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HomeMy WebLinkAboutTR-9246A Michael J.Domino,President O*QF SO Town Town Hall Annex John M.Bredemeyer III,Vice-President VV�r 54375 Route 25 h O P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams a0 Fax(631) 765-6641 CpUIdTY,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1576C Date: June 4, 2019 THIS CERTIFIES that the construction of a proposed 668sq.ft. wood deck with steps to ground in the northeasterly rear yard; and construct a proposed 38sq.ft. wood entry deck landing with steps to ground in the front yard on southerly side; , At 8045 North Bayview Road, Southold Suffolk County Tax Map#1000-79-4-66 Conforms to the application for a Trustees Permit heretofore filed in this office dated May 8, 2018 pursuant to which Trustees Administrative Permit#9246A Dated June 20, 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 proposed 668sq ft wood deck with steps to ground in the northeasterly rear yard; and construct a proposed 38sq ft wood entry deck landing with steps to ground in the front yard on southerly side. The certificate is issued to Jeff Seibel &Judith Alpert-Seibel owners of the aforesaid property. Authorized Signature ' a Michael J. Domino, President ��OF S0(/�yO 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 KrupskiG Q � O Telephone(631) 765-1892 Greg WilliamsO Fax(631) 765-6641 OOUNT`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE - - Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction Y2 constructed Project complete, compliance inspection. l � INSPECTED BY: COMMENT // / , / L ya: e'0-5 Co 4-1 oe(el 4S e ,�-7s C� n i CERTIFICATE OF COMPLIANCE: ` a Michael J. Domino, President ��o�ps11FFOC/(0.9 Town Hall Annex John M. Bredemeyer, III, Vice-President o 54375 Route 25 Glenn Goldsmith H z P.O. Box 1179 A Nicholas Krupski �y • �� Southold, NY 11971 Greg Williams Ol , dap Telephone (631) 765-1892 Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction '/ constructed Project complete, compliance inspection; J p l _ v o Michael J.Domino,President S' if S0 01 Town Hall Annex John M.Bredemeyer III,Vice-President O 54375 Route 25 1 P.O.Box 1179 Glenn Goldsmith Southold, New York 11971 A. Nicholas Krupski �pQ Telephone(631) 765-1892 Greg Williams ?Ie Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9246A Date of Receipt of Application: May 8, 2018 Applicant: Jeff Seibel & Judith Alpert-Seibel SCTM#: 1000-79-4-66 Project Location: 8045 North Bayview Road, Southold Date of Resolution/Issuance: June 20, 2018 Date of Expiration: June 20, 2020 Reviewed by: Board of Trustees Project Description: Construct a proposed 668sq.ft. wood deck with steps to ground in the northeasterly rear yard; and construct a proposed 38sq.ft. wood entry deck landing with steps to ground in the front yard on southerly side. 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 site plan prepared by Robert I. Brown Architect, P.C., dated April 16, 2018 and stamped approved on June 20, 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 �Y ,AWROVED' J' '_,40A`RD-'OF TkUSTEES LOT G5 LAND N/F TOWN, SOUTHOLD OF HARBOR LIGH-f5 PROPERTY ;,. DATE,P,xi/ g ZpI S , 72"58'10" •E 135.00' OWNERS A550CIATION INC, 'S ` , \ 8 10\ 12 14 PROPOSED 51LT • p S FENS DURING �\ `\ O�F?� \ \ 16 , \\ CON5T\RUCTION Cp �(92 20 \gip 64 06 22 .1 NlpL LOT G3 \ PROP05ED STAIR „,,, PROPOS D `\ 1 \ OUTDOOR\ / i //` \ � �,• ' SHOWER I 2 CAR GARAGE I 5LA5 22.3 10 I \ EXISTING 2 STORY FRAME HOU5E 0.9'E I � \\ 1 \ PRM, WITH ATTACHED I STORY GARAGE SHED / \ 1 5'E PROP05E FFE 23.2 12 WOOD D K CELLAR 14,6 1 g'E LANDING AND w 5TEP5 w U r Z 24 � 1 \ \ " W w 14 16 F = � I 1 ' 122 °- I N I 20 18 � '� j � z I 1•\ FC Ln 4'N 135.00' 1 . 'E w I\ REBAR N 7305'20" W I 135,00' EDGE OF PAVEMENT WATER MAIN CL 22'2 NORTH BAYVIEW ROAD CL 21 5 CL 19 5 BASED ON SURVEY BY- KENNETH M WOCHUK LAND SURVEYING DATED APRIL 18, 2017 5CTM: 1000-79-4-GG SITE PLAN AREA 22,893 a SF = 0 52 A ZONE R-a0 EXISTING EXCEPT AS NOTED NOTE- ELEVATIONS HEREON REFER TO NAVD 1988 LOT COVERAGE: EXISTING. 1 g; HOU5E: 1 ,GOG. 15F 7.0% ,1 T 6` f:i.i 5.r stt, £T1=�3 ie DECKS: o ' )� p-- r --•ter CONC/BRICK PATIOS- 25 2 5F O 1% F.RED ARC MAY r U;S_tiACk,{`G �.kgCf:,9THE 8 2��� 'Ei:;:�a'f^i? 'E=: i VeM�D TOTAL I .G3 1 .3 5F 7 1% Q�Q00 OGG20� ' t 1:• \i is^ ` eZl=!ii%! !\tea ii1� PROPOSED: - fz T uthold lewrn `� le',''r� :''.�',f' t=�C�fiss��� HOU5E. I ,GOG. 1 5F 7.0% ward Gf Tr:+slimes -...?J`-, 7-;1 Is.°';0 11;1}::iT L E DECKS 702.6 SF 3. 1% ,f`. ? `•;\S J% :{1 �Df4 C� TOTAL 2,308 7 5F 10 1% ALLOWED 20 SEIBEL RESIDENCE Robert I. Brown ADDITIONS AND RENOVATIONS Architect, P.C. 8oq.5 N. BAYVIEW RD, SOUTHOLD, NY 205 Bay, Ave, Greenport NY 16 APRIL, 2018 SCALE: i" = 20' info@ribrownarchitect.com 6-1-277-47r,2 46'-7" F T-8 3/4" 4'-8" ►O' O" 24'-2 I/4" 1'I — i. Psa MAY 2018 0 3710" PROPOHD DECK O G70 5r O ?,5T.hG­Dal . �T.• •MF,DQh I Z°MQJE�Y•$T n.G 70OF ar.0 r •O FFa,a.. O:fFJa.h I .•�•,:�J.._,\Ca3+.._ '••L\.-:�F Jvftr•:. N 1 .O Bf'FJv OEO 5 S �fmOvt fY•�T.r.r�Df C. 2 i y n Tr.S AFFa I �.`.G tTCr:•. 3 3 � 3FPLACE-Tr nfw P '!N'_. _OO• ^• •7MN>JOM ` _\J7 :3 :t-LC1L4[ 'D i 1, 5'Ohr.f. r u y CSB I �i j I - ----- ----- S. O.. .o. ;5-58 -tO F­11 `.fw T_`_00f TO BI Ba:-:DOa•, nfw ai Tac, 'A -- G 51•iD5O.-D On xL rr}_7 51:)—!q ° c Au O 0 I I 1 D .c GaiAGF an C vf"' O VA hEw WOOD Dt CFt c .D•hC.10:TfN m "I FY�IhC _•V.e.G FDOI.• n_taG WOOD ` Ma.r. FIRST FLOOR PLAN _a-70f TO Ff EX157ING EXCEPT A5 N07!D 71E BRED A)INC 7 Fr cS� ' 'q3gA Q� ! N yO SEIBEL RESIDENCE Robert I . Brown ADDITIONS AND RENOVATIONS Architect, P.C. 8045 N. BAYVI EVV RD SOUTH OLD NY 2-05 nfo@rx Ave. r eenpotrcom 16 APRIL, 2m8 SCALE: 1/8" = i' - o" 631-477-9752 ..,.�_-.....`_...._ _�.-. __-..._._�'� •jam 11-4 MAY 2018 �.w anDFaSFn.+rte#a�F� r--------------- -------- ------, --------- 1 1 1 I I 1 W.-FxF yOR If Opt.wl 1 i 1 _ca�.�:`7rt.,Fw Orrn.hG I I i I 1 1 I 1 I 1 I 1 I `.i+5�•hG bfDkOOl' O� TO ffLff h 1 1 I '- I1 ---------------- I 2 1 1 Q 1 1 � 0 I 1 a«t O I 1 I 1 I 3� I 1 -------------- I I 1 I 1 I I I 1 I I 3� 1 1 hEw i 7bot f I I I 1 1 1,151.1(WORM. SECOND FLOOR PLAN I I hFhWh [i+�T+hC bI DSOOM 1 I �i0 U."U15'ING EXEM AS NOTED AP ._.,a _ i... r;yte E �. •�� e r 'I� SEIBEL RESIDENCE Robert I . Brown ADDITIONS AND RENOVATIONS Architect, P.C. 8045 N. BAYVIEW RD, .SOUTH OLD, NY 05 Bay ainfo@i� ro Ave. r e tporcom 16 APRIL, 2o18 SCALE_ 1/8 = - 0 631-477-9752 L MAY 82018 -f3Lfk-L-W, Mimi I %•5".5 WEST ELEVATION E)(157-ING E)(CEP7 AS NOTED EAST ELEVATION EY15-ING EXCEPT AS NOTED V" A "o- 0 N ENP4 I SEIBEL RESIDENCE Robert I . Brown ADDITIONS AND RENOVATIONS Architect, P.C. 8045 N. BAYVIEW RD, SOUTH OLD, NY 205 Baybro ve. Grchreeitenpct-ort N-Y iwnacom 16APRIL, 2oi8 SCALE: 1/8" = i' - o" 631-477-9752 F IF' MAY 2018 yr ,I-W G-Mf DOOR nfw ou—otc tA.D nG-0 51E-t SOUTH ELEVATION EX157ING-F)(CEF- A5 NOTED ED ARC aCT 1. 6 AA 34A 0--ORDANCE SEIBEL RESIDENCE Robert I . Brown ADDITIONS AND RENOVATIONS Architect, P.C. 8045 N. BAYVIEW RD, SOUTH OLD, NY 2o5 Bay Ave. Grcreepport N-Y lDfo@rjbrownahitect.com 16APRJL, 2oi8 SCALE: 1/8" = i' - 0" 63j-477-9752 Michael J. Domino, Presid �, SUFFOL/rC � -) Town Hall Annex John M. Bredemeyer III, Vice-President �� ��f Q 54375 Route 25 Glenn Goldsmith co z P.O.Box 1179 Wo A.Nicholas Krupski 0 Southold,NY 11971 Greg Williams 4 p� Telephone(631)765-1892 ��1 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in field by: FT t Robert Brown Architects on behalf of JEFF SEIBEL & JUDITH ALPERT-SEIBEL request an Administrative Permit to construct a proposed 668sq.ft. wood deck with steps to ground in the northeasterly rear yard; and construct a proposed 38sq.ft. wood entry deck landing with steps to ground in the front yard on southerly side. Located: 8045 North Bayview Road, Southold. SCTM# 1000-79-4-66 CH. 275-3 - SETBACKS, WETLAND BOUNDARY: Actual Footage or OK=� Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275_, Ch. 111 SEQRA Type: 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: 1 have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino Goldsmith ✓ N. Krupski __,ZG. Williams Other S.C.T.M. NO. DISTRICT. 1000 SECTION: 79 BLOCK: 4 LOT(S):66 I LAND N/F OF LOT 65 \ HARBOR LIGHTS PROPERTY OWNERS ASSOCIATION INC. PIPE S 72058'10"\ E 135.00' 12 to1\ 8 \ \\ \ ASANITARY LOC. LOT 63 IST 64 S SHOWN ON \ \ \ PREVIOUS SURVEY \ \ L() \ \ \ FRESHWATER WERANDS BOUNDARY 20 22 \\OJ \\ \ \ \-AS DELINEATED BY EN-CONSULTANTS \ \ \ \ \ 02-02-17 Li \ 60 1, \ WALK-OUT `CE X8.4 . WOOD "R:':. \ \ \ DECK \10 GARAGE-• \ 9'E I .';.GF 22.3;;;::;f0.8'.:: J�' 10.8' 21.2':•:..':. •SHED X38. XI STOOP .:;:.;::::• 1.9'EI I m ^ '; ':'; \ co 24 w \ ko � W A I I I � 1 \\ \ 16 \\14 J2I ABANDONED 18 WELL 20 rc ` 0 e'E I I \ � 135.00' 1.4'74 REQ N 7305'20" N 1 135.00' EDGE OF PAVEMENT CL 22.2 NORTH BAYVIEW ROAD CL 21.5 CL 19.5 E C E �11 V E I Di Ay 8 2018 M � P SU[rti?f)if?TOlYtI M ; THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL LOCA77ONS SHOWN ARE FROM FIELD OBSERVA77ONS AND OR DATA OBTAINED FROM OTHERS AREA: 22,893.4 SQ.FT. or 0.52 ACRES ELEVA77ON DATUM: NAVD88 _— UNAU774ORIZED AL 1FRA AON OR ADD177ON TO THIS SURVEY IS A VIOLA 77ON OF SEC77ON 7209 OF 77-IE NEW YORK STATE EDUCA 77ON LAW. COPIES OF 7HIS SURVEY MAP NOT BEARING 7HE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM 774E SURVEY IS PREPARED AND ON HIS BEHALF TO THE 777LE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS777U77ON LISTED HEREON, AND TO THE ASSIGNEES OF 7HE LENDING INS77TU770N, GUARANTEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM 774E PROPERTY LINES TO 774E STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE 7HEREFORE THEY ARE NOT INTENDED TO MONUMENT 774E PROPERTY LINES OR TO GUIDE THE EREC77ON OF FENCES, ADDITIONAL S7RUC7URES OR AND OTHER IMPROVEMENTS EASEMENTS AND/OR SUBSURFACE STRU&TURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON 7HE PREMISES AT THE 77ME OF SURVEY SURVEY OF: LOT 64 CERTIFIED TO: JEFFERY & JUDITH SEIBEL; MAP OF: HARBOR LIGHTS ESTATES SEC. 3 FILED: AUGUST 7, 1968 No.5147 SITUATED AT: BAYVIEW TOWN OF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design P.O. Bog 153 Aquebogue, New York 11931 '/ FILE #17-40 SCALE: 1 =30 DATE: APRIL 18, 2017 PHONE (831)298-1588 FAX (831) 298-1588 N.Y.S LISC. NO. 050882 maintaining the records of Robert J. Hennessy & Kenneth M. Woychuk ia� n 'SFS' � �' � .' t • �- y ,�` } ' k •yw•� 1� 1 f liy } \ 1 pt xV L a LLf � �x a�s I mw .ff i �' ��� . _ `1 6 / 13/2018 12 ' 48 +. or, �\ $ i ------------ ` t ne w' S;->' 504 r y > 40 r ' i • SEIBEL RESIDENCE-8045 N. BAYVIEW ROAD, SOUTHOLD, NY SCTM#:1000-79.-4-66 PHOTOS TAKEN MAY 7, 2018 , F r i' ;MrN .�..• ��N �"h� ( t �, .& � i i„' k r•” / �a �. � t,[ ,nu '�'K�,,s.=S4a .,�f �,"�, t r•<�r.Y £ .. ¢'F f y.r �.'d'ki w •: ,iltlr,- iG 1 IrMf '� �� � ����1 IL'� 1 � _`, � I'' w w- a N e i' r 4 u r 4 � n � �> �.:' `° a• . .x _fah.. y� pyo "4. h L S" 5l 6 PHOTO 3 PHOTO 4 FACING EASTERLY FROM WEST REAR SIDE YARD TOWARDS FACING EASTERLY TOWARDS TIDAL WETLANDS TIDAL WETLANDS IN REAR YARD SEIBEL RESIDENCE—8045 N.BAYVIEW ROAD, SOUTHOLD, NY SCTM#:1000-79.-4-66 PHOTOS TAKEN MAY 7, zo18 r - - 1, F G �g11Tr..,•..-ems t- e�w•` Y...J/ r •'— '�a*c�t F L:.k a `�.aa -ti��,�� '�` PHOTO 5 PHOTO 6 FACING NORTHEASTERLY IN REAR SIDEYARD FROM FACING NORTH FROM FRONT YARD. 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Real Property Tax Service Agency v E tea.._ -�— ,..,_.,�,.,.r. (21) ..... a — — ,a.r� Y11", "^ 078 r r,vnn M o w,o T'nrMy.vrE ..�� w user ��: .b ,:.. ..... � .N Utl[rr a � • m„e.x �- _ �. .... -». •iv.. is � �., ..a .:' � '.\ OFFICE LOCATION: ��®f S®��� MAILING ADDRESS: Town Hall Annex �® �® P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Telephone: 631765-1938 Southold, NY 11971 a® P ® - Fax: 631765-3136 ®U9� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino; President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: June 15, 2018 Re: Local Waterfront Coastal Consistency Review for JEFF SEIBEL & JUDITH ALPERT-SEIBEL SCTM# 1000-79-4-66 Robert Brown Architects on behalf of JEFF SEIBEL &JUDITH ALPERT-SEIBEL request an Administrative Permit to construct a proposed 668sq.ft. wood deck with steps to ground in the northeasterly rear yard; and construct a proposed 38sq.ft. wood entry deck landing with steps to ground in the front yard on southerly side. Located: 8045 North Bayview Road, Southold., SCTM# 1000-79-4-66 '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 Michael J. Domino, President F04 410, - Town Hall Annex John M. Bredemeyer, 111, Vice-President ' 54375 Route 25 Glenn Goldsmith y P.O. Box 1179 A Nicholas Krupski • Southold, NY 11971 Greg Williams y�41 „ �a�! Telephone (631) 765-1892 D.a IJ SOUTHOLD TOWN BOARD OF TRUST MAY ® 82018 TO: SOUTHOLD TOWN BUILDING DEPARTMENT BUILDIKGD 'RE: VERIFICATION OF BUILDING DEPARTMENT PERMIT Rgo" pA OLD SCTM#: a Property Owner Name: SCSI��L Date Sent to Bldg. Dept: The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated below: YES NO Will the proposed project require a Building Permit?� Will the proposed project require a variance determination from the Zoning Board of Appeals? Will any part of this application be considered a Demolition as described under Town Code? COMMENTS: Signature of eviewer Date Michael J.Domino,President QS;��, Town Hall Annex John M. Bredemeyer III,Vice-President 54375 Route 25 P.O. Box 1179 Charles J.Sanders Southold, New York 11971 Glenn Goldsmith .yO� Telephone(631) 765-1892 A. Nicholas Krupski `�C4UNTI Fax(631) 765-6641 r, BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application __7Wetland Permit Application Administrative Permit Amendment/Transfer/Extension �,/� Received Application: Received Fee: $ 100,00 =Completed Application: 5. ` rr Incomplete: J SEQRA Classification: Type I_ Type II_ Unlisted Lead Agency Determination: MAY ® 8 201 Coordination:(date sent): �LWRP Consistency Assessment orm Sent: CAC Referral Sent: L Date of Inspection: t"11?c1 Receipt of CAC Report: Technical Review: Public Hearing Held: 6�Resolution: Legal Legal Name of Property Owner(s): I ......-k Mailing Address: Phone Number: Suffolk County Tax Map Number: 1000- Property 000-Property Location: (Y �_ � U__ y (If necessary,provide LILCO Pole#,distance to cross streets, and location) AGENT(If applicable): fi)�� . AlAl- �Q h6ej� A-4 Or Mailing Address: 34W 44 Phone Number: ---- - �_— � 1/ Board of Trustees Appli':,--,,ion GENERAL DATA Land Area(in square feet): Area Zoning:- ,e- 4-D Previous use of property: Intended use of property: Covenants and Restrictions on property? Yes No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? . Yes No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept:? Yes No Does the structure,(s) on property have a valid Certificate of Occupancy? _Yes No Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. ,Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: Project Description (use attachments if necessaryF�(.��1%�� Ad &eL n�n �° A 4-0dCaAdiAa a�;A , Z"/ ' 10 i I � --1 _. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: '' feet Closest distance between nearest proposed structure and upland edge of wetlands: t'o- feet Does the project involve excavation or filling? J / �! No Yes If yes,how much material will be excavated? cubic yards How much material will be filled9 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): 61 Z20 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 l based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information, Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part l -Pro.ect arkud Sponsor Information Name oQctio�a eProje 6 ktej Project Location(describe,and attach a location map): 19e. , W/ 4A V6W Bri Description of Propose Action Name of Applicant or Sponsor: yA Telephone: E-Mail: �• n �� Ad ress: City/PO: State: Zip Code: 1 f9__ 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordi_nance_. , NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2 KI 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: 3.a.Total acreage of the site of the proposed action? ^,__S2,acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? —5-7-1—acres 4. Check all land uses that occur on,adjoining and near the proposed action. E]Urban El Rural(non-agriculture) ❑industrial ❑Commercial Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, _ NO YES N/A a. A permitted use under the zoning regulations? ❑ ® ❑ b.Consistent with the adopted comprehensive plan? ❑ 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; IE ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES 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: ❑ 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 ❑Forest ❑Agricultural/grasslands ❑Early mid-successional Wetland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ❑ 16.Is the project site located in the"100 year flood plain? -,,NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a. Will storm water discharges flow to adjacent properties? ts NO []YES ❑ b. Will storm water discharges be directed to established conveyance systeni runoff and storm drains)? If Yes,briefly describe: ]NO ❑YES Page 2 of 4 r 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: -. _ 0 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 1S TRUE AND ACCURATE TO THE BESTOF MY KNOWLEDGE Applicant/sponsor nam , �/� Date: Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the,following questions'in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning [Lregulations? 2. Will the proposed action result in a change in the use or intensity of use of land? of 3. Will the proposed action impair the character or quality of the existing community? 11 ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure for mass transit,biking or walkway? L J 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate (� reasonably available energy conservation or renewable enely o ortunities? 7. Will the proposed action impact existing: ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of'4 No,or Moderate small to large impact impact Illay Inay Occur occur 10. Wil I the proposed action result in an increase in the potential for erosion,flooding or drainage problems? u 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 detennined that the Impact may or will not be significant. Each potential impact should be assessed considering its setting,probability of occurring, duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. ❑. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any,significant adverse environmental impac Town of Southold-Board of Trustees / b v / _Name of Lead Agency _ Date Mll tI President Print or Type Name of Res poT ibl O A icer in Lead Agency Title of Responsible Officer T Sign ture of Responsibl Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSUU FORM The'I'o o(Southold's Code of Ethics rot' 's conflicts of interest on the.vart atownofficers and elngloyces,The pumose of this orm Isjo povide information whiclican alegtitre town,pf possible conflicts of inwmt and allow-it to take whatevor action i •pecessary tn,avoid same, YOUR NAME: (Last name,first name, iddle 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 rv_ Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or thrpough your company,spouse,sibling,parent,or child)have a rcitdior)ship with any officer or employee of thcTowmat'Souiholcl'? "Relationship"includes,hy,blgpd;.tpardage,or bus'tness'interest."Business interest"menus a business, including•a partnership,'in-which the town officer oremployee has even a partial oivtteN-iigf(or entploynient by)a corporation in which the`iowti 6fficer or cmj>loyee•owns,tnore•tjutn 5%of1he shares, YES _ NO ,SCI 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 Y Describe the relationship between yourself(the applicant/agGnt/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 chili 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 J Submitted this da of —201-C" Signature Print Name Form TS 1 i r - APPLICANT/AGENT/R.EPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of rthies prohibit~conflict of interest on th4 vart L)Flowij pfficors r d eninjoyees,The vurvosg-o of this form is to lrQyide inl'orinntion which caul glcrl•tile toF n ofpossible eonfllcty of interest nod glow it to take whaleygf action is le .stir t v d te, EYOUR NAME: Last name,fir t die 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 APPLICA'T'ION: (Check all that apply.) 'Fax grievance _ Building _ Variance Trustee _ Change of Zone Coastal Erosion Approval of plat _ Mooring Exemption from plat or official Wrap _ _ _ Planning Other (If"Other",name the activity.) Do you personally(or through your comptmy,spouse,sibling,ptirent,or child)have it relationship with uny officer or omployce of the"Town ol'Southold'1 "RehdionsJtip"includes by blood,11111rriags,or business itltetest."Business iuleicst"metros a bi sincss, including a partnership, in which the:town officer or employee has even a partial ownership of(or employment by)a cutlwi anon i11 which the lown olllcer or cinployee Vwns Inore than 5%of the shine~, YES _ NO I� 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 applicwit/agcndrepresentative)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 thi o20 g Signature _ _ _— Name Print Nam _ &&VJA - Form TS 1 Board of Trustees Application AFFIDAVIT A-AJ-)- 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 IN ,= MA 'i4EI ALL WORIK WiLL'9E'b0Nj9-z N �SET FbRTH-IN 'THIS APPLICATION AND AS MAY HE APPROVED BY THE SOUTHOLD TOWN BOARD oFTRUSTEES. 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 Property t SWORN TO BEFORE ME THIS DAY OF 4n 20 No/ary Public NOtaMy Public,State Of NOW" NO-02SE6364909 '0ua1iWed1nKings County MY commission expires Sept.2s.242L Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) �residing at (print name of owner-of property) (mailing address) do hereby authorize (Agent) to apply for permit(s)from the Southold Board of Town Trustees on my behalf. X V J er's signat e APPLICANUAGENT/RE PRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the j)urt 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 neecssaa to avoid same. YOUR NAME: 4�kl �j(La,t a,,. 5r tnme, piddleiflal,unless you are.�plyingin I 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 f 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 corporutiun in which the town officer or employee owns more than 5%of the shares. YES NO ---IV If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by Lhe'rown of Southold____ I. 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 appliqlrit (when the applicant is a corporation); B)the legal or beneficiai owner of any interest in it non-coj porate entity(When the applicant is not a corporation); Q an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP jA 00e W'u iis da of 00 Form TSI IT? 5et-eq L7-4., 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 signi licault beneficial and adverse effects upon the coastal area(which includes all of Southold'l awti., 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# _ ` _- ze/,�, 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: F] Nature and extent of action: pw) 1-11b?-,I�� and &dL 6-n r 0 Location of action: v Site acreage: Present land use: —� .�f 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: (b) Mailing address: (c) Telephone number: Area Code( ) (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No❑ If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No� Not-Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes F1 No�Not Applicable 1 Attach additional sheets if necessary Policy 3. .Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria :F� Yes El 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 a Yes ❑ NoApplicable 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, ❑ E Yes No Not Applicable 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. F] Yes '❑'NogNot 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 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. (� -1:1 Y11 No gNot Applicable 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 E] 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 ❑ NoNot 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 1 TITLE �. DATE_