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HomeMy WebLinkAboutTR-8324A` homvA L vnL 1730 `bleat Creek, Iluen,ue, CuWw4.ue, `N`Y 11935 June 15, 2015 Board of Trustees Town of Southold Town Hall Annex 54375 Main Road, P.O. Box 1179 Southold, New York 11971 Re: Permit # 8324A Applicant: Thomas E. Uhl SCTM# 110-1-7.3 Project Location: 1730 West Creek Ave., Cutchogue, NY Dear Sirs: The above project is complete and I would like a compliance inspection. Please be advised that the following items are not going to be completed: -------. JUN 1 1. 30" x 24" generator 2. 4" x 14' long trench to install underground electric and water lines on the landward side ofthe,house. 3: Enlarge existing shed to 8' x 12' Thank you for your attention to this matter. TEU:cm DN: Board of Trustees Letter 6/15/15 John M. Bredemeyer III, President®�®�® *Of Soil Michael J. Domino, Vice -Presidents " >w James F. King, Trustee , Dave Bergen, Trustee Charles J. Sanders, Trustee ��Owi BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 CERTIFICATE OF COMPLIANCE # 1131C Telephone (631) 765-1892 Fax (631) 765-6641 Date: July 13, 2015 THIS CERTIFIES that the maintaining the existing 4' wide path; the three (3) existing 5'x8' wood vegetable_ planters; to maintain the trimming of shrubbery throughout the established lawn area; and the removal of dead trees and vegetation around planters. At 1730 West Creek Avenue, Cutchog_ue Suffolk County Tax Map #110-1-7.3 Conforms to the application for a Trustees Permit heretofore filed in this office Dated October 25, 2013 pursuant to which Trustees Administrative Permit #8324A Dated November 13, 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 maintaining the existing 4' wide path; the three (3) existing 5'x8' wood vegetable planters; to maintain the trimming of shrubbery throughout the established lawn area; and the removal of dead trees and vegetation around planters. The certificate is issued to THOMAS E. UHL owner of the aforesaid property. Authorized Signature John M. Bredemeyer III, President Michael J. Domino, Vice -President James F_ King Dave Bergen Charles J. Sanders DATE OF INSPECTION: Ch. 275 ��o�oguFFO(�y-�OGy o C* y�ol BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Ch. 111 INSPECTION SCHEDULE Pre -construction, silt fence 1't day of construction '/ constructed _V__ Project complete, compliance inspection. INSPECTED BY: - e�, COMMENTS: ich 4 o, tL� f3 CERTIFICATE OF COMPLIANCE: e. --p k Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 James F. King, President Bob Ghosio, Jr., Vice-president Dave Bergen John Bredemeyer Michael J. Domino 0 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD i Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax(631)765-6641 YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE -CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. Pre -construction, hay bale line V4 day of construction _ % constructed Project complete, compliance inspection n L� James F. King, President Bob Ghosio, Jr., Vice -President Dave Bergen John Bredemeyer Michael J. Domino BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 0 Permit No.: 8324A Date of Receipt of Application: October 25, 2013 Applicant: Thomas E. Uhl SCTM#: 110-1-7.3 Project Location: 1730 West Creek Avenue, Cutchogue Date of Resolution/Issuance: November 13, 2013 Date of Expiration: November 13, 2015 Reviewed by: Trustee Dave Bergen Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax(631)765-6641 Project Description: To install a 30"x24" generator and create a 4"x14' long trench to install underground electric and water lines on the landward side of the house; enlarge existing shed to 8'x12'; maintain existing 4' wide access path; maintain three (3) existing 5'x8' wood vegetable planters; maintain and trim the shrubbery throughout the established lawn area; and to remove dead trees and vegetation around the vegetable planters. 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 Thomas E. Uhl, received on October 25, 2013, and stamped approved on November 13, 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. =1 - James F. King, President Board of Trustees James F. King, President Bob Ghosio, Jr., Vice -President Dave Bergen John Bredemeyer Michael 1. Domino Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: dj o 1,3 P.O. Box 1179 Southold. NY 11971 Telephone (631 765-1892 Fax(631)765-6641 THOMAS E. UHL requests an Administrative Permit to install a 30"x24" generator and create a 4"x14' long trench to install underground electric and water lines on the landward side of the house; enlarge existing shed to 8'x12'; maintain existing 4' wide access path; maintain three (3) existing 5'x8' wood vegetable planters; maintain and trim the shrubbery throughout the established lawn area; and to remove dead trees and vegetation around the vegetable planters. Located: 1730 West Creek Avenue, Cutchogue. SCTM# 110-1-7.3 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: ,L-Chapt.275 _Chapt. 111 _other Type of Application: Wetland _Coastal Erosion _Amendment —Administrative—Emergency _Pre -Submission Violation Info Modifications: 6- 1 J,_ ()„ --� -F' '�i JPL � r��. • �1 /4lt Present Were: J. King _B. Ghosio - D Bergen, J. Bredemeyer Michael Domino D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: Town oT outnow .A-2701 Suffolk County, NY The People of the "ata otNew York us. L(AST��NjAME IDEFENDANIj FIRST NPME MIDDLE INITIAL 11tT� T�I"Ln1LG S1 REEi ADDRESS d APr. NO, C O NX, ❑ N.J. ❑ N.Y. O.N.J. ❑ ❑ PASS ❑ COMM ❑ VEHICLE MAKE ❑ ❑ BUICK ❑ CHEV ❑ CADILLAC ❑ PONNAC ❑ FORD ❑ OIAS ❑ PLYM ❑ TOYOTA ❑ yCS ❑ BODY ❑ 2 D ❑ <UA ❑ BUS ❑ MCY ❑ S W. TYPE ❑ TRUCK ❑ TRNIER ❑ VAN ❑ FACTUAL PART NOT FOR TVB) THE ABOVE NAMED DEFENDANT DID ON THE STATED DATE, TIME AND PLACE T - ✓PGS n.� I'MOIA We,[: -a./--7 t 1 -may 4,_ Tro Fm.9°uP e PARKING SCHEDULED MNE 3 CONTACT COURT ❑ THE PESSCN OFSCRNIFD ABOVE IS SUMMONED TO APPEAR AT 80UTNBUD TOVIN JUSTICE COURT, SUNNI ROOM SS, SOVTHOLD, NY 11971 FAIRESTATEMp1SI NM PMy51 MAGWSAMISDEMP pUi$LL TOSECTION3100OF THE PLN. Y. S. COMPWNANT DATE 1 BADGE I l- LAN L �- ■ :w I E] w J f c s s � _ i 1 v Air Op s` ri. �� r y I �I• s } . �C - Yi ta" l?7K I go 4 *: =W �f 7 eIse., =W �f 7 -.'yam . � � � '�_ r..- 4 ?� i.: � - t, 5., - �.. tai `--+< :. :. _ - ' 3o v 3 � � � ,�, r}� � � (J ,a7 j P y ..�� Ale I No Z19661 Y'URM NO. 4 • TC 7N OF SOUTHQL.D —A:;� BOLDING DEPARTMENT Office of _he Building Inspector Town Hall E )uthold N -Y. CERTIFS:ATE OF OCCUPANCY Date JAN. 16, 1991 THIS CERTIFIES that the build ng ADDITIONS Location of Property 1730 WE:"'T CREEK AVE. CUTCHOGUE Hamlet `.--� House No. .Street County Tax Nap No. 1000 Section_ 110 Block O1 Lot\,7.3 Subdivision F led Map No. Lot No. conforms substantially to the Ap-lication for Building Permit heretofore filed in this office dated crT 5 1990 pursuant to which Building Permit No. 194552 de ted OCT. 12 1990 was issued, and conforms to all (.f the requirements of the applicable provisions of the law. The occutancy for which this certificate is issued is DECK AND STORAGE SHED ;DDITION TO EXISTING DWELLING. The certificate is issued to__ Howne"Eunm of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEAICH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. i PLUMBERS CERTIFICATION DATED_ 44BU ilding Inspector Rev. 1/81 0 L r.Miiinim `ete I 1 es6Mr» DO E .ar. �� ter_ r Yrs• wm _ axe p. q• '9 � P` ' J J 5 PP `J • f A »Ktl �iW1 • e C '� • c' ' CD S 1 4 • • FO.� ill 1� � �.. m•tl3 i A ' A �� a �•`, /t%4 +. © /^ Ile n � scn o.s l � e cn ,,._..-- �� r —_— __ __ � __ __ — w =e.n �.+..'.•.�.w 770 0 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 OF SO(/TyO� T CIO G • O ��y00UNn,�`� 0 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jim King, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: November 6, 2013 Re: LWRP Coastal Consistency Review for THOMAS E. UHL SCTM#1000-110-1-7.3 THOMAS E. UHL requests an Administrative Permit to install a 30"x24" generator and create a 4"x14' long trench to install underground electric and water lines on the landward side of the house; enlarge existing shed to 8'x12'; maintain existing 4' wide access path; maintain three (3) existing 5'x8' wood vegetable planters; maintain and trim the shrubbery throughout the established lawn area; and to remove dead trees and vegetation around the vegetable planters. Located: 1730 West Creek Avenue, Cutchogue. SCTM# 110-1-7.3 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 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 0 James F. King, President Bob Ghosio, Jr., Vice -President Dave Bergen John Bredemeyer Michael J. Domino BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Applicatio _Wetland Permit Application Administrative Permit AmendmenVTransfer xte ion t_/Received Application: /aceived Fee:$ mpleted Application (3 _Incomplete _SEQRA Classification: Type IType IIUnlisted _ oordination:(date sent) LWRP Consistency Assessment Form CAC Referral Sent: Date of Inspection: _Receipt of CAC Report: —Lead Agency Determination: _Technical Review: Public Hearing Heli Resolution: �'TT Name of Applicant -1`i10WM 6 , I,t }{ L Mailing Address LTe3o Wlht C(Lt£K Atkk,�LL� • Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax(631)765-6641 L,la640(getl, til . —Phone Number:&3) "1 3 � _ a I d 1 Suffolk County Tax Map Number: 1000- f T _ 1 t O Property Location: LAAO (( e,_V CEk A. r0J k F ', b,f n7T 3C It, 69 5 (provide LILCO Pole #, dist earl ear ci to cross AGENT: (If applicable) Address: Phone: Bygd of Trustees Application GENERAL DATA Land Area (in square feet): q5- 1 -3q, 4+ Area Zoning: ^ Previous use of property: t --- Intended use of property: 12(-5 ILEA) i r 4 L Covenants and Restrictions on property? Yes __Z No If "Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes __A, -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 __v� No If "Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes N0 Does the structure (s) on property have a valid Certificate of Occupancy? _Yes No Prior permits/approvals for site improvements: Agency Date 6 Dili �W? , /.z IV l No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended If yes, provide explanation: Project Description (use attachments if to \J I,e-,c6e�/� . i ask rrn�! iWµ Board of Trustees Application • WETLAND/TRUSTEE LANDS APPLICATION DATA J Purpose of the proposed operations: j, P QQ' /4, it 7� L�j—k a r' n� ..n._ A..].O ✓J AIG I l Lln $ ,. U � D✓`�Ll 121. Area of wetlands on lot: square feet VV Percent coverage of lot:% Closest distance between nearest existing structure and upland edge of wetlands: !;L.i feet Closest distance between nearest proposed structure and upland edge of wetlands: : feet Does the project involve excavation or filling? /Ift �� iliJ No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards 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: a -NruCE -Tr-) Pir, ) UST¢ LCtl- 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): 0 617.20 Appendix B Short Environmental Assessment Form Instructions for Comoletina L Part I - Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding, are subject to public review, and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item, please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency; attach additional pages as necessary to supplement any item. Part 1 - Project and Sponsor Information Name of Action or Project: i1Jsr4kgrTlo/) Dr- (;6'A-'04TDP '4 511l6 -D EX76"ID/J Project Location (describe, and attach a location map): T3v c cstt 10 *_9em_�_C I Ccc-T04 ccf Brief Description of Proposed Action: _W13 v%Ck6=!/7/Cd ".S AIA,2C �fPCJrr 4C^� 4747C _ 7D El / s�7,6 Name of Applicant or Sponsor: Telephone: a /S/L. E -Mai : -.JcW/,Ca Address: 1730 U). Ung )90f TeHc�,ut< A),(- ), 'City/P0: City/PO: State: Zip Code: 1. Does the proposed action only involve the legislative adoption of a plan, local law, ordinance, NO YES ❑ administrative rule, or regulation? If Yes, attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no, continue to question 2. 2. Does the proposed action require a permit, approval or funding from any other governmental Agency? NO YES ❑ If Yes, list agency(s) name and permit or approval: 3.a. Total acreage of the site of the proposed action? acres b. Total acreage to be physically disturbed? acres c. Total acreage (project site and any contiguous properties) owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on, adjoining and near the proposed action. ❑Urban ❑ Rural (non -agriculture) ❑Industrial []Commercial esidential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page I of 4 r, L-A Ll 5. Is the proposed action, a. A permitted use under the zoning regulations? b. Consistent with the adopted comprehensive plan? NO YES N/A ❑ (,Z �v _17-20— 6. Is the proposed action consistent with the predominant character of the existing built or natural landscape? NO YES 7. Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area? If Yes, identify: NO YES Er ❑ 8. a. Will the proposed action result in a substantial increase in traffic above present levels? } b. Are public transportation service(s) available at or near the site of the proposed action? /q Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? NO YES Fyr F-1 Idc. 9. Does the proposed action meet or exceed the state energy code requirements? If the proposed action will exceed requirements, describe design features and technologies: 4/44 NO YES ❑ ❑ 10. Will the proposed action connect to an existing public/private water supply? If No, describe method for providing potable water: NO YES 11. Will the proposed action connect to existing wastewater utilities? If No, describe method for providing wastewater treatment: NO YES 5d n 12. a. Does the site contain a structure that is listed on either the State or National Register of Historic Places? b. is the proposed action located in an archeological sensitive area? NO YES 13. a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain wetlands or other waterbodies regulated by a federal, state or local agency? b. Would the proposed action physically alter, or encroach into, any existing wetland or waterbody? If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: NO YES Q 14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: ❑ Shoreline ❑ Forest ❑ Agricultural/grasslands []Early mid -successional ❑ Wetland El Urban &Kuburban 15. Does the site of the proposed action contain any species of animal, or associated habitats, listed by the State or Federal government as threatened or endangered? NO YES 0 0 16. Is the project site located in the 100 year flood plain? NO YES TvT 17. Will the proposed action create storm water discharge, either from point or non -point sources? If Yes, a. Will storm water discharges flow to adjacent properties? ❑ NO ❑YES b. Will storm water discharges be directed to established conveyance systems (runoff and storm drains)? If Yes, briefly describe: ❑ NO ❑YES NO YES Lv I Page 2 of 4 0 0 18. Does the proposed action include construction or other activities that result in the impoundment of water or other liquids (e.g. retention pond, waste lagoon, dam)? If Yes, explain purpose and size: NO YES ❑ to large impact impact may 19. Has the site of the proposed action or an adjoining property been the location of an active or closed solid waste management facility? If Yes, describe: NO YES occur ❑ El Elregulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑ 3. Will the proposed action impair the character or quality of the existing community? 20. Has the site of the proposed action or an adjoining property been the subject of remediation (ongoing or completed) for hazardous waste? If Yes, describe: NO YES T establishment of a Critical Environmental Area (CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ El 1 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE r Applicant/sponsor name: F Date: Signature: -ti.( S-ke of Part 2 -Impact Assessment. he Lead Age is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the in orrn ned in Part I and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept "Have my responses been reasonable considering the scale and context of the proposed action?' Page 3 of 4 No, or Moderate small to large impact impact may may occur occur I . Will the proposed action create a material conflict with an adopted land use plan or zoning El Elregulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑ 3. Will the proposed action impair the character or quality of the existing community? ❑ ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the❑ ❑ establishment of a Critical Environmental Area (CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ El existing infrastructure for mass transit, biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ ❑ a. public / private water supplies? ❑ ❑ b. public / private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic, archaeological, ❑ ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources (e.g., wetlands, ❑ ❑ waterbodies, groundwater, air quality, flora and fauna)? Page 3 of 4 10 0 Part 3 - Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered "moderate to large impact may occur", or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact, please complete Part 3. Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting, probability of occurring, duration, irreversibility, geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold - Board of Trustees Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency of Responsible Officer in Lead Agency Date President Title of Responsible Officer Signature of Preparer (if different from Responsible Officer) PRINT Page 4 of 4 No, or Moderate small to Inrge impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion, flooding or drainage 1:1 1:1problems? 11. Will the proposed action create a hazard to environmental resources or human health? El El Part 3 - Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered "moderate to large impact may occur", or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact, please complete Part 3. Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting, probability of occurring, duration, irreversibility, geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold - Board of Trustees Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency of Responsible Officer in Lead Agency Date President Title of Responsible Officer Signature of Preparer (if different from Responsible Officer) PRINT Page 4 of 4 b�Town of Southold '�a, ��• Erosion, Sedimentation & Storm-Water Run -off ASSESSMENT FORM 'est Y� PROPERTY LOCATION: s.C.TA. k THE FOLLOWING ACTIONS MAY R MNM THE SUBRUSS MAN A •sim- Sidon -BfT —CnT STATE OF NIRN YOWL SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM # / WORK ASSESSMENT Yes No a. what is the Total Area of the Project Parcels? I WB Oft Project Raledrn AN Sbrtn-Water R m•Off — it* (Include a of Area or an Parcels located timk � Mds ire a by I two (2) inch Rainfall on She? ��� the Scope of work for Proposed Corlstruetorh) tem w1ti include act nxwO created b b. What is the Toted Area of Land Is.. r noxa) fm+s y site Ciearhhg clearing etnd/ar construction activities as weti as all El and/or Ground 'dol site Improvements and the permanent Creation of constructionImpervious surfaces.) i. 2 toes t» Site Plan anaiorSurvey shm m Proposed l� /� PROVIDE PROJECT DESCRD'170N (Pie+Ne Adexwei n+.a..Nwara pre„�3tr11C11N'88 Indicating SizeBLocation? TMs ?/ tem shall Include all Proposed Grade Charges and �V El Slopes Controlling Surface water Flow. �`' 3 Does the ant Flee and/or Survey twigdescribe the erosbn� /Al � %A•t-L (y�+(i'blfi9+� IZ �% iYca,j � am sediment conora practices that wig be used to control ata erosion and skim water disdharges. TMs item must be maintained throughout me Eedire Construction Period. l 4 Will rva Project Require any Land e tot Natural or ❑ Existing r where mere is a change to C Natural r/ 6dstng Grade Involving more man 200 Curie Yards jy of Material within any Parcel? rj Will this ApplicaLandtionDisturbing Activities Encompassing an Am in Excess of Five Tlroua�I i (5,000 S.F.) Square Feat of Ground Surface? s S e? I a Natural Water Course Rlmftilg tl isdici n Site? Is tide Project within me Trustees jurisdiction Garen/ DEC SWPPP Ramdre nente or within One Hundred (100') feet of a Wetland or Sutmwaabn of a SWPPP Is requked for as Constnmdon actiAles i waift sop Beach? dislurbanow done (1) or more scree kx kx&V dbWrbmws of lm then ore acre man 7 Will mere be Site prepareiron on Existing Grade SI ISI ere pert of a law comm pbn that wit ukkmlNy dbbrb we or mare acres of lard; which Exceed Ffiloen (15) feet of Vertical Rise to induBg Conahumbn aatlNdes kwdving wp daWnarwes dbes men ane (1) acre Wen Me DEC has deterrmred Orel a SPOES permit b mgmred brsrmm wwterdlamegac one Hundred (100 M Horizontal Dom? (SWPPP's WON meat Nna Mldmarn Requirements of the SPDES tlenwal PemNt 8 Will Driveways, Paddng Areas or Omer Impervious for storm Wow Discharges from Comuuctlon activity - Penna No. eP410 ovi.) Surfaces be Sloped to Direct .glom//-Water Run -Off 1. 1. The SWPPP anal be pretend Prior to Oe subMsel Of me NCI. The NOI anal be into and/or in the direction of a Town dglhRof-way? subndted to the Deparbrwd prlorto the aomronearmra dmnsmrdbn aa.ey. 2. The SwPPP anal deswbe de erosion and sedpmm Garrod pndkav and when 9 Will this Project Require the solacement of Material squired, postcommadm sbmr vAdw maregerrem pampas Orel wit be eaed anaar Removal of Vegetation and/or the Construction of any wrebudea m to ramie e poaNenb in alarm water and Ws asauitem amripfi m wpm mtenor or ane WWII tea dmb pamh, dt adeabn, the SwArea7(rPPP eine ? mw pr. we eorithin the Town Right-of-Way-Way a Road Shou klePotential wares d Pohwn Wdch may reasonady be expected m asect the Areu.aua m. x.m.aonawnwesyAsrea.. ndN l guaNydsbrm wnle,"kedwPo in a Nes and the comtrretlan she Aeaabarres Is bets a .A I Am � 3. As Ont sh min ega%e may aatmobr Desicbm elarin water mwaenW i New Y arae, wnymera shal be Papered lry a WOW Design Prekeam Water in New York a slam-Wates. Must b g, th tW for Eawba Coots Plan b itspuaed ultimo Pwm that bkmwfedgeeNe htle pdndples and praclbes of Storm Wabhr Managmed. aodheld arrdMest be auareptedfar Bellew Prior to leermres dAry &MNrg Panni (NOTE: Atlwlafak N).rdmrNew baacM1 eefamaR�ewaa bra aaehans Apppvlbn) STATE OF NEW YORK, COUNTY OF ............. SS That I. ............... -191Ji �' ts...L ..:. ! :.5.� ............... being duly swom, deposes and says that he/she is the applicant for Petard[, d bmrkAW algrdrg Dowmenn) Andthat he/slJ�is the .................R �tf�•!�%t�................................................................................................................. // Owner and/or representative of the Owner or Owners, and is duly authorized to perfome or have performed the said work and to make and file 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 herewithAi&LJ Sworn to bed re me this; �a..� dayof...._.._:Q. :Notary Public:...... . (.�, ..�{.ti:........ ,I �J;��TATE.OF NEW YORKNo. 0IM16249641 FORM - 06/10 Qualified In Suf o My Commiulon Expires October 11, 2015 BoQf of Trustees Application • County of Suffolk State of New York —/ a 4� L, / BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OFTHIS APPLICATION. i Signaa of Property Ow6er SWORN TO BEFORE ME THIS DAY OF 0 (19� 20 \S ALSENA MITOVA NOTARY PUBLIC -STATE OF NEW YORK No.0IMI6249841 00011fled In Suffolk County ' My COMMISSIon Expires OCiObpf 11, 2018 Notary Public 0 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM necessary to avoid same. YOURNAME: U -.Y L 14Vfif �-� •, (Last name, first name, ipiddle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate theother person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If "Other", name the activity.) _ Building Trustee Coastal Erosion Mooring Planning Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest "Business interest" means a business, including a partnership, in which the 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 or position of that person Describe the relationship between yourself (the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non -corporate entity (when the applicant is not a corporation); C) an officer, director, partner, or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of Print Name Form TS I Town of Southold • A. INSTRUCTIONS • All applicants for permits' including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. 'Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant 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. Thu& each answer must be explained in detail. listine both supportine and non- supportin¢ 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 website (southoldtown.northfork.net), the Board of Trustees Office local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION 0CT 2 5 2013 i SCTM# f O0Ci -SIFT//© I PROJECT NAME I A)S7 ?FiL3t 2 C1r6�ZV-76X d -91E4 The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board ❑ Budding Dept. ❑ Board of Trustees P 1. Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital ❑ construction, planning activity, agency regulation, land transaction) ❑ (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: '-PEnld- -fL2 C, ),��vu17� (��.� kAT�P �1,a9� � >, r,t,�E �� ���t✓ 42 01410141d s tSr, 1,�-��i( �rP)P, 1��I Location of action: Site acreage: 0 %`i s Present land use:"' d L Present zoning classification: 1)- #L 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: i ?s „�C :r,- !</L (b) Mailing address:W67 ewv G-�E A-� (c) Telephone number: Area CodekN `13� �/ D / (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ❑ No LICJ If yes, which state or federal agency?. C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. [-]Yes ❑ No ETNot Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III-�Policies Pages 3 through 6 for evaluation criteria 1:1Yes ❑ No L Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section HI — Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No VrNot 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 IH — PoliciesPages 8 through 16 for evaluation criteria ❑ Yes ❑ No E Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section IH — Policies Pages 16 through 21 for evaluation criteria ElYes 1:1ro No 0Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section HI — Policies; Pages 22 through 32 for evaluation criteria. Yes No VOCA4able • 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 ❑ NoNot 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. 1:1Yes ElNo Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III — Policies; Pages 38 through 46 for evaluation criteria. ❑ YeF] No 2 Not Applicable Attach additional sheets if necessary WORKING COAST POLIC10 • Policy 10. Protect Southold's water -dependent uses and promote siting of new water -dependent uses in suitable locations. See LWRP Section III Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III — Policies; Pages 57 through 62 for evaluation criteria. 11Yes❑ No U 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 u Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III — Policies; P 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable PREPARED BY TITLE DA G3dr rt f >c VED BY BOARD Of TRUSTEES TOWN OF SOUMOLD n v X a DATE II l3 13 i M J l � • r. t � � %may i��`Qr1 ., dJ I — - --� M 3Ui2VEYt-=G RD I 7�I-4QMq_ ' 1 V To- vvN cF- 5 \6(1T;40� c, N'. Y. 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