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HomeMy WebLinkAboutTR-1614 James F. King, President o~g~FFO(,rco Town Hall, 53095 Main Rd. Bob Ghosio, Jc, Vice-President g~ti'>` ~ P.O. Box 1179 Dave Bergen ~ Southold, NY l 1971 John Bredemeyer Telephone (631) 765-1892 Michael J. Domino '~'Ol ~ 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 O~ `~OF S~UTyOI Town Hall Annex Bob Ghosio, Jr., Vice-President ~ ~ 54375 Main Road P.O. Box 1179 Dave Bergen # ~ Southold, New York 11971-0959 John Bredemeyer G C ~ • ~O Telephone (631) 765-1592 Michael J. Domino O Fax (631) 765-6641 ~~OOUNT'I,l1cc~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 15, 2013 Ms. Regina Cartselos Latham Sand & Gravel PO Box 608 Peconic, NY 11958 RE: 1120 BROADWATERS ROAD, CUTCHOGUE SCTM# 104-9-2 Dear Ms. Cartselos: The following action was taken at the Southold Town Board of Trustees regular meeting held on Wednesday, May 15, 2013: RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a Transfer of Wetland Permit #1614 from Eugene Bolter to Marilyn Sferrazza, as issued on March 4, 1981, and BE IT FURTHER RESOLVED, that the Southold Town Board of Trustees APPROVE the Administrative Amendment to Wetland Permit #1614 for the existing 3'x72' fixed catwalk; 3'x14' ramp; and floating dock with four 8"diameter batter piles, with the condition the floating dock be downsized to 120sq. ft. and must be done within 60 days, and as depicted on the project plan prepared by Latham Sand & Gravel, received on June 5, 2013 and stamp approved on June 7, 2013. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please contact our office at (631) 765-1892. Si rely, ~ 1,/ James F. King C~'~Jt~. President, Board of Trustees .~~~~g~f~¢c~~ James F. King, President y ~ Town Hall Annex Bob Ghosia, Jr., Vice-President w 54375 Route 25, P.O. Box 1179 ' Dave Bergen ~,j,.y` 0~ Southold, NY 11971 John Bredemeyer Y!j ,y~ ,~3 Telephone (63l) 765-1892 Michael J. Domino 'R Fax (63l) 765-6641 BOARD OF TOWN TRUSTEES ITOW/N~ OF SOUTHOLD TO: L~-Y~LQVVI SQVIrI (N~\Jp 1 ~Ir~II/Vl ~Y ~7Q Please be advised that your application dated 3D 3 has been reviewed by this Board at the regular meeting of S 5 and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Constnaction Hay Bale Line Inspection Fee ($50.00) 1St Day of Construction ($50.00) / Yz Constnacted ($50.00) Final Inspection Fee ($50.00). v Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed. below atxording to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The folowing fee must be paid within 90 days or rye-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION O PERMIT FEES: final ~vlsPeckionD. DD Dack-~ccs: Catwalk C3'xIS')=St-! sq..~~-, x~3.bo~~-sQ.~.~-_~ (fo2.6D ramp (3`X Z') = (o S ~ X ~ 3. oo per sQ -F-1- I g . D0 -filoa~n9 dock = C (`~2' K l(o'~ = Z~{ ~~F~, xN3 2.Dd TOTAL FEES DUE: $ 3 D Z , bb BY: James F. King, President Board of Trustees suFFO~~. .lames F. King. President p~ C P.O. Box 1179 Bob Ghosio, Jr., Vice-President ~ ~ Southold. NY 11971 Dave Bergen ~ ? Telephone (631 765-1892 .lohn Bredemeyer ,y n# Fax (631)765-6641 Michael J. Domino ~ ~ y'yo1 # aao~. Southold Town Board of Trustees Fieldplns ectionNVork Session Report Date/Time: u Latham Sand & Gravel on behalf of MARILYN SFERRAZZA requests a Transfer of Wetland Permit #1614 from Eugene Bolter to Marilyn Sferrazza, as issued on March 4, 1981; and for an Administrative Amendment to Wetland Permit #1614 for the existing 3'x72' fixed catwalk; 3'x14' ramp; 10'3"x16'3" floating dock with four 8" diameter batter piles. Located: 1120 Broadwaters Road, Cutchogue. SCTM# 104-9-2 Type of area to be impacted: - Saltwater Wetland Freshwater Wetland Sound -Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: ~Chapt.275 Chapt. 111 -other Type of Application: Wetland -Coastal Erosion ~Q,mendment _Administrative_Emergency -Pre-Submission / Violation Info needed: ~ ~ ~ 3 ~ X ~6 r 3 /l ~ `-I °4 Z C4, w a Modifications: Conditions: Pre~t Were: Kin B. Ghosio D Bergen, J. Bredemeyer Michael Domino D. Dzenkowski other Form filled out in the field by ~3°. Mailed/Faxed to: Date: /Vlar~' lyn Sic rra ZZat sc 7~n ~ l o ~-4-2 fi r. - _ _ . - - ~r= ':ice,. ~4~-'~ Iii ~y ~ i 4:II.~~ T 4,. ~ _ ^S- `.~Ti'~L9M~ - ,t ~c-- - _ - ~ _ I. _ _ ~~G'IJky'y'1~F- s i~~ _ i J _ _ _ ,'yr.~ c/ ujy ~'~~I .~k.- - \ S' A:~J Ific;Sy PiS?:..=.Y VZSID~ 1•.OGRZ v ii4:IJ..: J ~.~iu i~Cit^. ~l NJ A.ID ~ . nL" DC":S ni:J nu 7 :TLS \iUSi DiS 1K+~ V15It3L PF: 'Z^ iIU::3 PS ~ ~~i.. /.:.mom ~ ~J ~ ~.'.`~~..~~.7.x~ J+.~r'r..ncc. ~..~f-.. .7 ~~a-!~ •rT ~ ~ K~'_/ i'?^ti4 t'wti ~ > ~ l r G _ ~ia+t 5 "w D r. y.±~ni .t rs .fir >y ,I^ t ry! t „Y a^ v~lt .FTC Ir r~~~ f^ E~r 2 ::ii , f 4 , .n C ' . r f'1 T ~,4„ ~ rV"~~-~nT 7 ^~i~7~ Y4~~.-+r ~ `~/..s » Y ~ h F t t , aoard Gf ~outriosd i o~r~n Trustees 1 ~ ` ' . . SCUTHCLD, N'cW YORK i'1 iffy r~G,r\, o NSA ' : ASCC S'G NO r`!S ~ 1` c 1614,. DATE March 4, 19.81 x~~, y' ~ ' PERMIT NO ,_..T- a 1 4~ ~.hw~~ Titjl/ ? -r ISSUED TO En Consultants 'for Eugene Bolter ~ ~ ~ ^ s ( - YtE~ ~i , ri Pursuanfi to the provisions of Chapter bas of the Laws of +`~c ~d.~~ 1w r'7, fhe 5+ate of New. York, 1843; ane Chapter 404 of the Laws o,f the 3~~£`_`L<` .,--.h; State of New York 14SZ; and the Sourhord Town Ordinance en- a ? t =`x' tifiled "REC-ULATING AND THE ?LACWG OF OBSTRUCTIONS ~'ii~ ~~t IN AND ON TOWN WATE-e5 AND Pt3BL1C LANDS arsd the f.;fry H j. n - REMOVAj_ OF SAND, G:cAVEL OP, OT, ,cR MATERIALS FROM . ~7;' t y LANDS UNDER TOWN WATERS;" and in accordance with the r5L" ,r c Resolution of The Board adopted afi a m =nrg held on .k>~rGh,_,4, }a~'~ r 'L b~~ f' ~ 81 r ' r r- ty~ ~ g~', 19..._..., ana m wnsiderarion or the sumo $ 103 ,Q0 palo'by yi { yJ TZ ' ~ ~ of .._.._~.111r~~.A3.Ae N Y. and s~oject to the r~ ~rl; `'\t i JO t.! ~ Terms ,and Cor,ditw~s "listed on the reverse side hereof, #;3 ~ ">J/ ~ ~ ,p of Southold Town Trustees. aufhonxes ana permia the foilowmc~: " a r~T • ~ Approved to constFUCt a tiriber dock, fixed cat- P yf, walk,. hinged ramp and float plus associated pilings ~~:1, . s subject to: See teverse side for provisions of ;y~ ~ #~wi ~E.. x t r ~r >v„ \l ~ s : a1~~~2t~t,.ance with t..e deiaileq zpeei;rcatiors as present=d in f ~ . ~ I, ! fhe onginaring applicaficn_ - . ~-r Tr, I RF: a ~E~`: IN WITNESS WHcREv^F, The said Board of Trusfiees here- y,i~f~. ~S;~p b~ " ~ by causes lts Corporate .Seal to be affixed, and these presents to ~~r~' ~ ~E 6e snbscribea' by a majority or the said aBoard as of this dare. ~a < /j i ~ ~v.'' 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I 'x ~ Y 1. . ; fir. , ` ; ri $ItS$., $E'CT IQN. Ti~lR~1! DoLK. -F,. ~r ~ _ _ SCAM - r ~ ~ ~ . %?o~Ea ~ `GALE ~~aSA , _DQTVM:~ L1e! . . f + , EZ~S'?eNb ~QVRPO l~pr~4;7@;,13oc~c~Nlr AO7AC~?~~~wAI~RS HaME ~ A Rock r'~~( i M 40 ,r~' r v l r. , ~ lsRAP_o~SF AEGK, CFITwAtK`, , ....RAMP ANP'::,- FLOAT x ' for EU~EME., $dc;TER ~ at NASSAU 'PT,) $OvTNOGD, , ~ P° _ SuF.FQ~.~"C~,~fl~ R.o oh ~3~t9CWATBRS . CLIy~F ' „ P~ 6~ FN-,C DN$UtTf~NT$~, SNC. JP ~ by N MA~.v ST. SOVT H A~-1P.ToN, N..Y. 0~,~° sHSEr Hof i. NaYlgr'. , ,r, , , . u, h,.~ . , _ $ u..u ^Aa C.u sa~~ ~ r--F$-_~ A w~ .p a ~ - ~ ~ ~ ~'7 ~ ~ - O ~J ? ' ~ ~tl3 ~ ~'r _ ? O.' • n • orW uP ? 1~ 9 ~ ~ y .?DW~ p 1 e V ? O ` P" F 9 w n ? . 9 p ~ nwc v^~' ~r P P• vnem~. q S ? 9~.d g F'\ O © e e " ` `i ? flSpppWITERS LOVE \ ~i. ? ? ~ o ? 4 m ra~o~sanro~o N 1i a t . .~~w o ~ha I r r Y j ~ ~ ~ ~ l~ P_ ~ ~ f ~ ~ ~ ~ ~ ~ - ~r" .8 ~ ~ .n ~ P .mow. 2 P . B xmK€ COUNfY OF SUFFOUC © fE1f9M~ n~i Q - _ _ _ aw a~rwMr ru SarAw Poeiq' E ° 104 OFFICE LOCATION: ~~Of SOUTyO MAILING ADDRESS: Town Hall Annex ,~O l~ P.O. Box 1179 54375 State Route 25 ~ y Southold, NY 11971 (cor. Main Rd. & Youngs AveJ H ~ Telephone: 631 765-1938 Southold, NY 11971 ~ ~ i0 Fax: 631 765-3136 ~~OOUNTV LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jim King, President ~ ---,I l Town of Southold Board of Trustees ~ , ~ Illl llll MAY 1 4 2C13 From: Mark Terry, Principal Planner LWRP Coordinator Southo!tl Town Date: May 14, 2013 ~ r ~ s e Re: Proposed Wetland Permit for MARILYN SFERRAZZA SCTM#1000-104-9-2 Latham Sand & Gravel on behalf of MARILYN SFERRAZZA requests a Transfer of Wetland Permit #1614 from Eugene Bolter to Marilyn Sferrazza, as issued on March 4, 1981; and for an Administrative Amendment to Wetland Permit #1614 for the existing 3'x72' fixed catwalk; 3'x14' ramp; 10'3"x16'3" floating dock with four 8" diameter batter piles. Located: 1120 Broadwaters Road, Cutchogue. SCTM# 104-9-2 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 ~~Of SD(/ryO Town Hall Annex 54375 Main Road Bob Ghosio, Jr., Vice-President ,~O l~ P.O. Box 1179 Dave Bergen #t # Southold, New York 11971-0959 John Bredemeyer G Q Michael J. Domino ` Telephone (631) 765-1892 ~yCOU~'~~ Fax (631) 765-6641 p E EIVE D BOARD OF TOWN TRU D STEES ppR 3 0 2013 TOWN OF SOUTHOLD oxm APPLICATION FOR A TRANSFER OF A WETLAND PERMIT DATE ~~~1,~ OWNEK Fn~n ~ ~~A >G} PHONE ~I~ C14Y"sIOS MAILING;7A-DDRESS~~j ~J~ Ule ~ CtJfjSJ~,~G~-~on~ nu ~iosb AGENT L~.7.!~~ ~-~Se I ~ PHONE ~3~- `~34- 6 g~ GA~}hFxr1 ~d+ 6re~?sz ADDRESS,3s~SO -rz+ 48 ~ ~,x Gob ~e .c PROPERTY LOCATION IJ~ '~OF3O~cJ~fCh'~ rI C't~Cfx>~t~n TAX MAP NO. /~j¢ ~ ~ "i I/We ~BC~ ~u17 ~rt'AZ7f} ~ ~~e~jlnF} ~r--~e~d`j request a Transfer of Permit# / / from ~(~qC ~xl-l-e~ Signed By: ~ ' ~iLt • James F. King, President ~QF SO(/jy Town Hall Annex Bob Ghosio, Jr., Vice-President ,~0~ 54375 Main Road P.O. Box 1179 Dave Bergen l~1 Southold, New York 11971-0959 John Bredemeyer Michael J. Domino G ~ ~ Telephone (631) 765-1892 Fax (631) 765-6641 ~~'~OOUNiV p E EIVE BOARD OF TOWN TRUSTEES APR 3 0 2013 TOWN OF SOUTHOLD own APPLICATION FOR AN AMENDMENT TO A WETLAND PERMIT DATE Q~/~i(~ I I ~ OWNERmAr~ I,~Q ~ r~F3 7A PHONE SI 99.4- SOS ADDRESSo~~S l~O(l('~VI ~ \ c~~ll(~ ~a~+(.c~RS~iinS'~O(~~ (X/ //QSO AGENT lfY3 C~-~S~CQ` PHONE 7~4- ~og~ Hm Sr~nd+ 6crTU~ ADDRESS i g b '2+ 4 ~ /~C~ ~80 k C~O~' ~~r~~ C'/~ ~ ~r PROPERTY LOCATION //~~o ~Ai~()~}Y~JPr~~~~ ~ ~-~J7c u~~9 (lP TAX MAP NO. ~O 4 I/We I"ppr ~un 444'or~r~ax-~+ ~r-k~`~r~luest an Amendment to Permit #I l( l4- to ~"~rmr~ eXiS-I~nq ~x'~c~' CF1~wHl~ I `I"' rhJrnC~, /0',~ "x I~'3" ~ior~-~- fi g`l x~~ wry ~l--~e~ le j Signed By: / ^ • Bn.2o • SEAR PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANTlSPONSOR 2. PROJECT NAME 1 ~ C 3.PROJECT LOCATION: ~ / _ / k~0 ~rol~ r-~~2rS KfY 5 U-FTU f Municipality County 4. PRECISE LOCATION: SVeet Addess and Road Intersections. Prominent landmarks etc • or provide map ~ro~ ~~~~r ~ Cv-l-cfx~9~.Q 5. IS PROPOSED ACTION : ~ New ~ Expansion ~rJl Modification / alteradan 6. DESCRIBE PROJECT BRIEFLY: Jul ~r'mr-a- ~tS-~-Ir,9 X'73' CR-~u~R~~ x ~ 4' rx?m P /0'~3'' x ~ 6' 3" f lore-~- 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILY PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? fyr+-(-'/t~l Yes ~ Na If no, describe briefly: 9. W AT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential ~ Intlustrial Commercial Agriculture ~ Park /Forest /Open Space ~ Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Feder State or Locaq Yes No It yes, IisC agency name antl permit /approval: 11. DOES A ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes o If yes, list agency name and permit /approval: S A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? es No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / S onsor Name Date: } Signature 4~~0 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 Tr~com leted b Lead A enc • A. DOES ACTION EXCEED 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 617.67 If No, a negative deGaration may be superseded by another invobed agency. Yes ~ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, ff legible) C1. Existing air quality, surtace or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or Hooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or wltural 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: C6. Growth, subsequent development, or related adivdies likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in Ct-CS? 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 (CEA)? Yes ~ No If Yes, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? Yes Q 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 "rf you have identfied one or more potentially large or significant adverse impacts which MAY occur. Then proceed direly to the FUL EAF and/or prepare a positive deGaration. Chedrthis box Hyou have determined, based on the information and analysis above and any supporting tlocumentation, that the proposed action VVl NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting this determination Board of Trustees Name o ea Agency ate President Print or Type Name of Responsible cer in Lead Agency Hle o Responsible cer gnature o esponsi k cer in Lead gency ignature o reparer ( Brent rom responsible o icer) From: ltham gravel <lathamgravel@optonline.neb Subject: Trustee forms Date: April 30, 2013 2:43:14 PM EDT To: lynns@optonline. net ? 2 Attachments, 528 KB Hi Lynn, Here are the forms that we spoke about. If you could sign them and overnight them back, that would be great Latham Sand 8 Gravel P.O. Box 608 Peconic, NY 71958 Thanks, Regina Board of Trustees Application AUTHORIZATION (where. the applicant is not the owner) /~}y r ~ S 4C I, ~~iQ-R r~ ?,t~~9°~pZL p,~ residing at a ~S. ~dcl I//Cw ~ ~ ~~.r ~A ~ primeowner o£ property] (mailing address) ~ ~ /IUS~~ do hereby authorize (Agent) ~7If7/~ C~~-{S~~C;J to apply for permit(s) from the Southold Board o£ Town Trustees on my behalf. r ~ (Owns ~s~{iature From: ltham gravel <lathamgravel@optonline.neb Subject: Trustee forms Date: April 30, 2013 2:43:14 PM EDT To: lynns@optonline. net ? 2 Attachments, 528 KB Hi Lynn, Here are the forms that we spoke about. If you could sign them and overnight them back, that would be great Latham Sand & Gravel P.O. Box 608 Pecronic, NY 11958 Thanks, Regina Board of Trustees Application - AUTHORIZATION (where the applicant is not the owner) ~j 1, ~ R~ ~ SF~~ C A2 ~ A resiaing at //~P. ~ ~ Kof]~JCvA7r~ S ~C~ ~ ~ (print owner a p~rtg) (mailing 'address) L?r. ~bc do hereby authorize 1 (Agent) /L~71(7H C~~"15F~t~J to apply for permit(s) from the Southold Board of Town Trustees on my behalf. ~ (Owner' si n re) Board of Trustees Application County of Suffolk State of New York ~i I~~ ~P~r~2Z~ - BEINGDULYSWORN .DEPOSES AFFBtMS THAT HBISHE IS THE APPLICANT FOR THE A$O'I!E - DESCRIBED PERMIT(S) AND THAT ALL STATHMENTS. CONTAINED HI3REIN ARE TRUE TOTHfi BESTUF HIS/HERKNOWLEDGE AND BELIEF, AND THAT ALL WORK WII,LBE DbNE-IN THE MANNER SBT FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTIIOI;D TOWN BOARD OF TRUSTEES. THEAPPLICANT AGREES T'O HOLD THE TOWN OF SOi1THOLD AND THE TOWN TRUSTEES - HARrS+T FcS~ AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING '~UNDERORBYVIRTUEOFSAID~PEiLMIT{S),IF.GRANTED.INCOMPLETINGTHIS APPLICATION, I HEREBY. AUTHCiRIZE THE TRUSTEES, THEiR AGENT(S) OR REPRESENTATIVES(S); TO ENTER ONTO MY PROPERTY TO INSPECT THE 'PR'EMISES IIQ'CONJIINCTION WCI'ti REVIEW OF THIS APPLICATION. T .,u~ ~l Si na r ~ SWORN TO BEFORE ME THIS ~JL/ _ _DAY OF !~/r11__,20~ REGINA L. CARTSELOS Notary Public- State of New York taty Public No. 01 CA6198908 Qualified in Suffolk Courriy My Commission Expires January S; ZOt~. APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM 'n+ 'r f a, nhnld' ['ode of Ethics prohibits conflicts of interest on the part of to>1m dtficers and emplovces The purpose of - - this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessarv to avoid same. rr - YOURNAME:~Q-r"/t~~ ~'~c`jQIC:~ t0~ I~1Hri~rlf~S~er'{7-~ZA (Last name, first name, griddle initial, uples y aro applying iri the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building - Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring - Exemption from plat or official map Planning Other (If "Other', name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "RelaGonsfiip" includes by blood, marriage, or business interest "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation - in which the town officer or employee owns more than 5% of the shares. YES NO 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 br position of that person Describe the relationship behvcen yourself (the applicantlagenUrepresentative) and the [own officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town otiicer or employee or his or her spouse, sibling, parenk or child is (check allttiat apply): A) the owner of greater than 5% of the shares of the corporate stock of the applicant . . (when the applicant is a corporaton); B) the legal or beneficial owner of any interest in anon-corpomte entiTy (when the applicant is not a corporation); C) an otticey director, partnerr.or employee of the applicant; or D) the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this ~~~day of ~ _20~ Signature Print Name r~l~s Form TS 1 ~ Town of Southold ~ • LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for pennits* 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 infonnation used by a Town of Southold agency in making a determination of consistency. *Ezcept 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 significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town. ~ 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be exulained in detaih listin¢ both suaaortine and non- ~ supportive facts. If an action cannot be certified as consistent with the LWRP policy standazds and f conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED I~1 cj ~ B ~ ~ D SCTM# ~ - ~ _ a D APR 3 0 2013 PROJECT NAME - uthold own The Application bas been submitted to (check approp Tr ~ e i• Town Board ? Planning Board ? Building Dept. ? Board of Trustees ~ ~ I 1. Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital ? construction, planning activity, agency regulation, land h~ansaction) ? (b) Financial assistance (e.g. grant, loan, subsidy) I i (c) Permit, approval, license, certification: ii Nature and extent of action: ~Cmr-~ esc~}~~1C~~ ~1x~4~t-~~ 10'3" X /~iX~~~cx~l- + ~t ~Xo~O'n1~P t~~~h f~-l-~e/ ~1 Location of action: / 1~(~~C~S ~ , Cl}~(.JQ Site acreage: Present land use: c~~~-~F} 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: ri ~ l 1 /~22 (b) Mailing address: ~ ~qU U~~ C~ ~~-~-(rI~ f ~,q q~ ~n ny I i (c) Telephone number: Area Code ( ) ~ 1 '7~- hgQQ (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 efScient 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 j 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 LWR,P Section III -Policies Pages 3 through 6 for evaluation criteria ~i ? Yes ? NQ~Not Applicable . r ~ 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 I ? 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 i ? Yes ? No~Not Applicable Attach addtnonal sheets ~f 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 Applicably • 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 wjas~tes. See LWRP Section III -Policies; Pages 34 through 38 for evaluation criteria. ? Yes ? Noll 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. ? Ye~ No~Not Applicable i I Attach additional sheets if necessary WORKING 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 ? Noc~ Not Applicable i Attach additional sheets if necessary ~ Policy 11. Promote sustainable use of living marine resources in Long Island ,Sound, the Peconic Estuary and Tow~ngw.aters. See LWRP Section III -Policies; Pages 57 through 62 for evaluation criteria. ? Yes ? NoJ~ 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 I 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 i i I PREPARED BY TITLE (y~~i CQ f~l~ ~Q~ DATE 3 1,~ ~ 'T n: .sc-T. 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