Loading...
HomeMy WebLinkAboutCosola, Peter PATRICIA C. MOOR E, ATTORNEY AT LAW 51020 Maur-Roadp, Southold, NY 1197'1 LETTER (631) 765-4330 email: pcmoore@mooreattys.com Date ......... ... . To Subject. is /�-Q.�1. .. .. ............... ...... .. � .... ... SIGNED ElPlease reply ElNo reply necessary MR's valV61As QUILT L 1)wil OKk � "''C1 EX 15S lrt b ' r Qt U O w(�lll� PS SI"o0P OUTS vob Spov.1GR C�nitiEctG-0 Ta OR1�n1GL1 TU�f U WfIAX ,� Cly l M�►E1 .� U Fu-f C� p �ry S1 P1.R5 l�� V� (�Rtprwe �\ l!! JUL 2 2012 AAL PAIN LGPX-QS ARC rtG ,�lpRIWJPA �ct;thold iv`,1i. PATRICIA C. MOORE Attorney at Law 51020 Main Road Southold,New York 11971 Tel:(631)765-4330 Fax: (631)765-4643 March 22, 2013 Board of Trustees p SCE VE Town of Southold P.O. Box 1179 MAR 2 2 2013 Southold, NY 11971 HAND DELIVERED Southold Town fT Re:COSOLA Premises: 450 West Shore Drive, Southold SCTM: 1000-80-5-2 . 1 Dear President King and members: With reference to the above, enclosed please find three prints of the revised survey which I believe is the last item outstanding for the issuance of the permit. Thank you. Very truly yours, atricia C. Moore PCM/bp encls. C: Cosola N SURVEY OF PROPERTY Mti A T SO UTHOLD sow TOWN OF SO UTHOLD Tti SUFFOLK COUNTY, N. Y. �� SJFF O 1000-80-05-2.1 030 o� �� SCALE.- 1'= 30' Eebruory 14, 2012 March 20 60 , 20/2 (revisions) ` Boa 6 March 29, 2012 (revisions) JULY 20, 2012 (NON-TURF BUFFER) Aug. I, 2012 (revisions) o° \A• '� •��°. / / off' � pl 6\ � O 0do E C E I V E o� �s ssxi / e3 .8. � ^° MAR 2 2 2013 IQ,* Town o / / Q- / own X,A\. "°" Ro9 Board of Trusteeg ' P / Go o• �o ° / 90 Gp �0 '< gyp• / ��c .14 p\ R N� r0 • Id . AREA = 19,904 sq.ft. .� \ �'00 °ti a_ to tie line -4901 ■ = Monument \ / LAND N. N. . . L C. NO. 49618 ANY ALTERATION OR AD0177ON TO THIS SURVEY IS A VIOLATION ECONIC EYORS, P.C. OF SEC77ON 72090F THE NEW YORK ST47E EDUCA77ON LAW. LOT s REFER TO MAP OF REYDON SHORES" 631 765-5020 FAX 631 765-1797 EXCEPT AS PER SEC77ON 7209–SUBDIVISION 2. ALL CER77F1CA770NS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF RLED THE SUFFOLK COUNTY CLERKS OFFICE P.0. BOX 909 SAID MAP OR COPIES BEAR 77-IE IMPRESSED SEAL OF THE SURVEYOR ON JULY 22 1930 AS MAP ON. 631 1230 TRAVELER STREET WHOSE SIGNATURE APPEARS HEREON. SOUTHOLO, MY 11971 12-116 -- i , SURVEY OF PROPERTY Mti AT SO UTHOLD s� TOWN OF SO UTHOLD 1 0 SUFFOLK COUNTY, N. Y. SJF F yQ 1000-80-05-2.1 5 0 0� o� �� SCALE: 1'= 30' / iy'' eo f� e February 14, 2012 March 20� 2012 (revisions) 4n/p l•.,' ��-F .. ,� 00 LF pyo 9�s� MAY 14 2012 I. utho-I To,�-- s-•-.a j � �ti \ry pJ P / Go o• �o 8 o •, 0 Op / 0 .��T.fie AREA = 19,904 sq.ft. �Q?0to tie line ti C• Orel %, ` ■ = Monument / 5 N0. 49618 ANY ALTERATION OR ADDI77ON TO THIS SURVEY IS A VlOLA77ON IPECONIC EYORS, P.C. OF SECTION 7209OF THE NEW YORK STATE EDUCATION LAW. EXCEPT AS PER SEC77ON 7209—SUBDIVISION 2. ALL CER77FICA77ONS LOT s REFER TO MAP OF REYDON SHORES" (631) 765-5020 FAX (631) 765-1797 HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF FILED 7N THE SUFFOLK COUNTY CLERK'S OFFICE P.0. BOX 909 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR ON JULY 22, 1930 AS MAP ON. 631 1230 TRAVELER STREET 12_116 WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N. Y. 11971 w{ � - _ A + jwl Peter Cosola 430 West Shore Dr.,Southold :0 6113/2012 r rt> 'r1M' .. � - � • moi. `A � .. _ - `s _ • �ra �n w1 alai + l .µ • I W a iµ z `- S � �fn -a. w wM• - , a +tl � 4 v N ' c OSUF FQ(,� James F King,President P O Box 1 179 Bob Ghosio,Jr.,vice-President a Gy Southold,NY 11971 Dave Bergen ti ? Telephone(631 765-1892 John Bredemeyer ,y I" Fax(63 1)765-6641 Michael J Domino Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: Patricia C. Moore, Esq. on behalf of PETER COSOLA requests an Administrative Permit to trim the vegetation landward of the bulkhead; plant evergreens along the property lines; as-built patio and walkways; and 4'X 5' outdoor shower enclosure. Located: 430 West Shore Dr., Southold. SCTM#80-5-2.1 Type of area to be impacted: _Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: _Chapt.275 Chapt. 111 other Type of Application: Wetland _Coastal Erosion _Amendment _Administrative_Emergency Pre-Submission Violation Info needed: Modifications: t Condi ' ns: Present Were: V J. K�Vaichael �B. Ghosio `�D ergen, Bredemeyer Domino D. Dzenkowski other Foam fille ou the field by Mailed/Faxed to: Date: l+ _ J P 1 A ce "- 1 } f T Y ..1 • jr Y ` � .. � �•_ COSOLA SCTM: 1000-80-5-2.1 ��`" 430 WEST SHORE DRIVE • ti 1 4 - rjr 3 S�� . � �.. .� � .f r. ..�{:�11 -• �r r !',r n•� r 1'�'�e �'"• • � � nor• .tM �* ;•. s _ r1 ., � �•� :�R �� ,.! Al + Y 1`� 'I. ! ' fig' �`4 ..{ • y�I 1 '' ;�-.i. 1 ■ 4 - 7 -r ` - , ' �',`� s i ► ,''�' , . + 4r, ��� Fly ,,.�•` ���� it [� — .Ra j air �. At ' i spy Lr a . � ,-•1 14 FF r ,COSOLA SCTM: 1000-80-5-2.1 430 WEST SHORE DRIVE z X _ v -An �w AL w i 41 rat w.! r " • 4 {. t ri t t 4 re COSOLA SCTM: 1000-80-5-2.1 430 WEST SHORE DRIVE i 3 ; +*` J4 jL I .�y a 1 r_ COSOLA SCTM: 1000-80-5-2.1 30 WEST SHORE DRIVE ;: ,... t job , j ! AIR . 4 f 'k -- r � z .. � � •+ .{+�!:i _ to,'-�• ' „�" :1 a f • `hJ� i 1�. f ,. yY .. �f i VA � z h' T• fJ� -" "k v �.p �4L.'. t� - 1� 4# yr R .�..• ~ice f 1 1 — C • � �r COSOLA SCTM: 1000-80-5-2.1 30 WEST SHORE DRIVE y � i r IPA Ak. ` ,. f AN r Abr A 4• P 4 - 1 r COSOLA SCTM: 1000-80-5-2.1 30 WEST SHORE DRIVE .. 4 1 � PWITT�r mom �o Y mom r 4w 1�7, kit zi roi 1 •1� r� f. • � �e�ti.. • ,1 SCS,• .. �..�r.,,y'+' � l� �'wf �d- �� ' ••� �i � . .. '(dry a,. �� ��» r1• ',� �� ..; •ter•_ *k•+- �- L� �f� Ati ?qr i ••eb j � r �y COSOLA , SCTM: 1000-80-5-2.1 ` 30 WEST SHORE DRIVE �2j sem sn Y- IG" rt—.—.+_d—'S'.,_ Ei, 09. ------- ------- ------- M, - ------------ _.--pt- ----------- ------- ---:-------4t - I --- ---- - -------- ziq, LAKE Oft. L 4 ---------- ---- z ---------- AP--- ---------- GROVE - ---------- � CY COUNTY OF SUFFOLK'© x n tolrtttatn Tax Service Ag 81, y-1 sE IG � OFFICE LOCATION: � OF SO!/ryo MAILING ADDRESS: Town Hall Annex ,`O 01 0 P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 G Q Telephone: 631 765-1938 Fax: 631765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD DECE E MEMORANDUM JUN 2 0 2012 Southhold Town Board of Trustees To: Jim King, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: June 20, 2012 Re: Proposed Wetland Permit for PETER COSOLA SCTM#1000-80-5-2.1 Note that the "as built" submitted does not conform to § 275-6. Application. The plan is not certified by a registered land surveyor or registered professional engineer, licensed by the State of New York. Patricia C. Moore, Esq. on behalf of PETER COSOLA requests an Administrative Permit to trim the vegetation landward of the bulkhead; plant evergreens along the property lines; as- built patio and walkways; and 4'X 5' outdoor shower enclosure. Located: 430 West Shore Dr., Southold. SCTM#80-5-2.1 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 the denoted following 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 c1 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. The action was constructed without the benefit of Board review. Further it is recommended that the Board: 1. Clarify the need to trim vegetation on the bluff. 2. Clarify the location of drywells referenced on the as built Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney James F.King,President �QF SO!/ry Town Hall Annex Bob Ghosio,Jr.,Vice-President �O� Ol0 54375 Main Road P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer co* G O Telephone(631) 765-1892 Michael J.Domino Fax(631) 765-6641 �yc4UNT`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Applications _Wetland Permit Application ✓ Administrative Permit Amendment/Transfer/Extension Received Application: 5 ( '4- �ceived Fee:$ completed Application I 12' _Incomplete t �'; �� + •; _SEQRA Classification: Type I Type 11 Unlisted t 212 Coordination:(date sent) ! MAY 1 4 `' -,LWRP Consistency Assessment Form ' 3 _CAC Referral Sent: ✓trate of Inspection: (^ _Receipt of CAC Report: __ ._- --•- - - -" _Lead Agency Determination: _Technical Review: (Public Hearing Held: Resolution: Name �� � Name of Applicant C711:-)C' ' Address H -6 W 2bt' Sh rJ�re-�( ern c�C7l l 0 I /Q � .�I�( � I � Phone Number:( ) / Suffolk County Tax 1VIap Number: 1000 - �?-0 _ d S d' Property Location: w f 5h D I-C Dr,y-e I �C9 tit-pito �c� � (provide LILCO Pole#, distance to cross streets, and location) i AGENT: (If applicable) -r /D / Address: , 5-f 02D /�Q i`t Ileo ��UA0 l� Ai-Y, /1677/ Phone: -)(a 3 3c� BoarA of Trustees Application GENERAL DATA Land Area(in square feet): Area Zoning: R- `C o Previous use of property: Intended use of property: Q2 GXA C-AA Covenants and Restrictions: Yes X No If"Yes", please provide copy. 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 )( _No Does the structure(s) on property have a valid Certificate of Occupancy—X—Yes No Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. (Feyvv � Fa-r ".a,� a i{o uat� 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): �r rn 1�_e�e i��hO►J lumd� c� crL ���1U.�o oc�- n .�aQ" • F, rr` 9•Mda- a� ou#a o Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Pn„n I Alp 10 e I Area,of wetlands on lot: quare feet Percent coverage of lot: 5 % Closest distance between nearest existing structure and upland edge of wetlands: S feet Closest distance between nearest proposed structure and upland edge of wetlands: o q l "feet + Does the project involve excavation or filling? x No Yes If yes, how much material will be excavated?__hqA,___cubic yards How much material will be filled? N(A cubic yards Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations: 4%(,��- 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): 11 o I Lp '1 PROJECT ID NUMBER SEAR - APPPENDIENDI X C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1 APPLICANT/SPONSOR 2.PROJECT NAME 'N_� C so(ti Cosa(c., 0 3.PROJECT LOCATION: y50 vvts- - r5h0m urw-e I Municipality County 4.PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map ,H3a Wc.st- 5.IS PROPOSED ACTION ❑- New ❑Expansion ❑Modification/alteration 6.DESCRIBE PROJECT BRIEFLY CA,T- YCL!3� ��ro , Q/VICYS c CT*' J 7 AMOUNT OF LAND AFFECTED- Initially , 6-� acres Ultimately '.S acres 6 WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ViYes ❑ No If no,describe briefly- 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply) PResidential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open Space ❑Other (describe) 10 DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ❑Yes lel No If yes, list agency name and permit / approval: 11 UOLS ANY ASFIEGI 01-- lHt AUIIUN HAVE A CURRENTLY VALID PERMIT OR APPROVA V] ]Yes El No If yes, list agency name and permit / approval: 8_ Re.� �( � jR ISI �!►'L 0=1/'�"i.�—- - --- - - - - 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑Yes 0,No I CERTIFY THAT T OR ION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Na Date. Signature If the action is a Costal Area,and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment _ 1 PART II- IMPACT ASSESSMENT To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF. Yes Q No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. aYes. Q No C. COUW ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) C1. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. E ic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly.- C4. riefly:C4. A community's existing plans or goals as offidally adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly- 05. rieflyC5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: C6. Long term,short term,cumulative,or other effects not identified in C1-05? Explain briefly C7. Other impacts(including changes in use of either quantity or type of energy? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AR=I,a Iain brief) : 13 Yes a No E IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL.ADVERSE ENVIRONMENTAL IMPACTS? If s Iain: QYes Q No PART 111-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) yia INSTRUCTIONS: For each adverse effect Identified above,determine whether it is substantial,large,Important orotherwise significant. Each effect should be assessed in connection with its(a)setting(i.e.urban or rural);(b)probabitrtyof oocuning;(c)duration;(d)irreversibility;(e) geographic scope;and(f)magnitude. If necessary,add attachments or reference supporting materials. Ensure th4t explanations contain suf dent detail to show that all relevant adverse impacts have been idenfified and adequately addressed. If question d of part Q was checked yes,the determination of significance mustevaluate the potential impact ofthe proposed.acoon on the environmental characteristics of the CFA. Check this box Ifyou have Identified one or more potentiafiy largeor significant adv+else Impacts which MAY ocau Then proceed directly to the FUU FAF andfor prepare a positive dedaration. Check this box If you have determined,based on the Information and analysis above and any supporting documentation,fhat the proposed actio WILL NOT result In any significant adverse environmental Impacts AND provide,on attachments as necessary,the reasons supporting thi determination. Board of Trustees ✓Y Al g /2. fName of Lead Agency Date V � �5 /- • 1��� President Print or Type Name of Responsible Officer in L ad Agency Title of Responsible Officer Sign re of Responsible Officet in Lead A cy Signature of Preparer(If different from responsible officer) Town of Southold b�SUFFQ� Z Erosion, Sedimentation .& Storm-Water Run-off ASSESSMENT FORM g PROPERTY LOCATION: s.C.T.M.it: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A Or STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN i -t;rcoo—n –9loe� -T� CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? nG Will this Project Retain All Stone-Water Run-Off (include Total Area of all Parcels located within 1 t Q(�_� Generated by a Two(2')Inch Rainfall on Site? the Scope of Work for Proposed Construction) (S.F/ ) (This item will include all run-off created by site ❑ b. What Is the Total Area of Land Clearing clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed O Site Improvements and the permanent creation of construction activity? impervious surfaces.) (S.F/Aces) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT DESCRIPTION (-aAddbwatPe9esesNeeded) Drainage Structures Indicating Size&Location?This � a Item shall include all Proposed Grade Changes and Slopes Controlling Surface Water Flow. I 3 Does the Site Plan and/or Survey describe the erosion `! Pill l 5�(/1�IGt and sediment control practices that will be used to )(, control site erosion and storm water discharges. This item must be maintained throughout the Entire Construction Period. 4 Will this Project Require any Land Filling,Grading or Excavation where there is a change to the Natural F] 1C Existing Grade Involving more than 200 Cubic Yards — of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities a Encompassing an Area in Excess of Five Thousand (5,000 S.F.)Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction General DEC SWPPP Requirements: or within One Hundred(100')feet of a Wetland or Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres; including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes ❑ are part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to including Constriction activities involving soil disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? the DEC has determined that a SPDES permit is required for stone water discharges. (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious ❑ for Storm Water Discharges from Construction activity-Permit No.GP-0-10-001.) Surfaces be Sloped to Direct Storm-Water Run-Off 1 The SWPPP shall be prepared prior to the submittal of the Not.The Not shall be into and/or in the direction of a Town right-of-way? submitted to the Department prior to the commencement of construction activity. 2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any a �( constructed to reduce the pollutants In storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder r compliance with the terms and conditions of this permit.In addition,the SWPPP shall Area?9,y rmm wta NOT include the rmtaaaeon of Drl-y AP-) identify potential sources of pollution which may reasonably be expected to affect the quality of stone water discharges. NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark 3.All SWPPPs that require the postconstruction storm water management practice In a Box and the construction site disturbance is between 5,000 S.F.31 Acre In area, component shall be prepared by a qualified Design Professional Licensed in New York a Stone Water,Grading,Drainage&Erosion Control Plan is Required by the Town of that Is knowledgeable in the principles and practices of Storm Water Management. Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit (NOTE: A check Mark(,i)and/or Answer for each Question is Required for a Complete Appkadon) STATE OF NEW YORK, C UNTY OF.... ..SS That I,.......... ... .... . .......................................being drily sworn,deposes and says that he/she is the applicant for Permit, me of Individu sining Document) And that he/she is the ............................................ ................................................................ ... . .............. .......................... (Owner,Contractor,A ,Corporate Officer,etc.) Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be performed in the manner set forth in the application filed herewi Sworn to before me this; ............. q...... .......... day of... ...-- . ..... ....................12 . Notary Public: ... J eetsv n IefNs.......................... ..... Nfty Public.State of New York i (Signature of Applicant) FORM - 0 !10 dmliflod in Suffolk County ftlyniiiian ExiXes July 1 Bo,' ; of Trustees Application County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S)OR REPRESENTATIVES(S),TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. ignature SWORN TO BEFORE ME THIS DAY OF i No is BETSY A.PERKINS Notary Public,State of New York No.01 PE6130636 Qualified in Suffolk Counlvd b Commisslon Expires July tai of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, -c- ov- Ca b(c` residing at Lf 30 V j Q c,,+ (print owner of property) (mailing address) svRt,m c1r-�W do hereby authorize (Agent) �cL,NYCc, cam. C M O tv'e to apply for permit(s)from the Southold Board of wn Trustees on my behalf. (Owner's signature) i APPLICANT/AOENTmEPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics arolnNts conflicts of ba rest on the tart of town officers and employees.The ouroose of this form is to ucovide information which can alert the town of ooss<ble conflicts of interest and allow it to take whatever action is necessary to avoid same_ YOUR NAME. �2�t.+i t. G 5 0 Q 1T �y r GC ci (� I ► 1 t'�6r� (1,=name,first na>ae,muldle 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 APPUCA71AN: (Check all that apply.) Taos grievance Building Variance - Tnistee X Change of Zdne Coastal Erosion Approval of plat Mooring Exeniptwn froth plat or official map Planning Other (lf"Other",name the activity.) Do You WsOnallY(m through your COUIP2Hy,spouse,sibling,parent,or child)have a relationship with arty 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`ACES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold 'Pitta or position of that person Describe the relationship betwoen yourself(the applicalWagentkepresentative)and the town officer or employee.Either check the appropriate tine A)dluougb D)a&or describe in the space provided The town officer or employee or his or her spouse,sibling,parent,or child is(ctecc all that ap pl y} A)the owner of greater than 5%of ate 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,pwuw,or employee of the applicant or D)the actual applicant.. DESCRIPTION OF RELATIONSW Submitted th" day of rc/ 20d O Signature Form TS 1 me Print Na 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 area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold 's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# PROJECT NAME 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: , � a c s eS r7 T Location of action: c - Site acreage: (9 Cf Present land use: cG ",uft ate' Present zoning classification: k - O 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: Te � ` -O S o A (b) Mailing address: y 6O W2 c%6v,-P c �'yVre (c) Telephone number: Area Code ( ) C71-7- 9 72 9 (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No E4 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. N Yes ❑ No ❑ Not Applicable A44 Muvd 4tv- -6 O a Attach additional sheets f neces Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria Yes ❑ No l Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages S through 16 for evaluation criteria ❑ Yes ❑ No R Not Applicable I Ile 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 NNotApplicable cCc o a 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 Not Applin Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LW" 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. rVi ❑ 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. ❑ YeF-1 No Not Applicable Z4rPA 'uA'Zta Attach additional sheets.if necessary WORKING COAST POLICIES 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 0 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 r Not Applicable ` Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable PREPARED BY TITLE DATE 9��Z- PATRICIA C. MOORE Attorney at Law 51020 Main Road Southold,New York 11971 Tel:(631)765-4330 Fax: (631)765-4643 May 14, 2012 Board of Trustees T Town of Southold ` `_' P.O. Box 1179 f` Southold, NY 11971 MAY 1 4 2012 hd HAND DELIVERED 1 B0?,dni .r, Re:COSOLA Premises: 450 West Shore Drive, Southold SCTM: 1000-80-5-2 . 1 Dear President King and members: With reference to the above, enclosed please find an original and two copies of an administrative permit application together with my client' s check in the amount of $100 . 00 ! Thank you. Very truly yours, ricia C. Moore PCM/bp encls . C: Cosola