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HomeMy WebLinkAboutTR-8656A Glenn Goldsm President o��S1lFF0(,�e Town Hall Annex A. Nicholas Krupski, Vice-President „� �� 54375 Route 25 John M. Bredemeyer, III N P.O. Box 1179 Michael J. Domino o ^� Southold, NY 11971 Greg Williams y� a��� Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in field by: o""05 willl JOSEPH & KRISTINA OTTOMANELLI request aTransfer of Wetland Permit#8656A from David Schab to Joseph & Kristina Ottomanelli, as issued on August 19, 2015. Located: 250 Midway Road, Southold. SCTM#: 1000-90-1-9 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 -&/""-Ch. 111 SEQRA Type: I II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: R I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. redemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other Authentisign ID:F3A901FC-74A0-0265-9A7D-90C4 E C E C! E Joseph & Kristina Ottomanelli UAR 2 4 2021 116 Oxford Blvd. Garden City, NY 11530 Southold Town 917-306-2208 Board of Trustees March 22, 2021 Town of Southold,Trustee Department P.O. Box 1179 Premises: 250 Midway Road, Southold Southold,NY 11971 Tax Map#: 1000-90-1-9 Dear Board of Trustees: Please let this letter serve as written acknowledgement that Joseph&Kristina Ottomanelli are the current owners of the above-mentioned property. Attached,please find a copy of the current deed. At this time,we request the Trustee permit# 8570 & 8656A be transferred into our names. I understand and give permission to the Trustees to enter my property for an inspection. Enclosed, please find a check for$100.00 for the necessary fees involved to achieve this transfer. If you have any questions or concerns in reference to this request,please contact My Broker, Thomas J.McCarthy at 631-765-5815. Thank you in advance for your prompt attention in this matter. Sincerely, CAu enfisicrr 1�' 17 PPM'EDTi Joseph Ottomanelli Authenfis crr I �iiawea.VU#Maadfi —1-1 a•an•zo ou Fnr Kristina Ottomanelli • BARGAIN AND SALE DEED WITH COVENANT AGAINST GRANTOR'S ACTS(INDIVIDUAL OR CORPORATION) STANDARD NYBTU FORM 8007 CAUTION:THIS AGREEMENT SHOULD BE PREPARED BY AN ATTORNEY AND REVIEWED BY ATTORNEYS FOR SELLER AND � y_{ PURCHASER BEFORE SIGNING. THIS,INDLNTQ ir,•niado-the. 14W, day of 6\)f 2021 .1. �l i vt l �'n�:Zy' 4&rF ,Zo' . between Davrd�chab And,Ancl Kaminer,as tenant by-the tnt►rety,residing at 30 West 13th Street, Apartment 3A,New York,New ork 10011 party of the first part,and Joseph Ottomanelli and Kristina Ottomanelli,as husband and wire,residing at 116 Oxford Boulevard,Garden City,New York 11530 party of the second part, WITNESSETH,that the party of the first part,in consideration of Ten Dollars and other valuable consideration,paid by the party of the second part,does hereby grant and release unto the party of the second part, the heirs or successors and assigns of the party of the second part forever, ALL that certain plot,piece or parcel of land,with the buildings and improvements thereon erected, situate,lying and being in the SEE SCHEDULE A ATTACHED(DESCRIPTION OF PREMISES) Said premises is being and intended to be the same premises described in a certain deed from Belle View,LLC to David Schab and Ariel Kaminer,as tenants by the entirety,dated 5/31/2011 and recorded 6/13/2011 in Liber 12662 Page 592. TOGETHER with all right,title and interest,if any,of the party of the first part in and to any streets and roads abutting the above described premises to the center lines thereof, TOGETHER with the appurtenances and all the estate and rights of the party of the first part in and to said premises, TO HAW AND TOHOLD the premises herein granted unto the party of the second part,the heirs or successors and assigns of the party of the second part forever. AND the party of the first part,covenants that the party of the first part has not done or suffered anything whereby the said premises have been encumbered in any way whatever,except as aforesaid. AND the party of the first part,in compliance with Section 13 of the Lien Law,covenants that the party of the first part will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose. The word"party"shall be construed as if it read"parties"whenever the sense of this indenture so requires. EV WITNESS WHEREOF,the party of the first part has duly executed'this deed the day and year first above written. 17V PRESENCE OF. Davi c uab iellCnmiuer / . NYSBA RWdmtiai Real Estate Forms on HotDocs'(9/00) Copyright Capsolf Development M State'of IVeiv York ) Cauaity'of On this. 'T day of�2 � , 2021,before me,the undersigned,personally Appeared David Schab.and Ariel Kaminer,personally. 6**to rile or proved to me on ihe•basis of satisfactory evidence to the be individuals whose navies aro subscribed to the within instrument and acknowledged to me that they executed the same in their capacities,and that ' t air-signatures,on the instrument,the individuals,or the person upon behalf of which the individd,executed the instrument Nrata' lie DYLAN SHOWN NOTARY PUBLIC-STATE OF NEW YORK No.01BR6367521 Ousllfled in Queens County My Commission Expires 11-20-2021 1 NYSBA Rcsidcntlel Real&vato Forms on HolDoce(9/00) CopyfiBht Cepsofe Development -2- 11 1 1ir�E Title Number; 71136668 SCHEDULE A—DESCRIPTION ALL that certain phot,oieee or paucel:gf land,situate,lying and beuig'et Cedar Beach,-near,Sotuthold,.in the Town of Southold,_County of Suffolk,and State of New York,.k nown and designated.as Lots 141 and 142 and Bart of Lot 143 on s certain ltiap entitled,"Subdivision Map.of Cedar Reach Park situated at Bayview,Town of Southold,New You&";_tiiade:September 15,1926 by Otto W' .Gari Tuyl,Pidfessional- Engineer aind Surveyor,License No.168-2,Arid which map i§filed in the Suffoll-Count Clerk's CQifice as and 15-lap No.90,said Lots-and part of Lot,being bounded and described.as.follows: BEGINATNrG at it point on.the westerly side of West Labe Drive distant 75.91 feet northe*f�bm the extreme norther27'end.of the arc of a curve con_nectin'gthe northeAj side of West Lake Drive Rzth the westerly side of West Lake Drive; RUZr'NL\TG THENCE along lands now or formerly of Sowinski the following three(3)courses and distances: 1. North 70 degrees 43 minutes 50 seconds West,133.13 feet; 2. South 24 degrees 13 minutes 10 seconds West,24.00 feet; 3. North 64 degrees 17 minutes 27 seconds West.130.00 feet to the high-water mark of West Lake; THENCE along the high-water mark of West Lake the following three(3)courses and distances; 1. North 01 degree 49 minutes 37 seconds West,31,88 feet; 2. \Torth 05 degrees 00 minutes 06 seconds West,29.43 feet; 3. North 22 degrees 40 minutes 59 seconds East,134.34 feet to land now or formerly of Kaminer; THEN@E along said land of Kaminer,South 70 degrees 43 minutes 50 seconds East,231,10 feet to the x ester�l-side of liidwap Road; THENCE along the westerly-side of Midway Road the following two(2)courses and distances: L South 04 degrees 44 minutes 30 seconds East. 109-47 feet: 2. South 19 degrees 13 minutes 10 seconds East,23.06 feet to the westerly side of West Lake Drive; THENCE along the westerly side of West Lake Drive,South 21 degrees 14 minutes 40 seconds West. 82.00 feet to the point or place of BEGINATING. FOR CONMANCING ONLY:TOGETHER with all right,tide and interest of the party of the first part,of,in and to any streets and rads abetting the above described prerriues to the center lines thereof. Schedule A Description(Page 1 of 1)- John M. Bredemeyer III,President ®F s®(/��® Town Hall Annex l 54375 Route 25 Michael J.Domino,Vice-President �® ® P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski Telephone(631) 765-1892 Charles J.. �'®UNT�,�� Sanders ® _ Fax(631) 765-6641 l� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1262C Date: September.l, 2016 THIS CERTIFIES that a Ten(10)Year Maintenance Permit to hand-cut Common Reed(Phragmites australis) to 12"in height by hand, as needed. At 250 Midway Road, Southold Suffolk County Tax Map#1000-90-1-9 Conforms to the application for a Trustees Permit heretofore filed in this office Dated August 3, 2015 pursuant to which Trustees Administrative Permit#8656A Dated August 19, 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 a Ten(10)Year Maintenance Permit to hand-cut Common Reed(Phragmites australis)to 12"in height it by hand, as needed. The certificate is issued to DAVID SCHAB owner of the aforesaid property. Authorized Signature suf�ocx�y John M. Bredemeyer III, President 'o�� oo� Town Hall Annex Michael J. Domino, Vice-President :��a y� 54375 Route 25 Glenn Goldsmith '.N ,�}Yi P.O- Box 1179 A. Nicholas Krupski ® Southold, NY 11971 Charles J. Sanders 'dl , ���r Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DAT E OF INSPECTION: q t,'14 Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction % constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: 0 K, ,�- CERTIFICATE OF COMPLIANCE: John M.Bredemeyer III,President ®� S® y®l® Town Hall Annex Michael J.Domino,Vice-President 54375 Main Road P.O.Box 1179 James F.King, Trusteecoo Southold,New York 11971-0959 Dave Bergen,Trustee a Telephone (631) 765-1892 Charles J.Sanders,TrusteeFax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8656A Date of Receipt of Application: August 3, 2015 Applicant: David Schab SCTM#: 90-1-9 Project Location: 250 Midway Road, Southold Date of Resolution/Issuance: August 19, 2015 Date of Expiration: August 19, 2017 Reviewed by: Board of Trustees Project Description: Ten-Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to 12" in height by hand, as needed. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the project plan submitted by Henry Kaminer, received on August 3, 2015 and stamped approved on August 19, 2015. § 275-5 Permit procedures. (i) Cutting of common reed (Phragmites australis) to within 12 inches of the soil surface landward of the wetland boundary. This does not include mowing to ground level. Special Conditions: Do not disturb native vegetation during the hand cutting of Common Reed (Phragmites australis), including but not limited to; Eastern Red Cedar(Juniperus virginiana), Northern Bayberry (Myrica pensylvanica), Marsh Elder(Iva frutescens), and Groundsel Bush (Baccharis halimfolia). The approved operations must be commenced within two (2) years from the date of the resolution. The permittee is required to provide the Trustees with before and after photos of the area within this time period before any further maintenance is conducted. 2 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 ' t a deter in tion from any other agency. T John M. Bredemeyer III, President Board of Trustees John M. Bredemeyer 111, President Town Hall,53095 Main Rd. �G Michael J. Domino, Vice-President P.O.Box 1179 �� �� James F. King y Southold,NY 11971 honelee Charles J. Sanders y « !� TP (631)765-1892 Dave Bergen 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 1 st day of construction % constructed Project complete, compliance inspection John Bredemeyer, President guFF01,pTown Hall Annex Michael J. Domino, Vice-President 54375 Route 25 James F. King ti P.O. Box 1179 Charles J. Sanders o Southold, NY 11971 Dave Bergen 'oi ,�, �a Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: ,, � J y , ?� S-- Henry Kaminer on behalf of DAVID SCHAB requests an Administrative Permit for a Ten (10) Year Maintenance Permit to hand-cut the Common Reed (Phragmites australis) to not less than 12" in height by hand, on an as needed basis. Located: 250 Midway Road, Southold. SCTM# 90-1-9 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Zay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Viola/tion Notice of Hearing card posted on property: Yes No ✓ Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed: Modifications: Conditions: Present Were:_ZJ. Bredemeyer �M. Domino VJ. King Bergen C. Sanders Bay Constable Other Form filled out in the field by Mailed/Faxed to: Date: James F.King,President ®����ry� Town Hall Annex 01 Jill M.Doherty,Vice-President 54375 Main Road Peggy A.Dickerson P.O.Box 1179 41 Southold,New York 11971-0959 Dave Bergen Bob Ghosio,Jr. Telephone(631) 765-1892 Fax(631)'765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD " Permit No.. 7119A Date of Receipt of Application: May 29, 2009 Applicant: Henry Kaminer ! J SCTM#: 90-1-9 AUG - 3 2015 Project Location: 250 Midway Road, Southold Date of Resolution/issuance: June 24, 2009 Date of Expiration: June 24,2011 �- Reviewed by: Trustee Peggy Dickerson Project Description: To trim the phragmites to 12" by hand, as needed. 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 Henry Kaminer, and received on May 29, 2009. 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. )James F. King, � resident Board of Trustees JFK:eac - IMG_1127.JPG https://mail.goog] ii/_/scs/mail-static/Jjs/k=gmail.main.e... } + "f 1 ,rry yew �ao�` We st FROM dLvr is AUG - 3 2015 G�M TE-5 2 2-o y 1 of 1 7/29/15, 11:28 AM IMG_1128.JPG https://mail.googl �_/scs/mail-static/_/js/k=gmail.main.e... 1 vi-ek) J_V7 �c Y4 2s) L-b i� 5-0 c) � Jul � - � �,� AUG 3 2015 1 of I � 7/29/15; . AM IMG_1158.JPG https://mail.goog n/_/scs/mail-static/_/js/k=gmail.main.e... View S � ISO' Mlc -w att TqA C �, , ,r,5 AT 2-so �, �� U/,-y So u Ll AUG lb 3 2015 "'rte - Sys_: 7/29/15 1 :20 AM 1of1 __ zap a szw osno� pzaa AF CEDAR Po1w wm \ 'a� �'Q 3 •c 1_3 z bl! ,pKESmE� nn c. ,• x u art s �i n a u t.znal � + z e ° of ♦ a ------------------- t tgv.N OE y Z rr oEDAR a�� O IIA rowN OF souTMlxu ,,,� Po/N7 )+ - a r° r a 110 r J n� WEST !ME m1 e � b C ♦e V' ° f P W WtE • `a �' / X1 ,a n xt 23 NOG NECK \ BAY E u... —�— ...,n.....,.,. (xt) O ,,. ._— _ ° m NOTICE caa COUNTY OF SUFFOLK © K or Sp„TM� SECTION No c y ------ ^-�a-�- ...W -- a...,.._ __ Real Property Tax ServiceAgency v a..,«a.,aea 090 ' r 1 l � OFFICE LOCATION: a®�*0 S®UT�®1 MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) �r Southold, NY 11971 ® a®� Telephone: 631 765-1938 ®lyc®UNTY,�c� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM L = f; AUG 12 2015 n , To: John Bredemeyer, President Town of Southold Board of Trusteeslo_d From: Mark Terry, Principal Planner LWRP Coordinator Date: August 12, 2015 Re: Local Waterfront Coastal Consistency Review for DAVID SCHAB SCTM# 1000-90-1-9 Henry Kaminer on behalf of DAVID SCHAB requests an Administrative Permit for a Ten (10) Year Maintenance Permit.to hand-cut the Common Reed (Phragmites australis) to not less than 12" in height by hand, on an as needed basis. Located: 250 Midway Road, Southold. SCTM# 90-1-9 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 actions are EXEMPT from LWRP review pursuant to: § 268-3. Definitions. MINOR ACTIONS item "FF"which states: FF. Cutting phragmites to greater than 12 inches and vegetative restoration, provided that native wetland vegetative species are not affected or disturbed in any manner, 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 ti John M.Bredemeyer III,President �0f SyO Town Hall Annex Michael J.Domino,Vice-President �O l0 54375 Main Road P.O.Box 1179 ' James F.King,Trustee C00- Southold,New York 11971-0959 Dave Bergen,Trustee '% Telephone(631) 765-1892 Charles J.Sanders,Trustee COUP� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only - _Coastal Erosion Permit Application - -- Wetland Permit Application L ',% Administrative Permit Amendment/Trans r/E?�tqnsion f eceived Application: { AUG — 3 2% tRomeceivpedFee:$ leted Application: 10 �- —•- a _Incomplete: _SEQRA Classification: Type I Type II Unlisted Coordination:(date sent): r� TLWRP Consistency Assessment Form: CAC Referral Sent: Date of Inspection: _Receipt of CAC Repoft: _Lead Agency Determination: _Technical Review: Public Hearing Held: 19 Resolution: Name of Applicant: Mailing Address: test 101* &&FET ,4-PT i i'4 ew` -V'kA1y !!106 r 1 4 Phone Number: Suffolk County Tax Map Number: 1000 - Property Location: ITT M l b WAY ►�2�r SneT►6 oCl� N`/ (provide LILCO Pole#, distance to cross streets, and location) AGENT: li CNAX N" (If applicable) `y{ Su nn ale i- Address: � ("–S by y Phone: ? 0 f281-2_Z Z B, 'gid of Trustees Applicatior 1 GENERAL DATA _ Land Area(in square feet): ( S r Area Zoning: ides -h' N/A Previous use of property: re N /I Intended use of property: 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? Yes ( 03 If"Yes",be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes o Does the structure(s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: g Y � }enc �v �� S Date I)q A No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?Cpb Yes If yes,provide explanation: Project Description(use attachments if necessary): We W%sN -ia Coo—%ROL IET - L%eTe9".JT to 1"V Bc,- -' I of Trustees Application, WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 7b Ce / c 5 Lir FISC Area of wetlands on lot: dos+ square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: 00 �L feet Closest distance betweennearest proposed structure and uplan � edge of wetlands: �Q feet Does the project involve excavation or filling? o Yes , / If yes,how much material will be excavated? /YA ' cubic yards How much material will be filled? cubic yards Depth of which mate 'al will be removed or deposited: feet N Proposed slope through ut the area of operations: Manner in which material will be removed or deposited: A11A Statement of the effect, if any, o the wetlands and tidal waters of the town that may result by reason of such proposed operatio s (use attachments if appropriate): e-00L C� f a t t�✓P� d r 0 gLll C -�sly w f11 (m onv-e.. I ` 617.20 Appendix B Short Environmental Assessment Form Instructions for CompletinI4 Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 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 l -Project and Sponsor Information Name of Action or Project: n I Project Location(describe,and attach a 18-cation map 0 Gw SO(R O Brief Description of Prop sed Action: eqw_z� I&A '��� �I wrfib I ��� N 1S owl e C.01 e' X /D 6'nrs. Name of Applicant or Sponsor: Telephone: 201 7-4 YV` \Y��� 1 C . I e:1� E-Mail: Q vv»1' Address: I �Sb9 tt w c� d i .Sou Ul ` 1 • 11 q-71 il S Ic1 / c:n"\ ,S �U t*t 00 1 C•,ity/PO: tState: Zip Code: SOtL0C-44 . a ` I lq y/A�,� 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 R1 ❑ may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: '© ❑ 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned A /,Q 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 ❑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 regulations9 ❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ N ❑ 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: (� LJ ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? © ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? © ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: `CW1 ❑ 11.Will the proposed action connect to existing wastewater utilities? _NQ YES If No,describe method for providing wastewater treatment: ❑ �( 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES / Places? N-71 El 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 ❑Agri cultural/grassIan ds ❑Early mid-successional Wetland ❑Urban uburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? /c ❑ 16.Is the project site located in the 100 year flood plain? NO YES A 0� 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? B5TNO EIYES b. Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: MNO AYES / 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? If Yes,describe: ® ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Rell rq ,'4�� !ZA Date: �J I 2, o Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? F71 0_ 2. Will the proposed action result in a change in the use or intensity of use of land? F� ❑ 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 © El of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or �j( ❑ affect existing infrastructure for mass transit,biking or walkway? u 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ reasonably available energy conservation or renewable energy opportunities? 121 7. Will the proposed action impact existing: ® ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 1 i No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. I:r,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 impa ts. J Town of Southold-Board of Trustees t �� Name of Lead gency, Date President Print or Type P(aine of Responsi Officer in L ad Agency Title of Responsible Officer Si re of RcspondkqeOfficer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 07/27/2015 11:49 631765176--- THE INK SPOT PAGE 02/03 i Board of Trustees Application. AFFIDAVIT n Z�j& BEING DULY SWORN D POSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE 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 REPRESEN'T'ATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING 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. Signature of Property Owner SWORN TO BEFORE ML THIS DAY OF , 201.5- z ry u ic N�fhantQkT`Hafns" Notary,PubTic*$Te of NO,-youik O 81HA9.222771 Qpalrf M#Njw York Cotio y ComPtsstca exAra 0 NoovedtbepU� 2010 0727/2015 11:49 631765176`' THE INK SPOT PAGE 03/03 B�,a--ti of Trustees Application AUTHORIZATION (where the applicant is not the owner) residing at aeor sG 6 Srr y�rlE c�l w• (print name of owner of property) (mailing address) do hereby authorize 14 E N AY J<A M �` (Agent) to apply for perm it(s) from the Southold Board of Town Trustees on my behalf. (Owncr'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 necessaryto avoid same, `� r� YOUR NAME: R(�i� rl� l � (Last name,first name,diddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) r c L H Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO '$11� 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 'y Submitted this '2,-3 day of v Jr 200 zG 1 s Signatur Print Name 44e_✓J L1 (<4 M IAIV _iU -1 Form TS l Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this .form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 90 _ 61 -62 PROJECT NAME^cc -rRCL #T P R��ru r —/E7 b y Cy�f;„� acc&.- ►� c,� The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees X❑ 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ 1 construction,planning activity, agency regulation,land transaction) ❑ N 16- (b) Financial assistance(e.g. grant, loan, subsidy) (c) Permit, approval, license,certification: n Nature and extent of action: �tir;f72A1 6�f�� C-��w�-f o� A C ��� AJ b W 12 �T4 e G U I-OS L 1 e S O O W A I f i Location of action: Z.56- M I Site acreage: � [� Present land use: Qt S -�.�► c -2 Present zoning classification: Rei i Jon cQ 1 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: �1 (�1�R/I -DAq)-1 S� (b) Mailing address: 2.37, &gE l0�4 5�wyr'-J -- �3 d (tlR"' a✓� Ny ��� if-t VIP, YA M o 0 .CSP( Seztv - Ac7-t Nu 1 (c) Telephone number: Area Code O 1 2_z (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? )W NoZ If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No X Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LW" Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No X Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes [:] No � Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No M Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria Yes ❑ No �4 Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ POVA Yes No of Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ Nol/ Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. nn 1:1YeLl NoX Not Applicable Attach additional sheets if necessary i WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No N6 Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No M1 Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III— Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No VIX7] Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No 4 Not Applicable PREPARED BY 't7�I I �i'1 M ��Z/ TITL ��� 1 �� A�n M � DATE�, XX"'Y SURVEY OF � 1 1 � _*� LOTS 141 , 142 & P/0 143 MAP OF s ,0• ��NRY%��, CEDAR BEACH PARK �3 50" L° ��fN�R FILE No. 90 FILED DECEMBER 20, 1927 A� , £ 7, '¢O SI T UA TED A T BAYVIEW TOWN OF SOUTHOLD / aN C/NK HaN "K FfjyCf "�F w SUFFOLK COUNTY, NEW YORK NOF /Qz� ��f S.C. TAX No. 1000-90-01 —09 X47 / 1/�4 "l' J.7' 23 SCALE 1 "=30' Raw of�s �0y NOVEMBER 8, 2007 Zop 2� '• (V � \\ Sg ca Fo �\CCGj�W� g / \\\ a _w-.OVERHEAD "� M NO � �2 Ar eP4� POLE ' Cj A41 N �/ , J � WATER . O - N � A OJh METER a F o AREA 56,414 sq. ft. M I ;' O /y 0, mQ BRICK a`>o�� I �N►_J (TO TIE LINES) 1 .295 CJC. DOPC. O� . .4 i •; O I \ pO '' �' I{w .• y O\�� Iii. Iro O \ a 79.fi__ _ I . LTJ o(!� .74 (3) a tis G•� • .I W , CERTIFIED T0: oLO? t I I; A FIDELITY NATIONAL TITLE INSURANCE COMPANY ' Q¢2 G°��° 'd Z PECONIC ABSTRACT, INC. Z. \ Y4 •. •' r�I W z ` :. ,� I F ' H HENRY KAMINER O r `\\ �/ \ ph�o I t .. . BELLE VIEW, LLC I \ bo "'t I � / � L•.•.•.. 1g.X306, oo ZE WATE f • �\ / 110 ZOP 1300 �0°43 ASO 0, I • ,l- e4 A. :•� A/O ^ O „ PO'to N LO'T M Q ' p/pec C17ce- .•'.'a •:� ¢3 11 � Sk�Nskl � APPROVED BY N �.• 1. f' `.,; UNAUTHORIZED ALTERATION OR ADDITION �`g /� � �u f �,•�y � �:_° • ro ; ti,..^ ..1 TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE y EDUCATION LAW. BOARD OF TRUSTEES TOWN OF SOUTHOLD o•' AUG 3 2015 THE ILA DES FSU IRVEYORRS�INKED SEAL OR NOT RING s EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VAUD TRUE COPY. DAT L(5� / �� 'go ONLY TOATHESPERSON FOR WHOM THINDICATED HEREON E SURRVEY ;- � _ ,' •° ' IS PREPARED, AND ON HIS BEHALF TO THE N °"""'�" TITLE COMPANY, GOVERNMENTAL AGENCY AND 2 LENDING INSTITUTION LISTED HEREON, AND TI- k,2± 10o TO THE TUTION. CERTIFICATIONS S OF THE NO TRANSFERABLE. 2 THE EXISTENCE OF RIGHTS OF WAY T� AND/OR EASEMENTS OF RECORD, IF �/4►'/� ANY, NOT SHOWN ARE NOT GUARANTEED. ST PREPARED IN ACCORDANCE WITH THE MINIMUM v STANDARDS FOR TITLE SURVEYS AS ESTABLISHED BY THE LI.USE AND APPROVED AND ADOPTED Nathan Taft Corwin FOR SUCH USE BY THE NEW YORK STATE LAND TITLE ASSOCIATION. Land Surveyor 61 - ✓/ k LJ — — Title Surveys — Subdivisions Site Plans Construction Layout F PHONE (631)727-2090 Fax (631)727-1727 W OFFICES LOCATED AT MAILING ADDRESS r r•,;,. 322 Roanoke Avenue P.O. Box 1931 N.Y.S. Lic. No. 50467 Riverhead, New York 11901 Riverhead, New York 11901-0965