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HomeMy WebLinkAboutTR-8518John M. Bredemeyer l[1, President Michael J. Domino, Vice -President James F. King Charles J. Sanders Dave Bergen BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Full, 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 CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre -construction, hay bale line 1St day of construction % constructed Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 8518 DATE: OCTOBER 22, 2014 ISSUED TO: FIRM FOUNDATIONS PARTNERS LLC PROPERTY ADDRESS: 1060 FOX HOLLOW ROAD, MATTITUCK SCTM# 113-6-23 AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on October 22, 2014, and in consideration of application fee in the sum of $250.00 paid by John C. Ehlers Land Surveyor and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to install a 16'x36' in -ground swimming pool with 16" bluestone pool coping; a 101x16' bluestone pool patio; install a pool equipment area; install pool fencing; for the 236sq.ft. upper deck and 577sq.ft. lower deck; with the condition to establish and subsequently maintain a vegetated non -turf buffer seaward of the fence line; and as depicted on the survey prepared by John C. Ehlers, Land Surveyor, last dated October 20, 2014, 2014 and stamped approved on October 22, 2014. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board asAf this date. ,;�gOFFO1�•Ca� - 0 TERMS AND CONDITIONS The Permittee Firm Foundations Partners LLC residing at 1060 Fox Hollow Road, Mattituck, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any' and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. 8. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. 9. That the said Board will be notified by the Permittee of the completion of the work authorized. 10. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. 11. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee October 22, 2014 Mr. John C. Ehlers 6 East Main Street Riverhead, NY 11901 BOARD OF TOWN TRUSTEES - TOWN OF SOUTHOLD RE: FIRM FOUNDATIONS PARTNERS LLC 1060 FOX HOLLOW ROAD, MATTITUCK SCTM# 113-6-23 Dear Mr. Ehlers: Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 The Board of Town Trustees took the following action during its regular meeting held on Wednesday, October 22, 2014 regarding the above matter: WHEREAS, John C. Ehlers on behalf of FIRM FOUNDATIONS PARTNERS LLC applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated June 25, 2014, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on October 22, 2014, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, 2 WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of FIRM FOUNDATIONS PARTNERS LLC to install a 16'x36' in -ground swimming pool with 16" bluestone pool coping; a 10'x16' bluestone pool patio; install a pool equipment area; install pool fencing; for the 236sq.ft. upper deck and 577sq.ft. lower deck; with the condition to establish and subsequently maintain a vegetated non -turf buffer seaward of the fence line; and as depicted on the survey prepared by John C. Ehlers, Land Surveyor, last dated October 20, 2014, 2014 and stamped approved on October 22, 2014. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. . Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, John M. Bredemeyer III President, Board of Trustees JMB/amn 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 TO: John C. Ehlers for Firm Foundations Partners LLC Town Hall Annex 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Please be advised that your application dated 6/25/14 has been reviewed by this Board at the regular meeting of 10/22/14 and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre -Construction Hay Bale Line Inspection Fee ($50.00) 1St Day of Construction ($50.00) '/ Constructed ($50.00) XX Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) XX The Permittee is required to provide evidence that the non -turf buffer condition of the Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ 50.00 BY: John M. Bredemeyer III, President Board of Trustees • ,., ,yyr , . r +iF �'1S r F . 11- -Firm Foundations Partners LLC .int YF' it+w•d ♦. "SCTM# 113-6-23 10/15/14 t II , fa Kr Y t. ad r �`. .1 S 1 � � K 1 •A'Y` ft .. . • _ � ti � 111 e: ti r : jGr. } 10/15/2*014 15' 18 �. � #��a '�l�.,w YID%'�►YiA . ' � �,•, ,`� n" { �' Firm Foundations Partners LLC 'VIP 1060 • • • ,�.,A SCTM# 113-6-23 ./wwN i 10/15/14 ' ,. j A4 io Af �t> ' f� �. 0 ::e 10/15/2014 15:21 a li� ':irm Foundations Partners LLC ivc, �! ! ' . �+.• r�. � gip' ��y • �. ' ��< �bK `.':+�. '• ���'"' � ��M Alt it'R All rk i i1 4 �• r _ 10/15'/20:14 15 23 .. A John Bredemeyer, President %UFF014-'rr Town Hall Annex Michael J. Domino, Vice -President h°° �y 54375 Route 25 James F. King y P.O. Box 1179 Charles J. Sanders • Southold, NY 11971 Dave Bergen y��1 ,� �a Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: DcT / John C. Ehlers on behalf of FIRM FOUNDATIONS PARTNERS LLC requests a Wetland Permit to install a 16'x36' in -ground swimming pool with 16" bluestone pool coping; a 10'x16' bluestone pool patio; install a pool equipment area; and install pool fencing. Located: 1060 Fox Hollow Road, Mattituck. SCTM# 113-6-23 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay —'' c� Distance of proposed work to edge of wetland d'-- '0 Part of Town Code proposed work falls under: (/Chapt.275 Chapt. 111 other Type of Application: ;` 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 NoN� of Applicable Info needed: Modifications: Conditions: Present Were Bay Constable 7-r17 �T- 7//J. Bredemeyer ✓ M. Domino King ve Sanders Bergen Form filled out in the field by Mailed/Faxed to: Date: Other John Bredemeyer, President guFF01 Michael J. Domino, Vice -President James F. King y Charles J. Sanders • Dave Bergen 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: 06-� rb John C. Ehlers on behalf of FIRM FOUNDATIONS PARTNERS LLC requests a Wetland Permit to install a 16'x36' in -ground swimming pool with 16" bluestone pool coping; a 10'x16' bluestone pool patio; install a pool equipment area; and install pool fencing. Located: 1060 Fox Hollow Road, Mattituck. SCTM# 113-6-23 Type of area to be impacted: altwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other Type of Application: Wetland Coastal Erosion 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: Modifications: Ad �)b, Abe e> 01- 'iV 5 Conditions: Present Were: J. Bredemeyer M. Domino. Bay Constable _ Form filled out in the field by J, I!~ Mailed/Faxed to: Date: - . King . C. Sanders Other D. Bergen Firm FoundationsPartners LLC 1060 Fox Hollow Road, MattituCI7.-. '�,CTM# 113-6-23 ;/13/14 4. ff4 WmW Iw ti,, I A i ro40 r. -.s Av ow • � x R M�# Owl_ Fillip, 1., FoundationsPartners LLC Fox Hollow Road, Mattituck I# 113-6-23 (14 �,��. `�� �._���;. �. �'OF� ^�j �tS j ��, .p 1., 1, 4 �. ' � {„ � i v ��Y � � i 6 _ �� } 'i _ 3 � 4.. 4 � � t _ .: � � {�, t � tit:. ' ti.. � r. �� � " �y� y 6': \ s _ _ � M1. �t '^ . �'. � �" � � ! � <, r � xw �' ��� rg �. �� �' .. 'apt, y µ'�+' � ,� f ,,1y�, y ��. :� _ F4 ; e , r � �- - w .:-%iii. � F John Bredemeyer, President �ogoFFot��, Michael J. Domino, Vice -President o James F. King y � Charles J. Sanders • Dave Bergen 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 InspectionMork Session Report Date/Time: J� / / �i I �: 3a John C. Ehlers on behalf of FIRM FOUNDATIONS PARTNERS LLC requests a Wetland Permit to install a 16'x36' in -ground swimming pool with 16" bluestone pool coping; a 10'x16' bluestone pool patio; install a pool equipment area; and install pool fencing. Located: 1060 Fox Hollow Road, Mattituck. SCTM# 113-6-23 Type of area to be impacted: I Saltwater Wetland Freshwater Wetland Sound Bay ` ok l Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other Type of Application: Wetland Coastal Erosion 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: G- ifications: 7 /_ �� I Conditions: S5 -0m &e Llrc l�'a � �c�,,z�G n S,s",r � �_ V16 Present Were: J. Bredemeyer LM. Domino J. King ZC. Sanders D. Bergen Bay Constable // Other Form filled out in the field by Mailed/Faxed to: Date: re- �- e- - 19i` l Jr`n p(2 r �1�' J (k S 13�'c i A7 _-- � =- " -_ !f � n �' h - _ $ .�,' f� "' �•_ shy. .�. / �." ♦�� .; :rte � � ".✓�� B•. 4" s M � ~ ! n1in�, `. .iY T _ � I � Wit^• 'r„` a/ Ag ' OW..' �w� • - � � !# �� •��� .may 1. Y. �� ` � i - fJ �y 4 irm Foundations Partners LLC 060 Fox Hollow Road, Mattituck CTM# 113-6-23 /16/14 �r x-. W ; �~ 13 7- dL ;,♦p 0 \ ,�# S? iF f t - -c`' �' R .'s � F m 'l ` � � '•h„ :�,'� - "�r� , t -�f .3 t � s + Y � ,. $,n�-' .kir 4'�' Y f Y , :.+ab „EF 'f 7`'if�i "•.- �� �'� t R yie ,L 'EP'r sk ;y -T��E, � � "! - �. r , .rs,¢- y. 'r •� .... � Ea r �, •-� � �.:.. � � � ' .; y._ l�yn ��r y��} , �� ... � t. ; �..� � • A/Y.� � •-` It:� ��w. ' r'�' 'e'pi�'" 1 .�. a � '�X L•' � �,,•.. (� �-rc.' •d'�^ +fii'!G.': � lw t r yr+'`.�r y�' .,..r- ...,_ _ _ - � .... �T r AM • - ah �. O�Y4 Foundationsirm 11060 Fox Hollow Road, Mattituck CTM# 113-6-23 ' '.� 3Y:�i•yW R ., \ I.. `�' R � moi. • ! .• t.l - 144 ' 77 -Tr Firm Foundations Partners LLC 1060 Fox Hollow Road, Mattituck CTM# 113-6-23 7/16/14 irm Foundations Partners LLC 060 Fox Hollow Road, Mattituck CTM# 113-6-23 /16/14 ��A 711 W.�5. am"9 V T v v a J. <M - wy mow. ;, aw y R_ r k rmw ^ Y P v m y , u a � 01 1.044 ,�, •. n .� Wn, w- - wy mow. ;, aw v. , R_ k rmw , u a v 90 ,.., .,. �: „q{iM^ Nk4 i JUN 3 0 2014 Town of`Southold -A.-:2 712 : Suffolk'Count','A The.People-of-the State.of New .York vs - LAST NAME (DEFENDANT) --_, _ FIRST NAME - MIDDLE IN_ITIA_L"- 6V4c..S 2�L��.1 1C . STREET•ADDRESS - :n -- - APT NO. cm s TE zIP _ _ ,1 If:FAICF (.1RDF(�IC'I'Cennr I . ® 77. 7,11 . ' - �STATE TYPE OF,WOENSE . './DATE EXPIRES SEX - DATE OF BIRTH _ I—OPERATOROYES -ONO -­ I.,.,..-HNL.:. ;jjMG- FM%,..,,-I,QITY.-IPVVN..VILLAGE.OR HAMLET • . - INVIOLATIONOFSECTION` SUBD. ..:OF THE❑ -VEHICLE AND TRAFFIC LAW' OF THESTATE OF. NEW YORKg ,80THER (SPECIFY) -❑"O.S: ❑COM ;❑ BUS , ❑ HAZ �� �. '•�.. ; DEF VEH °,.: MAT ❑` SPEEDING - OTHER OFFENS - -- -- - MPHINA -'"'.MPH-ZONE ,,,( MISDEMEANOR ❑ -. ... FACTUAL PART (NOTFOR-TVB).' -THE ABOVE NAMED DEFENDANT. DID ONTHEESTATEDDATE,TIME AND PLACE .{I.C.Y!'�UV - U �`lD✓� dN � t'i'le ui � ��[�t (ni^ �2 1 • Gf N� GGvic@ �'v - : - The:FoTgomg isbw-don(p rsonel imowjl�edge)_ date_ d 4�� PARKING. SCHEDULED -FINE$ 7CONTACT COURT❑ .THE PERSON DESCRIBED ABOVE IS SUMMONED To APPEAR AT - SODTHOLDTOWN JUSTICE COURT;53095-ROUTE 25,.SOUTHOLDINY 11971 - 1 - DATEE OF,APPEARANCE (NOT FOR TVa) OtJ- /✓ L. -t WV �. -AT / �� pµ& FALSE STATEMENTS•HEREIN ARE PUNISHABLE ASA CLASS'A MISDEMEANORPURSUANTTO SECTION 210A5 OF THE P.LN.Y.S.' COMPWN-ANT - DATE -L BADGE'# - •• ••- ••��•. • ice.. •.•rrr��n yr v�nl�l-c UCa�.IIIOCU OCLVVY" PI'ATE NO. ' 'DATE EXPIRES STATE _PLATE TYPE'_ ❑ N.Y. ❑ N.J. ❑N.Y. ❑.N.J: ❑ ❑ PASS ❑ COMM ❑ VEHICLE MAKE ❑ DODGE ❑ BUICK =❑ --CHEV O CADILLAC­ -❑ -.:.I O --' `- O FORD ❑ OLDS ❑ PLYM ❑ • TOYOTA � ❑ --'VOLKS BODY ❑ 2 DR ❑ 4 DR ,.,. ❑ BUS ❑ MCY - ❑ S.W. - TYPE - ❑--TRUCK - -,.❑ ..TRAILER ❑- VAN - ❑ VIN NUMBER .. .. =- -.... .. - "' • " ' " ":THE:PERS.ON DESCRIBED ABOVEIS-CHARGEDAS FOLLOWS -­ I.,.,..-HNL.:. ;jjMG- FM%,..,,-I,QITY.-IPVVN..VILLAGE.OR HAMLET • . - INVIOLATIONOFSECTION` SUBD. ..:OF THE❑ -VEHICLE AND TRAFFIC LAW' OF THESTATE OF. NEW YORKg ,80THER (SPECIFY) -❑"O.S: ❑COM ;❑ BUS , ❑ HAZ �� �. '•�.. ; DEF VEH °,.: MAT ❑` SPEEDING - OTHER OFFENS - -- -- - MPHINA -'"'.MPH-ZONE ,,,( MISDEMEANOR ❑ -. ... FACTUAL PART (NOTFOR-TVB).' -THE ABOVE NAMED DEFENDANT. DID ONTHEESTATEDDATE,TIME AND PLACE .{I.C.Y!'�UV - U �`lD✓� dN � t'i'le ui � ��[�t (ni^ �2 1 • Gf N� GGvic@ �'v - : - The:FoTgomg isbw-don(p rsonel imowjl�edge)_ date_ d 4�� PARKING. 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INORO` ��) n pP SEEEEC. NO. 121 9 s+ G.F7. 49 A MIpOIE R�' --�— wua r (21) O w„M ...,� _ "-- m NOTICE vP" COUNWOFSUFFOLK © K aF $OUTHOLO SECTION NO E ,– .____ e .. --.-- ...� ReaiP"roprtyTRax SenriceAgenq n s7.P 113 N r�.r.. r. .. W ___ o.eu. __ __ u.__._ „e o -- -- M 1000 PROPERTYMM John C. Ehlers Land Surveyor 6 East Main Street Riverhead, N.Y. 11901 Dear Trustees, I would like to request that my existing request for a pool permit at 1040 Fox Hollow Road be amended to add the request for a permit for the existing decks as shown on the accompanying surveys last dated 08-14-2014. Sincerely, John C Ehlers a E , - ry ecjC D Z// ^^ �`a o w e—r a 5 72--?P-4L Q d edcb a3, s,, 49- 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: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM'S To: John Bredemeyer, President Town of Southold Board of Trustees-�•a..._..._,.:P;.rc,,,;,.; rt„_ From: Mark Terry, Principal Planner LWRP Coordinator Date: July 21, 2014 Re: Proposed Wetland Permit for FIRM FOUNDATIONS PARTNERS LLC SCTM# 1000-113-6-23 John C. Ehlers on behalf of FIRM FOUNDATIONS PARTNERS LLC requests a Wetland Permit to install a 16'x36' in -ground swimming pool with 16" bluestone pool coping; a 10'x16' bluestone pool patio; install a pool equipment area; and install pool fencing. Located: 1060 Fox Hollow Road, Mattituck. SCTM# 113-6-23 Note that the bottom of slope has been identified, however, a top -of slope line is not shown on the survey. It is recommended that the Board verify the regulated natural feature on the property. The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed actions are CONSISTENT with the Policy Standards and therefore are CONSISTENT with the LWRP provided the following: 1. A pool de -watering drywell is specified. 2. A non -turf, vegetated buffer is required seaward of the proposed fence. 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 Peter Young, Chairman y Lauren Standish, Secretary i Conservation Advisory Council Town of Southold Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (63 1) 765-6641 At the meeting of the Southold Town Conservation Advisory Council held Thurs., July 17, 2014 the following recommendation was made: Moved by Peter Meeker, seconded by Jack McGreevy, it was RESOLVED to NOT SUPPORT the application of FIRM FOUNDATIONS PARTNERS LLC to install an in -ground swimming pool 16'X 36' with blue stone patio, pool equipment and pool fencing. Located: 1060 Fox Hollow Rd., Mattituck. SCTM#113-6-23 Inspected by: Keith McCamy, Peter Meeker, John Stein The CAC does Not Support the application because the project wasn't staked and there was no indication of a drywell. Vote of Council: Ayes: All Motion Carried BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD To: Southold Town Building Department Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Re: Verification of Building Department Permit Requirements SCTM#: 113 Property Owner Name: Date Sent to Bldg. Dept.: Telephone (631) 765-1892 Fax (631) 765-6641 E C E � W E J U N 2 G 2014 - ] ] BLDG. DEPT. TOWN OFSOUTHOLD 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 i the proposed project require a Building Permit? Will the proposed project require a variance determination from t oning Board of Appeals? Will any part of this application be considered as Demolition as described under Town Code? COMMENTS: N -7Cet, Ie 11K Signature oOKeviewer Date James F. King, President OF SUUryo Bob Ghosio, Jr., Vice -President � 01 0 Dave Bergen. John Bredemeyer va Michael J. Domino COU BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD To: Southold Town Building Department Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Re: Verification of Building Department Permit Requirements SCTM#: 113 Property Owner Name: Date Sent to Bldg. Dept.: Telephone (631) 765-1892 Fax (631) 765-6641 E C E � W E J U N 2 G 2014 - ] ] BLDG. DEPT. TOWN OFSOUTHOLD 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 i the proposed project require a Building Permit? Will the proposed project require a variance determination from t oning Board of Appeals? Will any part of this application be considered as Demolition as described under Town Code? COMMENTS: N -7Cet, Ie 11K Signature oOKeviewer Date BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only jCoastal Erosion Permit Application �ZWetland Permit Application — Administrative Permit Amendme d!15 /E t on eived Application" ivedFce:S ompleted Application q._ jncomplet- ____SEQ,RA Classification: m, Type L_Type 13 Unlisted ; Coordinatiow(date sent)_ aWRP. Consistency Assqssmeql t Form ateC Referral Sent: of Inspection: of CAC Reporl._ Lead Agency Determination: �chnical. Review-. _Zpuueblic Hearing Held: 1) 1 #4 . Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 on. S ed (-9r-,s LL-C— Name of Property Owner(s) 'Z o rel�G Address l24 1001 Phone Number:( Suffolk County Tax Map Number: 1000 - Lo — 1, 3 Property Location: l Oto ri [57 Z-; p'13 20) (provide LILCO Pole #, distance to cross streets, and location) AGF,Nt: (Kapplicable) Aodress: Phone: Co -3 -87,.89 James F. King, President W Bob Ghosio, Jr., Vice -President Dave Bergen John Bredemeyer •-Ase Michael J. Domino BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only jCoastal Erosion Permit Application �ZWetland Permit Application — Administrative Permit Amendme d!15 /E t on eived Application" ivedFce:S ompleted Application q._ jncomplet- ____SEQ,RA Classification: m, Type L_Type 13 Unlisted ; Coordinatiow(date sent)_ aWRP. Consistency Assqssmeql t Form ateC Referral Sent: of Inspection: of CAC Reporl._ Lead Agency Determination: �chnical. Review-. _Zpuueblic Hearing Held: 1) 1 #4 . Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 on. S ed (-9r-,s LL-C— Name of Property Owner(s) 'Z o rel�G Address l24 1001 Phone Number:( Suffolk County Tax Map Number: 1000 - Lo — 1, 3 Property Location: l Oto ri [57 Z-; p'13 20) (provide LILCO Pole #, distance to cross streets, and location) AGF,Nt: (Kapplicable) Aodress: Phone: Co -3 -87,.89 Lrd of Trustees Applicatio: GENERAL DATA Land Area (in square feet): O "1 -1 Area Zoning; Previous use of property: 1"'? z; Intended use of property,: -I,\,— Covenants ,\s;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 "Yds", be advised thisapplication 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 require any demolition as per Town Code or as determined by the Building Dept.? �,. Yes ___K__No Does the structure (s) on property have a valid Certificate of Occupancy? _Yes No Prior permits/approvals for site improvements: Agency A46-Aq-4 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; Project Description (use attachments if necessary). Brief Description of Proposed Action: YTS ''ii iJla..dl 15y..1, a..i.► A y " QCS 6L4 �" G��P 1 jiV �'tP r �sS" sy : • oti `� J �ts4� L 1-��c Id Of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: 1A Sn square feet Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands: l2 gz, _ feet closest distance between nearest proposed structure and upland edge of wetlands: 82, feet Does the project involve excavation or filling? No ?e Yes if yes, how much material will be excavated?_ 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:_ 1'p Manner in which material will be removed or deposited: rg X e 2 Statement of the effect, if any, on.the wetlands and. tidal lusters of the town that may result by reason of such proposed operations (use attachments if appropriate): 617.20 Appentl& B Short Enpironmental Assessment Forin Instructions for Completing Part I - Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding, are subject to public review, and may be subject to further verification. Complete Part 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 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency, attach additional pages as, necessary to supplement any item. Part 1- Project and Sponsor Information Name of Action or Project. T Project Location (describe, and attach a location -map): Brief Description of 'Proposed Action: 13 r 0 Cr C- Co Jby �Lv '_�e 5 -ro A C;z' 3 C))t__ (2F,7 LN r,%u AJT- 0 e> L_ � Name ofApplicant or,§p2%w, Telephone, L E -Mail: Addrs s-L) city/po: Zip Code: tz Z!-7� lme�&o , Ll V3t 6 1 1. Doesilie proposed action only involve the legislativeadoptionof a plan, local law, ordinance, NO 'VLS administrative rule, or regulation? If Yes, attach a narrative description of the intent of the proposed action and the environmental resources that MV F-1 may be affected in the municipality and proceed to Part 2. If no, continue to question 2. Ulsi 2. Does the proposed action require a permit, approval or funding from any other governmental Agency? NO YES If Yes, fist agenq(s) name and permit or approval; 3.a. Total acreage of the site of the proposed action?j acres b. Total acreage to be physically disturbed? acres c. Total acreagge(project site and any contiguous properties) owned or controlled by the applicant or project sponsor? (I Le acres 4. Check all land uses that occur on, adjoining and near the proposed action. [a Urban 0 Rural (non -agriculture) [JIndustrial Mommercial ENResidcatial(suburban) OForest MAgriculture, [MAquatic 00ther (specify): E3Parkland Page I of 4 "/&C - ! 5. is the proposed action, a. A permitted use under the zoning regulations'! b. Consistent with the adopted comprehensive plan? NO YES /A 6. 'is the proposed action consistent with the predominant character of the existing built or natural landscape? NO YES M 1 MR 1 7. is the site of the proposed action located in, or does it adjoin, a state listetCritical Environmental Area? if Yes,. identify: NO YES U9 M 8. a. Will the proposed action result in a substantial increase in traffic above presentlevels? b. Are public transportation service(s) available at or near the site of the proposed action? e. Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? NO YES L2J El M MX 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: NO Ylis f mm 10. Will the proposed action connect to an existing public/private water supply? If No, describe method for providing potable water: NO YES F-1 11. Will the proposed action connect to existing wastewater utilities? If No, describe method for providing wastewater treatment: NO YES 12. a. Dom 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 otbervaterbodies regulated by a federal, state or local agency? b. Would the proposed action physically alter, or encroach into, any existing wetland or waterb6dy? If Yes, identify the wetland or waterbody and extent of alterations in square^feet or acres: NO YES 14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: IM Shoreline OForest CAgrieultural/grasslands 0 Early mid -successional [A Welland 0 Urban El Suburban 15. Does the site of the proposed action contain any species of animal, or associated habitats, listed by the State or federal government as threatened or endangered? NO YES 0 16. Is the project site located in the 100 year flood plain? NO VF V 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? FANO f_JYES, b. Will storm water discharges be directed to established conveyance systemsrunoff and storm drains)? If Yes, briefly describe:' NNO AYES NO YES FRO El "Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of water or other liquids (e.g. retention pond, waste lagoon, dam)? If Yes, explain purpose and size: NO YES ❑. to large impact 19. }-las 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 - w, NO YES FRI F1 occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning 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: �m NO VES ® F] 2. Will the proposed action result iri a change in the use or intensity of use of lend? I AFFIRM THAT THE INFORMATION ]PROVIDED ABOVE IS TRUE AND .ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name- ^� , Date: o Signature: A 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 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 � 1:1regulations? 2. Will the proposed action result iri a change in the use or intensity of use of lend? 3. Will the proposed action impair the chat -deter or duality of the existing community? 4. Will.the proposed action have an impact on the environmental characteristics that caused the establishment ofa Critical Environmental Area (CF..A)? 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 walk%vay? 6. Will the proposed action cause an increase in the use ofenergy and it fails to incorporate rluq tt._lt ❑ reasonabl available enerV conservation or renewable energyopportttnities? 7. Will the proposed action impact existing: Q a. public! private water supplies? b. public / private wastewater treatment utilities? S. Will the proposed action impair the character or quality of important historic, archaeological, (U I E t�l architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources (e.g., wetlands, ful waterbodies, groundwater, air quality, flota and fauna)? Page 3 of 4 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 occue, or if there is a nce4to explain why a particular element of the proposed action mayor 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 h - avc 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 impaco and an environmental impact statement is required. Check this box ifyou have, determined, based on the information and analysis above, and any supporting documentation, that the proposed action will not result in any significant adverse en . viron7mla 'm Town of Southold - Board of Trustees ;(7 - Name of Lead Agen LI e-, Print or Type Name of Responsible Offi in Lead Agency Signittire of ResponsiblojOhicer in Lead Agency .President V4' / 49 1 Title Responsible Officer Signature of Preparer (if different from Responsible Officer). PRINT:] 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 MV 1:1 problems? el% 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 occue, or if there is a nce4to explain why a particular element of the proposed action mayor 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 h - avc 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 impaco and an environmental impact statement is required. Check this box ifyou have, determined, based on the information and analysis above, and any supporting documentation, that the proposed action will not result in any significant adverse en . viron7mla 'm Town of Southold - Board of Trustees ;(7 - Name of Lead Agen LI e-, Print or Type Name of Responsible Offi in Lead Agency Signittire of ResponsiblojOhicer in Lead Agency .President V4' / 49 1 Title Responsible Officer Signature of Preparer (if different from Responsible Officer). PRINT:] Page 4 of 4 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: r KIC- fJ N T -K 12 6- n,, s /-�, 1,,,tikL STATE OF NEW YORK COUNTY OF SUFFOLK tiL� residing at AJ" 1141 is , , bein duly sworn, deposes and says that on the 104' day of L�P y s,,;A; , 20, deponent mailed a- true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at WaT ig, j , that said Notices were mailed to each of said persons by CERTIFIED MA MIRETURN RECEIPT. Sworn to before Me this a: Day of 20 ) l Notary Public CONNIE D. BUNCH Notary Public, State of New York No. 01 BU69 8505o Qualified in Suffolk County /I Commis ion Expires April +4, 2 ©ft to ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired./ A. Signal I ❑ Agent 'and X ❑ Addressee ■ Print your name aaddress on the reverse so that we can return the card to you. B, ceived 4yrin e Name) C. Date of Delivery ® Attach this card to the back of the mailpiece, ° °'� y �. / or on the front if space permits. - D. Is delivery address different from item 19 ❑ Yes 1. Article Addressed to: $,ran#r,'a very address below: 11 No' C LP per. --I,, y . t u --%L ir f ��. /V, �) 3. ,.Service Type `1CD ti, all ❑Express Mail I 'Regi�ipt for Merchandise I ❑ Insured Mail ❑ C.O.D.. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number, I ?0-1-4, 0150 0001 '-2901 7 8.9 3 (Transfer from service 1! PS Form 3811, February -2004 Domestic Return Receipt ,102565-024-1540 j i • • s o o s ■ Complete items 1,, 2, and 3. Also complete item 4 if Restricted. Delivery is desired. ' • Print your name°and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: Gc�.Lti TK D� Si.L���-� ,7 3 c7 Com,✓ � � `�r , 11°►�(_ �3i 1 A. Signature C tl Agent X y �� "'�"�� ❑ Addressee � B. Received by ( Printed Name) C. ate of Delivery i D. Is delivery address different from item 1? Er Yes If YES, enter delivery address below: ❑ No t 1 3. Service Type I ❑ Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. i 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number (Transferfrom sei 7014 0150 0001 2901 7909 PS Form 3811, Domestic Return Receipt 102595-02-M-15401 ® Complete items 1, 2, and 3. Also complete A. Si t ❑ Agent item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse ❑ Addressee so that we can return the card to you. B. ceived by (Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, - c5 -JS If A or on the front if, space. permits. D. Is delivery address different from item 1? ElYes 1. Article Addressed to: If YES, enter de addre;b low: El No it ve y- dw�R� ca. TDA- NOL.7:; o � I �-LN o 17 -LIC -a- A-)Selvice . 1. l � � 3. T y°°'' yp I x- I ❑ Mdll. Mail Certified M'Q�Cess El Registered 17 Return Receipt for Merchandise I ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 'e Number I 7014 0150 0001 2901 7886 er from service label) 3811, February 2004 Domestic Return Receipt 1,02585-02-M,1540 ; ■ Complete items 1, 2, and 3. Also complete A. item 4 if Restricted Delivery is desired. X U Print your name and address on the reverse so that we can return the card to you. N Attach this card to the back of the mailpiece, or on the front it space permits. 1. Article Addressed to: i ��� � � � � I � r�-�4 �. s ✓tom ❑ Agent ❑ Addressee C, Date 4 De ve e- q,1 j ( �f Is delivery address different from item 1? ❑ Ye: If YES, enter delivery address below: ❑ No 3. Service Type N� r S� Q) �( ❑ Certified Mail El Express Mail J ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number 14 0150 0001 2901 7 916 1 (Transfer from s. , I PS Form 3811, February 2004 Domestic Return Receipt 102595=02-M-1540 John Bredemeyer, President #fFotr�o Michael J. Domino, Vice -President Gyp James F. King y Charles J. Sanders • Dave Bergen BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of FIRM FOUNDATIONS PARTNERS LLC COUNTY OF SUFFOLK) STATE OF NEW YORK) Town Hall Annex 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR EIGHT DAYS I, . v IcW 1-2-I-tL 0,2 f , residing being duly sworn, depose and say: That on the 1 Olay of V',-&AoLb&_/�2014, I personally posted the property known as 1,0,a— -_ci 1... _ �. U .— 1A w__...— . _- - -` J_ byplacing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday, September 17, 2014. Dated: (sig at re) Sworn to before me this :6A- day of d 4 20 1 9 Notary Public CONNIE D. BUNCH Notary Public, State of New York No. 01 SU6185050 Qualified in Suffolk County Commission Expires April 14,' �) L NUTILt CSF HLAKING NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: FIRM FOUNDATIONS PARTNERS LLC SUBJECT OF PUBLIC HEARING: Install a 16'x36' in -ground swimming pool with 16" bluestone pool coping; a 10'x16' bluestone pool patio; install a pool equipment area; and install pool fencing. TIME &DATE OF PUBLIC HEARING: Wednesday, September 17, 2014 — at or about 5:30P.M. If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours of 8 a.m. and 4 p.m. BOARD OF TRUSTEES *TOWN OF SOUTHOLD * (631) 765-1892 8:__A of Trustees Application County of Suffolk State of New York �4 \1 A G S 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�QFJi"PPLICATION. i' Signature of Pro erty Owner SWORN TO BEFORE ME THIS ._�' t DAY OF _Ar 1120 19 RIO Notary rjublic AISTE ULEZKO Notary Public - State of New York NO. 01 UL6295018 Oualified in Suffolk County My Commission Expires Dec 23, 2017 I rd of Trustees Application AUTHORIZATION (where the applicant is not the owner) lAAP,L.F—WL: A5Aj>d I, '.Zb i--rAw YON A C 5 residing at (print owner of property) Southold Board (Owner's )z4 vv z'SQ-,D -at. �4[.W (0VVN)W.v. 100 11 (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Trustees on my behalf. APPLICANT/AGENT/REPRESENTATWE TRANSACTIONAL DISCLOSURg FORM eeoid same . YOUR NAME: , U i� � � c% 2 ` (Last name, first name, quddle initial, unless you arc applying in the name of someone else or other entity, such as a company. If so, indicatk the,other person's or company's name.). NAMEOF APPLICATION: (Check all that apply.) Tax grievance Building variance Twee — --- Change ofZone Coastal Erosion Approval ofplat 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% of the shares. L YES NO Tf you answercd "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 applicantlagent/rcpresentative) and the town officer or employee. Either check the appropriate line A) through A) 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 Ute applicant (when the applicant is a corporation); T3) the' legal or beneficial, owner of any interest in a non -corporate entity (whets the applicant is not a corporation); C) an officer, director; partner, or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this - day of - 200 _ Signature - Print Name Form TS 1 Town of Southold.. A. INSTRUCTIONS { i 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). 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. ® E �r B.. DESCRIPTION OF SITE AND PROPOSED ACT ON SCTM#1 ti 1 jai•°� , PROJECT NAME The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board ❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Sbuihold 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: and extent of actidp: /C 1 / t� / C 7 ii S'�. L.�C..� (Dd1 fiT 1! 9' X -3/, I'1 • Location of action Site acreage Present land use: Present zoning classification: 2. If an application"for the proposed action has been filed with the Town. of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: (c) Telephone number: Area Code ( } (d) Application number, if any:, Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes 11 No ❑ If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Jncomplete answers will require that the form be returned for completion. R,EVELOPED COAST POLICY Policy 1. Poster a pattern of development in the Town of Southold that enhances community character, peeserves 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 [A 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 F1 Yes ❑ No Iq 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 ❑ Yes ❑ No RX Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion..See LWRP Section III —Policies Pages 8 through 16 for evaluation criteria ❑ yes ❑ No © Not Applicable Attach additional.sheets if necessary Policy S. 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 F� No Not Applicable Attach additional sheets if necessary Policy 6. Protect , aad 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. ❑ ❑ 19 Yes No of 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. YesE] No M Not�Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III — Policies; Pages 34 through 38 for evaluatioip 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. Yelo® No Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water -dependent uses and promote siting of new water -dependent uses ht suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No FANot Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III — Policies; Pages 57 through 62 for evaluation criteria. Yes 1:1 No � 11 Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands- in the Town of Southold. See LWRP Section M —Policies; Pages 62 through 65 for evaluation criteria. ❑ 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 [9 Not Applicable PREPARED BY .�c51-w (. , ��=VZ TITLEA.- f, Ar r DATE SURVEY OF PROPERTY SITUATE: MATTITUCK TOWN: 50UTHOLD 5UFPOLK COUNTY, N.Y. SURVEYED I I -14-13 PROPOSED POOL 04-01-14 PROPOSED POOL OG -19-2014, 10-20-2014 SUFFOLK COUNTY TAX # 1000- 113-6-23 CERTIFIED T0: KARLENE ASADI FIRM FOUNDATION PARTNERS LLC TOPOGRAPHY REFERENCES NGVD 1929 DATUM WETLAND FLAGS SHOWN THUS P SET BY SURVEYOR AT EDGE OF VEGETATED SALTWATER WEr AND5 ON I 1-14-13 T� \oo� � 0\3 F V