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HomeMy WebLinkAboutTR-8528 John M.Bredemeyer III,President ®��QF SOUjy�jl Town Hall Annex Michael J. Domino,Vice-President ® 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold, New York 11971 C11A.Nicholas Krupski G Telephone(631) 765-1892 Charles J. Sanders %IFCOUN Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1228C Date: June 3, 2016 , THIS CERTIFIES that the construction of a 248 sq. ft. two-story addition onto the existing 1,325 sq. ft. two-story dwelling with attached 687 sq. ft. deck; a 6'x12' two story addition; and a 4'x12' stoop on the landward side of the dwelling; with the condition of the addition of gutters to leaders to dryffells; At 130 Cleaves Point Road, East Marion Suffolk County Tax Map#1000-38-2-32 Conforms to the application for a Trustees Permit heretofore filed in this office Dated October 23, 2014, pursuant to which Trustees Wetland Permit#8528 Dated November 19, 2014,was issued and Amended on January 21, 2015 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 a 248 sq. ft. two-story addition onto the existing 1,325 sq. ft. two-story dwelling with attached 687 sq. ft. deck; a 6'x12' two story addition; and a 4'x12' stoop on the landward side of the dwelling; with the condition of the addition of gutters to leaders to drywells. The certificate is issued to STEPHANIE NECKLES owner of the aforesaid property. Authorized Signature � r ' I John M. Bredemeyer III, Presidentg1}FF0( �oG`=t Town Hall Annex Michael J. Domino, Vice-President54375 Route 25 Glenn Goldsmith s P.O. Box 1179 A. Nicholas Krupski Southold, NY 11971 Charles J. Sanders `,y�Ipl �a� Y Telephone (631) 765-1892 Fax (631) 765-6641 i BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD ..a v DATE OF INSPECTION: Ch. 275 Ch. 111 IINSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction % constructed 7 Project complete, compliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: • John M_ Bredemeyer III, President Michael J. Domino, Vice -President James F. King Charles J. Sanders Dave Bergen BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD • Town Hall, 53095 Main Rd. P.O_ Box 1179 Southold, NY 11971 Telephone (63 1) 765-1892 Fax (631) 765-6641 YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN - APPOINTMENT FOR A PRE -CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre -construction, hay bale lime 1 st day of construction % constructed AL Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 8528 DATE: NOVEMBER 19, 2014 ISSUED TO: STEPHANIE NECKLES PROPERTY ADDRESS: 130 CLEAVES POINT ROAD, EAST MARION SCTM# 38-2-32 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 November 19, 2014, and in consideration of application fee in the sum of $250.00 paid by Stephanie M. Neckles 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 construct a 248sq.ft. two-story addition onto the existing 1,325sq.ft. two-story dwelling with attached 687sq.ft. deck; with the condition of the addition of gutters to leaders to drywells; and as depicted on the survey prepared by John C. Ehlers, Land Surveyor, last dated October 6, 2014 and stamped approved on November 19, 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 as of this date. • TERMS AND CONDITIONS • The Permittee, Stephanie Neckles residing at 130 Cleaves Point Road, East Marion, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: I . 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. 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. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. 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. 10. 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. N W E S OF Noy �o �PNO �O�N ON Pl\- �1� ayQ C; �P T P 0 In 5 U RV EY Of LOT 4 O 'MAP OF MARION MANOR' FILED MARCH, O (� 18 1 9G8 AS MAP NO. 2038 51TUATE: EAST MARION TOWN: 5OUTHOLD SUFFOLK COUNTY, NY 5URVEYED 12-1 1-2013 PROPOSED ACTIONS I O -OG -2014 SUFFOLK COUNTY TAX # 1000-38-2-32 CERTIFIED T0: STEPHANIE NECKLES WESTCOR LAND TITLE INSURANCE COMPANY SOUTH BAY ABSTRACT, INC. BANK OF AMERICA, N.A. Ir - 0 A W f� tra OCT 2 3 2014 n TOPO LINES REFERENCE NAVD'88 DATUM C E H L ANNOTATED FROM COASTAL EROSION HAZARD AREA MAP SHEET 29-0 NOTE: HOUSE AND GARAGE ARE IN FLOODZONE X A5 SHOWN ON F.I.R.M. PANEL 3G 103CO 1771-1 EFF. DATE 9/2 NOTES. ■ MONUMENT FOUND '— SPLIT RAIL FENCE STOCKADE FENCE Area = 21,954 Sq. Ft. Area = 0.5039 Acres GRAPHIC SCALE I"= 30 JOHN C. EHLER5 LAND 5URVEYOR G EA5T MAIN 5TREET RIVERHEAD, N.Y. 1 1901 N.Y.S. LIC. NO. 50202 3G9-8288 Fax 3G9-8287 1oncgi51andlanc15urveyor.com 5 "Unauthorized alteration or addition to a survey map bearinga licensed land surveyors seal is a violation of section 7209, sub—division 2, of the New York Slate Education Low." "Only copies from the original of this survey marked with an original of the land surveyor's stomped seal shall be considered to be valid true copies" "Certifications indicated hereon signify that this survey was prepared in accordance with the ex— isting Code of Practice for Land Surveys adopted by the New York Stale Association of Professiono Land Surveyors. Said certifications shall run only to the person for whom the survey is prepared, and on his behalf to the title company, governmen— tal agency and lending institution listed hereon, anc the assignees of the lending institution. Certifica— tions are not transferable to additional institution=_ I l I A \ �ryiy 4��pis 5�° o 2 32.2 `( �N tP 5 U RV EY Of LOT 4 O 'MAP OF MARION MANOR' FILED MARCH, O (� 18 1 9G8 AS MAP NO. 2038 51TUATE: EAST MARION TOWN: 5OUTHOLD SUFFOLK COUNTY, NY 5URVEYED 12-1 1-2013 PROPOSED ACTIONS I O -OG -2014 SUFFOLK COUNTY TAX # 1000-38-2-32 CERTIFIED T0: STEPHANIE NECKLES WESTCOR LAND TITLE INSURANCE COMPANY SOUTH BAY ABSTRACT, INC. BANK OF AMERICA, N.A. Ir - 0 A W f� tra OCT 2 3 2014 n TOPO LINES REFERENCE NAVD'88 DATUM C E H L ANNOTATED FROM COASTAL EROSION HAZARD AREA MAP SHEET 29-0 NOTE: HOUSE AND GARAGE ARE IN FLOODZONE X A5 SHOWN ON F.I.R.M. PANEL 3G 103CO 1771-1 EFF. DATE 9/2 NOTES. ■ MONUMENT FOUND '— SPLIT RAIL FENCE STOCKADE FENCE Area = 21,954 Sq. Ft. Area = 0.5039 Acres GRAPHIC SCALE I"= 30 JOHN C. EHLER5 LAND 5URVEYOR G EA5T MAIN 5TREET RIVERHEAD, N.Y. 1 1901 N.Y.S. LIC. NO. 50202 3G9-8288 Fax 3G9-8287 1oncgi51andlanc15urveyor.com 5 "Unauthorized alteration or addition to a survey map bearinga licensed land surveyors seal is a violation of section 7209, sub—division 2, of the New York Slate Education Low." "Only copies from the original of this survey marked with an original of the land surveyor's stomped seal shall be considered to be valid true copies" "Certifications indicated hereon signify that this survey was prepared in accordance with the ex— isting Code of Practice for Land Surveys adopted by the New York Stale Association of Professiono Land Surveyors. Said certifications shall run only to the person for whom the survey is prepared, and on his behalf to the title company, governmen— tal agency and lending institution listed hereon, anc the assignees of the lending institution. Certifica— tions are not transferable to additional institution=_ G Lt b.\j lz �0 I NY R0 I 8 x 2."deE�p A n., r F�467o� `� r to 15 IL! 4i 16:5 10 P Ro YIR�T L 00 1Z F�QL) t4 ; vf�, q " .I`.1_ 64.4 Cu. r-Tj W�- 'j"T E.- LIEV1�T10l.-A66'. K r-- b. -.L.) '. �a t-:�-tgT IN(::;, Hoose. 1 325 5,�, FROPOotnE.o PlJOI't'lUM 2,48 3.F. ItE COND Fl� 9 OCT 2 3 2014 M �� I -4-i �LEVaTIOt�I/e Q N • John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee November 19, 2014 Mr. Donald Feiler PO Box 1692 Mattituck, NY 11952 • BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD RE: STEPHANIE NECKLES 130 CLEAVES POINT ROAD, EAST MARION SCTM# 38-2-32 Dear Mr. Feiler: 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, November 19, 2014 regarding the above matter: WHEREAS, Donald Feiler on behalf of STEPHANIE NECKLES 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 October 23, 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 November 19, 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, 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 approves the application of STEPHANIE NECKLES to construct a 248sq.ft. two-story addition onto the existing 1,325sq.ft. two- story dwelling with attached 687sq.ft. deck; with the condition of the addition of gutters to leaders to drywells; and as depicted on the survey prepared by John C. Ehlers, Land Surveyor, last dated October 6, 2014 and stamped approved on November 19, 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. Brederneyer [11, President Michael J. Domino, Vice -President James F. King Charles J. Sanders Dave Bergen tizz�N SUfFQ(,�-`oG 0 C13 � BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall Annex 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Telephone (63 1) 765-1892 Fax (63 I) 765-6641 TO: mot jaI CL I --c 1 to -tear 1,-�nUii Iv--- 1VLLLs=LTJ Please be advised that your�application dated b 2S3/1 i� has been reviewed by this Board at the regular meeting of and your application has been approved pending the completion of th4 fol owing 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) 1�6/ Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) 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. $ CSCpd BY: John M. Bredemeyer III, President Board of Trustees a John Bredemeyer, President %UFF01 Michael J. Domino, Vice -President o �c°°s� James F. King ; Charles J. Sanders • Dave Bergen y�o! ,� -i° 6 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: 11113117 0-2q_'5- Donald -2qS Donald Feiler on behalf of STEPHANIE NECKLES requests a Wetland Permit to construct a 248sq.ft. two-story addition onto the existing 1,325sq.ft. two-story dwelling with attached 687sq.ft. deck. Located: 130 Cleaves Point Road, East Marion. SCTM# 38-2-32 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: Conditions: �<- �� 'rA/-0 Present Were: /1-1j. Bredemeyer M. Domino J. King C. Sanders D. Bergen Bay Constable Other Form filled out in the field by ' ldrl'e Mailed/Faxed to: Date: DAALD G. FEILER •ARCHI%OCT 11725 Main Rd • Box 1692 • Mattituck, NV 11952 • 631-298-5453 • Fax 298 1380 NC-1C��L, E �:) f\' E5 10 1E,N C_ MCTO -p I - N F, 6 f 2ol4 (te a TO -tV- 2 I.00 - I t -A61 1114 8/2014. ,'IJ- Y wM1R SMTCn ONE nm�J`\ ` ♦ _ — _.._.. � � N nn h h 4 --NN. ♦ S° � ° T O� �� h T ♦1 O R` h R, oea[War[MNmri4 \� t ♦eV. � � � SEE scc. No. 132•^ SouTNpu) de R rn w r \^r e I d� R° ♦ SEE SEL, NO. HJT Or♦ 0 0_c" ss 2 0 ,. oifiamEx.xrxx R`' r +oT !♦ � ♦♦r o -w TomP eWTNOLOx•°` d 'L ♦ w �'� nx +o a w1 ♦h R 4 4 ..n 3 ioA m ��� ♦°R .` R � 1 �y oe1012♦ ♦R ° d 4 Ift tort ` ,C1 q1 r 4 � w+a +axo n n a r 9 ow mm Gj ss ♦o` �..� n 9 �r / 1 41 attm �_ 0xA P.D. 65 /:: x�a z_ u- ix,I — d._ --•-- .rw --x-- r NOTICE v'r`^� COUNTY OF SUFFOLK x s ttouTNoin SECTION No --x-- '� Real Property Tax Sece Agency v Geunry Gnur RN.mw,Nv nem M 38 wx.xr�raaaaom�n rvi�,waa r: innx uiw wxnwaa �ui/xnion aNe a •a' ^o"" o�nianuraxamr.oxrior.orrt �cxr nr ronr e�wroxcwnr. rM NMarxoxiNrro w...,a.. ,..comm ,. w,+ �_� rro..w --•-- r.weww--x-- _ :,. roc n .... w mm w.wrvNrtrax rcnrMiwr c�rrt :!•�, `,n veva ee� A r.xxx.. n wr RrNN�M xn ru. �_�� x�erw -- •-- oerRcr xR toeo ermr ia�N.i '�`� —___� are..w --r-- aw wgaExir-u NRwcaw¢xc• rola," .. _....— P u •n rM PROPERTYMM 44 John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee • BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 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#: Z— 3 2— Property Property Owner Name: Date Sent to Bldg. Dept.: I �J 3 G a Telephone (631) 765-1892 Fax (631) 765-6641 DEC 3 0 2014 BLDG. DEPT. TOWN OF 50UTH0! D 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? vl�Will the proposed project require a variance determination from oning Board of Appeals? Will any part of this application be considered as Demolition as described under Town Code? COMMENTS: Signature of FKviewer Date John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD i Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 F[F'�� , J DEC 3 0 APPLICATION FOR AN AMENDMENT TO A WtTLAND PERMIT DATE 12 I -Jb 12014 OWNER 5,we I\ `Nth N ec*j es PHONE 1-11- 4 2I 2 MAILING ADDRESS I900 G4 -04957S AGENT N D EI L�EV— PHONE 2 S 51+1517 ADDRESS M. P`�' l 10 CX— PROPERTY LOCATION TAX MAP NO. 10 0 0 — 3 8 - 2 ' �J 2 I/We 5reP 4 P} t e- �4E C kx.� request an Amendment to Permit # to IMti.VOr_1 P(2-oP65-eO `X 12' TW 5F0 W1 w l -rt o >4 + 4- x 12 co Ho SToo P @ N off' (s- ) 5iot-; oz �=�u-jiNy 4posa Signed By: 0 John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee oF so�ryo� Charles J. Sanders, Trust COU b NOV 1 8 2014 BOARD OF TOWN TRUSTEES _ TOWN OF SOUTHOLD To: Southold Town Budding Department Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Re: Verification of Building Department Permit Requirements SCTM#:3S-2--32- Property S-2-3Z Property Owner Name: Date Sent to Bldg. Dept.: 11) Telephone (631) 765-1892 �( OCT 7 20;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: Y7//"*" ES NO Mill the proposed COMMENTS: Signature of project require a Building Permit? Wil the proposed project require a variance determination from e Zoning Board of Appeals? Will any part of this application be considered as Demolition as described under Town Code? 11116 Date C� OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 oF so�ryo� O 4 'roum,� MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: John Bredemeyer, President ii Town of Southold Board of Trustees U •'a bf From: Mark Terry, Principal Planner LWRP Coordinator Date: November 17, 2014 Re: Proposed for an Wetland Permit for STEPHANIE NECKLES SCTM# 1000-38-2-32 Donald Feiler on behalf of STEPHANIE NECKLES requests a Wetland Permit to construct a 248sq.ft. two-story addition onto the existing 1,325sq.ft. two-story dwelling with attached 687sq.ft. deck. Located: 130 Cleaves Point Road, East Marion. SCTM# 38-2-32 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 CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP provided that the Board considers the following recommendation: 1. Require storm water controls pursuant to Chapters 275 and 236 of the Southold Town Code. 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 Lauren Standish, Secretary • Conservation Advisory Council Town of Southold Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 At the meeting of the Southold Town Conservation Advisory Council held Wed., November 12, 2014 the following recommendation was made: Moved by John Stein, seconded by Doug Hardy, it was RESOLVED to SUPPORT the application of STEPHANIE NECKLES to construct a two- story addition to the existing house. Located: 130 Cleaves Point Rd., East Marion. SCTM#38-2-32 Inspected by: Peter Young, Doug Hardy, John Stein The CAC Supports the application with the Condition gutters, leaders and drywells are installed to contain the roof run-off. Vote of Council: Ayes: All Motion Carried NOV I y • John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee oF so01 �ryo O ' COUNT'1,�`�.9 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD oastal Erosion Permit Application Wetland Permit Application _Amendment/Transfer/Extens ion Received Application: eceived Fee:$ Completed Application _Incomplete _SEQRA Classification: Type I Type II Unlisted � oordination:(date sent) WRP Consistency Assessment Form VQAC Referral Sent: ate of Inspection: _Receipt of CAC Report: Lead Agency Determination: �echnical Review: ublic Hearing Held: Resolution: Office Use Only Administrative Permit 0 Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 Name of Applicant 5TE PH it," , E I `1 EGA LAS Mailing Address 1--50 Gtr JAS F0 10.0 &Pfd FP'ST +yl—ION Phone Number:( ) 41 -] - Co 2-12 Suffolk County Tax Map Number: 1000 - 'fig- 2 _b2 Property Location: ( 30 C l�ELyJtS f7O 1 M 1 FOA-tp ,DST ' PWlotl @ t5-30 o,=- G I ert_*—=-7rM Lilly (provide LILCO Pole #, distance to cross streets, and location) AGENT: "ID 0Mb-&-0 f L.IF-rfz (If applicable) Address: 11-725 M P 0 R49 1612 , M ^T i I ti C -K- Phone: 2 �8 ' S�•5 0ard of Trustees Applicat* GENERAL DATA Land Area (in square feet): 2 ► , 9 F SQ ,FT . Area Zoning: R 40 Previous use of property: 'Rv-s 1 D SCE Intended use of property: Sp47I'i✓ Covenants and Restrictions on property? Yes X No If "Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes X 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 X 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 X No Does the structure (s) on property have a valid Certificate of Occupancy? X, Yes No Prior permits/approvals for site improvements: Agency Sinot o' opw 1ito,46 Der, 1, 11 M 11 M N T M Date l Q (2 New frot)sE t q go 2dO" Alrwo- nos 16166 PwrsorJ A opt 1169 & cAC4--,c N Y:5 v f� t 9 9-L &U Llt-ttcap R1r-core3nwaT No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No If yes, provide explanation: Project Description (use attachments if necessary): FKO Fos 2 STof-�+' 1-nonl Ty f�jr-LST► t"lG RQUSE 2.48 5.�. Yes FROM :DONALD G. FEILER * ARCOT FAX NO. :631 298 1380 is 28 2014 03:36PM P1 DONALD G, FEILER-ARCHITE( 11725 Main Rd -Box 1692 - Mottituck, NY 11952.631-29&5453- Fox 29$ Date 10 to j OCT 2 g To _e P To pio Mid S fi Re Pages to follow 'r For your review As requested Please call at your convenience Comments_ � _ `�� C.fl - Vd of Trustees Applicatioie WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: P,W I-Ro 0 I? jqG MTWG kam. 24a 5 . f . Area of wetlands on lot: 3 Percent coverage of lot: O % square feet Closest distance between nearest existing structure and upland edge of wetlands: G8 feet Closest distance between nearest proposed structure and upland edge of wetlands: -1$ feet Does the project involve excavation or filling? No X Yes If yes, how much material will be excavated? '30 cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: 4 feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: TRuc�eeri nu T 6'tL-LL.c-nf; Vo?tff- 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): • i 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l - Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding, are subject to public review, and may be subject to further verification. Complete Part l 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 l - Project and Sponsor Information Name of Action or Project: 5 T EWP -k t E. 06 Project Location (describe, and attach a location map): I �5 O GLM�P-ye-s ?0 l NT R0a0 Brief Description of Proposed Action: p19 0yotW�o 2 srM" x-00 1 TtOM -M VF-C45T 1 N61 HaOSO, Name of Applicant or Sponsor: Telephone: E -Mail: 1)0r*.,O 1 Le_g • 4RIM'17e Address: Cq MSI V , COM I l 2 City/PO: State: Zip Code: P0. �� 169 2 Mk-TTIT'UC_1F_ NY 111152 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? O. 03 acres b. Total acreage to be physically disturbed? 0 , o 04t acres c. Total acreage (project site and any contiguous properties) owned or controlled by the applicant or project sponsor? O• 'S0'lq acres 4. Check all land uses that occur on, adjoining and near the proposed action. ❑ Urban El Rural (non -agriculture) ❑ Industrial ❑Commercial Residential (suburban) ❑Forest ❑Agriculture ❑ Aquatic ❑Other (specify): ❑Parkland Page I of 4 • 5. is the proposed action, a. A permitted use under the zoning regulations? b. Consistent with the adopted comprehensive plan? NO YES N/A ❑ X ❑ ❑ ❑_ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural landscape? NO YES ❑ 7. Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area? If Yes, identify: NO_ YES ^ IYTI ❑ 8. a. Will the proposed action result in a substantial increase in traffic above present levels? b. Are public transportation service(s) available at or near the site of the proposed action? c. Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? NO YES F -1- Ful ❑ © ❑ 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 YES ❑ 541 10. Will the proposed action connect to an existing public/private water supply? If No, describe method for providing potable water: NO YES ❑ 11. Will the proposed action connect to existing wastewater utilities? If No, describe method for providing wastewater treatment: NO YES F1 12. a. Does the site contain a structure that is listed on either the State or National Register of Historic Places? b. Is the proposed action located in an archeological sensitive area? NO YES © ❑ © ❑ 13. a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain wetlands or other waterbodies regulated by a federal, state or local agency? b. Would the proposed action physically alter, or encroach into, any existing wetland or waterbody? If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: NO YES ❑ © ❑ 14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: ❑ Shoreline ❑ Forest ❑ Agricultural/grasslands ❑ Early mid -successional ❑ Wetland ❑ Urban ;K 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 ® El 16. Is the project site located in the 100 year flood plain? NO YES 17. Will the proposed action create storm water discharge, either from point or non -point sources? If Yes, a. Will storm water discharges flow to adjacent properties? JK NO EJYES b. Will storm water discharges be directed to established conveyance systems (runoff and storm drains)? If Yes, briefly describe: ONO ®YES —_PZ-OF 407T 2�s TO Sulo_ 0RCFcE 'MaM DR.4145 NO YES ❑ Page 2 of 4 • 0 18. Does the proposed action include construction or other activities that result in the impoundment of water or other liquids (e.g. retention pond, waste lagoon, dam)? If Yes, explain purpose and size: NO YES ❑ to large impact impact may 19. Has the site of the proposed action or an adjoining property been the location of an active or closed solid waste management facility? If Yes, describe: NO YES occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning © ❑ F]regulations? 20. Has the site of the proposed action or an adjoining property been the subject of remediation (ongoing or completed) for hazardous waste? If Yes, describe: NO YES 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 ® F-1establishment of a Critical Environmental Area (CEA)? 1 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE 10[24 [ALO �- Applicant/sponsn e: P-V,/J >E-rl (Z Date: Signature: Part 2 - Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the, following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept "Have my responses been reasonable considering the scale and context of the proposed action?" Page 3 of 4 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 © F]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 ® F-1establishment 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 Part 3 - Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered "moderate to large impact may occur", or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact, please complete Part 3. Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting, probability of occurring, duration, irreversibility, geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. F] Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action will not result in any significant adverse environme tal impacts. Town of Southold - Board of Trustees ` 1 7� J l I % L) kName of d Ag/e�nc Date � C� � Jew Q President Print or Ty Name of onsible Officer in Lead Agency Title of Responsible Officer Signature of Res si le Officer in L d Agency Signature of Preparer (if different from Responsible Officer) PRINT Page 4 of 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 ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3 - Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered "moderate to large impact may occur", or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact, please complete Part 3. Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting, probability of occurring, duration, irreversibility, geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. F] Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action will not result in any significant adverse environme tal impacts. Town of Southold - Board of Trustees ` 1 7� J l I % L) kName of d Ag/e�nc Date � C� � Jew Q President Print or Ty Name of onsible Officer in Lead Agency Title of Responsible Officer Signature of Res si le Officer in L d Agency Signature of Preparer (if different from Responsible Officer) PRINT Page 4 of now Town of Southold gErosion, Sedimentation & Storm-Water Run -off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A Ol STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN -M—strict 3e­ctro—n –E3 oTck— T— CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM # / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? 71 9 54 5. F. (Include Total Area of all Parcels located within Will this Project Retain All Storm-Water Run-Off SO3q the Scope of Work for Proposed Construction) Generated by a Two (2") Inch Rainfall on Site? (S.F. !Acres) (This item will include all run-off created by site k b. What is the Total Area of Land Clearing clearing and/or construction activities as well as all — F] and/or Ground Disturbance for the proposed 3 &(D is.*:. Site Improvements and the permanent creation of construction activity? O ' (S g1 (S.F. !Anes) impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT DESCRIP'T'ION (Prov(deAdditi wPages asNeeded) Drainage Structures Indicating Size & Location? This ❑ Item shall include all Proposed Grade Changes and PlIzo rot-ptno 2 s l l Cn IAnot.� Slopes Controlling Surface Water Flow. =7 _ 3 Does the Site Plan and/or Survey describe the erosion TO Gx, S N Gi K SF1 and sediment control practices that will be used to n control site erosion and storm water discharges. This 8 item must be maintained throughout the Entire Construction Period. 4 Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? rj Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand ❑ iC (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 x General DEC SWPPP Requirements: or within One Hundred (100') feet of a Welland or Submission of a SWPPP is required for all Construction activities involving sol Beach? disturbances of one (1) or more acres; including disturbances of less than one acre that7 Will there be Site preparation on Existing Grade Slopes are part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen (15) feet of Vertical Rise to F]including Construction activities involving sol disturbances of less than 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-0-10-001.) Surfaces be Sloped to Direct Storm-Water Run -Off X 1. The SWPPP shall be prepared prior to the submittal of the NOT. 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 shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, required, post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any Fi y constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of this permit. In addition, the SWPPP shat Areas (This Item will NOT Include the Installation of Driveway Aprons.) identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark 3. All SWPPPs that require the post-construction storm water management practice in a Box and the construction site disturbance is between 5,000 S.F. $1 Acre in area, component shall be prepared by a qualified Design Professional Licensed in New York a Storm-Water, Grading, Drainage & Erosion Control Pian is Required by the Town of that is knowledgeable in the principles and practices of Storm Water Management. Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit (NOTE: A Check Mark (,I) and/or Answer for each Question is Required for a Complete Application) SPATE OF NEW YORK, '�'') COUNTY OF .......,�........ ... ..........SS That I, . !i).N. uo. 1,.' E!"o ........... being duly sworn, deposes and says that he/she is the applicant for Permit, (Name of individual signing Document) �.�� ; And that he/she is the al�!..►.`r-Jj..`���v.�...................................................................................... ( mer, Contractor, Agent, Corporate Officer, etc.) Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are hue to the best of his knowledge and belief-, and that the work will be performed in the manner set forth in the application filed here t. Sworn to before me this; / ` .......................... P.. ....... day of................... , 20.1. r NotaryPublic: ..... .... . ................................................................... ................... PATRICIA RICHEHI (Signature of Applicant) o ary u is a e o :evr _rri h FORM - 06/10 No. 3b-4741154 Qualified in Nassau / Suffol Cou les Commission Expires a 3/ / PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: • �o$g�.�}} L L CG I p.(Lt7 I Jip G (SEA-�/ E 9 ft5 1 HT FO Pp � Cd"�INE plNo t= A5'r iy1P-2�oo.1� NY /1q 39 2. At-IT�totil� t� <SvSP� �aPOI. ITA-nr o 3. 'r0Hrj &r souTEtoL-v 4. tKI F-(,1 KE -r -04 e 4' STATE OF NEW YORK COUNTY OF SUFFOLK 2�i� G LC1�.V6s g pot'-rr )"WA -0 �aS7- Mb�,on� N Y 10 1:�ot TowN oT s007ViOL40 PD, &)c Inc), .50urkowNV 119?► ?;0x 40 GoLtq SPnt"Ci , ,.res at 11-12 M.jt!,1 N 1ZtJ,&.D MA=- 1 TV C-14.1 N Y , being duly sworn, deposes and says that on the 7 day of Noyw",-�,C 2 , 2Q14, deponellt mailed a tru: opy 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 MArrr I TU C r, , hJy , that said Notices were mail to each of said persons by CERTIFIED MAEURETURN RECEIPT. Sworn tq t)efore me this �i Day of NQ y , 20 Notary P.ubli(r'` MFLPliilfi. G.. .4dKy Nk go of ounw h a" 0qM1&1bdN! r cCr. ", 2-D) • John Bredemeyer, President Michael J. Domino, Vice -President James F. King Dave Bergen Charles J. Sanders h�o�pgUFFOL*Irk" N W BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of STEPHANIE NECKLES 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, t),441wW L_E�e , resid at /dba 11125 N 4 N j?4D A,0 M tfrr 1 TU C- '- being duly sworn, depose and say: That on the 3 day of KVvMe,oL , 2014, I personally posted the property known as /yMl EGr-L..y 13a GL ES-&oES W(NT Rte✓ , EPSr MAWtaS_N by placing 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, November 19, 2014. Dated: /��I► (signature) worn to before me this day of W 20 i I Notary Public N�.1gi��� Yard L1wlW N S" cowly NOTICE OF--HEARINGI 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: STEPHANIE NECKLES SUBJECT OF PUBLIC HEARING: Construct a 248sq.ft. two-story addition onto the existing 1,325sq.ft. two- story dwelling with attached 687sq.ft. deck. 0 TIME &DATE OF PUBLIC HEARING: 0 Wednesday, November 19, 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 Bod of Trustees Application 4 0 County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS HE AFFLICAN I FOR THE ABOVE 7 DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGETH IN THISAPPLICAT ON AND AS MAYELIEF, AND THAT ALL WILL BE DONE IN THE MANNER SET FOR 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 THE,IF GRANTED. IN COMPLETING TRUSTEES THEIR AGENT(S) ORTHIS APPLICATION, I HEREBY AUTHORIZE REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Sigdature of Property Owner SWORN TO BEFORE ME THIS ) 0 DAY OF QCO d F K ,20_L�— -----——----- MICHAEL T HORN Notary Public - State 01 New York W. 01 M06303417 Qualified in Suffolk County Notary Public My Comnassion Expires May 12.2018 Wd of Trustees Applicatio0 AUTHORIZATION (where the applicant is not the owner) 1, 5 -CCP VkPl�,A IC �J 6:*-L-E:�n> residing at (print owner of property) 130 CLep-je5 PCIMT Rapp (mailing address) f,:-P6T MP-PtOtA do hereby authorize (Agent) �< ti 0 �:IE 1 LE� to apply for permit(s) from the Southold Board of Town Trustees on my behalf. signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees. The puroose of this form is to Rrovide information which can alert the town of v9ssible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: � • � Ott lylrlt7 G (Last name, fust name, ipiddle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate, the.other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If "Other, name the activity.) Building Trustee X Coastal Erosion Mooring Planning Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship .with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. `Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO k 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 applicantlagent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non -corporate entity (when the applicant is not a corporation); C) an officer, director, partner, or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted thi� L/f ofOP'�'-2014 Signature & Print Name T --)n. : �eC �E t ma y, --P- • IfAr•7,.. 1'f1/2Ffft"-I� ,2' _ � r 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 06hich 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 of>South;old'"s-- website (southoldtown.northfork.net), the Board of Trustees O , fihe b�g.Department,all I TIT local libraries and the Town Clerk's office. :; 9 i B. DESCRIPTION OF SITE AND PROPOSED ACTION OCT 2 3 SCTM# - 2 - 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 Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital ❑ construction, planning activity, agency regulation, land transaction) a (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: ?90 2 s1V t-WrpoA TO �4G-YlNGi �Aoyt)M 248 -5. 0 0 • Location of action: 13 o CLJrA\l t;S 1?0 1 "T- _ 6'sT Npqp, Io N Site acreage: © • 15 D 3 61 Present land use: RAS I O1E4'ACJF-; Present zoning classification: F 40 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: A ' (a) Name of applicant: STJ +t l" (b) Mailing address: �Jt� G1 }..�/ cvez> 'FO► t-tT F -OP -10 ST M bi9-ta4, 14Y lltbl (c) Telephone number: Area Code G 2, l 2 (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes F-1No 9 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 0 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 Q 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 ElYes 1:1 No 0 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 0 No © Not 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. Yes No Not Apptable Attach additional sheets if necessary r1 Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes []No XX 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 evaluation criteria. ❑ Yes ❑ No [i] 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. ❑ Yes[] No 0 Not Applicable Attach additional sheets if necessary WORKING COAST POLICIESO 0 Policy 10. Protect Southold's water -dependent uses and promote siting of new water -dependent uses in suitable locations. See LWRP Section III Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No 0 Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III — Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ 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. F] Yes ❑ No 0 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 BYt001t*0 �!n LEV— TITLE k&M-r DATE 10.,464 John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee January 21, 2015 Mr. Donald Feiler PO Box 1692 Mattituck, NY 11952 • pF SOUr,�o� � O �y�OUNri BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD RE: STEPHANIE NECKLES 130 CLEAVES POINT ROAD, EAST MARION SCTM# 38-2-32 Dear Mr. Feiler: Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, January 21, 2015: RESOLVED, that the Southold Town Board of Trustees APPROVES the Administrative Amendment to Wetland Permit #8528 to construct a 6'x12' two-story addition; and a 4'x12' stoop on the landward side of the dwelling; and as depicted on the revised survey prepared by John C. Ehlers, Land Surveyor, last dated December 30, 2014 and stamped approved on January 21, 2015. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, John M. Bredemeyer III President, Board of Trustees JMB:amn Stephanie Neckles 130 Cleaves Point Road, East Marion SRM# 38-2-32 1/14/15 7 _awjm ANN j z a fav y r �J�' x. -- ,� �• �' -e N, Stephanie Neckles 130 Cleaves Point Road, East Marion SCTM# 38-2-32 1/14/15 c ff€mlm trNil j, John Bredemeyer, President $uFFntr Michael J. Domino, Vice -President �oo� James F. King 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: 'A D ,:3 sk 14 t S 4, . 11 i STEPHANIE NECKLES requests an Administrative Amendment to Wetland Permit #8528 to construct a 6'x12' two-story addition; and a 4'x12' stoop on the landward side of the dwelling. Located: 130 Cleaves Point Road, East Marion. SCTM# 38-2-32 Type of area to be impacted: / Saltwater Wetland Freshwater Wetland Sound V Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: V6hapt.275 Chapt. 111 other Type pplication: Wetland Coastal Erosion ✓Amendment Administrative Emergency Pre -Submission Violation Notice of Hearing card posted on property: Storm Water Management Review: Yes Yes No Not Applicable No Not Applicable Modifications: Conditions: Present Were Bay Constable O v 0- '-t"e J. Bredemeyer M. Domino J. King `/ C. Sanders D. Bergen Other Form filled out in the field by CC�AdIyLa_j a- SG.htta S Mailed/Faxed to: Date: N W E �IfS 0f` 0��0�5 NOvO NOS OF 50 �PNO 1O\VN i ON 0- PO �O 09 �Pv a5'P G�- ��o� y0 �QO\ by 5 U RVEY Of LOT 4 'MAP OF MARION MANOR' FILED MARCH, 1 8 1 9G8 AS MAP NO. 2038 51TUATE: EAST MARION TOWN: 50UTHOLD '5UFFOLK COUNTY, NY SURVEYED 12-1 1-2013 PROPOSED ACTIONS i O -OG -2014 12-30-2014 5UFFOLK COUNTY TAX # 1000-38-2-32 CERTIFIED TO: STEPHANIE NECKLES WESTCOR LAND TITLE INSURANCE COMPANY SOUTH BAY ABSTRACT, INC. BANK OF AMERICA, N.A. �0 Ft- I 0'',N TOPO LINES REFERENCE NAVD'88 DATUM C.E.H.L, ANNOTATED FROM COASTAL EROSION HAZARD AREA MAP SHEET 29-0 NOTE: HOUSE AND GARAGE ARE IN FLOODZONE X A5 SHOWN ON F.I.R.M. PANEL 3G 103CO 177H EFF. DATE 9/25/09 0 OX 0 NOTES: ' ON / 1.Uncuthorized oltsrotion or addition to a survey map bearing o Ucensed load surveyor's seal is a violation of section 7209, sub -division 2, of the New York State Education "Onlycopies from me ori p ginal of this survey marked with an original of the land surveyors stamns ped seal sholl be coidered to be valid true copies" � Nso Area = 21,954 Sa. Ft. Area = 0.5039 Acres n_ t GRAPHIC SCALE I 30 o ��A 0 * "9 '•�, g- �j - -op Q (C 2 �" \, ANL 4jJ Q M �P� 0, 4 p�OA 1 0 � �0 ��o� y0 �QO\ by 5 U RVEY Of LOT 4 'MAP OF MARION MANOR' FILED MARCH, 1 8 1 9G8 AS MAP NO. 2038 51TUATE: EAST MARION TOWN: 50UTHOLD '5UFFOLK COUNTY, NY SURVEYED 12-1 1-2013 PROPOSED ACTIONS i O -OG -2014 12-30-2014 5UFFOLK COUNTY TAX # 1000-38-2-32 CERTIFIED TO: STEPHANIE NECKLES WESTCOR LAND TITLE INSURANCE COMPANY SOUTH BAY ABSTRACT, INC. BANK OF AMERICA, N.A. �0 Ft- I 0'',N TOPO LINES REFERENCE NAVD'88 DATUM C.E.H.L, ANNOTATED FROM COASTAL EROSION HAZARD AREA MAP SHEET 29-0 NOTE: HOUSE AND GARAGE ARE IN FLOODZONE X A5 SHOWN ON F.I.R.M. PANEL 3G 103CO 177H EFF. DATE 9/25/09 0 OX 0 NOTES: JOHN C. E H LE R5 LAND 5 U RVEYO R ®� N�/�- C i/Y ��' �G• EH< y() y 1.Uncuthorized oltsrotion or addition to a survey map bearing o Ucensed load surveyor's seal is a violation of section 7209, sub -division 2, of the New York State Education "Onlycopies from me ori p ginal of this survey marked with an original of the land surveyors stamns ped seal sholl be coidered to be valid true copies" MONUMENT FOUND SPLIT RAIL FENCE o- STOCKADE FENCE Area = 21,954 Sa. Ft. Area = 0.5039 Acres n_ t GRAPHIC SCALE I 30 G EAST MAIN STREET N.Y.5. LIC. NO. 50202 RIVERHEAD N.Y. 11901 3G9-8288 Fax 3GO-8287 � Ion i5landland5urve or.com 9 * "9 '•�, g- �j - -op Q (C 2 �" \, ANL 4jJ "Ce,tificatians indicated hereon signify that this survey was prepared in accordance with the ex - illithe Cade of Practice far Land Surveys adopted by the New York Slate Association of Professional Land Surveyors. Said certifications shall run only person y' prepare a the for whom the sure ,s d, and on his behalf to the title company, governmen- tal agency and lending institution listed hereon, and o the assignees of the lending institution. Certifica- tions are not transferable to additional institutions