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TR-8979
Michael J.Domino, President ��OF SU!/ryO Town Hall Annex John M.Bredemeyer III,Vice-President h0 l0 54375 Route 25 P.O.Box 1179 Charles J. Sanders Southold,New York 11971 Glenn GoldsmithG Q � O Telephone(631) 765-1892 A. Nicholas Krupski �co O Fax(631) 765-6641 UNTY,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1433C Date: December 12, 2017 THIS CERTIFIES that the existing 52.3'x46' (1,721sq.ft.) irre ug larly shaped dwelling-, existing 39 10'x21' irregularly shaped deck attached to the side of dwelling; existing 8'x10' shed and to reduce the size of the existing garage from 14'x19' to 11.8'x14.5'• with the condition to establish and perpetually maintain a 15' wide non-turf buffer landward of the , bulkhead with no vegetation to be cut within said non-turf buffer area; At 1540 Smith Drive South, Southold Suffolk County Tax Map#1000-76-3-5 Conforms to the application for a Trustees Permit heretofore filed in this office Dated March 22, 2017 pursuant to which Trustees Wetland Permit#8979 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 existing 52.3'x46' (1,721sq.ft.) irregularly shaped dwelling; existing 39.10'x21' irregularly shaped deck attached to the side of dwelling; existing 8'x10' shed; and to reduce the size of the existing_garage from 14'x19' to 11.8'x14.5'; with the condition to establish and perpetually maintain a 15' wide non-turf buffer landward of the bulkhead with no vegetation to be cut within said non-turf buffer area. The certificate is issued to VICTOR FERRULLI owner of the aforesaid property. a d Authorized Signature OF SO!/l�, Michael J.Domino,President � ��� Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J. Sanders v, Southold,New York 11971 Glenn Goldsmith ® �O Telephone(631) 765-1892 � A.Nicholas Krupski cOUNTV Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: s Q Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction Y2 constructed Project complete, compliance inspection. ;INSPECTED BY: COMMENTS: i wP q c v"L% v i, v vu s 111.3 Ld �cJ ► L a CERTIFICATE OF COMPLIANCE: 1111111 IIII IIIII IIIII IIIII IIIII IIIII IIIII 11111 IIII IIII 111111 IIIII IIIII IIII IIII SUFFOLK COUNTY CLERIC RECORDS OFFICE RECORDING PAGE Type of Instrument: DECLARATION Recorded: 04/26/2017 Number of Pages: 6 At: 02 :14:40 PM Receipt Number : 17-0070677 LIBER: D00012910 PAGE : 260 District: Section: Block: Lot: 1000 076.00 03.00 005.000 EXAMINED AND CHARGED AS FOLLOWS Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $30.00 NO Handling $20.00 NO COE $5.00 NO NYS SRCHG $15.00 NO TP-584 $0.00 NO Notation $0.00 NO Cert.Copies $7.50 NO RPT $200.00 NO Fees Paid $277.50 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk County tar FL'" ffi PG�ORDFCx 017 Apr 26 02mi4:40 Phi JUDITH A. PASCALE Tis documerrt will be public CLERK OF nerd. Please remove all SUFFOLK COUHW - L CYCtt]��i29ii7 Security Numbers - nr to recording. Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps FEES /llg Fee 0CMortgage Amt. g 20. 00 1. Basic Tax 2. Additional Tax Sub Total SpecJAssit. � P Sub Total or Spec./Add. TOT.MTG.TAX Dual Town Dual County Held for Appointment of Ed- 5. 00 �a ' . u Transfer Tax Mansion Tax The property covered by this mortgage is •y f�J or will be improved by a one or two 15- 00 family dwelling only. Sub Total ZZ .S YES or NO Grand Total If NO,see appropriate tax clause on page# of this instru nth. i `�- 3383869 1000 07600 0300 005000 5 Community Preservation Fund el Property P T IIIIIIIVIIIVIIIVIIIVIIIVIIIVIIIIIIIIIII Ex Service R DHO A Consideration Amount $ Agency 26-APR-17 CPF Tai Due $ kation Satisfactions/Discharges/Releases List Property Owners Mailing Address Improved r, /� ` RECORDr&RETURN TO: Vacant Land 0 Q1(d TYP1 CO V S r.,- TD Sfi # I� TD Yy [l l V�- TD Mail to: Judith A. Pascale, Suffolk County Clerk 7 Title COMDany Information 310 Center Drive, Riverhead, NY 11901 www.suffolkcountyny.gov/clerk o.Name Title# Suffolk Count Record-m* & Endorsement P � � aye - ANTS nCOVEN 18-- day of April, 2017, by Victor Ferrulli, r . Dett TIOiR trade this .. r. Sou , 6� d to a Southold hereinafter referre FMUresi��3 at 1540 Smith Drive South, 'lq� W I T N E S S E T H : located W �iEAS, DuCLARANT(S) is/are the owner(s) of certain real property tag drive Iouth, Town of Southold, -COMty of Suffolk, State °of N'aw r'' r Section 76, Block TF€ york, described in the Suffolk County Tax Map as District 1000, ` bounded and described as set Forth in g Lot 05 which is €store particularly a ,�®xed hereto, hereinafter referred -to as the Property; p rtv is situated on lands within the jurisdiction of the- SAS, tt�e _ _ rustees of the Town of Southold (hereinafter the "Trustees") pursuant g, and of T and Chapter 2�� of the Town_ Code of the mown of Southold or its successor, to P the _ed zhe aronert— may thus be subject to z-s avt=-s:ivies cond::c_ --_ -- s to beim conducted; �,^ c'1�c=��"c= CS= �� �="`'S te�eS �3r i o_r E3 there made made application to the Trustees for a T ARA' '(S) the Wetlands Law of the Town of Southold to undertake certain ` vel= I€rSE3 -r=t to mss_ S I_t a�iv-ities,' and f a wetlands Permit to undertake WHEREAS, as a condition of the granting o such regulated activities, the Trustees required that.a 15` wide "non-turf buffer" tion to be cut within said non-turf and as i landward of the bulkhead with no vegetat A adjacent to and landward of adjacent properties; ovenant and agree as NOW, THEREFORE, the DEC,I�ARANT (S) do/does hereby C follows: completion of the aforementioned permitted 1) Upon the substantial comp tablished and perpetually maintained I5 activities there shall be es 15r z;a 77, jg "t�%t M M It 5 wide -non-turf buffer" as defined by Chapter 275 of the Town Code, to "A designated area where •turf grass, pesticides and fertilizers not perm i:jau-ed naxch ZZ are -i-tted, and as dear-ribed- it' Perin #897 2017 and as depicted on the survey prepared by PJM Land Surveying, PLLC last dated March 28th 2017 and stamped approved on March 31't 2017, see Exhibit "A" attached; and Z) These QQVeaa_ata si-ta-11 run with the land a-rx-d ahall be biia-dlixg Qti the DEECIARANT(S) , his/her/their heirs, assigns, purchaser6, or successors in interest and may only be modified after a public hearing and upon resolution of the Trustees. duly executed this instrument this IMS W��F, the owners) has/have 2011 4 1a CM)rdll Q .I RE 0011 smms UP IZFEW w2LK UFAM ss: before me the On the ,.2�day of in the year 20L7 appeared 4V personally i4nderslX Id Notary P?*ubl' in and for said States Le personally known to me or proved to me on the basis of ZLA�u satisfactoryal (s) whose name Es) is/are subscribed to — - evidence to be the individual the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity, and that by his/her/their signature(s) on the instrument, the individual or the persons on behalf of whic he individual(s) act d, executed the jastrument. Notary Publi GERALDINE HACKETT 2 NOTARY PUBLIC-STATE OF NEW YORK No.01 HA6174215 aualified in Suffolk County My Commission Expires 09-17-2019 er BIWACKIX&K ONLY PRIOR-§T)RF4MRT1Y%.G0R FFTTNr� - sty p`."-- :- q Z17� PMpeny Description mirai ax 5:{ai�:$�r� ° h� ' •9�y;3`^^ Y�m�+v��i.v'b.?^'"`'�-�. ,.- - A :'.,)t�`S`�,.'-,�, #C,VNDU fD 'A' NMI MRAULLI AM that oartsl.a plot, plena or parer,$& of land, with the buildings sad laprovesents thereon erected, situate, lying and being at hayView, near Southold, in the Town of Southold, County of Suffolk tud State of New York, being known and designated as the easterly stens-half of Lot 42 and the wssterly thrss-fourths of Lot 41 on a stain awp entitled, •lisp of Goose flack, situate at sayview, Town -F of old, luffalk County, V,Y,, owned by a. W, Smith A ions, =ft br Otto t#, Van Tuyl, Licensed Surveyor, Ossenport, N.Y, and ILUd U the Suffolk County Clerk's Office on Ncrember 23, 1942 as Sad bY FA10 Xv. 1663, said premises being more particularly bounded ANUM1W as follows t 3 ? `. at a point an the curved southeasterly lids of Smith r 37.10 fat northeasterly along said southwesterly line „`moi z fry m stake uet at the northwesterly corner of Lot 43, as sham on a imp antitlid, Nap of oaoi- 10ii-k_iitusle at WayViii",-Nivi fid, Suffolk, fi.Y., made by Otto W. Van Tuyl, February 27, Q and =fined in the Suffolk County Clark's Office as N&V No. - 9011n Of beq&zftUq being the northeasterly corner of ;e y tabs cganreyed by 4sovge w. Smith a fans 4.,h34;:tixi tai seid Paint of beginnin running !! = IMM MOM C=Vmd 202tbsasterly line of faith Drive CRT2e Sett having a radius of 130 .0 lest, a .w 40_0 X"ft to land conveyed or about to be conveyed by we adwa d stets Inc., to Sprague; gamma 2SWACE along said land conveyed or about to be conveyed to " AVIC109M, south it degrees 44 winutea 30 seconds east, a distance of M®90 fast to the Shore of a proposed canal) TREMS along said shore of said csnal, South 47 degrees 00 minutes east a distance of 127.50 feat to said land conveyed or About tb be Conway" to Rispertl TfiflNCX along said land conveyed or about to be conveyed to Rispert, north 0 degrees 35 ainutaa 10 seconds west, a distance of 22442 fast to the point of begineing according to survey of Otto W. Van Ztiyl, Licensed Surveyor, dated April 10, 1953. SSL 11000-076.00-03.00-005.000 '1US YS OR WILL " 2WROVia RV A ONN alt Wo FAMILY DWEMINO ONLY, �a.^,".Y. {i.-'e y3'•-1'= . rFa � -^.i•zrN' }21'x�.y i _��_'v _ - 1.y;..�._-'V..s�r-�i:•- - 9 000ll b0• D - I PROP`-GAR 'TQ E _ MODIFMD'AS;;TOFE [jl EX. RESIDENCE SE! GAROF 2.9'N Z I �o PROP-GAR. , } r ' MODIFICATIONt 03 EX.BLDG. I42 ROP.G 2.9N 1.9�S' ;s,•#'y �s ffi,LPAR- s - I$.DG m BLDG. es Q6 2.9rN 29N ' .42 - EE r R p 1 LOT Rag �r�'�''-2��_r.;`�.`':°{�e�:t`' •.tip=,� � DEI'A7L X y <<,r '• f�,�P'»�_,�;.--`_ _ Lzv - "h'i71Y2URF —A'�AUJA APPROVED BY ; BOARD OF.TRUSTEES; TOWN OF SOUTHOLD S4700010001 w e DATE MAW&3�I io�7 127.50' 's wo UM wa t SM Nm aimmo m BE•V>fD x s afioE x M a IF OF oPrsrs oR mrim� sowN RCN LM oeimvoeN�s TO 711E MMM30 M �i p�Nm100P6 Nor sola.PRWM;,cQain uuiJ�56 wiE"a IF sFr AS A PART F Pons.Paras ermm+r•.aNmtta m etattN UNAIII}I ALIERAiION ORI AS A PART OF if05 MNEY N77 OR SNR-OF�WAY aF .6 Nrl.[oT 91rteN - - ADOMON TO RV SUEY IS A i PJM LAND SURVEYING,PLL VIOLATION Oq SECMON 72M OF 132 CLYDE STREET/SLTTE 16, NEW YORK STATE EDUCATION V.W. WEST SAYVII.LE.NY 111796 7EL,631-563-0400 pims AO COM RVbY1NG® 5808' 1 REVISIONS _ oT-Pfo 41&42 ray, DUWAM q 16Zi76 r= "— ok:GOOSE NECK DOS DOM 41' 'NOVEMBER22 1948 NO:1663 COIJNIY:SUFFOLK DEzjL �4sT- j _ AIDBL�r..+C �"CGPc CE T�sl---f +m ; c• `� MAR 3 p 2011 I` TI[lATE:BAYVIEW TOWN OFSOUTIiOLD �t��T )IL mc s o f! CERTIFI M TO: TPfLE NO.:— EE` ANO%W-0 COPY r _ DRAWN:PM CI;ECKED BY:PM SCALE:1"=40' DISTRICI':1000'- t Sg(;IgON:76� '"''HLOCK'03°R a4 fA {�t RI', �,�� i � • �' �.'� - ` `. 'i. , ,�. , • fir.`'? it :♦ 1 f ' ,rail Jam. y 3.� •4'� - . . 1 A t 1 ) - i' 1` r .! . I i I 1 i hi . i t 11 �� �, r�r_�,.._:.i . .•/• -- i r- i 1 I II ,.. . . rA' . / r -irrnrrA 11 �,.u. 1 .- :..• �1 it- i 1 r 1 . 1, r - I \-Z �:It71• ..i i i• 1 `=� ApA _ t j T1 ml: � -ra ®F SO�l Michael J. Domino, President � yQIO Town Hall Annex John M. Bredemeyer III,Vice-President 54375 Route 25 l [ 1 P.O. Box 1179 Charles J.Sanders �, Southold,New York 11971 Glenn Goldsmith Telephone(631) 765-1892 A.Nicholas Krupski l9'COUf 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 TERMS AND CONDITIONS The Permittee Victor Ferrulli residing at 1540 Smith Drive South Southold,New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will,at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved,but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees,the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required, upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. 8. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety(90)calendar days of issuance of this pen-nit. 9. That the said Board will be notified by the Permittee of the completion of the work authorized. 10. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. 11. No right to trespass or interfere with riparian rights. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. SOF SOOT Michael J.Domino,President �O� y®�O Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 Charles J.SandersP.O.Box 1179 y � Southold, New York 11971 Glenn Goldsmith ® �@ Telephone(631) 765-1892 A. Nicholas Krupski ��C�UNTV,� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 22, 2017 Richard Trpicousky 173 North Main Street, #152 Sayville, NY 11782 RE: VICTOR FERRULLI 1540 SMITH DRIVE SOUTH, SOUTHOLD SCTM# 1000-76-3-5 Dear Mr. Trpicousky: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, March 22, 2017 regarding the above matter: WHEREAS, Richard Trpicousky, on behalf of VICTOR,FERRULLI, applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated February 9, 2017, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policy 6.3 of the Local Waterfront Revitalization Program to the greatest extent possible through the imposition of the following Best Management Practice requirements: the issuance of a permit for the structures, and the installation of a 15' wide non-turf buffer landward of the bulkhead; and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application March 22, 2017, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that for the mitigating factors and based upon the Best Management Practice requirement imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, RESOLVED, that the Board of Trustees approve the application of VICTOR FERRULLI for the existing 52.3'x46' (1,721sq.ft.) irregularly shaped dwelling; existing 39.10'x21' irregularly shaped deck attached to the side of dwelling; existing 8'x10' shed; and to reduce the size of the existing garage from 14'x19' to 11.8'x14.5'; with the condition to establish and perpetually maintain a 15' wide non-turf buffer landward of the bulkhead with no vegetation to be cut within said non-turf buffer area, and as depicted on the survey prepared by PJM Land Surveying, PLLC last dated March 28, 2017, and stamped approved on March 31, 2017. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) Fees: $50.00 Ve trulyyo rs, �J Michael J. Domino President, Board of Trustees MJD/dd CERTIFICATIONS HEREON SIGNIFY THAT THIS PUT OF PROPERTY IS A TRUE AND CORRECT REPRESENTATION OF A RECENT SURVEY MADE UNDER MY DIRECTION IN ACCORDANCE WITH THE EXISTING CODE OF PRACTICE LAND SUVEYORS BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS.SAID CERTIFICATIONS SHALL RUN ONLY TO THE PERSON WHOM THE SURVEY WAS PREPARED AND ON THEIR BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON.THIS CERTIFICATION IS ONLY FOR THE LANDS DESCRIBED HEREON, ITS NOT A CERTIFICATION OF TITLE, ZONING,OR FREEDOM FROM ENCUMBRANCES. CERTIFICATIONS ARE NOT NOT TRANSFERABLE TO ADDITIONAL OR SUBSEQUENT OWNERS. e , o / g-/ a S� 0.00 R 14° °0' L' N FE FE O.L.E/W O.L.N/S FE 0.2'E PROP.GAR. TO BE 0.55 DSS MODIFIED AS TO MATCH V' EX. RESIDENCE SETBACK Z I 1 000 PROP.GAR. OF 2.9'N 0 d Jtt MODIFICATION I N � 0 11 ti PROP.GAR. 2.9N EX.BLD G. 142 0 MODIFICATIONI \ 1.91S �. - BLDG. 8Sl 1.91s o� o BLDG. 06 'BLDG. a 2.9 N P/O LOT � * 2.9W 4 O 24,1, 42 1 �' -SHED S, 12•Z � ` '_ 1.4'S o ?� o P/O LOT sHED "� 6 q� FJ•II FRAME O.L.N/S 41�q' q a SHEDS 1.9'^6. t3 a p 1FTRAME ` a DWEL NG DETAn" N - N 0� P/O LOT P/O LOT p� 42 41 W LANDyj' / CEN RN� all OIV RINWA9TA OF s � APpR)G— H wA�t L� Dom APPROVED BY + S 47000foorr = BOARD OF TRUSTEES 127.50' TOWN .OF SOUTHOLD DATE` MA�ec 3l,201 THE OFFSETS OR DIMENSIONS SHOWN FROM THE IMPROVEMENTS TO THE PROPERTY LINES ARE FOR A SPECIFIC PURPOSE AND USE,AND THEREFORE ARE NOT INTENDED TO BE USED AS A GUIDE IN THE ERECTION OF FENCES, WALLS, POOLS, PATIOS, BUILDINGS,ADOTIONS TO BUILDINGS OR ANY OTHER IMPROVEMENTS.SUBSURFACE AND ENVIORNMENTAL CONDITIONS NOT SHOWN. PROPERTY CORNER MARKERS WERE NOT SET AS A PART OF THIS SURVEY. EASEMENTS AND OR RIGHTS—OF—WAY OF RECORD, IF ANY, NOT SHOWN. PJM LAND SURVEYING PLLC UNAUTHORIZED ALTERATION OR , ADDITION TO THIS SURVEY IS A _ 132 CLYDE STREET/SUITE 16 VIOLATION OF SECTION 7209 OF WEST SAYVILLE,NY 11796 NEW YORK STATE EDUCATION LAW. TEL:631-563-0400 FAX-631-563-5808 PJMSURVEYING®AOL.COM t&ED /O 41 &42 REVISIONS L� '��`' ^ 1F:GOOSE NECK OAR MODIFICATION 10/24/16 DID DOCKDIMS. 01/23/17 :NOVEMBER 22 1948 NO: 1663 COUNTY:SUFFOLKADDKDIMS. 02/02/17 ADD DETAII. 03/06/17 MAR 3 0 2017TE:BAYVIEW TOWN OF SOUTHOLD ADD BUFFER 03/28/17 COPIES OF THIS,SURVEY MAP NOT r �ERTIFIED TO: TITLE NO.:------ BEARING THE LAND SURVEYOR'S EMBOSSED SEAL AND SIGNATURE SHALL NOT BE CONSIDERED A TRUE } AND VALID COPY Southold fown p aB�rd of Tri tgYS J PROJECT NO.:2015-58 DRAWN:PM CHECKEDBY:PM SCALE: 1"=40' DISTRICT: 1000 SECTION:76 BLOCK:03 LOT(S):05 Michael J.Domino,President o�OS�FFOea,` Town Hall Annex John M.Bredemeyer IIl,Vice-President GW 54375 Route 25 Charles J. SandersN = P.O.Box 1179 Glenn Goldsmith d Southold,NY 11971 A.Nicholas Krupski Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: VccTvp- F—G-u l r✓l 4o eK j 7"R-PfcovsJg Please be advised that your application dated 1:jF6 R1 900 has been reviewed by this Board at the regular meeting of Memel- ZZ, 201 and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1St Day of Construction ($50.00) &u-Aso Stvaq us d / Y2 Constructed ($50.00) Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) The Permittee is required to provide evidence that the non-turf buffer condition of the Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: ' f �� TOTAL FEES DUE: $ 50,6-0 BY: Michael J. Domino, President Board of Trustees Michael J. Domino,Presid, �OS� Co � Town Hall Annex John M. Bredemeyer III,Vice-President ��� Gym 54375 Route 25 Charles J. Sanders � z P.O.Box 1179 Glenn Goldsmith � Southold,NY 11971 A.Nicholas Krupski ?� p��S Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 3!``�l'? Completed in field by: N• P���� Richard Trpicousky on behalf of VICTOR FERRULLI requests a Wetland Permit for the existing 52.3'x46' (1,721sq.ft.) irregularly shaped dwelling; existing 39.10'x21' irregularly shaped deck attached to the side of dwelling; existing 8'x10' shed; and to reduce the size of the existing garage from 14'x19' to 11.8'x14.5'. Located: 1540 Smith Drive South, Southold. SCTM# 1000-76-3-5 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool):_100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet 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: I II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: 0 ISs+I� l,1 Z � Cwe O( becv\ COO W4, 19 �tots.' Present were: J. Bredemeyer M. Domino G. Goldsmith L/N. Krupski C. Sanders Other Page 1 of 2 Michael J. Domino,Presidi Q gfF01 l Town Hall Annex John M. Bredemeyer III,Vice-President j�� ��,�, 54375 Route 25 Charles J. Sanders C P.O.Box 1179 CA Glenn Goldsmith wc� PP? Southold,NY 11971 A.Nicholas Krupski rlha� p Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: Richard Trpicousky on behalf of VICTOR FERRULLI requests a Wetland Permit for the existing 52.3'x46' (1,72-1sq.ft.) irregularly shaped dwelling; existing 39.10'x21' irregularly shaped deck attached to the side of dwelling; existing 8'x10' shed; and to reduce the size of the existing garage, from 14'x19' to 11.8'x14.5 . Located: 1540 Smith Drive South, Southold. SCTM # 1000-76-3-5 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: 1. 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 • k r ' 4 •e _ � ` l'r- �,� ����rR���.�� -"��:`�.. »� -.�' x '11 uY" �c.• k' - ■ r •, . . og YLI odw .-yoffAL r . • �. �yF � •M" -�. -�► ';'ikir Ferrul I i 5r , + L r - Irk In VA Allo dm It 7•a .■ r. rte■�� a�j' r a �,'� ��_Q�'.i4�. .. �*•'p,•+ � ,• �� Y: ` �y ,�/•}•.tea .�r `�a •�r R�iP. 5.���'- �, �.ea..��a a,. • s� „tea � � r 1� ► `} � �i�.l`• '�' •� '��'' .' ` •� F-. 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Trustee )Southold, New York 1.1971-0959 Dave Bergen, Trustee Telephone(631)765-1892 Charles J.Sanders,TrusLce OIyC�(I Fa_e(631) 765-6641 'BOA-RD OF TOWN TRUSTEES D TOWN OF SOUTHOLD FEB 16 2017 To- Southold-T_ow6 Building Department BUII.ID3�TG DE". Re- Verification of Building Department Permit Requirements To"OFSotTT C"I_D SCTM#: Property Owner Name: ' FEVLL� Date Sent to Bldg- Dept-: �'��•� / The Office of the Board of Trustees is forwarding the above referended application for verification of the Building Department's permitting requirements stated below: YES NO a Will the proposed roject require a Building Permit? 9 ,-an- l �[I the'roposed project require a variance determination from e Zoning Board of Appeals? Will any part of this application be considered as Demolition as 'described under Town Code? COMMENTS: - r Sig a re of i,evlewer Date �e OFFICE LOCATION: s® MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Telephone: 631 765-1938 Southold, NY 11971 ® a0 P ® Fax: 631 765-3136 C®UNTi,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: March 17, 2017 Re: Local Waterfront Coastal Consistency Review for VICTOR FERRULLI SCTM# 1000-76-3-5 Richard Trpicousky on behalf of VICTOR FERRULLI requests a Wetland Permit for the existing 52.3'x46' (1,721sq.ft.) irregularly shaped dwelling; existing 39.10'x21' irregularly shaped deck attached to the side of dwelling; existing 8'x10' shed; and to reduce the size of the existing garage from 14'x19' to 11.8'x14.5'. Located: 1540 Smith Drive South, Southold. SCTM# 1000-76-3-5 i The proposed actions have 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 INCONSISTENT with the below Policy Standards and therefore is INCONSISTENT with the LWRP. Policy 6. Protect and restore the quality and function of the Town of Southold ecosystem 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions The as-built structures were constructed without a Wetland Permit. In the event the action is approved, the installation of a non-turf, vegetated buffer is recommended landward of the wetland. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Peter Young,Chairman Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O.Box 1179 Southold,NY 11971 Telephone(631)765-1889 Fax(631)765-1823 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., March 15, 2017 the following recommendation was made: Moved by Peter Young, seconded by Greg Williams, it was RESOLVED to SUPPORT the application of VICTOR FERRULLI to maintain existing conditions of wood deck, existing garage, maintain existing single-family dwelling and shed, and modify garage to reduce size as per Zoning Board of Appeals. Located: 1540 Smith Drive South, Southold. SCTM#76-3-5 Inspected by Peter Young The CAC Supports the application with a 15' non-turf buffer landward of the high-water mark. Vote of Council: Ayes: All Motion Carried BOARD MEMBERS �� soar Southold Town Hall Leslie Kanes Weisman,Chairperson ��� yQ� 53095 Main Road•P.O.Box 1179 h O -Southold,NY 11971-0959 Eric Dantess Office Location: Gerard P.Goehringer G Town Annex/First Floor,Capital One Bank George Horning �Q ® YO 54375 Main Road(at Youngs Avenue) Kenneth Schneider Irou y,� Southold,NY 11971 http://southoldtown.northfork.net ZONING BOARD OF APPEALS TOWN OF SOUTHOLD Tel.(631) 765-1809• Fax(631) 765-9064 November 4, 2016 Richard Trpicovsky 173 North Main Street Sayville,NY 11782 RE: Request for De Minimus determination #6952, Ferrulli, 1540 Smith Drive South, Southold Dear Mr. Trpicovsky; I have reviewed your letter dated September 7,2016 and your submission of the revised survey received on November 1, 2016 (no revision date shown)requesting a de minimus determination in the above referenced Zoning Board of Appeals decision. You are requesting that that the Board change the side yard setback of 3.7 feet from the southerly lot line granted in ZBA#6952 to 2.9 feet, which is consistent with the side yard setback that the residence maintains. The Board members and I discussed your request at our November 3,2016 Regular Meeting work session. Based upon the information provided,Uwe have determined that your request is de minimus in nature because the submitted survey depicts the intent of the Board's determination which requires that the setback be consistent with the principal structure and further conclude that no additional nonconformity will be created. This de minimus determination is conditioned upon the submission of a final survey that eliminates the area of the garage to be removed and properly displays a revision date. I will instruct the office to send a copy of this letter,a stamped revised copy of final survey and your de minimus request to the Building Department, so that you can apply for a building permit. If you have any questions,please call the office. in erel E sli n s lWeisman Chairperson cc: Michael Verity, Chief Building Inspector BOARD MEMBERS Southold Town Hall Leslie Kanes Weisman,Chairperson ���rg SDiy®l 53095 Main Road•P.O.Box 1179 p Southold,NY 11971-0959 Eric Dantes y Office Location: Gerard P.Goehringer Town Annex/First Floor,Capital One Bank George Homing '`cam ^��� 54375 Main Road(at Youngs Avenue) Kenneth Schneider �ycou Southold,NY 11971 http://southoldtown.northfork.net REC IVc�E® ZONING BOARD OF APPEALS c� TOWN OF SOUTHOLD Tel.(631)765-1809•Fax(631)765-9064 PJUM 2 2 2016 FINDINGS DELIBERATIONS AND DETERMINATION 05outhold Town Clerk MEETING OF JUNE 16,2016 ZBA FILE: 6952 NAME OF APPLICANT:Victor Ferrulli PROPERTY LOCATION: 1540 Smith Drive South, Southold,NY SCTM 1000-76-3-5 SEQRA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type II category of the State's List of Actions,without further steps under SEQRA. SUFFOLK COUNTY ADMINISTRATIVE CODE: This application was referred as required under the Suffolk County Administrative Code Sections A 14-14 to 23, and the Suffolk County Department of Planning issued its reply dated April 18, 2016 stating that this application is considered a matter for local determination as there appears to be no significant county-wide or inter-community impact. LWRP DETERMINATION: This application was referred for review under Chapter 268, Waterfront Consistency review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. The LWRP Coordinator issued a recommendation dated May 26, 2016. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to us, it is our recommendation that the proposed action is INCONSISTENT with LWRP policy standards and therefore is INCONSISTENT with the LWRP because "The as-built structures were constructed without the benefit of(ZBA)Board of Review."Furthermore,"The setbacks(including encroachment onto the adjacent parcel) to the southern property line for the as-built structures do not support the character of the community and built environment of the neighborhood."However,with the alternative relief granted and the conditions imposed herein, the Board finds that the proposed action is now CONSISTENT with LWRP policy standards and therefore is CONSISTENT with the LWRP PROPERTY FACTS/DESCRIPTION: The applicant's property is a .476 acre waterfront parcel in the R-40 Zoning District. The parcel has 40.00 feet along Smith Drive South, 268.98 feet along the northerly property line which is adjacent to a residential parcel, 127.50 feet along Goose Neck Creek to the westerly property line, and 226.63 feet along a residential parcel bordering the southerly property line. The property is improved with a single family dwelling including a wood deck, an "as built" non-conforming, enclosed carport that encroaches upon neighboring property, and an "as built" non-conforming shed located in a side yard, as shown, with building setbacks, and a sketch of proposed building alterations,on the survey drawn by PJM Land Surveying,PLLC, dated March 25,2015,and on the site plan T-1, drawn by Fishers Engineering Services,P.C.dated October 19,2015. BASIS OF APPLICATION: Request for Variances from Article XXIII Section 280-124 and Article III Section 280-15 and the Building Inspector's February 3, 2016 Notice of Disapproval based on an application for building permit to legalize and make changes to `as built' additions and alterations to existing single family dwelling and Page 2,June 16,2016 #6952,Ferrulli SCTM# 1000-76-3-5 accessory shed, at; 1) less than the code required single side yard setback of 15 feet, 2) less than the code required total side yard setbacks of 35 feet,3) `as built' accessory shed located in other than the code required rear yard. RELIEF REQUESTED: The applicant requests variances in order to make alterations and additions to "as built" construction with a single side yard setback of+/- 1 (one) foot, where 15 feet is required, a combined side yard setback of+1-15.5 feet,where 35 is required, and an"as built"shed located in a side yard,where a rear yard area is required by Code. ADDITIONAL INFORMATION: A letter was received from applicant's neighbor, Greg Tyler, dated May 25, 2016, indicating his support of applicant's petition to legalize the"as built"structures. FINDINGS OF FACT/REASONS FOR BOARD ACTION: The Zoning Board of Appeals held a public hearing on this application on June 2,2016,at which time written and oral evidence were presented. Based upon all testimony, documentation,personal inspection of the property and surrounding neighborhood,and other evidence,the Zoning Board finds the following facts to be true and relevant and makes the following findings: 1. Town Law&267-b(3)(b)(1). Grant of alternative relief will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. A minimum side yard setback of 3.7 feet will be established along the adjoining westerly lot line, removing the structural encroachment. The detached shed in the non-conforming side yard is aligned back to back with the neighboring shed of the same size and a front yard location, as a possible alternative, is not characteristic of the neighborhood 2. Town Law 4267-b(3)(b)(2). The benefit sought by the applicant cannot be achieved by some method, feasible for the applicant to pursue,other than area variances because the existing dwelling has a non-conforming side yard setback of 3.7 feet,and the existing shed is located in a non-conforming side yard. 3. Town Law §267-b(3)(b)(3). The variances granted herein are mathematically substantial, representing 75% relief from the code for the single side yard setback of 3.7 feet, 52%for the combined side yard setback, and 100% relief for the side yard location of the shed. However,the structural encroachment along the westerly lot line will be removed,and the shed is located a far distance from the seaward side of this waterfront property. 4. Town Law§267-b(3)(b)(4)No evidence has been submitted to suggest that the variances granted by alternative relief in this residential community will have an adverse impact on the physical or environmental conditions in the neighborhood.The applicant must comply with Chapter 236 of the Town's Storm Water Management Code. 5. Town Law§267-b(3)(b)(5). The difficulty has been self-created. The applicant purchased the parcel after the Zoning Code was in effect and it is presumed that the applicant had actual or constructive knowledge of the limitations on the use of the parcel under the Zoning Code in effect prior to or at the time of purchase. 6. Town Law §267-b. Grant of alternative relief is the minimum action necessary and adequate to enable the applicant to enjoy the benefit of "as built" and proposed construction, and an "as built" shed currently located within a side yard area, while preserving and protecting the character of the neighborhood and the health, safety and welfare of the community. RESOLUTION OF THE BOARD: In considering all of the above factors and applying the balancing test under New York Town Law 267-B, motion was offered by Member Horning , seconded by Member Dantes, and duly carried,to Page 3,June 16,2016 #6952,Ferrulli SCTM# 1000-76-3-5 GRANT the shed location as applied for, and GRANT ALTERNATIVE RELIEF as follows: A minimum southerly side yard setback of 3.7 feet and combined side yard setback of 18.2 feet is granted for the single family dwelling. SUBJECT TO THE FOLLOWING CONDITIONS: 1.A minimum side yard dwelling setback of 3.7 feet will be established along the southerly lot line. 2. The encroachment of the "as built" structure onto neighboring property along the southerly lot line will be removed. That the above conditions be written into the Building Inspector's Certificate of Occupancy, when issued. Before applyfng:for a buildingep rmit, the applicant or agent must submit to the Board of Appeals for approval and filing, two sets of the final survey, conforming to the alternative relief granted herein. The ZBA will forward one set of approved, stamped drawings to the Building Department. Failure to follow this procedure may result in the delay or denial of a buildingpermit, and may require a new application andpublic hearing before the Zoning Board of Appeals. Pursuant to Chapter 280-146(B) of the Code of the Town of Southold any variance granted by the Board of Appeals shall become null and void where a Certificate of Occupancy has not been procured, and/or a subdivision map has not been filed with the Suffolk County Clerk,within three (3)years from the date such variance was granted. The Board of Appeals may,upon written request prior to the date of expiration, grant an extension not to exceed three(3) consecutive one (1)year terms. Vote of the Board.- Ayes: Members Weisman (Chairperson), Schneider, Dantes, Horning, Goehringer. This Resolution was duly adopted(5-0). T � Leslie Ka es Weisman,Chairperson Approved for filing 1 /7 /2016 � (/�y John M.Bredemeyer III,President ®f S® Town Hall Annex�� ®� --�- -—Michael J..Domino,Vice-President— h_ _ O _.____ ______543.7.5__Route25___ . P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski Telephone(631) 765-1892 Charles J.Sanders -UW '� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Zoastal Erosion Permit Application _Wetland Permit Application Administrative Permit _Amendment/Transfer/Extension V. Received Application: Z.qL l7 Received Fee:$ Completed Application 4 l ( Incomplete rj SEQ RA Classification- Type I Type 11 Unlisted 71, FEB 9 2017 k Coordination:(date sent) 3� 1-7 LWRP Consistency Assessment Form ` VE� CAC Referral Sent: Sat,tfialr;Town i Date of Inspection: 3, 1 j I Bnarci ofi Tres'z e -� _Receipt of CAC Report: _Lead Agency Determination: Technical Review: Public Hearing Held: moi,2-Z l Resolution: Name of Property Owner(s) Address 100 Sf-1 ,111\ IN7 -QO(/,fk '�)Wtj.d Phone Number:(c3i) 91 r C9 /Y6 Suffolk County Tax Map Number: 1000 - - - -��� Property Location: �/ 0 Sin,VX JM S'oWf-ti �C)`ti•�O'/� (provide LILCO Prole#, distance to cross streets, and location) AGENT: 2 i Gly %r d -C .f/�v (If applicable) Address: o A �� i� � ) e ? , — Phone: 6 31 'P �1 card of Trustees Applicata — ------- —GENERAZDATA�- ------- -------- ------------- Land Area(in square feet): _ �{ (, Area Zoning: 'R Previous use of property: N d4 f G ni , Intended use of property: i (G of ---? Covenants and Restrictions on property? Yes No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes No If"Yes",be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project,require a variance from the Zoning Board of Appeals? Yes No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? ---V--Yes No 6-0,--a P 4,, 6 e .�nvu°1 is e cl 4 'r-n^P/Y G-,r•{--�. 213,1 Does the structure(s) on property have a valid Certificate of Occupancy? i\ Yes No Prior permits/approvals for site improvements: Agency Dat i f%, 4-e 1 y'/(0I �4)--9-h s� 76A- b ns2, -�fte1/ L No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?1�_No Yes If yes,provide explanation: r/ f Project Description (use attachments if necessary): 1�(i ly./ Al h nn �� .,,,�, /(9 r---pV 3 y 6 i r r�,,,1 / I T`r`���� CL,C 1•/ �'� l 0 She�,Q CwavrJ Mod, y 7' `� �� ( cQcAc-f F�-2, 5 pe f 2� Pr Co y � )ard of Trustees Applicat � -------T__----- - WETLAND%TRUSTEE-LANDS APPLICATIOYDATA T—�-- Purpose of the proposed operations: fo tx, pproi-e._ a wd o4 c ;,✓ ot C Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: ' feet w�Te/' {-rte Does the project involve excavation or filling? r4— 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: 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): 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part I -Project and Sponsor Information Name of Action or Project: m \l rie Grp Dc C Project Location(describe,and attach a location map): 0 'rz,t*I, 0-r— OLJ 16P r � Brief Description of Proposed Action: f Mwl r& rJ -P .4t6 li✓i'-/- `d Co-/a_j 'P J en c%lfJ a1r P.0 f )/O Y\ G rlc, Gi Lx;s��n (�` ,r� �SF� �17 hoy 4 Aprd.-ot- 17X) SF ` Ww N rJ Fc►n / 2 r1\0 J 161 r P >1 �� 0, redcAc ,-2-e GU pe,,— -z-,61,* Name of Appli ant or Sponsor: Telephone 31 V-1 R3 C 4 E-Mail: Gw ed 90k- L,Co�'►•. Address: City/P 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 any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: IK ❑ 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) E]Industrial F]Commercial residential(suburban) El 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? ---------- -_------b.Consistent with the adopted comprehensive plan? ❑ FAT F-1 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YE 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: A ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES Il 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: X� El 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑ b.Is the proposed action located in an archeological sensitive area? ❑ 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ❑ F-1- b. 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: ❑Shoreline El 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? ❑ 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 DYES 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)? es,exp ain purpose aiid'size: Q 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: IJ ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE nn Applicant/s onsor name: �l �G�ad�✓ 'CUJ J6'GVj Date: 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? EA ❑ 3. Will the proposed action impair the character or quality of the existing community? [A ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? 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 -im act im act- Pimp aa may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage 1-1problems? Eff 11. Will the proposed action create a hazard to environmental resources or human health? L71 1:1 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 environmental i pact . Town of Southold-Board of Trustees l 3 ame of Le Agency I D to President Print or Type Name of es risible Officer in Lead Agency Title of Responsible Officer Signature of RcVonsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT I Page 4 of 4 e , Of .��8g a+,��' : yrs 05"., s. •'�,°�s.. M1�F► -aNO N,, a.qn��,. ?.i � r � s�y� as ( 'i r • i 9•. ! .a -s41•e'� i° Biu. �f. - AAR e; 'aa4��,,'��,,�.•,-�g��" Ape �� !��r� ��\ a'x• r ,°�,�rr� ,fey��' Y `�o�.o�'.r �� ,y 4� �� A,i:.taS: !�•�1`l� }, Nl q �" Miiw AK WNW _Amm _ ■ _ M � x \ �P,��i a �.'��,\•, � Aa �_.J J ��r�1► ,• �� '��,� .r;:`' lr.��e,�� ar i �= 1• ..� - moi,`► .ram� •,�'����,,.��i1►� � ���� {gi��� _ 1 j,�R �� Y. ....s�to x. .:�+,p `.[g"� � R���� � 't., �v �R� •�� `�!`� i�;•`�,4•�- „ f s F q / 12 ��� )to c cry _ �• k""""""" � � ��ti� �I •o :t'"!3 �'`�����°,1�axe{ .r •�� .,•.•..v:iC11 Michael J.Domino, President rQSV�~ C Town Hall Annex John M.Bredemeyer III,Vice-President ��` ��,�� 54375 Route 25 Charles J. SandersN a P.O.Box 1179 Glenn Goldsmith 0 htii Southold,NY 11971 A.Nicholas Krupski p! Telephone(631)765-1892 L�% Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of VICTOR FERRULLI COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS INPLACE FOR AT LEAST SEVEN DAYS PRIOR TO THE PUBLIC HEARING DATE I, �JCy c i ✓ // , residing at/dba /9 3 r//,. , /6 L-1 2__ S a L/ I being duly sworn, dep se and say: That on the 130day of MaYon , 2017, I personally posted the property known as by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday, March 22,2017. Dated: - ature) Sworn to before me this jo day ofMeO)O GERALDINE HACKETT NOTARY PUBLIC-STATE OF NEW YORK No.01 HA6174215 Not y Public Qualified In Suffolk County My Commission Expires 09-17-2019 PROOF OF MAILING OF NOTICE ATTACK CERTIFIER--MAIL RECEIPTS L J Name: Address: p N. I l a Ir) 4 15 2 �, ��1C�r�I firp ► C�11SK y SCS 1 Or JIM- R6. I54U mit orw sauth �U Ufih d l N� STATE OF NEW YORK COUNTY OF SUFFOLK l G�G✓ l , residing at r�3�`Yf GAG✓ � /T�- C",q v I -e /C/' �/' Lein duly sworn, deposes and says that on the day of , 20�, deponent mailed a true copy of the Notice set orth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessmentgmt= uthold; thatsaid Notices were mailed at the United States Post Office at that said Notices were mailed to each of said persons by CERTIFIED MAEURETURN RECEIPT. Sworn to b fore me this o20 Day of 20 /`7 GERALDINE HACKETT Notary Public NOTARY PUBLIC-STATE OF NEW YORK No.01 HA6174215 Ouaiified In Suffolk County My Commission Expires 09-17-2019 S.-Postal Service Postal CERTIFIED�MAILO RECEIPT CERTIFIED o RECEIPT a Domestic Domestic Mait Only Iff b - 50U7NOL f!Y 11971 A L U 8 E SOUTIOL1}r P!Y 1971 �� 1 v b �� U c� cO Certified Mail Fee w Certified Mail Fee IYI $ $3.35' 4471 M $ $3.35 4871.1 "n Extra Services&Fees(check box,add 1114 02 1 v u7 Extra Services&Fees(check box,add lee ate) 42 P(hardcopy) $ ❑Return Receipt ardco 0 ❑Return Receipt(hardcopy) $ Q ❑Return Receipt(electronic) $ $0.00 Postmark O ❑ 0 ❑ Return Receipt(electronic) , $—$0.00— Postmark' i Certified Mall Restricted Delivery $ 44— Here O ❑Certified Mall Restricted Delivery $�_L__rep� Here j C3 ❑Adult Signature Required $• -n1r�� I= []Adult Signature Required $—,��t,VV�--t�'�iSL�• ❑Adult Signature Restricted Delivery$ pU■Ue= ' ❑Adult Signature Restricted Delivery$ 00— C3 Postage O Postage rq $ $0.49 C3 $ $0.49 Total Postage and Fees 43/13/2417 Total Postage and Fees 43/13/2017 I r^ $6.59 M $ $6.59_ u-) sen u7 Sen r� Y ra p /- d p X -------------- Lir d' - -- -- - ----------------------------•------ [- -- '` -e- - - - - Ell Hy, t, {/ :ee 0 :U.S. Postal Service CERTIFIED MAIL@ RECEIPT :1 1 11 eel•I � r Domestic - N r9 • delivery � ALBERT ON, NYj 1=1'547 f=0 Certified Mail Fee $3.35 M $ 4971 Ln Extra Services&Fees(check box,add fee 49 pr6 te) 02 O ElReturn Receipt(hardcopy) I $ O [I Return Receipt(electronic) $—$4a44— Postmark, El Certified Mail Restr(cted Delivery $ scue 1:3Here r3 E]Adult Signature Required $ ❑Adult Signature Restricted Delivery$ Postage rrq $4.49 M $ 03/13/2417 Total Postage and Fees M $ $6.59 i L! 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ECEIPT n wd nasi �U a . . * SOUTHOOr NY t1971 _ n O Cerbried Mail Fee G 0171n $ $3.35 n Extra SBrvicas&Fees(check hoX ad6lee ate) 02 ❑Roturn Receipt(hardmpy) S ❑Rai=Racoipt(elecimlic) $ k*�� Postmark ❑Certified Mai Restricted Delivery $ p Here ❑Adult Srgmtum Roqurrod ❑Adult Signature Restricted Defiuery S �V•4� -q Postage $0.4(9 a s 0=/1312M �+ y Total Postage and Fees J J � ti/t/S{ �n1 J t �/ T1 s $6.�9 C Y✓/11 O V IStiJ J, sen II tr - n —. ....-•- i•• ......................... I PS Forth :.r ,April 2015 PsN 75.3o-o2-uqu-qo4'i See Reverse for Instructions Postal - - CERTIFIED D RECEIPT Domestic Only Iti For delivery Inforrination,,Asit our'website at wimmusps.com'�. ALBERTSONt-NY 115137 ca M Certified Mall Fes $33.W J.W (1971 Ln Exir Services&Fees(deck box add ree appp te) 02 []Feiurn Receipt(hardcop,Jl $ O E:3ElFear.Recetpt(electmnM $ d;r _ Postmark U O ❑certified Mad Rasutwd Dernery $ _ Hers E]Adult S gnature RogWmd $ ❑Adull E gnalura Restricted Nitaery$ C3 Postage � $ u.49 EM Total Postage and Fees 03/13/2017 M $ $$.59 Lrl Sent To r•a . r ,NUT1L 't---:- U1 H t 4 K--- ING NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: VICTOR FERRULLI SUBJECT OF PUBLIC HEARING : For a Wetland Permit for the existing 52.3'x46' (1 ,721sq.ft.) irregularly shaped dwelling; existing 39.10'x21 ' irregularly shaped deck attached to the side of dwelling; existing 8'x10' shed; and to reduce the size of the existing garage from 14'x19' to 11 .8'x14.5'. Located: 1540 Smith Drive South, Southold. SCTM# 1000-76- 3-5 TIME & DATE OF PUBLIC HEARING : Wednesday, March 22, 2017 — at or about 5:30P. M . If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours of 8 a.m. and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 Board of Trustees A pplicittion .13EINGDULY SWORN DEPOSES AND AFFOM THAT HIUSHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMS)AND THAT ALL STATEMENTS COWAEqM HER2IN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND RELIEF*AND THAT ALL WORK WRL BE DONE IN THE MANNER SET FORTH IN THM APPLICATION AND AS MAY BE APPROXED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES- THE APPLICANT AGREES TO HOLD THE TOWN OF SO OLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES- AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAM PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHOR=THE TRUSTEES,THEIR AGENT S)OR REPMFXfAT1VF_%INCLUDING THE CONSERVATION ADVISORY COUTqCH.,TO ENTER ONTO MY]PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WrIH THIS APPLICATION, -INCLUDING A FINAL INSPECTION. I FURTEUM AUTHORIZE TIRE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO,INSURE CON[PLL4JXCE_WrM ANY CONDITION OF ANY WLTL&ND OR COASTAL EROSION,PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OFTHE PERMIT. Sigmftw offtopexty Owner r) SWORN TO BEFORE ME TMS DAY OF, �O,nuazw .,2q—jl U L rr , V MdyPublic GINA M.SUPOW 10, gf Notary Public,State Of Floridaa commisslon#FF 460 ;j My comm.expires April 03.2017 Scanned by CarnScanner �3a Board of TrusteaD application �i A A lL BEING DULY SWORN . DEPOSE AND AFFIRMS THAT HWHE IS THE APPLICANT FOR THE ABOVE DESCRIBED P AND TRAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THEBESTOF HISMR KNOWLEDGE AND BELIEE,AND THAT ALL WORK WILL BE DONE IN THE MANP R SET FORTH IN TMS APPLICATION AND AS MAY BE APPROXED BY THE SOUTHOLD TOWN BOARD-OF TRUSTEES. THE APPLI�ANT AGREES TO HOLD THE TSI WN'OF SO OLD AND THE BOARD OF TRUSTEES HAIIIVdLESS AND FREE FROM ANY AND ALL DAMAGES ANIS CLAMS ARISING UNDER OR BY VULTUE OF SAID P `I'(Sa IF .GRANTED: IN COMPLETING THIS APPLICATION,IIIEREBY AUTHORIZE THE TRUST _AGENT(S)OR REPRESFWATINCLUDINGTHE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE 1�SES IN CON C ON WITH APPUCATION, INCLUDINGA FINAL INSPECI`IOM I FURTHER AUTHORME THE BOARD OF -TRUSTEES TOENrER ONTO MY PROPERTY AND AS REQUMD TO MURS COMPLIANCE WITH ANY CONDITION OF ANY WETLAM OR COASTAL EROSION PERMIT IssuED By TuE BOARD OF TRugnm DuRwG THE TEiRm OF THE PE VI y SWORN T4 BEFORE'NdE THIS DAY OF 20 I ' „Its AC"GM.SUPONO Notaly Public.State of RNift - k Commiission#FF 4668 Ndtay Public My comm.expires A0103,2017 Scanned by CarnScanner i APPLICANT/OWNER TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME : (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.Dso,indicate the other person's or company's name.) TYPE,OF APPLICATION: (Check all that apply) Tax grievance Building Permit Variance Trustee Permit .j Change of Zone Coastal Erosion Approval of Plat ' Mooring Other(activity) Planning 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 that 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 t day of3% 20 GfRALDINE HACKETT Signature NOTARY PUBLIC-STATE OF NEW YORK N0.01 Print Na h6 'EfKr Qualified In Suffolk County My Commission Expires 9-17-2019 I Y\ • APPLICANT/OWNER 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: I C�tO I ( Fry ru I I i (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.) TYPE OF APPLICATION:(Check all that apply) Tax grievance Building Permit Variance Trustee Permit 1[ Change of Zone Coastal Erosion Approval of Plat ' Mooring Other(activity) Planning 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 that 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 f 20 GERALDINE HACKETT NOTARY PUBLIC-STATE OF NEW YORK Signature No.01 HA6174216 �� , I I I Qualified In Suffolk County Print Namey ,V i My Commission Expires 09-17.2019 a �� 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 necess=to avoid same. YOUR NAME: r fCU LP o f( I f C C_ (Last name,first name,.ii dle 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,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%o 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 day of 200_ Signature Print Name ,C.kc c) rd-1,C4. Form TS 1 y GERALDINE HACKETT NOTARY PUBLIC-STATE OF NEW YORK No.01 HA6174215 Qualified In Suffolk County My Commission Expires 09-17-2019 Bovxd of Trustees Application AMHORWAnON (whim the applicant is not the owner) YcL�1�_A' rwiditng at 46nt name of owner of property) (mailing ad ) do hmbyaorize,�O j "�i / ' (Agent) k to apply for s)fivm the Southold Board of Town Trust=on anyf. (maces si ) GERALDINE HACKETT NOTARY PUBLIC-STATE OF NEW YORK No.01 HA6174215 Qualified in Suffolk County try Commission Expires 09-174019 *&4— Scannedned by camScanner Board oil' Tzust,sssApplication AWHORMATION (whem ffie appRmfis not o / ��,I' _ -,A- , r idingat_! o .CM -# n of ownek of ( ) 10 dohm*y=&mtw fifdvaAC)' (Agwt) F m- . v ,€ 90nft14 B=dof Town T on my b&ff s,s>tgpad»e) GERALDINE HACKETT NOTARY PUBLIC-STATE OF NEW YORK No.01HA6174215 Ouslified In Suffolk County My Commission Expires 09-17-2019 r Scanned by CamScanner Town of Southold __Lip-CONSISTENCY-ASSESSMENT FORM-.----- A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE ANDc�PROPOSED ACTION SCTM# - d > - 0 J PROJECT NAME ® 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. 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: MCt I A, u COo mood Do k-3 r ��P wL ✓ _ I'%x%si -rq- al;—# SFY-► 9 ')P 6 5P S trd to ort-r.,,Iy / o to T o d► �o no,--o l ed c.e-,e 1i L e as Location of action: 10 nA To U""l- l -1 Site acreage: 4-7 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: iC(.),/J (b) ailing address: 2 I /7 F�- (c) Telephone number: Area Code t�i Q3 a (d) Application number,if any: Will the action be directly undertaken,require funding,.or approval by a state or federal agency? Yes ❑ N k If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No Not Applicable 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 0 No LyxNot 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 ❑ Yes ❑ No 4�ot 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 th ugh 21 for evaluation criteria El Yes El 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 No Not App'ticable 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 ❑ N ENot Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Ye❑ No�ot Applicable Attach additional sheets if necessary WORKING COAST POLICIES -_-_P_olicy_l.0.-P_r_otect_Southold's-water- dependent-uses--and-pr-omote-siting-of-new-water--dependent-uses-in------- suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No Tot 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 ❑ N&ANot 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 Tot 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. ElYes ElNoNot Applicable PREPARED BY 1 C 0 TITLE DATE*7 7