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TR-8485A
John M.Bredemeyer III President 0 ®�`v y®; Town Hall Annex `L "'Y�,; ® 54375 Main Road Michael J. Domino Vice-President » "• r � , P.O. Box 1179 James F. King,Trustee 44, a ; Southold, New York 11971-0959 t. Dave Bergen,Trustee ® '. q4. Telephone (631) 765-1892 Charles J. Sanders,Trustee =l4-COUNO;%ifs Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1154C Date: August 12, 2015 THIS CERTIFIES that the construction of a roof over an existing 16'x22' deck At 855 Fisherman Beach Road, Cutchogue Suffolk County Tax Map#111-1-30 Conforms to the application for a Trustees Permit heretofore filed in this office Dated August 1, 2014 pursuant to which Trustees Administrative Permit#8485A Dated August 20, 2014, was issued and conforms to all of the __. __. _.requirementsand_conditions of__.the_applicableprovisions_of law. The project___ for which this certificate is being issued is for the construction of a roof over an existing 16'x22' deck. The certificate is issued to BOBETTE &RICHARD SUTER owners of the aforesaid property. g9WN i .;: Authorized Signature John M. Bredemeyer III,President ,��, `; Town Hall,53095 Main Rd. Michael J. Domino,Vice-President P.O.Box 1179 11 James F. King • y Southold,NY 11971 rrr Dave Bergeny � �`� Telephone(631)765-1892 �O _ `VI 041Fax(631)765-6641 Charles J. Sanders - 1 * BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: d iff5 X Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, silt fence 1st day of construction 1/2 constructed Project complete, compliance inspection. INSPECTED BY: (- COMMENTS: f f/� CERTIFICATE OF COMPLIANCE: • • John M. Bredemeyer 111, President ',ao��g1IFF0t,�- ,� Town Hall,53095 Main Rd. Michael J. Domino, Vice-President � �" '9V‘i P.O. Box 1 179 James F. King P1� Southold,NY 11971 Charles J. Sanders ; 1%* ON ,11 Telephone(631)765-1892 Dave Bergen �',i Fax(63 1)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 A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. • INSPECTION SCHEDULE • Pre-construction, hay bale line 1st day of construction / % constructed V Project complete, compliance inspection • 04.• John M. Bredemeyer III, President 0 4s0(/jy� Town Hall Annex Michael J. Domino,Vice-President � ,`O 0 ; 54375 Main Road P.O.Box 1179 James F.King,Trustee ; SIE i Southold,New York 11971-0959 Dave Bergen,Trustee :c4 Q . •• Telephone(631) 765-1892 Charles J.Sanders,Trustee OI�,C�U �• Fax(631) 765-6641 i BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8485A Date of Receipt of Application: August 1, 2014 Applicant: Bobette & Richard Suter SCTM#: 111-1-30 Project Location: 855 Fishermans Beach Road, Cutchogue Date of Resolution/Issuance: August 20, 2014 Date of Expiration: August 20, 2016 Reviewed by: Board of Trustees Project Description: To construct a roof over an existing 16'x22' deck. 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 prepared by Suter & Suter, last dated July 31, 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. dirof,"— 4)1, evoligIsir J7L- John M. Bredemeyer III, President Board of Trustees _ ... .riggaip- Bobette& Richard Suter e." 855 Fishermans Beach Road, Cutchogue SCTM# 111-1-30 8/13/14 t - _ ... - ..... - --10 -VP .;-....1 - i ) . ., ---- ------ t A 1 ‘ ' - . _,' -• , , ------- __ - --- •• 4' IMO ,4 Ilk IR 4 Ilk I . . ...,4 , it v.,ior i _ ...., 1 111111411;;t14111 0 . , 4 AP' . li. 0. iillr:?r' • * leo • tr, 4.0100 a''' 4111 ,-.00. • IP' II. ail At° -4e .... . , „... 1 • • John Bredemeyer, President i1iiii Fot Town Hall Annex Michael J. Domino, Vice-President ,��\S �c°�: 54375 Route 25 James F. King ? P.O. Box 1179 Charles J. Sanders ?! �,� Southold, NY 11971 Dave Bergen _yel * it, Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: 5V) )h y BOBETTE & RICHARD SUTER request an Administrative Permit to construct a roof over an existing 16'x22' deck. Located: 855 Fishermans Beach Road, Cutchogue. SCTM# 111-1-30 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 pplication: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed: ra Modifications: Vo o,.. Conditions: IQ C� Present Were: J. Bredemeyer /M. Domino 1 King Sanders — . Bergen Bay Constable Other Form filled out in the field by . iTS e.�J e Mailed/Faxed to: Date: • • • • • 9 W � r Amiss• y. R • ry fir ` o-.• • U f E AUG - 1 2014 L • • s x,44, R b .r �� E ',:7',4";,., r „„,,,,,,,,,,,A.,,...,.-„,'',.,:if<,=,)::::...,''.1,::•.-:17.- -t x f 3 , a g t • ,nfl, J , c Rr. �s� 4.4 r a �,- W \ 11,24,88 V M� �O..-02.03.99 � ' e. �' 013-1,9 tt tt.pt \ q�b�� -��'7a7 ,�ti '.� rel O /� na,ewx V ��ii ® � � , 1 - II, _ - �,� 2 ,Nq • A,' aur!' ,' RI - -' 16 C m,aae � nn mo ,2n-nt C.I. : 1". - . Viti 1 I F1F. 'Le•',' 'r;849:.117. 0/4441444111lik CT'' I '40 001144I l ''''''04 - 'k \ ,tnr.,w a e°atOa 414:003 1:1).4 I, . Sir. :„ '. tM 0. 1 I , . .- A *f ' \ iipr ,40.,,,• c / r �� © W , s- -- � ' ' al L--__ m. NI ____ -:'''''''-- lieuzisaita7: _ :i#;-_-_-_i -e<4,....o!"., 'i ill .. - 1$10 vs, 00 .444 _ 1,100.\ IMMSIIIVI6OP l704111001mag w , 4 _36 „ --, '4 x-.....-- 5 wiroolp46,_ . 44.4 so .4. V J1- s5� dt' ' bi*.m ( \,. xufq °i tr';s'~ 1 i n.t ✓ xxt' yttyW \ 111111hi, ., ": v : ,. ,... ail, e /e,/ , ,r7 ro4 .,... ._ tiM4w �Iw \ .._ 1��. �' E "WET' roN xL NO.tpA,,•. .�, iWcl �� tM1�S._ See sec.No ` \`. So(o EESECuNEu 00: \ • �.. aDW,TCN 1 ° $ . <.p KS ttiywe e N 40* W=..oma. --�— •r..- . (x,) r.. O �...,. ,r •, .— NOTICE COUNTY OF SUFFOLK © El; ,wnn aOUTHOLD SEC TWNN E �•- �-- _—.-- Q.)RealGProperty Tax pAgency r t....'" m.*•- ,,.w y ,_..... --•-- �,,..�.•....,..E..,�.�..�. — M PROPER,111 23 ' �k �•�/sSO(14 OFFICE LOCATION: � l MAILING ADDRESS: Town Hall Annex ' ' ' : P.O. Box 1179 • 54375 State Route 25 ; 4I J , Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) • co Southold, NY 11971 �Q,,�� Telephone: 631 765-1938 Fax: 631 765-3136 e4Uffi l,* r� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM b) E C To: John Bredemeyer, President Ft!I—AUG 1 8 2014Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: August 18, 2014 Re: Proposed Administrative Permit for BOBETTE & RICHARD SUTER SCTM# 1000-111-1-30 BOBETTE & RICHARD SUTER request an Administrative Permit to construct a roof over an existing 16'x22' deck. Located: 855 Fishermans Beach Road, Cutchogue. SCTM# 111-1-30 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 items "II" which states: II. Additions to an existing building or rebuilt residential structure which results in no net increase in ground area coverage, except where the parcel is located in a coastal erosion hazard area; The property is not located in a coastal erosion hazard area. 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 t IP • James F.King,President �,i'f�.��SOULy_ Town Hall Annex Bob Ghosio,Jr.,Vice-President ,�e4 sl OHO P.O.Box 1179 5475 Main Road Dave Bergen * * , Southold,New York 11971-0959 John Bredemeyer : ��� Telephone(631)765-1892 Michael J.Domino :- '�� Fax(631)766-6641 Q o� t BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Applicatio _Wetland Permit Application V Administrative Permit _Amendment rransfe tension eceived Application: �(I ceived Fee:$ l Li , L`(l� — —_ _.______ mpleted Application pl Ecr WIncomplete _ fSEQRA Classification: Type I Type U Unlisted AUG -- 1 2014Coordination:(date sent) l !`-;i-}11 VWRP Consistency Assessment Form g'1 /11-{ , . AC Referral Sent: 11 Date.of Inspection: ;., Receipt of CAC Report: ,. _ , . .-. Lead Agency Determination: /Technical Review: • V Public Hearing Held: 111WII Resolution: Name of Applicant ¶3 o 0 - I\Nc K LCtwo ckf Mailing Address )L l i O c QuoCiiu E N t _ i ll g Phone Number:( ) ( 3 t 40 5-3 7 81 7 Suffolk County Tax Map Number: 1000- ` t — I --3 0 Property Location: DS-3 E u i' e YYl a'), 7S ' TD !AG go/ (provide LILCO Pole#,distance to cross streets,and location) AGENT: (If applicable) Address: Phone: •rd of Trustees Applicatio. GENERAL DATA Land Area(in square feet): 3‘Z Area Zoning: -R 4. • Previous use of property: Gj IAr6CE., ritniLy (-6 l'Y90V L✓ P • �Ct< Intended use of property: Cj prin c L if oral- Covenants r fi'Covenants and Restrictions on property? Yes No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? )( Yes No If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes ✓< No If"Yes",please provide copy of decision. Will this project r uir any demolition as per Town Code or as determined by the Building Dept.? .. Yes No Does the structure(s)on property have a valid Certificate of Occupancy? >(Yes No Prior permits/approvals for site improvements: Agency Date • No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? Xf No Yes If yes,provide explanation: Project Description(use attachments if necessary): A019fr. raw Roo f- Az 3 iice4 - (4 -A 2-‘ 1 • BAIL of Trustees Application • • WETLAND/TRUSTEE LANDS APPLICATION DATA • Purpose of the proposed operations: f4 I►?7"r79'L Area of wetlands on lot: 0 square feet Percent coverage of lot: 9 % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between st proposed structure and upland edge of wetlands: G0 feet Does the project involve excavation or filling? •No Yes If yes,how much material will be excavated? cubic yards How much.material will be filled? — cubic 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: • 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): Ivo NE • • 1 - 617.2© Appendix B Short Environmental Assessment Form Instructions for Completing ' Part 1-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 I 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 I. 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: j -PD El-Tr ArA2 Afr-49 Project Location(describe,and attach a location map): 455-5- F 5lfi /pr's rap cu y Gut I .. Brief Description of Proposed Action: • COm4 Tour /4- /tai -z,2 120 H oV kit/ 7XL sriff& t, ‹, Name of Applicant or Sponsor: Telephone: 6 3) 4,53 3677 7O O i roti Yr,9 Skirt(Z- -Ivlail:MCice.ii'7512M49 r'7 Address: S(09 . ) 6? *. City/PO: S Zip Code: q2uO &v �t�v Y, l► d 1 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 El 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: p(J l L pi P r 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? -- u -:-- acres c.Total acreage"(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres .. 4. Check alI land uses that occur on,adjoining and near the proposed action. 0 Urban 0 Rural(non-agriculture) [J Industrial 0 Commercial NE Residential(suburban) OForest DAgriculture • MAquatic ❑Other(specify): []Parkland Page 1 of 4 • • 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? [ ❑ b.Consistent with the adopted comprehensive plan? El El LI 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? 7. Is the site of the proposed action located in,or does it adjoin,a state Iisted Critical Environmental Area? NO YES If Yes,identify: 10 El 4. 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES ❑ b.Are public transportation service(s)available at or near the site of the proposed action? El ElLei c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: ❑ NI 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: [ ❑ • 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: [Z Cl - 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? 11 b.Is the proposed action located in an archeological sensitive area? 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? -❑ Pi 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: • • 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: Shoreline 0 Forest 0 Agricultural/grasslands ❑Early mid-successional 0 Wetland ID Urban 0 Suburban - • 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES • by the State or Federal government as threatened or endangered? 54 0 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? NO YES If Yes, ❑ a.Will storm water discharges flow to adjacent properties? ,NO DYES b.Will storm water discharges be directed to established conveyance systemsrunoff and rm drains)? If Yes,briefly describe: , QLS+ �]NO OYES • • Page2of4 • 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: f0 19.Has the site of the proposed action or an adjoining property been the location of an active or closedNO YES solid waste management facility? If Yes,describe: • [JAI ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? if Yes,describe: 1=1 I AFFIRM THAT THE INFORMATION OVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE t , /Q� Applicant/sponsor name: J `,1C�i S,'1 YfiYn` Date: � ' I U 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?" No,or Moderate small to large impact impact may may I occur occur f. I. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ regulations? tz 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? [] a 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 affect 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: �t EIa.public/private water supplies? b.public/private wastewater treatment utilities? ❑ ' 8. Will the proposed action impair the character or quality of important historic,archaeological, ISI n architectural or aesthetic resources? I,Ly U 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 • • 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 gi problems? 1 1. Will the proposed action create a hazard to environmental resources or human health? is 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 environ ntal impacts. • Town of Southold-Board of Trustees `( Lt) /V Name of Lead Ag Date GvC.CG►L/ --J fro yvA.. / = President V" Prin or Type Name of Respo Bible leer in Lead Agency Title'Responsible Officer • Signature of Res ible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 • • (5. _ �% Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM b �•-% 4,s PROPERTY LOCATiOte s.C.T.M.ik THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A • -----14/1"--- *) ; STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN soon -ma-- —tom— CERTIFIED BY A DESIGN PROFESSIONAL IN I'IIE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? • (Include Total Area of all Parcels located within r� /� '� Generated this Project Retain All Storm-Water llonRun-Off the Scope of Work for Proposed Construction) 7 r 3' by a Two Inch Rainfall Sitee • (S.F.1 Anes) {This/tern will Include all run-off created by site b. What Is the Total Area of Land Clearing clearing and/or construction activities as well as all A— 0 and/or Ground Disturbance for the proposed ® Slte Improvements and the permanent creation of construction activity? impervious surfaces.) (s F.1 ) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BROW PROJECT DESCRIPTION rrovasA +P+asm arreara Drainage Structures indicating Size&Location?This fw Item shall include all Proposed Grade Changes andA NI . r r p /Neat J Ft Z2� Stopes Controlling Surface Water Flow. ..'� / 3 Does the Site Plan and/or Survey describe the eroslon 41 f E)C')o- () (1C and sediment control practices that will be,used to X ' control site erosion and storm water ❑ This (tem must be maintained throughout the Entire A'1L�,/� A-0111�4 fir(,{, OP�'i�t.(�rr(ili . 'i y� MIA! Construction Period. • ! G 0 I.4 4 iA IA! W 4 Will this Project Require any Land Filling,Grading or Excavation where there is a change to the Natural ❑ A Existing Grade involving more than 200 Cubic Yards • of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities . Encompassing an Area in Excess of Five Thousand • (5,000 S.F.)Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the • - . - Site? Is this Project within the Trustees jurisdiction ❑ General DEC SWPPP Requirements: or within One Hundred(1001 feet of a Wetland or Submission ore SWPPP is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres;including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes ❑ *� • are part of a larger common plan that will ultknately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to ..L including Construction activities invotvlre WA disturbances of leas then one(1)acre where One Hundred(100')of Horizontal Distance? the DEC has determined that a SPDES permit is required for storm water discharges. (SWPPP s Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways.Parking Areas or other Impervious ❑ for Storm Water Discharges from Construction activity-Permit No.GP-0-1 0-001.) Surfaces be Sloped to Direct Storm-Water Run-Off 1.The SWPPP shall be prepared prior to the submittal of the NOI.The NOI shall be Into and/or in the direction of a Town right-of-way? submitted to the Department prior to the commencement of construction activity. 2.The SWPPP shell describe the erosion and sediment control practices and where 9 Wnl this Project Require the Placement of Material, required,post-construction storm water management practices that will be used and/or Removal of Vegetation end/or the Construction of any II constructed to reduce the polutants in storm water dladharges and to assure item Within the Town Right-of-Way or Road Shoulder compliance With the terms end conditions of this permit.In addition,the SWPPP stall Area?(Ws arta ole NOTtedade the rrt.awon or Ddvawy aprmw.) identify potential sources of pollution which may reasonably be mmected to affect the • quality of storm water discharges. NOTE: If Any Answer to Questions Ons through Nine ie Answered with a Check Muir 9:AI SWPPPs that require the post-coraWction skim water management practice in a Sox and the construction site disturbance I.between 5,000 S.F.B f Acre in area, eorrnporuerd ahail be'Prepered by a qualified Deeign Professional Licensed kw Newyork a abrin Wahr,evading,Drainage&Erosion Control Plan is Required by the Town of that is knowledgeable In the pdnctples and mottoes of Storm Water Management. Southold and Must be )anti r A for rforearh Question n is Required atter a Building Permit (NOTE: A CMdt Mak(.►)andror Answer for each QuesSon b Rpuhal for a CompteM Avpgatlay STATE OF NEW YORK, COUNTY OF..21(, (L. SS That I,$42E3'ErTI individual a L being duly sworn,deposes and says that he/she is the applicant for Permit, (Name of And that he/she is the • gri:mer,Contractor, g ptrete Office,etc.) Owner and/or representative of the Owner or Owners,and is duly authorized to perform 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 ofhis knowledge and belied and • that the work will be performed in the manner set forth in the application filed herewith. Sworn to before me this; day of... ((r����� �...„..,24x. Notary Public: l...1.. 5�T K , 4r/r�• •1 yr, i NOTARY PUBLIC-STATE .,,�.. 'b)W :,n- �=ofApptetnt) FORM -osi�io Nd:.01KUo17': Qualified In Suffolk County • . • My Commission Expires November 05, 2015 Berd of Trustees Application IP County of Suffolk State of New York • T =y& 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 OF THIS APPLICATION. 14 • ,` iks..1(4,01,6) •. r Signature of Property Owner SWORN TO BEFORE ME THIS -G- DAY OF A 7— 20 / Notary b;ic WINDY L KUKLA NOTARY PUBLIC-STATE OF NEW YORK No. O1 KU6176871 • Qualified In Suffolk County • My Commission Expires November 05, 2015 . t . APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts_of interest on the oart of.Sown officers and employees,The purpose of ' this form js to ptQvide in�orination which can alert the town oossibls conflicts of inland allowit to take whatever action is _ necessary to avoid same. - - YOUR NAME: F. O1Wrg• A7vD ( CH,& `'u71C (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 Building • Variance Trustee Change ofZone Coastal Erosion - Approval of plat Mooring . Exemption from plat or official map Planning _ • : Other V (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 V 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 •V (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 1 da f J(�i LY 204 • Signature. . • Print Name Z(C l�j 1 5 r.. Form TS 1 • • Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 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 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 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 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 ACTION n E C F {`y SCTM# 1C)00 _ I I - 0 I r z_0 Th AUG - 1 . 2014 PROJECT NAME 1 U l'ciovvc '' 1 The Application has been submitted to(check appropriate response): Bodrd y _, . .:. _ - • Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 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 action:� n R�� � roc)r f . 1 rt) o v 11111 • Location of action: rig tit- A-Alc 030A-614 C-4.6 Site acreage: 5-t5 • Present land use: R 5'/O 'Th1 Present zoning classification: Z. 2. If an application.for theproposed action has been filed with the Town of Southold agency, the following information shall be provided:• (a) Name of applicant: • G�p K✓Ill TT- AND gAvi,-A(ZOU (b) Mailing address: (7 o'1 4u 040-F f l q?7 ' (c) Telephone number:Area Code( ) ( '3 4 9 — 3 g77 • (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes I ' No VA 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 �Not 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 ❑ Yes ❑ No XI Not Applicable • Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria E Yes ❑ No Igsj Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES f. Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section Ili—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No 'J 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 ❑ Yes El No Zot 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 III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ • S } Yes No Not Applicable } Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes C No Not Applicable 1-. Attach additional sheets if necessary { : Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑Yes ❑ No Not Applicable • 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 °;4/1 Not Applicable • Attach additional sheets if necessary 1111 • 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 M—Policies;Pages 47 through 56 for evaluation criteria. II 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 ffi—Policies; Pages 57 through 62 for evaluation criteria. E Yes C No, 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. n I Yes ❑ No Not Applicable .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 f\G+732'j2 l v/L TITLEiiT W DATE 7 33)-°') 4- 4., ,� �� w°°°%t o °o ,� U3 60`' SURVEY OF �0 .° I • LOT 13 , P/0 14 8c P/0 22 ti° _ ,=Q�� �� SUBDIVISION MAP OF ., a j s A 7' PROPERTIES Inc . `0 : 2 5244'' t- FILE 4.. ��� PECONIC BAY P , s �? � _5.,9 F C FILE No. 786 FILED APRIL 5, 1931 °°, O V SITUATED AT ®�% NASSAU POINT F� �� i ,� S.C. TAX No. 1000-111-01-20 \ Foy ti \a O (AREA = 483.69 sq.ft. tY` 4 O, = 0.011 ac.) TOWN OF SOUTHOLD N '. , �s0°, ,°oma° O SUFFOLK COUNTY NEW YORK N .°°.°°•� °�`0 o� S.C. TAX No. 1000- 111 -01 -20 Q 1000- 111 -01 -30 �\ / �s00 �`� SCALE 1 "=20' /if.' `� °`� C �� * v 1 . °o��a AUG 1 2014 NOVEMBER 27, 1998 . ,�/- , NOVEMBER 27, 2000 REVISED SITE PLAN / N. 0/M �4vr DECEMBER 18, 2000 ADDED PROPOSED GRADES / N M `;i,+4,,;, . MARCH 13, 2002 FINAL SURVEY FOR C.O. .p21 T / CERTIFIED TO. 0, 1 A RICK SUTER \\� , ''''' . J 00, / BOBETTE SUTER / p o,9 • 0 NORTH FORK BANK o TR ' o O', P; AQUEBOGUE ABSTRACT Corp. - a•• SIA °"O , ,F ,/ \ /� / ?) ,, -40,,,,---________/1 ., ��fiS� 3' �, roG�'c I w 9S. o `1' s• F °P S� / , rT °F e,, O� O, . iN NOTES: "�o�� QP�o >>� 7‘•9, q�C9�0R fr °�� 'o�'SF ��FS �Q', .,S�F)�9lj� �( \ o 1 . THIS PROPERTY IS IN FLOOD ZONE AE (EL 8) AS SHOWN ON tib f�. Nor ^h F �J FLOOD INSURANCE RATE MAP No. 36103C0164 G -o'� ;.is) 111P t° oyF�c� ?�T „ SO /' ZONE AE (EL 8): BASE FLOOD ELEVATIONS DETERMINED ? P 0 a 0 2. LOT COVERAGE WITH ADDITIONS = 9% �� �� ��`�� '��0/ �8� . la ' /VC c, oFc� " St - ?B • • o Mott ‘F GONG \ 100 /b.' •41,.. I.,•h 1< /\ 1 W ‘,. OP / ! 2,r 2s \<`to. ! V 80' / r\rro / I--�I 5,1 m z 0 G4.6* 5,� ��� ,,0 * `'� BOJ , Z i'`9` ,�0 9 / a• coo) i---1 III 0 / 6' Oy / �� / 't i, 5°` / 0 o �> tio�ro o ^i PQ`o 0\''`'O �'�''`�, 4,-'>' 43- /i c4' / G, - .,,„ rte• `P (o / o` , O /: / 1•D�43 / ti° 4iNNN- . s N et GNF / � / OA. \. C':) /N / <y N N ,ho ./ ------ ------...„..,„„,,N N 02. "� N -voti e4 Gj \ ^h ^, rSe" TF 1.5s444/4,4,1 UNAUTHORIZED ALTERATION OR ADDITION O�, � rq,- TO THIS SURVEY ISA VIOLATION OF Sr›.., . (0i SECTION 7209 OF THE NEW YORK STATE EDUCATION 06, li_ �R M �� COPIES OF THIS SURVEY MAP NOT BEARING � -ft, THE LAND SURVEYOR'S INKED SEAL OR k._..,6", N EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. 0 \ CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY V , IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND Q0' \ ON, AND TO TEGINSTITUTION ASSGN ES OF THE LE HERDING INSTI- NTUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. � THE EXISTENCE OF RIGHTS OF WAY "` � AND/OR EASEMENTS OF RECORD, IF getpANY, NOT SHOWN ARE NOT GUARANTEED. I PREPARED IN ACCORDANCE WIT THE MINIMUM STANDARDS FOR TITLE SURVEY.jAS ESTABLISHED Joseph A. Ingegno BYYTHE Lt Ab A .L.S. AND APPRO AND ADOPTED FOR SUCH USE BY THE N 7 lb RK STATE LAND TITLE ASSOCIATION. Land Surveyor ()t,;t II,, rCO '�j� `\ Title Surveys - Subdivisions - Site Plans - Construction Layout 1 r 'lam "' `*6 * ''``f II PHONE (631)727-2090 Fox (631)727-1727 I , = OFFICES LOCATED AT MAILING ADDRESS f : ., ", 1380 ROANOKE AVENUE P.O. Box 1931 ','� >. \',;;.** N.Y.S. Lic. No. 49668 ��,_,, ! RIVERHEAD, New York 11901 Riverhead, New York 11901-0965 98-593D ._., . . . . . . . . . . • . . . . . . . . • . . __________________ _________..._. .._.t1t. It__tgt.rfg_______________ _ • . . i . . 1 ' . i I I 1 . _ 9FA-L14 -_..-. 1 44 1 . , • ...., .. i • 9r0. o-F - Lp1,./t/ - - - - '-- . ' ; • I I i; ii . . . . II i 1 . . 1 ', , . i-4-5-it- r ---- 51,k,-vP 5.0 ......, -*'- I , ,• i . ( 1._ ) "'I R'1, 1.• ,1 -- ---,•,--' -:--+ i - 4— .------ NK I 6Pc.':.• c,• :. . 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