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HomeMy WebLinkAboutTR-8874 �O��pF SOUryolo Michael J.Domino,President Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J.Sanders S *ticSouthold,New York 11971 Glenn Goldsmith ® �Q Telephone (631) 765-1892 A.Nicholas Krupski COU Fax Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1327C Date: April 7, 2017 THIS CERTIFIES that the as-built in-place replacement of dilapidated 6.8'x14' seaward section of the existing 6.8'x38' fixed dock using 4"x4"piles; and to add plantings and place either mulch or stone along the berm between the grass land and bulkhead; with the condition that any future rebuilds of the dock be limited to not more than 4' in width; At 1425 Pine Neck Road, Southold Suffolk County Tax Map#1000-70-5-40 Conforms to the application for a Trustees Permit heretofore filed in this office Dated August 1,2016 pursuant to which Trustees Wetland Permit#8874 Dated September 21,2016,was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for as-built in-place replacement of dilapidated 6.8'x14' seaward section of the existing 6.8'x38' fixed dock using4'x4"piles; and to add plantings and _place either mulch or stone along the berm between the grass land and bulkhead; with the condition that any future rebuilds of the dock be limited to not more than 4' in width. The certificate is issued to SALVATORE PENNISI owner of the aforesaid property. 0 Authorized Signature S0 r Michael J.Domino,President � yp�o Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 iffP.O.Box 1179 Charles J.Sanders ticSouthold,New York 11971 Glenn Goldsmith ® �� Telephone(631) 765-1892 A.Nicholas Krupski Olif'COUl1� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: kvj I V Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction Y2 constructed Project complete, compliance inspection. INSPECTED BY: C�� �I a -7z J C U de COMMENTS: ] S 1A (` c' " ( 1414 CE CERTIFICATE OF COMPLIANCE: • Y t (` l SuF;=oto- John M Bredemeyer 111, President :}o��` cow'; Town Hall Annex Michael J Domino, Vice-President t`= Y �� ' 54375 Route 25 Glenn Goldsmith ii N `= P.O. Box 1179 A. Nicholas Krupski o ® F Southold, NY 11971 � ,,, Charles J. Sanders =:�01 �a;;` Telephone (631) 765-1892 =:> y Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1St day of construction x/Y2 constructed ' Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD,NEW YORK PERMIT NO. 8874 DATE: SEPTEMBER 21, 2016 ' ISSUED TO: SALVATORE PENNISi PROPERTY ADDRESS: 1425 PINE NECK ROAD, SOUTHOLD SCTM# 1000-70-6-40 AUTHORIZATION Pursuant totheprovisions of'Chapier 275,(if�'.the-Tbwm' ,C(ide''o,f,,the-Town of Southold and in accordance with the Resolution of the Board of Trustees-adbotdd af1heineekingl held on,Sgptember 21, 2016, and in consideration of application fee in the sum of$500.00 paid by Salvatore Pennisi. and subject to the Teinis and Town as'stated in the'Resolution, the Southold 6Am Board of Trustees authorizes;and permits the following: W an- f It in-place replacement:of dilapidated �x14 seaward ki '�, A'Permit or the,As- in section of the existing 6.8'x381 fixed dock using-'41IY4",pile§-`.andilt addtplintings and ,place either,mulch or stone along the berm between the grass land and bulkhead; with ­* "t" in the conditiontha(any,future reb`u11d'S-t6fRnued "the t o, le" en d width;,'and,as..depipt!ed,,op,the project plan pkepiied`by'-galvitoiP­ higi,' 'received on August 1,10.16,and stamped approved on September' 21;-2016. ff IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporatese'al t6'be dttikdd, and-these prese ts,to be subscribed by a,majority of the said Board as of this date. d 0413 V Paz TERMS AND CONDITIONS The Permittee Salvatore Pennisi residing at 1425 Pine Neck Road 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 permit. 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. EPA Imam do Japanese Forest Grass (3) Japanese Forest Grass (4 Fountain Grass (3)— (4) Fountain Grass (3) Inkberry (3) Blue oat Grass (8) ir Plati � E I;E C AUG 2016 Othold TOM OtO8, kvOwtty/,0a,'rb)g Maw to initializing construction. - drivomIly 1"Idii IIIILI (filliel-IS jOIIS 111LIst be dertemined by mitiactor prior proper Nvater rLinoff. :��jjrvwmidhig buildings R)i v)"Irklov, ;;1)flces to be [IslAwl.t. 5URVEY OF LOT -7 "MAS' OF PROPERTY OF N J. NELL5 PH I LL I P5 Greek FILED NOVEMBER 6,-1404, MAP No. 24'7 JOGkey W E SITUATE: FINE NECK TOM SOUTHOLD WIFFOLK COUNTY, NY tle Irne high ng N SURVEYED 04-01-2008 average h° � •�te; y SUFFOLK COUNTY TAX # 1000 - "10 - 5-- 40 1 _ C RMPIM TOs _ _ _ _ 'I n HAMM,LLC S`*' COMMONWEALTH LANA Tnu — INSURANCISOOMPPANY —,.- _ — 1 5to 1 Frame House . exec. r 1 t ` 11 � , \ ,1 1 , Vl \ 1 ' w 1 VV l � I 1\ vre 1 r h 1 cont. , 1 1 1 , 1 1 , • '–\ r 1 l 1 20 1 1 1 ' r I O 1 I r • 11I� _ 1 1 � O tl \ 1 I1 —as - _ 1 I AUG - 1 2016 ' ' 1 , i r , I Southold Tom I i ° n I 6f� 1 Road of Trustees cul• , , I qq� t; V41e 1 r i O I• I I ' ' , I - y I 1 r I � 1 ® vwr.w+:•a clt•ralle.a oawlw e o..,�w, edg©of pavement '�— ewi on9o! V-120k w a` 'nw 2.-f"u NOTE-5i r•, sra. «aw - +aly mor.f..,l w pgbl.r ua.ar..f _ •.aM•d wMh a> MONUMENT FOUNDPine �..nl,tpllry.�=gib ate` adLe°w. •c..wmo,w.•f.dicar•e w.on•�r,I bcl ws •E• bIV�h- PFWW Ip•=5.1v.f.PQWI•`Q O PIPE FOUND w w Ir.rQ►xaN.oca m a Prai„ . lad 5,1Y1,01.,deN Nrl/N.alfdltl dbli(yl b Uu•paww Ib n IN Yvy I•ry•p•r• dd an IJ.bMaf b w tRI• CONTOURS REFERENCE NGVD '24 DATUMads�� y. all.u.ebg b.l pAbn.c.M1rw- lbr.a•.ml IlonllwWi.b atl911afnl fu{9.A•arB Area = 46S. F. Area = I.Ob" JOI�N C. EHLERS LAND SURVEYOR (b-I E4 Acres 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 GRAPHIC, SGALE 1"= 40' RIVERHEAD,N.Y. 11901 369-8288 Fax 369-8287 REF.\\Compagserver\pros\08\08-130 TOPO.pro John M.Bredemeyer III,President _ ��®F Sou, Town Hall Annex Michael J.Domino,Vice-President h® l® 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G ® Telephone(631) 765-1892 Charles J.Sanders 'O Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 21, 2016 Salvatore Pennisi 1425 Pine Neck Road Southold, NY 11971 RE: S'ALVATORE PENNISI 1,425 PINE NECK ROAD, SOUTHOLD SCTM# 1000-70-5-40 bear Mr. Pennisi: E ; The Board'of Town Trustees took the following action during its regular.megtipg;�,eld,Qn Wednesday, September 21, 2016 regarding the above matter: WHEREAS, SALVATORE PENNISI 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;apolicati6rf-d8ited August-1, 2016, and, I I i WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and,tothe 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 that any future rebuilds of the dock be limited to not more than 4' in width; and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on September 21, 2016, 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, 2 y- J 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 SALVATORE PENNISI for the as-built in-place replacement of dilapidated 6.8'x14' seaward section of the existing 6.8'x38' fixed dock using 4"x4" piles; and to add plantings and place either mulch or stone along the berm between the grass land and bulkhead; with the condition that any future rebuilds of the dock be limited to not more than 4' in width; and as depicted on the project plan prepared by Salvatore Pennisi, received on August 1, 2016, and stamped approved on September 21, 2016. 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: $506.00 Very truly yours, John M. Bredemeyer III President, Board of Trustees JMB/dd John M. Bredemeyer III, President 4'o�� coal, Town Hall Annex Michael J. Domino, Vice-President _ , ti� 54375 Route 25 James F.Xing y ? P.O. Box 1179 Dave Bergen �y"s ��; Southold, NY 11971 Charles J. Sanders Telephone (631) 765-1892 Y` t Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: SALVATORE PENNISI Please be advised that your application dated August 1, 2016 has been reviewed by this Board at the regular meeting of September 21, 2016 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) Y2 Constructed ($50.00) X Final Inspection Fee ($50.00) x Dock Fees ($3.00 per sq. ft.) 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: 4'x38' dock = 152 sq. ft.x $3.00 = $ 456.00 TOTAL FEES DUE: $ 506.00 4 aao�/01 BY: John M. Bredemeyer III, President 3,31. 1 Board of Trustees ,. C ,, ` L r �- yw 4 k ,3 , • w i i 1! i l r M " a.% f ' n r y . v :✓� .. .e s alvatore Pennisi 1425 Pine Neck Road,Southold CTM#: 1000-70-5-40 :9/13/16 L i e i a t •t4� V R • Yl f,, John M. Bredemeyer III, Presiden',,f` FQg�FFO(C Town Hall Annex Michael J. Domino, Vice-President ,�o� ��y�� 54375 Route 25 Glenn Goldsmith N $�� P.O. Box 1179 A. Nicholas Krupski o '* Southold, NY 11971 Charles J. Sanders '1,Jj�' o��� Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 3 Completed in field by:' ���r SALVATORE 4NNISI requests a Wetland Permit for the as-built in-place replacement of dilapidated 6.8'x14' seaward section of the existing 6.8'x38' fixed dock using 4"x4" piles; and to add plantings and place either mulch or stone along the berm between the grass land and bulkhead. Located: 1425 Pine Neck Road, Southold. SCTM# 1000-70-5-40 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: 40-7-7d)fir ' cvkw-A? Bm yc Iw r Present were: J. Bredemeyer -�- ��d .� P �u�s� N. Krupski /C. Sanders S&vLD s 1 F�2 Qxg- w . r-GP.>fT-P i #V St4oVtp R , 6j7— Dc® f 9�6Vr F1— VlbLk+Two � -RAr PW4--t> 0.001�tP6_ N�V Page 1 of 2 Town Hall John M Bredemeyer III, Presiden ® UfFO(,��OG i 54375 Route Annex Michael J. Domino, Vice-President , � ��, 25 Glenn Goldsmith P.O. Box 1179 A. Nicholas Krupski , g A; Southold, NY 11971 Charles J. Sanders �4, o? Telephone (631) 765-1892 �l Fax (631) 765-6641 '��cufrc�l1}' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: SALVATORE PENNISI requests a Wetland Permit for the as-built in-place replacement of dilapidated 6.8'x14' seaward section of the existing 6.8'x38' fixed dock using 4"x4" piles; and to add plantings and place either mulch or stone along the berm between the grass land and bulkhead. Located: 1425 Pine Neck Road, Southold. SCTM# 1000-70-5-40 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 _t f i r, Irk t. i"- �' � 4t<v � '_yl+�r - r .a, r .�a � f'"T' x k+�„V'7., ��•�i y 7 v+ ,+ 1_ � - r'��+ y rt` �_ - Yv s r• -�j, � s .1 �^ + •?.T' �r r a _.. y, rpt rY* t'' 47 •�''r �,1�i�,a�� ���`p ' �� �y �+ ti � �?''.. � �r•"�Yhi v„'�, > r �r7, s .,f�5'!`! q�,� 8 AD ,�,fiyq.::.l'�.�:�rFA ..,t �Y�,..' �.�iS �'' �- '� .. ... 1�' r,,. �� a y r k 7t. { •'� �1 .: � ii z .„� *< e a e ! "p�f t,r. yt! r! 4• dh�.R.,'��t :.j - �, t'i'a 4 ,� r �•••Oh _�,`�W'.3rlj�` y��y � c '� �-���]]�� y�,�, .y a."�p '„P#+ �!v�, p�� �air+• � �;$ ;.V x � R P _ ��r^•.�a�'�' a.�r�.`` k r *� � �t;r� �� x M4, 1� :��'� ,�+ � .�'.1 . rata �v ' � � � ,a.'��a� � t '�. v'��"�fi�r � � •~ �A'•.. Y ; �'t � rr(�r M �!* .Ft,-. ', �r��` ,F �Y�C;} p J, w �r�'�;�,, vi'�°- '..t�y. '•f'.t r” _ ��� a ?moi a- f �^1�JM f� .os (`Y •�, ^+: rv'w>, VIL Rol PA-RN - -- /' x - - 4t , Vol , s / li -77 +tx. n� n f r/ T - TOS:_. .:r SOUTIIOLD OFFICE OF BUILDING INSPECTOR TOWN I NLL SOUTHOLD, N]!-,W YORK CERTIFICATE OF OCCUPANCY NOICCONFOR,MUNG PREMISES TIIIS IS TO CERTIFY that the /X/ Land Pre C.O. a- Z-16957 / 7(I Building(s) Date- June 3, 1988 Use(s) located at 1475 Pine Neck Road Southold, N.Y. Street Hamlet shown on County tax map as District 1000, Section 070 , Block 05 Lot 40 , doesi',not)conform to the present Building Zone Code of the Town of Southold for the following reasons: Insufficient total area; non conforming 2nd dwelling four accessories in front yard. Insufficient side yard set-backs on two dwellings and rear setback on one dwelling. One dwelling insufficient habitable pace. On the basis of information presented to the Building Inspector's Office, it has been determined that the above nonconforming / X/Land /x/Building(s) /_/Use(s) existed on the effective date the present Building Zone Code of the Town of Southold, and may be continued pursuant to and subject to the appli- cable provisions of said Code. IT IS FURTHER CERTIFIED that, based upon information presented to the Building Inspector's Office, the occupancy and use for which this Certifi- cate is issued is as follows: Property contains 2 one family, wood framed dwellings; four accessory buildings; wood retaining wall; dock and all situated in 'A' Residential Agricultural zone, with access to Pine Neck Rd. a Town Road. Permit 1204Z for addition to Main Dwelling C/O Z873. The Certificate is issued to CHESTER S ANNA AMRTSON (owner, 7IXX§MX)XX0VbXa Ll'CX of the aforesaid building. Suffolk County Department of IIealth Approval N/A UNDER?MITERS CEB.TIFICl1 T E NO. N/A NOTICE IS 11FREBY GIVEN that the owner of the above premises IU^S NOT CONSENTED TO AN INSPL'CTION of the premises by the Building Inspec- tor to determine if the premises comply with all applicable codes and ordin- ances, other than the Puilding Zone Code, and therefore, no such inspection has been conducted. This Certificate, therefore, does not, and is no-, intended to certify that the premises comply with all other applicable codes and regula- tions. 7 1 TMIT WT-11IN—w—f t6 4 66 4-1 6 Is 5 SOLTHOU)SCHOOLDISMICTM 12A 62 71 4. -Is- 40 V.A 13_ 14 ME NO . & E 0 - 6 la 1 9991113, 19.12 191 z 17 18? 12A(c) 1� 11, < —j,— (c 1.(C 15 CREEK DF .5 2 5 16 17 Is 1. 20 212 12w) 2"N i82 211 192 —.,SOIL)A —14 T1 ' 11A(C) BOWERY41 • 17 a4Y ffi45 10 an 8,13 A -A V.5 303 304 W, '33 17A(c) '3 3i4 32 I1A 41 V Is 10 IN OF 11 1163 n62- OID17 Y1n 42 SOUTH— 41 iA CLSTE" U7 3_ 47A m12 CL 0FMnLNO ;0 ­M, 29 1 N2 N S�OL g 26 MWTCH- LINE f Tm.OF NOTICE COUNTY OF SUFFOLK K SECTION 0 IE —7Z-- (21) =,Z—= C SOUTHOLD r E G ------- — Reel Property Tax Service Agen-Y y E — Y".. s — -- 070 m IN 'a, 21A A D RI--PE—WC­lCY p -T—N. 1000 12 1 Nc) PROPERTY MAP ;4-7- OFFICE LOCATION: ®'\\0 S®Ur�®� MAILING ADDRESS: Town Hall Annex ® P.O.Box 1179 54375 State Route 25 Southold,NY 11971 (cor.•Main Rd. &Youngs Ave.) CA Southold,NY 11971 ® �� Telephone: 631 765-1938 Fax: 631765-3136 COU LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: John Bredemeyer, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: September 14, 2016 Re: LWRP Coastal Consistency Review for SALVATORE PENNISI SCTM# 1000-70-5-40 SALVATORE PENNISI requests a Wetland Permit for the as-built in-place replacement of dilapidated 6.8'x14' seaward section of the existing 6.8'x38' fixed dock using 4"x4" piles; and to add plantings and place either mulch or stone along the berm between the grass land and bulkhead. Located: 1425 Pine Neck Road, Southold. SCTM# 1000-70-5-40 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is INCONSISTENT with below listed policies, specifically 6.3 (below) and therefore, INCONSISTENT with the LWRP. 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. A Wetlands Permit was not issued for replacement of the dock structure. Determine if the reconstructed dock meets Southold Town Code requirements. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. t%i)fFO1�.��� Peter Young,Chairman y 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., September 14, 2016 the following recommendation-was made: Moved by Keith McCamy, seconded by John Stein, it was RESOLVED to SUPPORT the application of SALVATORE PENNISI to repair the broken dock 14'X 6' wide and add plantings to berm between grass land and bulkhead. Located: 1425 Pine Neck Rd., Southold. SCTM#70-5-40 Inspected by: John Stein, Keith McCamy All dock and floats shall have the street address of the subject premises permanently affixed to the most seaward face for identification, in accordance with Chapter 275-11(6). Vote of Council: Ayes: All Motion Carried f i ,I l ' I J �QF soQryTown Hall Annex John M.Bredemeyer III,President ��� ��� 54375 Route 25 Michael J.Domino,Vice-President P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupslrt 0 �� Telephone(631)765-1892 Charles J.Sanders ��'COunm Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _/Wetland Erosion Permit Application Wetland Permit Application Administrative Permit / _Amendment/TranCs,[7r, xt_ension__ Received=Application: b`�' V' ►7_Receiv4ee:$ Completed A- 'cation � O Incomplete' 3EQR A''"Classification: Type I Type II Unlisted QUG r , 216 Coordination:(date sent) qi2 /� LWRP Consistency Assessment Form i ; _CAC Referral Sent: "ate of Inspection: Southold Town Receipt of CAC Report: i,,.8o�0 of Trustees Lead Agency Determination: Technical Review: Public Hearing Held: •_2-1! Resolution Name of Property Owner(s) Address ��- - Phone Numbeno/) Suffolk County Tax Map Number: 1000- C) Yy — Property Location: /`� ��� d0,,rJC a e-61 c- /Zk S u c U Al-Y 11971 (provide LILCO Pole#, distance to cross streets, and location) AGENT: ' {If applicable) Address: Phone: I oard of Trustees Applicat' i GENERAL DATA Land Area(in square feet): -7 5"16 S Area Zoning: z s:d e,,, 4,-,g 1 Previous use of property: A es c, e j+-,'a I Intended use of property: IZ N s �(e,�f• 1 Covenants and Restrictions on property? Yes V No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? 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.? Yes 7 No Does the structures on property have a valid Certificate of Occu ancy? Yes No ( ) P P Y P Prior permits/approvals for site improvements: Agency (Date/ .-/ l /3 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ✓ No Yes If yes,provide explanation: Project Description(use attachments if necessary): T$4 fo F.'K A'LeMev GCac.l< /y L vug lav G W1 J ct"dtz f's 7-d Z oL o c/c q,A e G Y x 4 x. C/e044ferz s 3 3 X G D e•s/G,'wq eC riKa,f s3-.5 7At s arZ¢a w4.. 3 i 4asn /ZA a7' vF IJtoac. 4- wi'rk esco&r o F what w &S ,3AC&- , Y-b bee •n 6e'+1 e a 9 4&JS L'09 A/OC t i3�..�Ie Ale-4,0.( ,oard of Trustees Appli.cat,l 31 WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: I Area of wetlands on lot: square feet e - Percent coverage of lot: l % Closest distance between nearest existing structure and upland edge of wetlands: 9 feet Closest distance between nearest proposed structure and upland edge of wetlands: A//,eco feet Does the project involve excavation or filling? he ✓ 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: -t Manner in which material will be removed or deposited: •7'o.te s o, L �6ae cket2v% ,,'Pe4 bit t-,Aeel bAAn W 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 lic cat become part of the application for approval or y available. If add'rt onal research or�invesand tsubjectay be subject to investigation ben needed to fully ion. ation currently a Complete Part l based on inform respond to any item,please answer as thoroughly as possible based on current information. nal information which you believe will be needed by or useful Complete all items in Part 1. You may also provide any additio to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information N e of Action or Project: Project Location(des ibe,and attach a loc tion map): 2- - t �0 Al Brief Description of Proposed Action: 7-c) /moi n &Z I c�c wf Dv X La s��po�3's ate 4- yx y X,/(, po/e•s 3- /,/e*IDr&S 3 x G , De C/C� is a6dL%1/s5 r,ot 7Ars ones. wars SceC90,4 Fao&1 4- R Co:iAf.4oc c %4/ --k xotc.r c) i W h ��/t-�rt'�vrj To 6�vr..� h� �e•� q��s.s Lr�.�� f- 3CAJ <eG6 f aa(4_ a /�4"t rnaJc,l, 02 5ro.J{ orL *Jh4tCVeM &s 17//0weaf Name of Applicant or Sponsor: � Telephone: /'�7�' —���� �-• E-Mail: I Address- /Y-4,57 d//dress: L /Y- S , '"�� '�°° �® Zip Code: State: City/PO: „/\/ /11 j NO YES 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, administrative rule,or regulation? ❑ (�" If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that LLJJ 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: ❑ ET 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 [Kesidential(suburban) ❑Forest ❑Agriculture El Aquatic []Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NOYES N/A a.A permitted use under the zoning regulations? 1-1 ❑ b.Consistent with the adopted comprehensive plan? Ea ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: F] 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES Z EL 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: IZI ❑ 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: Z ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑ b.Is the proposed action located in an archeological sensitive area? ❑ 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ❑ b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional Wetland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ❑ 16.Is the project site located in the 100 year flood plain? NO YES TT I ti 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES lfYes, �i1° ❑ a.Will storm water discharges flow to adjacent properties? [�NO ❑YES b.Will storm water discharges be directed to established conveyance systems(run and storm drains)? If Yes,briefly describe: NO ❑YES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed rNO YES solid waste management facility? If Yes,describe: F]20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or YES completed)for hazardous waste? If Yes,describe: Ef F I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor n : d�tar /Sid' Date:�� Signature: C'c.Idf+I? Part 2-Impact pact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all ofthe_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 Elregulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ I 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 ❑ 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, ffi ❑ 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 problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. 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 C�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 environme tal IM),,pacts. Town of Southold-Board of Trustees Name d Agency Date O CLea— President Print or Type Name of Respon le Officer in Lead Agency Title of Responsible Officer Sign o esponsi e Officer in LeadAgency Signature of Preparer(if different from Responsible Officer) NKIN'1 Page 4 of 4 postal 'PostalService ® 1 . © ■ ■ CERTIFIED © ■ ■ !! s. Only 1:0 estie • Lr II0 Foir u! 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Postage C3 Postage X0.47 ` ?Qj6 C3 $ g $0.47 9I, 12/201 $ g 3(� 09; 12 1 -0 Total Postage and Feee�s.47 ` 0 $Total Postage and Fg,6.47 Sp(a $ i� i7 O gent Tq �/ Sent Tp V.Vt/{{%/�T.t / aCi2e'Slit ��AfL U1 P C' /�/� AJC � ----------------------------------------------------- SVee�t�dv PL Noor P- Box vee-/C 21. � Street and Apt.No.,or PO Box No �'�//J L° !t! ------ 2 -_---. .J3 y L2 t ,Stat�ZIP�4® r- -------------------------------- City,State ZIP+4® �- icl� ✓t /e /V- !d :ee e I Postal. ervice CE ■ , ® ■ ■ © ■ ■ rTIFIElD r=1 ' _ � • •SC RSDA E; NYI ]x0 83 A j P •DUECT;i�i=OH431�16 p Certified Mad Fee � Certlfied Mad Fee $3 30 0971 ru $3.30 �> k`,ca0 ru $ 04 I �- $ r . L n Extra Services&Fees(checkbox,add fee te) tr � '� Extra Services&Fees check boz,add(ee a gpt4q tB1 1 < `�y ® Return Receipt(hardcopy) $ ❑Return Receipt(hardcopy) $ $ �(17 e� ❑Return Receipt(electronlc) $ $0_00 � V Postmdi k;',\ e� ❑ Return Receipt(electronic) '4, 0 ❑Certified Mail Restricted Delivery $ $A rife Com` < H81ti ��;f\� ❑Certified Mail Restricted Delivery $ esp, 1'� 0 ❑Adult Signature Required $ t� °`� V [� ❑Adult Signature Required $ FL••ULd Delivery$ 0 ❑ Adult Signature Resln � []Adult Signature Restrlctected Delivery$ �`2\ f� `�� I y � ' � •`�`f\, Postage ; V Postage $0.47 $ $0.47 .D Total Postage and Fees C19- .A Total Postage and W■47 o $ $6.47 0 $ ul L�Nr�eet n U Sent To co -------------- aJ2iA� ��� - ,atf S ,� ----------------- ------- -------•�----------------- ---- - Apt.No,or-F Box No Street and Apt No.,or PO Box N o ,� t:3 p �eyz✓�N -----f ------ C> .� ----- ---- ------%? r----------- ---------------------- ----------11 -- - IP+4State,ZIP r rte' OA;O :eo a ee eee•e' a 7 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS ry Name: 7a es C) 0 C rak rn STATE OF NEW YORK COUNTY OF SUFFOLK residing at being duly sworn, deposes and says that on the day of 20 , deponent mailed a-true copy of the Notice set forth 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 perso n*s as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at . that said Notices were mailed to each of said persons by CERTIFIED MAILIRETURN RECEIPT. Sworn to before me this Day of 20 Notary Public PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: pe7-/Lia- !'� ewdc 3 3 i9-C_2e ,L tiL/Gs �r tlr I lC Sev �`-f ►L S�e.vvi Fent S �K1 a �-o Qewc2IY (Z4 JCA-/40e0--1C' "Y rn en--osis dly-& .//7 7/ 74-7` 7 61/0 g eCe��.✓ p✓� JJ u��4'v ©!Z ' o y3blG STATE OF NEW YORK COUNTY OF SUFFOLK x11✓��-e,�� ��„�,s , residing at / Yap' d?,rje N cc /L f),x So(jL'-o/k !v Y. /r 9�/ , being duly sworn, deposes and says that on the 1 ,z day of sep j-e n h e., , 20 /(o, deponent mailed a-true copy of the Notice set forth 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 assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at , that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me�this 12 1 Day of -3EPT— ,20 Not Public DIANE DISALVO NOTARY PUBLIC-STATE OF NEW YORK No. O1 D1475593 Qualified in Suffolk County ¢Q My Commission Expires April 30, 20�U John M. Bredemeyerliii; President ��o�pg11FFOCA Zo ` r Town Hall Annex Michael J. Domino, Vice-President k" 7511 Route 25 Glenn Goldsmith y z P.O. Box 1179 A. Nicholas Krupski ;oy �� Southold, NY 11971 Charles J. Sanders ` �d ���= � Telephone (631) 765-1892 ` Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of SALVATORE PENNISI 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, 3f-1✓1 0m P Petiw, s ,' , residing at/dba I VAS- P,v e- w cc lz_ R4 SaL,- f olA /vera yore-1c I/ F7/ being duly sworn, depose and say: That on the /;L day of SeP tekn yeti , 201 L-, 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, September 21, 2016. Dated: -Or6weep (signature) Sworn to before me this l� day of X20/(0 I �c Notary Public DIANE CISAIVO NMA0 PUSlIC•STA1E OF NEW YORK No. O1 D1475593 9uaiitied In Suffolk County My Commission Expires ApNI 30, 201 ,NUTILt: Uim HtAKING 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: SALVATORE PENNISI SUBJECT OF PUBLIC HEARING : For a Wetland Permit for the as-built in-place replacement of dilapidated 6.8'x14' seaward section of the existing 6.8'x38' fixed dock using 4"x4" piles; and to add plantings and place either mulch or stone along the berm between the grass land and bulkhead. Located: 1425 Pine Neck Road, Southold. SCTM# 1000-70-5-40 TIME & DATE OF PUBLIC HEARING : Wednesday, September 21, 2016 — 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 _bard of Trustees Applicat a AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE ' DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,ANDXHAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S)OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. ---------------- z ®, — L , Si ature of Property Owner 1 .j SWORN TO BEFORE ME THIS �$ DAY OF UGI , 20�G Notary Public DIANE DISALVO NOTARY PUBLIC-STATE OF NEW YORK No. O1 D1475593 Qu011fied in Suffolk County tql My Commission Expires April 30, 29L! APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. / YOUR NAME: � ) •�� �` ��� � (Last name,first name,.piddle 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%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted t ' qday of J�/ 20t/ Signature Print Name Form TS 1 APPLICANT/AGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and emplovees.The purRose of this form is to provide inforination which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. r YOUR NAME: /�D on/.S% �— (Last name,first nam6,apiddle initial,unless you are applying to 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 V 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 applicgnt (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 . da of .J209t Signatures Print NameSA 1,1g4tyz e +i tit'S i Form TS l y Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS L 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 sioMcant 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- suARorting 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# A9 PROJECT NAME J— i The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees Z 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: (�) �—� �'��7 l�fr�-r,�•tr,J� '�v accit•n �t•7'' i�ic ✓�ul��+��cQ A(K Y-- -y 3 G_.,_7�t �: ¢ ,s D e 4y��` F. •n f0-3 F/ZC7AM1 ®t.�Yr yt ���GC W Ot�l FX R L7 �l�,¢7' fn9 4.T 4}Dn i{�A`Nf Tb •try _��w _ ADD .5rW4c 02 W�rrteJC& r 3 0A4)C04, Location of action: /Y x Site acreage: 06 ?g 4,-rzE-.s Present land use: Alvin e w, Present zoning classification: /Z e s 0- I 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 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 ElYes 0 No ZNot 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 12f Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No allot 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. ❑ ❑ LJ 1 ` Yes No Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LVW Section M — Policies Pages 32 through 34 for evaluation criteria. F] Yes [] No Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑Yes ❑;No Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public _resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. Ye[] No ENot Applicable Attach additional sheets if necessary WORKING COAST POLI CA Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No 9Not 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 thr ugh 62 for evaluation criteria. 1:1Ye8 0 No L2 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 Q No[�fNot 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 Sig-ly PREPARED BYorz . '� TITLE DATE 71,114//