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HomeMy WebLinkAboutTR-8581A John M.Bredemeyer III,President ��it S19 goO Town Hall Annex Michael J.Domino,Vice-President �� l® 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G ® Telephone(631) 765-1892 Charles J.Sanders Fax(631) 765-6641 COUNT 1 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1300C Date: January 3, 2017 TRIS CERTIFIES that replace in-place of the existing irregularly shaped deck attached to dwelling including the+/-236 sq ft on-grade decking off of deck; At 1525 Birds Eye Road, Orient Suffolk County Tax Map#1000-17-2-1.2 Conforms to the application for a Trustees Permit heretofore filed in this office Dated March 27, 2015 pursuant to which Trustees Administrative Permit#8581A Dated April 22, 2015, was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the replace in-place of the existing irregularly shaped deck attached to dwelling including the+/-236 sq. ft. on-grade decking off of deck. The certificate is issued to WILLIAM MATASSONI owner of the aforesaid property. Authorized Signature (/T John M.Bredemeyer III,President �o��'pE SOTown Hall Annex yp�� Michael J.Domino,Vice-President 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski O �� Telephone(631) 765-1892 Charles J.SandersFax(631) 765-6641 �y100UNT`1,� . BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE O INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction % constructed Project complete,-compliance;inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: John M.Bredemeyer III, President guFFO(,�c Town Hall,53095 Main Rd. Michael J. Domino,Vice-Presidents �G P.O. Box 1179 James F. King W Southold,NY 11971 Charles J. Sanders �y,� Telephone(631)765-1892 Dave Bergen Ol �� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE,CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, silt fence 1St day of construction 1/ constructed Project complete, compliance inspection John M. Bredemeyer III, President so Town Hall Annex h O 54375 Main Road Michael J. Domino,Vice-President P.O. Box 1179 James F.King, Trustee CP b Southold, New York 11971-0959 Dave Bergen,TrusteeO �Q Telephone(631) 765-1892 Charles J. Sanders,Trustee IyCOU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8581A Date of Receipt of Application: March 27, 2015 Applicant: William Matassoni SCTM#: 17-2-1.2 Project Location: 1525 Birds Eye Road, Orient Date of Resolution/Issuance: April 22, 2015 Date of Expiration: April 22, 2017 Reviewed by: Board of Trustees Project Description: To replace in-place the existing irregularly shaped deck attached to dwelling including the +/-236sq.ft. on-grade decking off of deck. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the project plan prepared by Gary Parker, last dated March 25, 2015, and stamped approved on April 22, 2015. Special Conditions: None Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. John M. Bredemeyer III President, Board of Trustees John Bredemeyer, President �$sSUD14.�, Town Hall Annex Michael J. Domino, Vice-President 54375 Route 25 James F. King x P.O. Box 1179 Charles J. Sanderso • Southold, NY 11971 Dave Bergen y�ol ,� �a Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: Gary Parker on behalf of WILLIAM MATASSONI requests an Administrative Permit to replace in-place the existing irregularly shaped deck attached to dwelling including the +/-236sq.ft. on-grade decking off of deck. Located: 1525 Birds Eye Road, Orient. SCTM# 17-2-1.2 T of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: Zchapt.275 Chapt. 111 other T e 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: Present Were: J. M. Domino J. King C. Sanders D. Bergen Bay Constable Other Form filled out in the field by Mailed/Faxed to: Date: ---s 40 F. FACING NORTH , 3/24/14 2:11 PMMAR 2 7 2015 FACINq WEST , 3/24/14 2:11 PM .:.,'"iii tr ','.�h'•.. t FACING SOUTH , 3/24/14 2:12 PM DETAIL OF EXISTING , 3/25/14 10:42 AM �.F �,�• � IS ,..v..��� a �F, � ��,.r s w ti FACING NORTH , 3/24/14 2:11 PM FACING WEST , 3/24/14 2:11 PM e. 1 FACING SOUTH , 3/24/14 2:12 PM DETAIL OF EXISTING , 3/25/14 10:42 AM J •i N 97 Owl— ol - g }ifbt M t10r N ,SL4ND L. 40 410 Jn :.a ,,wcl - - R ]tK n ]Mme, 1 2 11 . /Iy O • t7 on 21 N�1 • w 1 r y e 3 rs5 _ / '�� ' 1 3, tiµcl f t ' � I•n / NO, [ O 59 f f 6 ]15 li ,5 3°yG —s\/ ` b tt �{ C e r g Ril COUNTY OF SUFFOLK © E 1. CTKW NO ,l M — �- RealProDerty Tax Service Agency Y E W� y .....___ ei•_ u eww --•-- ru.-- -- a Cmwf firurrlMrnr.Nt,IM1 u 1 11 (21) 0 r..nr~ 5, r rir sr • r a...r.. riy s P ]�M0 10°0 PROPERTY IMP 1 'Jf SO(/r�, s OFFICE LOCATION: � OHO MAILING ADDRESS4 Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) N Southold, NY 11971 �O� Telephone: 631 765-1838 ��yCOUNTY,�`�. . LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM --- w7. To: John Bredemeyer, .President !, APR 1 3 2015 , Town of Southold Board of Trustees ¢ _ From: Mark Terry., Principal Planner [___ `_ua.•i rYi_,,;" "S_ �__ _j LWRP Coordinator Date: April 13, 2015 Re: Local Waterfront Coastal Consistency Review for WILLIAM MATASSONI SCTM# 1000-17-2-1.2 Gary Parker on behalf of WILLIAM MATASSONI requests an Administrative Permit to replace in-place the existing irregularly shaped deck attached to dwelling including the +/-236sq.ft. on-grade decking off of deck. Located: 1525 Birds Eye Road, Orient. SCTM# 17-2-1.2 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 action is INCONSISTENT with the Policy Standards (Policy 6.3) and therefore is INCONSISTENT with LWRP. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction. 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. The deck is under construction without a Board of Trustees Wetland permit. 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 1 John M. Bredemeyer I1I,President �*OF SO(/lyO Town Hall Annex Michael J.Domino,Vice-President �� l0 54375 Main Road P.O.Box 1179 James F. King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee G ® �O Telephone(631) 765-1892 Charles J. Sanders,Trustee y��UN�Y Fax(631) 765-6641 BOARD OF TOWN TRUSTEES D V TOWN OF SOUTHOLD To: Southold.Town Building Department MAR 3 0 2015 Re: Verification of Building Department Permit Requirements BLDG.DEPT. TOWN OF SOUTHOLD SCTM#: Property Owner Name: ' t'111% . n KA a� a S_s� n I! Date Sent to Bldg. Dept.: 3'13 1 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 Wig,the proposed project require a Building Permit? Will the proposed project require a variance determination from t Zoning Board of Appeals? Will any part of this application be considered as Demolition as described under Town Code? COMMENTS: . LAS Signature of Wviewer Date S17 Town Hall Annex John M.Bredemeyer III,President PQ 54 Main Road Michael J.Domino,Vice-President �� P.O..Box 1179 James F.King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee G Q Telephone(631) 765-1892 Charles J.Sanders,Trustee Ol�CO� � . Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Applicatio _Wetland Permit Application V Administrative Permit _Amendment/Transf r/Ex nsion eceived Application: 3 � ceived Fee:$ AS—�U 1'IFr) M" 77 Completed Application _Incomplete 1 -- _SEQRA Classification: Type I Type II Unlisted MAR 2 7 2015 Coordination:(date sent) ! ` � l LWRP Consistency Assessment Form _CAC Referral Sent: Date of Inspectio _ n: Receipt of CAC Report: ?Public Lead Agency Determination: echnical Review:Hearing Held: 5 Resolution: Name of Applicant ,G� V �-►A �. S S(OAJ f Mailing Address pa �o Z� P-1- - -Ea) l l 17 S Phone Number:( Suffolk County Tax Map Number: 1000 - - O 2— Property Property Location: E` ?E LCA � £ 'EA <3 F C.94 (provide LILCO Pole#, distance to cross streets, and location) AGENT: �- (If applicable) Address: �)n 1 S �� '► t O d� `t �l Phone: ard of Trustees Applicata GENERAL DATA Land Area(in square feet): -5JEF 4C-N9 Area Zoning: Previous use of property: S M:E Intended use of property: :54 4II F— 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 No If"Yes",be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes No1 Does the structure(s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: Project Descriptionuse attachments if necessary): �ALFE titJ � � 1� I A�� B �d of Trustees Applicatior WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 0-- I V J Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upand P(D edge of wetlands: feet C 1/A V')Closest distance between nearest proposed structure d upland SEP S u'R O E edge of wetlands: feet Does the project involve excavation or filling? No Yes I If yes,how much material will be excavated? cubic yards How much material will be filled? /, cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the areata operations: Manner in which material wil l be removed or deposited: i 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): 000 61Z20 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 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 2 4i a Name of Action orProject: Project Location(describe,and attach a location map): f Afros gg ,F_ 5vlE Iq-fFA-a-P_- Brief Description of Proposed Action: Name of Applicant or Sponsor- . Telephone: 7,> E-Mail: P395- Gl/blblli •CO Address: 4o CState: Zip Code: City/PO: _ i/�I/412 t a A-) fiu I I?_3 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 requirepermi -approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and perm approval: ❑ 3.a.Total acreage of the site of the proposed action? acres Ey.tS b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? . acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban V1 Rural(non-agriculture) ❑Industrial [-]Commercial Residential(suburban) El Forest ❑Agriculture JoAquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ [0' ❑ b.Consistent with the adopted comprehensive plan? ❑ a ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YE landscape? ❑ 7. Is the site of the proposed action located in,or does it adjoin a state listed Critical Environmental Area? NO YES If Yes,identify: 4eiA—G IS 4 A 0 A 90 M Q I'S ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? ry ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? _27❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: ❑ 10. Will the proposed action connect to an existing public/private water supply? NO/ YES If No,describe method for providing potable water: © ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑ b.Is the proposed action located in an archeological sensitive area? 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ❑ b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? El Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: Shoreline El Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES 1f Yes, a.Will storm water discharges flow to adjacent properties? �NO DYES ❑ b.Will storm water discharges be directed to established conveyance systems(runo�nd storm drains)? If Yes,briefly describe: 2-No DYES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: Ef F] 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: F I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Date: ZS f Signature: Part 2-Impact Assessment: The Lead Agency is responsible for the completion of Part 2. Answer all of the.following questions in Part 2 using the information contained in Part 1.and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning r( ❑ regulations? u 2. Will the proposed action result in a change in the use or intensity of use of land? EL 3. Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on th6 environmental characteristics that caused the (�/ ❑ establishment of a Critical Environmental Area(CEA)? u 5. Will the proposed action result in an adverse change in the existing level of traffic or f ❑ affect existing infrastructure for mass transit,biking or walkway? u 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ reasonably available energy conservation or renewable energy opportunities? I vI 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? Ej� El 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or 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. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees I��/r 5� Name of Lead Agency I 9atQ .�a - President Print or Type NN mee o•-Resp no si Officer,' Lead Agency Title of Responsible Officer n/ ✓ Signatd-re—aftespon bre Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Board of Trustees Application Countyof S&f,olk T�Ai i f ie\A State of ew k L^) . 1 I: Q,.. M-a� S t o•., BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)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 BOARD OF 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,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE.TERM OF THE PERMIT. z e——�-. Signature of Property Owner SWORN TO BEFORE ME THIS(., DAY OF tkairG�A ,20 (5- jZj ROBINSON ORTIZ Notary Public Connecticut My Commission Expires Aug 31,2019 Notaryblic Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, ltJ i l i Aw� �1 a residing at 1S Loa An (print owner of property) (mailing address) NgW GT o4 '2 t do hereby authorize (Ag&) ea,f ke4- to apply for permit(s)from the Southold Board of Town Trustees on my behalf. (Owner's signature) APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics_prohibits conflicts of interest on the part of town officers and employees.The puMgse of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is neC688a_rV to avoid same. YOUR NAME: G4 iZ (Last name,first name .tpiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate,the.other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee ✓ Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial.ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,of 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 isnot 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. ri Print Name Foran TS I Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS I. All applicants for permits* including Town of Southold agencies; shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non-. supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION F E � 1 SCTM# MAR 2 7 2015 � t PROJECT NAME 2 ILI The Application has been submitted to (check appropriate response): Town Board ❑ Planning.Board❑ Building Dept. 14 Board of Trustees Ai 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity,agency regulation,land transaction) (b) Financial assistance(e.g.grant, loan, subsidy) (c) Permit, approval, license,certification: Nature and extent of action: Y Location of action: -Z 5 B I PMS 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: �© �c9 DC 4 (c) Telephone number: Area Code� � �2 (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? If yes,which state or federal agency? Yes ❑ No 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 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 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 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No INNot 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. ❑ ❑ 01A Yes No Not App ible Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ No 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 D4 Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Ye n E] No U-V Not Applicable Attach additional sheets if necessary WORKING COAST POLICM_��� 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 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 ❑ NoXNot 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. ❑ Yes ❑ No EA Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable PREPARED BY ��� �1'C � TITLE W� DATE aj AP P3lEt3 tRQ OF � $ � �`K MAS 27 2015 ' f a t i f / p!yry t n TEU lie; � a . . 7 r ! 1 It r. Yswr ... :;�L.KiA�• Ta E x�SN�-c. 51.11 lad Of 1` 04 fe l� 3 - - "- G n`-- -�•I Feotta�Cs C1.o� r 4Z2 E`. _ 1 �1-1Eo �.. m- _._4 501- SURVEY_ OF PROPERTY N AT ORIENT TOWN OF SO UTHOLD SovND SUFFOLK COUNTY, N. Y ISLAND 1000-17-02-1.2 L010 N89.42'41"E 86.24' SCALE. 1'=40' NOVEMBER 19, 2007 9 Auq. 11 2012 (certl(Icvtlons) 10. tii�ti MARCH 27, 2015 (CEHL) y OSPREY �P *NEST y / to / o O CO rrl CEHL izcs M � o = DECK � y m DECK BALCONY D Z 26.4' z t/2 STORY FRAME Z HOUSE do GARAGE O GENERATOR `O v O A/C SHED m Z tT1 rn 2.9' IV U) I z = i 00 IV j cD I tV ' mFAM i i 135. � PrrE $82'13'30"W w� 3p' WIDE R•�' w > 00 Zn 99.32 N8273 30 E w I r i w PEAR 2 7 2015 � t CERTIFIED TO: WILLIAM MATASSONI PAMELA VALENTINE 5 2 01 FIDELITY NATIONAL TITLE INSURANCE SERVICESr LLC ell w P Nh O r� CO A � WO kAIN ROAD (.SR 25) oF Nei ro CEHL FROM COASTAL EROSION`HAZARD AREA Mj6P " ^- Photo 47-651-83 N. YS. LIC. NO. 49618 ANY AL7ERA77ON OR ADDITION TO THIS SURVEY IS A VIOLATION EC01VlC" MORS, P.C. OF SEC71ON 72090F THE NEW YORK STATE EDUCA77ON LAW. (631) 765-5020 FAX (631) 765-1797 AREA-!�44 508 SO. F7. EXCEPT AS PER SEC77ON 7209—SUBDIVISION 2. ALL CER77FICARONS P.O. BOX 909 r HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF •=REBAR SET TO 'TIE LINES SAID MAP OR COPIES BEAR 7HE IMPRESSED SEAL OF 7HE SURVEYOR 1230 TRA VELER STREET 107-2201 0 A=STAKE SET WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N. Y. 11971