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HomeMy WebLinkAboutTR-8584John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee # 1141C BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 CERTIFICATE OF COMPLIANCE Telephone (631) 765-1892 Fax (631) 765-6641 Date: August 5, 2015 THIS CERTIFIES that the rebuilding in-place existing 24'x32' deck attached to dwelling. At 1225 Aquaview Avenue, East Marion Suffolk County Tax Map #21-2-16 Conforms to the application for a Trustees Permit heretofore filed in this office Dated March 2, 2015 pursuant to which Trustees Wetland Permit #8584 Dated April 22, 2015 and Coastal Erosion Management Permit #8584C 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 rebuilding in-place existing 24'x32' deck attached to dwelling. The certificate is issued to LEWIS & HELAINE TEPERMAN owner of the aforesaid property. dw- *" J-91 Authorized Signature John M Bredemeyer III, President Michael J. Domino, Vice -President James F. King Dave Bergen Charles J_ Sanders ®ATE 9f INSPECTION: V/ Ch. 275 INSPECTION SCHEDULE Pre -construction, silt fence 1St day of construction '/ constructed Project complete, compliance inspection. / 1--f INSPECTED BY: � , �� � ev COMMENTS: CERTIFICATE OF COMPLIANC t.o Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Creative Environmental 631Q7y34'g7924 d 7 p 1 ..c,:+U�•G'.: .'.� L/>iFO nEKEON. ANC �f U V 1.0 fI. 1`J..�!!1 AS J1J V B 0 - .<SSI_NEES OF TUiE LEAVING INSRTUTTO!1_ G;.'ARA:v rc ES .4R� A'OT TRANSFERABLE TO ADJJ PCA'AL I.NSP; URON5 OR SUBS£OUENT OWNERS S 87'57'35"E 40. ()l r APPROX. .IIf TH'S DATE Lrr�,tUTHORIZEG ALTFRA TION OR ADDlRON 70 THIS 4� S:IP trY IS A V70.A R0.\' OF SECTION 7203 a' STAIRS W000 _ 7ME A:EBV ''/ORK STATE EOUCARON LAW. ,FL 6 Y , / fY00D , O%JFS O. r-r.'.S $�Y.'RfAp NOF B£ARI11G OECK(NG � g '•c LA'.DSL!?:c r0-5 E'/.BOSSED SEPI SPALL strOWER - \'t TJ EF A VALID TRUE AREA rPPPL�Uondf QF BBwr%' EL r0- DECIr C. 7' BAH N FRCA1 PROP LINE HOUSE - EL r0 Cl/ 2.7° �-EL J4 T =_EL 16 L 20 1 EL 11 EL EL f,4 f,4 _. LTALZ -� �it .?? EL 28-_�- EL 30-'�a EL 32- ELQ- FL uG •'- -• } END ' ° � 'FPPROY. TOP OF BLL'rP ��'I(((''!���'-+++ STOCKADE .' FENCE WOOD STEEPS �9_--� NE COASTAL ER057CIv - MAR 3 2015 ` ° ® _8� Ro E� • z Iv w�RAIUNG Il � t PESID'cNCE � J� T V F 4 wood .52-�• �10E 1. 2 CELLAR/ ITR ` c OD --1 .--..�L 10-90 CP G ] II AY PnRiMISTONE DRIVEw caBONC _ 7 2GQ'r/— l $0' CONC � � 3� / � � . �4 V T s O c�Cf A VE f n j 'i U SURVEY OF DESCRIBED PROPERTY SITUATE EAST MARIONP TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. SURVEYED FOR: LEWIS TEPERMAN HELAINE TEPERMAN SURVEYED" 5 APRIL 2004 SCALE 1"-- 40' AREA = 12,457.7 S.F. OR 0.266 ACRES John M. Bredemeyer Ill, 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 (631) 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, self encem- 1 st day of construction % constructed __�Z_ Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 8584 & 8584C DATE: APRIL 22, 2015 ISSUED TO: LEWIS & HELAINE TEPERMAN PROPERTY ADDRESS: 1225 AQUAVIEW AVENUE, EAST MARION SCTM# 21-2-16 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 1 I 1 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 April 22, 2015, and in consideration of application fee in the sum of $500.00 -paid by Creative Environmental Design 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 rebuild in-place existing 24102' deck attached to dwelling; and as depicted on the site plan prepared by Creative Environmental Design, last dated April 2, 2015, and stamped approved on April 22, 2015. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents'io be subscribed by a majority of the said Board as of this date:. TERMS AND CONDITIONS The Permittee, Lewis & Helaine Teperman, residing at 1225 Aquaview Avenue, East Marion, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 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. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. 4. - That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said,Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be. no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if futurekoperations 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 shat cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. 8. 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. John M. Bred_emeyer 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 Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 119,71-0959 Telephone (631) 765-1892 Fax (631) 765-6641 COASTAL EROSION MANAGEMENT PERMIT COASTAL EROSION PERMIT #8584C Applicant/Agent: Creative Environmental Design Permittee: Lewis & Helaine Teperman SCTM#: 21-2-16 Project Location: 1225 Aquaview Avenue, East Marion Date of Resolution/Issuance: April 22, 2015 Date of Expiration: April 22, 2017 Reviewed by: Board of Trustees DESCRIPTION OF ACTIVITY: To rebuild in-place existing 24'x32' deck attached to dwelling; and as depicted on the site plan prepared by Creative Environmental Design, last dated April 2, 2015, and stamped approved, on April 22,._2015.._,_.____.__._ INSPECTIONS: Final Inspection SPECIAL CONDITIONS: (apply if marked) In accordance with Chapter 111-15 Erosion Protection Structures: N/A A maintenance agreement is attached hereto and is a necessary special condition of this permit. John M. Bredemeyer III, President Board of Trustees John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee April 22, 2015 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. David Cichanowicz Creative Environmental Design PO Box 160 Peconic, NY 11958 RE: LEWIS & HELAINE TEPERMAN 1225 AQUAVIEW AVENUE, EAST MARION SCTM# 21-2-16 Dear Mr. Cichanowicz: 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, April 22, 2015 regarding the above matter: WHEREAS, Creative Environmental Design on behalf of LEWIS & HELAINE TEPERMAN 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, and Chapter 111 of the Southold Town Code, Coastal Erosion Hazard Areas, application dated March 2, 2015, 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 recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policy 4.1 of the Local Waterfront Revitalization Program to the greatest extent possible through the imposition of the following Best Management Practice requirements: the issuance of a Coastal Erosion Management Permit; and the applicant is proposing a 10.9% addition of total deck to be reconstructed in the Coastal Erosion Hazard Area; and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on April 22, 2015, 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 and Chapter 111 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 for the mitigating factors and based upon the Best Management Practice requirement imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, RESOLVED, that the Board of Trustees approve the application of LEWIS & HELAINE TEPERMAN to rebuild in-place existing 24'x32' deck attached to dwelling; and as depicted on the site plan prepared by Creative Environmental Design, last dated'April 2, 2015, and stamped approved on April 22, 2015. —T--Permif to cons ruct and' complete project will expiret�Vo- 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, OU - John M. Bredemeyer III President, Board of Trustees JMB/amn John M. Bredemeyer III, President Michael,i`. Domino, Vice -President James F. King Charles J. Sanders TO: Dave Bergen BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD . Town Hall Annex 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Please be advised that your application dated has been reviewed by this Board at the regular meeting of - and your application has been approved pending the completion of t e fo lowing items checked off below. Revised Plans for proposed project Pre -Construction Silt Fence Inspection Fee ($50.00) 1 st Day of Construction ($50.00) % Constructed ($50.00) Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) 30 -Year Maintenance Agreement (complete original form enclosed and submit to Board of Trustees Office) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ 50 BY: John M. Bredemeyer III, President Board of Trustees I'iy1GLn John Bredemeyer, President Michael J. Domino, Vice -President James F. King Charles J. Sanders Dave Bergen Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: Creative Environmental Design on behalf of LEWIS & HELAINE TEPERMAN requests a Wetland Permit and a Coastal Erosion Hazard Area Permit to rebuild in-place existing 24'x32' deck attached to dwelling. Located: 1225 Aquaview Avenue, East Marion. SCTM# 21-2-16 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other Type of Application: IWetland 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: Av� Present Were: J. Bredemeyer M. Domino J. King C. Sanders D. Bergen Bay Constable Other Form filled out in the field by Mailed/Faxed to: Date: Town Hall Annex s� 54375 Route 25 y = 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: Creative Environmental Design on behalf of LEWIS & HELAINE TEPERMAN requests a Wetland Permit and a Coastal Erosion Hazard Area Permit to rebuild in-place existing 24'x32' deck attached to dwelling. Located: 1225 Aquaview Avenue, East Marion. SCTM# 21-2-16 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other Type of Application: IWetland 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: Av� Present Were: J. Bredemeyer M. Domino J. King C. Sanders D. Bergen Bay Constable Other Form filled out in the field by Mailed/Faxed to: Date: Creative Environmental 6331�7C347.1 924 p _--- :•a5- !!%:G':: L� USifO ;,fxEON. axC •� v 1 v l_l' U IN $� r.,SSIGNEES OF iFJE LENDING INS77RJTTO.N - GL'.;RA.'JTc 5 .4R5 A'OT TRANSFERABLE TO AL1D1721CAIA1 ?,NST.!,U710A'5 OR SUBS£OUENT 0I.IVCRS S 87.57'35"E. 40, t APYROX. M!� THIS DATE ur,iAb•i?+DA.7ZEG ALTERATON OR ADOlTON TO 7HT5 SVP? 1=Y IS A KOLA ,ON OF SECTION 7209 OF' WOOD 7!+E NEIV 1`01'K STAT£ EOUCA T7ON LAW. d-- 6,_ _._IYLR�I(jp'G..RS - -.- J IVOOD DECKING L0%!£5 OF ir.'!S 5`P.�Y MAP TJOT BfARkJG FL e_ 1 '''c LAr:4' Sir?;c r'J=5 E.'/.BOSSED SEAL SPALL y+curR �'••?7 aE �L�.A'Sr.?- =EG %D RE A VALID 7ftUE ARCA -- _ _ •gyp �B.Tc. BttaF' •��. . Jv EL r0— EL BDECK C.I' • /j /•BEACH in .FROM PROP. LINE Cl/ 3E[•t�• HOL5E F' EL r0 2,7• _=EL 72 5•�` t Z - __.__.. _ =SEL 34 CL 24-d IYALt -�-- EL 25 - �`-'-- EL 50-� EL 72- EL J!-- -O- EL CL I;- EL H - _ END ^APPFO>: fOP OF ]LWT STOCKADE �^ FENCE. WOOD STEPS !1 L T COASTAL LtNE• Iy�7A100 L t MAR 3 2015 _- 1 : RESIDENCE C rm. _ �i.ZrEUPR! N _ 1 = f*R, o C Q) z ...-�� -BL'Ot�-LEIS. ?.IHS._ r � .I EAR1t1I?TONE L'Rh'EWAY � LONG 1.!O`1• 810.35 10 ' 10 c.VI fVIEW 62.6 ,moo Fac AV . ru E SURVEY OF DESCRIBED PROPERTY SI7UA.TE EAST MARION, TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. SURVEYED FOR: LEMS TEPERMAN HELAINE TEPERMAN SURVEYED: 5 APRIL 2004 SCALE 1"= 40• AREA = 12,457.7 S_F. OR 0.286 ACRES i Creative Environmentaf1Design P.O. Dox 160 Peconic, N Y119.58 631734-7923 Creativeenvde n@yaFioo. com John Bredemeyer, Pres. Southold Board of Trustees Southold Town Hall, Annex P.O. Box 1179 Southold, NY 11971 RE: Teperman SCTM# 21-2-16 Dear Mr. Bredemeyer: I' :a MAR 3 1 2015! March 25, 2015 As per our conversation last week, I have looked into the history of the CO on the above reference property. As per Southold Town Building Dept. and Town Assessors Records the house was built in 1975. In the late 70's the Building Dept. "lost" some files. As the years went on the Town re-established the files to the best of their ability. As a practice back then the Building Dept. did not include decks on CO's even though you still needed a building permit. That is why the deck is not listed on the "Duplicate Original" CO. Enclosed you will find a copy of a survey from 1972 showing a small deck. You will also find a copy VanTuyl survey from 1973 showing the deck the size it is today. The copies came from the building dept records. Also, if you look at the Coastal Erosion Hazard Area maps from 1988 that are in your office, you will find these maps show the deck as it is today. Given this proof that the deck was pre-existing prior to Wetlands Code and Coastal Erosion Hazard Area Code and we are repairing inkind/inplace, I understand we do not need to go through the full permit process. The builder is ready to start the work before the season gets busy for him. Please advise as to what permit process, if any, we need to do in order to move ahead with this project in a timely manner. Sincerely, David Cichanowicz, Pres. Creative Environmental Design DC:jd enc. cc: Board of Trustees Mike Verity, Building Dept. Lori Hulse, Assistant Town Attorney '• L O N G j i L.A M fl � o p •.l 4 r ' 'SWKt�pGYw4u, �'48 FAutJTKL4r ' _ _._.., .. LIM" . S. . dNo aK {N Qi �JLiI.Awla►.>E T�ESIl.,[. S�•-T ��� rzJro� alt/7x�✓. , •wikrulun oi tftn Gea:om•: r • I! ' I i —.1 E.Y—I. Is tnufd". + �ikl° 'fir• , OVA a r i'• WNr Mgr,. •6 f•,1 - CJ,u�a •a»• .a • lo' s td F MAR 2015 + o _ b"s , • ar4N'ot. r ' Office Of — -- �JLiI.Awla►.>E T�ESIl.,[. S�•-T ��� rzJro� alt/7x�✓. , •wikrulun oi tftn Gea:om•: r 4a f. by •• Vc.-..d i:ro4._��� —.1 E.Y—I. Is tnufd". + �ikl° 'fir• , Mgr,. •6 f•,1 - CJ,u�a •a»• .a imp yaoN { TOWN OF SOUTHOLD -PROPERTY RECORD CARD -I_WN R a I -- FeCn?,ve aln STREET 5 VILLAGE DIST.1 SUB. LOT F s�,j k FORMER OWNERSs t�o��noPacc jo N t -,+��:�:"�-��.CGY4. -�,Gh l`;�� ��._.._t� �! l p�.�- (i , r E� �' , L�4rnlUl�.®6.1 ACR Q n. Z, `�i� �t`r�e:_Gre�r .��©rC� I.V\!crmoa,S W _ TYPE OF BUIL ING RES. �)116 'S S. t VL. P FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS-' "✓� f �� / / a o 5_ � a / .t; o � � , ,5-'��2 ! / 7.5 s o �9 - � � J J. �� 3 � C�Y��-ti-�� �o -►� �� .� �� �� 5, �c�, ro,L-) LoQ ,. D/1 %�,� rd -7 qa 1!1102FQ5.2 1 - We-fma,-e `ice XAos,u4 ems✓ mer I I c� 2 27 zdl�rr—L-(Azs�r�37/- r®Z � 2__kCj2rDt07 a?/9f—L.lI ;P)1-7j4,519--0-hr,se —wonu? N -7 12 2-4 9 ,3/�7q9— ra✓1�lD�Dll%®.5 �iq�r�D�r/C1s ��,':�- S s- O --L 231 Ela gq - _ _ r� "lY3'1Cl % 75- 5AGE AGE BUILDING CONDITION !y#as L, ; f al +f,,rai;6ns NEW NORMAL BELOW_ ABOVE 411 (o j6-7 6P 32_906 1.,i 6 z4Q:Yi 1 ,t a�g v 9 �t �,Y'4 5.� ti �k Fes•+ i ;�. t p Cv" �Al RL'/•' S8 y4 C° v 1 dr �! Ri xyd` `'h ' a: �,`� �.`-> C°'4 �,t;',R A ' *�* '" �,. ,s Pa a. '0. j• ✓:,b 9726 - 2xIT-' AKlo. fl AUTHORRW ALTEIULTION OR A ¢'y T "i'S SURVEY IS A VLOLATfON �YfJ Yl 1„Qtik� CT ION 7109 OF THE NEW YORY AT! TZ' ♦ - ',�j/a/ {,.� - j�/r• �� ,bUCATIOH LAW. I? well f ` ' t -•T . L/ � l� +�. Y�t+ %i,. � r j OflfS OF TCtS SURVEY MAP NOV REARING ! LAND SU;.VEYCk'S IN' ZD SE � OR • If r�UQ �` ( � � i6�LgSSED SEAL SHALL N3T RE �6NSIDERED 1'I -� ��� i sbo c,&, - To RE A VALID TRUE COPY. (((r CiIARANTEES U.DICATED NERC SHALL RUN ' �` .. _. Z,i TO THE PE::=I FO” Y S Tt1E SURVEY It hr i PR6ACED, A! -.'Z HiS C_a LF TO THE ^� i COMTAT.Y, GOV:.;iV-'l tXL AGLNCY AND F4D*IG II•.STiTU-.IJN L.•Si.b iq�REON, AND 9 fir' b / J L THL A UARA ES ZS 'Zi PT Ig i LVSTL• ry �R S T WAR /10 /Y i_ • Y [ON. GUARANTE:S ASE \PT 7RAt:SF'cRARLE � � J I T ADOITH?NAL INST IiDr*AL.Q$SURSEQUENT _ti••� L o 1 � G j r � � �orelr ; `-- 40 --.•+ .' --- 0 Ntr3:ytittlfa�d�' 1 1 11 rl 3, br ba. ,r'.x✓cr 1 E6, /979 785 rz V4060-- MAR. im— MAR. 3 1 2015- S `�S • gam• � } �r �:�Itf7 i.3 ine:;n C+ .. iEl�• i. �a yp [ r I , r` r � �! .Q t:1 ei r! Ge t: • •�:`,' ti<- � i75 Dl2l V6 �. MAY 04 104 02:3OPM SOUT, NO: z- 6793 ! BUILDING 531-765, 9502 8 1, P.1 TOWN OF SOUTHOLD r `' BUILDIM DEPARTMENT Offide of the Building Inspee or MAR 3 1 2015 Town Haat Southold, N.Y. CERTIFICATE OB OCCUPANCY THIS C%RTIFIRS that the building DWELLING Date: 05 83 +4 Location of Property: 122S A UAvI)RW AVE EAST MARION (HOUSE NO J (BTRB9T) (Yi MLST) County Tax Map No. 473889 Section 211 Block 2 rot 16 subdivi vion _ Filed leap No. Lot NO. conforms subatanti,ally to the Application for Building'Permit heretofore filed in this office dated_ JANUARY- _ 7, 1975 pursuant to which Building Permit No. 77685-Z dated JANUARY 9, 1575 was issued, and conrorms to all of the requirements of the app�iaable pxovisi.ons of the law. The cccupangy for which thin certificate is issued XS ONr% FAMILY DWELLING *NOTE: TIES �XS A DUPLICAT.S ORIGINAL OF C33RTIFICATE OF OCCUPANCY ISSUED 014 NOVEMBgR 28, 1975. The cextificate is issued to FRANK .7. & -MYRA K. SALAMON$ (OWNER) of the afgresaid building. SUFFOLK COUNTY DEPARTMENT OF BMTH APPROVAL 5-50-3_. 11 /75 BLEG"1`RICAL C8ftT.IFI'CaU NO. PLUMBERS CERTXP31CATXCN DATOD Rev. 1/81 N-251162 10 20 7 N/A Qxiaed 605nature 02'25'2004 14:54 63173479- I-APN REALTY �� F'►�l:i•: �'. Ito. R TOWN OF S()lI'T oLo Z3v�i.DING �DIPA OMINT ' TOWN CLERIC'S OFFIGH Jh $,, •1 <•i. 7 SOUTHOI.1)► K Y. BUILDINr PIERMIT CCHIS -P&MIT MUST BE KEPT ON J -HE Pltr-MISES UNTIIr FULL t�oMpi.ETION OF THE WORK AUTHORIZED) 1 ryr ' N? 76$5 �' cy��e 1 ...... 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JI..1/.,.s«h,.h..,«...1.ha.,.h. 1..1..............n....1./1,.h.•t........ /...1arh«h. ...•..... ....... 1..... pr_:rfdJtiYlt to application dated ................. .......:!�.s":�.......1..�............. ow cp%PY`tf by tau Il:litti Inspector. pet? obtla.5 ........... . ha.......T ..Ha1J lJ.i.i� ..'Y. u.. rJ..eJl..b If'..♦ t 6 _ MAR 3 1 2015 Lewis & Helaine Teperman 1225 Aquaview Avenue, East Marion CTM# 21-2-16 3/11/15 I P► it i ♦♦♦♦♦♦eek♦♦♦♦ 3/11/2015 Lewis & Helaine Teperman 1225 Aquaview Avenue, East Marion 4_ISCTM# 21-2-16 r ----------------- % MUNN 0:20 5 John Bredemeyer, President g11FFD( Michael J. Domino, Vice -President James F. King y = Charles J. Sanders • Dave Bergen yWOl Town Hall Annex 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field InspectionM/ork Session Report Date/Time: 3-11 ,-r Creative Environmental Design on behalf of LEWIS & HELAINE TEPERMAN requests an Administrative Permit to rebuild in-place existing 24'x32' deck attached to dwelling. Located: 1225 Aquaview Avenue, East Marion. SCTM# 21-2-16 Type -of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: ,Chapt.275 3 Chapt. 111 other l Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre -Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Storm Water Management Review: Yes Info needed: No Not Applicable Modifications: Ck -P&j/m;dC� r° �m e °,� /�✓J.a ,-G (0 co !) C Cry f6 -. : 74 ry it ,fie Conditions: Present Were: - J. Bredemeyer "M. Domino "J'—King C Sanders D. Bergen Bay Constable Other Form filled out in the field by Mailed/Faxed to: Date: \G 1p*a SURVEY OF PROPERTY`S AT EAST MARION TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. N 1000-21-02-12 SUM 1'=20' JAMY 1$ 2005 H N � yl �AB7F L4"1t7Fy � NEIIYBN,!Wi Q a3 1 s � y 12 9 air 54• ,W - air � :n y ro Bow NBA p 1p.� SOF wtv 9 �' 9� I METl O T �AADM5 8Q Ff OU9 WA. TO TE LICEY' ANY AL7ERA7?aV ORADWWN 70 THIS SURVEY IS A WaLAAav �l� C"/ 19 OF SEC37ON '720*F THF NEW YORK STA IE EWICA77ON LANG . P CONIC SUR R , DMEPr AS HER SECAAN 7209-SUBWLL Wgiw 2 ACERAflCADavS (631) 765-5020 FAX -1797 lAEW W ARS,. 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Br souiNa+n secrioI No m o< 21 N . n� w. n.tN o e '•' - _� ea.. --.-- o�.w--.w'-- ov.�a YSJ!y,� P iwnw 1000 PROPE0.TY MAP LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: John Bredemeyer, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: March 12, 2015 M MAR 13 2015 Re: Proposed Wetland Permit and Coastal Erosion Hazard Permit for LEWIS & HELAINE TEPERMAN SCTM# 1000-21-2-16 Creative Environmental Design on behalf of LEWIS & HELAINE TEPERMAN requests an Administrative Permit to rebuild in-place existing 24'x32' deck attached to dwelling. Located: 1225 Aquaview Avenue, East Marion. SCTM# 21-2-16 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 determination that the proposed action is INCONSISTENT with the following Policy Standards and therefore is INCONSISTENT with the LWRP. 4.1 Minimize losses of human life and structures from flooding and erosion hazards. Portions of the deck are located seaward of the Coastal Erosion Hazard Area (CEHA). The reconstruction of portions of the un -permitted structure within the CEHA is not permitted. The Board of Trustees issued a Wetland Permit and Coastal Erosion Hazard Permit (6483) on December 21. 2005. however. the permit did not include the subiect deck structure. A. Minimize potential loss and damage by locating development and structures away from flooding and erosion hazards. 1. Avoid development other than water -dependent uses in coastal hazard areas_ b. Avoid hazards by siting structures to maximize the distance from Coastal Erosion Hazard Areas. �pF SO!/Ty OFFICE LOCATION: Ol0 MAILING ADDRESS: Town Hall Annex ��� P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) Telephone: 631 765-1938 Southold, NY 11971 apQ Iy�DUNV LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: John Bredemeyer, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: March 12, 2015 M MAR 13 2015 Re: Proposed Wetland Permit and Coastal Erosion Hazard Permit for LEWIS & HELAINE TEPERMAN SCTM# 1000-21-2-16 Creative Environmental Design on behalf of LEWIS & HELAINE TEPERMAN requests an Administrative Permit to rebuild in-place existing 24'x32' deck attached to dwelling. Located: 1225 Aquaview Avenue, East Marion. SCTM# 21-2-16 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 determination that the proposed action is INCONSISTENT with the following Policy Standards and therefore is INCONSISTENT with the LWRP. 4.1 Minimize losses of human life and structures from flooding and erosion hazards. Portions of the deck are located seaward of the Coastal Erosion Hazard Area (CEHA). The reconstruction of portions of the un -permitted structure within the CEHA is not permitted. The Board of Trustees issued a Wetland Permit and Coastal Erosion Hazard Permit (6483) on December 21. 2005. however. the permit did not include the subiect deck structure. A. Minimize potential loss and damage by locating development and structures away from flooding and erosion hazards. 1. Avoid development other than water -dependent uses in coastal hazard areas_ b. Avoid hazards by siting structures to maximize the distance from Coastal Erosion Hazard Areas. 3. Move existing development and structures as far away from flooding and erosion hazards as practical. Maintaining existing development and structures in hazard areas may be warranted fora a. structures which functionally require a location on the coast or in coastal waters. b. water -dependent uses which cannot avoid exposure to hazards. C. sites in areas with extensive public investment, public infrastructure, or major public facilities. The deck does not require a location on the coast, is not water dependent or a public facility. It is recommended that the deck area be modified to exclude portions that are located within the CERA. Figure 1. Subject parcel and adjacent properties. It is important to note that no permits were found for the deck within the CEHA on the property located to the east of the subject parcel (circle). A Coastal Erosion Hazard permit was issued for SCTM# 1000- 22-2-13 by the Board of Trustees in 1992 (rectangle), however, the deck on the parcel does not comply with permit conditions and should not be considered in decision making. 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 co Lauren Standish, Secretary rrW Conservation Advisory Council Town of Southold Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1889 Fax(631)765-1823 At the meeting of the Southold Town Conservation Advisory Council held Wed., April 15, 2015 the following recommendation was made: LEWIS & HELAINE TEPERIVIAN for a 24'X 32' deck. Located: 1225 Aquaview Ave., East Marion. SCTM#21-2-16 The CAC did not make an inspection, therefore no recommendation was made. APR 1 7 2015 X e BOARD MEMBERS Leslie Kanes Weisman, Chairperson Eric Dantes Gerard P. Goehringer George Horning Kenneth Schneider Southold Town Hall 53095 Main Road • P.O. Box 1179 Southold, NY 11971-0959 Office Location: Town Annex /First Floor, Capital One Bank 54375 Main Road (at Youngs Avenue) Southold, NY 11971 http://southoldtown.northfork.net ZONING BOARD OF APPEALS TOWN OF SOUTHOLD Tel. (631) 765-1809 • Fax (631) 765-9064 FINDINGS, DELIBERATIONS AND DETERMIN MEETING OF FEBRUARY 19, 2015 L - �jj Fh Iftl FEB 24 2015 ;� TIO _J ZBA FILE: 6826 NAME OF APPLICANT: Lewis Teperman SCTM41000-21-2-16 PROPERTY LOCATION: 1225 Aquaview Avenue (adj. to Long Island Sound) East Marion, NY. SEQRA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type II category of the State's List of Actions, without further steps under SEQRA. SUFFOLK COUNTY- ADMINISTRATIVE-CODE:--This-application-was-referred-as required- -under -the--Suffolk-- - - - County Administrative Code Sections A 14-14 to 23, and the Suffolk County Department of Planning issued its reply dated December 29, 2014 stating that this application is considered a matter for local determination as there appears to be no significant county -wide or inter -community impact. LWRP DETERMINATION: This application was referred for review under Chapter 268, Waterfront Consistency review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. The LWRP Coordinator issued a recommendation dated January 29, 2015. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to us, it is our recommendation that the proposed action is INCONSISTENT with LWRP policy standards and therefore is INCONSISTENT with the LWRP because the subject deck is partially located in the Coastal Erosion Hazard Area (CEHA). However the Board finds that, under Southold Town Code Chapter 111-6 Definitions: Unregulated Activity, structures or parts of structures less than 200 square feet are permitted in the CERA. The proposed reconstruction in-kind of the subject deck has and will have an area of 182 square feet within the CEHA, which is less than 200 square feet. Therefore, the Board finds the proposed reconstruction in-kind as CONSISTENT with the LWRP standards and therefore CONSISTENT with the LWRP. PROPERTY FACTS/DESCRIPTION: Subject property is non -conforming located- in a R40 Zone District. It is improved with a two story frame dwelling with attached rear deck, accessory deck and accessory beach house. It has 62.65 feet of frontage on Aquaview Avenue, 245.85 feet on the west property line, 40.01 feet on Long Island Sound and 357.78 feet on the east property line as shown on the deck reconstruction plan prepared by Matthew Benjamin Sherman LPE dated 11-19-14 as drawing number C.1. BASIS OF APPLICATION: Request for Variance from Article XXII Section 280-116 and the Building Inspector's September 29, 2014, renewed December 9, 2014 Notice of Disapproval based on an application for building permit to reconstruct a deck, at; 1) less than the code required bluff setback of 100 feet. RELIEF REQUESTED: The applicant requests a variance to rebuild, in-kind and in-place, an existing deck having a setback of 24.8+/- feet from the top of bluff where the code requires a minimum setback of 100 feet. Page 2 of 3 — January 19, 2015 ZBA#6820 — Teperman SCTM# 1000-21-2-16 ADDITIONAL INFORMATION: 1. The Suffolk County Soil and Water Conservation District did a site inspection on December 29, 2014 of the subject parcel with respect to the proposed reconstruction of the existing deck and found the property to be suitable for the current proposal with no apparent degradation to the surrounding natural resources. 2. John T. Metzger, L.S., obtained field measurements that the East side of the existing deck to the top of Bluff is approx. 24.8 feet. 3. There are three letters of support for the proposed reconstruction from neighboring property owners. FINDINGS OF FACT/ REASONS FOR BOARD ACTION: The Zoning Board of Appeals held a public hearing on this application on February 5, 2015, at which time written and oral evidence were presented. Based upon all testimony, documentation, personal inspection of the property and surrounding neighborhood, and other evidence, the Zoning Board finds the following facts to be true and relevant and makes the following findings: 1. Town Law 4267-b(3)(b)(1). Grant of the variance will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. The existing dwelling with attached deck has been in the same location since 1975 without detriment to nearby properties. Attached decks are common additions to residential properties in this neighborhood. 2. Town Law &267-b(3)(b)(2). The benefit sought by the applicant cannot be achieved by some method, feasible for t116-appl Icant to pursue, other than an area variance. The deck ekists in a nonconforming location and therefore - - its reconstruction in-place and in-kind will also be in a nonconforming location which requires a variance. 3. Town Law .4267-b(3)(b)(3). The variance granted herein for a 24.8 foot setback from top -of -bluff is mathematically substantial, representing 75%. relief from the code. However, this variance is for a. deck reconstruction in-place and in-kind and the existing deck exists at this non conforming location with no evidence of degradation to the surrounding natural features. 4. Town Law 4267-b(3)(11)(4) No evidence has been submitted to suggest that a variance in this residential community will -have an adverse impact on the physical or environmental conditions in the neighborhood. The applicant must comply with Chapter 236 of the Town's Storm Water Management Code. 5. Town Law 4267-b(3)(b)(5). The difficulty has been self-created. The applicant purchased the parcel after the Zoning Code was in effect and it is presumed that the applicant had actual or constructive knowledge of the limitations on the use of the parcel under the Zoning Code in effect prior to or at the time of purchase. 6. Town Law §267-b. Grant of the requested relief is the minimum action necessary and adequate to enable the applicant to enjoy the benefit of reconstructing an existing deck in-place and in-kind, while preserving and protecting the character of the. neighborhood and the health, safety and welfare of the community. RESOLUTION OF THE BOARD: In considering all of the above factors and applying the balancing test under New York Town Law 267-B, motion was offered by Member Schneider, seconded by Member Weisman (Chairperson), and duly carried, to GRANT, the variance as applied for, and shown on the Site Plan, Deck Reconstruction, drawing number C-1, prepared by Mathew B. Sherman, P.E., dated 11.19.14. CONDITIONS: Deck shall remain open to the sky. That the above conditions be written into the Building Inspector's Certificate of Occupancy, when issued. I Lr Page 3 of 3 — January 19, 2015 ZBA#6820 — Teperman SCTM#1000-21-2-16 Any deviation from the survey, site plan and/or architectural drawings cited in this decision will result in delays and/or a possible denial by the Building Department of a building permit, and may require a new application and public hearing before the Zoning Board of Appeals. Any deviation from the variances) granted herein as shown on the architectural drawings, site plan and/or survey cited above, such as alterations, extensions, or demolitions, are not authorized under this application when involving nonconformities under the zoning code. This action does not authorize or condone any current or future use, setback or other feature of the subject property that may violate the Zoning Code, other than such uses, setbacks and other features as are expressly addressed in this action. The Board reserves the right to substitute a similar design that is de minimis in nature for an alteration that does not increase the degree of nonconformity. Pursuant to Chapter 280-146(B) of the Code of the Town of Southold any variance granted by the Board of Appeals shall become null and void where a Certificate of Occupancy hasnot been procured, and/or a subdivision map has not been filed with the Suffolk County Clerk, within three (3) years from the date such variance was granted. The Board of Appeals may, upon written request prior to the date of expiration, grant an extension. not to exceed three (3) consecutive one (1) year terms. Vote of_tbe Board....Ay-es.-,4ySchneider,-Horning-Dantes.-_(Absent_ was..._ Member-_Goehringer)___ This Resolution was duly adopted (4-0). Leslie Kanes Weisman, Chairperson Approved for filing � /a � /2015 c� U o 8 LONG ISLAND SOUND FINAL MAP p r 4" REVIEWED BY ZBA w SEE DECISION D #�Q "s EL. 6' DATED/4 ICi U -+--�- / cd EL 8' L. 8' r� '4'.' X 6• DECKING 7 O °_ `, EL 10' V ° EL 12' HO SE EL. 101... ' EL. 4, w o EE Z7 EL. 16 2- 2' X 10' ACO GIRDER E� 2 L 2, 4' X 4' ACO POSTS ON EL. 24 EXISTING CONCRETE FOOTING EL. 26' = Ci (TYPICAL ALL FOOTINGS) EL. 28' d EL 30' C LYS' Y33 EL. 32' . ,y3 EL 364 EL. 38' EL. 40' N EL. 42' DECK 1f 2' X S• ACO LEDGER BOLTED YS TO HOUSE FRAME WITH S' El. 44' LEDGERLOK• SCREWS • 1S• O.C.; TOP HANG D.J. FROM LEDGER WITH 4 lIC SIMPSON LU28 CONNECTOR SE C�7 _ U EL. 46' 7.9' 0.e' NE S m DECK TO FRAMING PLAN I /A� SCALE V=Y4" TEPERMAN PROPERTY lY� 1225 AQUAVIEW AVENUE, EAST MARION SCTM: 1000-21-02-16 m 2 STORY m RESIDENCE SITE PLAN BASED ON SURVEY OF PROPERTY BY; m 31 STANLEY J. ISAKSEN JR. a LAST REVISED 05-16-05 r x r /no ,mom Balm STRUCTURE HOUSE m Nauss nw¢mx e' STRUC [•a � w TUU RE TO REMAIN 1moa4at e°en � Ir• ac: r-rw.�ma r [ Ir IHV [oNa [ r oex p,� _..RNma /�/��—// OaMM1a1137 CIalIO T [ 1r ICO a Ir OZ LL• Ww O [- r R 10• ACa - r [ 10• ICO 496!11 V n >.� �( momma (Dr) = L1 Z o s PIta roars ax o__- -- —"� SITE PLAN T, room"wz 1 " SCALE 20:1 a 90 PARKING _ O aZ)Q SECTION AA :2 Ld �¢ SCALE NTS o �Nw AQUAVIEW AVE RECEIVED cl- _ DEC 91014 LLJ < ` ZONING BOAKO OF 4,EALS [] g B m o �` mU i a < o: INm°®A!A®Of.m 9IL Oti,�f.®m7MS f C O,Co w m IF AOS ®aA CI C fIl m Cantrell, Elizabeth From: David Cichanowicz <creativeenvdesign@yahoo.com> Sent: Friday, March 06, 2015 9:50 AM To: Cantrell, Elizabeth Subject: Teperman Can't find the email I sent Amanda..... amendment is to rebuild in place a 24'X 32" deck attached to house. You should also have a copy of the recent ZBA approval in the file. Received Application: _ 7, eceived Fee:$ VCompleted Application 3 S "►�I�7 _Incomplete _SEQRA Classification: Type I Type II Unlisted oordination:(date sent) WRP Consistency Assess Hent Form c[� DAC Referral Sent: ate of Inspection. _Receipt of CAC Report: _Lead Agency Determination: Technical Review: Public Hearing Held: Resolution: Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 MAR 2 2015 ` � Jr Name of Applicant I n �`_S �� . a� Ili Mailing Address ��t212 F��} ?� � - 35 TH `'�� too Phone Number:( Suffolk County Tax Map Number: 1000-'n �- r Property Location: (provide LILCO Pole #, distance to cross streets, and location) AGENT: 0 (49 V Q (If applicable) Creative Environmental Design PO Box 160 Address: PwMicy NY 11958 Phone: SO(/Jy®l John M. Bredemeyer III, President ���OF Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee G Q Charles J. Sanders, Trustee COUa BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only / ' Coastal Erosion Permit App lica ion Wetland Permit Application Administrative Permit Received Application: _ 7, eceived Fee:$ VCompleted Application 3 S "►�I�7 _Incomplete _SEQRA Classification: Type I Type II Unlisted oordination:(date sent) WRP Consistency Assess Hent Form c[� DAC Referral Sent: ate of Inspection. _Receipt of CAC Report: _Lead Agency Determination: Technical Review: Public Hearing Held: Resolution: Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 MAR 2 2015 ` � Jr Name of Applicant I n �`_S �� . a� Ili Mailing Address ��t212 F��} ?� � - 35 TH `'�� too Phone Number:( Suffolk County Tax Map Number: 1000-'n �- r Property Location: (provide LILCO Pole #, distance to cross streets, and location) AGENT: 0 (49 V Q (If applicable) Creative Environmental Design PO Box 160 Address: PwMicy NY 11958 Phone: yard of Trustees Applicata'-- GENERAL DATA Land Area (in square feet): i 0.113, Area Zoning: — �t Previous use of property: L�l� Intended use of property: RcS,Ad-n Covenants and Restrictions on property? Yes �No If "Yes", please provide a copy. Will this project require a Building Permit as per Town Code? a/ 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? i/ Yes No If "Yes", please provide copy of decision. Will this project require y demolition as per Town Code or as determined by the Building Dept.? Yes No Does the structure (s) on property have a valid Certificate of Occupancy? C/ Yes No Prior permits/approvals for site improvements: �-anDate ( �J.bi 5` f1��lT No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? V No Yes If yes, provide explanation: Project Description (use attachments if necessary): v E ---d of Trustees Applicatior, WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations:pCe� C �X-i 5�� Area of wetlands on lot: Percent coverage of lot: square feet Closest distance between nearest existing structure and upland edge of wetlands: feet bG� 1�4464r-(- O Closest distance between nearest proposed structure and upland edge of wetlands: a 1;f feet f9 P O� 12AA V'\ Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? cubic yards How much material will be filled?cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): Board F Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are wetlands present within 100 feet of the proposed activity? No Yes Does the pr ject involve excavation or filling? No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? (cubic yards) Manner in which material will be removed or deposited:. APR -2 2015 <r Describe the nature and extent of the environmental impacts to the subject property or neighboring properties reasonably anticipated resulting from implementation of the project as proposed, including erosion increase or adverse effects on natural protective features. (Use attachments if necessary) nDr\p-, W& -t) b ftp- A A -'Z- -7z)5' Lj-�2 617.20 _ Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 - Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding, are subject to public review, and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item, please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency; attach additional pages as necessary to supplement any item. Part 1 - Project and Sponsor Information Name of Action or Project: Project Location (describe, and attach a location map): i las ►v�.�v ��� , �-KOADC) Brief Description of Pro osed Action: li Name of Applicant or Sponsor:: Telephone: J ; L E-Mai1:z I Address: Creative Environmental Desigrn ® Box 160 City/PO: Peconic, NY 11958 Zip Code: 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 YE If Yes, list agency(s) name and permit or approval: ❑ 3.a. Total acreage of the site of the pr osed action? . acres 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 ❑ Rural (non -agriculture) ❑ Industrial ❑ Commercial EKesidential (suburban) E3 Forest ❑Agriculture El Aquatic ❑Other(specify): ❑Parkland Page 1 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 F-1. ❑ [2 ❑ 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 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 ❑ ❑ 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 ❑ 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 ❑ 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: gricultural/grasslands El Early mid -successional ❑ Shoreline [--]'Forest ❑rs, E3 Wetland El Urbanburban 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 o ❑ 16. is the project site located in the 100 year flood plain? NO YES 17. Will the proposed action create stone water discharge, either from point or non-po' t sources? If Yes, a. Will storm water discharges flow to adjacent properties? NO ❑YES b. Will storm water discharges be directed to established conveyance systems (runoff and storm drains)? If Yes, briefly describe: ❑ NO ❑YES NO YES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of water or other liquids (e.g. retention pond, waste lagoon, dam)? If Yes, explain purpose and size: NO YES a 1 ❑ 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 ❑ ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land?E4 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�l ❑ establishment of a Critical Environmental Area (CEA)? I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor ame: 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 ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land?E4 0 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�l ❑ 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 ❑ 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: El 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. 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 3_ G— 15 Name of Leaq Agency Date Print or TyNa of Responsible Officer in Lead Agency Si, a Lire of Respon ' e Officer in laad AOency President Title of Responsible Officer Signature of Preparer (if different from Responsible Officer) PRINT I Page 4 of 4 No, or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion, flooding or drainage ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? 171 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 3_ G— 15 Name of Leaq Agency Date Print or TyNa of Responsible Officer in Lead Agency Si, a Lire of Respon ' e Officer in laad AOency President Title of Responsible Officer Signature of Preparer (if different from Responsible Officer) PRINT I Page 4 of 4 FORM - 06/10 Town of Southold ear J Erosion, Sedimentation 8f: Storm-Water Run -off ASSESSMENT FORM `O y01yty PROPERTY LOCATION: S.C.T.M. #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN sq tiric�ec3 tion —gof a tl— —[0—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? � Will this Project Retain All Storm-Water Run -Off Include Total Area of all Parcels located within _ 9 3J Generated by a Two (2") Inch Rainfall on Site? the Scope of Work for Proposed Construction) (S.F./ Acres) (This item will include all run-off created by site ❑ b. What is the Total Area of Land Clearing J_ �/ clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed Site Improvements and the permanent creation of construction activity? impervious surfaces.) (S.F. I Acres) 2 Does the Site Plan and/or Survey Show All Proposed PROVEDE BRIEF PROJECT DESCRIPTION (Provide Additional Pages as Needed) Drainage Structures Indicating Size & Location? This ❑ Item shall include all Proposed Grade Changes and — Slopes Controlling Surface Water Flow. 3 Does the Site Plan and/or Survey describe the erosion J v and sediment control practices that will be used to ✓— control site erosion and storm water discharges. This 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 r Existing Grade Involving more than 200 Cubic Yards V—/ of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5,000 S.F.) Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the / Site? Is this Project within the Trustees jurisdiction Or within One Hundred (100') feet of a Wetland or F-1 General DEC SWPPP Requirements: Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one (1) or more acres; including disturbances of less than one acre that are part of a larger common plan that will ultimately disturb one or more acres of land; 7 Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise to El— including Construction activities involving soil 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 stone 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 1. The SWPPP shall be prepared prior to the submittal of the NOI. The Not 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 required, post-construction storm water management practices that will be used and/or 9 Will this Project Require the Placement of Material, / Removal of Vegetation and/or the Construction of any constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way of Road Shoulder ❑ \—// compliance with the teens and conditions of this permit. In addition, the SWPPP shall identify potential sources of pollution which may reasonably be expected to affect the Area? (This Item will NOT Include the Installation of Driveway Aprons.) 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. & I Acre in area, component shall be prepared by a qualified Design Professional Licensed in New York that is knowledgeable in the principles and practices of Storm Water Management. a Stone Water, Grading, Drainage & Erosion Control Plan is Required by the Town of Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit (NOTE: A Check Mark (4) and/or Answer for each Question is Required for a Complete Application) STATE OF NEW YORK, CONNIE ®. - BUNCH Wary Public, State of New YorkNo. COUNTY OF........................................... SS 01 BU6113M QuallW In Suffolk County That%I, ... i. . L %�.� tr1171.9.1 t.2................... being duly swom, deposes and sayGdMr l+hil lXWrffPPVAtlArU7a (Name of individual signing Document) And that he/she is the ...................................... (Owner, 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 true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed herewith. Sworn to before me this; �... l 1 \v�! ......--........ da of L.............. , 201-t y l , NotaryPublic: .... ....i ..... ............ ...................... .................................... (Sig ur of Appli nt) FORM - 06/10 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS . ? ' µn t ` F „� • f APR 2 0 2015 -Name: Address: Soi}ttrM, him _. m� q of ust� Z� . STATE OF NEW YORK Creative Environmental Design COUNTY OFSUFFOLK PO Box 160 residing at Peeonic, NY 11958 , being duly sworn, deposes and says that on the _ day of , 20 1:5, deponent mailed a- true copy of the.Notice set forth in the Board o Trustees rustees 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 atnl L-. . that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this a04I"% Day of Any-, , 2015 TRACEY L. DWYER NOTARY PUBLIC, STATE OF NEW YORK NO. 01DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION:EXPIRES JUNE 30, 2 DI ,a" .. •I I I . O ct) For delivery information visit our website at www.usps.coma CO � ,Q � } Postage $ ¢}4d 0958 Certified Fee $3� Postmark C3 Retum Receipt Fee I . ` O (Endorsement Required). Here �! O Restricted Delivery Fee (Endorsement Required) $0.00, O C3. . Total Postage & Fees $ -04/08/2015 O Sent To a Sfree' 'VERY, ---------- City,'State, ZIP+4PS Form 3800, August 2006 See Reverse for instructions Ptastal Service -r. + M (Domestic Mail Only, rr NFor delivery information visit our website at www.usps.come r t q �ru Postage $ ' 0.49 a r 1 gq� Certified Fee . $3.30 /. f 03 -�.� Reium Recelpt Fee yraya* O (Endorsement Required) $2.70 Here O Restricted Delivery Fee P O (Endorsement Required) $0.00 Total Postage &Fees $ $76.49 04705/2015 . Sent To I1J C � ----- -- -- � Street Apt hlo.; Mor PO Box No. L N--- �a-r-� -------- --------------- c�, stare, ZIP+4 :,• ,,.See Reverse ior Instructions Ln(Domestic (Domesticrq Only; f`- r� r3 For delivery information visit our website at www.usps.come m FRGS : �( II 5 T ,13 n ri�- L U 3 M M Postage $ $0.49 0958 ra Certified Fee $3.30 03 O C3(Endorsement Retum Receipt Fee Required) Restricted Delivery Fee y?`e7Q ,�k'd�tmak Here / C:3 (Endorsement Required) $0.00 M Total Postage & Fees rj 6, 49 04/08/2015 , fU Sent To Street Apt. No.; ----- --------------------------- O r% -r' 11 or PO Box No. l �--- Ave---" -_, ---- `- City Sfate, 2IP+4PS Form 3800, August2006 c3c�" ------ - - - - �jJ (Domesticrq Only; r� For delivery L DRUEV F 11, Ov U A L U 3 f M Postage $ $0.49 0958 M Certified Fee X3.30 -Postmark O O Return Receipt Fee (Endorsement Required) • ,� a e" 1 O $2.70 O Restricted Delivery Fee (Endorsement Required) ;0.00 �..� Total Postage & Fees $6, 49 04/08/..2015 mj ru Sent To �— O f\- --------- ---- --- Street, A t No.; or PO Box No.rl �� !�L-�cLQ-a-. A--------------------------------- __J 7S Form city, siate,zlP+4. �ynb`c�c�l�, , Ifs :rr August 2006 1153 See Reverse for Instructions -Name: STATE OF NEW YORK COUNTY OF SUFFOLK PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS residing at being duly sworn, deposes and says that on the day of , 20_____, deponent mailed a- true copy of the.Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at , that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this Day of , 20 Notary Public John Bredemeyer, President %UFFOIt Michael J. Domino, Vice -President oro�o °<%� James F. King x Dave Bergen �y • '� Charles J. Sanders BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of LEWIS & HELAINE TEPERNIAN 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 APR 2 0 2015 `w ` AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR EIGHT DAYS _ Creative Environmental Design <<c_Z, residing at /dba®Box 160 Peconic, NY 11958 being duly sworn, depose and say: That on the i D day of (���` , 201 , I personally posted the property known as q_1—x 11 `Vi2�rW,.jn 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, April 22, 2015. Dated: q_ fU—/5 (signa ure) Sworn to before me this A0 t" day of Apr.1 20 15 TRACEY L. DWYER NOTARY PUBLIC, STATE OF NEW YORK NO. O1 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30, 2 01 NUTlt,t uim HLAKING NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: LEWIS & HELAINE TEPERMAN SUBJECT OF PUBLIC HEARING: To rebuild in-place existing 24'x32' deck attached to dwelling. TIME & ®ATE OF PUBLIC HEARING: Wednesday, April 22, 2015 — 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 B -d of Trustees Application County of Suffolk State of New York BEING DULY SWORN DEPOSES AND A FIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN.THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature of Property Owner SWORN TO BEFORE ME THIS 2 r4 DAY OF MM ,20 %Jf C r'-4 L/&U Notary Public CONNIE D. BUNCH Notary Public, State of New York No. 01 BUe165050 QuaWW in Suffolk County Commission Expires April 14, 2 —(O/ ('o B, d of Trustees Appli.catior. AUTHORIZATION (where the applicant is not the owner) residing at (print owner 'property) (mailing address) 5� l do hereby authorize c (Agent) vt (-,-Z, to apply for 1 permit(s) from the p ( Southold Board of Town Trustees on my behalf. wner's 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 purpose 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 necessary to avoid same. YOUR NAME: )�j �i °� C.•i l U� (Last name, first name, Viddle 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 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%oft 61 shares. YES NO V If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself (the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): A) the owner of greater than 5% of the shares of the corporate stock of the applicant (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 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 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 SCTM#_ - -� PROJECT NAME The Application has been submitted to (check appropriate response): ��/ Town Board El Planning Board ❑ Building Dept. ❑ Board of Trustees E 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: a y Y_ Location of action: Site acreage: 1 D 11-1 Present land use: f Present zoning classification: V, -47 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: oco Z,5 b . (c) Telephone number: Area Code ( (d) Application number, if any: �), l --�— � Will the action be ectly undertaken, require funding, or approval by a state or federal agency? Yes ❑ No If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. 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 LVVRP 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 —Poli 1:1 Yes Pages 3 through 6 for evaluation criteria Yes 1:1No 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 —=otApplicable ages 6 through 7 for evaluation criteria F-1Yes ❑ No 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 I — Policies Pages 8 through 16 for evaluation criteria ayes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 5. Protect and impro a water quality and supply in the Town of Southold. See LWRP Section III — Policies Pages 16 throug 1 for evaluation criteria El Yes 1:1Applic No of able 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 Api' able 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 ev uation criteria. F-1Yes❑ 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. e LWRP Section III — Policies; Pages 34 through 38 for evaluation criteria. 1:1 Yes 1:1 No Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town o Southold. See LWRP Section III — Policies; Pages 38 through 46 for evaluation criteria. ❑ Ye,0 No Not Applicable Attach additional sheets if necessary WORKING COAST POLICIF Policy 10. Protect Southo 's water -dependent uses and promote siting of new water -dependent uses in suitable locations. See RP 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 wat s. See LWRP Section III — Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes 1:1No 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 eva:Not tion criteria. 11Yes 1:1 No Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III — Policies; Page 5 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable o,W_ PREPARED R1 i imll M_ TITLE3�,6 -DATE 3 N L ANG ISLAND SOUN I ; I , I ; I I I I I I I I I 1 I , I I I i I I I F /L7777�-' ------- - - - - -- ST It A 1 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I VIE -APPROVED WARD OF TRUSTEES 1 10W OF'-SOuTHous APR - 2 2015 <; 41 N- Revision Sucle: an, Date. 41212015 11 " = 10 ' Tie p erman I I ,I -- el l o I - -------------- - el 12 14 -; --- --�-- --- - -- ---e �s 20 - ---- -- a 8 22 ------- ► ---------------- e124 -------- ---- , -- - --- ells — ---- -- - - --- el 2s el 36 -- ------ e138 -- ------ e140 --------------- e142 APPROX. BOTTOM OF BLUFF -------------- e144 APPROX TOP ENLE EXISTING PRIVFTE OF BLUFF -- — — ---------- COASTAL EROSION HAZARD LINE 1 I I I I i I I I I I I I I I I 1 I I I I I i I I I 5c-rm# 1000-2T-2-16 Landscape Design by. David Cichanowcz CreativeCreativeEnvironmenial Design