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TR-8739
• ,,,,,,,,,, John M Brederneyer 111, President Town Hall, 53095 Main Rd. ,�, g11FFOC,Yeo,; Michael J. Domino, Vice-President ,��� Gds; P 0. Box 1 179 4 • is NY l l°71 James F. King • x Soiithold, Charles J.Sanders • y�Ol • •��pl• �� (63 1) 765 1892 Telephone 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 15t day of construction V2 constructed Project complete,-compliance inspection .. •.a„ .''^ '.e.. ,. .ti 0.11'.:'..,,,, '.y, 11 s ^� ,r li fr 3 4 �, S t. . 4.4Atl,. 4'4 ''iNStf O�dIF ' r. ,.11 •' t'• i,1 �.�/. fy: t? _..;ik, 41,Y1�s .9 S iltli 'iiip t . yt l 4 i 14:- �- U,A j Y ..s.,' +.AU S J ..t ', (. „"''6'u...'_„x- .. U- � Y .,,,,,:,1-.0g04''''- " ,,,,,-• ^ �'It � S"",,,.c �.t�,zv:t�` •a";;.. {,y4h" � 1 r� m"' � 1 r' `u`"`. `.\ P � J a;r lli KT9J•..''.C»'Y012F<'.!•SS,,V," «.F,.3,.mT<,.t'ri.... '!" . Ot4A4'.„ .>J'S`itY4!�•fi,.^'"'L. V,,,RT1- T,.n?414 49:t\.:Xt-..ia.,E LS4P g .]t 04:SJ! ,'h.._-•1v? uk,?I.X'1 hf..,,vR d 4 Th:A44,,, �.z ';t,. r E i'4,.1'j , �1tl41 t'f' ' BOARD OF SOUTHOLD TOWN TRUSTEES '' , .f°„ NEW YORK ".,� ,,.., SOUTHOLD, 4i' ,4k7)r ' DATE: FEBRUARY 17, 2016 , tAtb 4 PERMIT NO. 8739 . i ISSUED TO: SAYWARD MAZUR , g e S.:::0 PROPERTY ADDRESS: 555 WEST ROAD, CUTCHOGUE '_�`� ta SCTM# 1000-110-7-7 iJ-:..'V'l- . r, AUTHORIZATION P � : 4 .‘„,, Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in • h- accordance'with the Resolution of the,Board of Trustees adopted at the meeting held on February 17,2016 and ' `. =.-' I in consideration of application,fee in.the sum of$250.00'paid by Sayward Mazand subject to the Terms and i1 , , Conditions as stated in the Resolution,the Southoldur Town Board of Trustees authorizes and permits the :';1 following: N . .. t. i yr- l�1:: Wetland Permit to construct a 378sq.ft;one-story'addition`and a`943sq:ft.two-story s y, l addition that includes an attached garage, onto,the`exist ng rl',481sq:ft:two-story Jx; .,.4 dwelling and a 197sq.ft. front porch; and to exp'and'exlstmg front"porchadditional 4%-;',"SF t'•,�j 270sq.ft.=-`and:as depicted on=the site;plan.prepared by ro Robert I. Brown,Architect, P.0 , ; ' ', 1'`''1. " dated December 22,2015 and stamped approved on February 17,20;16. +` . .. . , , , i , J ,:.14' ' .,.1:,..„00,,,,,,,,$,;, !/' ,,,,,,. , 4_:_,,,,,,, ' IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, 0. = and;these presentsto be subscribed bytla majority of the said Board-as,of this date.. ,' :.....ik%..., :-.:0 ' ki ,,• ) gy :, , �, , Q :::,,, . ,a �- -iIIIII,`` L' Lw tW i /" I— '#, ! a' A.%x'4- cs 7.41 L:crT(4�s..t �`,r..�4MIttr,iac:,. zriatS. .%.3, �r6` "t .12=t,W w'r. .r .',4, ..ar.., .t x0-5 i 7 -,s a ,. c,K�fi. i�,. w4�;x+,C�'.moi s a,� ri dor iil 44; r o 1 . ' 'viz, �i:- 't p�( f&• .71:„.„,,,,>411 ....744� 1 ,, ',,,,;:ii ,". ,s::-. "-..x..,4, . .LF t, .14.,-,.,A .-cty :,--.11y,.. .l 1 es.. --,,..4%.40:::,...- ti ,„;,.,,,f,..;,.,...,..,1§,.,,,,-.,-, 7` r:i.. { 1 Fly'. . �., ��� .. � ��..r2 � .. .7._ s 'f'j O�iitl r; v� iF��F fffff 1,+J�f �ti' �F As, ��, ya TERMS AND CONDITIONS The Permittee Sayward Mazur, residing at 555 West Road, Cutchogue,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 John M.Bredemeyer III,President Iol &N-• ®(/�� O_l Town Hall Annex Michael J.Domino,Vice-President ® ` 54375 Route 25 P.O.Box 1179 Glenn Goldsmith `� ;° e, Southold,New York 11971 A.Nicholas Krupski N "" a �1� Telephone(631) 765-1892 Charles J. Sanders Fax(631) 765-6641 (COMM,\\ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD February 17, 2016 Robert Brown, Architect 205 Bay Avenue Greenport, NY 11944 RE: SAYWARD MAZUR 555 WEST ROAD, CUTCHOGUE SCTM# 1000-110-7-7 Dear Mr. Brown: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, February 17, 2016 regarding the above matter: WHEREAS, Robert Brown Architects on behalf of SAYWARD MAZUR 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 January 8, 2016, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator,issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on February 17, 2016, 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 have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of SAYWARD MAZUR to construct a 378sq.ft. one-story addition and a 943sq.ft. two-story addition that includes an attached garage onto the existing 1,481 sq.ft. two-story dwelling and a 197sq.ft. front porch; and to expand existing front porch an additional 270sq.ft.; and as depicted on the site plan prepared by Robert I. Brown, Architect, P.C., dated December 22, 2015 and stamped approved on February 17, 2016. 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: $50.00 Very truly yours, John M. Bredemeyer III President, Board of Trustees JMB/dd Y • < SOV — _ _ — It.r, ..._.,_I71;CD `CAJ CII ' J CD ��t. N JAN8015 I4-J'--J _ — Na i N�rZ g 6 Z e 3ou, N 5,.;,th;i3;,,.vn .—__+ 1 ZZ Ico \� N �� �_� :L1i Tt1<F4rc .CD _ Ov' � �" VI mxf ,1 3NId DlQ.SI --- M_ __ :CI' ' l\} r f � 3NId 'AtQ.2i -'� .�� '--�_ {in h�Tv . 3NId n � nCo = lQ.02a Iv 1-- � RELOC' r 3 I9211I� 1IJOIB Wfl[91 a •c '. a'YWeLL(SEr \ __ N - � '� DRAINA -Iv • \ MI! \ M coo 0 ' --___._ So9 Z N o a NEW ONE STORY xb y r o o Mini; ° o, w '1(7� ;PI i b e " -1 ADDITION v, \ t.� 332!1 'OM,pr PI : _— ► am.�j / • �'ilio iiiiiiii\.. L. ii\\ Nv. ` N . o , kiO ~ r [ � �j/�// \`�\ `` B O. ' I p PRo�oTT REPLAC '/ 1 jGnl s ,o �,- m ;P on yr 31••-i ` ` rU i INCE V \, ...s, �" d i' r/ -.); I ,/iii/�%% \ `\ ; ' I TOW • 4E. A, ys A° , :►. /; � ►.�\\=�I 39: 9 4' EIS� • 1! 1.4:44--::: = clay� �� N. I r EW PO:C.IVOVIDE I /2 T. NE WO STOR ` '/ / ' • - ....474.1...:. / p INGOVER ASPHALT DRIVEWAY s s/ — a BLEND BASE DITION n / •�• �)� ��: Y - (RECONFIGURED) * e m /�oOOtt fi' L nv� c r n, Q1 ry ' 4 b CONSTRUCTION �0 - s s O o s 6"W TRENCHbib r, is �' of I \` n n SILT FENCE DRAIN '< b Atv o , 1 x o �8'9t "0 3°Q , r' I 1 P i • (� �� S�LZoBZ 2b Cil n I :/••• S v y m' S (�� il-z I i e _ t` PROVIDE I-I/2'Thf� [Y tz• I y BLUESTONE PAVING,OVER ���(///�y [� I I t 4°BLEND BASE a/ `,o- I/ 1 d .� � � ` JI ! 3, .1 awn/ ! n ti / ;' /�'/a cO V J CO i CD 4 - - - // , 1 121 ti � CO Ul v CD N N i I' \ • /aYDgp '\� CA) I ,. '1.,.'r, ri = fU N 1 PI ///(' aQ��� I. RoG`A��\ ADDITION SITE _ , P L A N APPROVED BY °� A r : BOARD i I. = W S MAZU R RESIDENCE O OF TRUSTEES ••' .. �� :�, X � TOWN OE.$OHO \` ti ` ;c'L`` DEC. 22, 20 15 BASED ON SURVEY BY ,•- , - . . , _ LOT COVERAGE: *' �'r `�`,...1c-,, `=`' SCALE: I " = 30' JOSEPH A. INGEGNO, LAND SURVEYOR - •-'- -- EXI TING STRUCTURE (INCLUDING PORCHES): 2,415 SF —. z,7 r ;E .FE'R11M.' 17-2010,' _•FRCP05ED (INCLUDING PORCHES): I ,471 SF : ' " - :-_-:2'..4, ` Robert I . Brown DATED: SEPTEMBER 7, 2000 --•:.,; __ 1 SCTM No 1000- 110-07-07 /.` . N „TOTAL: , 3,886 5E 7. 1-1-- ` _=' ; 1 Architect, P.C. ELEVATIONS TO NGDV DATUM b '� %4 -. 3-,5-3G / 2G,3 18.82 SF (LOT SIZE) = I4<8%D i ` . : _` ` 205 Bay Ave. Greenport NY admin@falrweather-brown.com AREA: 26,3 18.82 SF (TO TIE LINE) - � '�_� - � - ' , ,- _ � , '.� -: �,_ 0.604 Ac. - . .. M 63 I -477'-9752 ^ or' 4- Mk MI . e Yap VW BUILD NEW STEPS wAHOGANY TO 1.10 CA1,.0 , 1 2. 2 5- • ,....:. .._1 5IE 0 9 LI :IC / , • i",,1-----' - 3 4.. 2. 2 ;0 I/2. 5.0 ,." 5-0.- 1 S-C.11. 30.1' / ..,) Kr, ) .,,, (7, LOOR DRAIN 5.OPE TILE c) e FLOOR TO ORAL Z.! c,..,..1.j r:IIZEN.7 ., ='ATVAIIIMINE7 ,I=11=1Y zd1•••••=7 4, NEW A/C K A STACK , WASHER •N PR,E-FAB i.,..! (--) - - z I I I (7`; • /Th /DRYER ONCRETE - EXISTiNG DECK AND ••-• \_./ if, ti'Th, 6 ,., \._.., i'M SIDING TO BE 5,1 6- DIRECTION Of NEW FLOORING POWER WASHED 124 .0 ..--.. MIRROR 51zt TO t''. 4-7 v8BE DETERMINED 0. .4 K1 OM„ „.,,- AIL 8,,t MB ==__________,„42:311.11.111MMENIV,7 ..92 4 15'7 :iJ a e PROVIDE B.wIDE-PLANK PROVIDE AMEPJCAN BLACK WALNUT FLOORING THROUGHOUT ADDITION BLOCKING IN WALL AS NECESSARY TO SUPPORT I, r 3, g - '- 0 1 r "rj 11 orli - - viim-4 . , ,.. , . - , „ . / PROVIDE GAS FIRED REMOVE EXISTING INSERT IN EXISTING WINDOW FRAME FpRzpuscE PROVIDE NEW TRIMMED • REMOVE EXtT1NG DOOR.)RRIE IN TO MATCH EXISTING WALL REMOVE COSTING WINDOW FRAME IN TO MATCH COSTING f 1-.1.5 V,./ ,=f 1 EXCEPT CERAMIC TILE IN BATHROOM WALL-HUNG VANITY r4 A — VI 1%, GA5 UNE OPENING PROVIDE ;; WOOD FLOORJNG SHALL SE,,,,,,,o A-ID F,. ,2,.., AUG ^ OAR SADDLE PATCH FLOORING AS MI6 BE FINISHED WITH I ;, A I,2. FOR BATHROOM - z 5 5 ,., . t-.1 .5-'1. •' WATERLOX TUNG OIL I NECESSARY DETAILS '': S'* 7 ', ' A 4 APPLIED IN 21,,S• ACCORDANCE 112TH .'2 ,-,t.2t", / ):-. $. ..-- MANUFACTURERS • ,,,, ,,', I$r , flr,.;›,....,„.._ - ,SPECIFICATIONS AND 42°H PARTMON ELEC TO ./. 9. 5 PAINTED PROVIDE i•FIRECODE GYP BD ON / :3 - RECOMMENDATIONS ...-•Gr,r,g. _ A/7,: ! SHELVES WALLS AND CEIUNG IN NEW GARAGE IT 3 lie "Ell11111--__,, -' TAPE.SPACKLE AND SEAL WITH / FIREPROOF CAULKINGRE AS REQUIRED -. I, r I FOR FIRE SEPARATION V 0 '.2 .3/-,-,_\ WALK-IN CL• \-:-/ ,.., 5 I 1] DIRECTION OF NEW r/ FLOORING PROVIDE POLISHED FINISH ON •4 ...__,„ CONCRETE SLAB , r,:', •,,, - b - - L, ; 1111111.1 r r 4_,_., v gli IIMMIII% r n 5''C.)I 2 4.-,I• $ I 5 R @ 8 - / UP • 4.'''rTh \ / , - - IC A ,: t. NEW PORCH , . ,.?/DErCF7J.N:TO MATC11 • :„ ''', i 7 Z.1 111121 Ii 1.) a [0: 0 m. 1111 14 I MATCH NEW PORCH , .--• DECK TO ECSTING 1.1111.11MIM, I I 1 I 1 I I memos immnimmImmollum V-S: ...:(/ • i I 1' =.1 .1-..fer 2.9 I P SC-) I.2-,,••?' \..11 VET r//7/ZWA—-—— 10-9. , '•,..„.„... 1 I I V-I 1• I 4-I. ?...,'-3 1.2. I I 1 ) I I I INM"5" \\\.......--- ..„„.--.,..‘ -1 ill 1 1 1 i cm0AiiucmtiNA,Tcr:,.G F. - EXISTING DECK ANO e;'", ----K2—imumommmmmmom , sp SIDING TO BE POWER-WASHED I • I -S71 ' RD Er--2.--C--L-----, D REMOVE EXISTING )I , I CI 0 f1.1 1. r__1 GUARDRAILS ON FRONT PATIO PATCH PORCH AS 0 NECESSARY - .,,.vsE.D A Rot. -\ '7/2. . .. At 1 I - t..-„ckl.I.Bil_ <(• it, 0,,.,„ , u„,. , . _________----1 J iMIsor:::010:::n40165 li 1 Lio te if t e* I 1 . . _ _, 4.!_::::--_- ' * I e.:2 -cci ' I ' LL t 11 ( 111 \ , W $ 5 MAZUR RESIDENCE i 1 t i I I lit ---t tit 1111' 11 \ '',..• ' • _ 0; EAN-_,„,k , ADDITION Itilll - II0- X--.11111I DEC. 22, 20 1 5 if: v,,--“..:F..-":".5EL1 CF THE ,.../-.':• i--`0.' -: ;':‘ :'-'-,F.fir:NI, SCALE: 1/5" = 1 '-. .... U:' 171 THE ,..:* Robert I . Brown r . '1 :' l'-"• V.T,r_.; \! FIRST FLOOR , 1 .. .,,,,,\... , .i.' vr''s, --,:, , I Ho RILED Architect, P.C. --.... EXISTING EXCEPT AS NOTED i''.. "7 ;1.-, ._\‘ - ‘r,,sZ."; LI E .... , ..Z..7... `..E.-:...,.1 205 Bay Ave. Greenport NY . i:,CC,ORDANCE acirmn@fairweather-brown.corn ‘,. .7-I-i ,..... ,...- . 63 I -477-9752 .:..,,.. W * 5 MAZUR RESIDENCE _ ADDITION DEC. 22, 2015 SCALE: I/8" = l '0" Robert I . Drown Architect, P.C. 205 by Ave. Greenport NY admin@fairweather-brown.com 63 I -477-9752 NEW CONSTRUCTION NN . 1 _ _ I INA — — ---, -----------„______,, r--------------1 EXISTING DEGA AND I I Ve lir- — MEM UM RIM UM NMI IMO SIDING TO BE IR I — MEM MEE IEEE EEM MEM MEE POWER-WASI1ED —..,:... ..— - ----T"------- -..... .=.-- ... ...-- -':--'<:: - - - ill NIMMi . 33.0 . _ , . EAST ELEVATION . ------ ,.r I ,• , .--- (r1 r. /ty !c.., 5 -:- ,, L....A v L., c.:T.: ::: UNI---f•,-Fi THE ,z-4,!:. --c,or -..j., \ fil, Li . .7 _.7,: ' LK:41.24$ 4 ).,2. ,-ril * I1 I JAN - 8 2016 1 ,-,--,.- -----_-. .}~(..- A!...TER ANY * I. ii "' :.,':-i t!`:73 D,--;AVilii•:?-3 RI v /1 1 I , ' -7:AV.: ,-z .-;i4C)RiZD ,, -• of iN!---: .;:'...:` '''..-.; 1-31'BE Saddd Town 16 • • e,,-, c , F.7F: LED,AND '''N ?----CF NV- Baarij of-Trustees .::*: -::: .1 AC:CC.,.RDANCE VV:TH-i-E-IF Li:111. " - - s I . W $ S MAZUR RESIDENCE ADDITION DEC. 22, 2015 SCALE: I /8" = I '0" ' Robert I . Brown Architect, P.C. 205 bay Ave. Greenport NY admin@fairweather-brown.com 63 I -477-9752 Z . , Aillb . _ ■■11-111 --- I II ➢ II II it u II III JI II II Il I■ ' r EXISTING DEC.AND I II II IT II II II II II II II II II II 11 II II II II I SIDING TO BE POWER-WASHED I I} I J rmi I 1 -- s - - .�' 'C '�' 1 . 0 _ ter/ Mi T € _, I IES. , ` WEST ELEVATION NEW CONSTRUCTION - j in= n r— n p4 c {— l-' n �. ms' 3� T ,Dr,--,---,---, ' --, v` �c,,, ;111 t^F �• '_,- (';�,`ISG �(:�= l`/Y i� • I.' .-.• :�; . _ " U: ';:_R TSE ,4. o,���a��O Zc JAN e 2016 -.:.-.: , . " .z= "..:ENsED v:,,,, ___., ' __i ,-„,--„,,,,-,„,..,.,--„:-. ..,i_717;ANY • ' ."I'=1-1••1 * 11 ^,rr nt'':i�:C�S is v ':::.:k--)-/ I� E ° �',. .34i 0--.,.. , . CES 1't"%'s=`. J{',1ACCORDANCE \ N WfTEi osi._."_r.W. w I W $ S MAZU K RESIDENCE ADDITION DEC. 22, 20I 5 SCALE: I /8" = I '0" Robert I . Brown Architect, P. C. 205 Bay Ave. Greenport NY admin@fairweather-brown.com '63 I -477-9752 I I 1 1 1 1 JL ' EXISTING MCA.AND , ® SIDING TO BE POWER-WASHED \\\ intr 1------------------:------- J SIINT DECK AND SIDIDINGGB TO BE POWER-WASHED _ ` . li-3 L7. - 11 V U i^ ('`9,,.W iii\11 • 11 I / i m ' JAN m 8 2016 _) NORTH ELEVATION t South kI Town NEW CONSTRUCTION I Board of'Rag os i -..i: THE E / - _ -:'El:::. ( :) /- -'' \_ ,,1 k. -=1: ;-11i--.:!NM' . 1 l'''(--.-1'7.1' * .1 • , ' --,`,- ;.,-.. I 17---i.ONZED . 0 Ii--=,:',-j... - ' illi �',ri? i THE LAW. ::Fa. T -- ✓' W $ S MAZUR RESIDENCE ADDITION DEC. 22, 2015 SCALE: I/8" = 1 '0" -Robert I . Brown Architect, P.C. 205 Bay Ave. Greenport NY admin @ fa i rweather-brown.com 63 I -477-9752 I 1j 1 1 n Il II if II II II II II II II u II II If Il II 11 If II II u u 1 EXISTING DECK AND , SIDING TO BE POWER-WASHED I _ t NO:CONSiRUCIION I ! _r - ��� IiV „-- ' ► L- t ,-- ,�LA", ; ' _ �-- - - `- y JAN s 8 2016 1 • .... Southold layin i , Adif% • ��\ ���� Board of Trusteg� . 1 . _ I. \ I. SOUTH ELEVATION :T. . . . - OF TUE , q�D C, i'_ '- ._(..`- t1v:'.VTHE i,w z-c`� .0.r,,,\� . ,,,_-- , . , _-,- -::::i. ik`' - - ' .--- 4 , v John M. Bredemeyer Ill, President '`'''UFFO( ,�c � Town Hall Annex Og Michael J. Domino, Vice President ,Or 0 54375 Route 25, P.O.Box 1179 James F. King z ,I Southold,NY 11971 +` 631 Telephone 765-1892 Charles J. Sanders ,y , ( ) Dave Bergen , . *,�'a'fn', Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD ' TO: Roe Y' viii / (� SAy(IJJl9 e-' Please be advised that your application dated 'A-Nv i � .20/to has been reviewed by this Board at the regular meeting of Evil 20/6o and •N 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) - -------- --- -- %Z Constructed ($50.00) - — - -- - - ' V 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: 1D41/611 Of 1'61 I TOTAL FEES DUE: $ o®a6-.° BY: John M. Bredemeyer III, President Board of Trustees SURVEY OF PROPERTY , 'L SITUATED AT CUTCHOGUE TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK FOONO MON S.C. TAX No. 1000-110-07-07 SCALE 1 "=30' �� t,ap`' �� NOVEMBER 16, 1998 APRIL 6, 1999 UPDATE ELEVATIONS TO N G.V D. DATUM �� colt MS,t.A a0,pp 7,,,.., SEPTEMBER 7, 2000 FINAL SURVEY /'�(� AREA = 26,318 82 sq ft N\I- S Y G' "„ v " (TO TIE LINE) 0.604 cc. 1-� ,pp p0 �G 533 .s / ' ,,,�P�NS ° ,o. va '�., v ,1 Q" syco,. FO0N 0 8'ap 1. A.0 MENS /-y�'� pOV`- �0. S 6 4 - A 6a E 6F P os — SPEP' 0 `\ a NNPY f • 1101,iii10. / - "NS CP°R �NN °S• ` \O° FpNO� NG c0P0°6� ....z. FRNp-E 2.A ���, __ll '° ,, GPR 134 v9 SR S °O " �. F 4'o T' % �9 o °,, x 5-Cc's' W tri ° � s^°�°° HFbce WOoo \gE N.cA \ -aW Wok 03- C. mf " OS'�PJ°�\O\a " / \\ 0 o o. 'ppP nOPN , �� 000 / / �4+ G'1.'Z. Zc • ` JPO � \ EPN F°EP bra °i v • N O°ON 0 '$p�, '.od ooi pOP° `,CO 06°N `in OE.OS , 1,g 1P ��O s a 411 w 1i / s' y / MPPS ‘;‘(c)3,0" 12°e / • 1 0 /� ♦'U-0.1.1,C- �/ °.'' /,A e / ER ,�Oi / O0µ0 SIF, ..--:>b°----- 0/ J x o �Q °,° \s.o,, eJ c'''ock °app \yS ' °oQ°AO C'• `` c eo�GE 17°�•Y 2.V1= n0, oy, 'oc5` <I �\ ````CP`` OJaO''P \�0,0°PK �J 0 7�� s. ;t O,°�,. .NO,pS 5 a� ai°,° 9 9 OP' p`Nf 0,'"\Lq A, of g fop S°P ,......4' \S. �� C p0 Ppm,, F\pc o'..4.a `i„ ,0, VS' 0V�'•Ak° % 0° �cWwppa V, ,;Kp00 O\y6 -'t-PS p00 y{P 0Eo'A cP „, u 8 . O�NGP° ...., 0 _, ' WPWIO 5 F°MO ON G°Na \NON v5P `Z 1 00 PPPEN 10 °NO • 0Ec F, t\F.ONS'''°4' O O6 R - r'y co - PY) 6tiD4 26' 005\)14`0 9 ( c Cp ( 3 PREPARED IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS AS ESTABLISHED BY THE LIALS AND APPROVED AND ADOPTED FOR SUCH USE BY THE NEW YORK STATE LAND TITLE ASSOCIATION tr, •~ 1 f"'\\ N Y S LIc. No. 50467 LIi -` ._.;:_i'',_____1. I i? UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF Nathan Taft III 1 ' SECTION 7209 OF THE NEW YORK STATE Corwin JAN 2 0 2016 i._ E EDUCATION LAW Land Surveyor I COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR I EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VAUD TRUE COPY , 5 --4 i t11;1,ii',1 I:'`lt'1 CERTIFICATIONS INDICATED HEREON SHALL RUN Successor To Stanley J Isaksen, Jr L S • 1 ONLY TO THE PERSON FOR WHOM THE SURVEY Joseph A Ingegno L S La._ 1,:..f.„-;. 1 IS PREPARED, AND ON HIS BEHALF TO THE 1 TITLE COMPANY, GOVERNMENTAL AGENCY AND Title Surveys - Subdivisions - Site Plans - Construction Layout LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTI- PHONE (631)727-2090 Fax (631)727-1727 TUTION CERTIFICATIONS ARE NOT TRANSFERABLE THE EXISTENCE OF RIGHT OF WAYS OFFICES LOCATED AT MAILING ADDRESS AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P 0 Box 16 ANY, NOT SHOWN ARE NOT GUARANTEED Jamesport, New York 11947 Jamesport, New York 11947 28-60.5H1 John M. Bredemeyer Ill, President .( ; , ',�o�OgUFFOtq x ed ,,. �✓' • ,,. ,_ . Town Hall Annex Michael J. Domino, Vice-President "4" 'j�� 1 t 54375 Route 25 o w P.O. Box 1179 ; � �� Glenn Goldsmith � A. Nicholas Krupski ,oy ter Southold, NY 11971 Charles J. Sanders ,t �Ol �� r Telephone (631) 7.65-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: d/4 II'`fd Completed in field by: Nis kN1f1-` Robert Brown Architects on behalf of SAYWARD MAZUR•requests a Wetland Permit to construct a 378sq.ft. one-story addition and a 943sq.ft. two-story addition that includes an attached garage onto the existing 1,481 sq.ft. two-story dwelling with a 737sq.ft. waterside porch and a 197sq.ft. front porch; and to expan. - e . - :: - - - - .•i io at270sq.ft. Located: 555 West Road, Cutchogue. SCTM# 1000-110-7-7 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual/>_ = "X" 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Setback waiver required Part of Town Code proposed work falls under: SEQRA Type Ch. 275 Ch. 111 Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation . Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultan,Japplication completeness/comments/standards: --s � pth N)01- Sia Kec ere_, )--/ Q/1‘)1‘ - 3:3opM e,4-10,. re-604 five,/• S fa,k — 6. fwd dtArtweay Present were: V J. Bredemeyer V M. Domino I/ G. Goldsmith ✓ N. Krupski C. Sanders Other Page 1 of 2 3 ' SUFFOI. John M. Bredemeyer III, President ,�'o�o a Town Hall Annex Michael J. Domino, Vice-President = � � x y<; 54375 Route 25 Glenn Goldsmith . '" P.O. Box 1179 A. Nicholas Krupski �y , o�4" Southold, NY 11971 Charles J. Sanders (11 �a, ' Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: Robert Brown Architects on behalf of SAYWARD MAZUR requests a Wetland Permit to construct a 378sq.ft. one-story addition and a 943sq.ft. two-story addition that includes an attached garage onto the existing 1,481sq.ft. two-story dwelling with a 737sq.ft. waterside porch and a 197sq.ft. front porch; and to expand existing front porch an additional 270sq.ft. Located: 555 West Road, Cutchogue. SCTM# 1000-110-7-7 Ch. 275-12 - STANDARDS FOR ISSUANCE OF PERMIT MET=X or Comment=* A. Adversely affect the wetlands of the Town: B. Cause damage from erosion, turbidity or siltation: C. Cause saltwater intrusion in the fresh water recourses of the Town: D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife.& vegetation or the natural habitat thereof: E. Increase the danger of flood and storm-tide damage: F. Adversely affect navigation tidal waters or the tidal flow of the tidal waters of-the Town: G. Change the course of any channel or the natural movement or flow of any waters: H. Weaken or undermine the lateral support of other lands in the vicinity: I. Otherwise adversely affect the health, safety and general welfare of the people of the Town: J. Adversely affect the aesthetic value of the wetland and adjacent areas: Ch. 111-9 - ISSUANCE OF PERMIT MET=X or Comment * A. Is reasonable and necessary, considering reasonable alternatives to the proposed activity and the extent to which the proposed activity requires a shoreline location: B. Is not likely to cause a measurable increase in erosion at the proposed site and at other locations: , C. Prevents, if possible, or minimizes adverse effects on natural protective features and their functions and protective values, existing erosion protection structures and natural resources: D. 5525% Expansion/Calculation Work Session Notes Application Complete SEQRA Classification Confirmed Coordinated Review Y/N Pos/Neg Declaration CAC: LWRP: Additional information on comments/to be discussed/Public Hearing: Date: Completed By: Present: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders . E. Cantrell D. Di Salvo Other Page 2 of 2 ,,-"su�FO" i t0 Co' Town Hail Albert J.Krupski,President ,� , *A.\ 53095 Main Road James King,Vice-President o P.O.Box 1179 Henry Smith ti #1.5 $ Southold,New York 11971 Artie Foster Ken Poliwoda •�.f. ������ Telephone(516)765-1872 =_�Ol */ Fax(516)765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD February 23, 1999 Samuels & Steelman, Architects Tom Samuels 25235 Main Road Cutchogue NY 11935 RE: MAZUR RESIDENCE SCTM #110-7-7 Dear Mr. Samuels, The Southold Town Board of Trustees reviewed the survey dated and received in our office on February 23, 1999 and determined that the construction of a second story addition, to be out of the Trustee Wetland jurisdiction, under Chapter 97, of the Town Code. However, any activity within 75' of the Wetland line, or any project seaward of the Coastal Erosion Hazard Line would require permits from this office. This determination is not a determination from any other agency. If you have any further questions, please do not hesitate to call . Sincerely, �• / ' 9• Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc . Bldg. Dept. 00143" s LJ r ll _ e � FEB 2 31999 S A M U E L S & TOWN OF SOUTHOLD STEELMAN February 18, 1999 Board of Town Trustees Town of Southold Town Hall, 53095 Main Road P.O. Box 728 Southold New York 11971 RE: Mazur Residence 555 West Road, Cutchogue, NY Tax Map# 1000-110-7-7 Dear Trustees: FQfc ^'-1 A144, Enclosed please find two Site Plan drawings for the property referenced above. The proposed construction is greater than 75 feet from the edge of wetlands; we are therefore requesting a determination of Non-Jurisdiction from the Board of Trustees. If you have any questions, please do not hesitate to call us. Sincerely, SAMUELS & STEELMAN ARCHITECTS Principal Architect "LA_ ie.,11/a-.1 0.4-6 ARCHITECTS 25235 MAIN ROAD CUTCHOGUE.NEW YORK 11935 i516)734-6405 FAX 15161-34-6407 - '9.`- -,•KI,-,.� i--.,,.,z�x�5 e,-c�+•tc,=. 5 '7,Fev"::i,e-ti.-g(?.cT;1.•• ✓.+r .. V All `t jam* 10. F`` - .. OWNER le 'Cep ya.+AOf- t li r� 1,,,1-12 (�- Glut Nki00t11021••,, m U Y aITE AREA 2¢,318.82J(OEWsreI� - S mt� Il f: 1{40910imnaL4o , F • FLd00 ZONE 'C' r , WEST Y a.WEr°W- •r r ° , OA Wo U} L ,Q.L8a�0a Z Ama.11Tities0ibn 74 �- W NOTES. Woocaa aorolaHrsoewodq a0a ale w z �dLL�rwwm�bb --0,0STIN4 WELL Taam>Ims-M-w4NantceasmabencLn I •-• '•Ahs Baltara MrOW aMa r0 • zezli Mil I CO W 004TH 1amlmrWlerwNf Na Ulm 111 a' 01!Ir(IWTrfENT e0e ne11awaionmwp4wom amteEeaeptym ExISTIN4 WELL sx1uIN61{Oaf-4-1 2 STjTEVENT weans far anal.Tartly 000003033,41 H 508. r ItinFEL 0 0leo by ma mnmuw 082 rata morin armM F mop 7nm m mNbyet. 0 Ex1571 N0 0 SIGNED • 4Houaa Serve d re n. I 4\-\__ -� 0 / 1 ' ' :\.\, , NMI M 0 CL W2 W -.----________- ® - EI LO '��o' 2 ti--Tol-j-:---". n, I I �ti, =�a\ YauNG al J2- 41 FxIIX O Nb b nowtMIAaa-Cv `I ❑' � -fjVsfW E.w TAIiY E a� 1 �I '.,:.:t:1"."'..", lY lye' -Ex16TNGi c N1TAcY To a W EGT n WAUTIC.AM 5.♦'.A 4"R 4t'3fi1"� x QE ABiNCbNED AND r 1}}+'� y ¢, FILLED N NITH 4kW3 e ❑ GY L' ria.�o EXIaT1N4 4/ 'I-L -:•�`� ••.• \ BrISr`^��P186 Tb✓3A f+ENOWATF-0 a Z 0 100 1 I ❑• '.rW ARY SYtTI.M- r I1.9 FTyy, iied 1 'A t -3 T20 Cul �(j/ �40.jal� IIP40,11 �aoSeo PoaaH ano n8. '9�=oI Cf a:� o (�� 7r4(--� ,..� I I'PoPDI�.2 STnRY WDIr4o 1W8.' a- -TaGT N3LE -- <os.,11:1,- _. :x H uo GE I t` LAWN I Ext T1Na1 (v� r_ 'c" :Mir ir ,57 ! ,.,00 __.-_.. _.. - 24 ,..0 [38.cT m _ L _ CTT-*'GlC 4? KGEoryEN GE WO KTH GUTGHo4UE NAR.BoIL a',J1- L- sw,Thy 1I NaKr4 I ��3ya I TEM WCWDNNc,1 I T 22-1-/{= F I-I�ysL yEvTIG TANIc I In KEY MAP o IT DEEP LEAD "4'p,f` h.1 w la 1 Or F r ; I OAKK b�i ZFNVY Lw-T lt 41 • � A gaiMN 142.1•1Y.0.411, 3 �JOFoL1 sL II .....:/ 'v."' ' ' Ir I1IIIIIyyE�pll lV IWi6 nv S 7, 1:T r 0"As u orr--/2.7 r.rrr���"""--- 1 •.� SITE 4 �- h4 Shen TM ec `-6rAlri P.V-E BPdAN FILI&?o MiR46 EwJr ____ _,,i_ �LT'FTT RTsiE�- / �`L y ws-1041.Ur•A,,Gt. SITE 47"fi r=•.: GUTGHOUL� H+Pp' PLAN _`•Lr"••+Oki No IW,LTE2 ¢N.a/NTEREn SITE PLAN IT 13.iTE-NO,0.t0a0 la,Iy50 SCALE.1'.20'-0' DY McFONALV 06o=GIEN00 Gwen No LOCATION MAP TEST HOLE 1- New York State Department of Environmental Conservation Building 40-SUNY, Stony Brook, New York 11790-2356 Telephone (516) 444-0365 11111100 Facsimile (516) 444-0373 John P. Cahill Commissioner LETTER OF NONJURISDICTION TIDAL, WETLANDS ACT May 14 , 1999 Re: 1-4738-02213/00001 Mazur Property Construct addition to Single family dwelling Sayward and Stephanie Mazur 16 Highland Terrace Great Neck, NY 11021 Dear Mr. & Mrs. Mazur: Based on the information you have submitted, the New York State Department of Environmental Conservation has determined that: The property landward of the topographic crest of the bank as shown on the site plan prepared by Joseph A. Ingegno, dated November 16, 1998, revised April 6, 1999 is beyond jurisdiction of Article 25. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 661) no permit is required under the Tidal Wetlands Act . Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary, as indicated above, without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and your project (i.e. a 15 ' to 20 ' wide construction area) or erecting a temporary fence, barrier, or hay bale berm. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. Very truly yours, „.....a.e."21/42.0444044147 George W. 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Main Rd:&Youngs Ave.) • 0,2 Southold, NY 11971 �pQ��• Telephone: 631 765-1938 l'"eou J11,%.°'''° ... LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM E v no ,=4 ' To: John Bredemeyer, President s ; FEB - 9 2016 Town of Southold Board of Trustees SG iti,,z d 10ot'(I From: Mark Terry, Principal Planner Board ofTrustees LWRP Coordinator - Date: February 9, 2016 Re: Proposed Wetland Permit for SAYWARD MAZUR SCTM# 1000-110-7-7 Robert Brown Architects on behalf of SAYWARD MAZUR requests a Wetland Permit to construct a 378sq.ft. one-story addition and a 943sq.ft. two-story addition that includes an attached garage onto the existing 1,481sq.ft. two-story dwelling with a 737sq.ft. waterside porch and a 197sq.ft. front porch; and to expand existing front porch an additional 270sq.ft. Located: 555 West Road, Cutchogue. SCTM# 1000-110-7-7 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 provided that: Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. I Y ,i` oFFOtar eso Peter Young,Chairman e - • Town Hall,53095 Main Rd. • Lauren Standish,Secretary P.O.P.O.Box 1179 • cp "% �t' Southold,NY 11971 �;-4 �et Telephone(631)765-1889 = Jig ,• Fax(631)765-1823 Conservation Advisory Council - Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., February 10, 2016 the following recommendation was.made: Moved by John Stein, seconded by Doug Hardy, it was RESOLVED to SUPPORT the application of SAYWARD MAZUR to construct a one-story master bedroom, two-story garage/workshop addition and expansion of existing front porch. Located: 555 West Rd., Cutchogue.'SCTM#110-7-7 - Inspected by: John Stein Vote of Council: Ayes: All Motion Carried ;, ° ////�////i ice-- ,+ John M. Bredemeyer III, President rrgr� �®� Sa�Tiyo Town Hall Annex Michael J. Domino,Vice-President II /•. ,�s.r lQ 54375 Main Road s t ',, y P.O. Box 1179 James F. King,Trustee i ,;,.s,,, % Southold,New York 11971-0959 %Dave Bergen,Trustee co tYy4 :r e. t Charles J.Sanders,Trustee ': 'ct p - ..._ ' . �• Telephone(631) 765-1892 lyCOU • ,,, Fax(631) 765-6641 r�r 1 . BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD = To: Southold Town Building Department 1� I , JAN 2016720 � Re: Verification of Building Department Permit Requirements 1 I SCTM#: Property Owner Name: ' S�Ylu i1t/Zvi Date Sent to Bldg. Dept.: i.l `I 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 q /Will the proposed project require a Building Permit? 17Will the proposed project require a variance determination from he Zoning Board of Appeals? - Will any part of this application be considered as Demolition as described under Town Code? • COMMENTS: • a r / 0//2 ignature of 'Newer Date - , \__ i ,.,„__,-- _ yf Cantrell, Elizabeth From: karen@ribrownarchitect.com Sent: Thursday,January 28, 2016 12:43 PM To: Cantrell, Elizabeth Subject: Mazur Hi Elizabeth this Is what Rob gave me: House: 1481 SF Waterside Porch: 737 SF Front Porch: 197 SF Total: 2415 SF Could you confirm receipt? Thanks. -Karen 1 ,,,,..frz=z-,es,,,\ , John M.Bredemeyer III,President tt` Nik'b � ,' Town Hall Annex -- 54375 Main Road Michael J.Domino,Vice-President i( . }�!- P.O.Box 1179 James F.King,Trustee k- c ,� ', , , Southold,New York 11971-0959 Dave Bergen,Trustee 1. ':.'', '.. Telephone(631) 765-1892 Charles J.Sanders,Trustee Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only /Coastal Erosion Permit Application Wetland Permit Application r,--) - ' --7---1:,yAdministrative Permit - _ tt / _Amendment/Transfe}xtepsion IF• i V Received Application: Id If I/p '' Received Fee:$ 2$-A OD JAN 8 2016 : t/ Completed Application: I i ad/10 Incomplete: SEQRA Classificatiidn: j - T • - �~ Type I Type II 'r0 Unlisted 1— -- --,_ :_: ` _._ F Coordination:(date sent): /117LWRP Consistency Assessment Form: F CAC Referral Sent: I.D-7•/4P i„,..•••• Date of Inspection: It/0i/(D Receipt of CAC Report: • Lead Agency Determination: Y —Technical Review: , 17—Public Hearing Held: 2.I7, Resolution: 1 Name of Applicant: Sq/a)42/rz ' /21,47.2,,/.c Mailing Address: /y thei bid, ve � 2gL . /t92 Phone Number: l/ '9� - 9,e- 9&'3 Suffolk County Tax Map Number: 1000 - /10 07—6'7 _ ' Property Location: 55j— 1)4 /6a 66e61/0. 4te `mac _(provide LILCO Pole �distance to c oss streets, and location) AGENT: ►,...i3�1!i,,,� . Of,. i 4, .4' � ,I 1J I A _. a Ol) (If applicable) Address: ,2,65- /52v/d, 00 ����a2 1 f2i9 //yz.VPhone:.6 33/--.$7 7 9'75-2_ cii-?—\\J4- Board of Trustees Application GENERAL DATA Land Area (in square feet): Z2/ ).(Z,.(??2 CFQ-�/L- L Area Zoning: — J Previous use of property: sj � � -LCdr A Intended use of property: Sings', —O attiti YSCd e ;f, 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 - No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes No / Does the structure(s) on property have a valid Certificate of Occupancy? i/ Yes No Prior permits/approvals for site improvements: Agency Date ie_ o-mom,suicispicrmoN vlibil9901 ¶_cctEacddd (ctj 16 O 4 le__ Ce-lka t\iQZUicCtten- 1 - 4i4/199g 0--Ur checc 261:±26) 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): / load 371 N �� , sib /�/ ,�'. d• Oddi '1.inr► (9 �a � --�I . u peas«m Sq GT.) . ,�iuC lA4 c �J Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: / ,Li/ ; ,L :// 011/1/ J , or-7-2s e)e/sty -Cron/ p (26. 6, . , Area of wetlands on lot: /V A square feet Percent coverage of lot: /4, % ` Closest distance between nearest existing structure and upland _ edge of wetlands: 63' feet Closest distance between nearest proposed structure and upland edge of wetlands: 75"g " feet Does the project involve excavation or filling? No X Yes If yes, how much material will be excavated? '9 7 cubic yards How much material will be filled? � _ cubic yards , Depth of which material will be removed or deposited:, 2 ± feet , Proposed slope throughout the area of operations: /2% Manner in which material will be removed or deposited: ' (7k__/0 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): .Wrik-S-_ 5714rZtehan Z4 ©r ( &Q.�' 5e.s:- P_Ji/A ii2 sL, t. 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification, , Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1.-Project and Sponsor lnformatio . (knC� � 1 4 ( Jfl Arthtted1. f L. OCk3f li<I S Name of Action or Project: ProjecLocation( escribe,and attach a location map): 6. iS oicece 0,cd-doeiu_e Brief Description of Proposed Action: l' (rvicyab-advd) / 6D 0 7 kf''&di ? Fr�). _4db/66-21643 'f?Pr/flone) , OradiviAir)e3.' "'eXi (2-1-6 -*P-7-.) • . Name of Applicant or Sponsor: (Of Telephone:0/ _Qn, ., 4&"G. 76eith 74-011i-le1( l� E-Mail: �'/1� �a��op(�� �'� Address: V ' City/ O: State: Zip Code: I.Does the pr..osed action only involve the legislative adoption of a plan,local law,ordin nce, NO YES administrative rule,or regulation? . If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2. \ 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES. If Yes,list agency(s)name and permit or approval: Sb1, zb IOL,ODJ 131)LLa)t 1).E2p"r— .-. CA-LL--7)e)0-1 pee t-(i-1-. 3.a.Total acreage of the site of the proposed action? .122, 4 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? (7,(,,01,-/ acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial `6 Residential(suburban) ['Forest ❑Agriculture o' 'quatic ❑Other(specify): ['Parkland - loo Page 1 of 4 f 5 Is the proposed action, NO YES =N/A a.A permitted use under the zoning regulations? b.Consistent with the adopted comprehensive plan? ❑ N i.1 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES= landscape? ❑ J 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? NO YES 'IN.. I [ 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: s 10: Will the proposed action connect to an existing public/private water supply? NO 'YES , . « Adzice tz r- Psi aP�a t If No,describe met od for pro iding potable water: ;❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: C 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 arca? 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain .NO YES i wetlands or other yywa��terrbod es iegulated by a federal,state or local agency? b.Would thesedactin d—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: CI.Shoreline 0 Forest 0 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? r'( 16.Is the project site located in the 100 year flood plain? yNO YES - 'K i f 17.Will the proposed action create storm water discharge,either from point or non-point sources? ,NO YES, If Yes, .1{ .� a.Will storm water discharges flow to adjacent properties? [ NO OYES ' ❑ b.Will storm water discharges be directed to established conveyance systems( unoff and storm drains)? If Yes,briefly describe: NO EYES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundinent of NO YES water or other liquids(e.g.retention pond,waste lagoon,darn)? 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: _ • i t ' 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;,. , L 1 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE IBEST OF MY KNOWLEDGE Applicant/sponsor n. e: �j ,r ° / /1 Date; 7i �� i.�w� L� Signatur•. `may - 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? 3 2 Will the proposed action result in a change in the use or intensity of use of land? ri0 , 3. Will the proposed action impair the character or quality of the existing community? 0 (� 4. Will the proposed action have an impact on the environmental characteristics that caused the (�"T� ��(-J{J , establishment of a Critical Environmental Area(CEA)? I t 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? i 6. Will the proposed action cause an-increase in the use of energy and it fails to incorporate { 17---- reasonably available ener•y conservation or renewable energy opportunities? 1_I 7. Will the proposed action impact existing: . , a.public/private water supplies? . ' ' '! b.public/private wastewater treatment utilities? r Z { 8. Will the proposed action impair the character or quality of important historic,archaeological, El 2 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? U 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. uI i Check this-box if you have determined,based on the information and analysis above,and-any supporting documentation;' l 1 that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation,. that the proposed action will not result in any significant adverse environment imp cts. l Town of Southold-Board of Trustees )' 9 11j Name Lead gency date President Print or Ty,: Name a, Resrible Offi er in Lead Agency Title of Responsible Officer • of Res onllsi fficer in Lea Signature of Pre aver(if different from Res onsible Officer) p gency g P p PRINT Page 4 of 4 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: - - • Address: STATE OF NEW YORK COUNTY OF SUFFOLK fradn I'Gi, P� I' e/1 ' OC residing at .2.a.5-75a rem 24 /I , being duly sworn, deposes and says that on the day of ,,., , 20/4, deponent mailed a true copy of the Notice set forth in the Board of Trustee- Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at 2644Wi , that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURI RECEIPT. 4 Sworn 'o before e this 5 D. of ► 1 / _0 j(..e Notary P • is CYNTHIA M.CUSATI Notary Public,State of;fsw York No.01CU6100507 Qualified in Suffolk County Commission Expires Oct 2O 4 yrzrxra� - LosuL�oo John M. Bredemeyer III';riesident Town Hall Annex ,�o �.,,, Michael J. Domino, Vice-President �� <:P 54375 Route 25 Glenn Goldsmith y P.O. Box 1179 A. Nicholas Krupski �� � 4} h Southold, NY 11971 Charles J. Sanders s 41o.1 ` ,t��-{�' Telephone (631) 765-1892 = �K Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of SAYWARD MAZUR 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, / LV &) SZ 1 J ,residing at/dba 9 ,4i)6- 61rean' 1 Mi 119Lq being duly sworn, depose and say: That on the 2:i day of-O& , 201(e, I personally posted the property known as Was-1-- -F-4 ad Cu, Lit._ by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday, February 17, 2016. Dated: 74/o !(p -(s.tfflat e) '' S voorn to brefore me this l 6 day of b20 < <P fi ( f •ary ublic CYNTHIA M.CUSATI Notary Public,State of New York No 01C1.16700507 Qualified in Suffolk County a Commission Expires Oct 20 1 l (//),„( , -ill,,, ... Postal Service" 1 ` U.S. Postal ServiceTM '4 1 CERTIFIED MAIL® RECEIPT eERTIFIED MAIL® RECEIPT r- Qp- Domestic Mail Only ,:,„ Domestic Mail Only For delivery information,visit our website at www.usps.come. .D CUTCtE�llf 93C ` For.delivery information,visit our website at www,itsps.com®. � � `° CUTC a, UE'NY / 3 IIA €U i I S E a 4�1 r." Certified Mail Fee ,=- Certified Mall Fee ...-1 $ $3.45 ;m $ $3.45 'rn Extra Services&Fees(check box,add fee as eppro•nate) 0971 Extra Services&Fees(check box,add fee as appropriate) 0971 ..0 ❑Retum Receipt(hardcopy) $ •ss ❑Return Receipt(hardcopy) $ ��t`I Q ❑Rectum Receipt(electronic) $ 'J. 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TENAF Nimp M a n USE ,—Ei LONG AC filY[13561 c T l_ U S E Certified Mail Fee '- - Certified Mail Fee $3.45 0 $3 45 m $ i !rn $ Extra Services&Fees(check box,add fee as appro.nate) 0971 j Extra Services&Fees(check box,add feeas appro.riate) 0971 '.A 0 Return Receipt(hardcopy) $ `I - ..0 0 Return Receipt(hardcopy) $ •1 Q ❑Return Receipt(electronic) $ laltiiI 22-=7,----t - Q ❑Return Recelpt(electronic) $ 1iXiti 02 p, p Q ❑Certified Mall Restricted Delivery $ l•I 1 -C • _ , Q 0 Certified Mail Restricted Delivery $ I•I I • r tl' Q ❑AduR Signature Required $ , C] , �� � Q ❑Adult Signature Required $ ❑Adult Signature Restricted Delivery$ N�� cr) ❑Adult Signature Restricted Delivery$ -1 Q Cr. > C7 Postage Postage $0.49 = a 02�62�16 c : $ $0.49 1 ► -" C] Total Postage and Fees g OJ6 O Total Postage and Fees r-r i $ • , $6.74 i $6.74 -, 1 Sent To_t-[°11 l4rLt aoV 7 S `>.,. O Sent To�a�e I, I(�Tr Ln rya r4J5� 'i r tan No.,or PO Box.;. y" Street and No.,or PO BOX Aro. Ci Sta•te, .IVP• • 1 AA 0 &See�eversefor„In; •Cr Sate,Z/P+4®p. fW `� ,., , • ,r ry, . p L .7 opo-so47 See Reverse for Instructions J PS Form.3800,•A riY2015 PSNi753o-02-000-9047. Struchons�” PS Form 3800 Apr, 2015 PSN 7530 Oz•oo, i John M. Bredemeyer III, President oG?', ' I own Hall Annex Michael J. Domino, Vice-President :Yj 54375 Route 25 Glenn Goldsmith y P O Box 1179 A. Nicholas KrupskiSouthold, NY 11971 Charles J. Sanders � �o� �a 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 SAYWARD MAZUR 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, 1"x2."-e.."? ,residing at/dba .46 eri4 6&ec - - /�' 4rehde(7_6 f G •l 2s,e3aif Ate. J aree,-)/0694 (),:f being duly sworn, depose and say: That on the I day of� ®e€A-I ,;/ , 204,1 personally posted the property known as u� 5� aese,s�G!., C_!'�z�l � use , //ceV!oaf by placing the Board of Trustees official postef where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday,February 17, 2016. Dated: / atu An. S n to e re me this day of20 t /fir wry"'ub is CYNTHIA M.CUSATI Notary Public,State of New York No.01CtJ6100507 Qualified in Suffolk County Commission Expires Oct20 �� NUTILL UF tING HLA : ING 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: SAYWARD MAZUR SUBJECT OF PUBLIC HEARING : For a Wetland Permit to construct a 378sq.ft. one-story addition and a 943sq.ft. two- story addition that includes an attached garage onto the existing 1 ,481sq.ft. two- story dwelling with a 737sq.ft. waterside porch and a 197sq.ft. front porch; and to expand existing front porch an additional 270sq.ft. Located: 555 West Road, Cutchogue. SCTM# 1000-110-7-7 TIME & DATE OF PUBLIC HEARING : , Wednesday, February 17, 2016 — 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 Board of Trustees Application AFFIDAVIT SAY iide_,Li Z v,— BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. 1 FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITII ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. AiryAJAJ5T7/66t1A Signature of Property Owner SWORN TO BEFORE ME THIS 'ate DAY OF 3i cLr , 20 I Nom, ublic 11Rh'of 'k'N G, �Ui:;'s , Z,Vk oS �'4 'tfiEtt ai New X:zk Go7„4tv Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) 1 SA /r,JicAg IAA u,2 residing at -13 LJL 9T 2D, (print name of owner of property) (mailing address) CG LJ Tom/06-(J E /J,11 , do hereby authorize f 1.12 /AA (Agent) . :av{ r, to apply for pennit(s) from the Southold Board of Town Trustees on my behalf. (Owner' signature) Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, ,iy1,1/41 A 9-.0 MAztirL residing at /fid 1-3151 'FAD ?9V 2.8L (print name of owner of property) (mailing address) AL 6, / nl �, • ___^do hereby authorize -Po ix=e-T f leolow (Agent) -A —/rjkl Ai 7 I-1'4 �(�2� ' to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of•Southold_'s code•of Ethics prphi4ils conflicts sof intereston_the p rcoftown officers and•cinployees.The purpose of this form is to provideinforination.which can alert the town ofjssible conflicts of interest andaUowit 07/take-whatever action is necessary to avoid same. nn��, AII YOUR NAME: -'T �. eao V (Last name,first name, a ddle 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 NJ Variance Trustee �t Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (lf"Other",name the activity.) Do you personally,(or through•yaur c mipany,?pause,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"ii ciudes by blood,marriage,or business interest."Business interest"means a business, including a partnership,,in.which•the town officeroremployee has even a partial ownership of(or employment by)a corporation in which the town Officer or employee owns more than 5%ofthe 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 jnV • 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 greeter•than 5%bf the'shares of the corporate stock•of the•apptic?nt (when theApplicant is a eorporatiooii); 13)tiWiegaibteneileiat:owner,o€any interest in a non-corporate entity(When the applicant is•aot a corporation); C)an ofileer•,:director,partner,or empldyee of the applicant;.or D)the actual applicant. DESCRIPTION OF RELATIONSHIP \ ) e-n Submitted thi Z-Z day of 205 Signature Print Name (-2,0 Form TS 1 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town-of Southoldk.cede gt'Ethics prohibit conflicts of intereston ti part of town officers and employees.The pptpose o> this form Isle provide information which can aletithc_town of possible conflicts of interest and it to take whatever action iS necessary to avoid same. YOUR NAME: ( ast name,first name,.gniddle'iin tial,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 \s Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally•(orthrough 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 officei'or•employce has even a partial ownership of(or employment by)a corporation in which-the town offieeror employee owns m<ir khan 5%ofthe shares. YES NO \��J 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 �1 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%oftlie°shares'of the corporate;stockkof the applicant '(•wli it thenPplicant'Isa.cerpo.ratiori); $).the,legal,ar'bcnefrcial;owner of any interest in a non-corporate entity(wheirthe •applicant is:nota corporation); Clan off cer;:director,partner;or employee of the-applicant,or D)the actual applicant. ^`(IV DESCRIPTION OF RELATIONSHIP IU • • t� Submitted this d., of-%_w �' ,- 20d6 Signatu - �.-� +_ tel Print Name /Ye �`0'�zo 1LGl`_ Form TS 1 • ' 1 APPLICANT/AGENT/REPRESENTATIVE TRANSAC$'IONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.Thepurpose 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: -- • a yr.) /411111, . . s (Last nal e,first name,tpi.die 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 N'.\/ Variance Trustee Change of Zone Coastal Erosion -- Approval of plat Mooring Exemption from plat or official map i 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%1'0 of the shares. YES —_— NO �li If you answered"YES",complete the balance of this formland 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), \lirB)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of ..74 i• 20t‘ ' Signature 4A Print Name 4t/0P-4.4 N�frzv�L Form TS 1 1 / J 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,uponthe coastal ai a(whichincludes all°ofSoutholdTown);. 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. Tbtis;,each.answer must be explained in:detail. listinh'b'otk supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. ' A copy of the LWRP is available in the following places: online at the Town of Southold's website(southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. . B. DESCRIPTION OF SITE AND PROPOSED ACTION ` SCTM# I/O 07 - 077 C PROJECT NAME 4122.42-461— 7'�'G�, dL� The Application has been submitted to(check appropriate response): s Town Board ❑ Planning Board 0 Building Dept. 1 2 Board of Trustees tj4 Ma he_ 1. Category of Town of Southold agency action(check appropriate'response): (a) Action undertaken directly by Town agency(e.g. capital 0 ,construction,planning activity,agency regulation,land transaction) '0 (b) Financial assistance(e.g. grant,loan,subsidy) (c) Permit,approval,license,certification: Pi Nature and extent of action: . c&e,--e/T fi iotioitor ta _ ,/v 5v/en/ a4a‘be-'-iiefY9-e" 0 ' da w7,./1,a. a_ (-Q 5'pr/57-i/ i,,eidtT,4--)-) a? -6(?,____ , (C2/2alkidJw/,5/a," -epi smci , . Location of action: Veg-6 6,1, 111,e_1216( Site acreage: 6. 0(P O 4 . • Present land use: Sixicit& —�y J is f ieCe Present zoning classification: — 177-0- 2, If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: CA 1V77 L (a) Name of applicant: �/ / !!.// / �il.i. / 1 (b) Mailing address: fJo/ Ae.:L. //f . .19.o7-/-) .01s4 "(64 (c) Telephone number: Area Code( )&3/-977-1-)75, (d) Application number,if any: Will��th--e action be directly undertaken,require funding,or approval by a state or federal agency? Yes Li 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 ❑ No' Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Yes n Not 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 El Ni: E1 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 • 0 Yes 11:1No 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 Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — PoIicies Pages 32 through 34 for evaluation criteria. n Yes —1 No' Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—.Policies; Pages 34 through 38 for'evaluation criteria. Yes I No Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. Yen N Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water=dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. n Yes n No \l, 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. n Yes NotL 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. 0 Yes n No 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. :n Yes L No LNot Applicable `/ PREPARED BY "..../1 TITL DATE 4 //...c.--- I 1 1 1 I fOQNGO•Moa • I G ijs 4...I ttl'°. N'''' 1'IF-1,.., SURVEY OF PROPERTY N-9 ,°o, ' ty SITUATED AT O f0\4' N' �.�iCUTCHOGUE ° co`� S 6 A • e J• .° a 4 ° °o `L TOWN OF SOUTHOLD -0 (C 4 4 . 4 • 4 SUFFOLK COUNTY NEW YORK � �5 e 5 E 10 °° '' fo��°P�Q� .�o,\o' �, S.C. TAX No. 1000- 1 10-07-07 • A ° . �a °,z . P°� ,,` S 68 `� • SCALE 1 "=20 ' a ° a V Co. E bf pig 1'vj•5• q `'` \3%' NOVEMBER 169 1998 ,Y d • ' OP a I.5PN�P� o• ,�,e/ APRIL 6, 1999 UPDATE ELEVATIONS TO N.G.V.D. DATUM oR �. / ' SEPTEMBER 7, 2000 FINAL SURVEY N VI Moe • ° a° ° e ��1J� AREA = 26,318.82 sq. ft. up0 c°�N�o ,\V"\\? 1g4 ° •� (TO TIE LINE) 0,604 CIC, oFR PSE - o •• GpR Oo /3 (2 T.. 447.4 ,f°4 1.,/ ,e.°; • �4. e,:5OPK� • 6 ,E O 100`° V 8, J / a 1R p.o a A y 3 1.1. e • o a13 •° fv� -4. "OD TIE EDGE p/ 'T . 0 G 0 h a76 01 o e e ea �O`o, --4.- woo ,%E. N ' a 11 e a • ON• y0 A • Yf14.1 `t ..:::• ` e�� V 4:4. 4 ' � ' 76_ r' cG °a 1`PC e � a. Of5�o• V •.a 1 I '..4, • • °nG� •° g a a ♦ +, 415' 9 0 ' 6:_f_.c401 • ° GJ9f3 ,\�'�yL .�M O f aft �O O j • e tiOG� ��4'0' �0_0nQ QO�G n�G ee0�\0 •?c^ GO ° l7 c 01a a 1/ / 41 • • 19 / �P?S ° (;\°:§ 1... A / coag o�.W. /A+ c�P 1�� / 1, / P$ W / " '' 0° C1 Och n ��X05 OPK .I ���• 1 a°.o .�-t� Ga1Ma'` °O \ <5' �0° Q0� ,,c.,...:0.--.? _ 9`�trr- .CrN �� 0o O�y 4.1' W°```` G\).'' 1503 OP�� c�y o a „0:4C;\0• `� oP,( � 1� CZC T Ag- 11°.o O WOE MP ' P1�.6 G.�. .-1..--1 Opo. 4Z 6. '23- 00' PONE "P" '7 �110‘0 15.0 0 . .°.o• o0( • 15 . OP(-1D 12C)\0 • a of et' "..{k,,,, •co? ��.1 �� t4. Or" pL9r �^ 0 aOp p • h'oo IIPJ `�=W00.......... �1 i� cps W000 °� CP . t.r 8 Woo • L /Woo WPB 1.♦ Wimps Co:' ,1,11111at. O//' •� efi)' a1G� A J 1. `'� 4+0°- /on' 000 6 P'QPREt \O •S r P.\-()‘C' N� oc-�E `\C" \.0- Oo� ii,,,,,-0 ‘,,,,,,.._, '400VUNAUTHORIZED ALTERATION OR ADDI110N CP l TO THIS SURVEY ISA VIOLATION OF l9' r - . A A \/ SECTION 7209 OF THE NEW YORK STATE r�V �`./1 Y' EDUCATION LAW. n� !� �' �S IC COPIES OF THIS SURVEY MAP NOT BEARING e O CO lv THE LAND SURVEYOR'S INKED SEAL OR q)(-1' Cpl EMBOSSED SEAL SHALL NOT BE CONSIDERED c_. ( y� ` TO BE A VALID TRUE COPY. / C� CERTIFICATIONS INDICATED HEREON SHALL RUN C1/4)\)(C- ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTI- TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. • THE EXISTENCE OF RIGHTS OF WAY AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. PREPARED IN ACCORDANCE WITH - .. _BY . FOR TITLE SURVEYS AS TSUC STANDARDS USE YNTHEPPROVED NEW YORK !1T9TE•ANDD• ••• _-.�_-..-.T- ; Joseph A. Inaeano FOR TITLE-•S• DCIATION. , JAN 2 0 2016 Land Surveyor _ a r, ( . . � ,I I Title Surveys — Subdivisions — Site Plans — Construction Layout vlo PHONE (631)727-2090 Fax (631)727-1727 '.`'F. \4%C-; �.k?¢W K L e 1' OFFICES LOCATED AT MAILING ADDRESS '`�-=-", N.Y.S. Lic. No. 49668 1380 ROANOKE AVENUE P.O. Box 1931 RIVERHEAD, New York 11901 Riverhead, New York 11901-0965 ow... . 98-605B