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Home My WebLink AboutTR-8483AM. Bredemeyer III, President soar 'John 460� Michael J. Domino, Vice -President James F. King, Trustee CA Dave Bergen, TrusteeaQ Charles J. Sanders, Trustee 1,0UI 14 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 Telephone (631) 765-1892 Fax (631) 765-6641 # 1058C Date: October 16, 2014 THIS CERTIFIES that the footinas and (3 At 65490 Route 25, Breezy Shores -Cottage #18, Greenport, New York Suffolk County Tax Map # 53-5-12.6 Conforms to the application for a Trustees Permit heretofore filed in this office Dated August 1, 2014 pursuant to which Trustees Administrative Permit #8483A Dated August 20, 2014, 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 as -built replacements of (3) sill boards, (3) poured concrete footings and (3) posts under existing enclosed porch. The certificate is issued to JAMES TRUMAN owner of the r aforesaid property. Authorized Signature John M_ Bredemeyer 111, President Michael J. Domino, Vice -President James F. King Dave Bergen Charles J. Sanders DATE OF INSPECTION: Ch. 275 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Ch. 111 INSPECTION SCHEDULE Pre -construction, hay bale linelsilt boomisilt curtain 1 s1 day of construction /2 constructed 7 Project complete, compliance inspection. Town Hall, 53095 Main Rd- P.O. Box 1179 Southold, NY 11971 Telephone (63 1) 765-1892 Fax (631) 765-6641 INSPECTED BY: COMMENTS: t4,r -% CERTIFICATE OF COMPLIANCE: John M. Bredemeyer 111, President Michael J. Domino, Vice -President James F. King Charles J. Sanders Dave Bergen BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD C] Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (63 1) 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-GONSIDE-RE-D-A-VIOLAa4ON-AND- POS SIBLE R€VOGATION-OF THE_. PERMIT. INSPECTION SCHEDULE Pre -construction, hay bale line 1St day of construction % constructed Project complete, compliance inspection • John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 Permit No.: 8483A Date of Receipt of Application: August 1, 2014 Applicant: James Truman SCTM#: 53-5-12.6 Project Location: 65490 Route 25, Breezy Shores Cottage #18 Date of Resolution/Issuance: August 20, 2014 Date of Expiration: August 20, 2016 Reviewed by: John M. Bredemeyer III, President Project Description: For the as -built replacement of three (3) sill boards, three (3) poured concrete footings and three (3) posts under existing enclosed porch. 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 site plan submitted by Joan Chambers, received on August 1, 2014, and stamped approved on August 20, 2014. 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. John M. Bredemeyer III, President Board of Trustees • John Bredemeyer, President OfF01,t Michael J. Domino, Vice -President James F. King Charles J. Sanders • Dave Bergen r Town Hall Annex 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: rl 1y Joan Chambers on behalf of JAMES TRUMAN requests an Administrative Permit for the as -built replacement of three (3) sill boards, three (3) poured concrete footings and three (3) posts under existing enclosed porch. Located: 65490 Route 25, Breezy Shores Cottage #18, Greenport. SCTM# 53-5-12.6 Type rea 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 Type f Application: Wetland Coastal Erosion Administrative Emergency Pre -Submission Notice of Hearing card posted on property: Yes Storm Water Management Review: Yes Info needed: Modifications: Chapt.111 other Amendment Violation No Not Applicable No Not Applicable Conditions: 01-, Present Were Bay Constable J. Bredemeyer M. Domino J. King C. Sanders D. Bergen Form filled out in the field by Mailed/Faxed to: Date: 11- ` I&C Other #18 BREEZY SHORES 7.30.14 LOOKING NORTH L1 AUG 4 #18 BREEZY SHORES 7.30.14 LOOKING SOUTH 018 BREEZY SHORES 7.30.14 40 IFL ODD PLA I n; • U RR Town of Southold Section 2 of 4 New Zoning Map Adopted by Southold Town Board on November 3, 2004 as Local Law No. 23 of 2004 Scale: 1 inch =1000 feet i7 MH M RR HD • • Getting around Shaw: Traffic -Bicycling -Terrain Directions Greenport Pottery to S lhokl Fish Market ft 4:c ego F ishv*7 Eta 1. .1 Tackle , 6 �;a Ila ,111�11t, '., 3Iat 'S -r -n 11 IDOCOO? M.pd.ta%)2014G..gl,, 500h 11 .. _ .. _��,.,� n _ .. ., , . �s .� �, � �� . ff ..., A . ,� �� . , .:: ��. �.� �. � �.�. ,�. , �. � .. ��. � _ . - �i SHELTER ISLAND SOIJND S —aai •+r- - —' - --w-- - --^-- NOTICEwoReal COUNTY OF SUFFOLK Property Tax Service Agency Jtl:illON • OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 • MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: John Bredemeyer, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: August 18, 2014 Re: Proposed Wetland Permit for JAMES TRUMAN SCTM# 1000-53-5-12.6 , r AUG 1 8 2014 Joan Chambers on behalf of JAMES TRUMAN requests an Administrative Permit for the as -built replacement of three (3) sill boards, three (3) poured concrete footings and three (3) posts under existing enclosed porch. Located: 65490 Route 25, Breezy Shores Cottage #18, Greenport. SCTM# 53-5-12.6 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is EXEMPT from LWRP review pursuant to: § 268-3. Definitions. MINOR ACTIONS item "A" which states: A. Maintenance or repair involving no substantial changes in an existing structure or facility; 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 • John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee o�'�'pF SO!/j�,o h O ANC ��Ol` • iQ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application Administrative Permit _A men dmen t/Transf r/Extension Received Application: Received Fee:$_ VCompleted Application Ell Wf _Incomplete _SEQRA Classification: Type I Type 1I Unlisted _Coordination:(date sent) :�/:CWRP Consistency Assessment Form AC Referral Sent: ate of Inspection: _Receipt of CAC Report. Lead Agency Determination: Pechnical Review: ublic Hearing Held: Resolution: Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 Name of Applicant sJ b, &ATf Q � IE T— 71Z 0 M AN q J or'►1`s ST. W(C Clot 4 - Mailing Address Pq G+3 Phone Number:( ) �o Suffolk County Tax Map Number: 1000 - 53 —05— 12 • (o Property Location: Ca M M UN t T_ Y G0 ?d KT 15A_&L_ , L -V D . - SOU -TVA 0 I fZTa . 25 • (provide LILCO Pole #, distance to cross streets, and location) AGENT: C -ttAm (� S (If applicable) Address: FQ Z XX -A 01 Phone:9 31 – 24 #ard of Trustees Applicat4 GENERAL DATA Land Area (in square feet): 6 f2. (v 3 4,3 A S 35 37,f 2 2 $ .514-4. Area Zoning:_ _ —8r� Previous use of property: Se&sD N &-t- R e6 D Eo-nA L Intended use of property: S ATY1 e/ N O ct#lv-� C G Covenants and Restrictions on property? Yes No If "Yes", please provide a copy. Will this project require a Building Permit as per Town Code? ✓Yes No If "Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes 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 v/ No Does the structure (s) on property have a valid Certificate of Occupancy? v/ Yes No Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: W K ttA s 5E D M Le;-TeF P Project Description (use attachments if necessary): W R I LE PAIN -TING S r t R t 80 4 R o/7'R i ni pJ EsusS -, E,,CLOSEO TbRCrk P RS We RE— M&DE INCLUC1A{G NEW Slw $DAP`D 4 .3 PDSTS 9' 3 C-buRReo CbNC. FT6--S . i IJ :? LA<s O F ex vsr . 2 B(#d of Trustees Application • WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 'REPfcMS ARE CQMPLaG-- I-R-ems 1(\CL..L)De, '_6?UAC(M& ExISTrNG - SKIRT' Sawn ONJ t=,NCL�Ds ex> To Rct t t fZ&FLA-CN G 3 Po ;srs co ►s C . P -T -6S, Area of wetlands on lot: 19 square feet Percent coverage of lot: V % Closest distance between nearest existing structure and upland edge of wetlands: 0 feet Closest distance between nearest proposed structure and upland edge of wetlands: C7 feet Does the project involve excavation or filling? V No Yes If yes, how much material will be excavated? VlJkubic yards How much material will be filled? ,/�i A cubic yards Depth of which material will be removed or deposited: N A feet Proposed slope throughout the area of operations: r-L_�L T - Na C(-tAI'SG G' Manner in which material will be removed or deposited: p�fA 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): 3 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l - 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 l8 B RE&2- S E{OIZ�E;S -- M rtSa(Z. C eRA c RX . Name of Action or Project: Z -DIEL- JA L`( - C 0M TICA c K Project Location (describe, and attach a location map): S kcj� -B"D • t� l?dRT — Uint M Brief Description of Proposed Action: V1 G)R..r— i S AL'RiEAflY CZ) nnPL e Te D . (IU R (L -.E FA i N TI N Cz -rt- E- tsT . T(Zl M 80A1? -0 S44:1 EZT 6 IIA -E- E?c1ST', -PDROk+ W&S PEPLACED A POT WAS PoUN O W l+t CR f E C� . FV'c-t-,4 F-e� Prki R,. 4 F -E= -P LAC E m1EPJT O F Stu. 14 3 Po STs 3 Cb N C' . t=- r S Name of Applicant or Sponsor: Telephone: Telephone: &3(-7(25-(2,2 J b� DA LY Cc t31� a�C�DfZ E-Mail:,.Joe ( Da ti V 9&n (c Address: Q' v PO?o�c 3� 3 2 oS F>� City/PO: SouZl-rbc NY 7 State: M\( Zip Code: 1(9 -7 � 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: PLM S00S c. i (,Dl s\1 Cz- �D e-PA*XrnEr,3 i 3.a. Total acreage of the site of the proposed action? acres b. Total acreage to be physically disturbed? Q acres A{f"x- 30 c. Total acreage (project site and any contiguous properties) owned ALL oW Nl✓io 91 - 1 - by ® or the applicant or project sponsor? or controlled acres 59EF-Z'-t S K-MeS Clpm Ni r4C. 4. Check all land uses that occur on, adjoining and near the proposed action. 170 Box R 2S, (Mh-t'i. Urban Rural (non -agriculture) ❑ Industrial ❑ Commercial %Residential (suburban) S El Forest ❑Agriculture El Aquatic ❑ Other (specify): ReSOF-7 &A -61N.5 ❑Parkland Pagel of 4 e .neo Y' (Igs-z • • 5. Is the proposed action, a. A permitted use under the zoning regulations? b. Consistent with the adopted comprehensive plan? NO YES N/A ❑ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural landscape? NO YES ❑ 12 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 � ❑ 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? c. Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? NO YES Q ❑ ❑ ❑ 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: NA - NO YES ❑ 10. Will the proposed action connect to an existing public/private water supply? N If No, describe method for providing potable water: NO YES ER" ❑ 11. Will the proposed action connect to existing wastewater utilities? NA If No, describe method for providing wastewater treatment: NO YES ❑ 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 14. tify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: i7®'Shoreline El Forest ❑ Agri cultural/grasslands El Early mid -successional ❑ Wetland El Urban E3Suburban 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? MOS TD Ply (WaW NO YES ® ❑ 16. Is the project site located in the 100 year flood plain? NO YES 17. Will the proposed action create storm water discharge, either from point or non -point sources? If Yes, ❑YES a. Will storm water discharges flow to adjacent properties? ❑ NO b. Will stone water discharges be directed to established conveyance systems (runoff and storm drains)? If Yes, briefly describe: ❑ NO ❑YES NO YES ❑ Page 2 of 4 15 • 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 RT ❑ 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 ❑ Er Elregulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 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 N ❑ j ❑ establishment of a Critical Environmental Area (CEA)? LJ 5. Will the proposed action result in an adverse change in the existing level of traffic or I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: NAMBURS Date: S U4 Lq Signature: Part 2 - Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the.following questions in Part 2 using the information contained in Part 1 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 I No, or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning Er 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? EZ 4. Will the proposed action have an impact on the environmental characteristics that caused the j ❑ establishment of a Critical Environmental Area (CEA)? LJ 5. Will the proposed action result in an adverse change in the existing level of traffic or �f j ❑ affect existing infrastructure for mass transit, biking or walkway? u 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate �Y reasonably available energy conservation or renewable energy opportunities? L� 7. Will the proposed action impact existing: a. public / private water supplies? E21 F1 b. public / private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic, archaeological, El 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 I 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. F] 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 C (/ G/I Name of Lead Age Daie (�o`r 4ao ( T Oc r" ,,)" ✓p Print or pe Name of Responsible ficer in Lead Agency Signature of ResponATe Officer in Lead Agency PRINT President Title of Responsible Officer Signature of Preparer (if different from Responsible Officer) Page 4 of 4 No, or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion, flooding or drainage 1:1problems? 11. Will the proposed action create a hazard to environmental resources or human health? 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. F] 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 C (/ G/I Name of Lead Age Daie (�o`r 4ao ( T Oc r" ,,)" ✓p Print or pe Name of Responsible ficer in Lead Agency Signature of ResponATe Officer in Lead Agency PRINT President Title of Responsible Officer Signature of Preparer (if different from Responsible Officer) Page 4 of 4 B&d of Trustees Application County of Suffolk State of New York S , BEING DULY SWORN POSES 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 OF THIS APPLICATION. Signa ure of Property Owner SWORN TO BEFORE ME THIS 5 DAY OF �,20� Lj) Notary Public CAROL HYDELL NOTARY PUBLIC - STATE OF NEW YORK NO. 01 HY6189695 QUALIFIED IN SUFFOLK COUNTY, COMMISSION EXPIRES 06/30/20_ (v 0 Blyd of Trustees Application • AUTHORIZATION (where the applicant is not the owner) 1, residing at �� I (print owner of property) (mailing address) do hereby authorize—JOA-N) (Agent) to apply for permit(s) from the SoutholdB wn Trustees on my behalf. (Owner's signature) Ct%fl1YL8t-)Rs 17 APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees. The pumose 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 necessary to avoid same. YOUR NAME: CKNm60R-s V O kir,3 M • . (Last name, first 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 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 applic4nt (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 this2� f JU 204 Signature_ _ t Print Name— e(L�' Form TS 1 Es ToAvn of Southold 0 A. [-131 INSTRUCTIONS • LWRP CONSISTENCY ASSESSMENT FORM 1. 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 beneficial and adverse effects upon the coastal area (which includes all of Southold TownZ 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 explained in detail, listing both supporting and non - supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the website (southoldtown.northfork.net), the Board of Trustees Office, th local libraries and the Town Clerk's office. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 53 - 05- - /2. 4 PROJECT NAME UM 1T --W18 i AVG « 1 2014 The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board ❑ Building Dept. [?"*"'Board poseBoard of Trustees L"J 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: \t JOR1= IS A.1 -READ -Y CAMP LTE . WirkLl.E 'PA(NTIM& ff)1- eKLOF aF FORCti late SKIRT �BoAg-/D 1ti/4SS (ZLemoveD 4 Revel KOT SC>--rVtlE 5IL.1- i,.JPpSTs it 3 EF'T67S• WE2� &F=-PACRE.r Z RENtI&Cep Location of action: l �� fZ EEZ`( S N�(Z S : S14A 6 W O . G(LEEN Po KT Site acreage: S 2. (a36 3 ACK:r,—S Present land use: 8156 (DEQ -0 f -C_ Present zoning classification: R —8D 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: l C �(rl<rVT) C OW N E�2-� CON ln/Fe-TSR-/ (a) Name of applicant: 0 DAf-1 CtMm6�gS Fp(,-, -yguMA-tJ `10e DAAL1' Fa 5 O (b) Mailing address: PSD 66>1-� AOk aA 3 SDUT-WOL4D SC)U-V M u'> Telephone number: Area Code ( (d) Application number, if any: is-8s8s Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ❑ No K 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. F-] Yes ❑ No g Not Applicable wq) C tt� G-e� TD Ex t st'rn1 C,- V SC 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 X Not Applicable ! I,— (d) i I� 010 /- fiE (s- (vim C., t( A�Euoq-j ctc.r s (Te Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III — Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No U Not Applicable I�tJ Il—L I`iOT C'K "Ga✓ A-FpEAKAT%GE 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 S through 16 for evaluation criteria ❑ Yes ❑ No Not Applicable N D 0 tt1-44QG=f1Z etc l'ST tE t+kA--t- W l L -L Ar F 4� n::tE t S Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of .Southold. See LWRP Section III — Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No Not Applicable -To e?C- LS -T' . WA�Z Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III — Policies; Pages 22 through 32 for evaluation criteria. I3 It • ' Yes No Not Ap0able 0 1 A 1[ 1.1, f-tAV � ND f m PACT ON T71s+4 (b (Z W t Lfl Ll FE tt A6 (j2jjT S 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 M Not Applicable K) D f M PA C T A -T A Lt, DAI L=K 1ST 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 'P�'T Not Applicable yj [ LL- /OOT Av L -7-r= E ?x) ST ASTE FrZUIc s 9 sNss rnSs. 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. ❑ Yep ] NoD�tNot Applicable �S NOT A Lig, A Cc eS S PK -o m Attach additional sheets if necessary I i' WORKING COAST POLICI0 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 ❑ NoZNot Applicable -DDNOT&L CQM,ENI Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III — Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No Not Applicable ` PC)aS NO T- A -P- FF_ c -c-. M AfZcnl e 2 t✓SyUP_g e s'. 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 RNot Applicable I C v L,7U21✓ b A c E�,r\-3 — ANp 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 �0 C��ZS TITLE DATE 7 • Z `� • is- EXIST. WOOD FRAMED WALLS W/ WOOD HORIZONTAL SIDING. NO ALTERATION TO WALLS - MINOR REPAIRS TO SIDING AND CORNERBOARDS PLAN ``REPAIRS TO ENCLOSED PORCH 314 "= 1 1.011 EXISTING ENCLOSED PORCH -1 STORY EXIST. 2X6 FLOOR JOISTS - NO CHANGES ADDED THREE NEW HAND -DUG, POURED CONC. FIGS. W/ NEW 4 X 4 POSTS ATTACHED W/ GALV. POST ANCHORS. ADDED NEW 04 SILL SUPPORT ADDED NEW 1X8 SKIRT BOARD r�l I AUG - 1 2014 .APPROVED BY BOARD OF 'i RUSTEES TOWN OF SOUTHOtp DATE. 20 14 rD SURVEY FOR 5R r=ZY SHORES COMMUNITY at Greenport, Town of Southold Suffolk Goun4, New York TOP06RAPHIGAL SURVEY County TAX Map District 1000 section 53 Block 05 Lot 12.6 MAP PREPARED DEG. 30, 2010 Record of Revisions REVISIONS DATE GENERAL AMENDMENTS JAN. 25-2011 40 O 20 40 60 120 Scale: I" = 40' JOB NO. 2010-0203 DPW 2010_0203_topo 20F2