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HomeMy WebLinkAboutTR-9180A Glenn Goldsmith, President *QF SU!/TTown Hall Annex Michael J. Domino,Vice-President ,`O ��� 54375 Route 25 P.O.Box 1179 John M.Bredemeyer IIIL Southold,New York 11971 A. Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �� �� Fax(631) 765-6641 COUNT`(,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1675C Date: January 21, 2020 THIS CERTIFIES that the construction of a 380sq.ft. addition onto the landward side of existing dwelling; At 80 Glenn Road, Southold Suffolk County Tax Map#1000-78-2-11.3 Conforms to the application for a Trustee's Permit heretofore filed in this office Dated February 15, 20,18--pursuant to which Trustees-Administrative Permit.#9180A_ _ Dated March 23, 2018, was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the construction of a 380sq.ft. addition onto the landward side of existing dwelling. The certificate is issued to Joseph&Elizabeth Brittman owners of the aforesaid property. Authorized Signature i Glenn Goldsmith, President *1 SU(/� Town Hall Annex Michael J.Domino,Vice-President ,`O� ��� 54375 Route 25 P.O.Box 1179 John M. Bredemeyer III l�[ [ Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 �yCOUNTY BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 1 y )"014 INSPECTED-BY:" -Ch.-275 Ch. 111 INSPECTION SCHEDULE Pre-corfstructiom, haybale line{.silt:boom/silt curtain 1St day of construction Y2 constructed V Project complete, compliance inspection COMMENTS: CERTIFICATE OF COMPLIANCE: Michael J. Domino,President ��0� SUUry� Town Hall Annex 54375 Route 25 John M.Bredemeyer III,Vice-President ti0 l0 P.O. Box 1179 Glenn Goldsmith Southold, New York 11971 A. Nicholas Krupski • Telephone(631) 765-1892 Greg Williams O! Fax(631) 765-6641 MUM 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 1 st day of construction I% constructed Project complete, compliance inspection Michael J. Domino,President ��OF SOUl�o J Town Hall Annex John M. Bredemeyer III,Vice-President �O l0 54375 Route 25 P.O. Box 1179 Glenn Goldsmith Southold, New York 11971 A. Nicholas Krupski • Q Telephone(631) 765-1892 Greg WilliamsyCOU O Fax (631) 765-6641 � l�i`I,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9180A Date of Receipt of Application: February 15, 2018 Applicant: Joseph & Elizabeth Brittman SCTM#: 1000-78-2-11.3 Project Location: 80 Glenn Road, Southold Date of Resolution/Issuance: March 23, 2018 Date of Expiration: March 23, 2020 Reviewed by: Board of Trustees r Project Description: To construct a 380sq.ft. addition onto the landward side of existing dwelling. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the survey prepared by Nathan Taft Corwin, III Land Surveyor, dated February 3, 2018, and stamped approved on March 23, 2018. Special Conditions: None. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Michael J. Domino, President Board of Trustees SOFFO(�- Michael J. Domino, Presii �Q C� Town Hall Annex John M. Bredemeyer III, Vice-P'r`escient ��� Gym, 54375 Route 25 Glenn Goldsmith y ti P.O.Box 1179 A.Nicholas Krupski Southold,NY 11971 �:- Greg Williams 04, ® p! Telephone(631)765-1892 o, �� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date[Time:---2 Completed in field by: 7vI ;U 1009 JOSEPH & ELIZABETH BRITTMAN request an Administrative Permit to construct a 380sq.ft. addition onto the landward side of existing dwelling. Located: 80 Glenn Road, Southold. SCTM# 1000-78-2-11.3 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 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: �?.L I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer ✓ M. Domino . Goldsmith Krupski G. Williams Other Page 1 of 2 Michael J. Domino, Presic o�QSOFFO(�-�oG Town Hall Annex John M. Bredemeyer III, Vice-President h� y� 54375 Route 25 Glenn Goldsmith y z P.O. Box 1179 A.Nicholas Krupski 1�_ Southold,NY 11971 Greg Williams y ® p! Telephone(631)765-1892 �Ol 41 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: JOSEPH & ELIZABETH BRITTMAN request an Administrative Permit to construct a 380sq.ft. addition onto the landward side of existing dwelling. Located: 80 Glenn Road, Southold. SCTM# 1000-78-2-11.3 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 G. Williams E. Cantrell D. Di Salvo Other Page 2 of 2 SURVEY OF LOT I & P/0 LOT 2 APPROVED BY MAP OF BOARD OF I RUSTEES WEST CREEK ESTATES FILE NO. 3848 FILED ON AUGUST 19, 1963 TOWN OF SOUTHOLD SITUATED AT DATE M11 >t 2A �/g BAYVIEW TOWN OF SOUTHOLD 4e­,�- SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-78-02-11 .3 SCALE 1 "=30' X S -6 6-` NOVEMBER 9, 2004 ^ 9° 9 _ .y0 SEPTEMBER 14, 2006 ADDED FLAGGED WETLAND LINE ,Q OCTOBER 23, 2011 ADD PROPOSED GARAGE / V 9,10''� y D DECEMBER 9, 2011 RELOCATED PROPOSED GARAGE oj3 UFFER �� ,o �,� \ o\y� w/Rfs fOGf OF/'q�M DECEMBER 28, 2011DECEMBER 20, 20REVISE PER 11 REVISE 1ZBABCOMMENTS APRIL 24, 2012 ADDED PROPOSED PATIO & DRIVEWAY / pawl 0 MAY 012 LOCATE NEW N GARAGE FOOTING k DECEMBERI uiX 6.2 N� X FEBRUARY 3, 2018 STORMWATER PLAN ��ov �Qa �0 5 0 Ft• apoo x''0.3/ F BUILDING COVERAGE DATA O� �� �UO� SOIL xP�. / 1 \'(fOM.) (OVER UPLAND AREA) ��� L �p.3� 9P C47-CI, �S�N STOGKPIL.E �P,� Mme•/ �?, / 9 Y--..\ DESCRIPTION AREA X LOT COVERAGE co /� `1 ��� / O• / Xi' WETLAND AREA = 6,430 sq. ft.0.148 ac. HOUSE 2,520 sq. ft. 8.7X Frys� ,oR43, k N �Cr/Ory gpops 7.8 cad 4? UPLAND AREA = 29,073 sq. ft. DECK 375 sq. ft. 1.3X 0.667 ac. TOTAL LOT AREA = 35,503 sq. ft. BALCONY 48 sq. ft. 0.1% j�' ' / FFA a 7.8 ;' 0.815 ac. " s ?.. . � F�I/ 191, ry"'' -- 3g.3' /' GARAGE 864 sq. ft. 3.0% 0. 1, oOtjf fY ^ss� h \\ il! ^ PROPOSED ADDITION 380 sq. ft. 1.3% 8 m. ?� 3S • o M 01 // TOTAL 4,187 sq. ft. 14.4% ` ^��`y S3' oz i wii NOTES: X6.3 '/ _ o� �c/ o= •; 2.5 4'zz DECK 6'0 '/ �X �iia4' 1. ELEVATIONS ARE REFERENCED TO NAVD 1988 DATUM �c C 4P 00s�EP °10 wQ//a EXISTING ELEVATIONS ARE SHOWN THUS: 112..4 °°� 4�'. r"f�k X s' �� 0R wo Rye ! 2 FLOOD INSURANC. FLOOD ZONE E MAP NEO. 36�03C0166 H °� ^M •� sem, E X 0°°gyaOa ZONE AE: BASE FLOOD ELEVATIONS DETERMINED �E�pE�6� N0 �Q/f ZONE X: WITEHSOF AVERAGE%DEPTH OFCHANCE LESS THAN OD; FOOT OR WITH DRAINAGE AREAS CHANCE FLOOD AREAS LESSTHAN / 1 SQUARE MILE; AND AREAS PROTECTED BY LEVEES FROM 1% ANNUAL CHANCE FLOOD. rj p. .,..�,:•,,.'`.,./ 8/ X11 15' WIDE NON-DISTURBANCE NON/TURF BUFFER ^ 5,.4 EDGE WETLANDS / X 4 I %/ z4 GARAGE ROOF DRAINAGE CALCULATIONS: 110 00a it yrs\ 0PROP. ADDITION AREA: 380 sq. ft. 00 380 sq. ft. X 0.33 = 65 cu. ft. / 3° X5.5 =� Qa�� \ 65 cu. ft. / 42.2 = 1 .5 vertical ft. of 8' dia. leaching pool required / S 3 `` Q3 PROVIDE (1 ) 8' dia. X 2' high STORM DRAIN POOL 3 =�. S 63° 0 Aio 10S3 30'� '00' E � TYPICAL STORMWATER UNIT A/ (TOPS TO BE TRAFFIC BEARING) (NOT TO SCALE) .CO?,O � O 6"THICK REINFORCED CONC. COVER — FINISHED GRADE ^ ^ 8"TRAFFIC BEARING SLAB 1-0" 7*--------"----- max. r-'-� PIPE FROM ROOF GUTTERS O O 3'-0" 8-0" 3'-0" CRUSHED 3/ 1-1/2"STONErrW RINGS(min.) OROG (min.) ALL AROUND REINFORCED PRECAST CONC. �II 'n 4000 PSI 0 28 DAYS FEB 1 5 ?_n,�, 206 STORMWATER MANAGEMENT NOTES: 06' 1. ANY WORK OR DISTURBANCE, AND STORAGE OF CONSTRUCTION v �' MATERIALS SHALL BE CONFINED TO THE LIMIT OF CLEARING GROUND WATER AND/OR GROUND DISTURBANCE SHOWN ON THE APPROVED PLANS. �-"�'` - ---•- -1 2. PRIOR TO THE COMMENCEMENT OF ANY CONSTRUCTION ACTIVITIES, 36" HIGH POLE (MAX.) ACONTINUOUS LINE OF SILT SCREEN (MAXIMUM OPENING OF STEEL OR WOOD POST U.S. SIEVE #20) SHALL BE STAKED AT THE LIMIT OF CLEARING FLOW AND GROUND DISTURBANCE SHOWN ON THE APPROVED PLANS. THE SCREEN SHALL BE MAINTAINED, AND PLACED AS PREPARED IN NCE WITH THE MINIMUM DISTURBED A EASOFTEN AS S ARRE T PERMANENTLY RE VEGETATED.PROPER ETADTEDT SEDION,IMENTS NTS UNTIL ALL �0 ?,�O/� BYATHE L.IAFOR S.TITLE AONDAAPPROVEDAESTABLISHED AND ADOPTED TRAPPED BY THE SCREEN SHALL BE REMOVED AWAY FROM THE dj ,i, �, ,, FOR SUCH USE BY THE NEW YORK STATE LAND SCREEN TO AN APPROVED UPLAND LOCATION BEFORE THE `QILf _ /\//\ ^:' ✓\\//\�yj TITLE ASSOCIATION. - SCREEN IS REMOVED. 04�• 3. PRIOR TO THE COMMENCEMENT OF ANY CONSTRUCTION ACTIVITIES, S \ � �\z\ �( .Cad m A CONTINUOUS ROW OF STAKED STRAW OR HAY BALES SHALL " x s' TRENCH BE STAKED END TO END AT THE BASE OF THE REQUIRED SILT ii COMPACTED /� e S'/ ` r SCREEN AT THE BASE OF THE REQUIRED SILT SCREEN. THE BALES BACKFILL ; \ SHALL BE MAINTAINED, REPAIRED AND REPLACED AS OFTEN AS IS NECESSARY TO ENSURE PROPER FUNCTION, UNTIL ALL DISTURBED NOTES: AREAS ARE PERMANENTLY VEGETATED. THE AVERAGE USEFUL LIFE TO BE USED WHERE TOPSOIL IS NECESSARY FOR 1• AREA CHOSEN FOR STOCKPILING OPERATIONS TRENCH DETAIL OF A BALE IS 3-4 MONTHS. SEDIMENTS TRAPPED BY THE BALES REGRADING d VEGETATING DISTURBED AREAS. SHALL BE DRY AND STABLE. TEMPORARY STOCKPILE STABILIZATION MEASURES INCLUDE (NOT TO SCALE) SHALL BE REMOVED AWAY FROM THE BALES TO AN APPROVED 2. MAXIMUM SLOPE OF STOCKPILE SHALL BE 2:1. VEGETATIVE COVER, MULCH, NONVEGETATIVE COVER, AND 3. UPON COMPLETION OF SOIL STOCKPILING, EACH UPLAND LOCATION BEFORE THE BALES THEMSELVES ARE REMOVED. PERIPHERAL SEDIMENT TRAPPING BARRIERS. THE /j PILE SHALL BE SURROUNDED WITH EITHER SILT 4. STRAW BALES SHALL RECESSED TWO TO FOUR INCHES INTO THE GROUND. STABILIZATION MEASURE(S) SELECTED SHOULD BE FENCING OR STRAW BALES, THEN STABILIZED WITH ? -'• 5. SILT SCREEN SHALL BEE RECESSED BY TRENCHING SIX INCHES INTO THE GROUND. APPROPRIATE FOR THE TIME OF YEAR, SITE CONDITIONS, VEGETATION OR COVERED. 6. LEADERS AND GUTTERS THAT EMPTY INTO DRYWELLS SHALL BE INSTALLED AND REQUIRED PERIOD OF USE. STEEL OR WOOD tl'rf, I ON THE PROPOSED RESIDENCE. 2 SLOPE OR LESS POST(TYP.) t; - '{• N Y.S. Lic. No. 50467 7. ALL PROPOSED SWIMMING POOL DISCHARGES SHALL BE DIRECTED TO DRYWELLS. EXTRA STRENGTH FILTER FABRIC L 1 REO'D. WITHOUT WIRE MESH SUPPORT r.. 8. PROPOSED DRIVEWAYS MUST BE CONSTRUCTED OF PERMEABLE MATERIALS STABILIZE ENTIRE PILE UNAUTHORIZED ALTERATION OR ADDITION OR IF PAVED, BE EQUIPPED WITH DRAINAGE SUFFICIENT TO PREVENT RUNOFF WITH VEGETATION OR COVER ., 14, \V 14/ 14, 14, 10' MAX. O.C. SPACING TO THIS SURVEY IS A VIOLATION OF FROM BEING DISCHARGED ONTO THE ROAD OR OFF-SITE. W/WIRE SUPPORT FENCE SECTION 7209 OF THE NEW YORK STATE 9. ALL AREAS OF SOIL DISTURBANCE RESULTING FROM THIS PROJECT SHALL BE .t, .v .I, .1 .I, .1 .l s Max. O.C.W/0 WIRE SUPPORTT FENCE E G EDUCATION LAW. Nathan Taft Corwin III SEEDED WITH AN APPROPRIATE PERENNIAL GRASS, AND MULCHED WITH STRAW — IMMEDIATELY UPON COMPLETION OF THE PROJECT, WITHIN TWO (2) DAYS OF y 14, t `t `I t '• :r COPIES OF THIS SURVEY MAP NOT BEARING FINAL GRADING, OR BY THE EXPIRATION DATE OF THE BUILDING PERMIT, EyO y � � � EMBOSSED SEAL SHALL NOT BE CONSIDERED R THE LAND SURVEYOR'S INKED SEAL OR Land Surveyor ��"� WHICHEVER IS FIRST. MULCH SHALL BE MAINTAINED UNTIL A SUITABLE TO BE A VALID TRUE COPY. VEGETATIVE COVER IS ESTABLISHED. IF SEEDING IS IMPRACTICAL DUE TO :`-:`'; :: TIME OF YEAR, TEMPORARY MULCH SHALL BE APPLIED AND FINAL SEEDING `, 14, 11' IP `I' `v `I ATTACH FILTER FA6RIC SECURELY CERTIFICATIONS INDICATED HEREON SHALL RUN PERFORMED AS SOON AS WEATHER CONDITIONS FAVOR GERMINATION ''' To UPSTREAM SIDE of POST ONLY TO THE PERSON FOR WHOM THE SURVEY �, q, 14, %1, �t, � IS PREPARED, AND ON HIS BEHALF TO THE Successor To: StanleyJ. Isaksen, Jr. L.S. AND GROWTH. -- 7s� \� r \\ \\\ TITLE COMPANY, GOVERNMENTAL AGENCY AND 10 VEGETATIVE COVERSUITABLE TVE WITHOVER IS CONTIGUOUSNED AS A UNVEGETATIEDIMUM AREASF85X AREANO LARGER � �' J' q 14, /41\%\/1�\T\\i as��/�1i�/� SILT FENCE DETAILS LENDING INSTITUTION LISTED HEREON, AND Joseph A. Ingegno L.S. THAN 1 SQUARE FOOT IN SIZE. TO THE ASSIGNEES OF THE LENDING INSTI- Title Surveys - Subdivisions - Site Plans - Construction Layout nor ro scua TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. y y 11. ALL CONSTRUCTION ACCESS WAYS SHALL BE RAISED SUFFICIENTLY AT THEIR SITE ACCESS LOCATIONS WITH THE EXISTING ROADS, TO PREVENT RUNOFF NOTES: SILT FENCE SHALL BE PLACED PARALLEL TO SLOPE CONTOURS TO PHONE (631)727-2090 FOX (631)727-1727 OF WATER, SILTS AND SEDIMENTS FROM BEING DIRECTED OR DISCHARGED ONTO MAXIMIZE PONDING EFFICIENCY. INSPECT AND REPAIR SILT FENCE AFTER STRAW BALES OR SILT FENCE EACH STORM EVENT AND REMOVE SAN ARE WHEN NECESSARY. REMOVED THE EXISTENCE OF RIGHTS OF WAY THE ROAD. A NON-LOAM BASE MATERIAL, SUCH AS CRUSHED STONE, GRAVEL, OFFICES LOCATED AT MAILING ADDRESS SOIL STOCKPILE SEDIMENT SHALL BE DEPOSITED TO AN AREA THAT WILL NOT ALLOW OR RECYCLED CONCRETE BASE, SHALL BE PLACED ACROSS THE DRIVEWAY OR NOT TO SCALE OFF-SITE TRANSPORT. AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P.O. Box 16 CONSTRUCTION ACCESS WAY AT THE ACCESS POINT ALONG THE ROAD. ( ) ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947 26-335B POSPISIL & BROWN II.11 LI Il LI 1-_I-II JI I lllUl I_I11.111L1 Ili!_11JLI�_Ju1-UI.J Li!1-lu_I1 _I + L ARCHITECTS P . C . IJI ._II I 111111-� [Llll�uJJ_T.1J1_l_l _u� �t_a _. _ �I_�-�i"Al t � 11JI I__I)r111 1-_IiI IIJI(I 11-[I L I_ LJI 1L� IA iJ Il _ II_J1Ll l! " JL' JI " " "" I,, JJ� 4 L11�J11 I _ U1111 11111 lit 11 1I�11J11�il1JJL.l_I11i1! 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Existing Construction To De Removed New Framed Construction Poured Concrete www.pospisilbrown.com t14] Hampton Road T:631.283.3465 7. Southampton,NY. 1]968 F:631.283.3593 w> a:?`'" C.M.U. Block Eq. Equal Centerline F.V. Field Verify Project Name: 0.C. On Center T.B.D. To Be Determined Brittman Residence U.O.N. Unless Otherwise Noted Glenn Road A.F.F Above Finished Floor Southold New York Note: All dimenslons are from rough framing unless otherwise noted. - I / I I / I I / I I / I I UNEXCAVATED I GARAGE / Existing No Change / I Existing No Change I / I I ±7'-35/8' I'-I I " L.olNi_ I (10 -1 }j KI IMECHANICAU LAUNDRY UNEXCAVATED I COVERED PATIO I ROOM Existuig No Change I EXisting g No Chan e I Renovate I I _ O JEil— I Align New Foundation Wall with Existing I I I O i -- LEl - - o �—. h(�a f L 'III it in u� k - ---- - - -- ----- a- ( � f•�� CRAWL SPACE I — I I Ewsting Foundation I New 8" thick poured Conc. 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COPYRIGHT 2016. ALL RIGHTS RESERVED. ` t PROPOSED PARTIAL FRONT ELEVATION ( @ MAIN BAYVI EW RD) Seal: Att1c l �S: F-U NRC,, / �k,0\P�OLMES poT�pT First Floor Ceihng rM't' _ 17- 01840'5 . - _ IN -- 1 g - S 0184p5 I. N 11- TT y � i,;" O III 9 OF N�`N O Top of Finished - �o Floor @ F1r5t Floor +I Drawing Name: Laundry/ Mechanical Room `! PROPOSED PARTIAL Top Of Finished �- _ t Floor Laundr Room - r h �' ELEVATIONS Covered o �v. 0-911 - -- - --- ----- -- - " fy,� SECTIONS TNRU ADDITION s; ,., Top of Slab @ Garage- Elev. -2'-2"± % Crawl Space Drawing Number: =� -:: 4 SECTION TH RU LAUNDRY DOOM ADDITION Scale: %" b �, s �. 111 �' �;� �1 t ;.q��J �-. , �� e®<<, � � �i �' �� ,, � `� n ,� i- -� . : - - r ,� .�. - , f ,� ` •' �' � 1►`�'.'•' ..fir.; , ' � '' -."� � _ _ ' 1 � . ,,� .�, .� ..a - . � � 201 . 3 . 14 13 : 41 C) • i r .h S' 7 1 � i as Je s ,an / SLEEPY ....� vj tau IDA .s tWU � i • �. ♦ ,os n ,-os(U � .� G./ ter" 4 ♦ � toes ! � TOT OL t s Y ♦nn , � tut '° � ,•r ' ]] 9 � ^ Wa° m O / SOUfNOLD / ♦ ,1� ]].f "•t3 v Jt � � � "• 22 zs se n co FFOM iii / SUTOLK t] N tsz to 'as Is dNc / 20 sEE SEC.No.o,e C, 4ty� W`I i M. A ,..T,yU S2s ^\ rad . <J nA n. 13 P� b 2� ra ea vast Ro. � .♦'a as + _ �>• b b � �7 r nr •re .,1 I a N 9 s te? � •s a � � � � �e � z. � 1 � t>N(c, ,'WU yah 3 n 4�� ; . b n. /4I • .N � ,D ,Vl t1 a ate W a1.0 m x 'tYe>i A s-Fl ,. I 1 -13 SS nrr O I w t >s ,i P:�.1 �s � �y e n i r a zyU taVot 1 Se taeErm. P � �? 9 . ¢enT .ao, ♦ np � .g b \ .�, b o^ ,.tr� ]° 1 a ..a_ � tq �P�P r r �y Y+ ccao�' "p�c� p ah • s a � ata � )^ zl. I � w � r] 22 aK1 s a ^ '° n n9 7a ' b MA,N �� N a x ha p m 4 � a" ® L > 3Q �,o t �'_ 'NYU .A♦„bo,� h .ta w> � P '�� N ? e M ,s v o. S b o },�s )�f art "' �m T w • � ® °0) ZWc1 4 s>+ s ri •+ Y3 zw r _ °I t .t © y b. z4c/ ANc S .,s .as °, p to ♦ z ] is ;* b' .) w WU p t 124 t5V1 ,a SO 6� IIIA RY�.a'u ry �a Cnm ,MTGt--�--� 1 �-I L •� � �'4 �t ! mT/ 17 SEE SEC.NO.M �6C WrC. ,Sa SECTION NO NOTICE COUNTY OF SUFFOLK © K °°' m° '°""°' SOUTHOLD E ®tRs Real Property Tax Service Agency r ,m •�� —7Z--- ...�. (21) O 078tl x. o...W. --•-- ...r..--...-- n..,n c.xv,u..t°m..r„etn M en .u>mo rtr --�-- p Oae oA °m ps,mCt MD t000 PROPERTY MAP R � al 1 OFFICE LOCATION: �O��Of SU(/ryOlo MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 1197.1 (cor. Main Rd. &Youngs Ave.) � • �O� Telephone: 631 765-1938' Southold, NY 11971 Fax: 631 765-3136 COU � LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: March 15, 2018 Re: LWRP Coastal Consistency Review for JOSEPH & ELIZABETH BRITTMAN SCTM# 1000-78-2-11.3 JOSEPH A ELIZABETH BRITTMAN request an Administrative Permit to construct a 380sq ft. addition onto the landward side of existing dwelling. Located: 80 Glenn Road, Southold. SCTM# 1000-78-2-11.3 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. 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: Damon Hagan, Assistant Town Attorney Jamcs C' EGng- Tr'USLCC .r te ���old Nc— York 11971 0959 Dave Berger). Trust.ce � I � G g _�:lephonc (63U 765-1892 Charles J Sandcrs TrUSCCe fly COW-'t Fax (631) 765-6641 r .� - B O ARD OF TO WT1-T TRUSTEES TOWN 0FSOUTHOGD s.:: 'To: Southold.Tow6 Building Department Re_ Verification of Building Department Permit Requirements SCTMff-- I(` Property Owner Blame: Date Sent to Bldg- Dept_-- The Office of the Board of Trustees is forwarding the above referenced appficafioa for verification of the Building Department's permitting requirements stated befomr_ YES NO Will the proposed project require a Building Permit? Xlf the proposed project require a variance determination from the Zoning Board of Appeals? Will any part of this application be considered as Demolition as described under Town C6de? COMMENTS: Signature o iewer Date FEB 2 6 2018 BUMDIIVG DEPT. TOWN OF SOUTHOL-D Michael J.Domino,President OF Soyo Town Hall Annex John M.Bredemeyer III,Vice-President �� l0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A. Nicholas KrupskiO • i� Telephone(631) 765-1892 Greg Williams UN'i'1Fax(631) 765-6641 y�4 ,�� - BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application --/Wetland Permit Application —Administrative Permit Amendment/Transfer/ExtensioaY-h— / g Received Application: LL n L C", Received Fee: $ 1001©d Completed Application: J Incomplete: SEQRA Classification: Type I_ Type II Unlisted �I ; FEB 1 5 2018 ' Lead Agency Determination: Coordination:(date sent): �,2.(g � WLRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: 3 Receipt of CAC Report: Technical Review: 71*'--Public Hearing Held: >< < Resolution: Legal Name of Property Owner(s): Mailing Address: Phone Number: d Suffolk County Tax Map Number: 1000 - 8 - d - 1 Property Location: R LErA Jrp�,) ✓� �-� �' 1 (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT (If applicable): Mailing Address: Phone Number: { r ,:Board of Trustees Applicai >n GENERAL DATA Land Area(in square feet): 0 Area Zoning: �� 1 nil lTl A V Previous use of property: �— Intended use of property: "i T I �— 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? V 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. require a variance from the Zoning Pp Board of Appeals? Yes ✓ No Does this project req 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 on property have a valid Certificate of Occupancy? Yes No Does the structure (s) p p y Prior permits/approvals for site improvements: AgencDate �- ,��)A)& MA y a0 Iti Dir ►ti G �� r ©CT 2-0 O No prior permits/approvals for site improvements. Has any P Pp sus permit/approval roval ever been revoked or ended by a governmental agency? ZNo Yes p If yes, provide explanation: Project Description (use attachments if necessary 3� d P,v-rt�10S to ,-) ro a - 3 Yo o�- .Board of Trustees Applica' �m WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 1 1 1 KD 1 U 00005 T -J 2 CT XJ Q(- 7 Area of wetlands on lot: l� square feet Percent coverage of lot: I . % Closest distance between nearest existing structure and upland edge of wetlands: �O feet Closest distance between nearest proposed structure and upland edge of well feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? ubic yards How much material will be filled? UG=f LLC ) 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: (eX C t9 UegT /e K►-f ot: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (usea achments if appropriate): 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by oriuseful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: `� 3 S© QS f-`e_-C.1-2-44 Mi RIL yI N iN - avb1710&J Project Locationibe escr , attach a locatio LEVU U q , StkiTid o t 1 Brief Description of Proposed Actio/n�: AyD6' ) ��IV1AJbt`F 1 T I C)!J S l cb ©r- �ioose- Name of Applicant or Sponsor: Telephone: 7'4 °-'(Zt_. ' t21 E-Mail: 21 TT D S b O T-6,0 L t^J e— Address: N e T a��apme- city/PO- State• Zip Code: -'-71 �M t,J►J q� . I I 1r19-'-7- 1. .Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that F 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: N = ? 3.a.Total acreage of the site of the proposed action? 0 1 acres b.Total acreage to be physically disturbed? X0105 acres c.Total acreage(project site and any contiguous properties)owned ` or controlled by the applicant or project sponsor? " i5- acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial []Commercial EKsidential(suburban) ❑Forest ❑Agriculture El Aquatic ❑Other(specify): ❑Parkland Page I of 4 5 is the proposed action, NO YE N/A a.A permitted use under the zoning regulations? ❑ V1 ❑ 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: I r J ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES –90 b.Are public transportation service(s)available at or near the site of the proposed action? F-1- c. 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: ❑ Z 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑ b.Is the proposed action located in an archeological sensitive area? ❑ 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? 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 E]Forest ❑Agri cultural/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? El 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? Q'NO DYES ❑ Rr b.Will storm water discharges be directed to established conveyance systems(runoff and sto drains)? If Yes,briefly describe: E]NO OES Page 2 of 4 .1 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 INFO ATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Date: 3 2d d Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? El 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 F-1affect 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: EI 1-1 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, FA ❑ 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 i 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. El Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. ElCheck 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 im acts. Town of Southold / Board of Trustees 6 _/l r Name f Lead A cy Da /y`( �elr J- t0b/K,/A7 President Print or Type Nam of Respo sible facer in Lead Agency Title of Responsible Officer Signature of Respons' e Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 �3oard of Trustees Applicai'r ,n AFFIDAVIT a h BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) 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. Sign e f Property Owner Signature of Property Owner —44 /--DAY l �J k--/ SWORN TO BEFORE ME THIS 44 !DAY OF ('�. , 20 /8 Notary Public STEPHANIE COGNETTA Notary Public-State of New York NO.01C06244153 Oualified in Suffolk County My Commission Expires Jul 5,2019 02/26/2018 12:12 631765QaAl SOUTHOLD TRUSTE« PAGE 01/01 IOard of Trustees Applicat,... ` FFIDAVI 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 PERMUT. Sign tore of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS a, DAY OF ee b r Oar 20 c. Notary Public Hgather Lauletta Notary Public,State of New-York Nc.01 LA6008m Cuall ied in Suffolk County Commission Expires 6/15/20 /S APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the Hart of town officers and employees.The puroose 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: �2 (Last namd,first name,ipiddle 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 this 12 day of r Gi:—X> 200 I Signature Print Name 1-0S,E�?1/ 132 t T")t/1/VAfv,-D Form TS 1 APPLICANUAGENT/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: �R TTYN1(L•� L-1 2�9 3�T-1 (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 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 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 i?--day of(F60 QAV-J 200 Signature LPrint Name 65L 2-A6ol-U ZtZCf CY \J Form TS 1 Aa.t� ,tx a/� g Heather Lauletta Notary Public,State of New York No.Q1LA6M570 Qualified ip Suffolk-County Commission E)gfts 6/15/20 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# /D(�--7 9---D�),- //1 3 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: -2c) Location of action: S�'O v LD Site acreage: To-L-6 L 3 Present land use: R o'; I -D = �) Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: S--Q'2�C-Jaja (b) Mailing address: (c) Telephone number: Area Code (d) Application number,if any: A)/ 18 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 VNot Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWR.P Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes 0 No d 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 ❑ NoNot 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 Pa es 8 through 16 for evaluation criteria F1 Yes F-1NoNot 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 1:1 Yes 1:1 No a 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 HI—Policies; Pages 22 through 32 for evaluation criteria. Yes No Not hpplicable 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 E 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., El Yes ❑ No U 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. ❑ YeO No Not Applicable Attach additional sheets if necessary I I WORKING COAST POLIC.Ms 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 N t Applicable Attach additional sheets if necessary Policy 11.I Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town water s. PPW ee LRP Section III—Policies; Pages 57 through 62 for evaluation criteria. F1 Yes No Not A licable ` 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 eval 'ion criteria. F-1Yes ❑ 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; ages 65 through 68 for evaluation criteria. ❑ Yes No Not Applicable PREPARED BY � Q5C-bA IIJT-� TITLE DATE