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HomeMy WebLinkAboutTR-8672A John M.Bredemeyer III,President 0l'�..4 r/yO Town Hall Annex Michael J.Domino,Vice-President �� ,` • l0 ` 54375 Main Road P.O.Box 1179 James F.King,Trustee ; Southold,New York 11971-0959 Dave Bergen,Trustee G '" Q 1� Charles J. Sanders,Trustee �� � ��, Telephone(631) 765-1892 Fax(631) 765-6641 S , 101. BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1189C Date: December 7, 2015 THIS CERTIFIES that the removal of a set of existing bluff stairs and landings that encroach onto the property from the abutting property,by cutting the posts at ground level and removing all stair debris off site; At 310 The Strand, East Marion Suffolk County Tax Map#21-5-5 Conforms to the application for a Trustees Permit heretofore filed in this office Dated August 24, 2015 pursuant to which Trustees Administrative Permit#8672A Dated September 16, 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 removal of a set of existing bluff stairs and landings that encroach onto the property from the abutting property, by cutting the posts at ground level and removing all stair debris off site. The certificate is issued to CELESTE THEOPHILOS owner of the aforesaid property. Authorized Signature rrr'r'''''''I ' Town Hall,53095 Main Rd. John M. Bredemeyer(11,President `�rPP4rr�QSUFFU(�-C Michael J.Domino,Vice-President . ('Gy P.O. Box 1179 James F.King ; y x Southold,NY 11971 Dave Ber en o �� Ay ' Telephone(631)765-1892 g '-y�0 "••1 Fax(631)765-6641 Charles J. Sanders 1 s [ rr . .• rr BOARD OF TOWN TRUSTEES TOWN OF SOUTH[OLD " DATE OF INSPECTION: /2/1 Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, silt fence . 1St day of construction 1/2 constructed V Project complete, compliance inspection. INSPECTED BY: - 8 COMMENT' ./P, /1fry CERTIFICATE OF COMPLIANCE: g53 /21/2/--) v frf John M.Bredemeyer III,President �� � 01/4e® Town Hall Annex Michael J.Domino,Vice-President � =` ; 54375 Main Road Yg , P.O.Box 1179 James F.King,Trustee ; '" • , Southold,New York 11971-0959 Dave Bergen,Trustee 454\77.,461 Q ��� -� . a �� Telephone(631) 765-1892 Charles J.Sanders,Trustee ��� Fax(631) 765-6641 o'/ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8672A Date of Receipt of Application: August 24, 2015 Applicant: Celeste Theophilos SCTM#: 1000-21-5-5 Project Location: 310 The Strand, East Marion Date of Resolution/Issuance: September 16, 2015 Date of Expiration: September 16, 2017 Reviewed by: Board of Trustees Project Description: To remove a set of existing bluff stairs and landings that encroach onto the property from the abutting property by cutting the posts at ground level and removing all stair debris off site; no ground disturbance will - occur. 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 survey prepared by Peconic Surveyors, P.C. dated July 27, 2015, and stamped approved on September 16, 2015. Special Conditions: None. Inspections: Final Inspection. • If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. John M. Bredemeyer III, President Board of Trustees iii.,,--_ John M Bredemeyer EU, President ,•�Og�}FFOL j ; Town Hall,53095 Main Rd. 0�' �G ichael J. Domino, Vice-President P.O.P Box 1179 ,0 � �� —� Southold,NY 11971 James F. King y Charles J.Sanders :(2� o���� Telephone(631)765-1892 OlF ��•` 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. - INSP_ECTION_SCHEDULE Pre-construction, silt fence 1st day of construction 1/2 constructed .,\( Project complete, compliance inspection .. -ff / SURVEY OF PROPERTY AT _EAST MARION �,� TOWN OF SOUTHOLD ®,�� ���� O4 SUFFOLK COUNTY, N. Y 1000-21 05 05 . .0 ,:ii:6:/,/4)94' S 0�� SCALE: 1 a=40' - JULY 27, 2015 ���4:,. 715'4'. �� 3 ,_ 4,;,,,,,g:" ..., ,,,-,.-",,,,:i„i , , , YACC. 7-15 . y°E.S3 ,. ,; ,. ., a..., r�APPROVED BY,::::'r. '�' /� /� OF "�aUSTEES_ pQ �� 47 n Ty„;--T ,,W. NI OF .r� �,r S 04 , , v L/,9 is n A. / 4.>6 ;* / ,,,e' , s' ,(,e\- 0 ,... iii,.. . . . ,,,,/ ,il/esii / i7,6, iii;e<S‘1> . , \may /�) N vo,\ . . / oo:e 4 1 ..�.ii rl-:v'M1;' ;P47,:1.:r 6. °0 i--6 i t e&--'g i tai';',9f:g:, :''''':c u / Ok Q7 p40/ ` .UD R, `.k 0Q v �• 4 <0� /s , oti !y 4 of <2,,D6, ��• `� o' 2 za ? o kO: 9ZV V .0 FFe \)(1 ' 244.47 `� QjV U 't��� p �F ” h�Jv 1� ?��� ��` s Foy gyp . 000 .3N�S ® ���/ .``` <tip�s /I rcHsi �o�� ti v ti �' �9 P Or ` z / / } WAY •A- � ke CEHL S, vp \�' �` �E o COASTAL EROSION HAZARD AREA MAP Vj T4 t�j sTo \q\% '11),-,* ko� Z C 9 FLOOD ZONES FROM FIRM VeF QTS °s F •a I 47-c4- T `�q A �� 36103C0063H `Fj.�S s ti Q 144 ,�v SkS w 4v '�� �( O F:E.!��' SUBDIVISION MAP "PEBBLE BEACH FARMS" FILED IN THE OFFICE ''e4,042.rt,� 76 �3%� .�� ' •=i,,,:' , r�,�� OF THE CLERK OF SUFFOLK COUNTY ON /� �� �$ _ `,Y .F ; JUNE 11, 1975 AS FILE NO. 6266 • e‘ ,� \ .`'C, lei l ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLA 770N o'�eP, i 113 `''~*- • g �' .AREA = 27,195. SCS. Ff. �?� ,, _ .; uc. nlo. 4961 B OF SECTION 72090F THE NEW YORK STATE EDUCA770N LAVE! o� '±i !IPECO —*, `., °S, P.C. EXCEPT AS PER SECTION 7209—SUBDIVISION 2. ALL CERTIFICA770NS TO TIE LINE ► ., (63,1) 765-51. 0 FAX (631) 765-1797 HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF i AUG 2 4 2015 ¢ P.O. BOX 909 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER STREET WHOSE SIGNATURE APPEARS HEREON. Saut oki T01011 SOUTHOLD, N. Y. 11971 15-163 .nizim. 3.fiii.; .a. John Bredemeyer, President Town Hall Annex Michael J. Domino, Vice-PresidentcOoss 54375 Route 25 Al James F. King c ti P.O. Box 1179 Charles J. Sanders ,T2 �� Southold, NY 11971 Dave Bergen ol * �a°'�' Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: 9"' 9v/ 7';/() K. Russell Glover, Architect on behalf of CELESTE THEOPHILOS requests and Administrative Permit to remove a set of existing bluff stairs and landings that encroach onto the property from the abutting property by cutting the posts at ground level and remove all stair debris off site; no ground disturbance will occur. Located: 310 The Strand, East Marion. SCTM# 21-5-5 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 TypeApplication: Wetland Coastal Erosion Amendment ''Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed: Modifications: Conditions: Present Were: J. Bredemeyer M. Domino J. King/D. Bergen C. Sanders Bay Constable Other eredeiHepy---Form filled out in the field by Mailed/Faxed to: Date: .f31-11 11`f .k. ,�• •. i ! ,+ # ; ' • ..fid11111'6, Ii e sektio • ...s.,' V•I Vr. A jillik#le ,,,,,e, • • 1 F Vis,• �4,, f ty(+_ V� •" `I,���,t� � �MN•;1 '` � :;•� ..~ Aiii •r ," r •. , I / : Celeste Theophilos t• '• JJJ .;• • Mit: 21-5-5 4, .+ ` ? c 10 The Strand,East Marion z.t••,is „ • ,r q .t ' ':•-*. :/9/15 .. • ,d, •..- ,� . '�•... 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REED ME OVEELM NOTE • n.oa+rzidur[,or9dx.Pn /r ,^ .t01 • �� 6 O eyl SMOMS.4 LOT_ _ I I !\\I\ ' IIA I. 1 03 11011111 OA . 00 v. .....r.,,,,n. o 9 T itioliii �y FOR PCL n• u * tt a 1%0N. ZPLL.N. ,V ra,AOta SEE BEC.NO. . 40. , es 1� aawota 400 MATCH UNE 411111141111111* I w SEE SEC.NO. 0 1 B i E..�-e..�o.� —�— ......xr« « (]t) ..... O _ "."'"L"'^ --,0'_— a.�...� _—�-- v NOTICE �'aou COUNTY OF SUFFOLK ® E rawzn anuTNmn SECTION NO E— - ` Real Property Tax Service Agency v „L�90. 21 OM s....,s... -.�. .—. ,.......... •— —_ y........ o—L.. ., n I_) C my GME Yttwt w ur f9 Cruz _ . w IT CO •UNTY �N rEo C..... aT .. ... z w. •- —__ . o..... _ m Tu .HET HO,.MN HEMMEN Or THE A3' tt P ma o-n9crw taw .__ m m IO,.tL...l . n.._. .,... _. _. .— .. PR PER ��'c Soup: OFFICE LOCATION: �� O MAILING ADDRESS: Town Hall Annex ,lt �� l0 - P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) ``4, � �pQ1� Telephone: 631 765-1938 Southold, NY 11971 �yOOUNTV,' LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM L To: John Bredemeyer, President Town of Southold Board of Trustees SSP 4 2015 II e".7 From: Mark Terry, Principal Planner 1�� .SOUthOld TT/01 LWRP Coordinator -A :+a ofTv'ees Date: September 10, 2015 Re: Local Waterfront Coastal Consistency Review for CELESTE THEOPHILOS SCTM# 1000-21-5-5 • K. Russell Glover, Architect on behalf of CELESTE THEOPHILOS requests and Administrative Permit to remove a set of existing bluff stairs and landings that encroach onto the property from the abutting property by cutting the posts at ground level and remove all stair debris off site; no ground disturbance will occur. Located: 310 The Strand, East Marion. SCTM#21-5-5 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the LWRP policies and therefore CONSISTENT with the LWRP. 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 _ John M. Bredemeyer III, President ,°Si �,o SO , Town Hall Annex Michael J. Domino,Vice-President t��� , ' l® 54375 Main Road ANSifs P.O.Box 1179 James F. King,Trustee t `° . "� ' Southold,New York 11971-0959 Dave Bergen,Trustee `;® ` ".• AC? it • Telephone (631) 7654892 Charles J.Sanders,Trustee ;��'C®U� �� ���� Fax(631) 765-6641 oo BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland Permit Application Administrative Permit Amendment/Transfer/Extension ; "' j C'.r a m 5' i'� _Received Application: a • Received Fee: $ f p? _Completed Application: I '" Incomplete: AUG 2 4 2015 SEQRA Classification: Type I Type II Unlisted Coordination:(date sent): a. of T ustees� LWRP Consistency Assessment Form: _CAC Referral Sent: Date of Inspection: ' Receipt of CAC Report: _Lead Agency Determination: _Technical Review: _Public Hearing Held: Resolution: Name of Applicant: CE(-eS T E l+Q F'-(4(LOS Mailing Address: 2 3-22- 2,044' goA") A sic)R( A t( 6 t 6 0 2-„"2®C" Phone Number: 7 1 5 ” 721 - 27(4 , Suffolk County Tax Map Number: 1000 - 2, 1 - Os--®. Property Location: lO 7WE1 6 AS`s MRO NJ 6J'f (1°3Y) lob 6er vv&S i- ®F l k M C--(S t�®4 w int L,o&G irk P Y (provide LILCO Pole#, distance to cross streets, and location) AGENT: Rv�,S�U- G Ca®J&-g IT T (If applicable) Address: EA974 10 3( 514-6-1---M-e, (St- D Ni(611-TS t( cp&s Phone: 6 3 ( (`7 B d of Trustees Applicatior GENERAL DATA Land Area(in square feet): 27/ 10)S Area Zoning: K-40 Previous use of property: RS(�J Intended use of property: aeS t`96---tUC (N ) Gf n/Ge-) Covenants and Restrictions on property? Yes „5c No If"Yes",please provide a copy. 61407,5U Will this project require a Building Permit as per Town Code? )‹ Yes /\ No If"Yes",be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes X No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? X Yes No -- REMOVAL_0C cx Po ig Does the structure(s) on property have a valid Certificate of Occupancy? 7S Yes No Prior permits/approvals for site improvements: Agency Date e'Pl7C.9 .S _ ✓ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? 7c No Yes If yes, provide explanation: Project Description (use attachments if necessary): ZtMOv1L of 6--,5 HT1&4 t.Pri ioaav S �{tCrl� �6GIRDPK 060 ®w g\ f:C.S egoe FgOeut alt& loci( V ®pE� SiSPS .L-4510ai11JGS ®NB OWLS ee-C &al W I Ue C kr C lVD LG--ve- 4 g6MoveD— t/O 6koo N B{ 5d of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: TO 12,-E-Mesv 17C-14-C-4 Pre--C—SS 5011ES LProvp t fm Q,.Svc..$Zco A L 1 j ®tJ oti.+'d -eS egort--r N&I 6fYz 1'w& 1-017 4-or 13C.EHL 1 pePP0,2?‹ Area of wetlands on lot: square feet ( 2-Sp 5,z .F6E-- Percent coverage of lot: ± 7o % Closest distance between nearest existing structure and upland edge of wetlands: O feet Closest distance between nearest proposed structure and upland edge of wetlands: 0 feet — 5 ve-ryTI) (2- 1‘41:"/ Does the project involve excavation or filling? X No Yes If yes, how much material will be excavated? 0 cubic yards How much material will be filled? 0 cubic yards Depth of which material will be removed or deposited: 0 feet Proposed slope throughout the area of operations: /$ £'ITT NG N° �` ( -S. Manner in which material will be removed or deposited: Waopi6 5Tit- 1e5 LPrrvoiis iJe(.L cot- AT- 6 o LcV61.- 0 <,�Ou tis® p sib a C de 0<c_A-v TTO IL' 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): Z-&'ONO • 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part l based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information OWNWE'e - Name of Action or Project: Project Location(describe,and attach a location map): Zt 1 V.ofeST 0E f N l S Cl1c i w ten+ J(v /. Brief Description of Proposed Action: e --k'It iik c--© IF,e fk(—t-$ c-cesS sr i 94 ark6531k16S w tcft 6 o t$ oN c7viilue.2 egoP V PRafrl N 61+6oeA tum Name of Applicant or Sponsor: Telephone: 6.31K E-Mail: gosfrox)Q.eQ yAIto°.CO Address: eQ 1 4;31 City/PO: State: p Zip Code: 5 Rete L'e tom- D f6� �� /(56s 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 1j n 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: fiats c c `f-DW tJ OF uft1aoe.V> exprch`Z P or fituSretaS PrecH JI S {'1VL.ecgmci . 3.a.Total acreage of the site of the proposed action? _ 0'6.2:5 acres b.Total acreage to be physically disturbed? 0 to 05 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 6.62.-S acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban XRural(non-agriculture) ❑Industrial ['Commercial Residential(suburban) ❑Forest ❑Agriculture Ll 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? NI - 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? jJ 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: Co ---c 6ROSit p1•.) 2—' ®tai& El IA }� 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NOCYES IM ❑ 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: 14�n ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ® n 11.Will the proposed action connect to existing wastewater utilities? Df NO YES If No,describe method for providing wastewater treatment: ! / (E( ❑ 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? n (E b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? I( I/❑l If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: l `l. 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional 0 Wetland 0 Urban 0 Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? IN ❑ 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? ❑NO nYES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: n NO nYES 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 INFORMATI ROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE ^ , j Applicant/sponsor name: , l�'�`-� \ Date: 'I�I I 5 Signature: V.,o&LL- l e— 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 occurie.- 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? 3. Will the proposed action impair the character or quality of the existing community? I I 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area(CEA)? �I "" I 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? 1j 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 . 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? 1-1 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. • nCheck 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 vironmental impact statement is required. e 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 irrjpacts, s J Town of Southold-Board of Trustees Name of ad Agepc Date v "�G/ er President Print or Type •► . of•espi< .•le Officer in Agency Title of Responsible Officer i° I . Sig 4,e of Responsi vile Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 board of Trustees Applicata 1 AFFIDAVIT G&c eSrt ( II S 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 ALLrDAMAGES 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, 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 r J OF THE PERMIT. _ , Signature of Property Own SWORN TO BEFORE ME THIS l2 DAY OF41--el/e4At ', 20 /Sr a"o' ROBERT A MAZZAFERRO NOTARY PUBLIC-STATE OF NEW YORK NO.01MA6207376 No • 4 Ac QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 15,20 f 77 • B, d of Trustees Application, AUTHORIZATION (where the applicant is not the owner) I, CeLES't& i (tit L.o S residing at (print name of owner of property) (mailing address) do hereby authorize (Agent) —C—t to apply for permit(s) from the Southold Board of Town Trustees on my behalf. , , t (Owner's signature) APPLICANT/AGENT/REPRESENTATIVE • TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on thepart 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: V% g,t75 &U_-- (Last name,first name,.i_middle 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",narpe the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest"Business interest”means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation - in which the town officer or employee owns more than 5%of a shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person • Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check • the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,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 . pot.it Submitted this • ,da ..f 20 Signature - Print Name Form TS 1 t2,0 75 &'C_L 66-0 • 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# IC?oO - �i - OS — PROJECT NAME 310 ME 5 Flu® Mete_ibeL) 10 110)3c) The Application has been submitted to(check appropriate response): Town Board Planning Board fl Building Dept. Board of Trustees,, 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation,land transaction) (b) Financial assistance(e.g. grant,loan, subsidy) (c) Permit, approval, license,certification: Nature and extent of action: SSS 9' x0-- l4h3Pii•-) .Ju1-tlCtfi X8 6 . CUR) CAVW-12.3 Location of action: 31 0 ✓1-PtNo M Pre lot1/43 10 I (e)3`, Site acreage: ®a 625 Pc-C-R,& Present land use: g.65t 0 E&)C Present zoning classification: (. 0 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: n+(Los (b) Mailing address: Aefi"1 Pr GC�-6-ri- ' ,e toc( 15t-rrWD i t+1S 1J/ (( 5 S (c) Telephone number: Area Code( ) 6 SI r S.g.2 ost (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes No /2 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 KNot Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria n Yes No Not Applicable • 4) 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 J4 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 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. No Not Appli{ �e Mb'/AL_ OF &Yi5-110GSt"eue-"tve�. Pr(.wv J t tS ep pre '-o ge- veld *To iers Ni Peiv-PPL )Thr . 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 J Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. Yes No Ki 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. YeJ Noj Not Applicable Attach additional sheets if necessary ' I WORKING COAST POLICIES r' 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 M Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. Yes No Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III —Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes No EXI Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. Yes No Not Applicable PREPARED BY l)S L-L CLC)if(f TITLE l )f DATE Mfr( (S gski-1rr . K Russell Glover Architect PC Box 1031 Shelter Island Heights NY 11965 631 332 0517. _1� t t3- �I �l iii Board of Town Trustees f ' 1, Town of Southold 1 AUG 2 4 2015 Town,Hall i i 53095,Main Road E---- _,..•_.__ _ 1 PO Box 1179 SoLthold 1-4- it------a Southold ----- ltQ'`+?ll NY 11971-1892 August 14th 2015 Re:- Theophilos Residence 310 The Strand East Marion NY 11939 Tax Map#1000-21-05-05 This application is for a permit to remove a beach access stair and landings which encroach onto the owners property from a neighboring lot-the requirement is to remove only the offending parts of the structure which which are on the owners property, the rest of the structure not on the owners property will be left to be dealt with by others. Accordingly please find enclosed the following:- 1- 2 copies of the completed Application Form. 7- 2- 2 copies of the Short Environmental Assessment Form. / 3- 3 copies of a recent survey with the offending stair and landings highlighted in yellow. 7 4- Enlarged section of survey drawing showing photo locations. / 5- 2 copies of photo 1 taken from neighboring lot showing initial access to top landing. V- 6- 6- 2 copies of photo 2 taken from top landing down to bottom landing. / 7- 2 copies of photo 3 taken from bottom landing up towards top landing. V- 8- Property location map.Taken from USGS01304200 Orient. ✓ 9- Notarized Owners Endorsement V. 10- Our check number 4681 in the amount of$100.00 1" Yours :.s e u i ly 9 K Russell Glo•er