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HomeMy WebLinkAboutTR-9116A Michael J.Domino, Pres- __';t SO Town Hall Annex O 54375 Route 25 John M.Bredemeyer III,Vice-President P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith ® aO Telephone(631) 765-1892 A. Nicholas Krupski lif'10 0UM� 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 %2 constructed Project complete, compliance inspection Y Michael J.Domino,Pre; ._�1t ��OF S0(/TyO Town Hall Annex John M.Bredemeyer III,Vice-President ,`O l0 54375 Route 25 P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith G ® O@ Telephone(631) 765-1892 A.Nicholas KrupskiyCOUNTT`I O Fax(631) 765-6641 � ,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9116A Date of Receipt of Application: October 11, 2017 Applicant: Albert G. Wood SCTM#: 1000-117-7-32 Project Location: 1000 First Street, New Suffolk Date of Resolution/Issuance: November 15, 2017 Date of Expiration: November 15, 2019 Reviewed by: Board of Trustees Project Description: Install 4' high split-rail fencing around the perimeter of the property adjoining First Street and King Street, and property line along north side next to vacant lot. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the project plan prepared by Albert G. Wood, received on October 11, 2017, and stamped approved on November 15, 2017. Special Conditions: None. Inspections: Final Inspection If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. a Michael J. Domino, President Board of Trustees 1000 First Street. New Suffolk, �^ NY 0 o G2 EL s.o• 'y N PUBUC STREET IREEr) EL 4.91 u b ®00 / Gate to23 2 w , o� Red line indicates ew approximate LD`-"� EN�IOPE placement of 1 r r., soe 4'split rail /� o. ( z r( fence (F moONS P 35 s( M m a 3Nf7 z`I 5 be 3NOL'CAn ------ o -- ff--- ----- 3Nn (9 p 123 4.5 3N11_-- ( m^ O 3N0 6bbT3----- m( m 1? Ib C1-g 123 (n, V 5.4 Q r 3dOl3AN3Ch 9NIQllfl@ ' J Tai O v y tu • OU!O �-c n O P 2 - ------ -1 _� to HW'9 SONY L*30 3903 3„0£,L£.Os ��• o ao - ,£�'8L ____ (—� ro�S m �6861 'Ll lO0 ��- 3a�CJ,6b,�$ .-40 + mD �� 7R1FW N31tlM H91H NV314 �� O M o;� D= O u�!i O o rl r N NZO� _ -j_ CD z r C) o p o z M 3 � v En i S11FF01�- � Michael J. Domino,Pres �Q C� Town Hall Annex John M. Bredemeyer III,Vice-Fiesident ��� GyJ, 54375 Route 25 Charles J. Sanders y z P.O.Box 1179 Glenn Goldsmith % • Southold,NY 11971 A.Nicholas Krupski Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: I1 Completed in field by: ALBERT G. WOOD requests an Administrative Permit to install 4' high split-rail fencing around the perimeter of the property adjoining First Street and King Street, and property line along north side next to vacant lot. Located: 1000 First Street, New Suffolk. SCTM# 1000-117-7-32 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: 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: Present were: �J .Bredeme er M. Domino � G. Goldsmith �. Kru ski Y �" p / C. Sanders Other Page 1 of 2 UFFO( Michael J. Domino, Pres ��►�� Town Hall Annex John M. Bredemeyer III,Vice-President ti� yJ, 54375 Route 25 Charles J. Sanders y z P.O.Box 1179 Glenn Goldsmith $ Southold,NY 11971 A.Nicholas Krupski y,�0® Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: ALBERT G. WOOD requests an Administrative Permit to install 4' high split-rail fencing around the perimeter of the property adjoining First Street and King Street, and property line along north side next to vacant lot. Located: 1000 First Street, New Suffolk. SCTM# 1000-117-7-32 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 A Wood NOW W. 1000 First St New Suffolk Photos taken Sept 29, 2017 77T1 a -� Northwest Southwest Corner "` ,_ - Corner Looking Northeast Looking Southeast d �q _->- Northeast M c' Corner Southeast Corner �, Looking . ' Looking Northwest ,*�� j �� « ��_ ,, ,�� � i , Northwest + 'eT. 4/27/2017 ' 1000 1st St-Google Maps Go gie Maps 1000 1 St St (North Fork Country Club \ \�� 1'!Ck r,r,, Oak Rd rerh,','Rd rx c - r Geo,-gr Rd a New Suffolk Shlpyard 0 r ranpmC Rd tai:nnq Rd ❑ xPolar Chart C.tsRc v n ' - K:tIros Rd _ St in 4 - r.Ave New Suq s legends n Yn�e Mam st u, S.irrUk A.,- P:ew o�.rn. w FIo�Y. N ®O New Gu Jackson Sl :xkson St O New Su Map data 02017 Google United States 500 ft t 1000 1 St St New Suffolk,NY 11956 _-ZiZiA$* Namfm 3 b e .r59 MATCH UNE FOR FCL NO T 7 WE sm N AN 1uTHjLL RD. (so) rt 3 to 2al 4 ¢ 11 - @ t s 12 a r 19 12 FIXE .... 117A s 181 rq4 SEEsEc.No de� 1 1 Ift 1. 116-03-MI 914 p 5a, 2 15 d 19= 173 7 m1 99`e fl4 ISO— wm) "D 16. 17 187 Is CUTCHOGUE Ise 141 ti 419 SAW n4 HARBOR 21 47 22AC) 464 46 � E ]t w m]6 m w "4gCE 41�" 63�'6 3 X4.) ST Z9 1 r. IWO q4 4 2a pa 30 1 RL 3: 0 17- 1N93 20.2 -p 281 323 1 4AAC) V - NON 32.1 i 2 -1 m 51 85 312 '91 16 ms AVE 13 inn NM UFFO� 11 IT 2" 35A.) Oi 2 41 81 21-- 32� 21 d w4c) 314 ,5 19 11 202�21) z 16.1 182 3.1 2 dz IA(.) W 92 is 2.1A(, S9 122 209 42 2(3 FD J SAY pEcONIC GREAT NOTICE -&,) K SECTION NO COUNTY SOUTHOLD Real Property Tax Se Agency Y C—Y—N--d,.ri",C-e 1.'7 PROPERTY '1' A P =NO j0D0 .7 OFFICE LOCATION: MAILING ADDRESS: Town Hall Annex ® P.O.Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold, NY 11971 a� Telephone: 631765-1938 ®��c®UNTI,�� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: November 14, 2017 Re: LWRP Coastal Consistency Review for ALBERT G. WOOD SCTM# 1000-116-6-24.1 ALBERT G. WOOD requests an Administrative Permit to install 4' high split-rail fencing around the perimeter of the property adjoining First Street and King Street, and property line along north side next to vacant lot. Located: 1000 First Street, New Suffolk. SCTM# 1000-117-7-32 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. The fence will not impede public access. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. 16tAjA Michael J.Domino,President SOl1� � Town Hall Annex John M. Bredemeyer III,Vice-President 54375 Route 25 Am P.O.Box 1179 Charles J.Sanders 00Southold,New York 11971 Glenn Goldsmith .yo Telephone(631) 765-1892 A. Nicholas Krupski COU Fax Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application ® E 64VE Administrative Permit Amendment/Transfer/Extension Received Application: OCT 1 1 2017 Received]Fee: $ /00.1D® Completed Application: Incomplete:, Southold Town SEQRA Classification: Type I_ Type II_ Unlisted ard of IM_a•r ga Lead Agency Determination: Coordination-(date sent): LWRP Consistency Assessment]Form Sent: CAC Referral Sent:, _ Date of Inspection: Receipt of CAC Report: Technical Review: Public Hearing Held: 11,16-1- Resolution: Legal Name of Property Owner(s): /�jPr A/®o d Mailing Address: 4 R n JV iP y br 1 pI C S Pa r/c- t 1 I -7S I Phone Number: / 7 - 3 -7 T(v Suffolk County Tax Map Number: 1000- f 7 — © -7 2- Property Property Location: 0 0 F/ S.4 S4 . N eV gu''-xjV N y (If necessary,provide LILCO Pole#,distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: GENERAL.DATA Land Area(in square feet): lO, q S y Area Zoning: M — Previous use of property: Vac-ant l o l- Intended use of property: UA C6n4 /u 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 X No If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes X No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes No Does the structure(s)on property have a valid Certificate of Occupancy? Yes Y\ No Prior permits/approvals for site improvements: Agency Date )4, No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?__X No Yes If yes,provide explanation: Project Description(use attachments if necessary): L <Yc7" V ' p/ey SSPL/T RA/l- Felice 412-ouAjD loeQim ire2yF ?Rohner ti AD Ft2r' r ,ST Ajo )*o& ST' &,Q &PegLoSo'e /lex► 78 Pf&cAN, I i OF PAIL (Ser S'utzveY Act F-eace to 15r) WETLAND/TRUSTEE LANDS APPLICATI®N DATA Purpose of the proposed operations: roc even! T UiN,oreyalze n ,4CL-eS1 7n elzopeaty Anlp To P2eyPN7� Ayvmpltu. OF Area of wetlands on lot: ® square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: 0feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? Y 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): TM 45 (A/11-t- 4e n/0 EFFe c-T V JO i aOl?d PuBINjud❑ !v{./5� :(,C31oods)aaglO[Z otlenbdF] aanllnola�dC:] isaao E] (u-cgangns)lgtluaplsagE] (sloaawwoDE] lgulsnpulE:] (aanllnolave-uou)Igang[:] uggan❑ •uotloe pasodoad aql a-cau pug Sulutofpu`uo an000;gq;sasn pugl Ilt,iloago •t, solos /£t . Laosuods loafo.id ao lumgddu aql Xq polloaluoo ao poumo(sorpodoad snonSpoo Xug pug ol!s loofoad)afgaao-c lg;ql,•o saaoe ® Lpagmislp,Cllt,ots,Cgd aq of aguaaou lglo L•q salol /Fr • Luollos pasodoad agl jo ol!s agl jo oiltmos lt,lo L•t,•£ E :I-cnaddu ao ltuuod pug own(s),CouoSv isll`sa.C3I SHA ON LAou39V Igluawuaano$aaglo,Cul woa3 2utpun3 ao lsnoldds`ltwaad t,aa►nbaa uotlos pasodoad aql saoQ .Z El ® lggl soomosaa Isluauwoa.Z uotlsonb of onulluoo`ou jl 'Z ped of paaoo id put,XI!Isdtotunw aql w paloa33B aq,Csw tnua agl pus uotlou pasodoad agl3o lualui aql jo uollduosop anllsaat,u s got,:48`s2Ajf Luotlgln$aa ao`alru anllgalslulwpt, Sa.0 ON `aougurpio`mul(-cool`ugld-c jo uotldope oAgnisl0al aql anlonu!,Cluo uotloe pasodoad oql saoQ•I A-SL 1 l f&)(V�4 :apoO d!Z :als3S .•OdIXI!D :ssaappy ta)'l:vtii E-FESE POOMIV :ItgW-a ovm 9 IM$L ME :ouogdolol :aosuods ao lu-collddy jo awgK VI ZV7 71Hd 40 -In7 sNbs?-V/1 0.L -&><JN ae ljr ff lvop N o 3/vl'7 osA.L�A.Lvaelo /r/ v,Nf/ -,kr 9NiX vN, JS ir { �q y��3iJ�� ®r»U7/e � ' �d® ® 9� -ZI7dfSIf-PIN � � i)?/g :uoilod pasodoad jo uoildtaosoCl jopg (V ;'70-d.4r�s QO®A :(dew uotlsool g goslls pus`aq!aosap)uoj3soo-I loafoad ';�W-d—jklS M3�/ �S y J z!y ®o v/ -v tl 31 )1Nt� :loafoad ao uollovjo awgly uol;umaojul aosuodS pun laafoad- l land -mol!,Cue luawalddns of,Cressooau sg sagud leuolllppg gouac`.doua2B peal aql of lnjasn ao,Cq papaau aq lltM ana!laq noX golgm uol3-cwa03u!Igu0131pp9,Cog ap!noad oslu flew noA .I laud ui swal!llu alaldwo:) uollgwaojut luanno uo passq aIq!ssod se,ClgSnoaogl su.iomsuu asuald`wal!,Cul of puodsaa Xlln3 of papaau oq pinom u011132gsanu1ao goagasaa l-cuot3tppu jj •olq-cligns Xiluauno uotlguuojut uo pasgq I ltgd olaldwoO •uollsog!aan aaglanj of loafgns oq,Cgw pug`nnatnaa ollgnd of loafgns as-c'2ulpun3 ao Ignoadde aoj uolluollddu agl jo laud aw000q sasuodsog .I ltnd jo uotloldwoa aq;.to3 olgtsuodsaa st.tosuods laafoad ao luuotlddu aq jL •uo1jamaojul laafo.cd- I ljnd tgjajudo3.ion staot,�n.t�stil u.►.rod?uouissassv 1vivaauu0.1taug j.rozis g xipuaddV OCZ 19 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ ® ❑ b.Consistent with the adopted comprehensive plan? 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: ® ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES 0 ❑ b.Are public transportation service(s)available at or near the site of the proposed action? ® ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ® ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: ❑ ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: V/4C4dT (.o'- If ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: VA CA dT Lo T ❑ 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 El Forest ❑Agricultural/grasslands El 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? rql NO YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: D�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 NO YES solid waste management facility? If Yes,describe: ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: ® ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE f,[ lb Pr / ® Date: 9/Z7 h 0®-7Applicant/s 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 targe impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? ❑ ❑' 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑ 3. Will the proposed action impair the character or quality of the existing community? ❑ ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or F1 ❑ 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 El 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, F] ❑ 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 1:1problems? 11. Will the proposed action create a hazard to environmental resources or human health? 0 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-tern,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, I_! 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 impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 tsoara v7: 1rLLdsLCC:i ds�17�7.b.iV___vaa - AFFIDAVIT L►3�2� G WOO.& BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S)OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. ignature of Pro (erty Owner SWORN TO BEFORE ME THIS 2%A-V1 DAY OF )e-�tyyjGYK Notary Public JENNIFERS MURPHY ��� muemes Quontlpires nary 21 20 Y- APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The'Down of Southold's Code of Ethics.prohibits conflicts of interest on the part of town officers and emnloyices.The purpose of this form is to provide inforibation which can alert the town ofl2ossible conflicts of interest and allow it to take whatever action is, necessna 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.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee X " Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,liarent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,111al riage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employcc has even a partial ownership of(or uruployment by)a cotlnomtion in which the iown officer or employee owns more.Ilion 5%of the shares. YES _ _ NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this��day of CeFer XW,2 0/7 • Signaht r7 Print Name 64100 Form TS l Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal urea(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 supportuie and non- supporting frets. 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# /000 - 1 7 - 0 - - 3 2� PROJECT NAME FiFi4c 67 Fo 2 f 0 0 b Fi its r -Cr A I V Su F Fo t t The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. 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: AA l^2FGf s/�LITl1/.�lL FEn/C� lT2ou�® /�E2l�t<iE2 OF lVoAro C(n c N'Exr 7'o V,4c.4„t r L r 69 F ?H L Lo.ei .4 Location of action: l 00 b F1/l s f ST NE(,J .�u FFo i.k. tj y Site acreage: 0 ,'9 3 / Present land use: V' cAtir- Lo 7— Present Present zoning classification: IY7.0-- 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: A /-4 �� 6 woo rl (b) Mailing address: K La^)y r ew Lem Is A,k rJy //7S'y (c) Telephone number: Area Code( ) 9 J-7— 24 y - 7 f 6 P (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes 11No LiIf 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 LWItP 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 ❑ Now Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No [Z 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 S through 16 for evaluation criteria Yes ❑ No ® Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ 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. ❑ ❑ X Yes No Nm.-.�plicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. Yes [:] No® Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No ® Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ YeJ:1 No® Not Applicable Attach additional sheets if necessary WORDING COAST POLIX,.ES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No ® Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No ® Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No IX Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No ® Not Applicable PREPARED BY Iq 1�e f j -C wood TITLE DATE 912712 o 17