The URL can be used to link to this page

Home My WebLink AboutTR-8890A *OF SOUly Michael J.Domino,President Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 JW P.O.Box 1179 Charles J.Sanders CP Southold,New York 11971 Glenn Goldsmith ® y� Telephone(631) 765-1892 A.Nicholas Krupski l��'oU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1312C Date: February 28, 2017 THIS CERTIFIES that the removal of the existing shed; relocate the existing portable walk-in cooler; remove 532sq ft of wood decking; install helical piles and grade beams to support a new 16'x16' two-story accessory building and new 10'x4' utility shed; At 40200 Route 25, Orient Suffolk County Tax Map#1000-15-9-8.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated October 4, 2016 pursuant to which Trustees Administrative Permit#8890A Dated October 19, 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 the removal of the existing shed;relocate the existing portable walk-in cooler; remove 532sq ft of wood decking; install helical piles andgrade beams to support a new 16'x16' two-story accessory building and new 10'x4' utilily shed. The certificate is issued to MGH ENTERPRISES INC., c/o ROBERT HAAS owner of the aforesaid property. Authorized Signature John M.Bredemeyer III,President '\OF SOUlyo Town Hall Annex ,`4 l0 Michael J.Domino,Vice-President 54375 Route 25 F.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski Q Telephone(631) 765-1892 Charles J.S. �COUNT`I, anders Fax(631) 765-6641 � �� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: V 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: ai'C�1� 1 COMMENTS: /n V. e CERTIFICATE OF COMPLIANCE: J -" CUf`rot,i- John M Bredemeyer It resident �o� Town Hall Annex Michael J Domino, Vim,-, resident Y �� ', ' 54375 Route 25 Glenn Goldsmith N 'F` z `= P_O. Box 1179 51 A. Nicholas Krupski Yeo ® -" off;. Southold, NY 11971 Charles J Sanders == 01 ya;:Y 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 %2 constructed complete,lete fiance inspection 1 P compliance John M.Bredemeyer I11,President �0��0�S®(/tyOl Town Hall Annex Michael J.Domino,Vice-President O 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Telephone(631) 765-1892 Charles J.Sanders Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8890A Date of Receipt of Application: October 4, 2016 Applicant: MGH Enterprises, Inc., c/o Robert Haas SCTM#: 1000-15-9-8.1 Project Location: 40200 Route 25, Orient Date of Resolution/Issuance: October 19, 2016 Date of Expiration: October 19, 2018 Reviewed by: John M. Bredemeyer, III, President Project Description: Remove the existing shed; relocate the existing portable walk-in cooler; remove 532sq.ft. of wood decking; install helical piles and grade beams to support a new 16'x16' two-story accessory building and new 10'x4' utility shed. 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 Joan Chambers revised on October 23, 2016 and stamped approved on-October 31, 2016. Special Conditions: The containment of roof run off in accordance with Chapter 236 of the Town Code, Stormwater Management Control Plan. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. John M. Bredemeyer, III President Board of Trustees Scott A. Russell ,��° 4-� STOR M[WAITIE]k - fib. 117 o 95 Main Roa!28 UTHOLD, ORK 11971 Town of Southold i OCT 2016 � aut laltl raw i I A31fi 236 f STORMWATER MANAGEMENT WORK SHEET (TO BE COMPLETED BY THE APPLICANT ) DOES TMS PROJECT INVOLVE AINY OF THE F't9LLOWING:.,_. (CHECK ALL THAT APPLY) ! Yes No j ❑�A. Clearing, grubbing, grading or stripping of land which affects more j = than 5,000 square feet of ground surface. J❑Ef B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. jq 119C. Site preparation on slopes which exceed 10 feet vertical rise to k#' 100 feet of horizontal distance. 3t ? 910 D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. ; 1 ;: ❑® E. Site preparation within the one-hundred-year floodplain as depicted ;y3 on FIRM Map of any watercourse. '< ❑WF. Installation of new or resurfaced impervious surfaces of 1,000 square Ilk feet or more, unless prior approval of a Stormwater Management Ili Control Plan was received by the Town and the proposal includes { 4. in-kind replacement of impervious surfaces. x= If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information,Date & County Tax Map Number! Chapter 236 does not apply to your project. If you answered YES to one or more of the above,please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department wit►your Building Permit Application. M. Date- .i f, APPLICANT-. (Property Oitmer.Design Professional,Agent,Contractor,Other)_; s'C'T #' DOoo Istrict Section Block Lot i� U'ynmR. I 3 5,& ? FOR BUILDING DEPARTMENT USE ONLY (? Contact lnforniation ` "•( i l 7ekph—N•mbty }; Reviewed By: (a - - — — — — — — — - - — — — — — —�jj if {jf Date: Property yI ';. Property Address/Location of Construction Work; i't ;i) — — — — — — — — — — — — — — — — — .t )f t, i Approved for processing Building Permit. �-n 200 YYl/�t (Z'p - — Stormwater Management Control Plan Not Required. ! Stormwater Management Control Plan is Required. } (Forward to Engmeering Department for Revie7. +FORM ��SMCP-TOS MAY 2014_... APPLICANT. S.C.T.M.#: 1000 CI�P'TEI� 236 (Property owner,Design Professional,Agent,Contractor,Other) -m-:x:£ -- — '05UM/r �� l 0I- De Stormwater Management Control Plan CHECK LIST NAME: Section Biaci hot S M C P -Plan Requirements: Provide ONE copy of the Budding Permit Application. al The applicant must provide a Complete Explanation and/or Reason for not providing 10 6 25. 1� all Information that has been Required by the following Checklist( �Unalurc Wro,e wnben 1. A Site Plan drawn to scale Not Less that 60'to the inch MUST YE NO NA If You answered No or NA to any Item,Please Provide Justification Here! show all of the following items: If you need additional room for explanations,Please Provide additional Paper. a. Location&Description of Property Boundaries era -eo"EY Toit w\ ar- Z•2 .01 -m T 14.`v b. Total Site Acreage. ,(V.tE.e�-g v ctj .sugviy c. Existing-Natural&Man Made Features within 500 L.F. see sue-q - tt of the Site Boundary as required by§236-1700 -71 d. "rest Hole Data indicating Soil Characteristics&Depth to Ground Water, see e. Limits of Clearing& Area of Proposed Land Disturbance. �� SE, 6, '3, f. Existing& Proposed Contours of the Site (Mininnim z intervals) ® M.A. ALt-- F T g. Location of all existing&proposed structures, roads, V7 driveways,sidewalks,drainage improvements& utilities. 5 eff- sV XQt5 h. Spot Grades&Finish Floor Elevations for all existing& $Gs' so awe"? proposed structures, 1. Location of proposed Swimming Pool and discharge ring. 0 U)t M , fooi- j. Location of proposed Soil Stockpile Area(s). a C�LitP1 P4C- -k. Location of proposed Construction Entrance/Staging Area(s). (44 03 CAZ L Location of proposed concrete washout area(s). M. Location of all proposed erosion&sediment control measures. ® -8 V L-W� eo po cig-• 2. Stormwater Management Control Pian must include Calculations showing that the stormwater improvements are sired to capture,store,and infiltrate on-site the run-off from all impervious surfaces generated by a two(21 inch rainfall/storm eveni. 3. Details&Sectional Drawings for stormwater•practices are required for approval. Items requiring details shall include but not be limited to: a. Erosion&Sediment Controls. 0�] b. Construction Entrance&Site Access. c. Inlet Drainage Structures (e.g.catch basins,trench drains,etca d. Leaching Structures (e. .infiltration basins.swales.etc.) FOR ENGINEERING DEPARTMENT ALISEONLY i Additional Information is Required. Reviewed& ri Stormwater Management Control Plan is Not Complete. Approved Br. - - - - - - - - - - - - - - - - - - - - - - - - — Stormwater Management Control Plan is Complete. 4; Date: El SMCP has been approved by the Engineering Department.!'! ..._.. .. -_- FORM * SWCP Check List-TOS MAY 2014 LAND OF THE,:•`--STATE OF NEVI/ YORK a VACANT ry Few �� _p` p-- ---p- ,..,p'. `} q. ._.. n IAL f/1W—L O--- p 'o reg► Ao.,..9 Alweecy• of;=.7r lrn CWMAVI a/ �f el 7.0 ( /. f� J roj �^)5T � - V /77 Nn t W a rax /p 4a• '"�_......._.,.,,_ . .,.;3. `>�• ,. ...,_.. ..e.,. ell O s ST ,/cover O O� �� IIA.i01P�D E.i+s Tadw MULKWAD SIX P I L I N G S , 'LVExsSTM " O 0 0 0 �� RESTAURADIT l �4 Z = PROP. NEWAR ` P 1 L .1 N G S 05 SEATS I cotrwTt7r 0 0 0 0 0 0 MwVUMA° zQ WA" ate+ eD T 'V FW= CW "'001, `- � R � 'sy - GOVERNMENT TES 1N1T , ;— STA - THE > ORIENT BY THE SEA 40200 MAIN RD. "12 ROOF #3 ROOF #3 ROOF #3 ORIENT N .Y. EXISTING: MARINA/RESTAURANT 8 61 8-64 SCTM# 1000- 15-09-08 4 ZONE M- 11 �18�' PROPOSED: REMOVE EXIST. 16.3 X 10.4 STORAGE SHED. 22„ -3 ROOF #2 '�3., RELOCATE EXIST. PORTABLE WALK-IN COOLER. ROOF #2 ROOF #2 CONSTRUCT NEW 16'-0" X 16'-0" ACCESSORY STORAGE SHED & 4'-0" X 10'-0" UTILITY SHED. 1ST FL. STORAGE SHED - 256 SQ.FT. 2ND FL. STORAGE SHED - 320 SQ.FT. UTILITY SHED - 40 SQ.FT. GENERAL NOTES -64" �p"$I �� iQO x'81„ 1. All work shall conform to the requirements of the Residental Code of New York OFi �O\ State, County and Town Department Regulations, Utility Company requirements and ROOF # 1 ROOF # 1 �Oi \ best trade practises. -0" 3„ i 2. Before commencing work the Contractor shall file all documents required by the Building Department, pay all fees required by local agencies and obtain all required permits. 3. The Contractor shall visit the site and verify all dimensions and the existing conditions affecting the work prior to construction. Any discrepancies which would interfere with the satisfactory completetion of the work described herein shall be reported to the architect or property owner. Do not start work until such conditions have been examined and a course of action mutually agreed upon. Failure to notify AREA FOR REUOCATED the owner or architect of unsatisfactory conditions will be construed as an acceptance of the conditions to properly perform the required work. WALK—IN COOLER 4. All work is to conform to the drawings and specifications of the architect and engineer consultants. 5. The Contractor is to maintain a complete and up to date set of plans on the job site at all times 6. The drawings are not to be scaled under any circumstances. 7. It shall be the Contractor's responsibility to ascertain all prevailing procedures including storage and toilet facilities,protection of existing work to remain,access to work area, hours of permitted work,availability of water and electric power and all other conditions and restrictions for this particular location in order to execute the work in a careful and orderly manner with the least possible disturbance to the public. NORTH ELEVATION 8. The Contractor shall make the neccesary arrangements to utilities and services SOUTH ELEVATION EAST ELEVATION temporarily disconnected while performing the work as required. 9. The Contractor shall provide all dimensions and cut-outs for other trades. 10. The Contractor shall provide proper shoring and bracing for all remaining structure prior to removal of existing structure. 11. Plumbing, electrical, HVAC and similar work shall be performed by licensed persons who shall arrange for and obtain all required inspections. The General Contractor shall be responsible for scheduling all other inspections as required. 12. The Contractor is solely responsible for construction safety and shall hold the owner and architect harmless from litigation arising out of the Contractor's failure to provide construction safety means and methods. PROVIDE 2 PITS 37.7 SQ.FTx A- 101 PLANS, SECTIONS, ELEVATIONS, NOTES 2'-0" DEEP W/ 3" GRAVEL BED A- 102 SITE PLAN IN BOTTOM TO PROVIDE VOLUME FOR 493 GALS. EA. A— 103 STORM WATER RUN-OFF PLAN CONC. PIERS TYP. GRADE BEAMS TYP. ... . . .... . . ... _ .. .... .. . .. .. ..... .. 1. Q "! li L1 : 7. 1 I z ...I ROOF# 1 = 153.8 SQ.FT. I X ROOF #2 = 454.8 SQ.FT. Illi 1' I STORM WATER RUN-OFF PLAN Lu ROOF #3 = 94.2 SQ.FT. SCALE AS NOTED OCTOBER 23, 2016 TOTAL = 702.8 SQ.FT. z 703 SQ.FT x 1.25 GAL. PER II � SEAL: SQ '(2" PER HOUR) 878.75 ; �� %/, ,�',� /.::'•: ,can Ev WGGG GUTTER TO LEADER E GUTTER TO!LEADER Q �. s r/''// K . . GALS. f /. WALK WAv i .. . ......... A X03 LL I . i -- - — - -- - / I .'`,RELOCA E STEPS _ _ __ W. _ : ROOF -. HEW DnL 3 O F 3 T CHER TO UCNRE;�.�• ;;; #3' { W 94.2 S FT LEACH PIT PLAN ROOF #1 ROOF #2 153.6 SOFT. EDUiaMENT RM STORAGE 454 8 SOFT, x : Xw PO BOX 49 SOUTHOLD NY 11971EXIST ; JOAN CHAMBERS COOLER L«ATE° NORTH 631-294-4241 iST.RAiL i 1 ROOF OVER-ATTACHED�TO EXIST STRUCTURE /- GUTTER TO LE DER / / ''::'� AREA OF DISTURBANCE %: 'EXISTING AREA OF DECK TO BE REMOVED FOR CONSTRUCTION%>;•j j , m'-o-%.'a7 fes/ f/%/, ,. ..,,. .. .,: ..:,........:�. -.. ..... .. ... '"� r" 7, OCT 2 E 2 016 -7111111 711017-7, APPROVED BY A BOARD OF TRUSTEES AREA OF DISTURBANCE I ROOF PLAN TOWN OF SOHO 1/8" = V-0" NORTH 1/8" = 1'—On NORTH . o O '= DA'i E or.7�,g�ie 3l �l i i TEST HOLE SCDHS Ref.# ClO-01-0004 Asphalt 2' SEPTIC SYSTEM , ANxed sand MEASUREMENTS and loam i, A, Jdg. f�l.b e .r.e eo raa.e G.lc (o '12' L.P. Brown loamy C ei 9 yras+�.a � 38' proposed gradeo, half L 34' 4' 'L.P..�, 4 9�P►oved hr s s�M� 3b. 3 4' oved — — 27• 27' o iE 1200 GAL.. 8 j 24, The locations of wells and cesspools 62 "s'' sEPrxTANrc .e s' I�r.s., cEss>'oot Palo brown 3' � u 30' -3 3 " v dP shown hereon ore from field observations fine to e' °a `oei °t ""0'"' s°"°''and or from data obtained from others. coarse sand 3o Ja s with 10% 9iounae water ti!A grovel 5 3.7• highest 5easono.! eJ J.o' CENTER C.P. of(o POOL CLUSTER I am familiar with the STANDARDS FOR APPROVAL water in Palo AND CONSTRUCT/ON OF SUBSURFACE SEWAGE brown 'tie ' DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES to d with ITH CLPROPOSED SEWAGE ,COLLAR SYSTEM s POOLS PRE- forth b the conditions sat forth therein and on the Bond with CAS CLEAN SAES 3•COLLAR .9 O GAL. F L ' and will y 10% 5 ave/ cis To°" eE�L•SEPTIC AeovE Twp of L�►cnws permit to construct. 1 12' CROSS SECTION - SEPTIC SYSTEM LAND OF THE STATE OF NEW YORK VACANT q� �n RAL PD" 800.00' i 811 RAL Ft1N0E —0_ _ -0—_._.__o --o-- 0-00- -o---o-- --0 0 0 0 CO __o_--- - —o— o —0-- 2--0 o--- _ �O 0-0---.. V.0 Q4'g�; `��—o— —-o—- -� ,�7 6 �, s �.pr�o o f e t .�„9 ANee JrMr/awe► `a9• TED 0 Poo 0 Ni 00 OIfaOK 314• �wJ ��(o f� i�n `^'�'' � e17O vvirs �^ o c �x°J a e m e - a r �D`a r ° _ -- -- we' o d to 200.'_ a l' r S� >�� -. .. --------- �L. ''- N. 04 40 45 W. P / a' 3 h G/�7.o �f�xat�n� TMIaER YIA.K/IEAD � E,ps _ T&MI w�ioEAD / t/b/r G.5 R1 Box o 3 1.0'- A 0 0 0 0 0 0 o II - cowc • �� I II r I�EXISTING V' PILINGS $III S RESTAURAbI - - o 0 0 10 �I q I � y go.? - cb c SQ - PROP. NECx W BAR I WOOD lo.� Q fly SEAT De O/ PILINGS _ _ w��K �► \ y courrex coo,,.vr _ i 0 0 0 0 0 0 e �� B(JLIQIEAD X 4 WALK t, DOCKS �J SITE DATA K,EAD i V�1 SITE AREA = 4.6 ACRES* T'"�,W--e NEW RESTROOM AREA = 800 Sq. ft. LINE WNRE FENS ON ALLOWABLE SANITARY FLOW DENS/TY GROUND WATER MANAGMENT ZONE, IV ALLOWABLE FLOW FOR SITE 300 g.p.d / acre i I'43 S.S 20 VERNMENT 300 g'pd x 4.6 = 1380 g.p.d. • E. _ A'rES C� _ EWnW SE4 nW OF THE UN�T� S RESTAURANT - 83 SEATS LAND INDOOR BAR ., 26 SEATS _ OUTDOOR DECK - 75 SEATS TOTAL SEAT#iG - 184 SEATS PROPOSM SEA T RESTAURANT r 83 SEATS NVDOOR BAR - 26 SEATS ' OUTDOOR DECK = 60SEATS MAP OF PROPERTY OUTDOOR BAR - 1 5 SEATS TOTAL SEATNVG 184 SEATS AT ORIENT POINT TOWN OF SOUTHOLD SUFFOLK COUNTY N. Y. 1000 - 15 - 09 - 08 ' SCALE. 1" = 40' FEB. 2, 2001 1 r, FEB. 8, 2001 ( revision 1 E ra �// ka MAR. 7, 2001 DD JUNE 1, 2001 ( conc. foundation J j� o E S1, A w La TION w NOV. 2/ 2001 ( revlr/on J l ANY AL TERA TION 0 T £ E UC TIOIW A ' AREA) R ,q�p/ �p�y T S�Ry y Dec. 5, 200/ lfino/1 [IOCT - 4 2016 OF SECTION 7209 OF THE NEM' YORK STAT � j� J�ONS I JULY 14, 27i 0(RESTAURANT ` R r A C T' SEA� THIEOSURVE YOR A 711 ELEVATIONS ARE REFERENCED TO N.G.V.D. � �Soufhrld Town � �' '•' N.Y.S. LIC. N0. 496/8 ADDITIONALLY TO COMPLY WITH SAID LAW THE TERM' GALTE�PYBY• MAPPING INFORMATION FROM OFFICE RECORDS F;4 rd o, rs � MUST B£ USED BY NY,4 P 4 f SLPCRJ�AS SNS EC AN OFA P.C. Q TERURVY��7 A � No1lN COMPLIANCE WINHLAMP AND ACTUAL FIELD SURVEYS 63/J 765 - 5020 FAX /6311 765 - 1797 P. 0. BOX 909 Fq�/p 1230 TRAVELER STREET BROUGW SOUTHOLO, N.Y. 1197/ 98 - 356 i i i - i TEST HOLE SCDHS Ref.'# Cl0-0I-0004 el 6.7 Asphal 2, SEPTIC SYSTEM Wxed sand MEASUREMENTS and loom r, A, 13' brd 9 Brown loamy c.«� fo C•!.C to yimd e I 38• 42L.P. /1p, Q1 n3 Proposed grade .m ha./f L a4' ¢' •.v _�. - 4%waved07 c:rir.n�l � � 3' — — 1E 4• oved 27' v r20o GAL 1 24 Jo' L.P. The locations of wells and cesspools Palo brown �? Iss.' p T, ,E S., i'r s'' CESSPOOL 3' ' 30' 3& �P shown hereon are from field observations tine ro e.as oaw�r of �.t ^ .ena� 7 .30 and or from data obtained from others. coarse sand y,od�cc �,�e,, 1 ; . • with 10% Cl i.0 glove/ SW S.T, h19hest oetziono•! el r.o' CENTER C.P. OF(0 POOL CLUSTER ' I am familiar with the STANDARDS FOR APPROVAL water In poh AND CONSTRUCTION OF SUBSURFACE SEWAGE brown "-a DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and o he WITH CCLLESE�3' COLLAR Spon GAL.�-s and will abide by the conditions set forth thereto and on the r0% gravel CAST CONCRETE T P'SEPTIC T�"W;� OF LEArrwuc permit to construct. I s w 12' CROSS SECTION - SEPTIC SYSTEM LAND OF THE STA TE OF NEW YORK VACANT 800.00• /LIT RAL V -- ELEV TED aJ• �. s '-/.Plywoo--e-o 9 elr/Nlw 9 r--fE-mo- -- -o---o-- ---- ° o o - --o — — MM/T RAL fEKE — 0 --0 6.Z�0 o- e °- -L•°QQ•� r'e014 2O K OYM orlr�w t/moo re i O N �Ir el 7.o ; r.!• // �po•�-ci.^�o„J,,,C°J a v e m � � — Q ,-a►r /oma r,�� wella � {A. ��OYerl1� 1 n e �• - ---- - -- -- 200.1= h a- (- i" 3� >yc�vtr \ / f'p ��ST _..rL_-. N N. 04040'45' W. P a s e-eve �r exi�tny TMIYER WXKHEAO } 3 o 0 0 0 0 0 o 1l cpu • b� " . I'll� 1"EXISTING - g? P ! L I N G SI �l RESTAURAbITR i `��,,• - 0 111 f A 0 0 ° ° IIQ a • Q)••• a Dori _ '! 1 N - 10.4 ° P30SEA7S1 8AR I �� O 4- PILINGS VIALKR+ / ,v / \ V COUNTERcoaER _ i mom. ^ D o 0 o m ° ° I B(1LKiEAD 'Z(4 ;y WALK X� � I5 (s D 0 C K S I° 0 752'= S/TE DATA - N ES f '►, BU`""- 0 SITE AREA - 4.6 ACR T 1 —L NEW RESTROOM AREA = 800 Sq ft. ON LINE WIRE FENS ALLOWABLE SANITARYFLOW DENSITY GROUND WATER MANAGMENT ZONE, [V ALLOWABLE FLOW FOR SITE 300 g.p.d / acre 00 r G ` ERNMENT 300 4-pd x 4.6 = 1380 9-p.d. S. 11'43'20. E. ` ^ TCLS . OO V G ` UNITED S EWnW SEAnW OF THE RESTAURANT - 83 SEATS LAND INDOOR BAR - 26 SEATS _ OUTDOOR DECK 75 SEATS TOTAL SEA TkVG o 184 SEA TAW PROPOSM SEA TM RESTAURANT 83 SEATS WDOOR BAR = 26 SEATS _ OUTDOOR DECK SEATS MAP OF PROPERTY OUTDOOR BAR � 15 S SEATS rorAL SEA TM - 184 SEA TS AT RIEN T POINT TOWN OF S SUFFOLK COUNTY , N. Y. 1000 - 15 - 09 - 08 SCALE: 1" = 40' - -�� FEB. 2, 2001 FEB. 8, 200/ ( revision 1 I MAR. 7, 2001 SP 5 JUNE 1, 2001 ( conc. foundationR '- NOV. 21, 2001 ( revision Y AL TERATION O T 0 u S UC TIONTION AW " �' r AN ,g�Qp� �p�,/ T S R yATf EA �UL Y '14,2001 2010�RESTAURANT AREA) � � � i �� OF SECTION 7209 7rrE NEM' YORK ST �j��PP ON T' AL . .—sj UR v YO; ELEVATIONS TIONS ARE REFERENCED TO N.G.V.D. � ` ' N.Y.S. LIC. N0. 496/8 / W� SEG � �RREON. ADDITIONALLY TO COMPLY WITH SAID LAW THE TERMALTER£Py D BY' MAPPING INFORMATION FROM OFFICE RECORDS ORS, P.C. QFUSqTBpFt/.�ER DURv�°Y Y�A �No 1Nou�P TNCt;H �A►N►P AND ACTUAL FIELD SURVEYS. 63/1 765 - 5020 FAX (6311 765 - 1797 BROUGHT - too - DA P. O. BOX 909 1230 TRAVELER STREET SOUTHOLD, N.Y. 11971 98 - 356 NOTE: IT IS THE CONTRACTOR'S RESPONSIBILITY TO CONFIRM DIMENSIONS OF EXISTING WALK-IN COOLER AND VERIFY WITH OWNER THE CLEARANCES REQUIRED IN THE NEW LOCATION PRIOR TO START OF CONSTRUCTION. NOTE: IT IS THE CONTRACTOR'S RESPONSIBILITY TO CONFIRM THE SITE CONDITIONS ADJACENT TO THE EXIST. STRUCTURE & VERIFY THE DISTANCE FROM THE EXIST. STRUCTURE TO THE NEW HELICAL PILES. EXIST. WALL OF RESTAURANT EXIST. WALL OF RESTAURANT EXIST. WALL OF RESTAURANT i r: ;j Ii ( E tl: I, :E it w I yl i s 1 it W :I � 1" Z W I 1. 3'-0- W - Cr W U 4 Cr2 2X8 RAF E 16-OC e. � } 7 Y I F- II ij J H jl H I }}} I i F � a' U i � Z U 2 'E U ;1 2 H � I Ir I.' X EIL. T. 16" OC I 2 6 C J Ir I I I � co } i i I F 1, k ii s ! ! : !I: , Ir Lu ;I X Oco U r LU m ;: LL : .. .,. J :. ,: .. I .. ....- ... ..:.. ... - - .. .. .-.....:...:.... .......- I W X O Lu . w O EXIST. - t I r ,. I ; s ; o: (. I ,. - > o N ; O w WALK N COOLER rn .; ,1 ., .,. 1,;; , s ...._.. ..................... ...._............ ....._............__.__ ��.. .._.._.........._....._.__._ _....._.....__.._. ... HOJ .. .1 .. :: .: .... ............... ......... ....._......_................_..................__...... ...__......_...__.......-..... .....___._.._......_.._....._._...._....__. ......._.._._._...._.._ -.__....._...._..-__..._-....-._........_......___......-_. o o ¢ , , RELOCATED m w Lu W W uJ ............... C7 LL C7, LINE OF 2ND FL. O Z , 1 I i J - .. ... _. _ _ ..............._...__...-._........ U) I X Q , Q N N, ! w ! -0" 3'-5" U 1. 1,. IJ : I 2 2 f ' Ll 1 ' x � : 00 I - i .............. .. _- EQUIPMENT RM. _ a wi LL p - Oi O ... ..._.........................-.-.-..........__...�.. -- K ......__._..-...-...-....-_�.._--- -_-..............-- U J a u~ r- ...... ...... _._. .__ LL I DECORATIVE CUPLOA LL _-...:,-:_._ Q STAIRS ABOVE o o ; LL o ---------------------- ------- FD _....__... U _ .__.. ._. N x ABOVE - NO ACCESS I N J = LL LL ROOF BEAM _. ..... _ , o o I O ATTACHED TO . . `, EXIST T ROOF BEAM ATT4 CHED TO O L •S STRUCTURE 1 O N J p I n EXIST.STRUCTURE W I i 0 Q _ ._.._ ....-.._ ...-.., w I w 4'-0' DOOR TO ATTACHED TO Lu LJ m EXIST. COVERED AREA FOR UTILITY RM. m o z p l ¢ NEW UTILITY RM. STRUCTURE p X "' o WALK-IN COOLER UN O z ._.. ..._. ......_ .......... _. _ ._ -.... ...... .... o Q F-- w N x 0_ N STORAGE ROOM ¢ o p O W J A TACHED TO a EXIST. _ STRUCTURE o Oz D x� O+� � RE-BUILD DECK TO MATCH EXIST. ala TYP. - VL7EDGER 11 3'-0"x3'-6" 3'-0"x3'-6" 7'-104" 7'-104" SLID. WIND. TION 1s'-o•• � 16'-0" ` NORTH ELEVATION REV. 10.7. 16 SECTION #2 3 3 (3> REV. 10.7.16 FOUNDATION FRAMING PLAN FIRST FLOOR PLAN SECOND FLOOR PLAN REV. 10.7. 16 REV. 10.7.16 REV. 10.7.16 ORIENT BY THE SEA 40200 MAIN RD. ORIENT N.Y. EXISTING: MARINA/RESTAURANT SCTM# 1000-15-09-08 ZONE M- 11 PROPOSED: REMOVE EXIST. 16.3 X 10.4 STORAGE SHED. RELOCATE EXIST. PORTABLE WALK-IN COOLER. - CONSTRUCT NEW 16'-0" X 16'-0" ACCESSORY STORAGE SHED & 4'-0" X 10'-0" UTILITY SHED. _.._.._.-.._..__._....._ _---------..___._-_.... 1ST FL. STORAGE SHED - 256 SQ.FT. 2ND FL. STORAGE SHED - 320 SQ.FT. DECORATIVE DECORATIVE UTILITY SHED - 40 SQ.FT. CUPOLA CUPOLA NO ACCESS NO ACCESS DECORATIVE GENERAL NOTES b CUPOLA I NO ACCESS 1. All work shall conform to the requirements of the Residental Code of New York f State, County and Town Department Regulations, Utility Company requirements and -...:..:.......... ..._:....:..::..::.-:_ - _........... __............-, best trade practises. ___--- 2 Before commencing work the Contractor shall file all documents required by the ' Building Department, pay all fees required by local agencies and obtain all required _ permits. TheContractor h I ' sal visit the siten verify ad erl all dimensions ............. .............._......_...._._. ._......... _... ................._......._.-..._.._............ .._..... ........ _ _ -- -- - prior .......................... ........... .. . . tion. Any discrepancies which n0erferen wi hf the sat sfactory ompletet on tofcthe work described herein shall be Id k until such conditions reported o the architect or property owner. Do not start work _- _..................... .. .....___. _....................... . been examined n - .:.. e owner orxarchtectaof unsatsrfactoryaconditions uwil berconstrued as anuracceptance a th of the conditions to properly perform the required work 4. All work is to conform to the drawings and specifications of the architect and engineer consultants. 5. The Contractor is to maintain a complete and up to date set of plans on the job site at all times 6. The drawings are not to be scaled under any circumstances. 7. It shall be the Contractor's responsibility to ascertain all prevailing procedures including storage and toilet facilities,protect ion of existing work to remain,access to work area, hours of permitted work,availability of water and electric power and all other conditions and restrictions for this particular location in order to execute the 1 It P9 l t - _ ___ _ _ work in a careful and orderly manner with the least possible disturbance to the public. S. The Contractor shall make the neccesary arrangements to utilities and services performing the work as required. - - -. -, temporarilydisconnected while 9. The Contractor shall provide all dimensions and cut-outs for other trades. 10. The Contractor shall provide proper shoring and bracing for all remaining structure prior to removal of existing structure. 11. Plumbing, electrical, HVAC and similar work shall be performed by licensed __...__._..........._-..._.... persons who shall arrange for and obtain all required inspections.The General Po - -- --- �" Contractor shall be responsible for scheduling all other inspections as required. 12. The Contractor is solely responsible for construction safely and shall hold the I N owner and architect harmless from litigation arising out of the Contractor's failure to provide construction safety means and methods. A-101 PLANS, SECTIONS, ELEVATIONS, NOTES A-102 SITE PLAN NEW UTILITY RM.. BEYOND AREA FOR RELOCATED ATTACHED TO WALK-IN COOLER EXIST. STRUCTURE SECTION #3 SOUTH ELEVATION SECTION # 1 EAST ELEVATION REV. 10.7.1 6 11� SECTIONS, ELEVATIONS �"'""!"�� 1 ""�� SCALE AS NOTED OCTOBER 3, 2016 unaol plat�no I � SEAL: Ir s 9lOZ l � 1�0 � A 101 1 OF 2 1 PO BOX 49 JOAN CHAMBERS SOUTHOLD NY 11971 631-294-4241 A.C. A.C. GRAVEL WOOD WALK-WAYGRAVEL WOOD A.C. A.C. WALK-WAY o 00 o RELOCATE STEPS FENCE RAIL NEW UTILITY RM. ATTACHED TO EXIST. STRUCTURE WOOD FRAMED DECK 0-8" STORAGE R000.M EQUIPMENT RM. io EXIST. STORAGE & EQUIPMENT WALK IN COOLER -- ----- ----- ---- --- EXIST. WALK IN COOLER RELOCATED EXIST.RAIL ROOF OVER - ATTACHED TO EXIST. STRUCTURE 16'-0' EXIST. DECK < C0 co EXISTING SITE LAYOUT ORIENT BY THE SEA PROPOSED SITE LAYOUT SITE PLANS- REV. 10.7.16 1 /4 11 11 - 01V 10 . 2 . 16 C, rr:7c John M Bredemeyer III, Presic �6� S�FFQ1K� Town Hall Annex Michael J Domino, Vice-Presiaem �r�o ,z �y54375 Route 25 Glenn Goldsmith h P.O Box 1179 A. Nicholas Krupski 1;51 Southold, NY 11971 Charles J. Sanders 4, Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 1/ Date/Time: � Completed in field by: �� Joan Chambers on behalf of MGH ENTERPRISES, INC., c/o ROBERT HAAS requests an Administrative Permit to remove the existing shed; relocate the existing portable walk-in cooler; remove 532sq.ft. of wood decking; install helical piles and grade beams to support a new 16'x16' two- story accessory building and new 10'x4' utility shed. Located: 40200 Route 25, Orient. SCTM# 1000-15-9-8.1 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 4 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 I 7. Placement of C&D material: 100 feet 0 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 l✓ Ch. 111 SEQRA Type: 1 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: '��06"A'I v--e- Present were: Zi. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders Other Page 1 of 2 John M. Bredemeyer III, Presii_ ' oe Town Hall Annex Michael J. Domino, Vice-Presiae"ni yam, 54375 Route 25 Glenn Goldsmith y = P.O. Box 1179 A. Nicholas Krupski o Southold, NY 11971 Charles J. Sanders 'yqj o� Telephone (631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: Joan Chambers on behalf of MGH ENTERPRISES, INC., c/o ROBERT HAAS requests an Administrative Permit to remove the existing shed; relocate the existing portable walk-in cooler; remove 532sq.ft. of wood decking; install helical piles and grade beams to support a new 16'x16' two- story accessory building and new 10'x4' utility shed. Located: 40200 Route 25, Orient. SCTM# 1000-15-9-8.1 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 WALK IN .� ' 'e ` ► � t . w4 �, ,rr - i ORIENT BY THE SEA BOB HAASE LOOKING NORTH 9.23.16 AV SHE ERE ORIENT BY THE SEA/ BOB HAA E, LOOKING NORTH WEST 9.23.1616 X 16 ORIENT BY THE SEA BOB HAASE LOOKING SOUTH-WESTPORA I 9.23.16 N SHED RESTAURANTO CHANGES 1 1.01 Avowri 1, f �s + ' 6 .,, - 'LNC' �... .+��'• �� .. r AO s � a a 1 1 OFFICE LOCATION: S®Ur�®� MAILING ADDRESS: Town Hall Annex ®IL P.O.Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) CA Southold, NY 11971 �� Telephone: 631 765-1938 ® Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM x TOWN OF SOUTHOLD MEMORANDUM To: John Bredemeyer, President Town of Southold Board of Trustees l From: Mark Terry, LWRP Coordinator Date: October 11, 2016 Re: LWRP Coastal Consistency Review for MGH ENTERPRISES, INC., c/o ROBERT HAAS SCTM# 1000-15-9-8.1 Joan Chambers on behalf of MGH ENTERPRISES, INC., c/o ROBERT HAAS requests an Administrative Permit to remove the existing shed; relocate the existing portable walk-in cooler; remove 532sq.ft. of wood decking; install helical piles and grade beams to support a new 16'x16' two-story accessory building and new 10'x4' utility shed. Located: 40200 Route 25, Orient. SCTM# 1000-15-9-8.1 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 action is CONSISTENT with the below listed Policy Standards and therefore is CONSISTENT with the LWRP provided. 1. The location and construction comply with FEMA flood zone regulations to further Policy 4. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. John M_ Bredemeyer 111, Pres',. -It ��J�3r JU(/T�D ` Town Hall Annex Michael J. Domino, Vice-Pres, O l 54375 Main Road P O. Box 1179 James F King,Trustee Southold, New York 11971-0959 Dave Bergen, Trustee G 2 Charles J_Sanders, `Trustee Telephone(631) 765-1892 lyC,oU '�t� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD To: Southold Towri Building Department Re: Verification of Building Department Permit Requirements SCTM#: 15- q— 7' 1 MG-4 ��r�P�R,Is�S 1nl CKO�Y*ASE- 0AIEWF B Property Owner Name: C Date Sent to Bldg. Dept.: The Office o he Board of Trustees is forwarding the above referenced application for verificatio of the Building Department's permitting requirements stated below: YES NO ill th roposed project require a Building Permit? VV the proposed project require a variance determination from e Zoning Board of Appeals? Will any part of this application be considered as Demolition as described under Town Code? COMMENTS: 0 Signature or Rev ewer Date P"�` ,'7' S JOAN CHAMBERS , • r�. ?� PO BOX 49 SOUTHOLD NY 11971 joanchambersl0@gmaii.com '`". 631-294-4241 Southold Town Trustees October 7, 2016 Re: Bod Haase Orient By The Sea PO Box 333 Main Rd. Orient At the request of the Southold Building Department I have made some revisions to the plans for the storage shed addition at Orient By The Sea Restaurant at 40200 Main Rd. Orient. These revisions include attaching the storage building to the existing structure and noting that the cupola is decorative and not accessable. Thank-you, E � E G oan Chambers Q OCT ® 72016 Southold Town Board of Trustees John M. Bredemeyer III, President so Town Hall Annex Michael J.Domino Vice-President O 54375 Route 25 ' P.O.Box 1179 Glenn Goldsmith coo Southold,New York 11971 A.Nicholas Krupski ® ,OQ Telephone(63,1)765-1892 Charles J. Sanders ��' � Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD ` J LOS Office Use Only 4 _ OCT � 2016 ' Coastal Erosion Permit Applicatio,} 4 a _Wetland Permit Application pf Administrative Permit Amendment/Tra s er /xtension Received Appligation: 4 � f Tr ' Received Fee:$ Completed Application _Incomplete _SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) 74 W Consistency Assessment Form CAC Referral Sent: Date of Inspection: 0-11 _Receipt of CAC Report: _Lead Agency Determination: Technical Review: Public Hearing Held: Resolution: Name of Property Owner(s) $G—RF,-c SE 40eyEDOT 13`f Tlfte SES Address T-0- 160>c 25 R(GN T Phone Number:( ) (p 3 "" 3 23 - 2-o,41-2,4- Suffolk -o,41-2, -Suffolk County Tax Map Number: 1000 - 1 Jr-'� 0 8a 1 Property Location: 4 C? 2tw0 q M A-!!J (provide LILCO Pole#, distance to cross streets, and location) I AGENT: up A03 C�T�3 (If applicable) Address: W) 80X �sD0-k*tbLo Phone: (o r 1 _ aard of Trustees Applicatil" GENERAL DATA Land Area(in square feet): A-GR,f5S 2dC9 -S-7 6 , ` Area Zoning: Previous use of property: MCr("Ncz Intended use of property: PAc.L-r �wcL Covenants and Restrictions on property? Yes v✓ No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? L,-`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 p/ 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? t✓Yes No Prior permits/approvals for site improvements: Agency Date NJ 6C. —LO-Crrn. o F NDS ,JUg%SPLCMO,, t -- �E6 8� Zoo p S OL�CML o I-F OsT43Fs — 4t-5(7857— TA-N • 22, 2oa 3 SOUT' t lo Tf�-�s't 88 �j 2� LRR3 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): RECY kf6 C-,yqC : SSU. ket-OCA-11a; TDRTA-SL;6 tJ/`ft.aL tN COOLeg • F,0-0-%O E X32 tb D� wo• peck. . �NsT� (-��-L c,�L PGc.Es �2�� ZEMnS' 70 S LJ EPO RT N EyA-J l b��l log ACCESS'O Cz`f ^7'7 11� �'�!�_ �dr�j-i•>'�n�, �y f�1�4�'?J � `71�o� �-�-}J- 4 v �3�rU,i d, 3{-11_ CY •�r� I �O 1 z1A =IQQ=A 1 N0 �'7ta/LZ. Id. �-> > n •ate •s �'�-y dgsoao�a. 4* :(ajvudo iddv 3i sluauiiioullu asn) suoiju iado pasodo id Bons jo uosva i Xq ljnsaz X ui jugj umol agj jo s iowm Iupp pur spuL1i1am agj uo `XuL'ji `103ga agj Jo juauiajqS can 0 tUSD� -�V G2 N (::),g Qct 1a :palisodap jo panouiaJ oq Iiim iuualuuz go?gm ui.iauuL'w . (y :suoilarado jo gait, agj jnog2no-i j adois pasodoid 103J N :palisodap.To panouia.z aq Iiim Iuuapui goigm jo gjdaQ spy oigno Lpollg oq Iiim IuuaWluz gonui moH spiu.0 oigno N LpaTuAuoxa aq Iiim pualuui gonm mog`soK jI sa,k ON L2utiiU.io uoi4BAL'oxa anjonui joafoid agj sooQ QL —,/4 lo2� Ixg :sputi�am�o a�pa puvidn puL,ainjoiu4s pasodo id isamm uaamlaq aouulsip IsasoiD ��✓a aL � 10c 1aaj :spuLilampa�pa puridn put,oimoruls Suilsixa isareau uaamlaq aouvisip 180sOID % . :IOI JO 32Man00 Juaoiad S3�� • )•.b 3 O '+90j QjuasS�� :101 uo spuL'iIam Jo L,a id 2j0SSgDV-d 1S)xg gnavu_q-a 4 L :suoi��jodo pasodoid agl jo asodmd V,LVQ KOILVDI'Iddv SQIv`I Ha,LSf1HHL/QIv"IZgAA -',TIVOTTddy saegsn3:s go patc " 61Z20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part I -Project and Sponsor Information tE-t- 01 . SO t3 VVkA7T Name of Action or Project: Project Location(describe,and attach a location map): Ab20o ink 0 Brief Description of Proposed Action: gjE�rYI.OIJe� oKkST. ELoc {FO R_-M BLE� V)A-L,K - f A3-- C Oo LAag , JZ6yY\av G 53Z o F w p . be�-cK- . 09T-N" A-t�__U CAL- F t OE-S' & G 5"t ms '%-D So F?o 9--t New ,fie c e�-sso?.Y S 6-eo 4 &JL'W t o '-o Name of Applicant or Sponsor: Telephone: !'031-2AA-42,941 Ct s E-Mail: ' v0 OWicffic (Y1 X4. lavm Address: F-o Of City/PO: State: Zip Code: S0VTML-o N l t°t "7( IBJ,-( I tcq-7(° 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 �° F 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 andermit or approval: ❑ 3.a.Total acreage of the site of the proposed action? .4,b acres b.Total acreage to be physically disturbed? , Q ( acres ( '450 sq• 'el)• 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 Mural(non-agriculture) ' ❑Industrial Commercial KResidential(suburban) ❑Forest ❑Agriculture El Aquatic ❑Other(specify): (Y1A-6- (N A ❑Parkland Pagel 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? Z ❑ 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: 9 ❑ 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? ❑ 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: El Fv1 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ f�i 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ Ff 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? [0 ❑ b.Is the proposed action located in an archeological sensitive area? 9 ❑ 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: 0Shoreline ❑Forest KAgricultural/grasslands ❑Early mid-successional Wetland ❑Urban 01,S'uburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ❑ 16.Is the project site located in the 100 year flood plain? NO YES -F- 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES 1f Yes, ❑ a.Will storm water discharges flow to adjacent properties? [!I/NO DYES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO YES �xcsr• G-V Ry s Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g-retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: ® ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: J o C�— ��u Date: 1)GTa(367VJ 2b((6 Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning [1 ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? [1 ❑ 3. Will the proposed action impair the character or quality of the existing community? n 4. Will the proposed action have an impact on the environmental characteristics that caused the El ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or F] ❑ 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? FJ El 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, ❑ Elwaterbodies,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 1:1 ❑ 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. EICheck 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. FJCheck 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 of Trustees Applicata'___ AFFIDAVIT 4'm_g,Se_ 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. 4_0'� Signature of I�ro'perly Owner SWORN TO BEFORE ME THIS S4_ DAY OF 20� otary Public Pab1c,$w%of NW Yvk 0 S -rim, ry ' has xv (91 �� 1 jard of Trustees Applicati- AUTHORIZATION (where the applicant is not the owner) I, �b6e4 t cqq-- residing at ®,13C:pC. 3®_3 ® i eN `WY L 9 6-7 (print name of owner of property) (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) APPLICANUAGENUREPRESEN TATIVE TRANSACTIONAL DISCL®SURF FORM, The ON n of Souold}s�Cliklxihit�dortflicts of inter�st'on the u t 't awjt ofEcer rsttt i mpl spur aoq e o , t irLtt ra'to p !ideifrrnrorerltich can alert the Cn�vn oCnosthtd cortfticts of intetcs�art (1 wctt tc�tako►yhgv `t�is necessary to avoidsame, YOURNAME, 00 2emitial, (Last name,=firstname,qi ddunless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance _ Building Variance Trustee ._._ 6 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 ,rnarriage,or business'inteiest,4"BUsiness interest"means a'business, including a partnership,in which the town officer or employee has even a partial,owitcrsli'ip 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); TB)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of Ocm- 0 U Signature t Print Name Form TS l APPLICANT/AGENT/REPRESENTATM 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. YOUR NAME,: (Last name,first name,Viddle 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 �C Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"OtheC',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 1� 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. r DESCRIPTION OF RELATIONSHIP Submitted thV 200 Addaof Signature 3 Print Name g6ber 4 Form TS l J Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this, CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A posed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Townm 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# 1000 _ ( S _ 0 Q PROJECT NAME �SE14- The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board LJ Building Dept. Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation, land transaction) ❑ (b) Financial,assistance (e.g. grant,loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: ---Af?L• -b Ts10VE 5`LWAG 7S*-5D it (Z�CA-m Fz)jzT4'5LC- vvA-L4,--lN -coocae- ani uAcl- sir5e of pi,-a-T?weArJT t o R . 2;r,Ups' 53 2-a7 of w t>. V>C Cr-- . I t,-1 9rA-LL- •t-�u��—P t c.ES � Gf2->t�l✓- ��rns" � 5c��PdR-c p�s�vv • f-4-C-D I Location of action: 4-012-00 IM A(AJ {Z T, . O K l EiVT. Site acreage: CO kc PE S. Present land use: rAA P4A g( NAA Present zoning classification: Im ( 1 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: C DR(ek-n- EN rKe SeA) (a) Name of applicant: T O&J rt-�e az& F-Dek– 3Qe f AA $ t.-(c(b) Mailing address: 0 X' A-1 S D U-MOUO –7t.- (c) ) Telephone number: Area Code( } 31 - ZeK ~ 4 Z* (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ NoX 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. Kyes ❑ No ❑ Not Applicable J IL--T f(\J L-O CATi 0r'-) OF 6�e(5 . (St{e�p -to M(r J(m(2E t M.P9-C't (!-) COO-V7yc,'TL UJ — N o W O&tL Ont 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 0 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 nom, w i C-,L V ( V'T' A KE-& Q F� 'C—rb fZA0r4'- Z3!N,:]M0—sem c) z)g=6yY1& w t tet... 13!v m f AJ c nI6S I rr�P/�c X— 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 prYes ❑ No ❑ Not Applicable U-P--bU Stir—,—O W (L.i, Oe- BU l t.T 00 AcRV,=7-A V(ham --A-03 CJ K2er YCV [w ? t CE Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ZYes ❑ No ❑Not Applicable I t( 1)0 PLL)M 6(AJ G— D (� Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies;.Pages 22 through 32 for evaluation criteria. Yes No Not Ap�,,(-able - u1 d� -xcs i — m8 AJ 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 KNot Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No KNot 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❑ NoNot Applicable Attach additional sheets if necessary -WORKING COAST POLICIE6_1 `' 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 0 Not Applicable USS lS UK CST Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No Not Applicable PC) [ rA 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 1SA1 Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable f� PREPARED BY TITLE DATE ��