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HomeMy WebLinkAboutTR-8965A Michael J.Domino,President 0f SOUjy� Town Hall Annex John M.Bredemeyer III,Vice-President O 54375 Route 25 O P.O.Box 1179 Glenn Goldsmith l�[ Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 10ou BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1565C Date: February 12,2019 THIS CERTIFIES that the removal of 60sg ft of existing second-floor deck and 60sq.ft. of existing first floor deck-, construct a new second floor roof deck; a new first floor deck; and a new seasonal screened in porch for a combined total of 705sq ft onto the southerly side of the dwelling; At 405 Cedar Point Drive West, Southold Suffolk County Tax Map#1000-90-2-27 Conforms to the application for a Trustees Permit heretofore filed in this office dated January 25, 2017 pursuant to which Trustees Administrative Permit#8965A 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 removal of 60sg ft of existing second-floor deck and 60sq ft. of existing first floor deck; construct a new second floor roof deck; a new first floor deck; and a new seasonal screened in porch for a combined total'of 705sg ft onto the southerly side of the dwelling. The certificate is issued to K Mac Reality, LLC owner of the aforesaid property. Q Authorized Signature Michael J.Domino,President rg'so Town Hall Annex� John M.Bredemeyer III,Vice-President �� l0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski n_ • Telephone(631) 765-1892 Greg WilliamsyCoU 'O Fax(631) 765-6641 � NT`1,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: �d Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction Y constructed X Project complete, compliance inspection. INSPECTED BY: W . Q COMMENTS: _ � L CERTIFICATE OF COMPLIANCE: Michael J.Domino, President *®f So�jyo 1 Town Hall Annex John M.Bredemeyer III,Vice-President ~ ® 54375 Route 25 JP 0 P.O.Box 1179 Charles J.Sanders y� Southold,New York 11971 Glenn Goldsmith ® aOQ Telephone(631) 765-1892 A.Nicholas Krupski �lif'COUN Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction % constructed Project complete, compliance inspection o��pF ol Michael J.Domino,President Town Hall Annex h O John M.Bredemeyer III,Vice-President 54375 Route 25P.O.Box 1179 Charles J.Sanders Southold,New.York 11971 Glenn Goldsmith �Q Telephone(631) 765-1892 A.Nicholas Krupski ®lyCOW N Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8965A Date of Receipt of Application: January 25, 2017 Applicant: K Mac Reality, LLC SCTM#: 1000-90-2-27 Project Location: 405 Cedar Point Drive West, Southold Date of Resolution/Issuance: March 22, 2017 Date of Expiration: March 22, 2019 Reviewed by: Board of Trustees Project Description: Remove 60sq.ft. of existing second-floor deck, and 60sq.ft. of existing first floor deck; construct a new second floor roof deck; a new first floor deck; and a new seasonal screened in porch for a combined total of 705sq.ft. onto the southerly side of the dwelling. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by John J. Condon, Licensed Professional Engineer, received on January 25, 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 SpFF01,� Michael J. Domino, Pi !int �Q �0 � Town Hall Annex John M. Bredemeyer III, Vice-President ��� G�� T 54375 Route 25 Charles J. Sanders cz y P.O.Box 1179 Glenn Goldsmith Southold,NY 11971 A.Nicholas Krupski Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES - TOWN OF SOUTHOLD Date/Time: Y_W/� fato6 Completed in field by: Eileen Wingate on behalf of K MAC REALITY, LLC requests an Administrative Permit to remove 60sq.ft. of existing second-floor deck, and 60sq.ft. of existing first floor deck; construct a new second floor roof deck; a new first floor deck; and a new seasonal screened in porch for a combined total of 705sq.ft. onto the southerly side of the dwelling. Located: 405 Cedar Point Drive West, Southold. SCTM# 1000-90-2-27 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: "(2"�'�-ens � •� �1��11 S`a Present were: (/J. Bredemeyer VII'M. Domino G. Goldsmith N. Krupski db C. Sanders Other Page 1 of 2 Michael J. Domino,R' pmt �QOfFo1,��0 Town Hall Annex John M. Bredemeyer III,Vice-President �y`� G%, 54375 Route 25 Charles J. Sanders ro z P.O.Box 1179 Glenn Goldsmith 0 Southold,NY 11971 A.Nicholas Krupski Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: Eileen Wingate on behalf of K MAC REALITY, LLC requests an Administrative Permit to remove 60sq.ft. of existing second-floor deck, and 60sq.ft. of existing first floor'deck; construct a new second floor roof deck; a new first floor deck; and a new seasonal screened in porch for a combined total of 705sq.ft. onto the southerly side of the dwelling. Located: 405 Cedar Point Drive West, Southold. SCTM# 1000-90-2-27 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 146 MAP OF CEDAR BEACH PARK FILE No. 90 FILED DECEMBER 20, 1927 SITUATE BAYVIEW TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK SEPTIC SYSTEM TIE MEASUREMENTS (USES S.C. TAX No. 1000-90-02-27 pew SCALE 1 "-30' HOUSE HOUSE �� (/e�Fc</NG MAY 6, 2005 CORNER ❑A CORNER JUNE 2�3� 06 SEPTIC TANK 36, 14, <\ IYOCTOBER 18?2005 REVISED W, 2005 ADDED IETLAD TE NNOTE COVER �, 46 NOVEMBER 10, 2005 REVISED SITE PLAN LEACHING POOL39• 27' O j�� NOVEMBER 13, 2007 LATH OUT BUFFER LINE COVER 1 (p, ? V AUGUST 4, 2009 LATH SET FOR SITE INSPECTION LEACHING POOL X 6C/c Y JUNE 5, 2012 UPDATE DATUM & FLOOD ZONES 25 28' ��" ly FEBRUARY 7, 2013, 2012 REVISE HOUSE LOCATION COVER 2 3Q ATF FEBRUARY 27, 2013 2012 REVISE PER SCDHS NOTICE 02/19/2013 S R N MARCh 26, 2013, 2012 ADD TESTHOLE �vVT 6r°3 / STR ° T MAY 14, 2013 FOUNDATION LOCATION 3�"J� FST 9' FE'T OCTOBER 3, 2013 FINAL SURVEY 2 DECEMBER 5, 2014 ADD PROPOSED POOL APRIL 10, 2015 RELOCATED PROPOSED POOL / Q.. JUNE 12, 2015 RELOCATED PROPOSED POOL J O / •e..e. �')2 F �� (SFS AREA = 25,868 sq. ft. TO TIE LINE 0.594 ac. p W CV � O o24 �o p FTs /QT C' �G' =c� TgirF Rogo ATF CERTIFIED: oZ �Q°o RJ KEVIN McDERMOTT o" O FATEMA MEAH Qo • �� 4 ?a? O T J.P. MORGAN CHASE BANK CV FST WESTCOR LAND TITLE INSURANCE COMPANY NOTES: 3�� \ F ? oRcti �s•2 1. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM x R s 2 s'�Q " O w w��pF�y e A F'Y' y US S l \ EXISTING CONTOUR EXISTING SPOT ELEVATIONS ARE SHOWN THUS:E SHOWN S-— -7— —— J j ^ Wg7FR LINE W k N' F s /`9a, 2. FLOOD ZONE INFORMATION TAKEN FROM: FLOOD INSURANCE RATE MAP No. 36103CO169H ZONE AE: BASE FLOOD ELEVATIONS DETERMINED j= V' TEST HOLE ZONE X': AREAS OF 0.2% ANNUAL CHANCE FLOOD; AREAS OF 1% ANNUAL � � / "� \ CHANCE FLOOD WITH AVERAGE DEPTHS OF LESS THAN 1 FOOT 40, �y est rn a. ?,a, wa0DraRy w 0 / S 11.1 OR WITH DRAINAGE AREAS LESS THAN 1 SQUARE MILE; AND AREAS PROTECTED BY LEVEES FROM 1% ANNUAL CHANCE FLOOD. LOT COVERAGE Ell, ti �0 i s 0. O e% ~ DESCRIPTION AREA % LOT COVERAGE 2 4p•s' l -:Roo;'`'"? n/ fes, �,� HOUSE 1,725 sq. ft. 6.7% Fes✓/A/��� 3�': .::::::: .. 42�, PORCH 200 sq. ft. 0.8% DECK 105 sq. ft. 0.4% pooh CRY 9R ` — PROPOSED POOL 592 s ft. 2.3% q. O .4' DJ I 2G ` 1 TOTAL 2,622 sq. ft. 10.t:G X I c��OP� • ° �6 J ` 2 TEST HOLE DA TA N �NF �,* (TEST HOLE DUG ON APRIL 18, 2004 AT 1:30 pm BY OTHERS) THE NYS FRESHWATER WET EL. 1 1.1` a Q I O I (F SUFFOLK ENVIRONMENTAL LAND BOUNDARY IS HUMUS v S� � 6) ON THE SURVEYPREPARED ONSULTING LINE TO 2' z �� V `r 1 � � \ C REVISED 61221, PR BY . Inc. E -� - S ` — 5 AS JOSEPH A. AS SHOWN DARK BROWN LOAM 3 ? rAkF FSG �� \¢ DETERMINED BY R. MARSH ON %28/05 �a dGEGNO, LAST ., d. 10 X BROWN SILTY LOAM � a 1 f' i V e Ld N 7�°4 \ NON D 7S, S � F� 1.5' NON+F STU AN 33 BROWN LOAMY SILT .. resr wFLL W ( I IrBUFF f�ATIONE S 2 19 3� 3.3' °'7 I I x .5 p I I � 1 1 ` \ J •�Q' PALE BROWN COARSE SAND p� 1S-4�` y A PREPARED IN ACCORDANCE WITH THE MINIMUM 27 STANDARDS FOR TITLE SURVEYS AS ESTABLISHED 1� o qNj � qC v> y< s ,� BY THE L.I.A.L.S. AND APPROVED AND ADOPTED � �yO ���9 ��Q,3 J EL. -1.2 123 FOR SUCH ASSOCIATION BY THE NEW YORK STATE LAND 0- WATER IN PALE BROWN �1- COARSE SAND 17 N.Y.S. Lic. No. 50467 UNAUTHORIZED ALTERATION OR ADDITION TOTHIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE Nathan Taft Corwin iii EDUCATION LAW. E COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR i.;r T- -- I EMBOSSED SEAL SHALL NOT BE CONSIDERED Land Surveyor r TO BE A VALID TRUE COPY. V JJJ I JAN 2 5 2017 _ CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE Successor To: StanleyJ. Isaksen, Jr. L.S. TITLE COMPANY, GOVERNMENTAL AGENCY AND Joseph A. In e nn L.S. L-7k c LENDING INSTITUTION LISTED HEREON, AND P 9 9 `---—- u TO THE ASSIGNEES OF THE LENDING INSTI- 17.1-71111 NSTI- Title Surveys - Subdivisions - Site Plans - Construction Layout SOt�:i'';i'; I(""fin TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. y PHONE (631)727-2090 Fax (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 t ZX�PAP� _.VWV lea po Ill I' CCpc �_ _ - -- �� - - -- = - All f 6 4a '75 40 7045 SCE. 1 n 2 fes' ol_ _UA PCF� cru a1 f F�, J 2 2017 77 T R BOARD OF 1t?U�T EES ` i S Y ` TOWN OF SOUTHOLD DATE 1YiAM ;q -7--��04 NI-" It r 'o �n� 1 t / 1� i { { s { f e t k i - °�-� -r_�z.X��_��r_1:Lt�►-�-i-.�-r_7�t� r7 �r t r r --- _.-...__-____--___._.__.._ -' --__ _ { Li — 1 WOO- T6 CN lk i r : { J \j r o f f � r i i — w.�+rim....�......wr...-�...a+..i.,.. wr-.�K..r.._o• ..�....wrev.•rwn. � �"a 70 Kai Ile If MAI { JOIN 2 5 2177 t { x � •_ s c ;... ,.-. i .�,yfi�r_ �,•- '• ..._ •si•a++ -• � yy.xr � Y• L'� �'�'tW •+E*P'�' ... ,�, •�— .' .,• is e.� - - .,�,�, ! _.. � ..'a' ... "_;.�,���ix.���_',�'' �..■ ..� -�. - *, .� _ ;'r=:, ....� .�. '"¢� � .,.Yi6. y•��� ' �' '� Vii+,. � s aliT *. M _ � w�• '.. 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IT - - .. . r Ate_ arm �t�a.ti � � ��,� - -r' - v� - ` `\., r -` '� �. `( �•. 17, tf 1 1-'(r� .� �- � � .,..pry .r .•.�:r �tl �. ��'�y •{ i / F _• �. ,� � � ,ter, , _1/ i / � ,,..., o, - - � - , y • i Ak •r.y ';. oE .'9. � r� f} •� �iy,j 1 , �TtiK�.�t• ��<,0.�V�` n jJ7. v •'� ..,� �'r �...aL � _ lwr�x.��Fi,�O '�,,y�i .,.� '�`C^-o `ri��s+'s �; ` . � �-► � •a .+ice ., A i _.a` •.r ` / r��r _. .�_ ......i..d..,.-,. - �� - �'. .. � `� �� ,�` til . � �_._.. --•----'_-____ ,M r i ' w'�`l+� �� � ,tit `J. o� ` •�� � :i ���� �` � s -'r � .+.._. ,. i��y�r .. � r�•e �f. J �(x:,; .. ti ,.�i y 9' ,u�y�y3 .� _ .. -. � _ _ N prl 4 arm "n400l fs SURVEY OF }� LOT 146 ,•�rn �� Q� MAP OF ovtl�+aOtS • ti'>zy10(`4hj`I'I' oo-1—E CEDAR BEACH PARK i a d(� b� , • . L7ni-Arm rj — _ - { FILE No. 90 FILED DECEMBER 20, 1927 :`?,HGF:•." !•• •I).-•l.irF-ATOFhEA.LTHScRVICES ( SITUATE II BAYVIEW ` A:;^LtC'EO'-'/O=KSFGP. OCT 2 s 2013 TOWN OF SOUTHOLD " K nos L?tIl torn — '0g --_ 11.sPc:- �lQ Iz-oos� SUFFOLK COUNTY, NEW YORK .+,. ,t ._..spa'an^w:+�3 iOr•, •'•.res ///���'1 _ I -�s.:-'adlor r�rSCrl hy:dsC a•Y ^..;•i r.•, .11,.'nd fa S.C. TAX No. 1000-90-02-27 SEPTIC SYSTE / `�I �•�, (US a 6e�awi.Ucry FORANJJUtfi1M OF y"•i��r' I SCALE 1 =30� 1. Q Y �� HOUSE HOUSE R� Es p"dwf/Gr !t MAY 6, 200$Go QA CORNER QB 2$O ,A Aj� C/p '1'G f lUa:__`rJ.H,!hcraPz�-T•hiS; JUNE 22, 2005 ADDED SITE PLAN SEPTIC TANK 9 •6r W,FIERJ OG�ceolLVastew�-•F1..: Em�nt OCTOBER 18, 2005 REVISED WETLAND NOTE COVER 36' 14• .?�, - NOVEMBER 10; 2005 REVISED SITE PLAN LEACHING POOL O NOVEMBER 13, 2007 LATH OUT BUFFER UNE 7� AUGUST 4 2009 LATH SET FOR SITE INSPECTION COVER 1 39' 27• (pV -/1 j i JUNE 5, 2012 UPDATE DATUM & FLOOD ZONES LEACHING POOL t� >ZZ -1z,T •,840 v,� FEBRUARY 7, 2013 2012 REVISE HOUSE LOCATION COVER 2 25' 28' =Ur •g S s, kgTE,R/���]• i FEBRUARY 27,M YH14,620 1, 2N12 AD TESTHD LOCATINE 02/19/2013 2.1 Q ,r9�0 Rf�jY� OCTOBER 3, 2013 FINAL SURVEY AREA = 8ft. (To ME UNE),0 594ac. tiry��• �, ��"' k kNg7F,p�c!0- moms., / o 2 N f O 1.ELEVATIONS ARE REFERENCED TO H.A.V.D.1968 DATUM cli EIOSONO SPOT E]FFAlI0N5tg ARE SHOWN THUS:rnn a EXISTING CONTOUR LUES ASHOWN Tip15:--•-7--- 2.FLOOD ZONE INFORMATION FLOOD NSURAN ERATE MMP Na 3603COIGN p \\hy •^ .ty ZONE AE BASE FLOOD ELEVATIONS DEIER14Nm k a fD?yy w :ONE x•. AREAS OF 0.75 ANNUAL CHANCE HOOD:ARM Or 15 ANNUAL Q EJ i^, g e f OQY I CHANCE FLOOD WITH AVTMGE DEPTHS OF LESS THAN 1 FOOT _ �+ '�l• • 'R y0(A OR NDN DRAINAGE AREASLE55 THAN i SQUARE MLE; CA qq O g '�• 3� �•-0• AM AREAS PROIEMED Br LtVEFS FROM 15 ANNUAL CHANCE FL000. ¢� G, tiff 14Ij / �f 15 1p . W 4 x. THE a dAci I y �n THE E6ROFAIENruWATER WEMNa BDINDARE is EQUAL _ 1 ` ` 1, 1 > ED 6 9 m o a N 70. ` No Kp 7qT 43*so- W 1 1 'tN N oK / 9383 , RA L�qr� \ •Ns¢, y -" V�y46• •f\ S'•s4, �G` ?� ' a� ST ITE DS FOR M.D APPROVED S ESTABLISHED AOOPfm !a/ BY THE Ns FOR AND SURVEYS ASDADOD A �j.,T vTy F�yP •8A� • -Y Tn LER USE Bt TOfaC STATE LAND o�yol C.A333y/�c 'G ���� 9�,PR'a'CAFT O}o'ej.�A F— SaaI�n,11C pied �tPLL e i f H. N.Y.S.Liz.N. SD467 ' i�IDy),��$ { ; UNAVINOR®ALIEMTINI OR AmmeN :a To THIS SURVEY SMIKIN 7M Or EDUCkIlON LAW. s°HE Nal`°R`SMTE Nathan Taft Corwin 111 n COPS OF T16 SDNYEY MAP NOF OFMYC ZIR 5 Z NVP _ P CO Land Surveyor TO SEA VAUD TRUE COPY r m ONLY TO PERSON HEREON THE S RUN -�! ONLY TO 11E PERSON FOR YAWM THE SURVEY 6 ANO ON 115 Successor To:S1aNeY J.baleen,Jr.LS. PREPARED, BF}y1F 7D THE i i ,•� NRE C9LwAO',cOIE%ARMAL AGENCY AND Joseph AL.S. Ingeg.D L -n 1 r A To THC SSDNEEs f SUEDTHE EE INNS AH91 YI V 70 7NE ASS&NFLS a THE IHEREO HAND lie Sarve Subdrvisiarts— Ste P1am — OYnsfructimN 1 [.:^� � rJ v ,L1fI0H1 H3AI61fA7lkS ARE HaT TRANSFERABLE Ys— L9YaD= y7 1 iI PHONE(631)727-2090 Fax(631)727-1727 I /I THE EXISTENCE of R7tiR5 OF WAY OFFICES LOGITFD AT IFAIUNG AOORQS AND/OR EASEMEN75 OF RECORD.IF �C56 Moro Road P.0 Bon 16 ANY,NO7 SHOWN ARE NOT GUARANTEED. irt,New York 11947 Jamespor%New Y9rk 11947 - 2 9 is 'OF ma 02 1 3 2 3N.) 07 Pofjvr pn 3 Olt UNC) Av 4 5 IXA ---------------- ------------------- TOM OF 51 13 3 O CEDARS��OLO IIA PO/Afr 14 �O"s "0"0 IV 2.0p4c 0 11 4IS07 28 2S WEST 24 C LAKE10 O e '0 is ---------- cr-- TOWN OF Solrrtow DR E 17 29 W (331 22 26.1 is 21 25 17A(.) Is 17 18 i 19 19 211 5 91 24 ma 1 IA(cj .2 3 HOG IV--CK BAY SECTION N COUNWOFSUFFOLK (:11 -al Property Tax SemceAgei i:::!,, 090 7— _NOTICE 12IJ !!�!:lIUUll IN 1 1, 4 Kevin MlcDermott 5 Acorn Lane Commack, New York 11725 February 1, 2017 Southold Town Trustees Southold, New York To Whom It May Concern: As per the request of the Trustees,pertaining to pending application of a building permit to improve the property in question,attached are documents pertaining to my property located at 405 Cedar Point Drive West, Southold, NY. This property was placed in an LLC,named KMAC Realty in May 2014. Supporting papers are attached. This is the only property held by KMAC Realty. I am the Chief Officer of this LLC and my wife, Fatema P.Meah,MD,is the only other member of the LLC. Sincerely, �2 Kevin in McDermott z Fatema P. Meah C,V 04-d -c- on 2-0-1 7 { EDITH RE NVJALD , Notary Public -State of New York N0. 01 RE6024237 Qualified in Suffolk County My Commission Expires May 3, 2019 Entity Information Page I of 2 NYS Department of State Division of Corporations Entity Information The information contained in this database is current through May 29,2014. Selected Entity Name: K MAC REALITY,LLC Selected Entity Status Information Current Entity Name: K MAC REALITY,LLC DOS ID#: 4580745 Initial DOS Filing Date: MAY 21,2014 County: SUFFOLK Jurisdiction: NEW YORK Entity Type: DOMESTIC LIMITED LIABILITY COMPANY Current Entity Status: ACTIVE Selected Entity Address Information DOS Process(Address to which DOS will mail,process if accepted on behalf of the entity) K MAC REALITY,LLC 5 ACORN LANE COMMACK,NEW YORK, 11725 Registered Agent NONE This office does not require or maintain information regarding the names and addresses of members or managers of nonprofessional limited liability companies. Professional limited liability companies must include the name(s) and address(es)of the original members,however this information is not recorded and only available by viewing the certificate. *Stock Information #of Shares Type of Stock $Value per Share No Information Available *Stock information is applicable to domestic business corporations. http://appext2O.dos.ny.gov/corp public/CORPSEARCH_F.NTITY WFORMATMINT9n „a S/zni,)n1 n Entity Information Page 2 of 2 Name History Filing Date Name Type Entity Name MAY 21, 2014 Actual K MAC REALITY, LLC A Fictitious name must be used when the Actual name of a foreign entity is unavailable for use in New York State. The entity must use the fictitious name when conducting its activities or business in New York State. NOTE: New York State does not issue organizational identification numbers. Search Results New Search Services/Programs Privacy Policy I Accessibility Policy I Disclaimer Return to DOS Homepage I Contact Us http://appext20.dos.ny.gov/corp_public/CORPSEARCH.ENTITY INFORMATION?p^na... 5/30/2014 r J f r \ OFFICE LOCATION: ®�*OF SO(/jy®l MAILING ADDRESS: Town Hall Annex ® P.O. Box 1179 54375 State Route 25 Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) G Telephone:hone: 631 765-1938 Southold, NY 11971 • O P O � Fax: 631765-3136 cOUNT`I,'� 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 16, 2017 Re: LWRP Coastal Consistency Review for K MAC REALITY, LLC SCTM# 1000-90-2-27 Eileen Wingate on behalf of K MAC REALITY, LLC requests an Administrative Permit to remove 60sq.ft. of existing second-floor deck, and 60sq.ft. of existing first floor deck; construct a new second floor roof deck; a new first floor deck; and a new seasonal screened in porch for a combined total of 705sq.ft. onto the southerly side of the dwelling. Located: 405 Cedar Point Drive West, Southold. SCTM# 1000-90-2-27 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. 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 tiredemeycr Ill, President uctopli"X town Hall Annex Michael J. Domino, vice-Pry `nt54375 Niarn Road P.O. Box 1179 James F. King,Trustee Southold, New York 11971-0959 Dave Bergen,Trustee Charles J.Sanders, "Trustee Telephone(631)765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD To: Southold-Town Building Department Re- Verification of Building Department Permit Requirements SCTM#: YKA-C, RN LII OW LLC., Property Owner Name: ' qd-a-D'I Date Sent to Bldg- Dept.: The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated below: YES NO _ the proposed project require a Building Permit? yVllthe proposed project require a variance determination from 2 ,Zoning Board of Appeals? ll any part of this application be considered as Demolition as 'described under Town Code? COMMENTS: 4ibrYature of Reviewer Date Yj � s0(/fh' Town Hall Annex John M.Bredemeyer III, President rad; © `�, Michael J.Domino Vice-President 54375 Main Road F".. ' e P.O.Box 1179 James F.King,Trustee r Southold New York 11971-0959 Dave Bergen,Trustee ,(} Telephone(631)765-1892 Charles J.Sanders,Trustee / U � jjj� Fax(631)765-6641 . 00BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application Wetland Permit Application VAdministrative Permit Amendment/Transfer/E tension Received Application: �V Received Fee:$ 100 VO I {Completed Application: f• pt� Incomplete: I JAN 2 5 2017 _SEQRA Classific ion: Type I Type II V Unlisted V?� Coordination:(date sent): 3��D �•� Southold Town 4 :LWRP Consistency Assessment Form: CAC Referral Sent: B_o�[r1 of Trusteed TDate of Inspection: _Receipt of CAC Report: _Lead Agency Determination: Technical Review: Public Hearing Held: •Z ' Resolution: Name of Applicant: - ~��� _ Mailing Address: C.�.GCQ� �7` 2 qq ASO t{ ( (� /197 Phone Number: 616 -917c? " F-339, Suffolk County Tax Map Number: 1000 - 9d 662 -O9,7- Property Location: �� � /'J(��i cx,�4J7',� (provide LILCO Pole#, distanti to cross streets, and location) AGENT: L� (If applicable) Address: --W-S— 144S1- LI l0s=' _i zZj /:C� Phone: �6—/& " 75 f Board, of Trustees Application GENERAL DATA Land Area(in square feet): 26i gzp (T S,r, Area Zoning: - z Previous use of property: S A�It Z-.,/ Intended use of property: Covenants and Restrictions on property? Yes _ �( No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? Yes No If"Yes'', be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project,require a variance from the Zoning Board of Appeals? Yes _.,k- 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.? YesIX--Lf'To M17-26-7`V-1 4::77C a6L74Z/ Does the structure(s) on property have a valid Certificate of Occupancy?—k—yes No Prior permits/approvals for site improvements: Agency Date c a ll�Ll�lCa p PEE :CR 3� a cn to H 12—'s V� No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?,�2_No Yes If yes, provide explanation: Project Description(use attachments if necessary): �Qe ho Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 11A 4 Lhod Area of wetlands on lot: square feet Percent coverage of lot: 7. % � - Closest distance between nearest a isting structure and upland edge of wetlands: feet /4:o Closest distance between nearest proposed structure and upland edge of wetlands: /61V feet Does the project involve excavation or filling? -- No Yes If yes,how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: = feet Proposed slope throughout the area of operations: S Manner in which material will be removed or deposited: Statement of the effect, if any,on the wetlands and tidal waters of the town that may result by reason of such proposed operations(use attachments if appropriate): I I APPLICANT/AGENT/REPRESIENTATIVEI TRANSACTIONAL,DISCLOSURE, FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and-employices.The purpose of this form is to provide intornmtion which can alert the town of possible conflicts of interest and allow it to take whatever action is necessa to avoid same Al YOUR NAME: _j� /�-7- (Last name,first name,.rpiddle 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,rparriage,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 dale 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. 'Che 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 applicTnt (when the applicant is a corporation); B)lite legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partnee,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of EO0� Signature. Print Natne Form TS 1 r 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 ossible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: (Last name,first name,.rpiddle initial,unless (Tare 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 ,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 ek__— 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 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 day of 20004011 Signature Print Name Form TS I x EW-em 1 1� L Board of Trustees Application AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS THAT H �/SHE IS THE APPLICANT FOR THE ABOVE (DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINEID 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 AIPPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLID 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. Signat of Property Ow er �1 SWORN TO BEFORE ME THIS , DAY OF b� C� . 20 1 eanjeu6iS s,heloN ` tary u lic 1 Aq S141 uo i eua eaopq (pauui}je jo) uaoms pue of pequosgnS Asmaa Rankin State of New York jloflnS}o/(}unoC Notary Public,State of New York County of Suffolk )110A m9N 10 a;etg No.01RA6274068 Subscrbed to a swom (or affirmed) before me Qualified in Suffolk County �L o tf is by Commission Expires 12/24/20 `�.. Not `s SignatureJcAhA K`: OCt'!r:i[_' -.06125349 t A Q}jali!ied in Suffolk CoLnty Commission Expires Apr 18,2017 1 Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) �cJ G✓l ��Wt," residing at (print name of owner of property) r (mailing address) 6 At✓K LaKQ- COW(Y— l `a he�rebY authorize (Agent) to apply for permit(s)from the Southold Bo d To Trustees on my behalf. (Ow is signature) 617.20 Appendix B Sliort Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part t -Project and Sponsor Information /YID_ i P r Name of Action or Project: Pe� Project Location(describe,and attach a location map): '*� Brief escrtptioti o Prop sed Action: ��.mar� `l Name of Applicant r Sponsor: Telephone: ^ I E-Mail: Address: City/PO: State: Zip Code: 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that ❑ 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 a�rov nmental Agency? NO YES Aid(If Yes,list agency(s)name and permit or approval: � � 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑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? ❑ _R ❑ b.Consistent with the adopted comprehensive plan? ❑ _M ❑ 6. Is the proposed action consistent with the predominant character of the existing built or naturalNO YES landscape? ❑ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: 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: R El 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: !V h — (—I 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: W ! ® ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? � El-1 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? El 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: El Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional Wetland El Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? 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 ©YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: 0N .®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: ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: \{}� 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? lfYes,describe: "1� ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name:. Date:Al Signature: _ Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the.following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 111���111i 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 © 1:1establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate 1:1reasonably available energy conservation or renewable energy opportunities? Ef 7. Will the proposed action impact existing: ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage Elproblems? [d 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environments impac . Town of Southold-Board of Trustees 3 G T ead Agency bate uvt,N VU President PrintType Na a of Responsible Officer in Lead Agency Title of Responsible Officer or Signature of RespW si e Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT 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 sim ficant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION , SCTM# - - - PROJECT NAME Z\ T The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board Building Dept. , Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g.capitaI ❑ construction,planning activity,agency regulation,land transaction) ❑ (b) Financial assistance(e.g.grant,loan,subsidy) (c) Permit,approval,license,certification: Nature,qnd extent of action• sem- �/0i'z6rml Aa 1,o10 SF 7Ds SF i P Location of action:— PE �_� Site acreage:_ Present land use: Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: (c) Telephone number: Area Code( ) (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 �O 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 M Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No ® Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria 'H Not Applicable F] Yes 11 No 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-El 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 No 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[�d 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 evaluatiop criteria. ❑ Yes ❑ No,9 Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Ye❑ NoIF-79 Not Applicable Attach additional sheets if necessary J1 WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in 1 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 0 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 B TITLE DATEJ*��