HomeMy WebLinkAboutTR-8964A Michael J.Domino, President �*0f SyO Town Hall Annex
John M.Bredemeyer III,Vice-President �O lQ 54375 Route 25
P.O.Box 11
Charles J.Sanders 1 E
Southold,New York
11971
Glenn Goldsmith • Q Telephone(631) 765-1892
A.Nicholas Krupski O Fax(631) 765-6641
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BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
# 1418C Date: November 14, 2017
THIS CERTIFIES that replacement in the same footprint) of an existing+/-11'x16' enclosed
screened porch with a first story addition for habitable space;
At 905 Willis Creek Drive, Mattituck
Suffolk County Tax Map #1000-123-10-3
Conforms to the application for a Trustees Permit heretofore filed in this
office Dated January 26, 2017 pursuant to which Trustees Administrative Permit#8964A
Dated March 22, 2017, 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 replacement(in the same footprint) of an existing+/-11'x16' enclosed screened
porch with a first story addition for habitable space.
The certificate is issued to Kean& Bridget Driscoll owners of the
aforesaid property.
Authorized Signature
�oF S0114z'
Michael J. Domino, President Town off® Town Hall Annex
John M. Bredemeyer III,Vice-President 54375 Route 25
P.O.Box 1179
Charles J.Sanders Southold,New York 11971
Glenn Goldsmith 0 �� Telephone (631) 765-1892
A.Nicholas Krupski o��C®UftlTV Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
DATE OF INSPECTION: IIA-11-7
y Ch. 275 Ch. 111
INSPECTION SCHEDULE
�'�'re-construction, hay bale line/silt boom/silt curtain
1 st day of construction
% constructed
Project complete, compliance inspection.
INSPECTED BY: G. G��cSr�►'��
COMMENTS:
BIU'A 1t1 [ACGn�daClc� wi-6h Q��rni .
�o ►SSvL' C o� _
CERTIFICATE OF COMPLIANCE:
Michael J.Domino, President � SU�TyOlO Town Hall Annex
John M.Bredemeyer III,Vice-President r 54375 Route 25
P.O.Box 1179
Charles J.Sanders �[
Southold,New York 11971
Glenn Goldsmith �� ® yOQ Telephone(631) 765-1892
A.Nicholas Krupski �COUNFax(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
1St day of construction
% constructed
Project complete, compliance inspection
1
�Zf soUt
Michael J. Domino,President � y®l® Town Hall Annex
John M.Bredemeyer III,Vice-President 54375 Route 25
P.O.Box 1179
Charles J.Sanders v, Zt= Southold,New York 11971
Glenn Goldsmith ® �� Telephone(631) 765-1892
A. Nicholas Krupski l�'�oU �� Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 8964A
Date of Receipt of Application: January 26, 2017
Applicant: Kean & Bridget Driscoll
SCTM#: 1000-123-10-3
Project Location: 905 Willis Creek Drive, Mattituck
Date of Resolution/Issuance: March 22, 2017
Date of Expiration: March 22, 2019
Reviewed by: Glenn Goldsmith
Project Description: Replace (in the same footprint) an existing ±11'x16'
enclosed screened porch with a first story addition for habitable space.
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
survey prepared by Nathan Taft Corwin, III Land Surveyor, last dated January 24,
2017, and stamped approved on March 22, 2017.
Special Conditions: None.
Inspections: Final Inspection.
If the proposed activities do not meet the requirements for issuance of an
Administrative Permit set forth in Chapter 275 of the Southold Town Code, a
Wetland Permit will be required.
This is not a determination from any other agency.
Michael J. Domino,
President Board of Trustees
rl1FF0(�
Michael J. Domino,Presid, f O�Q C � Town Hall Annex
John M. Bredemeyer III,Vice-President 54375 Route 25
Charles J. Sanders y P.O.Box 1179
Glenn Goldsmith Southold,NY 11971
A.Nicholas Krupski ®41 �pl� Telephone(631)765-1892
Fax(631)765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Date/Time: 3/1-7/17 S:qo Completed in field by: G,
En-Consultants on behalf of KEAN & BRIDGET DRISCOLL request an Administrative Permit to
replace (in the same footprint) an existing ±11'x16' enclosed screened porch with a first story addition
for habitable space. Located: 905 Willis Creek Drive, Mattituck. SCTM# 1000-123-10-3
CH. 275-3 - SETBACKS
WETLAND BOUNDARY: Actual Footage or OK=q Setback Waiver Required
1. Residence: 100 feet
2. Driveway: 50 feet
3. Sanitary Leaching Pool (cesspool): 100 feet
4. Septic Tank: 75 feet
5. Swimming Pool and related structures: 50 feet
6. Landscaping or gardening: 50 feet
7. Placement of C&D material: 100 feet
TOP OF BLUFF:
1. Residence: 100 feet
2. Driveway: 100 feet
3. Sanitary leaching pool (cesspool) 100 feet:
4. Swimming pool and related structures: 100 feet
Public Notice/of Hearing Card Posted: Y / N
Ch. 275 ✓ 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:
Poco, CACO_aAy 1cades-s �0 �rvw�lls
Present were: J. Bredemeyer ,, ' M. Domino V/ G. Goldsmith N. Krupski
C. Sanders Other
Page 1 of 2
-- ,
Michael J. Domino, Presid, O�QSuFFoc/rCOG Town Hall Annex
John M. Bredemeyer III,Vice-President 54375 Route 25
Charles J. Sanders z P.O.Box 1179
Glenn Goldsmith Southold,NY 11971
A.Nicholas Krupski �L,�O gyp! Telephone(631)765-1892
Fax(631)765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Date/Time: Completed in Work Session by:
En-Consultants on behalf of KEAN & BRIDGET DRISCOLL request an Administrative Permit to
replace (in the same footprint) an existing ±11'x16' enclosed screened porch with a first story addition
for habitable space. Located: 905 Willis Creek Drive, Mattituck. SCTM# 1000-123-10-3
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
SURVEY OF
LOT 17
MAP OF
HARBOR VIEW AT MATTITUCK
ON FILE No. 8377 FILED AUGUST 21 , 1987
SITUATED AT
MATTITU
CK
TOWN OF SOUTHOLD
R, SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000- 123- 10-03
Sg)80
�I SCALE 1 "=30'
L MARCH 31 , 2003
�I MAY 2, 2003 ADDED CONTOUR LINES
L JANUARY 6, 2008 UPDATE MAP
SEPTEMBER 26, 2012 UPDATE SURVEY
MARCH 9, 2014 RE—TOPO WASHOUT AREA
n MAY 16, 2016 UPDATE SURVEY
�J 1 AUGUST 4, 2016 ADD PROPOSED FENCE
JANUARY 24, 2017 ADDED NOTE FOR SCREENED PORCH REPLACEMENT
AREA = 46,083 sq. ft.
(TO TIE LINE) 1 .058 cc.
N
CER TIFIED TO:
Ln
11 DRAINAGE AREA ��o BR DGET E..KEAN D. RISCOLL
DRISSCOLL
FIRST AMERICAN TITLE INSURANCE COMPANY
% CONTOUR MORTGAGE CORPORATION
�i
� WIDE
10 NOTES:
WALK / �6•$1 �
?m I _ / FpuNp 1. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM
p�pE pZS• �� EXISTING ELEVATIONS ARE SHOWN THUS:
EXISTING CONTOUR LINES ARE SHOWN THUS: — —— ——5
F.FL. - FIRST FLOOR
n " E •� G.FL. - GARAGE FLOOR
I Q•° `�'S� \\ vO; B.B. - BOTTOM OF L BUKHELKHAD
EAD
L—J
T.W. - TOP OF WALL
r� \ B.W. - BOTTOM OF WALL
rn \ 2. AREA OF DISTURBANCE IS 2,750 sq. ft.
EXISTING LOT COVERAGE OVER
LOT 17 \ 9y `�9
UPLAND AREA (42,857 sq. ft.)
DESCRIPTION
AREA % LOT COVERAGE
c�� �y`` e sr 4 4 , d �, EXIST. HOUSE 2,134 sq. ft. 5.0%
colo o� A0� oyF o ,. '. 4
,,�♦�Q� R��cyy-- 4' EXIST. FRONT PORCH Y.
4 P5�41 4 ` 1).4 , F n \ � 63 sq. ft. 0.1r�
e06�a,1, �4 ' ..fig: EXIST. REAR PORCH 493 sq. ft. 1.2%
c
'4
4 a 9t
�
o C GR6. !' \4 �0 -\p TOTAL EXISTING 2,690 sq. ft. 6.3%
CPO
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` ` ��� //' / xAPPROVEDBY
\ ,\xz.� l��\X�\`�\� BOARD OF 'I r?USTEES
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8, x�! x_ i \x\ \_// �� TOWN OF SOUTHOLD
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FLAG ,..�._.-_
TIDAL WETLANDS BOUNDARY AS DELINEATED ,8 FLAG S a 4e 2O'16"
IB EN-CONSULTANTS, `j 8.29'
NOVEMBER 10, 2015
TB
TB.
VINYL LOW SILL BULKHEAD PREPARED IN ACCORDANCE WITH THE MINIMUM
R TITLE SURVEYS AS ESTABLISHED
BY THE
ILLI S CR �j EK FOR STANDARDS SUCH USE BYNTHEPNEW,YORKNSTATE ADOPTED
�/�I TLAND
�EP LE OR
!/ TITLE ASSOCIATION: Ito
D
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N.Y.S. Lic. No 50467
UNAUTHORIZED ALTERATION OR ADDITION
TO THIS SURVEY IS A VIOLATION OF Nathan Taft Corwin III
SECTION 7209 OF THE NEW YORK STATE
EDUCATION LAW.
COPIES OF THIS SURVEY MAP NOT BEARING Land Surveyor
THE LAND SURVEYOR'S INKED SEAL OR
EMBOSSED SEAL SHALL NOT BE CONSIDERED
TO BE A VALID TRUE COPY.
CERTIFICATIONS INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY Successor To: Stanley J. Isaksen, Jr. L.S.
IS PREPARED, AND ON HIS BEHALF TO THE Joseph A. Ingegno L.S.
TITLE COMPANY, GOVERNMENTAL AGENCY AND
LENDING INSTITUTION LISTED HEREON, AND Title Surveys — Subdivisions — Site Plans — Construction La out
TO THE ASSIGNEES OF THE LENDING INSTI— y
TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. PHONE (631727-2090 FOX (631)727-1727
THE EXISTENCE OF RIGHTS OF WAY OFFICES LOCATED AT MAILING ADDRESS
AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P.O. Box 16
ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947
'0 10
DEAN AND BRIDGET DRISCOLL,905 WILLIS CREEK DRIVE,MATTITUCK
A
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Figure 1. Looking northwest at existing screened porch located at southeast corner of dwelling,
which is to be replaced(in-place) with first-story addition to habitable space.
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Figure 2. Looking west across waterside of house and seaward side of existing porch(to right)to be converted to habitable space.
4 f
DEAN AND BRIDGET DRISCOLL 905 WILLIS CREEK DRIVE MATTITUCK
■
■
Figure 1. Looking northwest at existing screened porch located at southeast corner of dwelling,
which is to be replaced(in-place) with first-story addition to habitable space.
, 1
Figure Z Looking west across waterside of house and seaward side of existing porch(to right)to be converted to habitable space.
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OFFICE LOCATION: ®��®f S® MAILING 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
®
Fax: 631 765-3136
LOCAL WATERFRONT REVITALIZATION PROGRAM
TOWN OF SOUTHOLD
MEMORANDUM
To: Michael Domino, President
Town of Southold Board of Trustees
From: Mark Terry, LWRP Coordinator
Date: March 17, 2017
Re: Local Waterfront Revitalization Program Coastal Consistency Review for KEAN & BRIDGET
DRISCOLL
SCTM# 1000-123-10-3
En-Consultants on behalf of KEAN & BRIDGET DRISCOLL request an Administrative Permit to
replace (in the same footprint) an existing ±11'x16' enclosed screened porch with a first story
addition for habitable space., Located: 905 Willis Creek Drive, Mattituck. SCTM# 1000-123-10-
3
The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the
Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy
Standards. Based upon the information provided on the LWRP Consistency Assessment Form
submitted"to this department, as well as the records available to me, it is my recommendation
that the proposed action is EXEMPT from LWRP review,pursuant to:
§ 268-3. Definitions. MINOR ACTIONS items `BB"which states:
BB. Additions to an existing dwelling constituting less than 25% of the existing structure where
the addition is greater than 75 feet from a natural protective feature, except where the parcel is
located in a coastal erosion hazard area;
Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in
preparing its written determination regarding the consistency of the proposed action.
I
John M bredemeycr [[t, President ��J"' _����0 town Hall Annex
Michael J. Domino, vice-Preside j �� 1p t �; 54375 Main Road
P O- Box 1179
James F. King,Trustee Southold, New York 11971-0959
Dave Bergen,Trustee G
Charles J.Sanders, `I'rustce 'rQ <2> �� - Telephone(631)765-1892
ly�'�UM`1,�� - Fa_e(631) 765-6641
BOARD OF TOWN TRUSTEE
TOWN OF SOUTHOLD D
To: Southold-Town Building Department JAS 2 7 20.17
Re- Verification of Building Department Permit Requirements
BUILDING DEPT.
TOWN OF SOUTHOLD
SCTMff:
Property Owner Name: ' DR i SCDC.I'
Date Sent to Bldg. Dept.: I i zt,?`�
The Office of the Board of Trustees is forwarding the above referenced application for
verification of the Building Departriient's permitting requirements stated below.
YES NO
ill 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:
MA Al k
2� I
Signature of Reviewer Date
John M.Bredemeyer III,President ��` �y Town Hall Annex
Michael J.Domino,Vice-President54375 Main Road
ti P.O. Box 1179
James F.King,Trustee d Southold,New York 11971-0959
Dave Bergen,Trustee
Telephone(631) 765-1892
Charles J. Sanders,Trustee
Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
_Coastal Erosion Permit Application
_Wetland Permit Application Administrative Permit
_Amendment/Transfer/Extension
_Received Application:
_Received Fee:
_Completed Application �� L 0 L=
_Incomplete �S
_SEQRA ClassificatJ'�n: �l )y
Type I Type II Unlisted JAN 2 6 2017
Coordination: (date sent) 1
LWRP Consistency Assessment Form
_CAC Referral Sent: Southold Town F
_Date of Inspection: ftj
_Receipt of CAC Report:
_Lead Agency Determination:
_Technical Review:
_Public Hearing Held:
Resolution:
Name of Applicant Kean&Bridget Driscoll
19 Broadway
Address Malverne,NY 11565
Phone Number: 441 532-9016
Suffolk County Tax Map Number: 1000 - 123-10-3
Property Location: 905 Willis Creek Drive,Mattituck
(provide LILCO Pole #, distance to cross streets, and location)
AGENT: En-Consultants
(If applicable)
Address: 1319 North Sea Road,Southampton,NY 11968
Phone:631-283-6360
Board of Trustees Application
GENERAL DATA
Land Area(in square feet): 46,083
Area Zoning: R-40
Previous use of property: Residential,single-family dwelling
Intended use of property: Same with additional first story living space m place of screened porch
Covenants and Restrictions: Yes X No
If"Yes", please provide copy.
Will this project require a Building Permit as per Town Code? X 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 Building
Dept. X Yes 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 Wetlands Permit No 3925 06/07/91,Amended 12/14/93
Southold Wetlands Permit No 5094 12/17/99
Southold Wetlands Permit No 5701 01/22/08,Amended 7/23/03
Southold Wetlands Permit No,7954 11/14/12,Amended 4/23/14
Southold Wetlands Permit No. 8878(pool) 09/21/16
NYSDEC Tidal Wetlands#1-4738-00266(dwelling) 01/04/13,Amended 7/11/14
NYSDEC Tidal Wetlands Letter of Non-Junsdiction
#1-4738-00266/00016(pool) 08/25/16
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):
Replace(m the same footprint)an existing+/- 11'x 16'enclosed screened porch with a first story addition to habitable space,as
depicted on the site plan prepared by Nathan Taft Corwin III Land Surveyor,last dated January 24,2017.
_ 3oarcl of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:
To convert an existing screened porch area into additional first story living space.
Area of wetlands on lot: o square feet
Percent coverage of lot: 0
Closest distance between nearest existing structure and upland
edge of wetlands: +/-75 feet
Closest distance between nearest proposed structure and upland
edge of wetlands: +/-83 feet
Does the project involve excavation or filling?
X No Yes
If yes, how much material will be excavated? N/A cubic yards
How much material will be filled? N/A cubic yards
Depth of which material will be removed or deposited: N/A feet
Proposed slope throughout the area of operations: N/A
Manner in which material will be removed or deposited:
Standard construction practices.
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):
The project consists only of the in-place conversion of an existing enclosed screened porch area into additional first story
living space for the purpose of expanding the existing kitchen. This minor project will result in no increase to the
dwelling footprint,number of bedrooms,lot coverage,or roofed area;and no change to existing wetland setbacks. As a
result,the project will not result in the physical loss,degradation,or functional loss of ecological components or otherwise
adversely impact the adjacent tidal wetlands or waters of the Town.
Board of Trustees Application
AUTHORIZATION
(where the applicant is not the owner)
I� Kean Driscoll residing at 19 Broadway
(print owner of property) (mailing address)
Malverne,NY 11565 do hereby authorize
(Agent)
En-Consultants to apply for permit(s)from the
Southold Board of Town Trustees on my behalf.
(Owner's signature),Kean Driscoll
Board of Trustees Application
AUTHORIZATION
(where the applicant is not the owner)
I, Bridget Driscoll residing at 19 Broadway
(print owner of property) (mailing address)
Malverne,NY 11565 do hereby authorize
(Agent)
En-Consultants to apply for permit(s)from the
Southold Board of Town Trustees on my behalf.
(Owner's sign4,—,Iridget Driscoll
Board of Trustees Application
County of Suffolk
State of New York
Kean Driscoll 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 TOWN 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(S),TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.
Signature,Kean Driscoll
SWORN TO BEFORE ME THIS DAY OF 'SLC,,,.^ ,20
Rober01fp?j01kl-
17 •, Public,Stotaq&WYorlt
ota ' Pub c unhfied in SuRol ��ty
No.02KV6?�"
Co
mm+sion E:pires,A%.1Apm,
Robert Xuzloski
Notary 1®blit,State of New York ���[{rrlosl.+
tjuellfled in Suffolk Coo®tY of York
lyo.0=116310189 Notary Pablic-Sl fe
Commislon Ezpl—A19.1%2018 Quallam lefiaffoll, ty
No.02KU631,.
Commisio®Ettphw Aug 1018
Board of Trustees Application
County of Suffolk
State of New York
Bridget Driscoll 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 TOWN 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(S),TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.
4" A0ev-1'/
Tgnature,Bridget Driscoll
SWORN TO BEFORE ME THIS DAY OF-- 2011
r`
/ Robert Kurloski
Notary Public,State of New York
( Qualified is Suffolk County
No.02KU631018918,2018
Commision Expires Aug'
tary ubl'
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics prohibits conflicts of interest on the hart 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: Driscoll,Kean
(Last name,first name,middle 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 X
Change of Zone Coastal Erosion
Approval of plat Mooring
Exemption from plat or official map Planning
Other
(If"Other",name the activity.)
Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee
of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business,
including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation
in which the town officer or employee owns more than 5%of the shares.
YES NO "'
If you answered"YES",complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check
the appropriate line A)through D)and/or describe in the space provided,
The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply):
A)the owner of greater than 5%of the shares of the corporate stock of the applicant
(when the applicant is a corporation);
B)the legal or beneficial owner of any interest in a non-corporate entity(when the
applicant is not a corporation);
C)an officer,director,partner,or employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONSHIP
Submitted this da 20q
Signature
Print Name Kean Driscoll
Form TS I
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 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: Driscoll,Bridget
(Last name,first name,middle 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 X
Change of Zone Coastal Erosion
Approval of plat Mooring
Exemption from plat or official map Planning
Other
(If"Other",name the activity.)
Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee
of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business,
including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation
in which the town officer or employee owns more than 5%of the shares.
YES NO
If you answered"YES",complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself(the applicant/agent(representative)and the town officer or employee.Either check
the appropriate line A)through D)and/or describe in the space provided.
The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply):
A)the owner of greater than 5%of the shares of the corporate stock of the applicant
(when the applicant is a corporation);
B)the legal or beneficial owner of any interest in a non-corporate entity(when the
applicant is not a corporation);
C)an officer,director,partner,or employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONSHIP
Submitted this I da tf 200%
Signature—
Print Name _'--bridget Driscoll
Form TS 1
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL. DISCLOSURE FORINT
The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees The pumose 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. HPrrm m Rnbn-r+ F
(Last name,first name,middle 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 Southold9 "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 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/agent/representative)and the town officer or employee.Either check
the appropriate line A)through D)and/or describe in the space provided.
The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply):
A)the owner of greater than 5%of the shares of the corporate stock of the applicant
(when the applicant is a corporation);
B)the legal or beneficial owner of any interest in a non-corporate entity(when the
applicant is not a corporation);
C)an officer,director,partner,or employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONSHIP
Submitted this y ofIV\, 209 �7
Signature
Print Name emt>ann
Form TS 1
617.20
Appendix B
Short Environmental Assessment Form
Instructions for Completing
Part I-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 I based on information currently available.If additional research or investigation would be needed to fully
respond to any item,please answer as thoroughly as possible based on current information.
Complete all items in Part 1.You may also provide any additional information which you believe will be needed by or useful
to the lead agency;attach additional pages as necessary to supplement any item.
Part I-Project and Sponsor Information
Name of Action or Project:
Driscoll Porch Conversion
Project Location(describe,and attach a location map):
905 Willis Creek Drive,Mattituck,Town of Southold,Suffolk County,NY,SCTM#SCTM#1000-123-10-3;property
located in cul de sac at southeast end of Willis Creek Drive,maps provided,location map attached.
Brief Description of Proposed Action:
Replace(in the same footprint)an existing+/- 11'x 16'enclosed screened porch with a fust story addition to habitable
space,as depicted on the site plan prepared by Nathan Taft Corwin III Land Surveyor,last dated January 24,2017.
Name of Applicant or Sponsor: Telephone: 441-532-9016
Kean&Bridget Briscoll E-Mail: kean.driscoll@validusre.com
Address:
19 Broadway
City/PO: State: Zip Code:
Malverne NY 11565
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. X
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:
NYS DEC X
3 a.Total acreage of the site of the proposed action? 1.058 acres
b.Total acreage to be physically disturbed? <3
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? 1.058 acres
4. Check all land uses that occur on,adjoining and near the proposed action.
❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial ®Residential(suburban)
❑Forest ❑Agriculture ®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? X
b. Consistent with the adopted comprehensive plan? X
6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES
landscape
X
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: Name:Deep Hole Creek,Pecomc Bay&Environs,Reason.Significant coastal fish&wildlife habitat
Protect public health,water,vegetation,&scenic beauty,Agency Town of Southold,Suffolk County,Date-3-9-90,7-12-88 X
8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES
X
b.Are public transportation service(s)available at or near the site of the proposed action? X
c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? X
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:
N/A
10. Will the proposed action connect to an existing public/private water supply? NO YES
If No,describe method for providing potable water: N/A
11.Will the proposed action connect to existing wastewater utilities? NO YES
If No,describe method for providing wastewater treatment: N/A
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?
X
X
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? X
b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? X
If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres:
14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply.
® Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional
® Wetland ❑Urban ®Suburban
15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES
by the State or Federal government as threatened or endangered? X
16.Is the project site located in the 100 year flood plain? NO YES
X
17.Will the proposed action create storm water discharge,either from point or non-point sources? YES
If Yes,
a.Will storm water discharges flow to adjacent properties? ❑NO❑YES
b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)?
If Yes,briefly describe: ❑NO❑YES
Page 2 of 4
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: X
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: X
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:
X
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE
Applicant/sponsor name: Robert E.Hemnann,Coastal Management Specialist Date: January 25,2017
Signature:
Part 2-Impact Assessment.The Lead Agency is responsible for the completion of Part 2. Answer all of the following
questions in Part 2 using the information contained in Part I and other materials submitted by the project sponsor or
otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my
responses been reasonable considering the scale and context of the proposed action?"
No,or Moderate
small to large
impact impact
may may
occur occur
1. Will the proposed action create a material conflict with an adopted land use plan or zoning /
regulations?
2. Will the proposed action result in a change in the use or intensity of use of land?
3. Will the proposed action impair the character or quality of the existing community?
4. Will the proposed action have an impact on the environmental characteristics that caused the .14
establishment of a Critical Environmental Area(CEA)?
5. Will the proposed action result in an adverse change in the existing level of traffic or
affect existing infrastructure for mass transit,biking or walkway? J
6. Will the proposed action cause an increase in the use of energy and it fails to incorporate
reasonably available energy conservation or renewable energy opportunities?
7. Will the proposed action impact existing:
a.public/private water supplies?
b.public/private wastewater treatment utilities?
8. Will the proposed action impair the character or quality of important historic, archaeological,
architectural or aesthetic resources?
9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands,
waterbodies,groundwater,air quality,flora and fauna)?
Page 3 of 4
f
No,or Moderate
small to large
impact impact
may may
occur
10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage
problems? V
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 I
Part 3 should,in sufficient detail,identify the impact, including any measures or design elements that have been included by
the project sponsor to avoid or reduce impacts.Part 3 should also explain how the lead agency determined that the impact
may or will not be significant. Each potential impact should be assessed considering its setting,probability of occurring,
duration, irreversibility,geographic scope and magnitude.Also consider the potential for short-term,long-term and
cumulative impacts.
❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation,
that the proposed action may result in one or more potentially large or significant adverse impacts and an
environmental impact statement is required.
❑ Check this box if you have determined,based on the information and analysis above, nd any supporting documentation,
that the proposed action will not r ultrrirZany si mficant adverse environmen 1 impa ts.
Name of Lea gency Date
(
e,1 J D J4-gA 00 ffrx�%
Print or Type N e of Re po le Officer in Lead Agency Title of Responsible Officer
`IbSignature of Respbrisible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer)
Page 4 of 4
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 si nig_ficant
beneficial and adverse effects upon the coastal area (which includes all of Southold Town).
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# 123 - 10 - 3
PROJECT NAME Kean&Bridget Driscoll
The Application has been submitted to (check appropriate response):
Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees Lnsi
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:
Replace(in the same footprint)an existing+/- 11'x 16'enclosed screened porch with a first story addition to habitable space,as
depicted on the site plan prepared by Nathan Taft Corwin III Land Surveyor,last dated January 24,2017.
Pursuant to Southold Town Code§268-5("Review of Actions")and the corresponding definitions of"action"and"minor action"by
§286-3 ("Defmitions"),the proposed in-place replacement of the existing 11'x 16'enclosed screened porch with additional first story
habitable space meets the following definition of a minor action and should thus be determined to be exempt from waterfront
consistency review pursuant to Chapter 268: "II.Additions to an existing building or rebuilt residential structure which results in no net
increase in ground area coverage,except where the parcel is located in a coastal erosion hazard area."
J
Location of action: 905 Willis Creek Drive,Mattituck
Site acreage: 1.08 acres
Present land use: Residential,single family dwelling
Present zoning classification: R-40
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: Kean&Bridget Driscoll
(b) Mailing address: 19 Broadway
Malverne,NY 11565
(c) Telephone number: Area Code 441-532-9016
(d) Application number, if any: -
Will the action be directly undertaken, require funding, or approval by a state or federal agency?
Yes ❑ No® If yes, which state or federal agency?
C. Evaluate the project to the following policies by analyzing how the project will further support or not
support the policies. Provide all proposed Best Management Practices that will further each policy.
Incomplete answers will require that the form be returned for completion.
DEVELOPED COAST POLICY
Policy 1. Foster a pattern of development in the Town of Southold that enhances community character,
preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and
minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation
criteria.
❑Yes ❑ No ® 1lTot Applicable
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP
Section III- Policies Pages 3 through 6 for evaluation criteria
❑ Yes ❑ No ® Not Applicable
Attach additional sheets if necessary
Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See
LWRP Section III- Policies Pages 6 through 7 for evaluation criteria
Yes 1:1 No ® Not Applicable
Attach additional sheets if necessary
NATURAL COAST POLICIES
Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP
Section III- Policies Pages 8 through 16 for evaluation criteria
❑Yes 0 No ® Not Applicable
Attach additional sheets if necessary
Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III
- Policies Pages 16 through 21 for evaluation criteria
❑Yes 0 No ® Not Applicable
Attach additional sheets if necessary
Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including
Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22
through 32 for evaluation criteria.
Yes 1:1 No ® Not Applicable
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® Not Applicable
Attach additional sheets if necessary
Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous
substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria.
❑ Yes ❑ No ® Not Applicable
PUBLIC COAST POLICIES
Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public
resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation
criteria.
❑ Yes ❑ No® Not Applicable
Attach additional sheets if necessary
WORKING COAST POLICIES
Y
` I
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 ® 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 ® 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 ® 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
PREPARED BY TITLE coastal Mgmt. Specialist DATE01/25/17
Robert E. emnann
Amended on 811105
EN-CONSULTANTS
January 25,2017
lit,EUFST FOR T VI&NI TRATIy �VF'ITLANDS PERMIT
Town of Southold ' E �1;,����; ; ;
Board of Trustees 1 �' L `' ;
54375 Main Road F"I
Post office Box 1179 JAN 2 6 2017
Southold,New York 11971
I '
Re: Kean&Bridget Driscoll s:iu!hold Tanfn
905 Willis Creek Drive, Mattituckrd J � s -1
SCTM#1000-123-10-3
Dear Board of Trustees:
In regard to the above referenced property,enclosed are the following for the Board of Trustees review:
1. Three(3)Wetland Permit Applications including:
a) Authorization&Disclosure Forms;
b) Short Environmental Assessment Form;
c) Survey prepared by Nathan Taft Corwin III, last dated January 24,2017.
2. One(1)set of site photographs.
3. Application fee of$100.00.
4. Three(3)LWRP Consistency Assessment Forms including:
a) Survey.
I hope this information shall allow you to process our permit request. Should any additional information
be required,please do not hesitate to contact our office.
Sincer ,
Robert E.Herrmann
Coastal Management Specialist
/khs
Enc.
1319 North Sea Road I Southampton,New York 11968 p 631.283.6360 f 631.283.6136 www.enconsultants com
environmental consulting