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HomeMy WebLinkAboutTR-8643A �pF SOUr�, Michael J.Domino,President h0� Ol0 Town Hall Annex John M. Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith • �� Telephone(631) 765-1892 A.Nicholas Krupski '00UNTV Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1326C Date: April 5, 2017 TRIS CERTIFIES that the existing 20'3"x30'6"wooden barn;patch the roof at the back end; replace rotted studs and sistered new studs to existing;replace rotted rafters and wood siding; and floated cement on existing slab footprint to make level; At 3500 Cox Neck Road, Mattituck Suffolk County Tax Map#1000-113-8-1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated June 26, 2015 pursuant to which Trustees Administrative Permit#8643A Dated July 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 the existing 20'3"x30'6"wooden barn; patch the roof at the back end; replace rotted studs and sistered new"studs to existing; replace rotted rafters and wood siding; and floated cement on existing slab footprint to make level. The certificate is issued to JOSEPH LAVELLE. owner of the aforesaid property. ' Authorized Signature �pf SOUly Michael J.Domino,President � Ol0 Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J.Sanders y Southold,New York 11971 Glenn Goldsmith ® �� Telephone (631) 765-1892 A.Nicholas Krupski �lif'COUf Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: ,IS�I� Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction Y2 constructed V Project complete, compliance inspection. INSPECTED BY: G. C" JIM A COMMENTS: —FC6,r>'-� �f,ain CERTIFICATE OF COMPLIANCE: John M. Bredemeyer 111, President O�OguFFQ(,�-c Town Hall,53095 Main Rd. Michael J. Domino, �G P.O. Box 1179 Vice-President �� �� James F.King y Southold,NY 11971 Telephone 631 765-1892 Charles J. Sanders y � �� P ( ) Dave Bergen �Ol O 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 % constructed Project complete, compliance inspection *®f S®(7j� John M. Bredemeyer III, President ®A' „ow ®�® Town Hall Annex `` 54375 Main Road Michael J.Domino,Vice-President R• • d . i P.O. Box 1179 James F.King,Trustee CA >;,, a Southold, New York 11971-0959 Dave Bergen, Trustee ® a Telephone (631) 765-1892 Charles J. Sanders,Trustee ��`'®U �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8643A Date of Receipt of Application: June 26, 2015 Applicant: Joseph Lavelle SCTM#: 113-8-1 Project Location: 3500 Cox Neck Road, Mattituck Date of Resolution/Issuance: July 22, 2015 Date of Expiration: July 22, 2017 Reviewed by: Board of Trustees Project Description: To for the existing 20'3"x30'6" wooden barn; patch the roof at the back end; replace rotted studs and sistered new studs to existing; replace rotted rafters and wood siding; and floated cement on existing slab footprint to make level. 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 site plan prepared by Joseph LaVelle, received on June 26, 2015, and stamped approved on July 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. 0 1P John M. Sredemeyer III, President Board of Trustees John Bredemeyer, President �o%UFF01,te Town Hall Annex Michael J. Domino, Vice-President 54375 Route 25 James F. King y = P.O. Box 1179 Charles J. Sanders o • IV Southold, NY 11971 Dave Bergen y�ol ,� �a0- Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: fl ?_0 /, � 6 JOSEPH LaVELLE requests an Administrative Permit for the existing 20'3"x30'6" wooden barn; patch the roof at the back end; replace rotted studs and sistered new studs to existing; replace rotted rafters and wood siding; and floated cement on existing slab footprint to make level. Located: 3500 Cox Neck Road, Mattituck. SCTM# 113-8-1 Typepf-area to be impacted: °/Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland --/-- a f Part of Town Code proposed work falls under: C ah pt.275 Chapt. 111 other Type of Application: � Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No c,- of Applicable Storm Water Management Review: Yes No Not Applicable Info needed: Modifications: �(/'} �'/ A) LO Pn C'r T U A Conditions: A 4--4,- D hl Flo 0r 119(lzi IJ7` Present Were: J. Bredemeyer M. Domino LJ. King D. Bergen C. Sanders Bay Constable Other Form filled out in the field by Mailed/Faxed to: Date: i t � i f• R .. jlw t • r T L JUN 2 6 2015 J r s, III J JUA12 6 2015 ^N, Ivo p I I , sFE SEGNO.iUO sEE raRwN 1 '� i NnrcN t�uNl ,SMcl1 �'"Mct\\ / � 1 ` SEE sE xin NnrcN Z ONE NnrcN - re Lx+Es y°^ yN� 1, x C +>,�+\ wrcN-.uN oR PCL. \ - o r5 +gin FOR PCL No ` \� mstw w 'EC i° ! \ ° trLq Im s.1 o�ilm EOR PCL xo. s 5-05E.rq 5 1.a l t.]Hcl 1^ a OR PCL NO l MI o'+ 5�0 > iE`E°xRE.°O°„w k a / �s00t III / e ] a.aaoe , I.cr.�ul .o�rN RPCO `�� ft-c. of aarm ,m bP r a� iWl°` it SEEPCL NO EESEC pN0 Ii �' 9 f^�,w W•t"„ , • t, \ LN 2.=I N ,� tP^� M1+ maxxina.usENE"rl \ [fvadLEM+grr]A N Y 7 B,l rt �pFl a R e RSMcI ?d' FOR PCL.NO SII SEEE.0 NO. ` .A I 5sA S.On P 6 +y+P P p1siin COn"uns oO�>AiSrEHO,N OR v t, + M sEEp SEC NO \\ / l' S -----------— ° M. - IINE �„ NI110N �-- ONE °+P 18PLq INo' O � " E.0 NO IV ,gyp SEESVC o.tz, MIDDLE RD L ...,� �... .. .., -O-_ o..� --.w-- +..u. _-.__ NOTICE ur _�_ ^ Is l ,]""r'r.� COUNTY OF SUFFOLK © N. sarrNOEO SECTION NO °"" - Y �� _ " �� ,y Real Property Tax Service Agency v1.4 113 E ______ —-- -- -- 19�yln LG ccumr Gn,n a".rINN,NYnwr M t Nt N mar --•-- o..�..--•-- ? A O..n.. n n,N. '� --_— m --.-- o."...--w-- n."my ✓-1.. P t ru[t ra 1000 PROPERTY MAP OFFICE LOCATION: ® MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 Q a� Telephone: 631 765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM 2015 To: John Bredemeyer, President Town of Southold Board of Trustees �--- From: Mark Terry, Principal Planner "-- LWRP Coordinator —- Date: July 20, 2015 Re: Proposed Wetland Permit for JOSEPH LaVELLE SCTM# 1000-113-8-1 JOSEPH LaVELLE requests an Administrative Permit for the existing 20'3"x30'6" wooden barn; patch the roof at the back end; replace rotted studs and sistered new studs to existing; replace rotted rafters and wood siding; and floated cement on existing slab footprint to make level. Located: 3500 Cox-Neck Road, Mattituck. SCTM# 113-8-1 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is EXEMPT from LWRP review pursuant to: § 268-3. Definitions. MINOR ACTIONS items "B" and which states: B. Replacement, rehabilitation or reconstruction of a structure or facility, in kind, on the same ss`1t6" (inplace), including upgrading buildings to meet building or fire codes, except for structures in areas designated by the Coastal Erosion Hazard Area (CEHA) law where structures may not be replaced, rehabilitated or reconstructed without a permit and shoreline erosion control structures (including, but not limited to, groins,jetties, bulkheads, filled piers) located within Great Peconic Bay, Cutchogue Harbor, Little Peconic Bay, Hog Neck Bay, Noyack Bay, Southold Bay, Shelter Island Sound, Pipes Cove, Orient Harbor, Gardiners Bay, Long Island Sound, Fishers Island Sound and Block Island Sound (excluding all creeks); 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 4 I- 4w vir�J - AOP Io 4P WO lo 'girs'LY James F. King,President *of SO(/jy® Town Hall Annex Bob Ghosio,Jr.,Vice-President 54375 Main Road h O P.O.Box 1179 Dave Bergenlil Southold,New York 11971-0959 John Bredemeyer Michael J.Domino � • �O Telephone(631) 765-1892 Q Fax(631) 765-6641 �yCOUNT`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD } ' To: Southold Town Building Department �%NJUL - 6 20711 ,0 Re: Verification of Building Department Permit Requirements - g,Dr hEpr SCTM#: Property Owner Name: -To2;2)i Lo-Vo-flP_ Date Sent to Bldg. Dept.: 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 the proposed project require a Building Permit? Will the proposed project require a variance determination from. Zoning Board of Appeals? Will any part of this application be considered as Demolition as described under Town Code? COMMENTS: Signature of Reviewer r Date John M.Bredemeyer III,President �'®F S® /y® Town Hall Annex Michael J.Domino,Vice-President �® l® 54375 Main Road P.O.Box 1179 James F. King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee G yo Telephone(631) 765-1892 Charles J. Sanders,Trustee Ol�Couff Fax(631) 765-6641 BOARD OF TOWN TRUSTEES C f TOWN OF SOUTHOLD F' �J Office Use Only JUAJ 2 6 2415 _Coastal Erosion Permit Application _Wetland Permit Application Administrative Permit Amendment/Transfer/E tension Received Application: 1-s Received Fee:$ OU Completed Application / _Incomplete _SEQRA Classification: Type [—Type II Unlisted Coordination:(date sent) fWLWRP Consistency Assessment Form — _CAC Referral Sent: jo_Date of Inspection: _Receipt of CAC Rep rt: _Lead Agency Determination: _Technical Review: Public Hearing Held: 7 Resolution: Name of Applicant C3 Is Nz-V Mailing Address 3 C�;0 T3 C® XKje C� �'+ Tt-►T�C. N 1 � 'ni 5c'�- Phone Number:( Suffolk County Tax Map Number: 1000 - Property 000 -Property Location: N I ti �C\ (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: B d of Trustees Applicatiox GENERAL DATA Land Area(in square feet): Area Zoning: Do,v� C l PA- Previous use of property: Intended use of property: S C 0 (Z Covenants and Restrictions on property? Yes °' No If"Yes",please provide a copy. /` Will this project require a Building Permit as per Town Code? I/ 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 V 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 No 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 Description (use attachments if necessary): f-, C-R It, v\ )C.1 ST �G © Y\ o6-T (2-Cv1kv-. Bot of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: V")'e-R PA,19— Y" Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No Yes If yes,how much material will be excavated? !�J (cubic yards How much material will be filled? VV I cubic yards Depth of which material will be removed or deposited: t,-) 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): 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): Brief Description of Proposed Action: r G k0&P- F Lc>FiQ-v� C%�->Ake_A Cs N t-'I-ls- t 1 5 VVQ2> ®oma- i?(Z4 VX7 c��' 3 i x. 30, Name of Applicant or Sponsor: Telephone: 6 :� I ti q �r S-6 `T -To S ccs e E-Mail: I A_V 21 I tT�3 ®(}a L,Cu yn Address: '3 Sid C)Y, City/PO: State: ,� i 1C`od 5 � 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, EES ES 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. 1f no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? If Yes,list agency(s)name and permit or approval: ❑ 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? <D 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. F-1 Urban El Rural (non-agriculture) ❑1ndustrial ❑Commercial $L1 Residential (suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES -N/A a.A permitted use under the zoning regulations? ❑ ff 1:1 b.Consistent with the adopted comprehensive plan? ❑ ❑ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES 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: PT ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES U ❑ b.Are public transportation service(s)available at or near the site of the proposed action? N1:1 ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed acti n? ❑ ❑ 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: El Ef 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: 4 ❑ 11.Will the proposed action connect-to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: v I ❑ ❑ 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? ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline El Forest ❑ ricultural/grasslands El Early mid-successional ❑ Wetland El Urban Ciguburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO ES 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 If Yes, ❑� a.Will storm water discharges flow to adjacent properties? O ❑YES b.Will storm water discharges be directed to established conveyance systems(eN and storm drains)? If Yes,briefly describe: ]YES 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: ❑ ❑ 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? 1-1 If Yes,describe: Zr F I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE r ` -- Applicant/sponsor name: �� `\ Date: �' �� 0 `� 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 infonnation contained in Part l 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 ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? I Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? 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. EICheck 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 Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 APPLICANUAGENUREPRESENTA.TIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and emplo ees.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 necessary to avoid same. YOUR NAME: (Last name,first name,-priddle 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 e rj (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 employ a has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 50 f the shares. YES NO Ifyou 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 Submitted this day of `' E'r-2 2067 Signature Print Name_T S e� Form TS 1 El d of Trustees Applicatio County of Suffolk State of New York S I;E V --� 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. S' ature of Property Owner SWORN TO BEFORE ME THIS DAY OF C)�—Q ,20 Nbta?y4ublic LUCY JULIA SCHLOESSER Notary Public,State of New York Qualified in Suffolk County Reg.No.01SC6225435 My Commission Expires 07-19-20 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 SCTM# I - 1 .13 - - 1 PROJECT NAME P ,> The Application has been submitted to (check appropriate response): ] Town Board ❑ Planning Board❑ Building Dept. Board of Trustees LJ I. 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: �� tSvcv� c�'GZ�v,� P Location of action: L l 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: l (a) Name of applicant: (b) Mailing address: C� y'C, (c) Telephone number: Area Code (d) Application number, if any: Will the action bedi 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, make fficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects f development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 2. Protect and pres rve historic and archaeological resources of the Town of Southold. See LWRP Section III—Polici Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 3. EnhancegNot l uality and protect scenic resources throughout the Town of Southold. See LWRP Section III— i Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No 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 Pag 8 through 16 for evaluation criteria 1:1Yes 0 No Not Applicable Attach additional sheets if necessary Policy 5. Protect and imp/roveW water quality and supply in the Town of Southold. See LRP Section III —Policies Pages 16 throw h 21 for evaluation criteria El Yes 1:1 No Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish 4nd Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluatio criteria. ❑ ❑ Yes No Not Applica-.ne Attach additional sheets if necessary Policy 7. Protect and i rove air quality in the Town of Southold. See LW" Section III — Policies Pages 32 through 34 for aluation criteria. Yes No Not Applicable Attach additional sheets if necessary Policy 8. Minimize en ronmental degradation in Town of Southold from solid waste and hazardous substances and wastes See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No Not Applicable. PUBLIC COAST POLICIES Policy 9. Provide for pu lie access to, and recreational use of, coastal waters, public lands, and public resources of the Town Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ((�� ❑ Ye�---1 No Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Sout 1d's water-dependent uses and promote siting of new water-dependent uses in suitable locations7NoZlicable Section III Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes F-1No Attach additional sheets if necessary Policy 11. Promote s ainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town wa rs. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No Not Applicable ` Attach additional sheets if necessary Policy 12. Protect agri ltural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for ev 11 ation criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 13. Promote ppropriate 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 TITLE DATE -- -- ---- --- ----- --- ® - -- - - - - --- -- - - -- - -------- -- -- -- ---- - - - --- - - APPROVED-BY - = --- --- - - - - -------- -�----- Q.,.--�,°-,BOARD-OF-T-RUSTEES-------- --- ---- ---------- - - ---- TOWN OF SOUTHOLD - -- - - - - - - -- -- - -- - -- ----- -------- -- --- i SURVEY OF DESCRIBED PROPERTY SITUATED AT OWN FCKKOUTHOLD �1Qc► SUFFOLK COUNTY, NEW YORK ��` S.C.T.M. N0. 1000-113-8-1 UPLAND AREA = 23,830 SQ. FT. yy MUST. ELEVATIONS ARE OR ERAAGE D. 2,058 SQ T FT/8.6% GUARANTEES OR EASEMENTS NOT SNOB D UTILITY POLE WM77TIR(14TIONS ARE NOT ONS ARE NOT GUAR UTILITIES v �I THE OFFSET DIMENSION SHOWN HEREON FROM THE STRUCTURES 70 THE PROPERTY LINES a,Y ARE FOR SPECIFIC PURPOSE AND USE;THEREFORE ARE NOT INTENDED TD GUIDE THE tf ERECDON OF FENCES RETAINING WAU.%POOLS, PAWS PLANTING AREAS, W W I ..�, ADDITION TO BUILDINGS AND OTHER CONSTRUCTION. THE DaVENCE OF RIGHT V OF WAYS, WETLANDS AND/OR EASEMENTS OF RECORD,IF ANY.NOT SHOWN ARE NOT GUARANTEED U9 7R OF7E NEW Yam STATE EDUCAT770M OR ADDITION TV 77i/S ION SURVEY IS A VIOLA77ON OF COPIES OF THIS SURVEY MAP Voy, NOT 1 \ MON B SYN OF ovr _RL O1 NOT BE CONSIDERED A TRUNG THE LAND E COPY TURE AND RED INK OR EMBOSSED SEAL SHALL 10.7' PD. .S° o , UTBOLD ALL LOCATIONS OF AND DISTANCES Ta WELLS AND CESSPOOLS ARE BY LOCATIONS 4 18 00 nE 156. 07HOERS HOMEOWNERS, ARE NOES�BLE THESE ATIONS LOCATIONOR S AND DIMENSIONS CANNOT 5' .�° FROM o —DR BE CERDFIED. c` Ci 30.6 ~\ \ i cam_ EL.2.9 i - .. ~ �-►• B ��\ \\ \\ / � �'�'��,�v \ 1\) s R® �\ �q~ o Z �tiu c� FEZ 1 40.7/ c�.i T SE ® \\` ®��l �`�'�' 30.1' \\ �\ 1�, g1�0�� I `\WOODED w' t MATTiTUCK DR/ ®� —_ _ !3 \\ CO 0 = EL.9 8' \ / \ �J LL VSs CREEK / ii iii_JJJ_ „� it �� jy RFvr `- ' ` a (HD yPARDS BRANCH) �. `�' ID�') C.L.EL.16.dt l� T 8 D-�'f"AY \ �� ------� _--�\ 'd'so 009' o. k0 d o WELL FOOD C 29.7 26. EL.15.B' \ \ a C� ^ r\C�^ ^^^^n^^^n ^ �•� \ �j ��`? �i�', 4 \ \ C ST0'z3. 2 S m \ \ �j' U.P. �'� O� (2.5 s3.7') D G 30. \ \ �1�✓\ CC \\ ED \\ EL 2.9' \ \ p s� 3500 2 ��—�s (< -WOOD \ 7� pppg I S77' c� q/�51 26.5 W CRq 5B.4'I FFEB' Bf —pp��—�* \ � � \\\�\ \ \ tVIV L [NYU DECK' �C-C, IroOD w \ Cq Y 07 251 71346 Ova CZ EL 24.1 N JO� EL.24.T �� � - IEpS D WIS& PAT T. SECCAFICO 16 FD'MoN" PROFESSIONAL LAND SURVEYOR, P.C. - SUCCESSOR TO - w DONALD TASE, L.S. a RICHARD WILHELM AND ASSOCIATES w NORTHSTAR SURVEYING, P.C. PAUL T. CANALIZO, L.S., ROBERT A. KART, L.S. GOOD GROUND SURVEYORS, P.C. 328A Main Street Hampton Atrium Unit D-4 Center Moriches, NY 11934 186 W. Montauk Highway Hampton Bays, NY 11946 on Phone: (631) 878-0120 Phe: 631 728-5330 Fax: (631) 878-7190 Fax: f 631) 728-6707 N.Y.S. LIC. NO. 049287 COPYRIGHT - 2012 PAT T. SECCAFICO P.L.S., P.C. FILE NO. 51067 SCALE. 1” 30' DATE: 02/08/2012