The URL can be used to link to this page

Home My WebLink AboutTR-8507A�*pE S®��`y John M. Bredemeyer I11, President Michael J. Domino, Vice -President James F. King, Trustee �s a Dave Bergen, Trustee Charles J. Sanders, Trustee C®UNTil 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 # 1135C Telephone (631) 765-1892 Fax (631) 765-6641 Date: July 14, 2015 THIS CERTIFIES that the construction of an 18'x23.4' covered porch over existing deck area; with the condition the drainage pipe is to be cut and removed, and re-routed to a drMell. At 5655 Nassau Point Road, Cutchogue Suffolk County Tax Map #111-13-3 Conforms to the application for a Trustees Permit heretofore filed in this office Dated September 12, 2014 pursuant to which Trustees Administrative Permit #8507A Dated October 22, 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 construction of an 18'x23.4' covered porch over existing deck area; with the condition the drainage pipe is to be cut and removed, and re-routed to a drywell. The certificate is issued to ROBERT & MARY SENA owner of the aforesaid property. Authorized Signature John M. Bredemeyer 111, President �'g1JFF0Z4, Michael J. Domino, Vice -President �� wry James F. King cQia Dave Bergen • Charles J. Sanders ��1 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: r2_ I X__ Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre -construction, silt fence 1St day of construction %constructed Project complete, compliance inspection. INSPECTED BY: e r r COMMENTS: j� A— f( N r 4 IGS, s CERTIFICATE OF COMPLIANCE: Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 0 John M. Bredemeyer 111, President Michael J. Domino, Vice -President James F. King Charles J. Sanders Dave Bergen ��o��gUEFQ(,�-coG 0 y� 01.) x BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD • Town Hall, 53095 Main Rd. P.O. Box 1 179 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 CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre -construction, hay bale line 1St day of construction '/ constructed :Z 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 • OF SO�jyo� • �O ;4*3�OUMY,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8507A Date of Receipt of Application: September 12, 2014 Applicant: Robert & Mary Sena SCTM#: 111-13-3 Project Location: 5655 Nassau Point Road, Cutchogue Date of Resolution/Issuance: October 22, 2014 Date of Expiration: October 22, 2016 Reviewed by: Board of Trustees 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 construct an 18'x23.4' covered porch over existing deck area; with the condition the drainage pipe is to be cut and removed and re-routed to a drywell. 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 submitted by Mark Schwartz, Architect, received on September 12, 2014, and stamped approved on October 22, 2014. Special Conditions: The drainage pipe is to be cut and removed and re-routed to a drywell. 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 fi President, Board of Trustees rt & Mary Sena Nassau Point Road, Cutchogue A W 111-13-3 LI Robert & Mary Sena 5655 Nassau Point Road, Cutchogue SCTM# 111-13-3 _ 10/15/14 ft "N r John Bredemeyer, President OF FN Michael J. Domino, Vice -President James F. King Charles J. Sanders o Dave Bergen i 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: Mark Schwartz, Architect on behalf of ROBERT & MARY SENA requests an Administrative Permit to construct an 18'x23.4' covered porch over existing deck area. Located: 5655 Nassau Point Road, Cutchogue. SCTM# 111-13-3 Typ f area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code propo�id work falls under: Chapt.275 Chapt. 111 . Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre -Submission Violation other Notice of Hearing card posted on property: Yes No Not Applicable Storm Water Management Review: Yes Info needed: Modifications: Conditions: / _ - 0 Z vc No Not Applicable I/ Present Were: _.,,ZBredemeyerZM. Domino King /C. Sanders D. Bergen Bay Constable Other Form filled out in the field by ' jj e, Y Mailed/Faxed to: Date: i. 1r If 0 ILI J, ■ 1 8,40 y 0 n Orr t rr �^ e..._�� .�.�—�,, �9,". �� Off'. I ...[ a •-- rxmrY..�.,x - - Real Property Tax Service A9en�IP��i. , „e �E O ,wa - f rQM r.q ® ♦ > s 'S P� •P, a �' 1 r PA w.N• an I M• xrtiT • �1 M` t r+ ,63 � �w,NZ P ` 40 8 Cotv No— Ib M� - /� �° a♦.. !y .� we � ' ,.,y ° • J. A ^, xmwo', �[e�' ��'"__�� • � w a r u., un IO• >,Nq �� `P _ >> aR. ,ten. ..m " P .• �>r i >o _ � ' - P N� . > 3 « re �I _ � ,Wel � J ,.Wel t3. +>' a• ,u•NI O I M' � 1).3 wq aw.i 1O+ rwq v . go ___ ` `FD /g/ rNief�—__._—_—_ 6 ♦ e ` '\ice ii L +••�'— '-'• "' '— — O -- Po••'— — -- '— --•-- ryoneE ✓""•'•� COUNTYOFSUFFOLK C x — •'+ SOUTHOED secrxx+ryp p • —_—.� �RealProperty Tex Service Agency 111 p rr �`rs r rN ^ '— u --.-- r,.--�•-- rt�v I Gxn,Y bn,•rPo ^•m•,e.NY„A, u ^ ,n rwcr •.° e,��r� .awe„ — ,e�iw+,v�sa nen r ^' saux • rx rr_ •••^ wnnxua NnMnM f•[t al ^'^'^'r mrme•M°s•xrroxlgxwtwE r.r '^ e•�s� �^ ewer _ _ _ ,m n wv ry •�•�•"� — .� wre •uioueowrr rn ruxpxi«rm ,N rr f « rin x— w.o,• n,xw•wvn[w•Ewn«Mor.a ,�� ¢t[ r•[r �I�Ntr •+•� -- •-- ••— rd w '•5•a+• s _.. • m P „e os t00D rN10PEarY NUP 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: October 15, 2014 Re: LWRP Coastal Consistency Review for ROBERT & MARY SENA SCTM# 1000-111-13-3 z. OCT 1 5 2014 ' Mark Schwartz, Architect on behalf of ROBERT & MARY SENA requests an Administrative Permit to construct an 18'x23.4' covered porch over existing deck area. Located: 5655 Nassau Point Road, Cutchogue. SCTM# 111-13-3 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 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 "II" which states: il. 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 proposed action(s) are not located within the CEHA. 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 SU(/ryOlo OFFICE LOCATION: MAILING ADDRESS: Town Hall Annex �0�*0f P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) V0 �r G @ • Telephone: 631 765-1938 P Southold, NY 11971 �O 00 N% 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: October 15, 2014 Re: LWRP Coastal Consistency Review for ROBERT & MARY SENA SCTM# 1000-111-13-3 z. OCT 1 5 2014 ' Mark Schwartz, Architect on behalf of ROBERT & MARY SENA requests an Administrative Permit to construct an 18'x23.4' covered porch over existing deck area. Located: 5655 Nassau Point Road, Cutchogue. SCTM# 111-13-3 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 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 "II" which states: il. 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 proposed action(s) are not located within the CEHA. 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 John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee F_, L 6 2014 �1 To: ��pOth oid',Ipwn Buildi OARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Department • Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Re: Verification of Building Department Permit Requirements SCTM#: 1)1-1,3-3 Telephone (631) 765-1892 Fax (631) 765-6641 Property Owner Name: -k- V1 Date Sent to Bldg. Dept.: I D110 //4 The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated below: YES NO Will the proposed project require a Building Permit? Vl/Will the proposed project require a variance determination from t Zoning Board of Appeals? Will any part of this application be considered as Demolition as described under Town Code? COMMENTS: U Signature of Reviewer Date 0 Office Use Only _Coastal Erosion Permit Applicatio _Wetland Permit Application V Administrative Permit Amendment/Tran f r/E a sion eceived Application: �eceived Fee:$ _Completed Application _Incomplete _SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) �LWRP Consistency Assessment Form t) CCAC Referral Sent: ate of lnspection: S _Receipt of CAC Report: _Lead Agency Determination:_ Technical Review: Public Hearing Held: Resolution: Name of Applicant Robert and Mary Sena Address 5655 Nassau Point Road, Cutchogue V ` SEP 1 2 2014 j t Phone Number:( ) ';3*" §'24- a Suffolk County Tax Map Number: 1000 - 111-13-03 Property Location: 5655 Nassau Point Road, Cutchogue (provide LILCO Pole #, distance to cross streets, and location) AGENT: Mark Schwartz, Architect (If applicable) Address: Po Box 933, Cutchogue, NY 11935 Phone: 631-7344185 &rd of Trustees Applicati* GENERAL DATA Land Area (in square feet): 36,449.01 Area Zoning: R40 Previous use of property: single family residence Intended use of property: single family residence Covenants and Restrictions:F]Yes __E_No If "Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals Yes _2]_No If "Yes", please provide copy of decision. Will thi ject requiream eolition 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 _nNo Prior permits/approvals for site improvements: Agency Trustees 2002 SCHDS 2002 Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or susnended by vernmental agency? ✓ I NoYes If yes, provide explanation: Project Description (use attachments if necessary): Covered porch over existing deck area [% X 2-3. q- Ord of Trustees Applicati* WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: covered porch over existing deck Area of wetlands on lot: 2105 Percent coverage of lot: % square feet Closest distance between nearest existing structure and upland edge of wetlands: 70' (hot tub) feet Closest distance between nearest proposed structure and upland edge of wetlands: 84' feet Does the project involve excavation or filling? NoF� 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: +/- 5% 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): no change in increased water runoff Ord of Trustees Applicati* COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Covered porch over existing deck area Are wetlands present within 100 feet of the proposed activity? No Yes Does the project involve excavation or filling? NoYes If Yes, how much material will be excavated? 0 (cubic yards) How much material will be filled? 0 (cubic yards) Manner in which material will be removed or deposited:= Describe the nature and extent of the environmental impacts to the subject property or neighboring properties reasonably anticipated resulting from implementation of the project as proposed, including erosion increase or adverse effects on natural protective features. (Use attachments if necessary) There are no impacts on the environment resulting from implementation of this project since there is no addition nor expansion beyond existing building structure. • • 617.20 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 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 Pati 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 I - Project and Sponsor Information Name of Action or Project: Robert and Mary Sena j Project Location (describe, and attach a location map): 5655 Nassau Point Road, Cutchogue _ Brief Description of Proposed Action: € E Covered porch over existing deck area Name of Applicant or Sponsor: Telephone' 631-734-4185 Mark Schwartz, Architect € - - - E -Mail' i mksarchiteq@optonline.net net Address: PO Box 933 City/PO: State: Zip Code: Cutchogue Y _ _[IN_ _11935 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? 36,449.01 siacres b. Total acreage to be physically disturbed? none 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) j Industrial -'J Commercial ✓ Residential (suburban) Forest !Agriculture ✓ Aquatic I 10ther (specify): Parkland Page 1 of 4 • 5. Is the proposed action, a. A permitted use under the zoning regulations? • NO YES s N/A t ✓ t b. Consistent with the adopted comprehensive plan? 6. Is the proposed action consistent with the predominant character of the existing built or natural landscape? 7. Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area? If Yes, identify: 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? 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: 10. Will the proposed action connect to an existing public/private water supply? If No, describe method for providing potable water: none to be used 11. Will the proposed action connect to existing wastewater utilities? If No, describe method for providing wastewater treatment: none to be used 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 NO YES J NO YES NO YES I NO 1 YES 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? 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: V Shoreline Forest _ Agricultural/grasslands Early mid -successional Wetland Urban Suburban 15. Does the site of the proposed action contain any species of animal, or associated habitats, listed NO by the State or Federal government as threatened or endangered? ✓ 16. Is the project site located in the 100 year flood plain? NO 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? (✓I NO F—YES b. Will storm water discharges be directed to established conveyance systems (runoff and storm drains)? If Yes, briefly describe: F✓] NO nYES Page 2 of' 4 NO YES YES YES 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: 19. Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes, describe: 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 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Ma- Ar . it_ __ ___ Date. September 17, 2014 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 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 j No, or Moderate small to large i impact impact j may may I occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning i ✓ regulations? 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 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: 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 No, or J small impact may occu r 10. W ill the proposed action result in an increase in the potential for erosion, flooding or drainage problems? 11, Will the proposed action create a hazard to environmental resources or human health? Moderate to large impact may occur 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, vr at the proposed action may result in one or more potentially large or significant adverse impacts and an vironmental 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 Age y Print or Typ ane of Res onsible Offr r in Lead Agency S' re of Resp tl Officer in Lead Agency President Date Title of Responsible Officer Signature of Preparer (if different from Responsible Officer) PRINT Page 4 of 4 4Wrd of Trustees Applicati90 I Robert and Mary Sena (print owner of property) Mark Schwartz, Architect AUTHORIZATION (where the applicant is not the owner) residing at 5655 Nasaau Point Road Cutchogue, NY 11935 (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's si ture) 4vrd of Trustees Applicati* County of Suffolk State of New York - ZeAKA =G��-Ax- z— 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 REV EW OF THIS A LIGATION. Sign SWORN TO BEFORE ME THIS t 2 DAY OF J -�- ,20-d Notary Public VICKI TOTTH Notary NPO. 01`fE 6190696 w York Qual fled in Suffolk County Commission Expires Juiv 28 2 APPLICANUAGENU/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The I= of Southold's Code of Ethics txohibits conflicts of interest on the of j&n offmm and emote am= of this form is to gMjj4e information which can alert the town of o uft conflicts of interest and allow it to take whatever lWMis Kgg= to avoid same. YOUR NAME: (Last name, fust name, jpkk le iriffial, unless we applying in the tratrre of someone else or other entity, such as a company. If so, indicate the other person's or company's nam.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If "Other", name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "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% ofthe ares. YES LJNO 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 applicantlagentImpresentative) 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 chill is (check all that apply): EJA) the owner of greater than S% of the shares of the corporate stock of the applicant Li(when the applicant is a corporation); m 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� of 2001 Signature, _ Print Name Form TS 1 Town of Southold • A. 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 Town). If any question in Section C on this form is answered "yes", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. 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 Trustee i a t, all local libraries and the Town Clerk's office. 1 �• L'— - �____ �� 1 i 3 B. DESCRIPTION OF SITE AND PROPOSED ACTION j SEP 12 2014 i SCTM# 111 _ 13 _ 03 The Application has been submitted to (check appropriate response): f Town Board ❑ Planning Dept. ❑ 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 of action: Covered porch over existing deck Location of action: 5655 Nassau Point Road, Cutchogue, NY Site acreage: 0.838 Present land use: single family residential Present zoning classification: R40 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: Robert and Mary Sena (b) Mailing address: 5655 Nassau Point Road, Cutchogue, NY 11935 (c) Telephone number: Area Code ( ) 631-734-5240 (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ❑ No Q If yes, which state or federal agency? 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 - please explain) This project entails covered roof over an existing deck of an existing single family home in a heavily developed neighborhood. Policy 1 is not applicable to the project. Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III — Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No ❑ (Not Applicable — please explain) The subject property does not contain nor does the project affect historic or archeological resources; nor is the project located in a historic maritime area. Policy 2 is not applicable to the project. 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 ❑ (Not Applicable — please explain) To the extent that this policy is applicable to the proposed project, visual quality and scenic resources will be protected at the site through the protection and maintenace of the well vegetated area buffering the developed portion of the site from the tidal wetlands of Little Peconic Bay. Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III — Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No ❑ (Not Applicable — please explain) The project does not address nor affect erosion control structures or other erosion/flooding control initiatives. Policy 4 is not applicable to the project. 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 — please explain) no increase in structures nor water runoff 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. ✓❑ Yes ❑ No ❑ (Not Applicable — please explain) This project will be consistent with Policy 6 for the same reasons described for Policy 5; because there will be no loss of wetlands and because the of both the Sold Town Trustees and the New York State Department of Conservation will be complied with. 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. See Section III — Policies Pages; 34 through 38 for evaluation criteria. ❑ ✓ (Not Applicable —please explain) ❑ Yes ❑ No The project will neither affect nor have an impact on air quality in the Town of Southold, Policy 7 is not applicable to the project. 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 — please explain) The project will neither create nor rrequire the handling of solid waste or hazardous substances. Policy 8 is not applicable to the project. 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. ((�� F]YeE J Non (Not Applicable —please explain) The project is limited to the upland portion of the property, public access and recreational use of the adjacent coastal waters and public lands and resources will not be affected by the project. Policy 9 is not applicable to the project. Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's warmer -dependent uses and promote sit*Of new water -dependent uses in suitable locations. See LWRP Section III — Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No✓❑ (Not Applicable —please explain) The project neither proposes nor affects water -dependent uses. Policy 10 is not applicable to the project. 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 — please explain The project neither proposes nor affects commercial or recreational fisheries or other uses associated with the living marine resources of Long Island Sound. Policy 11 is not applicable to the project. 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 21 Not Applicable — please explain The project site is neither situated on nor adjacent to agricultural lands. Policy 12 is not applicable to the project. 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 — please explain The project affects neither the use nor development of energy and mineral resources. Policy 13 is not applicable to the project. PEcOJ�jC, m SURVEY OF LOT 38 MAP OF AMENDED MAP A OF NASSAU APPROVED BY FILE No. 156 FILED AUGUST 16, 1922 BOARD OF i RUSTEES. SITUATED AT TOWN OF SOUTHOLD C U T C H O G U E TOWN OF SOUTHOLD DATE , SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-111-13-03 — 1�. i•.__ : ,-._•_ —=._� SCALE 1 "=20' FEBRUARY 2, 2001 SEP 1 2 ?014 APRIL 8, 2005 ADDED PROPOSED ADDITIONS AUGUST 4, 2005 REVISED PROPOSED ADDITIONS SEPTEMBER 14, 2005 REVISED PROPOSED ADDITIONS OCTOBER 6, 2005 ADDED WATER LINE & HOUSE No. JULY 6, 2007 FINAL SURVEY FOR ADDITIONS AREA v 36,449.01 sq. ft. (TO TIE LINE) 0.838 ac. PREPARED IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS AS ESTABLISHED BY THE L.I.A.L.S. AND APPROVED AND ADOPTED FOR SUCH USE BY THE NEW YORK STATE LAND TITLE ASSOCIATION. N.Y.S. Lic, No. 50467 cp o c1 ft 0M V ' Q 0 N 0 POINT UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON. AND TO THE ASSIGNEES OF THE LENDING INSTI- TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. THE EXISTENCE OF RIGHTS OF WAY AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. Nathan Taft Corwin III Land Surveyor Title Surveys — Subdivisions — Site Plans — Construction Loyout PHONE (631)727-2090 Fax (631)727-1727 OFFICES LOCATED AT MAILING ADDRESS 322 Roannke Avenue P.O. Box 1931 Riverhead, New York 11901 Riverhead, New York 1 1901-0965