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TR-8787A
aFeur John M. Bredemeyer Ill, President :�o�O - coG ,� Town Hall Annex Michael J. Domino, Vice President � r'.�.6 �` r = 54375 Route 25 - , .. Glenn Goldsmith z1 , P.O. Box 1179 A. Nicholas Krupski = .. � � Southold, NY 11971 Charles J. Sanders ~-Ao1 4 Telephone (631) 765-1892 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, hay bale line 1st day of construction / 1/2 constructed Project complete, compliance inspection John M.Bredemeyer III,President Town Hall Annex ,N® 54375 Route 25 Michael J.Domino,Vice-Presidentx i l $ � P.O.Box 1179 Glenn Goldsmith ; Southold,New York 11971 A.Nicholas Krupski - ••••. Telephone(631) 765-1892 Charles J.Sanders Fax(631) 765-6641 C®UNTO ,0 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8787A Date of Receipt of Application: May 4, 2016 Applicant: Lorraine Dunhuber SCTM#: 1000-137-4-22 Project Location: 875 Fleetwood Road, Cutchogue Date of Resolution/Issuance: May 18, 2016 Date of Expiration: May 18, 2018 Reviewed by: A. Nicholas Krupski, Trustee Project Description: For the as-built 8'x8' shed and two (2) 6'x6' fencing panels installed between the shed and bulkhead. Findings: The project meets all the requirements for issuance of an Administrative Permit-set forth-in Chapter 275 of the Southold Town Code. The - - - issuance of an Administrative Permit allows for the operations as indicated on the project plan prepared by Lorraine Dunhuber, received May 4, 2016, and stamped approved on May 18, 2016. Special Conditions: To establish and subsequently maintain a 10' wide non-turf buffer area along the landward edge of the bulkhead. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. John•M. Bredemeyer Ill, President Board of Trustees . _ . ___ .. , . \ ( -,i -1) \--- • / ALL MOORINGS AND STAKES MUST DISPLAY VISIBLE\„,,AOORING NUMBERS . .- . ALL DOCKS AND ii.ULKhEADS MUST DISPLAY: VISIBLE PERMIT NUMBERS :. -..-:-... , --- .____ ----:----->,.,.3_,-----. . ._,,,......,Th‹. .. .,- .-...,-. • •-• - -- , •• -- - ---:.--L----",------., . ,:ro.f.,,,, ,,,,,-4: 1414,... ..---.:.•,;.1i1_,...,. 6.e.,- r;;...4,, ,Aiii-r.-:"-.1-1-fo:•,.;•;;.,,,,--?.:,-,:-.1-rE,;,:•,,,-A::-,-- fr \ -.. %---- '44(00,"---'----- - •• 4,,, , -,..%,-,...:aii,sr:- 4,...,..„,... . ...)„.., 11,1: i.„.... ,...,. ot ..,,..,:„..,,.,,11 • ....,..,...-2,?,:o. , =...„,..,....,..„. .,...5,4-41 ..,. :,•.,- .,. 43,4 . .... . ,..„6..... •-..... 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IA'. ,.1 Boa-rd .'4 :..V' ' 11 Of So-uthold Town Trustees t- '...:“--- i• le* ••••,/ - .4..r, A_,:si . '"' ''' ''.'-'•-NktE?••01 W"fr4ii; :. ' . :';''' '..."-'2.4;:-'',i' SOUTHOLD, NEW YORK Mooring # -:.7.,",d.-k.•1 t-.;.",%:,••.,/:; -.ia7, .. • ,.„. . . ... . • . i .. : .._ ...._ .kL•., P.:.'. g PERMIT NO1S3DATEP2lyZ5, 1984 ,,f.,-......-:•.%:,;-A:4;..::i.—i';,' r4. ir....,:. 5,y.....c.•:...ei..?, ii . . , t - - ;.7141, ,.... ,:-...-- -1" •,- ' .. -...I f•-•''---- . Z.y.rt17;s,'' ISSUED-TO ,, . Lorraine Dunhuber • i'•:-i..1,."."•''' ..' • el ' ' tt '. *SCaG _ '*-,-;;;•s. .'7.........:7 . -3 IVk' 4 tig‘-1-.---•::41 -•:', i-,-.r,,r—i . ,„ , , ,. , - . - . •-‘ ,igt '..-1-1•1 -2;-;,i7c:-: -- ,--,` — , -- ' ---- 11 • - .. ," P2'..5% A :.',I.''' •,i•-• i -'7:;''' 1:4.-11; • •••'-'. ••••-•4 3 ' , ,.':' , -Altilliarization . : . ,,,,,..„.„. ,..„,., V..: ':.'''.f.ti 4.-A.-,e4. i : • ,::,.... 2;, ;`,..-:.i?-) !or. ' ' • - 3. -A .e.g• •.:.?-"'•fr :-,. ,..-•.::-,' , et ..-r4S, , -i:-';"•'.-.':4.--?, --).' "4 ,.,•:.,• -. ,,:.;:: ..;;„'•!X,..5 •:!,_. •7.,.1 -1 ",--.',• .•'•,.. •••"'"...sr* .' - • - ; •-:' el: .-• 4_ A:• ,:':' - %.•-•••:4 .'"Z. -i .:,-..----,', ,.•, ,,,-'' Pursuant to the -provisions of Chapter 615 of the Laws of ' -. : c',. ... .1§1 ...1.-ki:,;'• :`,.... ,.. .t....4--.4.4„ ,..t.- .1. -,.....ivi-• -.= n !...- -•-q. the State ofNe.'W!York I-B13; and ChaPter 404 Of the.Laws of the ' ''',... !•,.-'-''.4,".."'-'• A'• . 1 4, ,,_,-, ":.-'...: Ni.',•i;ii..,., .. .. 't,..s.0.-;.-",-VI.,,,,,. .‘1!'2.;•. ,•:k:tf.!4iiti::::.Ri, ,..-•,:-.4..St ate of New York:1952; and the, Southold Town Ordinance en- • i,e.-.4.--,.'-`,11',',;...:lam,.1 ' 4:titled "REGULATING 'AND THE PLACING OF OBSTRUCTIONS , •,! .,-,:',.--Y-Ai:-V4. a _Az .,. '...,:_*.-:•Ir.1 NI , -i-, ...: .•31.-.--,•!ir--..-1 . IN AND ON TOWNWATERS AND PUBLIC, ,LANDS and the arX,??....';.:..,:!...:a•.11.:7.''!,:..:„ Tr , . • lq! ,,,,,e-:,5.0. q •"pi.,.,- A.-_-, -4, — • ' REMOVAL OF SAND 'GRAVEL OR OTHER MATERIALS FROM - -,-.,..--,..-s.,--....• .,-.a, 5 . .:,). • ,..- .- , , c.Te..-i?',4'.,:.- •-'- LANDS UNDER T-O.W.N WATERS." _and in accordance with the 1:-..-..1-,•••-•-/:;-”,..-7- ,:.„•-..): .,•.,i-...11 ? „ _ , .. .....,ratt .' 15'r 0. Agli.:1, pc, :,a,-_ -1 . Resolution of The Board adopted at a meeting held on July....1.8., ..,;'-,,=..... ._$5.. .k, '.,tkv r'- I ..,.-.,,t 4,4'l•,.5.,,F7-As-h-4-.-,i d, -,,,,NAt---. • ,,..,. . •-. . . ..5,......, t.. .6•W`t4, ..0•Wi.."37124,.'''`A ;-,4-.1.i f-i.;1';43:70't:•I'f>.• C .•,-..:4--,19..RA..,,andinconsideration of the sum,of $....5.....0.0.. ' .paid by ( . •-:•:,..,..,_,„4...i. ,. ...-„..:,,•,•*,...,,-.0, ;,.! . ,„,.• ,.,; ,.....•. . . • •. - - - . . ,--•L 5.,;,,-..c.,-.-is,Y.s.,..-.;2- 4, - ;. t L.orr.a.ize..Divallutie . . , r • . - '-' . Li-. -40;A:-..- „,-...w ..,...:.:„..„. ,, . •, .,,,A,..,... ,.„-t„--44,...,..,.-:.„ti „„,.. . c.A.. cutchogue,. kl*„.4.,,,. ,;,,,,,,...z,.i •.-, N. Y. and, subject to the k._ -•-.-.06-',,--_-„.-**.% - :;--r•:-..14-, . 'I: Terms, and Conditions listed on the reverse side hereof, R is...4.:'....„.-****::',..!_t.'s ...:, -..; 1...-&...,,....--.4)4 ...- •-' :i.'-/-, ,...-P.,.:-.,f5.T4f . - -- 0:,'... k.',•,,-''',., r..4-4 ., of Southold ToWn'Trustees-.aufhorizes and permits.the following i._ - .. ..... ,,,,,,,,v-.; • ....0,.... . A.i}.F.,,.„.1.1A, ..1 A.p- plicatiOn approvedunder the GrandfatherClause L.h,r.a..,4,,L.,..k,..-,-.s...,..:.....,:.. t.,•_., 10::;'.-,-..,-,-,1/4r...-_,A..,. :,'.‘• -.: to secure a.-permit for a.: bulkhead and remains of 5\'.0-',L, _7-.1,4,• :‘,..,;!:;:-3, i;.'s$-..s.Esz- 0 ld .. ' .. . • .‹,47eit-lci, .."5.' "s . &pllings all in accordance with the application --.w$ z-ii,7•7 tillock . • .,•1441$--.4.-- y. q ;4.,vk%,:i.-:.•...t :---. ,3.-177, - s-ujomitted. , ,•.- .,....,1,,,,„ ,{:..AIN-:-,—,,,,..2---p ail. in .accordance with the.detailed specifications as presented in . •.1*.t.f-JA:,.-..-, I::-.......,_'',".- . .,410-q. .. ..- ,,i ---. . :) -: the originating application. q,-;- , • ,-.] .:: ,..... ... ' „......"", '"2 • -.‘".., ;.;:.,Pi..,I.% ::".......4*.,..!.7-7-:. ....,• ti:t.",'''.: , ...;:......,,,,'fie:' • ""g'4"'. A' ,. fia:r...7: :' • ....1.: :Pz.5' 10141 •'..••.t, ..;;''''--- 'ti:,..:.IN WITNESS WHEREOF, The said Board of Trustees here- , if-.-7..,.....01.,:zi.,.;=.1:_ii...i..---,:;;;:i..,:i'.. i ifik;..„-,..„ -,,7.7; _t ':z MI',..alt-A--.-z-.--p It -., .•• ' • ';'.,:1ii• "..51;...:*,:b li?s,V:-.4,,,,,V,111 -,„_.1%;.;=.X.:,!,.i,by,ca, uses its .Corporate.: Seal. to be aff.ixe-, and these Presents to .-r-.7„.;,-:; ;Z-;'-clo'ig,'"-:..i.e..;:!;-:...)-c:.; - )0.• ',..t.L. -z"-iNd :1.--,--4tbe -subscribed by..a majority, of the - • Board as of this ate. .." . .: -..4-lid, z.=::••,w_.,..-- , .,„4 ziv,,,,,,!.: , '...7'.•,.' tKti - • 00 if l .0,,''''.'t'%A.,S,.::::,-... ^.-"O'r - irier.....7.....- 'et-VV:It :Z- • "g,:: ,..,;.,, I C1W F a ir ed... 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':::,.........„,i• '''' ••• - ;!.. --II:, ',':--,,'; , , , - ,,-,-,,•,,,'•1'9z?- -•'-.7,.1 ' liii • INIEFWOMETWIM / - . . , T � - 1 . r C • ` r • • . . 111111 . (VI v �- { Fyt� r • t `v_. /_�^ •' _^}^.y - �, - L, , 1 I �\F fJ . . D.r-..,...7._k..,-., i...-.z• 41 • ,,___ , : ,;) / 1 • MAY 4 2016 p w _j _rcl.c�: - — t . i Mit YC�•. Yl.•:1 ilt .k - I • • - m 0 hili lawn T 1 — i' 7 S{ LS F �' 1 -• • - - • -i •-1 �'•ITS 1 ' it:,• t<; • A• • t � , t . I � J t` ; h(:y _ 'TSom n lif - • rri • 611=11111111=11 r: • t• ai >I II; V) I I• Vi 61I' - - C: H:tiI:t4Htep- 11011111=1 -r • v 1 - 1 CI s'7S'SO 3C w 10).O ea UNAUTIIOGIZID ACTEAAII_tl Ot • i I - TO THIS SLIMY IS A VIOLATED' LO't" j SECTION 726P OF THE NOW TW rrt�,17 c i- EDUCATION LAW. ' r 1 I COPIES OF TITS BLGYET MAP A, 1• rte.)v_t t�.-e• l' f:.l'•LJ^,_ • rjr J„•y 11E THE LAND SIt VFTOL•E iY.D I. - ^+-•= �..1•7 1 t- EMBOSSED SEAL SHALL N...7 S.t. I I i TO EE A VAVD i:UF COPT. >_.� - - • I 1_rte ^ . GUAEAIfiE:S INDICATES I,IESO• •. - r t'E-S ONLY TO TH: OIE FCE H W ��`� - --'—"I i IS FAEFAAED,MTl 0.•NS 5:10.. - TITLE COMPARE!,a,J.S.•.;E.•A LENDING INSTITUTION LISTED r• 10 THE AER GNUS CF THE LNG • TUTiOV.QUA,A\T':S A:E P,01 • TO ADDITIONAL INSfli viwn5 C OWNERS. - .. Nil Ap c.Fr LA.rNo - - Gt-tccvccr-Ifeecl -i'o +t;e 1.,, sE_ 1 Vc•rR.c Fe:-.1-<: 771-Ie. }r::i L(v-c-'1�::tee Cc .. 9 �F F- r' ��- r•j Az`� i .� ZJl-v :�G'GY 'i7.. i_ I • _ , ____,..„,... ...___ , ,_____TK .-- At.. _ _ - ..-7l S I T--ot37 ' ) 1.,-;,-- , ‘,.), i, ' ,.;\"\As 7\k\r, ''C"V"\''•\ \\ `Z=.' .\\1\1\j\\,\AN\I • \,,,\:. \\,.. •kv.,• \\:,-\\ :1).\:, :, 7\ _ . .. ... .............. .. ____ 41 - -----...---- •-G--- ...,....--- 1.•c-- ..-- ..--,- ----'7 ''•.7 4 oc) -,"--- fl 5 RE 12.h k - 0 ,,,:.... _ "--- 6.- . _ tire F A 0 A t 0 /7/„. .v. .z.7,-..y.„,--- -,•,----,,,--_,....-7„. ....,_ /-_,..< --- .., - ...„...-,-;:k s3A-sE_ lojor P. *_....., -11. -11 •:_,--- -, 1111 = APPROVED -BY u...) . : OARD'OF iRustEes sz,..„ -T( TOWN OF SOUTHOLD ': ' -Jo t (T) , , c12.4. DATE- _ Pug IS, zereo - ''' ,_ , . . . --1 .i. r- •' ' - !:, ) I i 1 -MAY - 42016 HI I ! zi . k , _ Br •il I Tats'en / ...-. to •--( 4' ‘')E., ''. - -'•."..-- --Ir-,=--- --=-.,--7-.--_e-:-:-.,---7::- - - fy-- ----•.------:----17- -':".'"=-1.-7-.----;_ —____,_---------=---7---j;-:- -_,_.,..1;----='-''''-' -- ---.----------_-.ef...._::- •••„sw71- ":7-.:-.--_z____,,,,, ",.. -7_,7:::,----77---__::_:2-_-,„-."-__ =---L-r,-..,----"- f I 1 i.xe 4-e.....4:32. ....:_-.1-__—,-_-,---_____:::--- ,77...:-..----..: <:- ---___------___„ , ,..... ...,_•-,r-&--. .. .11-,-;"", -._-,----. , . , H 0 0 I„L t)° V N), fr3) (g ' fi I Li MAY 4 2016 Outlick Town Bc•rri t„,..) . ,,,_i ., ,.. - --:, FUee:C- (1-Q-c- i/c R.0 (9- ''c . . ---7 3 = 9 i \-\Mv -SQ-- k.__ o. i i i F a 1 i I if l l r‘if reAce_ ..i„--__:5 IF „i IF ;1 MAY 4 2016 _ f` Southold Town "� pk il— vl,i� f�1� — tom_—._____B"-I{'Qf lr� n _.—___.._ .! \- ` n s YV �. e John M Bredemeyer Ill, President .,%11 No Town Hall Annex Michael J. Domino, Vice-President - y 54375 Route 25 Glenn Goldsmith *` P.O. Box 1179 A. Nicholas Krupski o . �g Southold, NY 11971 Charles J. Sanders \414/,_ perry Telephone (631) 765-1892 1 • �a irr Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 5/6/PrP 1 a Completed in field by: /U.K N.A. LORRAINE DUNHUBER requests an Administrative Permit for the as-built 8'x8' shed and two (2) 6'x6' fencing panels installed between the shed and bulkhead. Located: 875 Fleetwood Road, Cutchogue SCTM# 1000-137-4-22 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=I Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 '✓ Ch. 111 SEQRA Type: I II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: BQacL4 C7it1 3 `t0 Clef k —Dp,,tioy, $u14 ASP UI'. void Present were: J. Bredemeyer M. Domino G. Goldsmith k/ N. Krupski C. Sanders Other Page 1 of 2 John M. Bredemeyer Ill, President ' ,,o��SUFFO( ) Town Hall Annex Michael J. Domino, Vice-President d�At' " ,, °may,, t 54375 Route 25 a Glenn Goldsmith ; o P.O. Box 1179 A. Nicholas Krupski :w Southold, NY 11971 Charles J. Sanders 44; 0 Telephone,(631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: LORRAINE DUNHUBER requests an Administrative Permit for the as-built 8'x8' shed and two (2) 6'x6' fencing panels installed between the shed and bulkhead. Located:875 Fleetwood Road, Cutchogue SCTM# 1000-137-4-22 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 i•, V.;,c 0 4',W,%"':'' '.1;Iiic:',..it,.r ... spri,' ?,4. ** . , Nji-!-* .''1/4"fii-,#,;;:rie,j4,150,!..z.,"..1';',/..4'--:,::-,--L,,---.?-.! fi •.:!" Aiii,r 41c: 1. ' t'' :s''ii 44!Pi'4W ' t 111 ill:!r3,.S?ilL14,;4:/1 ii.i.ifitr"b•g.1'..i':°:?: .;'1;1.'''.7;4.1..?,21 ' di tre ‘'..-1,4 " itPe Alit,OW Atk- ipiii'--*III , • . 4411 ' ttlii/014411r i, , 1 4..01 tr': 1 ..... 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T+ r. i _.y �`c xda k 1yt. r s` y, 4 , - ,r t�� ..` ` i. ¢ �#. i "• �•-���Y14j.�7� Y�r �Y# t17 r�, �vai ;x•.51! � ', U the ,b r �. i� f,.� r; q : +'���''�,� l � �� car � - - �F+ ��x� . .$Fillsk • /r:.?:..1 . e.' i 1 sik 1 1 F itt .ktt....., \ - +, 4 40 1 •-, „yrs, ..„70.4-1_,,_ v 4 '11* - i."..____ ,_j r # N ` aS R -34 / yam/ -,--,44;t;_./$ap y. _ 7441* - �c\� f� .i�' �. may. 1iv �.�y r� .I� j }-+? .t v"'h�kJ .-v iiii s , ,,,rte .'.*-. - 4 _:C^ - T^ i✓^Sri 9'"./ %F+` • .'"�`il" pt j1� F _ . r; s v r ♦,'f 4.` t'' f ry • +,r 01c j : Y-. ,A) • * ''• —•--. `[ 4%, y_ ••'.0 IT.I .� ✓ ,� ! }� {,x.11 • /Y+ ';ft' -�`;, -cam• YVr , "/C'. 'N a"' .• �` •i 1 _r):4; .,/ :ak..r, {F ?erg �i 'y' v% >'L 7T`"°'' ''K' =•141 i' :AaY?--+ .1144 'I ,pr' '�..“ -• ;'#s.a. - .,r°f..-:., � t'*."'. • n ',• �S`�,ry} r t�11.,+gyp`'• f `fig T ,'-bli--,.:- ,5,,+ .. ..'�i �+� a��, ��a YS j� �<�4s7����t4;1v'6a 1,1 FORM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY / Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal—(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" • land uses: 1. Accurate survey•of property showing all property lines, streets, buildings and unusual naturol or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Dote .... . �` /g ' /14New Building Addition Old or Pre-existing Buildi g '' V ant Land Location Of Property �f7a�t e---,7... ...x. .7 r "-"-4-'� Owner Or Owners Of Property / Subdivision Lot No. Block No. r. House No..37b Permit No. Date Of Permit Applicant Health Dept. Approval Labor Dept. Approval • Underwriters Approval Planning Board Approval Request For Temporary Certificate Final Certificate Fee Submitted $ ,---- Construction on above described building and permit meets all applicable codes and regulations. Applican ?//-W 6 � Sworn to before me this .. 1 day f ., (stamp dr sea f /In. 1 WAITER F. EUCE '`�-.• I��� Notary Public .. .. . County x......\\. ?iOTARY PUBLIC In the State of Hai York t ` Raiding In Suffolk County Suffolk County CleExpires March 3O 4800 197 Cpmmls:ion Eapire�Mcrrh 30,1977 FOflM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 27182 Date Aug 18 , 19. 7b THIS CERTIFIES that the building located at VS Fleetwood Road Street Map No. =Da Block No. XXX Lot No. XXXX. . ..CutOIlo ggit . . . ?..Y,. . . . . r:me t: • •+:a fan l dwellin a & Housin code conforms substantially to the .��]'+ d'e'+M i ., sv::1+i r�i.ia: •:fti&ri•h+i=3ti',?:S :f:l "i• VC ,@f;1,Y. !:• ratit before Apr 23 certificate of occupancy , 19. 57 pursuant to which ANEWPOZEKUNo.Z7182 . . dated Aug. 18 , 1976 ., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . . tvq. . .11•G ft. .Q . .(W0.111140 The certificate is issued to .i+or11 .pq Owner (owner, lessee or tenant) of,the.aforesaid building. Suffolk County Department of Health Approval Pre" existing UNDERWRITERS CERTIFICATE No.-. P.re— existing -- HOUSE NUMBER .835 . .$. 87.5. Street Fleetwood Road 3 Cutchogue /0/0-{A) Building inspector HARQ2M S E. ---- -- - --- �: r . •i VI 7 ` ib r: 0 HOUSING CODE INSPECTION August 13, 1976 835-875 Fleetwood Road R-1 Cutchogue, N.Y. _ Tax Roll: . Lorraine Dunhuber Occupied: Seasonal tenants Upon receipt of an application for a Pre-existing Certificate of Occupancy -for two single,.dwelling units, I made an inspection of the buildings at this location. I' met Miss Dunhuber on the premises and began this inspection at approximately 9:45 A.M. A previous inspection was made for a Pre-existing Certificate of Occupancy on February 11, 1974 , for owner of record Ottomar J. Gerhardt. A copy of report of previous inspection is here- with enclosed. The violations of Chapter 52, Housing Code, Town of Southold listed in report were found to have been cor- rected. Also, in addition, each unit now contains a hotwater heating system suppling heat to each- room.- Bathrooms have been renovated and contain required fixtures to meet_►animum re- quirements for a living unit. Dwellings were found to comply with Housing Code for one-family occupancy. Inspection completed at approximately 10:15 A.M. Respectfully ubmitted, ard HindermannG�� Building Inspector EH:med -1.... n Oe� �- —____I ..p z1F7aaTyP7 I�'� _ I smmn o. u. ---E.--— I ..mw,, ,muWBTTERFMS.or PIE O wI RSu,mOPERTY.%SEMc[Arrxcr I 'X.,.. I rm m I A _ (.../...6.3,,N I Jasmn o 1000 3 PROPERTY MAP • - cvxoEnvwxa+TS.�u mu T CR d d + s e til i4 f if , \ ,' l''' d �' e. `° '': 4,., P C.1/4, \\ Z\ ALF 0: @ oaf' �\ • 11 N., .....„2.---, 4m t 12A(C) d , .l • 4 18, 9 9 q \ \ �e m t 0A(c) \ 3l © F,r \ 1 O x583 B5 a , 1sA(c) • Z S f3A �� TONVI SIXP,gIp V. OP' TOMO;sam,OE• 'A o m O a x85 / FIFA a `32 i g. a e .b.'-'....004, NFc �QPW , / m m % yPp / ' \ \--‘ \\ II .r 19 B 23 2y r a ® a s', STT T x�f RQ 000.11 \ RD •E' DDD B s PE ti 8��� ��T re. ,, — „„ ...,0„- IF a� e xzee Kt.) ®G�`v� _ V1310.182 Es*91* —�_ e. . (21)ii �� O r$ev°yw _— �a��__�-- ,cm ' NOTICE �� COUNTY OF SUFFOLK ® E ......... SOUIROw SECTION NO E_ 2 Real Property Tax Service Agency Y VILLAGE Of eRemr liReerrsroemddd xrnsm Im ®o 137 UP...w a r�gz,uat>,zu ��- —— P..u.�,.. --.-- x.��•..--«..-- _ ws,e...rtn6 im ixr m m A ��� c.....* ,x,Ncl wavy.. ----- �� _—x-- REM PROPERTY TAX SERNOEw¢xcY • MM. P Po vsiwcixa 1000 PROPERTY MAP -. -1-,...., 1 i f , I/. ... .. I { • 1 i ; Nc, • I. ::' ••• NM .• • C111 y,U • ....„...._____ t- •k• •- .. i,-,•-, -y. ••••77:-: 7.1-1:1'A•• •• — • I1.1 � • • • 4yr • ir 1 .'• •.... : ' ..:;,...;.44... ttrel prz, lia.1 Tc.:." I If MEI • + /.4.,......,...... I ; 1 'MAY - 4 2016 L� NOM "" - !! '•-TeI,Ce `.4•"" "n" " -- j . jl Yot. r,.�4u.4•""7"....% •�s 1El y— i 1 - �A• S m c Southold a>tin • • . ''` • 7.-• % J its 1.- -1.;.1'.!..' — , S.,:iit,?7,i7:111 ----:.----- . ir....)c.1 .1• . ' . ' -•';'•:..• 1: • 2:"Ifa:‘• •• .': .5.4'71 • h+ fit • :".• . - .1 ../ • O. 1 • 1 ;• - - , V - - • • . G1ci - • 0 • 1d rn 11111111•111 • -r . r- UI I 5cet le:40'---'. v . vi 111 j E..•t1:o1:W H+et'-i + 5.'75543O•W. • IO�.O t c ; 4 j•T•Jr( 'IK'+r' 1 UNAU111OIIZED ALTETA71_rl Ot _ _ 11 _ • TO THIS SU:VET IS A VIOLATIO• I I _ Lo • {•� E I SECTION 7209 OF THE HEW TOl •f•� o o i• . EWCATION LAW. • t r- lv,t p'.t• 1.'f':,'''-/ LCOPIES OF THIS EU:V(T MAP A. 1 -, NI! bal./- 1 I - THE IAN)SI[VEYOL•F R D: E ^,.•--- ••�•? '` ' I - _ EMBOSSED SGL SHALL H.,T GO ` - 1 I TO ZE A VALID NW COPT. _ I • • GUAEAlNTE3 INDICATED l 5( • • I ^•.1•, ^- •-+•ONLY TO DH_,•ES011 POD VM \ I --- 1 15 1TIETAPET.AVD O. NS S'I,A. LENDING UTIUL4 I' TO THE A(SINSTITG' ESON OE 1HE5TLENS • _s TOTTON.caw,AA(ES A.:E 9.01 TO ADDITIONAL SNUT1iu55Ut4 C OWNESS. •• - • M42 Or LAND Gt.lgvc deec.{ -so f►•e 4, ''''-'1 4-slE'r"!C vor<: Ti-t•Se 1 r:U L.YC.1 r: 'el.c -1 - t.. /-`�_C J ;N • t' -L r_- .. - .. >,.. - 7 - - • , I � *®F I SOU, OFFICE LOCATION: • y® � MAILING ADDRESS: Town Hall Annex �� � l® P.O. Box 1179 54375 State Route 25 ` * AligSouthold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold, NY 11971 91, ���� Telephone: 631 765-1938 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: May 16, 2016 Re: Local Waterfront Revitalization Program Coastal Consistency Review LORRAINE DUNHUBER SCTM# 1000-137-4-22 LORRAINE DUNHUBER requests an Administrative Permit for the as-built 8'x8' shed and two (2) 6'x6' fencing panels installed between the shed and bulkhead. Located: 875 Fleetwood Road, Cutchogue SCTM# 1000-137-4-22 The proposed actions have 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 INCONSISTENT with the below Policy Standards and therefore is INCONSISTENT with the LWRP. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. The existing shed and fence were not constructed pursuant to a Board of Trustees Wetland Permit. 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: Stephen Kiely, Assistant Town Attorney • - �S r, r-''': // iii��� ., awl /,gyp - J John M.Bredemeyer III,President I�,• $ 0 _--, 15Ql -' Town Hall Annex �I ".' '{ 54375 Route 25 Michael J.Domino Vice-President I� i.� '' O .. ' \ r Y ,, ;S ' % P.O.Box 1179 Glenn Goldsmith - _ - r.:z--:;.v.:;-...f. ;' Southold,New York 11971 A.Nicholas Krupski G -- - @ �� p .O �I Telephone(631)765-1892 Charles J.Sanders • =-01��,0(IN• f�M1� �• Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Applicata �\ _Wetland Permit Application Administrative Permit / , r - ri _Amendment/Transfer/Extension ,' f Received Application: 54,/(p 1. Received Fee:$ X0,0[7 - /FS-gd[LT �i. >, _Completed Application Q Incomplete / _SEQRA Classification: ' f Type I Type II Unlisted /Coordination:(date sent) 5,64 l& V LWRP Consistency Assessment Form CAC Referral Sent: Date of Inspection: 5,Ili/(p Receipt of CAC Report: - Lead Agency Determination: Technical Review: Public Hearing Held: 5I$-i( Resolution: Name of Property Owner(s) J '1( jfr7 ioF but.itil-1 1 -6-e Address PO 6r,t / SCI ,cjte_R-v , ii) 0 1193s' Phone Number:(bxt) 7-511 -51'O ie Suffolk County Tax Map Number: 1000 - 137- Li— Property Location: kTc I� wtvdi /t 1 ,40 1 Vy 1111?i, (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) 1 i P' Pf_�' " ,, , • f s 1; ) Address: � :! Ii ,/ �i i MAY - 4 2016 I- &tt-oCUt- % Atte) Phone: I F Q Sauthc(d Torun p ee'e)& 61 ( -A7 1145" P^ rd of Trustees Application GENERAL DATA Land Area(in square feet): Area Zoning: Previous use of property: Intended use of property: jl 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 y 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? VYes No Prior permits/approvals for site improvements: Agency Date rNo prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? 1/ No Yes If yes, provide explanation: Project Description (use attachments if necessary): ..__._.":" _ ,,. -Boa.zd`: of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: _el- y �i ,Q �� ibex. 2 Area of wetlands on lot: V 1 square feet Percent coverage of lot: f y c Closest distance between nearest existing structure and upland edge of wetlands: 2.5 % feet Closest distance between nearest proposed structure and upland edge of wetlands: F per Plats feet Does the project involve excavation or filling? 'I/ No Yes If yes,how much material will be excavated? 11 11' cubic yards How much material will be filled? 44/t)1U, cubic yards Depth of which material will be removed or deposited: LJIq feet Proposed slope throughout the area of operations: ifl(,9 Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): Yv 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: Project Location(describe,and attach a location map): Brief Description of Proposed Action: G Name of Applicant or Sponsor: Telephone: E-Mail: Address: City/PO: State: Zip Code: 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 n n may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: ❑ 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) ❑Industrial El Commercial ['Residential(suburban) EForest ❑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? Ti b.Consistent with the adopted comprehensive plan? !i 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: ❑ Fl 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NOYES rf n 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? g/ 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: 4 ❑ 11.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? p E b.Is the proposed action located in an archeological sensitive area? 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline ❑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? © O 16.Is the project site located in the 100 year flood plain? NO, YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, ❑ a.Will storm water discharges flow to adjacent properties? LINO nYES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: n NO OYES 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? 1 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: [2. I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor nam Lvu,,LCl ` Date: thne 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 I 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 I. 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? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 B----d of Trustees--Applicatiox, -- AFFIDAVIT 400 ijil i y ,44// . 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. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Si ature of Property Owner SWORN TO BEFORE ME THIS JO) DAY OF , 20 /, • 4 '' i. Notary ' 'lie CAROL HYDELL NOTARY PUBLIC-STATE OF NEW YORK NO.01HY6189695 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES 06130120)kr — _. _ ;H�_-dm.af Trustees Applicatioi 7 a` i i.�..n— t T�A�Yiti.:i+.nz:J• AUTHORIZATION (where the applicant is not the owner) I, kaie,/ 41t)r ,)alv APP R residing at , ) 66X, />2-ciV (print name of owner of property) (mailing address) 6A_Wit4-ctw qteez,r do hereby authorize (Ag nt) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. a oU,Gc� (• ner's signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the Dart of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: r� t 4 14 g/fhb ;Past64name,first name.rpt s a le initial,unless you are plying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) 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 or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP • Submitted this ofl4' 200' ASignature U66'61'ln, �-- j�"" Print Name LO6�r/dC 9 Plitt 4 a Form TS 1 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# - - PROJECT NAME The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. Board of Trustees ,,,r 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant,loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: �, L �'x// a Location of action: rlele ;b1-00-e6 , eit U0 Site acreage: Present land use: f 4 r / 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( ) 51/-5 , (d) Application number,if any: 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. n Yes n No 1(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 I I Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Yes No ( Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pa es 8 through 16 for evaluation criteria Yes No 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 throw h 21 for evaluation criteria Yes No Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. iV /n Yes No Not Appl' 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 /Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and waste . See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. Yes ❑ 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. Yell 1 No U 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. Se LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. Yes No Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Townn waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. Yes fl No I aI Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. Yes No Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. Yes No Ei Not Applicable PREPARED BY TITLE �< DATE V9`!. 4 . v- . --7 7 : i i 1 i 1 Z I I t,u i i 1 I i i I 1 i 1 1 , 1 1 z tV re_Ae_e_- -7i. RD ,__. --- .1------- - .% , cp ,,,-.7 4 , ,,, -,, il 5ISE �'' o ea 0 0 0 \-(4 0 - bini-se A Cr LA ir 0 —fc of —d -11 rn cpfi {� 11 Cr D --i v___. — , -e'er --.- / s i 1.l Jy 1 t tea` k J ' J _ 2 �.9 .D , I 0o V Ni a I II - - - . l kl,,,,. : ( ,, FORM NO. 8 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal—(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey•of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: - 1. Certificate of occupancy $5.00 - 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date -1 / ' 7,' New Building �. Addition Old or Pre-existing Build( V�ant Land Location Of Property K2 t,.; .-----,, ' . ;�79-e-�' Owner Or Owners Of Property (...7.ci .. '' Subdivision Lot No. Block No. ..,. House No,.i.7b Permit No. Date Of Permit Applicant Health Dept. Approval Labor Dept. Approval • Underwriters Approval Planning Board Approval Request For Temporary Certificate Final Certificate Fee Submitted $ d•r-- Construction on above described building and permit meets all applicable codes and regulations. Applican .. .., . .. ,. .. Sworn to before me this ?73/ 6 a , •7/. 2---- 1 day f (stamp seal) NotaryPublic M- 1 WAILER F. LUCE L /" �� ubl c County NOTARY PUBLIC In the State of Nei Yak Redding In Suffolk County Suffolk County Clerks March 3314800 97 Commission Expires March 30,197 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. .Z71.82 Date Aug 18 , 19. 76 THIS CERTIFIES that the building located at RAS Fleetwood Road Street Map No. XX= Block No. XXX Lot No. XXXX. . ..CutehQ te. . , . Nap. , , . = r ate=t: - • a fax 1• dwel in,,e & Eousin- code • conforms substantially to the ".r.)., "d•e,••M , ,1,6• .i_i: ;tial f:444:,?:S fa•1 :':i,a:r.,[f 1,4'. • Ilt before� Apr 23 certificate- of occupancy , 19. 5. pursuant to which BELERIPMEUCNo.27182 . . dated Aug 18 , 1976 ., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . . twql .G•. .Q c. a . .41wa1iige • The certificate is issued to .T+arraMq ,DI'e' Owner (owner, lessee or tenant) of.the'aforesaid building. Suffolk County Department of Health Approval Pre— existing UNDERWRITERS CERTIFICATE No.-. P.re— existin4 HOUSE NUMBER .835 . .$. $.75. Street Fleetwood Road p Cutchogue /Vow, Q Building Inspector t3AR ( 2 2 €s J . �l HOUSING CODE INSPECTION August 13, 1976 835-875 Fleetwood Road R-1 Cutchogue, N.Y. Tax Roll: Lorraine Dunhuber - Occupied: Seasonal tenants Upon receipt of an application for a Pre-existing Certificate of Occupancy -for, two single;,;dwelling units, I made an inspection of the buildings at thii' location. I-met Miss Dunhuber on the premises and began this inspection at approximately 9:45 A.M. A previous inspection was made for a Pre-existing Certificate of Occupancy on February 11,. 1974 , for owner of record Ottomar J. Gerhardt. A copy of report of previous inspection is here- with enclosed. The violations of Chapter 52, Housing Code, Town of Southold listed in report were found to have been cor- rected. Also, in addition, each unit now contains a hotwater heating system suppling heat to each- room. Bathrooms have been renovated and contain required fixtures to_neet minimum re- quirements for a living unit. Dwellings were found to comply with Housing Code for one-family occupancy. Inspection completed at approximately 10:15 A.M. Respectfully ubmitted, liGP�c�1 and Hindermann Building Inspector EH:med 0.,,,;'..%:':,:: r t rl S, i -f. y� 5 • ��i�i`,Yr{J. q "� '1'--. 1 ► `Y 4 3: _i♦�\ t -r. it 40! pea 0�♦ A. / e �..1•Irv. •!p I •, / 1`, '"i. i ! rot .4 1iftv,i!\ t• +a -i; : ft . ,. -•a i. 4 T )X' 1'yl.�A ii d� � 11 „st 14.0 it,11 Al isil. ..,, „yr..., ,•,...,• ,.. , ,,, . _< 'r: -44111..., 'W , .., ., <, 110,. y ... ..,.. Vs,,, . . w i "�' 075:i„.4,141.1,1,1,1! 1111'1.11111111111•..I. �� #irri I - a.r , mall11%.,.,.. Mj.. tiiiiliii�l,�1iii:1.1.� ._/' iY, 1 e 1 s .�+�... rr .47 91P47`7' ♦ ♦ ♦ ♦ 0000, a v�' a �9"� a �as� m ... ! r ` 1 ♦ ♦ ♦ ♦ ♦ ♦ w 11, Q ® a ® ® %® o o � r.1,;;;e:'<fr:,,. .,,''' 't::::::.47;,,,,*. 9 Y ' is �.- '' • ' t • < e }� �, {lr1' , P+ arc y, < . 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