ ~ 0 ~ ~ D D JUN 13 2013 outhald own To: Jim King, President r rose Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: June 13, 2013 Re: LWRP Coastal Consistency Review for EDWARD JURZENIA SCTM#1000-53-6-7 A Wetland Permit(s) for the proposed actions were not found. EDWARD JURZENIA requests a Wetland Permit to repair the existing ±75' long bulkhead; replace approximately 15' of bulkhead sheathing using untreated lumber; replace ±75' of bulkhead cap, waters and stringers; install 3.5' wide aluminum retractable steps to beach; add approximately 120 cubic yards of lost fill, and approximately 50 cubic yards of lost topsoil. Located: 3165 Bay Shore Road, Greenport. SCTM# 53-6-7 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 INCONSISTENT with LWRP Policy 6.3 (below) and therefore, INCONSISTENT with the LWRP. 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. The structures described were not constructed pursuant to Southold Town Trustees review and Chapter 275 Wetlands and Shorelines permit. If the action is approved, it is recommended that the Board requires a 10' wide landscaped buffer landward of top of bluff to further Policy 5: Protect and Improve Water Quality in the Town of Southold and Policy 6; Protect and Restore the Quality and Function of the Town of Southold Ecosystem. 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 ~~~~Of ~OVfyO~ Tows Hall Atmex Bob Ghosio, Jr., Vice-President 64375 Main Road P.O. Box 1178 Dave Bergen J~t # Southold, New York 11971-0969 John Bredemeyer ~ ' Michael J. Domino Win. ~ ~ Telephona(63ll 768-1892 Fax(831)76b-8641 ~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only oastal Erosion Permit Application ~We[land Permit Application Administrative Permit ~ Amendment/Tran1s~'erlErgtension ~eceived Application:.. -4 L1l~tttll ll``3~_ If " E V ~ ~ V eceived Fee:$ I'u~~l'u(I ~ Completed Application 5 ' -Incomplete ~M 3 j _SEQRA Classification: Type I Type II__ Unlisted Coordination:(date sent) ~I~WRP Consistency Asse m Form S .3 ~ ~~//_C/1C Referral Sen[: a[c of Inspection: .Receipt of CAC Repo .Lead Agency Determination: Technical Review: ~I~. - Public Hearing Held: In I IN II S Resolution: ~`~IIl~`~'~~~~ Name of Applicant ~1 L (,1(A` Y~L~ : r 7, c' l2L ('t-~ Mailing Address _ ~~~,~j /,`7 S (-~D~y/~C-7 /.I f~~ I) A~Lr1- -l _ ~ Phone Number:( ) / 7 ~ Z~ Z~ / Suffolk County Tax Map Number: 1000 - ~ ~ Gj Property Location: _ _ (provide LILCO Po~lep#, distance to cross streets, and location) AGENT: /V f-(~ (If applicable~r 'T i Address: j! i Phone: i ~ Sr~d of Trustees Application • GENERA((L``DATA Land Area (in square feet): Bfi7~ S 4f • `t"~(T• AreaLoning:_~~~_ Previous use of property: r(~ `~I L 1 ~ Z /~F Intended use of property: h~ Lj C <'-1 L ~ ( r Covenants and Restrictions on property? Yes ~__No If "Yes", please provide a copy. i i 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 wpy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes No ' Does the structure (s) on property have a valid Certificate of Occupancy? ~ Yes No Prior permits/approvals for site improvements: Agency Date No rior ermits/a royals for site im rovements. II P P PP P Has any permiUapproval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: ~'i; Project Description (use attachments if necessary): -1- ! . Boa~oE Trustees Application • WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~Q ~J1 ~ ~f I~ i~ I I~/1~ ~(X2/.L/ rf;9 kid y. Area of wetlands on lot: t?"- square feet Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands:~~5~ fit I Closest distance between nearest proposed structure and upland edge of wetlands: .,3~," feet Does the project involve excavation or filling? No~ Yes If yes, how much material will be excavated?cubic yards How much material will be filled?~~ ~ -cubic yazds ~I Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: I' _A 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): ~ I i II i • PROJECT ID NUMBER s1zz6 SEAR - APPENDIX C STATE ENVIRONMENTAL DUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 7 -PROJECT INFORMATION (To be completed by Applinnt or Project Sponsor) ~ i. APPLICANT/SPONSOR 2. PROJECT NAME 3.PROJECT L TION: i 7, / i~u~ia~ ~ C ~PE'r~ Sll~-~'{~ ~-K 4. PRECISE LOCATI :Street Addess and Road Intersection . Prominent landmarks etc -or «ovide map S /F7 YC e, ~ 5 .4 B7/~ I; 5. IS PROPOSED ACTION : ? New ? Expandion I4(Modificatlon /alteration I 6. DE RIBE PROJECT BRIEFLY: ~ I ~I c~.J(,(.civvL~,~c.,cc~- , h,e~f'c'~~Gt-~QQ- C,,~F:~-~ ! 20 rf~s 7 MOUNT OF LAND AFF ED: l/ nNally acres UlUmetaly n«es B. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? I, Yes ? No N no. des«ibe briefly: ~ ; I; i, 9. WHAT IS PRESENT IAND USE IN VICINITY OF PROJECT? (Choose as marry as appy.) Ir]eJ-'-'(-Itl`Residen0al ?Industrial ?Cammer©al ~dcullure ?Park/FOmstl Open Space ?Other (describe) { 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State « Lorap ~ { ?Yes (,~NO If yes, lislagency name and permit /approvaC I %F-r i ' 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL4 I~ ?Yes ~No M yes, list agency name antl permit !approvaC i III 12. AS A RE ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? es i. 1 CERTIFY HA7 THE 1 RMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MV KNOWLEDGE , Applies t / Spon ama ,~J n Date: I , I; i Sign u - If the acts h: a Costal Area, and you are a state agency, complete the Co al Assessment Form before proceeding with this assessment i' I I PART II - IMPACT ASSESSMENT T~ com leted b Lead A enc A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 677.4? 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? If No, a negative deGaration may be superseded by another involved agency. Yes O No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain brieFly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain brieFly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain brieFly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other nature) resources? Explain briefly: C6. 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 identified in C1-C6? Explain brieFly: C7. Other impacts (inGuding 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 (CEA)? Yes ~ 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) irceversibility; (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 identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL EAF and/or prepare a positive deGaration. Chedcthis box if you have determined, based on the information antl analysis above and any supporting documentation, thatthe proposed aCion WIL NOT resuR in any signfcent adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting this determination Board of Trustees ame o Lead Agency Date ° f !1d ~ S ~ ~~/.t/lr President Print r Type Name o espons~ibyle Officer in L d Agency itle of Responsible cer ign~l. re o esponsr a cer in Lea cY ignature o reparer ( arent rom respond o Icer) e • gpIFO(,~ • ~"~O~0 rOGZ' .lames P. King_ President ti ~ "Town Hall. X3095 Main Rd. 13ob Ghosio, Jr.. Vice-President ~ P.U. Box 1179 Dave Bergen ~ ~ 'Z`' Southold, NY 11971 John F3redemeyer 0~ Telephone (631) 765-1892 Michael J. Domino ~ Fax (631)765-6641 BOARD OF TOWN TRUSTEES ~ ~ ~ ~ ap ~ ' TOWN OF SOUTHOLD ~ Y ~J ' JUN 1 9 2013 BOARD OF TRUSTEES: TOWN OF SOUTHOLD Southold Town _ Board of huzF~^s In the Matter of the Application of EDWARD JURZENIA COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POS77NC REM,4/NS /N PLACF. FOR F_/GHT DAV/S~ r p l/ 1, ,residing at /dba p~/$1-f D~~ K I~e~~m t 1(q ~ ~ being my sworn, depose and s That on theq~day of Su1~Q~ , 2013, 1 rsonally posted t propert known as , r' ~ "Q,-~3%L,,ri YSi1~Sflfl~C E ~~1.~ Q.lil t707' ~ . lv, y by placing the Board of Trustees official poster wh~re it can easily be seen, and that I ave checked / to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday, June l9, 2013. Dated: (signature) Sworn to before me this I ~t~'h day ofSu~2013 ~ Notary Public COlVNIE D. BUNCH ~~.6atay Publiq State of New !'ork No.616U5165054 ~'J~aafiiied in Suffolk County ~:t~nFtrission Expiros AFrp! 3:+, ?~1.b NOTICE IS HEREBY GIVEN that a public hearing will be held by the SOUTHOLD BOARD OF TRUSTEES at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. ~ OWNER(S) OF RECORD:~~d Surzen~c~ SUBJECT OF PUBLIC HEARING: Repair the existing ±75' long bulkhead; replace approximately 15' of bulkhead sheathing using untreated lumber; replace ±75' of bulkhead cap, waters and stringers; install 3.5' wide aluminum retractable steps to beach; add approximately 120 cubic yards of lost fill, and approximately 50 cubic yards of lost topsoil. TIME & DATE OF PUBLIC HEARING: • G~.~esld~~~//, Scan e 19, X013 - ~ o~ S' 3b PY~'~ If ou have an nterest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours of 8 a.m and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 . p ECEIVE D D JUN 1 9 2013 PROOF OF MAILING OF NOTICE - ATTACH CERTIFIED MAIL RECEIPTS outhold own oar f Tr ~ e Name: Address: sT.~ca.4 IC,~M P~ ~(o QA'ySE~{o 2,E ~ . ~ wee o~ ~-r~ I I q ~NI~L ~~Vas 3o Ss ~P~s~fo2~ gyp., GR~Pd~r; II4~- ~+I-N~ f3A~l~l cE 3 ~S Q,~SI+oF~ R p. ~ ~R~JJ~kT, I Iq~1-~- STATE OF NEW YORK COUNTY OF SUFFOLK n _ 1 ,residing at 3~(oJr ~ S _ being duly sworn, depose and says that on the day of ~ , 20~, deponent mailed a true copy of the Notice set orth in the Board of Trustees Application, directed to each of the above named _ _ persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at P~ C~Dn//G that said Noti were mail e h of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this ~c2 Dany of ~~/1/~ , 20 l ~ ~M N-G ~ (.ZSN Notary Public CpNNIE D. BUNCN Nota~ ~ Pufalic, Siate of New York ~ iti£'f rti SE~ffolk (`~our~*.y Boa~of Trustees Application • County of Suffolk State of New York ' r ~ BEING DULY SWORN DEPOS AND AFFIRMS THAT /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 SOU"CHOLD 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, IHEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ON MY PROPERT T INSPECT THE PREMISES IN CONJUNCTION WIT IEW OF THI P ICAT[ON. Signature of Property O SWORN TO BEFORE ME THIS DAY OF 20~ i i - i ~ ~ ~u,tic~ Notary Public ~ i i CONNIE 6. BUNCH Notary Pubtic, State of New Yc;k No 656U6tS~*7 0 ~ ~ . C aaii's tl on Ssattolk ~osan4y 1 _ Con ryas+cri xpsra<; qtr ~'re. 7:L~ Y' 'I ~i i i ' ~ ~ • APPLICANT/AGENT/REPRESENTATIVE ~ ' TRANSAC'T'IONAL DISCLOSURE FORM ' To~.~ of C~uLhold s Code of E'hics p~hibits mnFlic~ of interest on the oaN frown officers and emolovcea The ornnost of _ I this form is m nroviae inforinaio~ which can alert the town of aosstble woflicts of mterest and allow rt m fake_whateve[ action is I ! rpaa°arv to avoid same. n A ( ,t ~ - f YOUR NAME: ~IfR.Z~r" I~,~ ~DG7•I/Tl~~~ ~ ~ (Last name, first nmoe,.rpidNe initial, undass you are applyrrtg m the rrune of someone else or other entity, such as a companY• If so, indicate the oilier persods or comperry's name) _ ~ ~~I ~II NAME OF APPLICATION: (Check ell thatappty.) ~ j 'Tax grievance Building Trustee " ' Change of Zone Coastal Erosion Approval of plat Mooring i i, Exemption from plaz or official map Plmming Other j (lf"Other", namethe activity.) Do you personally (or through your company, spouse, sitiling, parent, or child) have a relafionship.with any officer or employee of [tic Town of Southold? "Relationship" includes by blood, rttaniege, or business interest. "Busirress interest° means a business, including a partnership, in which the town ofTica or employee has even a partial ownership of (or employment by) a corporation in which Ne` tyo/wn officer or employce owns rrwre than 5°h of the shares. YES ~L~ NO ~ ' If you answered "YES", complete the balance of this form and date and sign where indicpttd. ^'1 I, _ Name of person employed by the Town of Southold L ~ ~ r lJ 1/~~ Title or position of that person ~ _ ' Describe the relationship between yourself (the applicanUagenVrepreseniative) and the town officer or employee. Either check ~ the appropriate line A) through D) and/or describe in the space proJided. ~ The town officer or employee or his or her spouse, sibling parent, or child is (check sit dial apply): A) tla owner of greater than 5%of the shares of the wrporate stock ofthe epplicerd 1-. (when the applicant is a mrporoNon); - i ~B) the legal or beneficial owner of any interest in anon-corporate entity (when the eppticant is not a rxapomtion); - _ _C) an ofFcer, director, partner, or employee of the applicam; or - ^D) the actual applicant ' DESCR[P770N OF 1tELAT10NSH[P ~ ~ ~i~ I! i. ~ Submitted this _ 3I d o ~ N 2oQ Signature Print Name ~ ~ Form TS I Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSES8MENT FORM $ PROPERTY LDCATIOU: s.c.TUr. s: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF 4 "4( ~ STORMiSATER. GRADING, D NAOE AND ION CONTROL I, "6E6IF 3~ac o~ii 71sT ~ CBRTIFIEri I~P N)NAL IN THE STATE OF NEW YORK. SCOPE OF WORK -PROPOSED CONSTRUCTION ITEM # /WORK ASSESSMENT Yea No a. What b the TotalArea of Me Project Parcels? ~ WIN Mis Project Retain AI Sloan-Water Run-OfF pndude Total Area of ap Parcels bcatetl whin Generated by a Two (2~ Inch ReMall on Site? the Swpe of Work for Propaed Construcaon) (This Item wiN include all runvR seated by sRe V b. What is the Toml Area of Land Cleadrrg (sF. r ao.sl dearkg andlor construdion acpvides as well es ap yam. andlw Ground Dklurbance fw the (xoposed Site Improvements and the permanent creation U consbuction aclivil)I7 impervious surfaces.) - (S.F.IAaoa) xf ~~8$IIB Plan 81M/Or $IaVey $FIOw MI PfepO3ad PROVIDE BRIEF PROIECI'DESCRIPPION pbabeMdm,wlPpes.x.xddr L prefnageSWclures lndieaNng SizeBLOCaOOn?This ' Item shell InUUde ap Proposed Grade Cha~7es and ~ - ~i,, f ~ Sbpes Cordrolling Surface Wetet Flaw. ~ ~ $ Does the Site Plan andla Survey describe the erosion ` and sediment conbd praetices that wB be used m control site erosion and slonn water discharges. This item must be malnmined Mroughout Die Entire ConslnMion Perbd. Q WNI Mis Projed Require any Larrd Filling, Grading a ~ Excavation where Mare is a change m the Nahaal ? ~ Exispng Grade Imdving more Man 200 Cubic Yards 01 Mamdal wiM(n ery Parcel? rJ WIII Mis Applicetbn Require Land Disturbing Activities ? V Encompassing an Area in Excess of Five Thousand ~-~C-/^-' (5,000 S.F.) Square Feet of Grourd Surtace7 ~ s Is Mere a Natwal Water Couroe Running Mrough Me ? / ape? Is Mis Project wihin Me Trustees jlrrisdicdon XL General DEC SWP RagWremenb: w within One Hundred (100') feet Of a Wetland w Submbabn a a SWPPP b required hx d CanNmkan aarvNes Involehg sap Beadr? . tlnmrbancaedorre (t)ar mae ease: bICMMYq tliamrbNCeadbW Nan one Sae Nat 'i, are part a a mrgsr carerDn pbn ant wS iAkrwmy OIaWm one ormae aces a brM; ~ VNA Mare be Site preperetlon on Existing Grade Sbpes ? , IrxLdhg Consbudbn aolbkks krrddrg sou dhlurbenoes a ties wren are (t) acre wnaM which FJCCeed FiReen (15) feat of VP.rlical Rise M the DEC roe demmwretl Nei a SPDES pemuta requred br dam vMardrclrergea One Hundred (700') of Horizontal Distance? j i (SWPPP's 9haR owes are Ninhrrmn RequlramMS sew BPOES Oanerd Parma $ Will DrWeways, Pading Ards or other Impervious for Slorrrr wemr [NSeMrpas from Conelructlon xawy • PamN No. Dp~s.to-0ot.l Sudeces be Sroped to Direct Slonri-Water RurFOff ~ ~ I t. TM SWPPP drek Ire prepamtl prior m are submNbl d Ne NOL The Not shat ba into and/win Me direction of a Torn rlghFOf-wa)? ~ ~I svdralma m Me txrp.rhrwnt prtw m era wnnrrcaront aowweudbn adbky. j 2. Tha SWPPP SIW MaafOe the erosion erxl sedlmmloonbd pmtaoeeaM where 9 Will Mis Protect Require Nre PlecementMMamr191, / required, pwlcomirearon skNm wrier nwnapamart pnaraN Net vA1 be uaM arrelor Removal of Vegetation andlor the ConsWdion of arty ~ ~ corrneucW to reduw the pomlaMS N atamrvata tlbohargea errd lp aurae Item Within Me Town RlghtOf•Way or Road StquMer , ~ I canpllancewM Notxms end aardROm athb pamrk.meddklon, Sre SWPPP ehaA Neal m+mm-nx aor l,wkrer ne aurawandea.eew/erwa) ida^Ny pobMbl eowces a wsukon whbh may roeeonaey M expeebd m affect Ne quelly of atartn weterd6drergan. NOTE: NNry Mwwam Owetlare OrreNrough NnebAmwast wfihe Cheek klwk 3. AiI SWPPPs Nel Mquha tM poalcombuctlon alamwabr merogenenr aedk:e In a sox and tlN oemtructbn aNa dieturbams is baheear gagq.0.F. i t hero m em, I eamporreM drep 6e prepaed by a 9uolHbd Deaipn Profesalawl Lkenaed b New York a Slam-Wamr, Gradng, Drainage 8 Erwbn Correct Plan b Reprkad by tlra TOwn a Ihd b krreWedgaede In rho pdndplas and pnrdroee a Slam Wales Management. Soulhdd eq Nua pe Submpbd Iw ~Wew Prior m bauanq aArry Bwlding Parrrkk j INOTE: ACIetl~MeMf~l soda MV.v br eaN DuurmbRewied fae0aryhm PPpke0on/ i-; STATE OF NEW YORK, r . L?." i G//COUN77JJOF..9J~...~t..TT~.~....~..---.. SS I! i !bat I, ~~It.r... V .vf' <ih.~.:-being duly sworn, deposes and says that he/she is the applicant for Pemvy ' . (Woe d IndbMud agda~ DoaxrimU And that he/she ~ the ...._'.~'~.~.6.)!..5a..1. ,.._......~ii~;i~:: c~o-:Eid:yAi~; cor6o%+t:"o'rii~:: ~j r~ i~ Owner and/or re resentatrve of the Otnxr or Owner3, and is dui authorized to edorm or have tfortned the said wcrk and [o i, make and file this application; that all statements contained in this application are true to rite best of his luto ledge and belief; and ~ that the work will be performed in the manner set forth in the appliaumt filed herewi r I, I~. Sw~ tt~ beFore me,,tJhis........riay of, ......~'::.^..~hP.:f.arf . `l0. ~3 No Pubhr ........Lrr.:....~:....-~F~. (3'gmNad ~i FORM - 06!10 T~MI S i ~n wale safe a fNw 161Y ~D. o~i~~i I ~ i v „ • • Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for pennits* 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 iufomtation used by a Town of Southold agency in making a determination of consistency. *Fxcept 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 arooosed action will be evaluated. as to its siStificant 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 e~lained in detail. listin¢ both suuportine and non- suouortint facts. If an action cannot be certified as consistent with the LWRP policy standazds and j. conditions, it shall not be undertaken. A copy of the LV?RP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Tnutces Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE A~N7D PROPOSED ACTION SCTM# 3 / ~ii PROJECT NAME 315 ~/17Y~~ ~I The Application has been submitted to (check appropriate response): i Town Board ? Planuing Board ? Building Dept. ? Board of Trustees ~ III 1. Category of Town of Southold agency action (check appropriate response): l' (a) Action undertaken directly by Town agency (e.g. capital ? constntction, planning activity, agency regulation, land transaction) ? 'r I (b) Financial assistance (e.g. grant, loan, subsidy) i (c) Permit, approval, license, certification: Nature and extent of action: j ~ ~ ~ ~E' _ ~-i C5 - ~~s) ~ N ~ 1 • • ~ Location ofaction//: Site acreage:T~i Present land use: G~9-~-~1 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: d-C,E ~ (b) Mailing address: ~((a.S (c) Telephone number: Area Code ~o ~ ' T 7 7- ~ Z~ ~ (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 I. Fbster 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 LR'RP Section III -Policies; Page 2 for evaluation criteria. ? No ? Not Applicable i i i Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III -Policies Pages 3 through 6 for evaluation criteria ~ ? Yes ? No Not Applicable i i • • Attach additicnal shcets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Soathold. See LWRP Section HI -Policies Pages 6 through 7 for evaluation criteria yes ? No ? Not Applicable Attach additional sheets if necessary NATU1tAI. COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LW12P Section III -Policies Pages 8 through 16 for evaluation criteria Yes ? No ? Not Applicable Attach additional shcets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LW1tP Section III -Policies Pagea 16 through 21 for evalaation criteria ? yes ? No ~ot Applicable Attach additional sheets if necessary I Policy 6. Protect and restore the- quality and function of the Town of Southold eeosystems including j Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III -Policies; Pages. 22 ~ through 32 for evaluation criteria. ~ ~ Yes No Not Applicable 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 ~-Nof Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III -Policies; Pages 34 through 38 for evaluation criteria. Yes ? No ~ Not Applicable i 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. _ j I Ye~ No Applicable ~ II 'h ii ii l i Attach additioaal shcets if necessary ~ ~I r ~ . WORHING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Secfion III -Policies; Pages 47 through 56 for evaluation criteria. ? Yes ? No ~iot Applicable Attach additional sheets if necessary Policy 11. Promote sustainahle 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 ~Vot 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 fory-evyaluation criteria. ? Yes ? No ¢41~Tot Applicable I Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III -Policies; Pages 65 through 68 for evaluation criteria. ? Yes ? No Not Applicable PREPARED BY TPPLE DATE ~i Southold Town Board -Letter BoardrMeeting of March 26, 2013 RESOLUTION 2013-280 Item # 5.44 ADOPTED DOC ID: 8695 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION N0.2013-280 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON MARCH 26, 2013: RESOLVED that the Town Board of the Town of Southold hereby waives Trustees' permit fees for any repairs or construction, that in the sole discretion of the Boazd of Trustees, are determined to be related to Superstorm Sandy, until May 1, 2013. Elizabeth A. Neville Southold Town C?erk RESULT: ADOPTED [UNANIMOUS] MOVER: Jill Doherty, Councilwoman SECONDER: William Ruland, Councilman AYES: Dinizio Jr, Ruland, Doherty, Talbot, Evans, Russell Generated March 27, 2013 Page 2 ~i -J ~kz_~.PJ _ i' HNi~RUVtU ~ Y BOARD OF TRUSTEES TOWN OF SOUTHOLD t DATE ~ (3 { , ~ 1 i f} i I I ~ ECEBiiE D 1 MAY 2 8 2013 -}IO~~ i ' uthold Town {~~'T i it I e _ - J srt~s --r-~ ~s~ f ~ re~~re~~l2~ v~ ~rc~ ~ ~~~,-0. ~ f~N~J s rcPs 11 '"1 C~~~~FE_ i\ 7 ~~t~ C A-P ~St ?~N~~'S' _ ~odc~ av'c~o~.. +~oRh-, `~~~IQCe I I 1 v,Ny~ s"~,~-r.H-i ~