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TR-8928A
Michael J.Domino,President �*0f SyO Town Hall Annex John M.Bredemeyer III,Vice-President h0 lQ 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Q Telephone (631) 765-1892 Greg WilliamsUNTI, O Fax(631) 765-6641 � �� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1478C Date: June 4, 2018 THIS CERTIFIES that the construction of a 9.5'x9.7' one-story bath addition;proposed 1.7'x5.2' expansion and reconstruction of existing 5.1'x5.2' front porch, construct a 3.5'x4.5' in- fill to existing 3.5'x10.3' rear entry porch; reconstruct and expand existing 12.1'x10.3' on-grade hot tub deck by expanding it by an additional 15'x12.3' raise the elevation to meet existing seaward deck and center existing 7.3'x7.3' hot tub on deck; new deck to connect to existing 12 1'x15 8' seaward deck to be reconstructed as necessary and for 200 linear feet of garden fence At 186 Willow Terrace Lane, Orient Suffolk County Tax Map #1000-26-2-4.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated November 21, 2016 pursuant to which Trustees Administrative Permit#8928A Dated December 14, 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 9.5'x9.7' one-story bath addition; proposed 1.7'x5.2' expansion and reconstruction of existing 5.1'x5.2' front porch; construct a 3.5'x4.5' in-fill to existing 3.5'x10.3' rear entry porch; reconstruct and expand existing 12.1'x10.3' on-grade hot tub deck by expanding it by an additional 15'x12.3' raise the elevation to meet existing seaward deck and center existing 7.3'x7.3' hot tub on deck; new deck to connect to existing 12.1'x15.8' seaward deck to be reconstructed as necessary and for 200 linear feet of garden fence. The certificate is issued to Susan Holden owner of the aforesaid property. Authorized Signature Michael J.Domino,President *OF SO!/j�o Town Hall Annex 54375 Route 25 John M.Bredemeyer III,Vice-President h0 l0 P.O.Box 1179 Glenn Goldsmith Southold, New York 11971 CC A. Nicholas Krupski • Q Telephone (631) 765-1892 Greg WilliamsO Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 1 50110, 9'. Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction % constructed Project complete, compliance inspection. p p p INSPECTED BY: COMMENTS: e A eer q s ans. �o U1�� ,i e- �b 4 vle 7 � � er 9 a - A CERTIFICATE OF COMPLIANCE: Oe-5 VN I� DUB I� e c S o;- � T"b t- � r`s tip �v✓l '� !'ft 2,7 kO SSC' DiSalvo, Diane From: Gary Steinfeld <gary@westcreekbuilders.com> Sent: Thursday, May 31, 2018 2:42 PM To: DiSalvo, Diane Cc: gary@westcreekbuilders.com Subject: 186 Willow Terrace Attachments: 2016-Caldera-Paradise-Makena-Specs.pdf Hi Dianne As per your request, I am writing to confirm that the relocated hot tub at 186 Willow Terrace Lane, Orient (Holden Residence) is a portable and fully self contained spa. It is a Makena model manufactured by Caldera Spas; see attached specification sheet. All wiring connections are made via Hubbell Marine weatherproof cable set with twist-lock plug/disconnects. There are no permanent water or electrical connections. Please let me know that you have received this email and If you have any additional questions. Thanks Gary Steinfeld West Creek Builders WEST CREEK PLAN I DESIGN I BUILD 631.734.8416 1 Y' Jrry 7« 7, DP IS 7'' g 'x'�'.�! OnR MA 'K'f' ENA@ 4, i'i 01 Maken&shown with White Pearl shell& Espresso cabinet Makena shown in White Pearl shell DIMENSIONS STYLE ENHANCEMENTS Seating Capacity 6 adults LCD Controls Adventg LCD Control System Dimensions 7'5"x 7511 x 36"/226 cm x 226 cm x 91 cm Lighting SpaGlo8 LED Lighting with 12 Points-of-Interior Light Water Capacity 395 gallons/1,500 liters Water Feature (1)Acquarella Waterfall with LED lighting Weight Dry:1,020 Ibis,/465 kg;Filled*:5,365 lbs. 2,445 kg Music-ready (4)Speakers(Optional) Insulating Cover 3.5"to 2,5"tapered,2 lb.-density foam core PERFORMANCE FEATURES Cover Lifter Options Prol-ift",Prol-Ift"11,Prol-Ift"111,or ProLiftO IV Jets 46Jets: Step Options EcoTech'or Polymer Step in Espresso,Coastal Gray,Teak 37 Euro 6 VersaSsageO,' COLORS 2 AdaptaFlo" 1 EuphorlaO Cover Chestnut,Ash,Caramel Pumps 2 ReliaFloO Pumps, Spa Shell White Pearl,Desert,Midnight Canyon,Tuscan Sun,Sterling Marble 1 Dual-Speed 2,5HP(5,2 BHP*') EcoTech®Cabinet Espresso,Coastal Gray,Teak 1 Single-Speed 2,5HP(5.2 BHP*') Heater EnergyProO Heater(4,000 Watts) Electrical 230V/50 amp Energy Efficiency Fully-insulated with FiberCor"material,2 lb.density, CEC-compliant WATER CARE Filtration 75 sq.ft,filter Water Care System Spa Frog"In-line Bromine System(Cartridge-ready) Ozone System Monarch"CD Ozone(Optional) 6 weight i9cludes the weight of the occupants assuming an average weightofl751bs C), ,f Cadde-.,raSpas- **Brake Horsepower(BHP)Is the horsepower a pump motor achieves for a brief period upon start-up wwwcalderaspas,com John M.Bredemeyer III, President ��o� S0ujyo Town Hall Annex Michael J.Domino,Vice-President '`� l0 54375 Route 25 P.O. Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski ® Telephone(631) 765-1892 Charles J.SandersNT`IFax(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/silt boom/silt curtain 1 st day of construction '/2 constructed Project complete, compliance inspection l I John M.Bredemeyer III,President ��,QF ljy0 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 Q ® O Telephone(631) 765-1892 Charles J.SandersO Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8928A Date of Receipt of Application: November 21, 2016 Applicant: Susan Holden SCTM#: 1000-26-2-4.1 Project Location: 186 Willow Terrace Lane, Orient Date of ResolutionlIssuance: December 14, 2016 Date of Expiration: December 14, 2018 Reviewed by:.•John M. Bredemeyer, III, President 7 9 Project Description: To construct a 9.5'x9.7' one-story bath addition; proposed, 1.7'x5.2' expansion and reconstruction of existing 5.1'x5.2' front porch; construct-, , a 3:5'x4.5' in-fill to existing 3.5'x10.3' rear entry porch; reconstruct and expand..-, . existing 12.1'x10.3' on-grade hot tub deck by expanding it by an additional 15'x12.3', raise the elevation to meet existing seaward deck and center existing 7.3'x7.3' hot tub on deck; new deck to connect to existing 12.1'x15.8' seaward deck to be reconstructed as necess8irriand,,for`200,ilinear feet of garden fence. 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 revised site plan prepared by West Creek Builders, LLC, dated December 27, 2016, and stamped approved on January 5, 2017. Special Conditions: Installation of a drywell if hot tub is to be permanent. 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 John M. Bredemeyer III,President �*®f S® yo Town Hall Annex Michael J.Domino,Vice-President '`� l0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith isp JW Southold,New York 11971 A.Nicholas Krupski G ® Telephone(631) 765-1892 Charles J.Sanders �O Fax(631) 765-6641 �yCouNr�,��' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: SOSO IW%d V0 Please be advised that your application dated kv 21 2-01Gr has been reviewed by this Board at the regular meeting of At Zof(I and your application has been approved pending the completion of the following items check d off below. Revised Plans for ro osed project pR��/�� �- 1�7_7)b P p Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1 st Day of Construction ($50.00) '/2 Constructed ($50.00) Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) The Permittee is required to provide evidence that the non-turf buffer condition of the Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety(90)calendar days of issuance of this permit Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ ® E BY: John M. Bredemeyer III, President Board of Trustees LOCATION MAP APPROVED BY �o •1avV'�- i _ PROPOSED PROJECT: BOARD-OF. TRUSTEES 1 - 9.5' X 9.7' BATH ADDITION (92SF) ORIENT, NY TOWN'0 :SQUTHOL _ 2 - 1.7' X 5.2' FRONT ENTRY PORCH EXPANSION i Ktn9St y -.I DATE SAJV9,� _ S ZoJ7 ,i N 3 - 4.5, X 3.5, REAR ENTRY PORCH IN-FILL L ` Kin9 t j) 4 - 200 LF 6' HIGH GARDEN FENCE 5 - 12.3' X 15' REAR DECK EXPANSION PRO SED DECK N o'27� EXPANSION(12.3'X 15') PROVIDEDRYWELL IF HOT TUB Q IS PERMANENTLY R1 INSTALLED ry _ SITEINC,ON•G DE DECK , E �(!! �t�l+ ���- ` 1 O ��,I j II D OT TUB OBE DW I PROPOSED ' E it L� `E d Z 123' OT 1 °BELE D FENCE PNG MEAN HIGH WATER(MHW) �, O �y/� AND TTACH DTO IT Ch t1 EXIS INC ST UGTURE ; Ini - AUGUST 1,2013 6:56AM�1 o n �illil� (� JAN 5 217ID kENNETH M WOYCHUK LAND 5URVEYING, PLLG �` O 121' 16 1' a' i kENNETH WOYGHUGK Z � � /q5 PROPOSED 9.5'X9.'1' WEST REEK ? Z f DECK 158' Southold Town ! cv o p �1 PORTRRH 5.2 ADDITION(92 SF)ON BLOCK FOUNDATION ���✓✓✓ v Board ofTrustees _J o m ,,,, 17, DESIGN BUILD I REMODEL 4 PROPOSED ENTRY PORCH �1 PROPO ED REAR Z I / EXPANSION(1 7' : 5.2') 1 PORCH IN-FILL .5'X 4.5') j °� EXISTING 142' DRAWINGS: x 1 STY FRM �' 7a I PROPOSED FENCE PARKING West Creek Builders,LLC SUFFOLK COUNTY TAX MAP #1000-26-2-4.1 10 HOUSE ON GRASS 'E:� 200 LIN. FT PO Box 256 OUTDOOR qLU ADDRESS: 186 WILLOW TERRACE LANE, ORIENT, NY 11957 0 301' FFL EL 7.5' SHOWER inNew Suffolk, NY 11956 OWNER: SUSAN HOLDEN 1 Ci o- T 631.734.8416 Cp 24 2' 66 9' SITE AREA: 13,719 SF �` REVISIONS/ISSUE 110116 LOT COVERAGE (UPLAND): 1355 SF = 14% EXISTING 12.2716 1472 SF = 16% PROPOSED 0t` m 372 RELOGA E 0 Q� py EXISTING BUILDING FOOTPRINT: 1224 SF EXISTIN SHED I oro' S EXI5TING ETBAG 5: PROPOSED ADDITIONS: 300 SF (24.5%) SANITARY 83` 35FRON YARD PROJECT (INCL. PORCH EXPANSIONS) 129.48 5SIDE Y RD 576° 747N SHE ;83' Holden Residence 212' 186 Willow Terrace Ln ZONING: R40 PROPOSED BITE PLAN Orient, NY FLOOD ZONE:, AE (EL6) SCALE: 1" = 20' COASTAL EROSION AREA DRAWING TOTAL COASTAL EROSION AREA: 4246 SF EXISTING FRAME HOUSE Site Plan UPLAND AREA: 9473 SF / PROJECT NORTH PROPOBED ADDITIONS - EXISTING COVERAGE BY IMPERVIOUS STRUCTURES: 1355 SF = 14% — PROPOSED FENCE S PROPOSED COVERAGE BY IMPERVIOUS STRUCTURES: 1656 SF = 17.5% LOCATION MAP PROPOSED PROJECT: 1 - 9.5' X 9.7' BATH ADDITION (92SF) ORIENT, NY 2 - 1.7' X 5.2' FRONT ENTRY PORCH EXPANSION K�asp 3 - 4.5' X 3.5' REAR ENTRY PORCH IN-FILL a 4 - 200 LF 6' HIGH GARDEN FENCE N v 1 5 - 12.3' X 15' REAR DECK EXPANSION D ECEIVE ~ 155.1 'Oyo PRO SED DECK N 0°27E 03 EXPANSION(12.5'X 15') NOV 2 1 2016 - r O rn O 115, 1 h SITE 1 // ����� EXISTING ON-G DE DELK� Southold Town 1 a z / Y✓l i END oT�Tus o 9E vw PROPOSED V\.\010'2 T ATE MEAN HIGWATER ATER(MHW) G p 123 AND TTALH To FENCE AU&U5T 1,2013 6:56AM�1 0 %llil�/ EXIS ING5T UGTURE ' ' kENNETH M WOYGHUK LAND SURVEYIN6, PLLG O 121' 161, kENNETH WOYGHUGK Z � 1DECK 15 8' PROPOSED 9.5'X 9.7' WEST CREEK r0NTTRY 52 ADDITION(92 5F)ON BLOCK FOUNDATION DESIGN BUILD I REMODEL '0 O 4 j PROPOSED ENT Y PORCH O �1 PROPO ED REAR z / EXPANSION(1.1 5.2') CDI 2 1 PORCH IN-FILL 5'X 4.51) � . A EXISTING 142' PARKING DRAWINGS 1 z 1 5TY FRM PROPOSED FENGE West Creek Builders,LLC SUFFOLK COUNTY TAX MAP #1000-26-2-4.1 d�L HOUSE ON GRASS Z 301' FFL EL l.5' ouT000R 200 LIN. FT PO Box 256 ADDRESS: 186 WILLOW TERRACE LANE, ORIENT, NY 11957 p SHOWER New Suffolk, NY 11956 ° T 631.734.8416 OWNER: SUSAN HOLDEN 1 3 24 2' 66 9' N SITE AREA: 13,719 SF REVISIONS/ISSUE- 1101.16 LOT COVERAGE (UPLAND): 1355 SF = 14% EXISTING t` 1472 SF = 16% PROPOSED ,�pn 372' RELOGA E EXISTING BUILDING FOOTPRINT: 1224 SF oTo EX15TINO SHED EXISTING SETBACKS: ° SANITARY 83 35'FROM YARD PROPOSED ADDITIONS: 300 SF (24.5%) _, PROJECT: '� 5'SIDE Y (INCL. PORCH EXPANSIONS) 129.48' RD5 76° 14y� SHE ;e3' Holden Residence ZONING: R40 z,2' 186 Willow Terrace Ln PROPOSED BITE PLAN Orient, NY FLOOD ZONE: AE (EL6) SCALE: 1" = 20' COASTAL EROSION AREA DRAWING: TOTAL COASTAL EROSION AREA: 4246 SF EXI5TING FRAME HOUSE Site Plan UPLAND AREA: 9473 SF / PROJECT NORTH PROPOBED ADDITIONS EXISTING COVERAGE BY IMPERVIOUS STRUCTURES: 1355 SF = 14% — PROP05ED FENCE PROPOSED COVERAGE BY IMPERVIOUS STRUCTURES: 1656 SF = 17.5% C lot 30.3' 15.q' nil, NOV 2 1 2016 I FILL IN EXI5TIN6 6 Co;'hf;IC T;Urn ` 17.5' DECK AND STEP + DBaan{of Tr.; +E_As_ _1 WRAP-AROUND STEP SQUARE FOOTAGE DECK /4.5: // ADDITION 92 SF Ci 14.4' DECK r 0 141' DEN LIVING/DINING 13.7' ROOM WEST CREEK DESIGN � BUILD � REMODEL MASTER `14 BEDROOM ui DRAWINGS: 6 West Creek Builders,LLC G%iGTNG � PO Box 256 10- 0 New Suffolk, NY 11956 r EP O O o T 631.734.8416 BEDROOM � BATH _ KITCHEN + NEW CABINETS&COUN R DETAIL5T5D q.4' REVISIONS/ISSUE. E 11.01.16 • q' o Dyq ______ ___668__ Ik w o z I ENTRY "J oi1 '- STORAGE C6 PORCH Ui I BAtTH 'Ln _` PROJECT Holden Residence 14.2' D N 186 Willow Terrace Ln Orient, NY ER (() RECONFIGURE&EXPAND SNow EXI5TING ENTRY PORGI-I (1'-8 1/2"WIDER) - " - DRAWING: Proposed Addition 30.3' 15A, PROPOSED BATHROOM ADDITION PROJECT NORTH PROPOSED q'-b"x q'-8" AZ SCALE: 3/16" = 1'-0" BATHROOM ADDITION q2 5F • �c P NOV 2 2016 ]BEE ❑ F Ell ® ❑ ❑ ❑ LZ EAST ELEVATION NORTH ELEVATION SCALE: 1/8" = 1'-0" SCALE: 1/8" = 1'-0" PROPO ED 9'-6" X 9' 8" BATHR OM ADDITIO 92 SF WEST CREEK DESIGN I BUILD I REMODEL DRAWINGS West Creek Builders,LLC PO Box 256 New Suffolk, NY 11956 T 631.734.8416 ® REVISIONS/ISSUE El11 01 16 PROJECT Holden Residence 186 Willow Terrace Ln Orient, NY EASTERN PERSPECTIVE NORTHERN PERSPECTIVE N.T.S. N.T.S. DRAWING: Elevations Perspectives PROPOSED 9'-6" X 9'-8" BATHROOM ADDITION 92 SF A3 '} LOCATION MAP PROPOSED PROJECT: 1 - 9.5' X 9.7' BATH ADDITION (92SF) j ORIENT, NY 2 - 1.7' X 5.2' FRONT ENTRY PORCH EXPANSION 3 - 4.5' X 3.5' REAR ENTRY PORCH IN-FILL IL ' 4 - 200 LF 6' HIGH GARDEN FENCE ` 1 ECEIVE 5 - 12.3' X 15' REAR DECK EXPANSION p yp PRO SEDDEGK N 0. NOV 2 1 2016 Tp EXPANSION 12.5'X 15') in SITE 15 ry - Southold Tawn EXISTING ON-G DE DECK," 0 / AND OT TUB OBE i DW `i PROP05ED `, .�02 Q O 12 3'/ ��AN D 7-FE . P c`� MEAN HIGH WATER(MHW) �, J" � AND TTAGH DTO NCE _ m t1 / EXI5 ING ST UGTURE AUGUST 1,2013 6:56AM�1 0 ilii/, 121' 161, kENNETH M OYGHUK LAND SURVEYING,PLL, kENNETH WOYGHUGK W r DECK 15 8' / PROP05ED 9.5'X 9.7' WEST CREEK ° ENTRY 52' ADDITION 02 5F)ON BLOCK FOUNDATION o 0 -A PORCH DESIGN I BUILD REMODEL C) PROP05ED ENTRY PORCH �1 4 PROPO ED REAR EXPAN51ON(1.7' ; 5.2') 1 PORCH IN-FILL HX 4.51 EXISTING 142, DRAWINGS X 1 STY FRM PARKING r 7a I PROP05ED FENCE West Creek Builders,LLC SUFFOLK COUNTY TAX MAP #1000-26-2-4.1 w d� ON GRASS Z L 301' FFLOEL57 5' OUTDOOR 200 LIN.FT PO Box 256 ADDRESS: 186 WILLOW TERRACE LANE, ORIENT, NY 11957 rn 5HOYVER in fn New Suffolk, NY 11956 OWNER: SUSAN HOLDEN N T 631.734.8416 1 24 2' 66"9' SITE AREA: 13,719 SF Ro REVISIONS/ISSUE: 11.01.16 LOT COVERAGE (UPLAND): 1355 SF = 14% EXISTING 1472 SF = 16% PROPOSED 0� m 3i.2 RELOCATE 0 Q� py EXISTING BUILDING FOOTPRINT: 1224 SF EXISTINGSHED I oTo' SETBACKS: EXISTING PROPOSED ADDITIONS: 300 SF (24.5%) SANITARY 83, 35FRON r YARD PROJECT: (INCL. PORCH EXPANSIONS) }29.48' .' '� 5'SIDE Y RD 576° 14Y� SHE �83' Holden Residence ZONING: R40 212 186 Willow Terrace Ln PROP05ED SITE PLAN Orient, NY FLOOD ZONE: AE (EL6) SCALE: 1" - 20' COASTAL EROSION AREA DRAWING' TOTAL COASTAL EROSION AREA: 4246 SF [:] EXI5TING FRAME HOUSE Site Plan UPLAND AREA: 9473 SF PROP05ED ADDITIONS PROJECT NORTH EXISTING COVERAGE BY IMPERVIOUS STRUCTURES: 1355 SF = 14% - PROP05ED FENCE PROPOSED COVERAGE BY IMPERVIOUS STRUCTURES: 1656 SF = 17.5% 30'-31/2" 13' DN WRAP-AROUND 5TEP 101-411 `-n DECK ED C E �I V E 4 m I NOV 2 1 2016 L` � S 7/ DECK `r 14'-4 1/4" _ SQUihnld Town e i�SCk7(�of Tft� 32°S_� - r— 0 14'-S 1/4" o DEN WEST CREEK LIVING/DINING DESIGN BUILD REMODEL in ROOM 13'-13/4" N T N _ MASTER DRAWINGS BEDROOM West Creek Builders,LLC v i— _ PO Box 256 jBATHTr- PROJECT o New Suffolk, NY 11956 LAB1NET `� T 631.734.8416 Q O O O o BEDROOM KITCHEN REVISIONS/ISSUE: 11 01 16 E5 ENTRY - STORAGE PORCH Holden Residence m 186 Willow Terrace Ln Orient, NY 14-3 15'7 DRAWING 30'-3 1/2" 15'-10" Existing Cottage EXISTING COTTAGE PROJECT NORTH Al SCALE: 3/16" = 1'-O" E �I '1 NOV 2 1 2016 I i FILL IN EXI5TING R i��old Tow ;+ DECK AND 5TEP Sn-l•I�a T Town WRAP-AROUND STEP I//j / SQUARE FOOTAGE DECK 4.5/ �/� ADDITION 92 SF DECK 14.4' in r b 14.1' DEN � LIVING/DINING 13•?� ROOM WEST CREEK DESIGN I BUILD I REMODEL �! MASTER `14 BEDROOM ui DRAWINGS: West Creek Builders,LLC Ui eN'Er PO Box 256 _ 10' 0 New Suffolk, NY 11956 EF O O o �6�, T 631.734.8416 BEDROOM BATH KITCHEN Al NEW LABINET5 8 COUN R ClIF-ILST1111 q.4' REVISIONS/ISSUE: EF 11 01 16 q' w o z 6.4' ENTRY '- `y 5T0 RAG E ocv m PORCH Ln I BAtTH <Ln ` J PROJECT Holden Residence 14.2' /—ON 186 Willow Terrace Ln b ;n Orient, NY ER m RECONFIGURE&EXPAND SHOW EXISTING ENTRY PORCH :1(1'-S 1/2"WIDER) DRAWING 6.?' 9.5' Proposed Addition 30.3' 15.q' PROPOSED BATHROOM ADDITION PROJECT NORTH PROPOSED T-6"x q'-8" A2 SCALE: 3/16" = V-01" BATHROOM ADDITION 92 5F b L o _6 ° M- L Ij Fm . NOV 2 1 2016El X� I I Bc?�rc{of TTrir�e�s �^. wJ EAST ELEVATION NORTH ELEVATION SCALE: 1/8" = 1'-0" PROPO ED 9'-6" X 9' 8" SCALE: 1/8" = 1'-0" BATHR OM ADDITIO 9.2 SF WEST CREEK DESIGN i BUILD I REMODEL DRAWINGS West Creek Builders,LLC PO Box 256 New Suffolk, NY 11956 T 631.734.8416 \ REVISIONS/ISSUE ® 1101.16 — PROJECT. Holden Residence 186 Willow Terrace Ln Orient, NY EASTERN PERSPECTIVE NORTHERN PERSPECTIVE N.T.S. N.T.S. DRAWING. Elevations Perspectives PROPOSED 9'-6" X 9'-8" BATHROOM ADDITION 92 SF A3 I S.C.T.M. NO. DISTRICT: 1000 SECTION: 26 BLOCK: 2 LOT(S):4.1 KIND (1r Sal ' +l7 LANODFN/F T THOMAS do MARY z KAVAZANJUW ?0• 1.0N � v80-z;,,00 EL 6.1^ wood oZ N 155_10. PLATFORM SPA t-� 1 OF - 01 ;,I 7.4x7.4• h LAND N/F H g0 / ?7' r r r r �% = N 0 p DAMS 16.0. J �1EL 5.6 — la 19• !Q, / kp / EL 5.6 ua. X77• r r r r r i EL 5.8 S1 u.o -:-ra1�= 59.92��' O lt9 - - __==- o aoao EL 6.5 F rib S79- - .- 'sr € S9 100-W Gf 67.72- CSI lel / SIONE - �A 1 t -1 S11'-f7tY_ AY wow QIYEWNG—�N G QEC7C '1_= /1d6QF -- ac '--- John M. Bredemeyer III, President+, S1IFFUC���`� Town Hall Annex Michael J Domino, Vice-President �y 54375 Route 25 Glenn Goldsmith y a� P.O Box 1179 A Nicholas Krupski o �; Southold, NY 11971 Charles J. Sanders �,�j p��? Telephone (631) 765-1892 NIu ���7' Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD J Date/Time: / fro Completed in field by. Gary Steinfeld on behalf of SUSAN HOLDEN requests an Administrative Permit to construct a 9.5'x9.7' one-story bath addition; proposed 1.7'x5.2' expansion and reconstruction of existing 5.1'x5.2' front porch; construct a 3.5'x4.5' in-fill to existing 3.5'x10.3' rear entry porch; reconstruct and expand existing 12.1'x10.3' on-grade hot tub deck by expanding it by an additional 15'x12.3', raise the deck elevation to meet existing seaward deck and center existing 7.3'x7.3' hot tub on deck; new deck to connect to existing 12.1'x15.8' seaward deck to be reconstructed as necessary; and for the existing 200 linear feet of garden fence. Located: 186 Willow Terrace Lane, Orient. SCTM# 1000- 26-2-4.1 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� 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 AT-(VI ee� nPIec'S-_ TOP OF BLUFF: CQ 1. Residence: 100 feet ��P���®'"P 2. Driveway: 100 feet "Pry d5led cam" �,Ce-� 3. Sanitary leaching pool (cesspool) 100 feet: P 4. Swimming pool and related structures: 100 feet hr� Public Notice of Hearing Card Posted: Y / N ;0 be- � �� � ..( � Ch. 275 Ch. 111 SEQRA Type: I II Psiicned tuv a6ser 7%" cz.�vt Type of Application: Pre-Submission Administr; lane and35' ae�, {r�n� Coastal Erosion Emergeni YO-rc( lof-/,n e_ I� Survey <_ 5 years: Y/N Wetland Line by: Additional information/suggested modifications/conditions/need for outside -- --i review/consultant/application completeness/comments/standards: Ho Aa Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders Other Page 1 of 2 John M. Bredemeyer III, President; �pS*JFFU('t�0 Town Hall Annex Michael J. Domino, Vice-President �° �y 54375 Route 25 Glenn Goldsmith oma` P.O. Box 1179 A. Nicholas Krupski o Southold, NY 11971 Charles J. Sanders 4, �pp� Telephone (631) 765-1892 y Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: Gary Steinfeld on behalf of SUSAN HOLDEN requests an Administrative Permit to construct a 9.5'x9.7' one-story bath addition; proposed 1.7'x5.2' expansion and reconstruction of existing 5.1'x5.2' front porch; construct a 3.5'x4.5' in-fill to existing 3.5'x10.3' rear entry porch; reconstruct and expand existing 12.1'x10.3' on-grade hot tub deck by expanding it by an additional 15'x12.3', raise the deck elevation to meet existing seaward deck and center existing 7.3'x7.3' hot tub on deck; new deck to connect to existing 12.1'x15.8' seaward deck to be reconstructed as necessary; and for the existing 200 linear feet of garden fence. Located: 186 Willow Terrace Lane, Orient. SCTM# 1000- 26-2-4.1 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 l 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 2 186 Willow Terrace Lane, Orient, NY—Site Photos Southold Board of Trustees Tidal Wetlands Permit Application Site Photographs Applicant: Susan Holden Suffolk County Tax Map #: 1000-26-2-4.1 Property Location: 186 Willow Terrace Lane, Orient, NY 11957 Date Photos Taken: November 9, 2016 12:30pm Photo 1 Page 1 of 4 :. Willow • Photos Aw •. r » w. a Y.I Photo Page 2 of 4 :. WillowOrient, Photos Photo 3 r �.� �� .. .pi •rot t .r Page 3 of 4 186 Willow Terrace Lane, Orient, NY—Site Photos - 1� snow ( I r T Photo 4 Page 4 of 4 S� L. r. Kings _� r it 186 WILLOW T E LANE .- EXISTING FRA USE , -• :. 1000 2-4,.1 - 4 p SITE y � � �O WEST CREEK DESIGN I BUILD I REMODEL DRAWINGS: 111 • West Creek Builders,LLC PO Box 256 111 New Suffolk, NY 11956 T 631.734.8416 REVISIONS/ISSUE: 10.26.16 PROJECT: Holden Residence '• 111 186 Willow Terrace Lane Orient, New York DRAWING: Aerial AERIAL 2 0161 M\ 13 Q �• � ,z, St T ,.., N 2. p \• 21 Z/ \ St. s,s i � ]v \ � 4 mx _ a 22 20.1 12 � O .0 •3A ,.OA 55 t 1Nc1 O 6\ \ 1 sT \ w 39.13 03.11 12.]38.1 \ tM 0.2A \ 9 � •�\�� \ � A \, m lY/1 M \ J Da \ ' 39.11 J x s m w 1\ 4 w ]at 1 ,.]Ale) 22 w ze 23 \ 2< w,. a �'te_ \ w I■ 1 s5 2 271 w m ,o _ QoR NOTICE COUNTY OF SUFFOLK © E P5 w«a souTNoLD SECTION NO c � —� w� tl ,� __�_ _ __ S� n� Real Property Tax Service AgenCy r � E µ___ o v. ___ ecow,b r..w RMrlwe.xY,tfa, M me �26 A P „100 PROPERTY MAP mea,ew,wea�w.t,M r.' OFFICE LOCATION: SOUr�ol SLING ADDRESS: Town Hall Annex ® P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 �� Telephone: 631 765-1938 O�y c0Fax: 631 765-3136 UN1`I,�� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: John Bredemeyer, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: December 8, 2016 Re: LWRP Coastal Consistency Review for SUSAN HOLDEN SCTM# 1000-26-2-4.1 Gary Steinfeld on behalf of SUSAN HOLDEN requests an Administrative Permit to construct a 9.5'x9.7' one-story bath addition; proposed 1.7'x5.2' expansion and reconstruction of existing 5.1'x5.2' front porch; construct a 3.5'x4.5' in-fill to existing 3.5'x10.3' rear entry porch; reconstruct and expand existing 12.1'x10.3' on-grade hot tub deck by expanding it by an additional 15'x12.3', raise the elevation to meet existing seaward deck and center existing 7.3'x7.3' hot tub on deck; new deck to connect to existing 12.1'x15.8' seaward deck to be reconstructed as necessary; and for the existing 200 linear feet of garden fence. Located: 186 Willow Terrace Lane, Orient. SCTM# 1000- 26-2-4.1 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 that: 1. The Board establishes a non-turf vegetated buffer landward of the wetlands. Require that the buffer be shown on a survey. 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 lil, President ��J"' �'/�O Lown Hall Annex Michael J Dom54375 Main Roadino, vice-Presid�' 'tt`�� � P O Sox 1179 James(I F. FGn�Trus Southold. New York 11971-0959 D veve�$� �t �� Telephone(631)765-1892 ,ries J.SandeersL7I tc O Fax(631) 765-6641 DEC 5 2016 BUILDINGDEPT. BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TOWN OF SOUTHOLD D To- Southold.Tow6 Building Department NOV 2 3 2016 Re- Verification of Building Department Permit Requirements BUILDING DEPT. TOWN OF SOUTHOLD SCTM#: � -Z� T I Property Owner [Mame: Date Sent to Bldg- Dept-: 12) 504 ' 15e Vi"5 -ec- eSC,C) Or) 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 req irea Bui(c�ing Permit? r'.s ptr 6,0AMIN pl � _V)s I pole c4- 4seripHey) receve� d2�ll S Will the proposed project require a variance determination from /the Zoning Board of Appeals? Wil( any part of this application be considered as Demolition as described under Town Code? COMMENTS: Si nature of Reviewer Date LOCATION MAP PROPOSED PROJECT: 1 - 9.5' X 9.7' BATH ADDITION (92SF) ORIENT, NY 2 - 1.7' X 5.2' FRONT ENTRY PORCH EXPANSION 3 - 4.5' X 3.5' REAR ENTRY PORCH IN-FILL ` 4 - 200 LF 6' HIGH GARDEN FENCE 5 - 12.3' X 15' REAR DECK EXPANSION DECEIVE PRO SED DECK N -27E NOV 2 1 2016 '.•. j EXPANSION(12.3'X 15') O "? 15' N SITE 1 � / EA5TING ON-6E DECK" Southoid Town O / AND OTTUB OBE DW PROP05ED 0A010 MEAN Board of WT 7' -FENCE MEAN HIGH ATER(MHW) AND TTAGH DTOEXIS NG5T GTURE AUGUST 1,2013 6:56AM� p iii � _ kENNETH M WOYCHUK'LAND SURVEYING, PLLG " o 12.1' kENNETH WOYCHUCK a �5 W y DECK 15.8' PROPOSED 9.5'X 9.7' WEST CREEK ENTRY 5z' ADDITION(92 SF)ON BLOCK FOUNDATION Pow„ DESIGN BUILD REMODEL 0 9 4 PROPOSED ENT Y PORCH PROPO ED REAR Z EX 5.21 PORCH IN-FILL °� EXISTING t DRAWINGS: S z 1 STY FRM PARKING SUFFOLK COUNTY TAX MAP #1000-26-2-4.1 i d�L HOUSE PROP SED FENGE ON GRASS West Creek Builders,LL� 200 LIN. FT PO Box 256 oG Z FFL EL 7.5' ovrooOR ADDRESS: 186 WILLOW TERRACE LANE, ORIENT, NY 11957 o 0 SHOVER � m New Suffolk, NY 11956 CZ in T 631.734.8416 OWNER: SUSAN HOLDEN 1 24.2' 66-9' SITE AREA: 13,719 SF 3 y6 REVISIONS/ISSUE: 11.01.16 LOT COVERAGE (UPLAND): 1355 SF = 14% EXISTING 1472 SF = 16% PROPOSED � st2 RELOCATE EXIS0 EXISTING BUILDING FOOTPRINT: 1224 SF _ 2� E 15TING pyoro SETB N SHED 1 ETBAG 5: 35'FRON YARD PROJECT: PROPOSED ADDITIONS: 300 SF (24.5%) 5 NITARY " 8_3' (INCL. PORCH EXPANSIONS) 576 9.48' SHE a3 5'SIDE Y RD Holden Residence 14w 212 186 Willow Terrace Ln ZONING: R40 PROPOSED SITE PLAN Orient, NY FLOOD ZONE: AE (EL6) SCALE: 1" = 20' DRAWING: COASTAL EROSION AREA `' TOTAL COASTAL EROSION AREA: 4246 SF EXISTING FRAME HOUSE Site Plan UPLAND AREA: 9473 SF ® PROJECT NORTH PROPOSED ADDITIONS EXISTING COVERAGE BY IMPERVIOUS STRUCTURES: 1355 SF = 14% — PROPOSED FENGE S1 • PROPOSED COVERAGE BY IMPERVIOUS STRUCTURES: 1656 SF = 17.5% John M tiredenneyer Ill, President UA Lown Hall Annex Michael J. Domino, Vice-Presidl 54375 Main Road P O. Box 1179 James 1:. Feng, TrusteeSouthold, New York 11971-0959 Dave Bergen, TrusteeCharles J. Sanders, `I rustceTelephone(631)765-1892 Fax(631) 765-6641 a - BOAR.]D OF TOWN TRUSTEES TOWN OF SOUTHOLD D To: Southold-Towii Building Department NOV 2 3 2016 Re: Verification of Building Department Permit Requirements BUILDING DEPr. 1 f TOWN OF SODU'1'H®LD SCTM#: -Z! Property Owner Name: ' I_k , Date Sent to Bldg_ Dept_: The Office of the Board of Trustees is forwarding the above referenced applicatioa for verification of the Building Department's permitting requirements stated below: YES NO Will the proposed project require a Building Permit? Will the proposed project require a variance determination from the Zoning Board of Appeals? Will any part of this application be considered as Demolition as described under Town Code? COMMENTS: dki Si nature of Reviewer Date I Town of Southold Board of Trustees Application Project Description Applicant: Susan Holden Suffolk County Tax Map #: 1000-26-2-4.1 Property Location: 186 Willow Terrace Lane, Orient, NY 11957 Project Description: 9.5' x 9.7' one story bath addition to existing residence, 1.7' x 5.2' expansion and reconstruction of existing 5.1' x 5.2' front porch, 3.5' x 4.5' in-fill to existing 3.5' x 10.3' rear entry porch, and reconstruct and expand existing 12.1' x 10.3' on grade hot tub deck; expand to 15' x 12.3', raise elevation to meet existing deck, center existing 7.3' x 7.3' hot tub on expanded structure, and attach to existing 12.1' x 15.8' deck to be reconstructed as necessary. 200 lineal feet of garden fence. All additions are landward of the Coastal Erosion Hazards Line and comprise less than 25% of the existing Building footprint. See Attached Site Plan & Survey. p E C E E DEC ® 1 2016 Southold Town Tru ' e ®�lot y' Town Hall Annex John M.Bredemeyer III, President ®V°� �� 54 Main Road Michael J.Domino,Vice-President ® '. P..O.O.Box 1179 James F. King,Trustee Southold,New York 11971-0959 Dave Bergen, Trustee •® y� Telephone(631) 765-1892 Charles J.Sanders,Trustee COW Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application 1JVetland Permit Application V Administrative Permit / _Amendment/Transfer/Extension h Received Application: Received Fee:$ 100, Completed Application: A ZZ, _Incomplete: _SEQRA Classificat' ° dl Type I Type IIIV Unlisted NOV 2 1 2016 Coordination:(date sent): I _74V RP Consistency Assessment Form: t2�Z`«o Suuth�ld Town CAC Referral Sent: rd of Truslec$ RJ Date of Inspection: 12,(o,( _Receipt of CAC Report: _Lead Agency Determination: Technical Review: Public Hearing Held: Resolution: Name of Applicant: Susan Holden Mailing Address: 186 Willow Terrace Lane Orient NY 11957 Phone Number: 917-273-7064 Suffolk County Tax Map Number: 1000 - 26-2-4.1 Property Location: 186 Willow Terrace Lane, Orient, NY 11956 Located off WillowTerrance Lane adjacent to Orient Harbor. 350' from King Street. (provide LILCO Pole#, distance to cross streets, and location) AGENT: Gary Steinfeld West Creek Builders LLC (If applicable) Address: PO Box 256, New Suffolk, NY 11956 _gary@westcreekbuilders.com Phone: 631-334-9205 J' ,oard of Trustees Applicat,; GENERAL DATA Land Area(in square feet): 13,719 Area Zoning: R40 Previous use of property: Single Family Residential Intended use of property: Single Family Residential Covenants and Restrictions on property? Yes X 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 X 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 X No Does the structure(s)on property have a valid Certificate of Occupancy?_X_Yes No Prior permits/approvals for site improvements: Agency Date Southold Bldg Dept 09/09/1958 Southold Bldg Dept 08/07/13 Pre-Exist. CO No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description(use attachments if necessary): 9.5' x 9.7' one story bath addition to existing residence, 1.7' x 5.2' expansion and reconstruction of existing 5. ' ' ' entry porch, and reconstruct and expand existing 12.1' x 10.3' on grade hot tub deck; expand to 15' x 12.3', raise elevation to meet existi,ig deck, center existing 7.3 1 x 7.3' not ttib on expa,ided sh actuie, ai i attach to existing 12.1' x 15.8' deck to be reconstructed as necessary. 200 lineal feet of garden fence. All additions are landward of the Coas aI Erosion Hazards Line and comprise ess an o of the existing Building footprint. See Attached Site Plan & Survey. JBoard of Trustees Applica� '.n WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Addition to existing single family resdidence Area of wetlands on lot: 0 square feet *Lot Line is At Mean High Water Percent coverage of lot: 0 % Closest distance between nearest existing structure and upland edge of wetlands: 41- feet Closest distance between nearest proposed structure and upland edge of wetlands: 44' feet Rear porch in-fill Does the project involve excavation or filling? No X Yes If yes,how much material will be excavated? 12 cubic yards How much material will be filled? 12 cubic yards Depth of which material will be removed or deposited: 3 feet Proposed slope throughout the area of operations: Flat Grade as is Existing Manner in which material will be removed or deposited: Small Excavator 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): None 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 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 1 -Project and Sponsor Information Name of Action or Project: 186 Willow Terrace Lane Project Location(describe,and attach a location map): 186 Willow Terrace Lane, Orient, NY 11957 Brief Description of Proposed Action: 9,5'x 9.7' one story bath addition to existing residence, 1.7'x 5.2' expansion and reconstruction of existing 5.1'x 5.2'front porch, 3.5'x 4.5' in-fill to existing 3.5'x 10.3' rear entry porch, and reconstruct and expand existing 12.1' x 10.3' on grade hot tub deck; expand to 15'x 12.3', raise elevation to meet existing deck, center existing 7.3'x 7.3' hot tub on expanded structure, and attach to existing 12.1'x 15.8' deck to be reconstructed as necessary. 200 lineal feet of garden fence. All additions are landward of the Coastal Erosion Hazards Line and comprise less than 25%of the existing Building footprint. See Attached Site Plan &Survey. Name of Applicant or Sponsor: LE-Mailgary@westcreekbuilders.com elephone:631-334-9905 Susan Holden Address: 186 Willow Terrace Lane City/PO: State: Zip Code: Orient NY 11957 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 ❑ 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: Southold Building Department ❑ NYS DEC 3.a.Total acreage of the site of the proposed action? 0.22 acres b.Total acreage to be physically disturbed? 0 02 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0,32 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban E]Rural(non-agriculture) ❑Industrial ❑Commercial ®Residential(suburban) ❑Forest ❑Agriculture El Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ I"j (—'q b.Consistent with the adopted comprehensive plan? ❑ ❑ ! J 6. is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ n 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO AYES If Yes,identify: 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: 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ Fil 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? n ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: IIJJ 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: M Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? M ❑ 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 [JYES ❑ L� b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO ®YES Qn-Site Dryell 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: ❑ a 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: F] ❑ 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 nam Sus&n Hol n Date: 11-09-16 Signature: SJ- Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the.following questions in Part 2 using the information contained in Part I and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 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? El 3. Will the proposed action impair the character or quality of the existing community? ❑ LJ 4. Will the proposed action have an impact on the environmental characteristics that caused the (� establishment of a Critical Environmental Area(CEA)? El 1:1 5. Will the proposed action result in an adverse change in the existing level of traffic or El ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? E] El 8. Will the proposed action impair the character or quality of important historic,archaeological, Elarchitectural or aesthetic resources? El 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ Ellwaterbodies,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 EJproblems? 11. Will the proposed action create a hazard to environmental resources or human health? a Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. ElCheck 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 _.,Board of Trustees Applica, ,_ 'a AFFIDAVIT Susan Holden BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF , 20 0� Notary Public SABRINA M BORN Notary Public,State of New York No.01 BO6317038 Qualified in Suffolk County Commission Expires Dec.22,2018 ,Board of Trustees Applic& n AUTHORIZATION (where the applicant is not the owner) I, Susan Holden residing at 186 Willow Terrace Ln (print name of owner of property) (mailing address) Orient, NY 11957 do hereby authorize (Agent) Gary Steinfeld, West Creek Builders, LLC to apply for permit(s)from the Southold Board of Town Trustees on my behalf. ner's signature) N/ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The puroose 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,.ri►iddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat 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,rgarriage,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 Ifyou 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 applicantlagent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this E day ofOV z9�' 20() Signature Print Name Form TS 1 �� � � � APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE.FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on life hart of town officers and emnloyees Theaumose of this form is to nmvide information which can alert(ILe town of possible conflicts of interest and allow it to take whatever action Is necessary to avoid same. YOURNAME: Holden, Susan (Last name,first name,.tpiddle 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 X 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'intcrest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial,owncrship of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares, YES NO X 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/agpnt/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(whe►t 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 of d� 20V� Signature f Print Name Form TS 1 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail,,listing both supporting and nog- 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# 26 - 2 - 4.1 PROJECT NAME Holden Residence, 186 Willow Terrace Lane The Application has been submitted to-(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. 0 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: FRI Nature and extent of action: 9.5'x 9.7' one story bath addition to existing residence 1.7' x 5.2' expansion and reconstruction of existing 5.1'x 5.2'front porch, 3.5'x 4.5' in-fill to existing 3.5'x 10.3' rear entry porch, and reconstruct and expand existing 12.1' x 10.3' on grade hot tub deck; expand to 15' x 12.3', raise elevation to meet existing deck, center existing 7.3'x 7.3'hot tub on expanded structure, and attach to existing 12.1'x 15.8' deck to be reconstructed as necessary. 200 lineal feet of garden fence. All additions are landward of the Coastal Erosion Hazards Line and comprise less than 25%of the existing Building footprint. See Att Location of action: 186 Willow Terrace Lane, Orient, NY 11957 Site acreage: 0.31 Present land use: Single Family Residence Present zoning classification: R40 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: Susan Holden (b) Mailing address:_ 186 Willow Terrace Lane, Orient, NY 11957 (c) Telephone number: Area Code( ) 917-273-7064 (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? em Yes L^J No❑ If yes,which state or federal agency? NYS DEC 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 F� No 0 Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No FK1 Not Applicable \r 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 Q Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes,❑ No Fx� Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of,Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No 0 Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ' r Yes No Not APY;icable 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 Q 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. ❑ YesEl No 0 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. 0 YeE- :] No 0 Not Applicable Attach additional sheets if necessary 1 WORKING COAST POLICik�; 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 Q Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑Yes ❑ No 0 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 X❑ 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 X❑ Not Applicable PREPARED BY-Giary S infeld'� TITLE Agent DATE 11/09/16 West Creek Builders, LLC