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TR-8711
g' v Soot,- John M.Bredemeyer III, President ,#�® 4375 Route 25 �°'• .'4S4 , �a 5Town Hall Annex �O : Michael J. Domino,Vice-President ; dt P.O.Box 1179 Glenn Goldsmith ` cn , Southold, New York 11971 A.Nicholas Krupski `` O•1Telephone(631) 765-1892 Charles J.Sanders ``reOUNit*C .11 Fax(63"1) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1208C Date: March 21, 2016 THIS CERTIFIES that the repair of the foundation on the existing+/-12.6'x33.6' cottage with attached+/-7.6'x19' porch by removing and replacing four(4) courses of 8"x16" blocks onto existing footing in an approximately 12' area, and install gutters to leaders to drywells to contain roof runoff; - At 65490 Route 25, Breezy Shores Cottage#16, Greenport Suffolk County Tax Map#1000-53-5-12.6 Conforms to the application for a Trustees Permit heretofore filed in this office Dated November 16, 2015 pursuant to which Trustees Wetland Permit#8711 Dated December 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 repair of the foundation on the existing+/- 12.6'x33.6' cottage with attached +/-7.6'x19' porch by removing and replacing four(4) courses of 8"x 16"blocks onto existing footing in an approximately 12' area, and install gutters to leaders to drywells to contain roof runoff. The certificate is issued to PETER SAKAS owner of the aforesaid property. 6904-- etAil6Nrir Authorized,Signature • r ) , .. . ..,,,,,,,,,,,„... . iL: SUFF9i a. John M. Bredemeyer III, President & v oo.t Town Hall Annex Michael J. Domino, Vice-President ,t• y s ��' , 54375 Route 25 Glenn Goldsmith .5 a P.O. Box 1179 A. Nicholas Krupski ', Old , Southold, NY 11971 . xy Charles J. Sanders ' �ol ��' Telephone (631) 765-1892- ' ' Fax (631) 765-6641 1 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: `) I, eli'ie-Q4 / '),d, Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction '/2 constructed \IC .. Project complete, compliance inspection. INSPECTED BY: CCA't ail Z---- /4'14 cAIJ COMMENTS: - ,' ' 4'"t r I,0-01A, - -- CERTIFICATE OF COMPLIANCE: t o ,'',,,,,,, John M. Bredemeyer 111, President Town Hall, 53095 Main Rd. ++, Og�}FFD(,f c Michael J. Domino, Vice-President 19/0- ' P 0 Box 1179 1 O Southold,NY 11971 James F. King ; W Southold,N i „ Charles J.Sanders y,� Y `o� ���, Telephone(631)765-1892 Dave Bergen Ol �'` Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, silt fence 1st day of construction / V2 constructed ✓ Project complete, compliance inspection 4 ,fir n. ,,,,,,F,- Town Hall, 53095Main Rd. John M Bredemeyer 111, President ,,o' gUFFO(,f c Michael J. Domino, Vice-President 0 � ' P.O. Box 1179 o �a NY 11971 James F. King W Southold, „ Charles J.Sanders ; 0� ��$ Telephone(631)765-1892 4/0 -, 1 ' ��•` 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 . 1st day of construction / 1/2 constructed ✓ Project complete, compliance inspection : Se:ei , .8 .7:".''''.y.„... ..4,r+ ,e ,,e, ,� .r e,!§eA i•^ 1 ¥base'•A 4 f PgA k�' F .,j Pt g4 +ef Afn. ..t rfP AAh i. . §�` P l', e4 it IF+ ...t.q4 .fi10, { to ul' ° ; .-.., Uttr '='....ti t aL u!1° ,,,.Wr..d.. Lli:4�.(�,,..,.fa° ,.;a�.a;&.. _ 141- !!tt a;Triva'o `il.. ,�,,,,,,,,,,��,.ti x,b� U • r \V q..�',, '1 ��" »'`4.� 4-.7.."7,,` "` ,rivitigkyThsCis,\7iIP �„w*"r.V z,;,,�. '�i � 1,f `""v\`'1 i f < - - ., "'w,,>.'� f' ;': Kl ..z N nkk Y.. Wi W'. �`u'•,..=Sak...,-•. .. ..V,,.a.2':' . T..'.92 �.a 8' .4;,<`4_.. :C .SI7Ve:14. Ti:4777:..f-t.._S a1.;�'Y^,....74:1T _itwe7'. .. �.+!- ?..11",r/ 6 I ---7 ''',','' t.,,,4 [ '� I !r,, i Pe, c I) F-j: :/{447: ®ARI) OF SOUTHOLD TOWN TRUSTEES . ,, ). SOUTHOLD, NEW YORK � 1----P PERMIT NO. 8711 DATE: DECEMBER 16, 2015 • i,,,,to VI 04,", . w ISSUED TO: PETER SAKAS (( x ''0 PROPERTY ADDRESS: 65490 ROUTE 25, BREEZY SHORES COTTAGE#16z '"' GREENPORT � • ,,; ,'. f SCTM# 1000-53-5-12.6 - ::' ;'#:!141.1...:-. '' i�-. 4 AUTHORIZATION lid A,' ti-P-, i ry ,kl,4 Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in �; A accordance with the Resolution of the Board of Trustees adopted at the meeting held on December 16,2015, ,e v „;,,,. • +'lf and in consideration of application`fee in the sum of$250.00 paid by Peter Sakas and subject to the Terms and $ '' Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits the i ''t" "ii following: 3° TON' !• Y; Wetland Permit to repair the foundation on the existing+/-12.6'x33.6' cottage with - t -� attached+/-7.6'x19'porch by removing and replacing four(4) courses of 8"x16" blocks ��?` ' r. e gg3 onto existing footing in an approximately 12' area, and install gutters to leaders to - ` 1 1 - drywells to contain roof runoff, and as depicted on the site plan prepared by.Joel Daly `1 General-Contracting Inc.,-received on November-16,2015, and-stamped-approved-on- December 16, 2015.4 , IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, • ' ,fr -.. and these presents to be subscribed by a majority of the said Board of this date. n ° a , 'St kl.'tb:r.,,Q: �V1( ' ,,s1 sOFOLir ; 1lLt�.t.+ i _,,,,,,,,,,, �� �oa. Gy� * James F. Kin_ — Absent i,,--' �,} may} , D ---P (3, '�r f6,< ..4 Q 1,� I'ter or' i �514, ii, :1ti (• '‘Al • R,I:k i' �Pt�'E .,S:`,----- 'i�S.1,C..�^l2 tY�""e'Vdcf.?i„ ' 47011 4... 1 '-'771.-.4'4`.61N21i 7,t,r4 ``v.eay..b y d of 1,. ''?i iut..7Vo 67&.TW Ii 7 .,ssw "V2W7.72w..uJ`T4"1�+Yol 'ri" + v Tt "r0,7+'C"'�7.,X' ▪ ,bi-: `z',.`, 1 `'� a1 \ ----.,,,4411 a` ; .T „ \ „ `�', ^� � dot1r -- ,y1,./k..,., 1 /" i d M .6 �§tl�`�`�..�"�*^*^^^�mr^..` !(1t, `,,.."°;*n '� j�J)., r ,, + �•-.,"^n..<-�._..."" ,,: `e'XII t-q,R--..`< <� "�.`-..- �-::1 r " (5$4:-.'"--4'''''.�n"I''qyr izj ti ,:.te rt 1 0 I+I 1a..N ..;�?r(d e r r� 1�l�� , ._..=�.-�- r T r.rita! ---..sa..�:.os- :,,+r ..[r..6Cgy1`s r Irl 1}+ .. "81 }f41. ..,,P,iA all�y:r'' f..112§1k4,4;;;;;;;:040..� i+iep �t§61>.: 'is.{�PN r4lleei '%x si iii S r TERMS AND CONDITIONS The Permittee Peter Sakas,residing at 65490 Route 25,Breezy Shores Cottage#16, Greenport, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from_any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will,at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto,to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved,but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely,or as long as the said Permittee wishes to maintain the structure or project involved,to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents,and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized,or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required,upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit,which may be subject to revoke upon failure to obtain same. 10. No right to trespass or interfere with riparian rights. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. OF SOU John M.Bredemeyer III, President �� 4� jy® Town Hall Annex Michael J.Domino,Vice-President I � `, -` ' � 54375 Main Road ,per , P.O.Box 1179 James F.King,Trustee ; ` ',Iff t Southold, New York 11971-0959 Dave Bergen,Trustee ;G Telephone(631) 765-1892 Charles J. Sanders,Trustee _ ®l�f I,. Fax(631) 765-6641 iii BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD • December 16, 2015 Joel Daly General Contracting Inc. P.O. Box 343 Southold, NY 11971 RE: PETER SAKAS 65490 ROUTE 25, BREEZY SHORES COTTAGE #16, GREENPORT SCTM# 1000-53-5-12.6 Dear Mr. Daly: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, December 16, 2015 regarding the above matter: WHEREAS, Joel Daly General Contracting on behalf of PETER SAKAS applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated November 16, 2015, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, in accordance with Chapter 268, said application was found to be Exempt from the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on December 16, 2015, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, 2 . WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of PETER SAKAS to repair the foundation on the existing +/-12.6'x33.6' cottage with attached +/-7.6'x19'porch by removing and replacing four (4) courses of 8"x16" blocks onto existing footing in an approximately 12' area, and install gutters to leaders to drywells to contain roof runoff; and as depicted on the site plan prepared by-Joel Daly General Contracting Inc., received on November 16, 2015, and stamped approved on December 16, 2015. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours,6914— _ ti ..,,. ;. :,ffi. John M. Bredemeyer III President, Board of Trustees JMB/dd JOEL DALY GENERAL CONTRACTING INC. A BETTER BUSINESS BUREAU ACCREDITED BUSINESS PO BOX 343 205 BOISSEAU AVE - SOUTHOLD NY 11971 Email: JoelDalyHl@optonline.net ' - 1 631 765 1223 OFFICE AND FAX ' "--Th r---, ft r rz u; Eliky 1-7, Mr -11Fi NOV----------0V 1 6 2015, Lib . , . ,,. ,,-, •: , APPROVED BY ! , . Peter Sakas Residence Ti - ".' - , '• , Breezy Shores#16 I A 1, -BORD OF 1RUSTEES '-, ,. Southold Town !:'''', •'-'-N.,TOWN OF, SOUTHOLD' B.• f if Tr_ Ii!., ,:•''''':- ' ,•;1 , r ‘pATE-4)06- 0.-7, go, z6t5'','-‘,-' 4:„. , . ,.*. l. - v ,,, - IrmikvElgove -''firitiONIONIIIIMEN I _ / . /, N, . , . \ . ,.„. . 0..... _, ..„ ., _ , T . :z. q . N. 1 4 A 06'1-71_ N. L 1,....________ i all r e i II 1. :wI4 1.4 ,,ELey) Cottage 76 12'8° V8" 78" s' 14' 2' 4' Door 2' 7'6" " N0 D E EJ t11 ,1 I NOV 1 7 2015 i 13' 1b'8° ,otaold Tcwn ' Board of Tn!�te�a 0&• ,(o x 33 C� APPxkr &+ 128° Co � 1 .Co x ak pcctb��r+cu ,,'',,,,,,,- John M. Bredemeyer [[l, President Town Hall Annex � C Michael J. Domino,Vice President ,�,��� o : 54375 Route 25, P.O. Box 1179 James F. King Southold,NY 11971 Charles J. Sanders --‘4% oy O�4',�� Telephone(63 1)765-1892 Dave Bergen - �'' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES iia21 �� Q g 5q-1:/16 0/0 TOWN OF SOUTHOLD Toe-t- DA-1,1 GENFR TO: Please be advised that your application dated A' J�°ic2015 has been reviewed by this Board at the regular meeting of /o 2115- and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Silt Fence Inspection Fee ($50.00) 1st Day of Construction ($50.00) %s Constructed ($50.00) / Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: M 236IP TOTAL FEES DUE: $ 60,07) fr5 BY: John M. Bredemeyer Ill, President Board of Trustees .John Bredemeyer, President '''guFFol` Town Hall Annex Michael J. Domino, Vice-President °�� ��OGy ; 54375 Route 25 James F. King ti P.O. Box 1179 Charles J. Sanders ye. w o Southold, NY 11971 Dave Bergen .9 �001 Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: �, )4 tt-- Joel Daly General Contracting on behalf of PETER SAKAS requests a Wetland Permit to repair the foundation on the existing +/-12.6'x33.6' cottage with attached +/-7.6'x19' porch by removing and replacing four (4) courses of 8"x16" blocks onto existing footing in an approximately 12' area. Located: 65490 Route 25, Breezy Shores Cottage #16, Greenport. SCTM# 1000-53-5-12.6 Type'of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-S'bmission Violation Notice of Hearing card posted on property: Yes No Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed: • Modifications: Conditions: y,o. h ,, a/v"ri� 7 i Present Were: J. Bredemeyer ✓ M. Domino 6�"J. King /D. Bergen /%teSanders Bay Constable Other Form filled out in the field by Mailed/Faxed to: TM Date: /4 411.41.00,11111 f. 40077 1i Peter Sakas vJ 65490 Route 25,Greenportillr*�""'"" • � ,� r',"4,�, aPON ---"Breezy Shores Cottage#16 [ wi i' fi Al.,, `; _I - __. - _. . _.... r-- 1000-53-5-12.6 i". /.,. 12/9/15 I i. `� -— ii T ...4111.!!7 . \ . om , . • ... • , & +� 12/ 9/2015 10 : 15 3teeZ,k s r ore s 474-1(a ?cA-cc So•Ka5 e moi L4 CO aSes o c $Xlfo b\ocXS - Q.Qplox rna}e.\� a mea ;� �\ COU. � b (5CS oc $X1( locks -'b es\54rin9 � 3lecz S'not(S 44 I!o ?eke( Sc KGS • _.1 e cno e '-k cov.<Ses o4 $X 1(o b\c S - o.wc07,\malre`� 2��cs\c-c.._kl covsSeS o IA1(4 b\o[-kS e c\ stNcgodVv�. (bt eGv` S\rlote9 1(1) ?etc SoN<GZ +r ,. ' et* ' a 4 ,• ,�, t r p'Mw .rrar.F�.. 0 .,.";', t 1 4a . ..i ,� sA a _ - .• • •• 4-. -. •• .1.• ii,„ -0. , - vo , ..„, . .,.- : :1,440f ocit 4 l'' " ' tSes oc, Bx\lo b\b S - awtoxi MCA 6°1_, 1,a, 0_1\ LA Cov rSeS o'' gxllo b1o�kS 41D ex\ n54�e� s� n - I - - JSEE SEC 110 045 MATCH 1.1N' 31CPat .'3 b 4 SEE SEC NO 045 //O UNE (//7 Nxn G 3 �.. MATCH _ —.�-- �/ K 1]A(c) o FOR PCL NO q '4 / P j 16 TOWN OF 055-05410aSEE SEC O a 0/ ,T3' -.?71//// P-------,, { SOUTHOLD�\ +� �/ / /( / w�\ ( e'N� t FOR SEC.NO NO / 7]A SO\ . S a 0 $ e SEE SEC.NO 29 ; T.6Al.) e V D45-05-007 a O i 62 O /Ike' / o C0W0Y6OFFSOSUUFTFHOU( OLD _ IaY'No 10 4A / TOWN OFSOUTHOLD 44 / I i mn.nab / � P/PES .'4,. � y i `® 4,41 N n / x CIc � A) 8 i f 132A(c) .. 0.I SOUTO . / C/ ' NTY OF SUFFOLK 1 a i Y /4' ' 'o 3Q a _/ / , ,7..,..,-; vN a, :woo To� i ; v - q Q � .151 _ ?m2 f 0£'�3*. .4 � . .' TWN t , /� OOLD DI Z1 $ Ar g o f ,.' TO SOF SOUTHOLO - Am �44114$1100, \ t t ffl ' RWIN s'e,;d o-p EeMANw L.1 -n ,. to 1 's 4 Z ,z (/ �` v i a.� m TOWN OF SOUTHOLD O •Ac s 4,1\, •. PIPES :R::::::16,0K: , .C1 ` N16 ‘44 o va is = 94 40 6 ' eJifs°` a5„ra) � 5` ,��eqr as ass 1 ' Lme, Spy ' � ROONaFsa]nnan ��x� @bv it , coNs9rvATNN 6vm.a•0 __ 4� k '' 0,�_.ac� v 43e 4 y]5 ,a EP' • /S H' 2 •,a t� fr m L 9ei 451,' M'- qzs 4, a tO a e,� r ���,� �� I 4], w.," . a /0, ;. ,ay" FY's,; 6 # III6 , ,te126 '2. a '''1,, ]3b., i Qt`;r q ,, p a;Y 4R / ¢r a6 10 s .. ny 'I% A i py] '°+�,� O J 76A ,.OM1' 5`83: B, r Aro- .110 1 1 U m,o 'a ni • *. © 'N. s112 ID ! 4.~ zz•ea b"P 46] °••`R^ — 0. l ....0� � \ a . ]5A TZC HST \ ' FOR PCL NO °' 46 a BP�41-' WA. 3in.1eQ a. a ]TA s . -01-0383 ar I .--,. .. Z:— UNE eAfr° WO.. w MATCH NY �R SEE No os] SEE SEC NO 057 SEE SEC NO OS/ P —1 \ I _.nnu un ' �,,1 pf SOut OFFICE LOCATION: MAILING ADDRESS: Town Hall Annex �����® l0 : P.O. Box 1179 54375 State Route 25 * Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 0 ��I�1, Telephone: 631 765-1938 =lyeOUNTY, •' ... oii LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: John Bredemeyer, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: December 11, 2015 Re: Local Waterfront Coastal Consistency Review PETER SAKAS SCTM# 1000-53-5-12.6 Joel Daly General Contracting on behalf of PETER SAKAS requests a Wetland Permit to repair the foundation on the existing +/-12.6'x33.6' cottage with attached +/-7.6'x19' porch by removing and replacing four (4) courses of 8"x16" blocks onto existing footing in an approximately 12' area. Located: 65490 Route 25, Breezy Shores Cottage #16, Greenport. SCTM# 1000-53-5-12.6 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, the action is recommended as EXEMPT from LWRP review pursuant too: B. Replacement, rehabilitation or reconstruction of a structure or facility, in kind, on the same site (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 I ,y," de Peter Young,Chairman ; '! ; Town Hall,53095 Main Rd. Lauren Standish,Secretary ; g P.O.Box 1179 '� nr *. Southold,Southold,NY 11971 4Nt• Telephone(631)765-1889 "0/ Fax(631)765-1823 IARr Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., December 9, 2015 the following recommendation was made: Moved by Keith McCamy, seconded by John Stein, it was RESOLVED to SUPPORT the application of PETER SAKAS to remove four (4) courses of 8X 16' blocks-approx. 12'. Reinstall four (4) courses of 8X 16' blocks to existing footing. Cottage is approx. 12.6'X 33.6' with a porch measuring approx., 7.6'X 19'. Located: 3050 Sage Blvd., Greenport. SCTM#53-5-12.6 Inspected by: John Stein, Peter Meeker, Keith McCamy, Doug Hardy The CAC Supports the application with an adequate wastewater treatment plan. Vote of Council: Ayes: All Motion Carried _�� l y John M. Bredemeyer III, President �if /*0 S 0045, Town Hall Annex ,:;:;y-' ,; l 54375 Main Road Michael J. Domino,Vice-President '` r_<<' ® P.O.Box 1179 James F. King,Trustee Southold,New York 11971-0959 •Dave Bergen,Trustee • G . %,,,.f` �� X _ ,� .i •4 Telephone(631) 765-1892 Charles J.Sanders,Trustee gir j / 631) 765-6641 COUNTO --- ors - D \.7 p BOARD OF TOWN TRUSTEES 1.11 NOV 1 7 2015 1 J, TOWN OF SOUTHOLD To: Southold Town Building Department Re: Verification of Building Department Permit Requirements 53—S-12. 69 SCTM#: keEil .st1 Property Owner Name: ' ie's coo° (P sA•, ieks) Date Sent to Bldg. Dept.: 11(17,15-- • 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 Will the proposed project require a Building Permit? Will the proposed project require a variance determination from the Zoning Board of Appeals? V Will any part of this application be considered as Demolition as described under Town Code? COMMENTS: • • Signature oReviewer Date • . I,,,, 1I‘00&�®� S®�ryq Town Hall Annex John M. Bredemeyer III,President ® +ac l Michael J. Domino,Vice President �t1 ® ,, 54375 Main Road \ '+ .'44,4-4.4 \ P.O.Box 1179 James F.King,Trustee -Prrt '' r %\ Southold,New York 11971-0959 ` � 'kt21.� Dave Bergen,Trustee ; �.`�i® �,- ")a0 0Charles J.Sanders,Trustee =,® env»ar:-° •iI Telephone (631) 765-1892 4 C®UNN Fax iir� Fax(631) 765-6641 .... i''r BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland Permit Application -- -,'° _Administrative Permit ' `' ,`_-°_.. r .,`,, ,. Amendment/Transfer/Extension 1Received Application: I I`«•15 E 1 Received Fee: $ Ze4ZiOT) " • __ '' IL NOV 1 6 2015 Completed Application: l 1'(m.1E I—- o Incomplete: _ ^_",1 _ SEQRA Classification: �' �`'"''''" r Type I Type II Unlisted ��`��� r-- '- - "- '`---- „ • - " /Coordination:(date sent): I/ LWRP Consistency Assessment Form: /1'38`15- ICAC Referral Sent: I I<1 ft-115- J '_Date of Inspection: 12t qe!.S _Receipt of CAC Report: _Lead Agency Determination: Technical Review: Public Hearing Held: 12.l(o.l5 Resolution: • Name of Applicant: c-- c"),)r_iSa.pp Mailing Address: 1 -5.D P 9-.' '(C...-) (---xe.,c2A- ---q_A-, Phone Number: Ci 1 El-SCia s I / .�,— Suffolk County Tax Map Number: 1000- 5 - \a Co Property Location: 3D5D n25- 101' , c \ c (provide LILCO\, Pole#, distance�_ to cross streets, and location) - AGENT: Y_ � \� Q (4–C.ND__C-CLD 6 1Un (If applicable) pp )) (� Address: c)D -303 A5A� C''l iq 1 7 I . Phone: Q�I b 12 2` ) 4\ • a-'rd of Trustees Application_ GENERAL DATA Land Area(in square feet): /at(, IticKP5 Area Zoning: ,� Previous use of property: fS1t TlL i01-` Intended use of property: e'S 1 U e_AY L 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 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 )C No If"Yes",please provide copy of decision. Will thisprojectrequire-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): RP(\tlpv2 2 J (,c1.u/5eS C cb CO \:\of — a)9xCo i I al (vvirsR 3X1 \o\ocks �ciS�r� r is ��l • 031-Ine ;S c .ra� ►Q4A 3C _ c)(c. ClAppycv_to-l-Q-17(, .X is • Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 'R.e co,-; j\ockS Area of wetlands on lot: , 60 D square feet Percent coverage of lot: 0(O Closest distance between rest existing structure and upland edge of wetlands: 55 feet Closest distance between nearest proposed structure and upland edge of wetlands: 6feet Does the project involve excavation or filling? No ' Yes _ _If_yes, how much materiaLwill be_excavated?____ cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: WI— feet Proposed slope throughout the area of operations: �/; Manner in which material will be removed or deposited: Il. .N 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): \kA\ �-e took e e6- a,cwe_AAGJAS r\; - \ 5APUS r 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 I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part I. 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 C.).CAef 1,1))‘(e. \-)oke 1 6 Name of Action or Project: Pee asi-\<cv s Project Location(describe,and attach a location map): cNt(lee_7-c. ± I • 47 , Brief Description of Proposed tion: 01-\81/4.41 C� -e__rc-)o\(e l( C o�scSeS o-C `a.N 1 to VD\oc-k«- ? n t-11 L( Cau(SPS cam' CSX 1 1ro1c V S n5 C-co-k)3. Name of Applicant or Sponsor: Telephone: X31--7105-1223 - \)D-e-\ OG,\1/4, G)t eCa-� CcD'Cl cic-'\->'(1 G E-�'oe1 c\c‘t_\,&i‘ P opt-on\� e. Address: G'oX 3LS City/PO: State: Zip Code: (5 o\ 9 1971 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 r-, 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: �jqu 01,6. -0.$,,;c � � i(� (yirya f n+ 1-1 ',- 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 or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban El Rural (non-agriculture) El Industrial ❑Commercial 'Residential (suburban) ElForest ❑Agriculture El Aquatic ❑Other(specify): ElParkland Page 1 of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? 1- 1 b. Consistent with the adopted comprehensive plan? ri 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? k 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: 8. a.Will the proposed action result in a substantial increase in traffic above present levels? N�OYES L � ❑ b.Are public transportation service(s)available at or near the site of the proposed action? i ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? f ❑ 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: 1,Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ® ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? _ b.Is the proposed action located in an archeological sensitive area? 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ❑ I 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 ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, nYES 11a.Will storm water discharges flow to adjacent properties? 111 NO 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 INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE _ r Applicant/spo vor name:; _ l _ "' : I 114 I a o 15 F^ Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning 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? 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? 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? o ° 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. 4 r - Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that he proposed action may result in one or more potentially large or significant adverse impacts and an ironmental 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 of8d Agenc Date oA4 /�'0 er President Print or Ty Name of Ressppoo'Sr O titer in Lea Agency Title of Responsible Officer gnature of Rest).•. - (icer in Lead Ag cy Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: P.o.P. �°� 1- 'mU.XIt - lC ® CJl 55 mcvviirh..04) oki) icbz STATE OF NEW YORK COUNTY OF SUFFOLK c SaYas ,residing at aL t9't,s+. 1 ficAo,eL0 Nq t Oc:x75 , being duly sworn,deposes and says that on the 31i. day of i�� y ,20:5-,deponent mailed a true copy of the Notice set forth in the Board of Trustees Application,directed to eacli.of the above named persons at the addresses set opposite there respective names;that the addresses set opposite the names of said,persons are the address of said persons as shown on-the current assessment roll of the Town of So thold; thatsaid_Notices were mailed at the United States Post Office ate. e„IN Spm vire: tha' said Notices. - mailed to each of said persons by CERTIFIED MAIL/RE RECEI' Ak.31. 104'N , Sraflekake— Sworn to before me this 3 r� Day of Dee fe vAsty 20 I•179*.'' s Notary Public MARlYNOVA :PSOtary Public;State of New York >• No.01MA6307080 Qualit'jed in New York County r ;": Commission Expires 06-30-2018 , - ''',',.;;.,N4, -;,,,?2.,..,, TizzX,;:yi„):4,,,,,,,, ..Vi'g:,e00,`:.,kg,-.4,',.,t-r ,',,,,...*/,,O.e&-,,,V4',N,T.1.14AVi IN'a-4`.''' 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I � <'`•`� •'� `"��- ��� � .1-;.,- '' `� � COMPLE7„E CC710N ON DELIVERY, ... . , THIS S- SE_NDER: COMPLETE THIS 5ECT10N `, ° .A Signature - 0 ggent�,' leteitems 1 at2+'and,S -` S Eli'Comp �, . , 0 Addressee: X, ',`-is,print dour name' tun address omthe-reverse' Printed Name) G'Date of Delivery 'so that weT an return the cardio,you. - , B. Received,by( , 4 a Atiach this card to the back of-the mailpiece, ertnits: � or,on the.front if space p D.Is del '� 's1 a from item 1? ©Nes � '• er-;deiive a'e - .elow i.7:No . 1. Artioie Addressed to:” ' ` � � ,t�, ry'' '"4; '' L,'' 'AS?, „r: gl, ,,,,, ., ,- ,,,,,,i, ,.:,:„, : , ,�-V) EiY�-�1;��� r �..�„°per :'pllrA ') _ , '',[fie- -1,y { oL g-IPiority Mali Express® `` ` 1 3. - Ce = ag1stered mom '`II ��IIS 11 I'I'111 I��{., , 0 Ad ignatdro: Delivery. Registered Mal4Restricted 4 .' III i iI�'�� I MIME' m i5TA Restricted 4. ,De1Nee O Certifl- �@ ,`pRetumReceiptfor',< wed „l • M tarn Receipt . ' - ' ' ; '- r ,0 - ' .'- 75'6 0:4:,„;,_ o,Coliecttonad De n�e -. [IMercheidise rmatlonT"a,'_ - p Collect on Delivery Restrioted Delivery 1:1LI signature Confirmation - *19 2 ArtlrlA Number!Transfer from servicelabeD • - - , isUicted Delivery Res 7 015 D 6 4 0 2 2 4 6 4 526 4 :,Domestic Return.Regeipt Ps Form Aril 2015 PSN 7530 02 000 g053, ` ' S POSTAL SERVICE i :First Class Maii UNi7E1. '.t ')s : ' '1 t „ Postage:&Fees Paid`' - 4i> Permit No.G-10 ' e.Sender.Please4print'.your'name,,address,,and ZIP+4°,in'this box® _ , \o • --ice 11 USPS TRACKING#` , ll . .-,, - 11 ] ].}� .°. }� iia' iajaia.�}.is•�}eii�i}i���el��,�t,'�i��.; ' V, ,` � , ' '' 9590 -94 4 - 6 � ili)��� d ' - .. , ti John Bredemeyer, President 'o$uFFo�c Town Hall Annex Michael J. Domino, Vice-President °�� 54375 Route 25 James F. King =4 P.O. Box 1179 Dave Bergen y 'r ;` '">=• „ Southold, NY 11971 t� Charles J. Sanders �-\ot, °°,.0 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN'OF SOUTHOLD BOARD OF TRUSTEES:TOWN OF SOUTHOLD In the Matter of the Application of PETER SAKAS COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR NOT LESS THAN SEVEN DAYS I, 9 CA ,residing at/dba (9 �� c 1-7 Ne 0 , N1\--1) i 000 being duly sworn,depose and say: That on the®l5day of Nolergicer,2015,I personally posted the property known as by placing the C oard of Trustees official po er where it can easily be seen, and that I have checked to be-sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held t L9 December 16 2015. Dated. /2/02 fis. ///os/,S (signature) Sworn to before me this 3 day'of Dec 20/5 Notary'Pul c ANNA N.MARTYNOVA ` ; Paotary Public,State of New York .No:01 MA6307080 - - _ `Quallited in New York County 1V,IY Conriniission Expires 06-30-2018 NUTILL Ut- HtAKING NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: PETER SAKAS SUBJECT OF PUBLIC HEARING : For a Wetland Permit to repair the foundation on the existing +/-12.6'x33.6' cottage with attached +/-7.6'x19' porch by removing and replacing four (4) courses of 8"x16" blocks onto existing footing in an approximately 12' area. Located: 65490 Route 25, Breezy Shores Cottage #16, Greenport. SCTM# 1000-53-5-12.6 TIME & DATE OF PUBLIC HEARING : Wednesday, December 16, 2015 — at or about 5 :30P. M . If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours of 8 a.m. and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 of Trustees Application i'. t AFFIDAVIT • - KBEING .it,ULY SWORN DEPOSES AND AFFIRMS THAT :E/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF I S/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVE* BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOL1 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, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CON._- 1 N OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUEDBY THE BC OF TRUSTEES DURING THE TERM OF THE PERMIT. \ r� Signature of Property Owner SWORN TO BEFORE ME THIS / 3 f`` DAY OF /1)6-‘;c b zs' , 20 / • Notary Pu. is I.IN MEH TA • Notary Public,State of New York Qualified in New York County No 01ME6271266 My Commission Expires 10-29-2016 • Application Board of Trustees • AUTHORIZATION (where the applicant is not the owner) tis C-kCCP,S residing at (print name of owner of property) (mailing address) -d Z -ePoI ( 9 St , PJ� � � ia�✓-da hereby authorize (Agent) \ G' to apply for pennit(s)from the Southold Board of Town Trustees on my behalf. (Owner's signature) ZUBIN MEHTA Net@ry Public,State of New York (qualified in New York County _ __._.No 0TUIE6271266 tntissio .sires $k 1 ` f f. F ` 1 / s ,J-J4, APPLICANT/ACENT/REPRIISENTATIVE 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 itto take whatever action is necessary to avoid same. YOUR NAME: SC q's (Last name.first name,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 Mooting Exemption from plat or official map Planning Other (If"Other".name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. • Name of person employed by the Town of Southold • Title br 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 • Sub •-tted this > d o x,14 '11 ZfD is Signatur Print Name S Form TS I ZUBIN MENTA Notary Public,State of New York Qualified in New York County 3 moo-8 71766 1 My ommtsstoxpiles 1 9- Town of Southold V - 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# 5 3 - - I2-6, V PROJECT NAME e. � The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(a•g• capital construction,planning activity, agency regulation,land transaction) (b) Financial assistance(e.g. grant, loan,subsidy) (c) Permit, approval, license,certification: of action: Nature and -e trno\l' Cc.s\u(5e.S C9-C 'iN\ p b106-5- F9 x \a' -,..\-ff-A-(50 cowrws Fs\ML0 b\laY,S r\D py,‘- 1c bc1'C1 • P Location of action: • '] ✓ • (6\0) ' b ee_o / i,9 q Site acreage: Present land use: `` Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: (c) Telephone number: Area Code( ) (d) Application number,if any: /10— Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No❑ If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes No Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria Yes NoY\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 n Yes n No K. 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 n Nog 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 X-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. • Yes No Not Appliif_ , 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. n Yes n No KNot 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. ._ 0-Yes _0_No g-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. LJ Ye No A Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES t\-___, 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. n Yes No W Not Applicable 1 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 111No0 Not Applicable ` 1 1 Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III —Policies; Pages 62-through65-for evaluatiobcriteria. - ❑ Yes ❑ No[SZINot Applicable • 1 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. n Yes No N Not Applicable - 1 1 PREPARED BY , I 30 TITLE ����J! .��lv DATE 1 12 J )5 I I ,•� �°SU� � STORM[WA.T]ER Scott A. Russel SUPERVISOR it 0 MANAGEMENT SOUTHOLD TOWN HALL-P.O.Box 1179 It p 53095 Main Road-SOUTHOLD,NEW YORK 11971 �� Town of So u th o l d 0 CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING: Yes No (CHECK ALL THAT APPLY) ❑ A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ❑Di B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. ❑E11 C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. EZI❑ D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. El 0 E. Site preparation within the one-hundred-year floodplain as depicted • on---FIRM--Map- of any watercourse. - - ❑® F. Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management . Control Plan was received by the Town and the-proposal includes in-kind replacement of impervious surfaces. If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. APPLICANT (Property Owner,Design Professional,Agent,Contractor,Other) S.C.T.M. #: 1000 Date: Ditnct NAME 30G1 Doo1► &ex ema (or f10� e. 53 S ? ' �r Section Block Lot Lgnamrel a X031—llorJ— 122 .'�:5"FOR BUILDING DEPARTMENT LSE ONLY Contact Information .7 tlephonc Xumbeo Reviewed By Date: Property Address /Location of Construction Work: O aC6o Iff11Y� Eli Approved for procesbing Building Permit r Stormwater Management Control Plan Not Required. Gree yper, 1. 11 lgg1 , Stormwater Management Control Plan is Required. (Forward to Engineering Department for Review) FORM " SMCP-TOS MAY 2014 7- Sr APPLICANT S.C.T.M. #: 1000 °' "••' CHAPTER 236 (Property Owner,Design Professional,Agent,Contractor,Other) — '��.•anStWCr,)' 53 5 1z-( i Stormwater Management Control Plan CHECK LIST NAME Section Block Lot :N �� P �a� i z ' S M C P -Plan Requirements: Provide ONE copy of the Building Permit Application. �6s) Date: ' ' * The applicant must provide a Complete Explanation and/or Reason for not providing ���12 / �' °-( *''''�, all Information that has been Required by the following Checklist! TJ4plwnc Nun,6rr ..s...!. 1. A Site Plan drawn to scale Not Less that 60' to the inch MUST If You answered No or NA to any Item, Please Provide Justification Here! show all of the following items: YESI NO NA If you need additional room for explanations, Please Provide additional Paper. a. Location & Description of Property Boundaries ,/- &for grrpu h. Total Site Acreage. - IjI c. Existing - Natural & Man Made Features within 500 L.F. I of the Site Boundary as required by§236-17(c)(2). d. Test Hole Data Indicating Soil Characteristics&Depth to Ground Water. illt �/� _ e. Limits of Clearing & Area of Proposed Land Disturbance. 11 _ f. Existing & Proposed Contours of the Site (Minimum 2'Intervals) N/ g Location of all existing & proposed structures, roads, driveways, sidewalks, drainage Improvements & utilities. h Spot Grades & Finish Floor Elevations for all existing & I VII pi oposed structures. I. Location of proposed Swimming Pool and discharge ring. , V- .1. Location of proposed Soil Stockpile Area(s). k. Location of proposed Construction Entrance/Staging Area(s). — I Location of proposed concrete washout area(s). in Location of all proposed erosion&sediment control measures. 2. Stormwater Management Control Plan must include Calculations showing i that the Stormwater improvements are sized to capture,store,and infiltrate I _ f on-site the run-off from all impervious surfaces generated by a two(2")inch �/ rainfall/storm event. ill, 3. Details&Sectional Drawings for Stormwater practices are required for approval. Items requiring details shall include but not be limited to: ` a. Erosion & Sediment Controls. V b. Construction Entrance & Site Access. c. Inlet Drainage Structures (eg catch basins,trench drains,etc.) ✓i- d. Leaching Structures (e.g. infiltration basins,swales,etc.) 77 • ' 11)1( I Nt,1NFL.RNNG DLPr\R'1`MENT USE ONLY '''' I I Additional Information is Required. Reviewed & I III Stormwater Management Control Plan is Not Complete. Approved By. — — I a Stormwater Management Control Plan is Complete. Dare. I SMCP has been approved by the Engineering Department. I FORM " SWCP Check List -TOS MAY 2014 Disapproved a/c e: E'x' ation ,20 Building Inspector APPLICATION FOR BUILDING PERMIT Date IO J a7 , 20 15 INSTRUCTIONS a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale.Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas, and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize, in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall:be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County,New York,and other applicable Laws,Ordinances or Regulations,for the construction of buildings,additions,or alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,housing code,and regulations, and to admit authorized inspectors on premises and in building for-necessary inspections. -T( C (Signature of applicant or name,if a corporai) co. c �4S Som®la,, 109 (Mailing address of applicant) 0 tiq ! J -- State whether applicant-is owner, lessee, agent, architect, engineer, general contractor,electrician, plumber or builder C cC . Ccr)c1 ithd Name of owner of premises 41Dei (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. i :?)0 t-1 F • Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: i , ci Li- ` y �+ if- /0 38C SIALf-811) House Number Street Hamlet County Tax Map No. 1000 Section S 3 Block Lot i Z ,Subdivision Filed Map No. 53 S r 7 Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy het'00, b. Intended use and occupancy e.45\- `-�® 3. Nature of wor (check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work R6iwa -CEL]��iee� /�S' zieeeosp Gscr'kElrj45 4. Estimated Cost YOGI 411=3 Fee .#01_36, JAIC/Sr -'aveRio (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business. commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories S. Dimensions of entire new construction: Front Rear Depth ..Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase 2.C10 Name of Former Owner G1 1,7,3-,=1,2. 1 1 cc, 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO 13. Will lot be re-graded?YES NO tX11 excess fill be removed from premises? YES NO 14.Names of Owner of premises S R\CqS Address L4 Zrl S i\`tc latos Phone No.9117 -S9-2--71 Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this properly within 100-feef of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO * IF YES, D.E.C.PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation.plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18.Are there any covenants and restrictions with respect to this property? * YES NO * IF YES,PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ) being duly sworn, deposes and says that(s)he is the applicant Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines,streets,and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%lead. 5. Commercial building,industrial building,multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings(prior to April 9, 1957)non-conforming uses,or buildings and "pre-existing"land uses: 1. Accurate survey of property showing all property lines,streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant.If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool $50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential $15.00,Commercial$15.00 Date. New Construction: Old or Pre-existing Building: (check one) Location of Property: 44-16 3060 Saky eqa• € ceenFoA House No. Street Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section 53 Block 5 Lot 12- Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ Applicant Signature 11/12/2015 23:18 3302599029 MODERN PRINTING PAGE 02/02 0 pe---c__ A ? e BREEZY SHORES COMMUNITY, INC. SAGE BOULEVARD GREENPORT, NEW YORK 11944 To whom it may concern: The Board of Breezy Shores,Inc., has approved the foundation repair of cottage number 16 (Peter and Valerie Sakas, shareholders), Thank you for your attention. Sincerely. The Board 7414,i-g-let-A--4-1)-P"-----, Judy Barron, secretary 11/12/2015 23:18 3302599029 MODERN PRINTING PAGE 01/02 tY� uau {'a°SCEP{ ` .aw Fax Transmission • s,. Date: 111 /-3 I .15 ?4�s��; ;fir.+ OFFICE PRODUCTS -��— — 7825 SOUTH AVENUE Attn: 6: _ / r • BOARDMAN, OHIO 44512 Youngstown Area: Fait# : Ph: 330-797-2600 Fx: 330-797-2612 Warren Area: Total Pages Sent: Ph: 330,369-1815 Fx: 330-369-5154 (ExcfudinA this cover page) Alliance Area: Ph: 330-823-1231 Fx: 330-823-1991 ;� Willoughby Area From: 1 pe, y a ninit/it Ph: 440-347-9853 Fx: 440-347-9856 Regarding: a p pr)111ec J Comments: save@modernofficeproducts.com www.modernofficeproducts.com