HomeMy WebLinkAboutTR-8904A �f%cpF SD�jT
Michael J. Domino,President � y®�® Town Hall Annex
John M. Bredemeyer III,Vice-President 54375 Route 25
P.O.Box 1179
Charles J. Sanders
Southold, New York 11971
Glenn Goldsmith �o Telephone(631) 765-1892
A. Nicholas Krupski lif'`+ou Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
# 1344C Date: June 5, 2017
THIS CERTIFIES that the construction of a+/-10'x12.4' addition onto the southerly side of
the existing dwelling;
At 250 Pine Tree Court, Cutcho ague
Suffolk County Tax Map#1000-98-1-7.11
Conforms to the application for a Trustees Permit heretofore filed in this
office Dated December 18, 2015 pursuant to which Trustees Administrative Permit#8904A
Dated November 16, 2016, was issued and conforms to all of the
requirements and conditions of the applicable provisions of law. The project
for which this certificate is being issued is
for the construction of a+/-10'x12.4' addition onto the southerly side of the existing
dwelling.
The certificate is issued to Steven&Laura Beck owners of the
aforesaid property.
Authorized Signature
*OF SO(/l�,
Michael J.Domino,President ��� Ol0 Town Hall Annex
John M.Bredemeyer III,Vice-President 54375 Route 25
' P.O.Box 1179
Charles J.Sanders
N Southold,New York 11971
Glenn Goldsmith ® �� Telephone (631) 765-1892
A.Nicholas Krupski �COUNr(,�c� Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
DATE OF INSPECTION: G/ 5-ki
y Ch. 275 Ch. 111
INSPECTION SCHEDULE
Pre-construction, hay bale line/silt boom/silt curtain
1 st day of construction
% constructed
Project complete, compliance inspection.
INSPECTED BY:
COMMENTS:
�,).1Lt
T cu- per Plcwr
C0 co lc�e.
CERTIFICATE OF COMPLIANCE:
John M.Bredemeyer III,President vq f S0(/jifo Town Hall Annex
Michael J.Domino,Vice-President ,`O l0 54375 Route 25
P.O.Box 1179
Glenn Goldsmith Southold, New York 11971
A. Nicholas Krupski G ® Telephone(631) 765-1892
Charles J.Sanders 'O Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUT14OLD
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/silt boom/silt curtain
1 st day of construction
/ Y2 constructed
Project complete, compliance inspection
� �Ujjy
John M.Bredemeyer III,President rf STown Hall Annex hO� Ol0
Michael J.Domino,Vice-President 54375 Route 25
P.O.Box 1179
Glenn Goldsmith Southold,New York 11971
A.Nicholas Krupski ® �p� Telephone(631) 765-1892
Charles J.Sanders M" Fax(631) 765-6641
CO NV
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 8904A
Date of Receipt of Application: December 18, 2015
Applicant: Steven & Laura Beck
SCTM#: 1000-98-1-7.11
Project Location: 250 Pine Tree Court, Cutchogue
Date of Resolution/Issuance: November 16, 2016
Date of Expiration: November 16, 2018
Reviewed by: A. Nicholas Krupski, Trustee
Project Description: To construct a +/-10'x12.4' addition onto the southerly side
of the existing dwelling.
Findings: The project meets all the requirements for issuance of an
Administrative Permit set forth in Chapter 275 of the Southold Town Code. The
issuance of an Administrative Permit allows for the operations as indicated on the
site plan prepared by DAK Associates, LLC, dated December 16, 2015 and
stamped approved on November 16, 2016.
Special Conditions: None.
Inspections: Final Inspection.
If the proposed activities do not meet the requirements for issuance of an
Administrative Permit set forth in Chapter 275 of the Southold Town Code, a
Wetland Permit will be required.
This is not a determination from any other agency.
Jo n M. Bredemeyer, III
President Board of Trustees
John M Bredemeyer III, President �oso1`01 ', Town Hall Annex
Michael J. Domino, Vice-President ��� ��F 54375 Route 25
Glenn Goldsmith o ` P.O. Box 1179
A. Nicholas Krupski 0 Southold, NY 11971
Charles J. Sanders Telephone (631) 765-1892
ala}' Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Date/Time: i��►y��4 13�°v Completed in field by: IJ,k411'
STEVEN & LAUREN BECK request an Administrative Permit to construct a +/-10'x12.4' addition
onto the southerly side of the existing dwelling. Located: 250 Pine Tree Court, Cutchogue. SCTM#
1000-98-1-7.11
CH. 275-3 - SETBACKS
WETLAND BOUNDARY: Actual Footage or OK=q 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
i
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/cons-ultant/application completeness/comments/standards:
61w4
i
Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski
C. Sanders Other
Page 1 of 2
John M. Bredemeyer III, President �oOFF01.1v ,f Town Hall Annex
Michael J. Domino, Vice-President �° Gym 54375 Route 25
Glenn Goldsmith o P.O. Box 1179
A. Nicholas Krupski o '* Southold, NY 11971
Charles J. Sandersy o�� Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Date/Time: Completed in Work Session by:
STEVEN & LAUREN BECK request an Administrative Permit to construct a +/-10'x12.4' addition
onto the southerly side of the existing dwelling. Located: 250 Pine Tree Court, Cutchogue. SCTM#
1000-98-1-7.11
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. :525% 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
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OFFICE LOCATION: ®� s ® MAILING ADDRESS:
Town Hall Annex P.O. Box 1179
54375 State Route 25 Southold, NY 11971
(cor. Main Rd. &Youngs Ave.) cps
Southold, NY 11971 Telephone: 631765-1938
a Fax: 631 765-3136
COUMTV,�
'LOCAL WATERFRONT REVITALIZATION PROGRAM
TOWN OF SOUTHOLD
MEMORANDUM
To: John Bredemeyer, President
Town of Southold Board of Trustees
From: Mark Terry, LWRP Coordinator
Date: November 16, 2016
Re: LWRP Coastal Consistency Review for STEVEN & LAUREN BECK
SCTM# 1000-98-1-7.11
STEVEN & LAUREN BECK request an Administrative Permit to construct a +/-10'x12.4' addition
onto the southerly side of the existing dwelling. Located: 250 Pine Tree Court, Cutchogue.
SCTM# 1000-98-1-7.11
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 EXEMPT from LWRP review pursuant to:
§ 268-3. Definitions. MINOR ACTIONS items "BB" which states:
BB. Additions to an existing dwelling constituting less than 25% of the existing structure where the
addition is greater than 75 feet from a natural protective feature, except where the parcel is located
in a coastal erosion hazard area;
Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its
written determination regarding the consistency of the proposed action.
BOARD MEMBERS ®� so 53095 Southold Town Hall
Leslie Kanes Weisman,Chairperson 53095 Main Road•P.O.Box 1179
Southold,NY 11971-0959
Eric Dantes a Office Location:
Gerard P.Goehringer _ Town Annex/First Floor,Capital One Bank
George Horning 54375 Main Road(at Youngs Avenue)
Kenneth Schneider C®U � Southold,NY 11971
http://southoldtown.northfork.net
ZONING BOARD OF APPEALS
TOWN OF SOUTHOLD
Tel.(631)765-1809•Fax(631)765-9064
October 21, 2016
Joseph Gulmi
250 Pinetree Court
Cutchogue,NY 11935
RE: ZBA Application#6994,Lauren Beck
SCTM No. 1000-98-1-7.11
Dear Sir;
Transmitted for your records is a copy of the Board's October 20,2016 Findings,
Deliberations and Determination, the original of which was filed with the Town Clerk regarding
the above variance application.
Before commencing any construction activities, a building permit is necessary. Please
be sure to submit an application along with a copy of this determination to the Building
Department.
If you have any questions,please call the office.
Sincerel ,
Kim E. Fuentes
Board Assistant
Encl. Ei�fes' ► V E
cc: Building Dept. , '
OCT 3 1 2016
k
r
Southold Town p
Board of Trustees ..�
BOARD MEMBERSOF so 53095 Southold Town Hall
Leslie Kanes Weisman,Chairperson �� H� 53095 Main Road•P.O.Box 1179
�® !� Southold,NY 11971-0959
Eric Dantes Office Location:
Gerard P.Goehringer Town Annex/First Floor,Capital One Bank
George Horning 0 a0� 54375 Main Road(at Youngs Avenue)
Kenneth Schneider 1�cou Southold,NY 11971
hnp://southoldtown.northfork.net RECEIVED
ZONING BOARD OF APPEALS V15ant,
TOWN OF SOUTHOLD tCT 2 4 2016
Tel.(631)765-1809-Fax(631)765-9064 �"
Southold Town Clerk
FINDINGS,DELIBERATIONS AND DETERMINATION
MEETING OF OCTOBER 20,2016
ZBA FILE 6994
NAME OF APPLICANT: Lauren Beck
PROPERTY LOCATION: 250 Pine Tree Court, Cutchogue,NY 11935 SCTM# 1000-98-1-7.11
SEORA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this
application and determines that this review falls under the Type H category of the State's List of Actions, without
further steps under SEQRA.
SUFFOLK COUNTY ADMINISTRATIVE CODE: This application was referred as required under the Suffolk
County Administrative Code Sections A 14-14 to 23, and the Suffolk County Department of Planning issued its
reply dated September 2, 2016 stating that this application is considered a matter for local determination as there
appears to be no significant county-wide or inter-community impact.
LWRP DETERMINATION: The relief, permit, or interpretation requested in this application is listed under the
Minor Actions exempt list and is not subject to review under Chapter 268.
PROPERTY FACTS/DESCRIPTION: The applicant's property is a conforming 1.1324 acre(49,223 sq.ft.)parcel
located in an R-80 Zoning District. The property has frontage of 118.63 feet along Pine Tree Court to the westerly
property line and frontage of 165.31 feet along Pine Tree Court on the northwest property line. The northerly
property line measures 149.66 feet, the easterly property line measures 203.77 feet along wetlands and the
southerly property line measures 245.30 along residential property. The parcel is improved with a one story frame
house with attached garage, a one story frame pool house, an in-ground swimming pool, and two frame sheds, all
of which is shown on a survey prepared by John Metzger dated December 20, 1986, and last updated September
27,2007.
BASIS OF APPLICATION: Request for Variance(s)from Sections 280-124 and the Building Inspector's July 12,
2016 Notice of Disapproval based on an application for building permit to construct additions and alterations to an
existing single family dwelling, at 1) proposed addition located at less-than the code required minimum side yard
setback of 20 feet; located at 250 Pine Tree Court, Cutchogue,NY SCTM#1000-98-1-7.11.
RELIEF REQUESTED: The applicant requests a variance to make additions and alterations that will result in a
side yard setback of+/- 15 feet where a 20 foot minimum is required.
ADDITIONAL INFORMATION: At the hearing the applicant stated that his neighbor to the south supports the
proposed addition. The subject property received prior variance relief in ZBA #5340, Feb. 12, 2004 for an
accessory pool,accessory garage and shed in a front yard where the code requires a rear yard location.
Page 2,October 20,2016
#6994,Beck
SCTM No. 1000-98-1-7.11
FINDINGS OF FACT/REASONS FOR BOARD ACTION:
The Zoning Board of Appeals held a public hearing on this application on October 6,2016 at which time written
and oral evidence were presented. Based upon all testimony, documentation,personal inspection of the property
and surrounding neighborhood, and other evidence,the Zoning Board finds the following facts to be true and
relevant and makes the following findings:
1. Town Law 4267-b(3)(b)(1). Grant of the variance will not produce an undesirable change in the character of
the neighborhood or a detriment to nearby properties. The subject property is located on Pine Tree Court, a short
R.O.W. that provides private access to three other homes, all on irregularly shaped lots. Sight lines to the subject
property are constrained by the slope of the terrain, wetlands, and buffers of woodland and natural vegetation. The
proposed addition on the southerly side of the dwelling will not be visible to neighbors or the street.
2. Town Law §267-b(3)(b)(2). The benefit sought by the applicant cannot be achieved by some method, feasible
for the applicant to pursue, other than an area variance.The existing dwelling is located very close to the southerly
side yard property line and currently has a conforming setback. Any expansion along that side will require variance
relief. The northerly side of the dwelling, which would permit the proposed addition to be built with a conforming
setback, is encumbered by electrical lines, AC equipment, and other utilities, and would require a costly new roof
design and the removal of extensive mature landscaping. Also,the interior layout of the existing dwelling supports
the logical placement of an enlarged bedroom addition on the prospered southerly side.
3. Town Law $267-b(3)(b)(3). The variance granted herein is mathematically substantial,representing 25%relief
from the code. However, the small 10 ft. x 12.4 ft. addition will not be visible from adjoining properties and an
existing framed shed is proposed to be removed from the southerly side yard. Moreover,the adjoining neighbor's
dwelling to the north is approximately 70 feet from the subject side yard property line.
4. Town Law X267-b(3)(b)(4) No evidence has been submitted to suggest that a variance in this residential
community will have an adverse impact on the physical or environmental conditions in the neighborhood. The
applicant must comply with Chapter 236 of the Town's Storm Water Management Code.
5. Town Law $267-b(3)(b)(5). The difficulty has been self-created. The applicant purchased the parcel after the
Zoning Code was in effect and it is presumed that the applicant had actual or constructive knowledge of the
limitations on the use of the parcel under the Zoning Code in effect prior to or at the time of purchase.
6. Town Law $267-b. Grant of the requested relief is the minimum action necessary and adequate to enable the
applicant to enjoy the benefit of a new bedroom while preserving and protecting the character of the neighborhood
and the health, safety and welfare of the community.
RESOLUTION OF THE BOARD: In considering all of the above factors and applying the balancing test under
New York Town Law 267-B, motion was offered by Member Weisman (Chairperson), seconded by Member
Dantes, and duly carried,to
GRANT the application as applied for, and shown on the survey by Peconic Surveyors, John T. Metzger last
revised March 14, 2016 and the architectural drawings by D.A.K.Associates labeled Al01-Al07 and A201-A202.
SUBJECT TO FOLLOWING CONDITION:
1. The framed shed along the southerly side yard shall be removed or relocated to a conforming location
That the above conditions be written into the Building Inspector's Certificate of Occupancy, when issued.
•I
l I
Page 3, October 20,2016
#6994,Beck
SCTM No. 1000-98-1-7.11
Any deviation from the survey, site plan and/or architectural drawings cited in this decision will result in delays
andlor a possible denial by the Building Department of a buildingpermit, and may require a new application and
public hearing before the Zoning Board of Appeals.
Any deviation from the variances)granted herein as shown on the architectural drawings, site plan and/or survey
cited above, such as alterations, extensions, or demolitions, are not authorized under this application when
involving nonconformities under the zoning code. This action does not authorize or condone any current or future
use, setback or other feature of the subject property that may violate the Zoning Code, other than such uses,
setbacks,and other features as are expressly addressed in this action.
The Board reserves the right to substitute a similar design that is de minimis in nature for an alteration that does
not increase the degree of nonconformity.
Pursuant to Chapter 280-146(B) of the Code of the Town of Southold any variance granted by the
Board of Appeals shall become null and void where a Certificate of Occupancy has not been
procured, and/or a subdivision map has not been filed with the Suffolk County Clerk,within three
(3)years from the date such variance was granted. The Board of Appeals may,upon written
request prior to the date of expiration, grant an extension not to exceed three(3) consecutive one
(1)year terms.
Vote of the Board: Ayes:Members Weisman (Chairperson), Dantes, Horning, Schneider(Member Goehringer not
present). This Resolution was duly adopted (4-0).
Leslie Kanes Weisman, Chairperson
Approved for filing f�/ "� /2016
I
John M. Bredemeyer III, President �*®F 501IT�0 Town Hall Annex
Michael J. Domino,Vice-President- �� l® 54375 Main Road
P.O.Box 1179
James F. King,Trustee Southold,New York 11971-0959
Dave Bergen,Trustee G�
® y0 Telephone(631) 765-1892
Charles J. Sanders,Trustee �OlyG'ou Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
To: Southold Town Building Department
I i !lI D E C 1 8 2015 ;� I
Re: Verification of Building Department Permit Requirements
-
SCTM#:
11
Ile
VFW lkl
Property Owner Name: '
Date Sent to Bldg. Dept.:
The Office of the Board of Trustees is forwarding the above referenced application for
verification of the Building Department's permitting requirements stated below:
YES NO
Will the proposed project require a Building Permit?
Will the proposed project require a variance determination from
th Zoning Board of Appeals?
Will any part of this application be considered as Demolition as
described under Town Code?
COMMENTS: �
,
Z/w,
Signature of eviewer Date
t
SOF SO!/T
John M. Bredemeyer III,President �� yQ� Town Hall Annex
Michael J.Domino,Vice-President 54375 Main Road
1 l�6 P.O.Box 1179
James F.King,Trustee Southold,New York 11971-0959
Dave Bergen,Trustee p�
Charles J.Sanders,Trustee ® � Telephone(631) 765-1892
�y�'QU �� Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
_Coastal Erosion Permit Application
Wetland Permit Application
_Administrative Permit
_Amendment/Transfer/Extension _
Received Application: 2 1 1 g.I S
Received Fee:$
.ice?;•- � � �
V�::Completed Application: 12,1$I5'
_Incomplete:
�
� DEC 1 8 2015
_SEQRA Classifica ' n: y
Type I Type II Unlisted
y�Coordination-(date sent):
V LWRP
Consistency Assessment Form: ' ` Southold bvin
CAC Referral Sent ______
Date of Inspection: -I -IG,
Receipt of CAC Report:
_Lead Agency Determination:
Technical Review:
Public Hearing Held:
Resolution:
Name of Applicant: � e.V�9�1 ��l✓C MN& �'O.Xmneo •6ect<
Mailing Address: 35 0 E a19`1 ,% n es
[o 0-6 Phone Number: 3 0 I a
Suffolk County Tax Map Number: 1000 - CB
Property Location: 250 �1t\Ae ! Ree Cur-L, I,Leo 5 frzc rA
?1tje 1 tzEt: x etySAotJ r,cvC ire ac Coure IN*e10 Cit�C�1C��12
(provide LILCO Pole#, distance to cross streets, and location)
AGENT:
(If applicable)
Address:
Phone:
"ard of Trustees Applicatj�
GENERAL DATA
Land Area(in square feet): ly -N:i
Area Zoning: —R, B0
Previous use of property: Tpsid-eNCC
Intended use of property: -Pes lae UCC
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? ✓ Yes No
Prior permits/approvals for site improvements:
Agency Date
x1 orTpwo� ,2astee5cmkt 5z1e211-01 &Me, cl /-zS,o�
7 _A I� t ti F C ate- y/7eMo' 3(0637
1 1 l t Ct �1 CeTE Icau Gcupivc,-t Up'
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): &X t E JU51 CP.1 (DE ON
ex ISE) ccof'Al i0 -A. Ll C tz ap�) +c;
;ard of Trustees Applicati`�
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: Same- V"s eXts-Lin5 , e-AWi)& ToS-z_ Mom
C r—n-Fo2f tzrA L_�J ci Ca
Area of wetlands on lot: aAg94x 30 square feet-See Z&_-e--c'�c-hed Su('%J e,- shoujaYj VJef .Ry(
Percent coverage of lot: e 00 f a % see Sc.:r Ve_1
Closest distance between nearest existing structure and upland
edge of wetlands: 78, L1 feet
Closest distance between nearest proposed structure and upland
edge of wetlands: rm- 2 S feet
Does the project involve excavation or filling?
No ✓ Yes
If yes,how much material will be excavated?Mpc 35- cubic yards
How much material will be filled? cubic yards
Depth of which material will be removed or deposited: -3 feet
Proposed slope throughout the area of operations: No We
Manner in which material will be removed or deposited: 6cLCXV\oz aDA 51)OVC'L
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):
I Here w i tL tae R o eV�Fec+ Oto -else W e Land s OR
-ki& L u Zt t e f s co4S\E. -�owiA _
r
61 Z20
Appendix B
Short Environmental Assessment Form
Instructions for Completing
Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses
become part of the application for approval or funding,are subject to public review,and may be subject to further verification.
Complete Part l based on information currently available. If additional research or investigation would be needed to fully
respond to any item,please answer as thoroughly as possible based on current information.
Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful
to the lead agency;attach additional pages as necessary to supplement any item.
Part I -Project and Sponsor Information
Name of Action or Project:
0 S(DfO �CClc-' ����L
Project Location(describe,and 4tfach a location map):
R t�G:—L PC—e —
Brief Description of Proposed Action:
C) se/dl RCCv\\. odk X151 bGNCC
Gff9ox o 10, X /o—).q
Name of Appricant or Sponsor: Telephone: �^3 0/ a a f
CSLRja) PRg--K= am& � ��-k �C�� E-Mail:LAS ttiCWOO' e VD-e
Address: _
SN
City/PO: State: Zip Code:
/i y I c oo s
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 H ❑
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: ❑ Pr
3.a.Total acreage of the site of the proposed action? Z /3,a y 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? ®, / dj( acres
4. Check all land uses that occur on,adjoining and near the proposed action.
❑
��Urban El Rural(non-agriculture) [:]Industrial ❑Commercial Residential(suburban)
69-forest ❑Agriculture ❑Aquatic Wther(specify):wee �dS
❑Parkland
Page 1 of 4
5. is the proposed action, NO YES N/A
a. A permitted use under the zoning regulations? ❑ ❑
b.Consistent with the adopted comprehensive plan? ❑ ❑
6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES
landscape? ❑
7. Is the site of the proposed act'pn located in,or does it adjoin,a state listed Critical Environmental Area? NO YES
If Yes,identify:
BZ QGl pn S fhe L�&tU C-R-ee.tC G\Jef L a AAs F-1 Er
8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES
b.Are public transportation service(s)available at or near the site of the proposed action? ❑
c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? FL;rl ❑
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:
Ii C) C Li a AJtrtC Ito ❑
10. Will the proposed action connect to an existing public/private water supply? NO YES
If No,describe method for providing potable water: ❑
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? � ❑
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 LOAForest ❑Agricultural/grasslands ❑Early mid-successional
Wetland El 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? Imo( ❑
16.is the project site located in the 100 year flood plain? NO YES
17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES
If Yes, ❑
a.Will storm water discharges flow to adjacent properties? ❑NO nYES
b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)?
If Yes,briefly describe: ❑NO ❑YES
Page 2 of 4
i
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: 9 ❑
19. Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES
solid waste management facility?
If Yes,describe:
20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES
completed)for hazardous waste? F]If Yes,describe:
0 I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE p
Applicant/Sp
e: sor name: �C(llV'e1-� `J� V e�I Date:
Signatur
7aAA,%.0— 6-�L�-[I
Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the_following
questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or
otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my
responses been reasonable considering the scale and context of the proposed action?"
No,or Moderate
small to large
impact impact
may may
occur occur
1. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑
regulations?
2. Will the proposed action result in a change in the use or intensity of use of land? ❑
3. Will the proposed action impair the character or quality of the existing community? ❑
4. Will the proposed action have an impact on the environmental characteristics that caused the ❑
establishment of a Critical Environmental Area(CEA)?
5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ El
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 El
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? El
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
evironmental impact statement is required.
Check this box if you have determined,based on the information and analysis ab ve,and any supporting documentation,
that the proposed action will not result in any significant adverse environmenta mpac ,c
Town of Southold-Board of Trustees
Name of L Agency Date
President
Print or Type me of Res ible 9fficer in Lead Agency Title of Responsible Officer
Sig e of-R— ible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer)
PRINT Page 4 of 4
`ard of Trustees Applicat> , .
AFFIDAVIT
�AuoeA ?)edc c�rvs�S 1�r► c.(G BEING DULY SWORN
DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN
ARE TRUE TO THE BEST OF HIS//HER KNOWLEDGE AND BELIEF,AND THAT
ALL WORK,WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION
AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES.
THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE
BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND 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.
Signature of Property Owner
SWORN TO BEFORE ME THIS_ _DAY OF O , 20 IS--
LORI
SLORI COATS
Notary Public, State of New York
No. 01 C06156429
Qualified in New York County
1 vzg
Commission Expires Nov. 27, 20/9
otary Public
r
APPLICANUAGENUREPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of
this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is
necessary to avoid same. i
YOUR NAME: S�=V C. 0 I, 2){y_ M JN Lien)
(Last name,first name,sliiddle 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 e�
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 ill,
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 N!o,
Title or position of that person uv IV.,
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):
i T` A)the owner of greater than 5%of the shares of the corporate stock of the applicant
(when the applicant is a corporation);
Td J B)the legal or beneficial owner of any interest in a non-corporate entity(when the
applicant is not a corporation);
an officer,director,partner,or employee of the applicant;or
uJ�G D)the actual applicant.
DESCRIPTION OF RELATIONSHIP
lV 00.e
Submitt day of,&J0Ve_1-"0S 0 L S
Signatur
Print Name
Form TS 1 3
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# % - I - -7, 11
PROJECT NAME 'BECK "-R ESt DC NCr✓
The Application has been submitted to (check appropriate response):
Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees Rr
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:
�5XPAM) GX- isbN� Resl6cg-C b&I l2, :sj Pf (i6c la�ti > . Stfx op
C��S-�2��C �1 o;J i S 6M�2t' -f�tv r�o 1 Z� bra. v�efLciVt�S oN ZL.Lc L
C(W,e 14!s R6wyabo+u IS a N1u1 qP- acbco PSdeFIw-6 ok § )68-.3 (a6)
Vatf)c\ S Sacro
1
Location of action:
Site acreage:
Present land use: les,E)e MC&L
Present zoning classification: r
2. If an application for the proposed action has been filed with the Town of Southold agency, the following
information shall be provided:
(a) Name of applicant: 1 C'—
(b) Mailing address: N I '�'
(c) Telephone number: Area Code( } l ek
(d) Application number,if any: N i aN
Will the action be directly undertaken,require funding, or approval by a state or federal agency?
Yes ❑ No Ef 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
iPc-c- IS Cc�nctglM L,)(U4 � L(n�,rccfer (-,F- F1-E 5urrcand��� iWStdenhgC
d1�'�� �p r� �t9Cc:i�i'�1tf•�t�-1 . It C�oEaS r1C'1� 1�tniku} Odd hnt i��iU �/KE� anrl' rytL1. h/Jy�
r?c.c-f 0i� 1-6 L—PhNsiCA o2 ens V1XOP4etA&L
C C� f2aX x-njj km)e lfi*A) (-)F- {-K REs, ctr-i s ce)Is f c-k -I /I I N►h is
lU h A-Ad- +NtLL Nat Veaa&;e Qee 2r M O&n es
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See
LWRP Section III—ZNot
PPolicies Pages 3 through 6 for evaluation criteria
11Yes 1:1No Applicable
Attach additional sher ets 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 2 Not Applicable
-rl¢(S g, ec-t L.-3 t,t_L WL-* i din O,N+k9-SXNtc-'e—<k%%rc e5 i w
—hLQ- 77)U30 O� o
Attach additional sheets if necessary
NATURAL COAST POLICIES
Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP
Section III—Policies Pages 8 through 16 for evaluation criteria
❑ Yes ❑ No Not Applicable
Attach additional sheets if necessary
Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section In
—Policies Pages 16 through 21 for evaluation criteria
Yes 1:1 No U Not Applicable _
7-HI's QGfi we Z L 'jot /M f u G OR-
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 IH—Policies; Pages 22
through 32 for evaluation criteria.
❑ ❑ LJ
4
Yes No Not Appucable
T S _tact ult G ryvtM �� o:� fc-- �a� OF
I6w OF SCK ( -off.D
Attach additional sheets if necessary
Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies
Pages 32 through 34 for evaluation criteria.
❑ Yes ❑No Rf Not Applicable
Attach additional sheets if necessary
Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous
substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria.
❑ Yes ❑ No [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.
❑ Ye�] No VNot A licabl
pp e
Attach additional sheets if necessary
t h �
WORKING COAST POLICIES J
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria.
❑ Yes ❑ No ❑ZNot Applicable
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic
Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria.
❑ Yes ❑ No 10"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 9Not 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 [dNot Applicable
DATE
PREPARED BY TITLE
l