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HomeMy WebLinkAboutTR-10895A O SQfFO(,I-Glenn Goldsmith,President �0 Cp Town Hall Annex A.Nicholas Krupski,Vice President �� Gym 54375 Route 25 Eric Sepenoski y a P.O.Box 1179 Liz Gillooly r Southold,NY 11971 Joseph Finora ?' p! s� Telephone(631)765-1892 �Ol �a � Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction % constructed XProject complete, compliance inspection 1 Glenn Goldsmith, President �rl S®Ur Town Hall Annex 54375 Route 25 Nicholas Krupski,Vice President ®� ®�® P.O. Box 1179 Eric Sepenoski J Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Joseph Finora Fax(631) 765-6641 COUNT` 1 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10895A Date of Receipt of Application: December 10, 2025 Applicant: Lester & Ethna Lay SCTM#: 1000-78-5-9 Project Location: 370 Williamsberg Drive, Southold Date of Resolution/Issuance: January 14, 2026 Date of Expiration: January 14, 2029 Reviewed by: Board of Trustees Project Description: Remove wood pergola at rear of dwelling; replace bricks of patio which supported pergola with pavers; expand patio footprint eastward by 4' adding an additional 72 sq.ft.; install two removable posts to support seasonal sunshade. 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 Howard Ruben, received on December 10, 2025, and stamped approved on January 14, 2026. 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. Glenn Goldsmith, President Board of Trustees December 2025 Site Plan: Wood Pergola Removal, Paver Installation, Sun Shade Post Installation, 370 Williamsburg Drive Southold NY 11971, Suffolk County. OWhOt''s: Lester aril 'Ethna Lay^. Prepared By Howard-Ruben Prepared December 2025. -1 i lr '.3RUVI C� r r 1��i! 1"1 L'f' �3 EXL5TINGV110L. ? 5Lk1ApC'4M r� , . 10 Noll i Ut�� 3L)ffER INC- 1 } � �G�..R�.�ab�-�. -• 11 oR,Eu laOvS �;:-j=� c��r�E2) � 3nt� w��ls�•��s���� �4 ' T. GRDEAIf=E[.D tv UJA rv��S L F_ E t I ibsEt L:;jr r r `i 1 i r t Z-Or ;�1 r��r� S _'_APPROVED BY Ii y i ('iv ,`B4OARD OF WN OF SOUTHOLD .! r?�Jc"fEFS TO DEC 1 0 2025 DATE �G ��.r LA C4 n -- (� , Sautnuid Town <. Board of Trustee,, �. Paver Patio/Sunshade Posts Plan Detail: Wood Pergola Removal, Paver Installation, Sun Shade Post Installation, 370 Williamsburg Drive Southold NY 11971, Suffolk County. Owners: Lester and Ethna Lay. Prepared By Howard Ruben December 2025. I:'l.Ll qu:?,lluxtl l;lq: EYE,. I,0011 - sun!yl iAl7r.•. rt6 OR 1._1__ I_C__i_ Paver!;for patio hulls lu sCcurc I,`�,...,,:,•. � pus. --_--. :_.-1---I�� 1•,� _ J _J_..-(----I-- �-- --[ _[ ._i 5. POST DETAIL PATIO PLAN t 1 ELE �1 DEC 1 0 ' CUSTOMFR: DRAWN BY; 'tr 's"9irn DRAWING: 2025 QVIN AR1'KTIE'L1',x,VKIIIYICAN(I Lay Residence CLS Design 4�11#= 1'-0" 011CONrreO.-ok roleNrs - PATIO Southold,NY b 10.31.25 Y iI]IS nRA%VIKCI AN ART] AI4TAIIANCLM1j}I,1(.f:FNjrIgL PLAN _ —�-•--�_ ` AI'I'}:AINKCL I,F I"NF PLSIGN.Ir L9;;[)1" 11kAM'IO11F.AN LUCr Rl:VDIII(,N, uuly t vY INL'I.L„ING WINI)OIVS A.VN rAMS. Board of Trustees SOUTH'OLD . .TRUSTEES No. I 0$95 A Issued T Date Address. � \n(' tl'an;sb�uq Dr;�e, Sv.��,o1d THIS. NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765.1892 Glenn Goldsmith,President �0�� COGy Town Hall Annex A.Nicholas Krupski,Vice President o < 54375 Route 25 Eric Sepenoski P.O.Box 1179 Liz Gillooly �y • o!VT Southold,NY 11971 Elizabeth Peeples ��l ¢ Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: 1 Completed in field by: 6-vo� 11- Howard Ruben on behalf of LESTER & ETHNA LAY requests an Administrative Permit to remove wood pergola at rear of dwelling; replace bricks of patio which supported pergola with pavers; expand patio footprint eastward by 4' adding an additional 72 sq.ft.; install two removable posts to support seasonal sunshade. Located: 370 Williamsberg Drive, Southold. SCTM# 1000-78-5-9 Type of area to be impacted: i,Saltwater Wetland Freshwater Wetland Sounds Bay 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 Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: A&''w 12LU) x% v5 '90— Present Were: G. Goldsmith N. K upski E. Sepenoski L. Gillooly X E. Pedples f��hlcP-4 SURVEY OF: PROPERTY LOCATED AT BAYVIEW TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C.T.M. # 1000-75-5-9 AREA = 24.003.2 SF. = 0.5510 ACRES SCALE: 1"=40' NOTE: THE EXISTENCE OF RIGHT OF WAYS. WETLANDS AND/OR EASEMENTS OF RECORD IF ANY. NOT SHOWN ARE NOT GUARANTEED. ELEVATIONS REFER TO 1986 NAVD ELEVATIONS SHOWN THUS +} 41 ti s�0710 1`y 44 � � O LAND N/F 1 1 4V LAND N/F C. MORRISSEY co J. GROENEWELD BRICK ��O WALLS ~ 665 3,d 0., ti�46 .00, IS h / LAND N/F V� �� 32 cf �R��fwiy � NE R. SPITZENBERG 441 C.I S4 h 2e 3 L1 �` QRIC cG" 0/ �O e C ryry P vw f w O �q CLIG � o4 dP 3 LAND N/F q ov 'co B ., RICK ,k,� m 62 2, Off, T. PETER S J 1 c V O �o 0 4c tih -0 • 04i O �, '�o O woo RAMP RAIL FENCE Ff2c"' LAND N/F HEDGE CONE. B. PARKER N 89028'30" W N 64043'50" W 50.00' DEC 1 0 2025 LAND N/F q WAMSLEY FAMILY TRUST OF Nt--�� Q � AQ�Q0J, BA&.yp� �j.0 UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION 05078?- OF SECTION COPIES OF THIS SURVEY EMAP WNOT RBEARING THE LAND SURVEYORS INKED A ND OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES OR CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED.AND ON HIS BEHALF TO THE TITLE COMPANY.GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON.AND TO THE ASSIGNEES OF THE LENDING INSTITUTION. SURVEYED B Y GUARANTEES OR CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. P A U L B A R Y L S K I LAND SURVEYING CERTIFIED TO: PATCHOGUE NY 11772 LESTER J. LAY PHONE 631-294-6985 ETHNA D. LAY FAX 631-627-3166 CHASE BANK, N.A. PAULBARYLSKIaYAHOO.COM FIDELITY NATIONAL TITLE INSURANCE COMPANY NOVEMBER 11. 2014 9-14-2023: TOPO 1620-1 11-17-2025: UPDATE SURVEY Photo Key: Woode ulkhead Replacement, Sout d NY, 11971 Suffolk County. Owners: Lester and Ethna Lay. Prepared By Howard Ruben Prepared-December 202.S. L J_ 4 f7 ' t t Photo Record Wood Pergola Removal, Paver Installation, Sun Shade Post Installation, 370 Williamsburg Drive Southold NY 11971, Suffolk County. Owners: Lester and Ethna Lay. Prepared By Howard Ruben Prepared December 2025. Photos taken September/November 2025 ARM 1. View North, 370 Williamsburg Dr. Front of house. 2.West side (N.East view) of pergola & bricks to be removed . Pf h 1: r` r{ �i I •11•� III/Ili 1 r' �• ��i 1�1�1�1:.a , vJ�11.1 w•I�� 1 f w*11'I�11 wA 11�1111�11 a' •4 s+1111 V •J 1/ IV /11 1 1/ I� iyy�,� _ a i•i11 ii1A•I' 1116.:1 I��1 1 i i 11�1�1�1�A 1�/ y,.A 1 I k I � 3. Pergola & brick patio, NE side view looking SW View NNW from Interior of pergola. Location Map: Wood Pergola Removal, Paver Installation, Sun Shade Post Installation, 370 Williamsburg Drive Southold NY 11971, Suffolk County. Owners: Lester and Ethna Lay. Prepared By Howard Ruben Prepared December 2025. Stra t rd d -r port ,.. Orlent s a Grecnpoct / South SHELTE ISLAND 370 Wi , burgh Dr sag Harbor '. 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Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Telephone: 631 765-1938 Southold, NY 11971O • Q a LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Glenn Goldsmith, President Town of Southold Board of Trustees Cc: Honorable Lori Hulse, Attorney From: Heather Lanza, AICP, Planning Director LWRP Coordinator Date: January 9, 2026 Re: LWRP Coastal Consistency Review LESTER & ETHNA LAY, SCTM# 1000-78.-5-9 This application is to remove wood pergola at rear of dwelling; replace bricks of patio which supported pergola with pavers; expand patio footprint eastward by 4' adding an additional 72 sq. ft.; install two removable posts to support seasonal sunshade. 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 policies of the LWRP as follows: Policy 6. Protect and restore the quality and function of the Town of Southold's 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. While part of proposed plan, including removal of the pergola, is consistent with the "Administrative Permit" requirements of Chapter §275-2 A of the Wetlands Law of the Town of Southold under §275-5 B (2) (d) Remodeling or renovation of a wetlands- permitted structure, provided that such activity will not have an undue adverse impact on the wetlands and tidal waters of the Town, expansion of the patio is not. For this reason, the application does not qualify under the Administrative Permit requirements of Chapter§275-5. 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. Glenn Goldsmith,President (l (��l�f Town Hall Annex Y f� - A.Nicholas Krupski,Vice President •. �4, ��`�"`= .54375 Route 25. - - Eric Sepenoski } P.O.Box 1179 .. Southold,New York 11971 Liz Gillooly Elizabeth Peeples . ,� Telephone(631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only _ _ Coastal Erosion Permit Application �� �� ' = --- Wetland Permit Application e t �C Administrative Permit DEC 1 0 2025 Amendment/Transfer/Extension ,l Received Application: a f 1 o 115 X. Received Fee: S aS o.00 Southold lavrn Completed Application: Board offristees Incomplete:_ SEQRA Classification: Type I Type lI Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): X LWRP Consistency Assessment Form Sent: I��D (; CAC Referral Sent: Date of Inspection: Receipt of CAC Report: _Technical Review: X Public Hearing Held: Resolution: Owner(s) Legal Name of Property (as shown on Deed): Lester and Ethna Lay Mailing Address: 111 Soifer Ave, N. Bellmore, NY, 11710 Phone Number: 516 301 7257 Suffolk County Tax Map Number: 1000 - 78-5-9 Property Location: 370 Williamsbetrg Dr. Southold NY 11971 (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Howard Ruben Mailing Address:2445 Haywaters Rd, Cutchogue, NY 11935 Phone Number: 718 838 8286 Email:Hjay@verizon.net --urd of Trustees Applicatic GENERAL DATA Land Area(in square feet): 24,003.2 Area Zoning: R-40 Previous use of property: Residential Intended use of property: Residential Covenants and Restrictions on property? =Yes MY" No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes _Z_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 W_No If"Yes", please provide copy of decision. is project re 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_21_No Prior permits/approvals for site improvements: Agency Date Southold Trustees 4/17/24 # 10568 ❑ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? Fv(l No_n Yes If yes, provide explanation: Project Description (use attachments if necessary): Remove wood pergola at rear of house. Properly dispose of lumber. Replace bricks of patio which supported pergola with pavers. Dispose of brick. Expand patio footprint eastward by 4' adding an additional 72 sq. ft. Install two removabl;� posts to support seasonal sunshade. rsoard of Trustees Applicatio__- WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Pergola is dated & unsightly and obstructs view shed f� owners and neighbors. Removable posts and sunshade greatly impove views. Replace- ment of brick with paver patio creates more stable, safer situation. . Area of wetlands on lot: 0 square feet Percent coverage of lot: 0 % Closest distance between nearest existing structure and upland edge of wetlands: NA feet Closest distance between nearest proposed structure and upland edge of wetlands: NA feet Does the project involve excavation or filling? ❑ No ✓ Yes If yes,how much material will be excavated? 0.78 cubic yards How much material will be filled? 0.78 cubic yards Depth of which material will be removed or deposited: 3 feet Proposed slope throughout the area of operations: NA Manner in which material will be removed or deposited: by hand 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): There should be no impacts to on the adjacet canal or impacts to any wetlands in the vicinity of the project actvity. 61 Z20 Appendix$ Short Environmental Assessment Form Instructions for Comnletin2 Part 1 -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 or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: Lay pergola removal and patio modification. Project Location(describe,and attach a location map): 370 Williamsburg Dr., Southold NY 11971 (Corey Creek) Brief Description of Proposed Action: Remove wood pergola at rear of house. Properly dispose of lumber. Replace bricks of path which supported pergola with pavers. Dispose of bricks Expand patio footprint eastward by 4' adding an additional 72 sq. ft. Install two removable posts to support seasonal sunshade. Name of Applicant or Sponsor: Telephone:718 838 8286 Lester/Ethna Lay-- Howard Ruben Agent E-Mail:Hjay@verizon.net Address: 2445 Haywaters Rd City/PO: State: Zip Code: Cutchogue NY 11935 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 ❑ 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: ❑ ❑ 3.a.Total acreage of the site of the proposed action? 0.551 acres b.Total acreage to be physically disturbed? 00117 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.551 acres 4. Che I land us"at at occur on,adjoining an ar the propclseAaction. Urban Rural(non-agriculture) Industrial Commercial ©Residential(suburban) Forest [:]Agriculture Aquatic mother(specify): recreatioal Parkland Page 1 of 4 5. Is the proposed action, NO I YES N/A + a. A permitted use under the zoning regulations? + ✓ I 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? y ✓ 7. is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO I YES If Yes,identify: — ' ❑ JE1_ f 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 theA Aproposed action will exceed requirements,describe design features and technologies: 10. Will the proposed action connect to an existing public/private water supply? NO YES NA 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: NA ❑ ❑ 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? 1-D FIFT 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: f 14 rl.ntify the typic bitat types that occ n,or are likely to be found on tnroject 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? ✓ 171 16.Is the project site located in the 100 year flood plain? NO YES II 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO ✓ If Yes, a. Will storm water discharges flow to adjacent properties? ❑NO DYES ❑✓ El b. Will storm water discharges be directed to established conveyance systems f an m drains)? If Yes,briefly describe: C50 �i'ES I Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO ! YES i 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: � Fv(] ❑ 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: ❑ 1 I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor a e. Howard Ruben Date: 1 — -o Z.5- 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 I 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 I. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑ 3. Will the proposed action impair the character or quality of the existing community? ❑ ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area(CEA)? ❑ ❑ 5. Will the proposed action result in an adverse change in the existing level of traffic or El ❑ affect existing infrastructure for mass transit, biking or walkway? _ 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? S. 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, I ❑ ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small - to large I impact impact i may may occur occur i 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage I ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? El El 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. Pait3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees -- Name of Lead Agency Date —� President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer y Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Boated of Trustees Applies-.._.._gin AFFIDAVIT'. L�s�c r .S�� a ,t✓ i 7 c�. y �u BEING DULY SWORN DEPOSES AND.AFFIMSIRAT HEISHE,ISTHI9APPLICANT FOR THE ABOVE DESCRIBED'PERMIT(S)AND"MAT ALL STATEMENTS CONTAINED HEREIN ARE TRURTO THE BEST OF HIS/HER.HNOWLEDGE.AND BELIEF,_AND THAT ALL WORKWLL BE DONE IN THE MANNER SET FORTH IN•T HIS APPLICATION AND AS MAY RE APPROVED By THE SOUTHOLD TOWN BOARD OF TRUSTEES:: THE APPLICANT AGREES TO.HOLD THE TOWN OF,SOUTHOLD AND THE' BOARD OF TRUSTEES`HARML•ESK AND FREE MOM ANY AND;ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID.PERM.T(S),IF GRANTED: IN COMPLETING TMS 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 ASREQUIRED TO INSUIM. COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE.BOARD OF TRUSTEES DURING THE.TERM OF THE PERt1'IIT. Signature of. .roperty Owner Signature of Property Owner SWORN TO BEFORE ME'THIS MARYANNE LEISENRING Notary Public,State of New York No.09 LE6420857 Qualified in Nassau County Notary Ptlblie _ Commission Expires August 23,20.) 41 f'Ov' 1 Hoard of Trustees Applica,_._. ..n AUTHORUATION (Where the applicant is not the owner) owners of the property identified as SCTM4 I0M 7�a — 9 in the town of . S New Yark,hereby authorizes. �d+.✓a�� �y b�� to act as my agent and handle all necessary work involved with the application process for permits)from the Southold Town Board of Trustees for this property. /l V Property Owner's Signature / Property Ownees Signature SWORN TO BEFORE ME THIS _DAY OF DCa MARYANNE LEISENRING Notary Public,State of New York No.01LE6420857 Qualified in Nassau county Commission Expires August 2.3 r 20r Notary Fomic S� a� yp� APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM he To n o Sout I'' Co e: f Ek is rohi its lets of rote"st e a f:town of tiers and em to e s The` se of . this form i` ovide'inforrnatt n wFiieh can ale ih wn of o'{`i 1e c 'floc lilt an a low it o take wh,teve.aetto :is riecessaty Nord same. YOURNAME. La). Lester J.; Lay, Ethna`D., Rdben,'Howard .`(Last name,fitst:name,ipiddle ini ial,unless you are:'applymg;n 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 Approvafof plat Mooing Exemption from plat or official map Planning :Other Administrative Wetland Permit (If"Other•',name the activity.) Do you persotially(or;through your company,spouse,sailing,parent,or child)have a relationship with any officer or employee of the Town oM b bl.. m .meansabuslnessuh s y r int t" .including a partnership,in which the town olficer:or employee .gs euen.a parfa1 ownership of(or employment.hy}aOmora ton in which the'lawn officer or employee:owns-more than.5?lo of theshares. 4. YES NO If you answered 'Y:ES';complete the balance of this form and date and sign where indicated Name of person employed by the Town of Southold Title r.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 spaceprovided. The town ofticeror employee or his or her spouse,sibling,parent,or child is(check all that apply): �A)the.owner of greater-than SO ofthe.shares of the corporate stock of the appl�eant. EI (when the applicant is a corporation); B)the legal or.beneficial owner of any interest in a non-corporate entity(whenthe applicant is:not a.corporation); C)an of icer;.director,partner or employee of the applicant;or D)the.actual applicant. DESCRIPTION OF RELATIONSHIP Subtmtted this 5th day of Dec r 20 25 Print Name.Lester La Ethna Lav, owar Fonn TS 1 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 simificant 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# 1000 _78 -5-9 PROJECT NAME Lay Pergola removal and patio modification 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: 0 Nature and extent of action: Remove pergola, properly dispose of lumber. Replace brick patio with pavers Install two posts on patio to support seasonal sun shade Expand patio eastward by 4', 72 sq ft. Location of action: 370 Williamsburg Dr. Southold NY 11710 Site acreage: 0.551 Present land use: Residential Present zoning classification: R-40 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: 'Lester and Ethna Lay (b) Mailing address: 111 Soifer Ave, N. Bellmore NY 11710 (c) Telephone number: 516 301 7257 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 This aroiect supports this policy. Removal of pergola and modification of the Patio enhances the character of the property by creating a benefical change to infrastructure by creating a better view shed improving this use of a coastal location and does so with very little to no adverse envronmental impacts 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 0 Yes ❑ No ❑✓ 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 This project supports this policy by improving,the visual character of the residense thus enhancing the visual quality of the community as a scenic resource. These project improvements also serve preserve this character. Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No Z Not Applicable Attach additional sheets if necessary — - ---- --: Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No ONot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ Yes ❑No 0 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. ❑ Yes ❑No W1 Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑✓ Yes ❑ No ❑Not Applicable This project supports this policy by properly disposing of all materials being discarded as a result of the project action. 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.ElYeO No Z Not 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 ❑ No ❑✓ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑Yes ❑ No❑✓ Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III— Policies; Pages 62 through 65 for evaluation criteria. ❑Yes ❑ No 0 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 &Zam TTTLE DATE Town of Southold Trustees Permit Applications To whom it may concern, The enclosed Permit application materials are being submitted for the removal of a wooden pergola, and the replacement of the brick patio with a paver patio at the rear of 370 Williamsburg Drive, Southold N.Y., 11971. Replacement of the brick with pavers will include extension of the patio 48' to the southwest. The pergola will be dismantled and the lumber properly disposed of. The brick will be properly disposed of. On the rear(northwest side)of the patio two removable posts will be installed(attached to a cement footer via studs, depth of post footer 3'). These will support a seasonal fabric sun roof attached to the rear of the house via the appropriate cables. The property is owned by Lester and Ethna Lay Within the application package is one original permit application package and 1 copy. Included in the application materials are: • Trustee Administrative Wetlands Permit Application Package Inclusing: • Location Map • Authorization Form* • Affidavit* • Applicant/Agent Transactional Disclosure Form i • Short Environmental Form DEC 1 0 2025 L"f • LWRP • Site plan(overhead) 1 • Paver patio/posts osts plan detail overhead and cross section of osts southe;d To��an p P p ( p L - Board oTrastess • Photographs • Photo key(2pgs,#s 1-4) • 1 Stamped property Survey,2 copies Sincerely, Howard Ruben (718 838 8286) Hjay@verizon.net 2445 Haywaters Rd Cutchogue NY 11935 ** The Authorization Form and the Affadavit Form related to this project/application,were previously submitted to the Trustees as needed for the pre-application site visit by the Town.