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HomeMy WebLinkAboutTR-10996A Glenn Goldsmith,President 0 C Town Hall Annex g ���en';� �Gy 54375 Route 25 A.Nicholas Krupski,Vice President Eric Sepenoski y P.O.Box 1179 Liz Gilloolyt Southold,NY 11971 Joseph Finora 4 y �.;!� Telephone(631)765-1892 Cl ;5'Y 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 Glenn Goldsmith,President so Town Hall Annex Nicholas Krupski,Vice President hOV� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly G Q Telephone(631) 765-1892 Joseph Finora • a0 Fax(631) 765-6641 CUUN N BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10996A Date of Receipt of Application: July 14, 2026 Applicant: JOSEPH & ELEANOR NARGENTINO QUALIFIED PERSONAL RESIDENCE TRUST SCTM#: 1000-113-4-6 Project Location: 400 Jackson Landing, Mattituck Date of Resolution/Issuance: August 12, 2026 Date of Expiration: August 12, 2029 Reviewed by: Board of Trustees Project Description: Construct an 813 sq.ft. deck 8' above grade with steps to grade; remove existing front masonry patio and replace with 65 sq.ft. wood framed porch. 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 Stromski Architecture, P.C., received on July 14, 2026, and stamped approved on August 12, 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 14'-0' 4'-0' 61-01 41-Ol C14 FRowl Pop= S M TMD-- SKI \j\ �� // - --- _ _ - - PROP ED architecture, p.c. P.O.BOX 1254 JAMESPORTNY 11947 DOWN TO BATH PHONE(631)779-2832 FAX(631)779-2833 BASEMENT 11 00 C: 0 +15.88 KITCHEN FOYER IL 04? (t4vel , CORNER BEDROOM 15.41 P1 th [A LAUNDRY CC FIREPLACE JUL A 1 4 2026 ea1 > r Pnnrd of Trustees + 15.09 LIM CLOS, 1 14 0 1 --------------17-J APPROVE) BY - 00 , + 14.68 Proposed Deck Plans For: BOARD OF ) �LISTEES G 14.66 L • 1) TOWN OF SOUTHOLD 00 , HF ON BOULDER + 14.16 /4+14.99 CAN CA LIVING ROOM Nargentino- DATE �A Cus��, 1�,, �©�(� � �`� q� ,� PROPOSED REPL IACE FRAMED Liberti PORCH TO Bgq MI DDL E BEDR OOM EXISTING MASONRY STOOP 40 11.15 65 S.F. Q) SLj aL Residence 4 V, 4LIC, 4-tv" ulve ZN o -------------------------------------------------------------- fi 'a C7 'XC4jq1VA,, --------------------------------------------------------------- 1�6 16.54 -�61 4) 6L 21 6C rp -L-C �.. v ��c� FFL SILL rc CLOS, 0.7 110)( 400 Jackson Landing n. Mattituck 0) 66 S6 New York ,Q 8. Pk R-40 ZONING 50' FRONT YARD DINING ROOM S.C.T.M.# 113-04-06 ,,1*3 20' SIDE YARD evi XXI 35' COMBINED REVISIONS 50' REAR YARD 7.7 7 BATH 131-71 Gr 20,060 S.F. LOT SIZE MASTER BEDROOM 1,889 S.F. HOUSE O 12'-0' x 0-15' GLIDER 813 S.F. PROPOSED DECK 65 S.F. FRONT PORCH (2g42 D.N. (2)M2 D.N. 0 1214 x 0-0 GLIDER 2,767 S.F. TOTAL -- 6.19 .87 (2) 2"A" 14DR X9& LA-HEADER W (2) 2YO; 1 (2) 2'x10' HDR *LVL HEADER (D C) 1/0, 0� LOT COVERAGE 4 2,767 20,060 0.138x100 13.13% 0 8.4 v� ED S 0 o + 6.91 W TAIR LANDING 8.42 Q DOWN TO GRADE OP05ED ELEVATED DECK W STAIR 0 Lot 4 813 S.F. APPROX. 8' ABOVE GRADE 0- LC) Subdivision - +7.32 0 40 Cr "Jackson's Landi Ej j REAR DECK REAR DECK - 0 PROPOSED PROPOSED + 15.50 DING . 0 L 4.73 LAWN PROPOSED O 17- 0 7- 4.10 %0 0 0 4.4 0 + 3.23 0 0 VEG TATION F-1 LjlI I 11%. + 3. 4.32 4.14 + 4. 6 \0 Li F-1 L-ij 0 rV 0 71-10 71-10 61-11, 41 41 'I-81 40 41 71-11 71-11 61-11, SEAL [1 43.52 3.75 2114 71-41 IV66 0 4a.0-1 4- 501 60 AR lyy -1911 11/ 4.71 /0"2� PROPOSED DECK PLAN Scale: 114' V-O' STR VE STATION 11 1 1 111111 11IN 111111 111111 111111 111111 Will 11111 1 lilt 11111 11111 ill'i'lli 1 11 11F. 111111 IfIl 111111 IIITI III ill 111111 111111 HIT 11 N53 0 310 -30 IV TIE LINE ALONG 4.93 1 11111111111111111111 11111111111111111111 11 11 -SALT GRASS LOCATE) 1111 1 11 11 11 11 11 11 11 it it 11 It it 11 1 IT 11 11 It 111111 ill 111 1111 111111 111111 Ill 11 Ill 11 Ill 11 11 1 1 ill IIITII 111111 111111 111111 11 1111 111111 111111 111111 Ill 111111 111111 111111 11IT11 111TIl 111111 111111 111111111 11 111111 111111 111111 11111 111111 111111 111111 111111 111111 111111 111111 111111 111111 111111 111111 11 37.22 04/06/26 111111 111111 111111 111111 111111 111111 1111 111111 11 111111 Ill 1111111111111 1 1 11 1 111111 111111 111111 111111 111111 111111 111111 111111 111111 111111 111111 HITT 111111 1111 11 1111 .97 11 Will Illill 111111 111111 1111111111 1111111 Ill Ill IT 11 1111 1 It IT 11 11 IT I 1 111111 111111 111111 111111 111111 111111 111111 11111 11111 1111111 11111 11111 Will I Will 1111111111111111111111 111111 1111 Ill 111111 111111 IIITII IIITII 111111 111111 111111 111111 IlIT1I 111111 1111 1 CMF 3.89 11111 111111 111111 11 IT 11 11 IT Ill Ill I It IT 11 11 IT 11 11 IT 11 11 IT 11 11 IT It 1111 11 11 If 11 11 IT li 11 IT 11 11 IT 11 111111 1 11 [ITT!! 111111 111111 111111 111111 HIT 111111 111111 111111 Ill 11 1 1 11 it 1 111111 111111 11111 2.62 Copyright 2026 STROMSKI architecture,p.c.All rights Ill 11 11 it 11 1111 11 1111 11 1111 11 1111 11 1111 11 lilt 11 1 11 111111 111111 lilt 11 lilt ii Iiiii lilill 111111 Hill ill] 11 111111 111111 111111 111111 Will 11111111 1111 IIITII ]ill 11 111111 111111 + H I ill illill 1111 1 Ill 11 1 11 11 design in its entirety any portion thereof.Unauthorized -4sreserved The Architect roerves the right to reproduce this PC 11111 11 111111 111111 111111 111111 lilt 11 111111 111111 111111 111111 111111 11111 11 Will 111111 HIT Ill alteration of these documents is a violation of the New York FL oq 71 C IV610 11 U 11 UU 11 lilt 11 111111 111111 1111 1111 111 State Education Law.These drawings and specifications are --PLql .11 Ulu an instrument of service and are the property of the Architect I lui-LLU LLILLU These drawings and specifications are not to be used on any N75041' 58 1111W 1511 h/ + 2.56 other project,except by written permission of the Architect 16.92 PROJECT NO. 2&ARX001 NOTED SCALE AS DATE 6/24/26 F.W . I i. DRAWN BY TM CHECKED BY RS OF N58057' 21"W LLLI TITLE 9.98 LLj-A1H111HI I H-HI -- ------- -=----- - - -------- ------- ----- �,,/ Propose Dec --------- - ------- --------- Site Plan & Floor Plan SITE PLAN scale: 1/16, V-01 SHEET 1 V40Z /"2 PROPOSED DECK ELEVATION Scale: 114' V-O' S.OUTHOLD . .. TRUSTEES No. Ocic� A ?oSeP"►a Ele4"or Issued To- Ma�g¢mT: no Date A . Aaaress 400 �acKso� .THIS. NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765-1892 (1)UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW.(2)DISTANCES SHOWN HEREON FROM PROPERTY LINES TO EXISTING STRUCTURES ARE FOR A SPECIFIC PURPOSE AND ARE NOT TO BE USED TO ESTABLISH PROPERTY LINES OR FOR ERECTION OF FENCES.(3)COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY.(4)CERTIFICATION 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 CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. (5)THE LOCATION OF WELLS(W),SEPTIC TANKS(ST)h CESSPOOLS(CP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. 400 Ostrander Avenue, Riverhead, New York IIQOI to I. 651.72-1.2505 fax. 651.727,0144 admen®youngenglneering.r-om N Howard N. Young, Land Surveyor ROAD Thomas r Wosiont, Professional Engineer Douglas Adams, Professional Engineer d Geologist MILL , Danlel A. Weaver, Land Surveyor SITE DATA yomla��oaaLHs sJ) AREA = 20,130 SQ. FT. I .5-VO, SUBDIVISION-"JACKSON'S LANDING" FILED IN THE OFFICE F OF THE CLERK OF SUFFOLK COUNTY ON MAR.28,1969 AS FILE NO. 5280. I IS * VERTICAL DATUM =NAVD(1988) 9 � 9 / 6/ 0C .I U L 1 4 2026 / \o V 4 •`'\ E;,ardof True'.^^s \ .15 41 withP46 C Otis //C wQ 4fy CMF S ter) S k'H�oNgy �/ eon Fpyo R;> bZ �qS w.14 NF® 116 1 .5.09 +14.68 zz- 1 O0 0 14.66 DHF ON BOULDER +14.16 414.99 14.1 CATV O B8A 11.15 % Szj °O e Q BG WgLK 3 �3 I DRTVETONF \ J % Z' c v 2 4y f( �, .o r �° ��� ,s 54 �, o F[fc rC41,q �P SURVEYOR'S CERTIFICATION v h V ti �� tee' FFL SILL 21 rRrcBO a 'y F IST 07 v� y k *WE HEREBY CERTIFY TO DONNA LIBERTI & TONY LIBERTI C Q a4 oq _m THAT THIS SURVEY WAS PREPARED IN ACCORDANCE WITH THE CODE OF of vj�yo 8 6 /GA AGF�(/S�c 341�`� PRACTICE FOR LAND SURVEYS ADOPTED BY THE NEW YORK STATE g tr� k�4 c �o� �� w ASSOCIATION OF PROFESSIONAL LAND SURVEYORS. 0 3 r 1 w� s m ti� 0 M Q 7.7 CFc ooK GF D L?. L^/ti 84 0 0 o O 6.19 /% 00�q/K R2Re 8.87' C I C11 +6.91 8.42 3 . . i Lot 4 �� �� HOWARD W.YOUNG,N.Y L.S.N0.45893 �Qh� i Subdivision- +7.32 0 ° DANIEL A.WEAVER,N.Y.S.L.S.NO.50771�/ "Jackson's Landing" +6.50 Q. °a' AL 0.' SURVEY FOR 4.73 / LAWN / 0 3 bONNA LIBERTI & TONY LIBERTI 4.10 / , b 41 4.4 / ti 3 ti w +3.23 4: a LOT 4 "JACKSON'S LANDING" \ VEGETATION / O +353. E 432 414 +4.96 0(V at Mattituck, Town of Southold N 66 0 24 +3.52 3.75 N 3 Suffolk County, New York I 1 N N 191,11' ° 71 VEGETATION BUILDING PERMIT SURVEY " N53036'3011 W e e TIE LINE ALONG 4.93 SALT SS LOCATED a 37.22' 04/06 26 +2 97 County Tax Mop District 1000 Section 113 Block 04 Lot 06 o CMF 0 3.89 FIELD SURVEY COMPLETED APR.06,2026 2.62 N MAP PREPARED APR.07 2026 c F(Oq rIC A1,6102,0/4 14,�7S1, + ~ 2.56 Record of Revisions LEGEND N75o4158I IW <S T +Q !A>r `4NC 16.92' REVISION DATE BBA = BELGIAN BLOCK APRON CC =CONCRETE CURB ,�J N58057'21"W \ CMF =CONCRETE MONUMENT FOUND ' + T�� 9.98' CM5 =CONCRETE MONUMENT SET g DHF =DRILL HOLE FOUND C MLF =METAL FENCE k cRF OL =ON PROPERTY LINE �k WSF =WOOD STAKE FOUND WSS = WOOD STAKE SET 30 0 15 30 60 90 =WELL 9 =END OF DIRECTION/DISTANCE Scale: P = 30' o. JOB NO. 2026-0037 DWG. 2026_0037_bp 1 OF 1 Glenn Goldsmith,Presiaenty\vSUFFO(� Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 Eric Sepenoski y P.O. Box 1179 Liz Gilloolyoy � �� Southold,NY 11971 Joseph Finorar �'•{v Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: S' 912Z Completed infield by: (9e Co )k� #"A Stromski Architecture on behalf of JO,SEPH & ELEANOR NARGENTINO QUALIFIED PERSONAL RESIDENCE TRUST requests an Administrative Permit to construct an 813 sq.ft. deck 8' above grade with steps to grade; remove existing frontmasonry patio and replace with 65 sq.ft. wood framed porch. Located: 400 Jackson Landing, Mattituck. SCTM# 1000-113-4-6 Typ of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: //Chapt. 275 Chapt. 111 other Typ of Application: Wetland Coastal Erosion Amendment 7Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: Present Were: v✓ G. Goldsmith N. Krupski E. Sepenoski L. Gillooly J. Finora 400 JACKSON LANDIN.., 7/9/2026 MATTITUCK NY 11952 NARGENTINO RESIDENCE-PROPOSED DECK PROJECT#26-ARX001 PHOTO 1 Photo looking North West Taken 7/9/2026 11:30 am w � 1 PHOTO 2 Photo Looking North Taken 7/9/2026 11:30 am t 1 t Y�_ •��� I �. II � F 9Y R T 1.q tin� v . � t STROMSKI ARCHITECTURE P.C. 400 JACKSON LANDINv 7/9/2026 MATTITUCK NY 11952 NARGENTINO RESIDENCE-PROPOSED DECK PROJECT#26-ARX001 PHOTO 3 Photo looking West Taken 7/9/2026 11:30 am U� PHOTO 4 Photo looking South West Taken 7/9/2026 11:30 am 1 CIF y i STROMSKI ARCHITECTURE P.C. g ^oEE SEC-NO-106 ,er.w1 __ .aieN �'e ttONe, tt� e�•.. N: 06-13Li xs 1MTCN IiNE _ `"tw`E .j} ; 1Mtcl T JA 1/-YB osEo 0 L.:, 4 a a ` i.6 1• —No NO 12 % S :Sao � =uNEuNI W-0°Ot SE�LSE�O ;n.. 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W w.os aoupaco w.r n,nNl �-- - -- - - - 113 US1wNIwN a.wr wn1nN n1 1NF _ S v OFFICE LOCATION: ��OF SOUj MAILING ADDRESS: Town Hall Annex h0 l0 P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold, NY 11971O • Q Telephone: 631 765-1938 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: August 10, 2026 Re: LWRP Coastal Consistency Review JOSEPH & ELEANOR NARGENTINO QUALIFIED PERSONAL RESIDENCE TRUST, SCTM# 1000-113-4-6 This application is to construct an 813 sq. ft. deck 8' above grade with steps to grade; remove existing front masonry patio and replace with 65 sq. ft. wood framed porch. 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. I I , l 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. This proposed action is on a nonconforming lot with a pre-existing residence that is less than 100ft from the wetland boundary of Maftituck Creek. I Although, the expansion of the existing deck,would fall under the administrative permit process as of Chapter §275-5 (13)(2)(1) Decks, the expansion of the deck seaward does not meet the required setback for residences, as per Chapter §275-3(D)(1)(a)([1]) Residence: 100 feet. As of right now, the deck is nonconforming and is already within the 100ft wetland buffer boundary, extending the deck closer to the wetlands makes it more nonconforming. 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. 2 so Glenn Goldsmith,President f q' jr Town Hall Annex A.Nicholas Krupski,Vice President 64375 Route 25 P.O. Box 1179 Eric Sepenoski r Southold,New York 11971 .'' Liz Gillooly Telephone.(631) 765-1892 Elizabeth Peeples �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application =Administrative Permit Amendment/Transfer/Extension Received Application: Received Fee: $. Completed Application: Incomplete: SEQRA Classification:, Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): -LWRP Consistency Assessment Form Sent: CAC Referral Sent: E 04 - "Date of Inspection: L.` J, Receipt of CAC Report: Technical Review; JUL 1 4 2026 Public Hearing Held:-. Resolution: Southold Town Board of Tnistees _ Owner(s)Legal Name of Property (as shown on Deed): pl EL A►JGiZA A. 1, 52 Mailing Address 1400 TACK-5CA (,�A VJ D-Z0 C� I(�T°T LTUGI� . N i �i _ . Phone Number: rJ (o- (PO 019 O Suffolk County Tax Map Number: 1000 - Property Location: 14 OCR Tr14 W L A Q D 1 P�1(1TTt TU C h 1� l l g 5 2 (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): jLCVXWSK:1 -. Tt2_ SK A az :L+T_F_C7rUe 6 Mailing Address: 2 f(o CttQ 9-C," Lr-N>J E tv ee'_kAF yc}p Phone Number: 10 1-7�A'2$g2 Email: Tiler'@ STV_C4WSK,1A9CM.nrF iZi�2E. ccw� -oard of Trustees Applica" =-:in GENERAL DATA Land Area(in square feet): _ 20 i O O Area Zoning: �- Previous use of property: Intended use of property: Covenants and Restrictions on property? Yes _2_No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes JJNo 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 J�E[_No If"Yes", please provide copy of decision. Wis 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=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?-a No_Yes If yes, provide explanation: Project Description(use attachments if necessary): re-oV;Da � E;LF_y rEQ 17Ec-� NpP lox- �` AZcyr GjaAoe �E�� t'�rzopc�sE� As St3 S.F. wpm STltirz GevsE To cj znoe . A4so F201,j'C MoSotj" Por..c 11 iy 'BF eE19L0C_F_0 wTt-F t-►oaQ> oard of Trustees Applicafi- "I WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Some-l1P►i►NiMENV Spec F, A- W F-t-t_ ADp r%ci in L. c�►2�s5 I? ATE. Area of wetlands on lot: 3 1 w SS —square feet Percent coverage of lot: 1 • 2 % Closest distance between'nearest existing structure and upland edge of wetlands: 5 feet Closest distance between nearest proposed structure and upland edge of wetlands: Sit . feet Does the project involve excavation or filling? ❑ No Yes If yes, how much material will be excavated?_ 09 .cubic yards -4 E2s How much material will be filled? N/_A Ocubic yards Depth of which material will be removed or deposited: 3 feet Proposed slope throughout the area of operations: S A m E Manner in which material will be removed or deposited: A P P9.ox $ 1A AN D _TDU Ct -0 scy— ?►E Q s Es-n metm o AT 12' ►W lb i tiArnEcee- - �Ci2 i'ecrtT. L►"e. '2ENciieD 501L To E 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): Nd E F r EC-TS 15 1=YLo 0J.Q- VIEW Pa►wT. SILT FENc.r MAy gE „ USED IF 1.1FCEssa 61 Z20 Appendix B Short Environmental Assessment Form Instructions for Completing 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: yoo Project Location(describe,and attach a location map): 'y oo -'iq CKSC 1 ult,)ovoc, t"AT n Tv e,(� Brief Description of Proposed Action: ELF�,4r�o �� Apprzo,c �� At STn 12 C' E Ta Ci V_e4 of. Ac,so F-Owr (V)050"Tr) RV2x,0 -16 BlE 2�P�v�rc �,� w t T-H Name of Applicant or Sponsor: Telephone: 51 b e(p0_qC1 o 5 FfitJY, AF—C1.E#jrtfJG E-Mail:.. w1A. Address: 100 �TACk_500 LAIR X>►NCI FI%}TrATUCk. ►.�� City/PO: State: Zip'Code: 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 [71 ❑ 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: ❑ ?1='-' n IT oW" o F S0LJ1-k�OL� 3.a.Total acreage of the site of the proposed action? , acres b.Total acreage to be physically disturbed? 000 VD acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? o y G acres 4. Che 11 land us at occur on,adjoining anfLgar the propqse4 action. Urban tRural(non-agriculture) Industrial Commercial fesidential(suburban) Forest Agriculture Aquatic QOther(specify): Parkland Page 1 of 4 S. Is the proposed action, NO YES . N/A 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 . I 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: W ES-` 132 4tjC,14 OF YYl4ATri TU CIL Mea rL -M Scu�-id El Z 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:. Qo UjATEv2 Caayo�iEGticsi5 ❑ �EQ�u1R-E 11. Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: . WO WW1rS1 E CuKJ NEG ❑ 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: _WI Al . NOS E1-1ct2GAG14 IWTQ $UT W%w CU,(Z.12.C2NT se.TBAc.V_ 14. ntify the typic bitat types that oc n,or are likely to be found on t1Mroject site. Check all that apply: Shoreline Forest Agricultural/grasslands Early mid-successional GWetland Urban Suburban I 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? Ff 16.Is the project site located in the 100 year flood plain? NO U 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? PNO ❑YES El b. Will storm water discharges be directed to established conveyance systems f an m drains)? If Yes, briefly describe: 1�50 4'ES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids (e.g.retention pond, waste lagoon, dam)? If Yes,explain purpose and size:. 71 ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name- 4 If A✓1GWS►G. ..P K Date:, Signature: S�tzrarn Sxz /�P_C�+�r�cc�-lerz .G. 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? El 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)? LJ 5. Will the proposed action result in an adverse change in the existing level of traffic or El existing infrastructure for mass transit, biking or walkway? u 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: 0 a.public/private water supplies? b.public/private wastewater treatment utilities? Li 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)? a Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage 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. FICheck 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 Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT7 Page 4 of 4 `ard of Trustees Applicat:' AFFIDAVIT, � SGv /�G %GEit/T- E .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 HARMLESSAND 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. ,1.40-7 Signature,of I erty Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF Notary,Public BONNIE CLAIRE ZELLNER NOTARY PUBLIC;STATE OF NEW.YORK Registration No.O1ZE6424367 Qualified in Suffolk co '� My Commission Fxpires l4& n srd of Trustees Applicati. AUTHORIZATION (Where the applicant is not the owner) I/We, A&ocnersae-za-y owners of the property identified as SCTM# 1000 113 - o �i s (o., _in the town of M4Th - ,New York,hereby authorizes cZ to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. Pro s Signature Property Owner's Signature SWORN TO BEFORE ME THIS _ DAY OF Notary Public BONNIE CLAIREZELLNER. NOTARY PUBLIC,STATE OF NEW YORK Registration No.OIZE6424367 Qualified in Suffolk County My Commission Ftpires APPLICANT/AGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southoid'.s Code of Ethics.prohibits conflicts of interest on the:part offown officer's and,emblovees.The nuroose of this form is to nroVide information which can alert'the fown'of oo5sible conflicts.ofinterest and allow it to takewhateveraction is necessary to Avoid same. YOUR NAME: :JIR tJCrt.crZ T l.E� L (Last name,first name,jpiddle 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 ofplat Mooring Exemption from plat or official map Planning Other (lf"Other",name the activity.) Do you personally{or throughyour.company,spouse;sibling,parent,of child)-have a relationship_with any officer or'employee ofthe Town of Southold? "Relationship"includes by blood,marriage,orb usiness;interest "Business interest"means, busigess, including a partnership,in which the townof AcCr or employee has even.a:partial ownership of(or employment by)a corporation in which the town officer or employee,owns more than 51%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 applicantlagent/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,3%ofthe shares ofthe cotpotate stock of the applictuit _n (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the -Rapplicant is notes corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitte 20 2 Signature Print Name "' —�— Fonn IS I 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.Si6ificant beneficial and adverse effects:upon.the coastal area,Mitch includes all of Southold Town).. 1 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 exnlainM 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# 113 aq NO PROJECT NAME �Qo Acy—Soo ��-K-- The Application has been submitted to(check appropriate response).- Town Board ❑ Planning Board2"Building Dept. FT Board of Trustees I. 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: 1�P�cr oS E� �i=C,►G.. �4cu� ��+iut t�a�c.t� 'iD �3 c. Location of action: 4100 TV;(-V-5Gt,) (,,►4 N D n.3 G� M 4M TU CK- Site.acreage: . y d4ci2 Present land use: E5 tC*a*JV t- Or-u-►fir, 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; �'201cG N At lZ Ci E4Tt 004 - (b) Mailing address: _ 400 JALiL N LPrN®IOC, NAwmruck- N"l (c) Telephone number: _5L �tOo — q�6-9 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 thattenhances 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 Q 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 ❑ No V 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❑' f 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 ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of,Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No I Y Not Applicable ttach ad ittonal 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 © 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 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 IJ 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 WORKING COAST POLICIE'' Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section H —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 I"1 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 ZNot 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 y�e,r ��'��"'" ' TITLE �' DATE 3 �j'�7�rr6K� A'�c,M�TEcrv2.E