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HomeMy WebLinkAboutTR-6186 Jill M.Doherty,President �QF so(/ry Town Hall Annex James F. King,Vice-President ,`O� ��� 54375 Main Road P.O.Box 1179 Dave Bergen Jxf Southold,New York 11971-0959 Bob Ghosio,Jr., G Q John Bredemeyer �O Telephone(631) 765-1892 COUKrv,��' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0603C Date November 8, 2010 THIS CERTIFIES that the in-kind repairs to the existing boat house, including stucco at existing;masonry walls,new wood doors, slab and new terrace over existing At 1230 Ruch Lane, Southold Suffolk County Tax Map#52-2-36 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 8/4/05 pursuant to which Trustees Wetland Permit#6186 dated 8/24/05 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 in-kind repairs to the existing boat house including stucco at existing masonry walls new wood doors, slab and new terrace over existing. The certificate is issued to DAVID HOFFMAN owner of the aforesaid property. uthorized Signatur Jill M.Doherty,President *QF SOUry Town Hall Annex James F. King,Vice-President ,`O l0 54375 Main Road P.O.Box 1179 Dave Bergen l Southold,New York 11971,0959 Bob Ghosio,Jr. G p@ Telephone(631) 765-1892 John Bredemeyer Q Fax(631) 765-6641 COUNTY,�c� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: I to Ch. 275 Ch. 11.1 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction Y2 constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: ( � 3" ud— O f� CERTIFICATE OF COMPLIANCE: as S 5c - VC VL r OPT, We ncl aq I c-oia � tea° •� `� .•/} -� �/. ,'f.`,_�')L�T _�..__ r� �/ James F. King,President ��OF SUUT�,� Town Hall Jill M.Doherty,Vice-President ,`O CIO 53095 Route 25 Peggy A. Dickerson P.O.Box 1179Southold,New York 11971-0959 Dave Bergen G Q John Holzapfel �� �� Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 7, 2006 Mr. David Cichanowicz Creative Environmental Design P.O. Box 160 Peconic,NY 11958 Re: DAVID HOFFMAN 1230 RUCH LANE, SOUTHOLD SCTM#52-2-36 Dear Mr. Cichanowicz: The Board of Trustees has looked over the approved plans for the above referenced project. The Board requests that there be a 50' non-disturbance buffer from the wetland line landward, in order to keep a buffer to the waterway. Please contact this office for any further questions. Very Truly Yours, James 1 King President,Board of Trustees JFK/hkc s ✓a. �� Board Of Southold Town Trustees �• SOUTHOLD, NEW YORK '.`_ �j August 24, 2005 PERMIT NO. ...�0.1..8- .. ........ DATE: . ...................... x _ ` DAVID HOFFMAN R ISSUEDTO .._...:.............w................................................................................................................. Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the" Laws of the State of New York 1952; and the Southold Town Ordinance en- titled ."REGULATING AND -THE•PLACING. OF:OB.STRUCZkQNS f IN AND ON TOWN WATERS AND PUBLIC LANDS and'-the REMOVAL OF SAND, GRAVEL-OR OTHER MATERIALS..-F11DM ` LANDS UNDER TOWN WATERS;•...'. and in. accordance with'the Resolution of The Board adopted at a meeting held on .Aug 2`4, 250.00 I 2005: and in consideration of the sum of ............................. paid by ' David Hoffman ......................................_..... = Southold N. Y. and. su6'ect to-the of .. ................:..................................... _ Terms and Conditions listed -on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Wetland Permit to rehabilitate the existing boat house and repair in-kind,including f 1 stucco at existing masonry walls,new wood doors,slab,and new terrace over existing, with the condition there is minimal disturbance to the surrounding wetland vegetation, and all as depicted on the site plan prepared by Thomas C.Samuels dated October 8, 2004. A( in accordance with the detailed specifications as presented in .the originating application. y IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to be subscnibed.by a majority of the said Board .as of this daf�e. • oho �� - � . TERMS and CONDMQNS Tub Perniittec David Hoffman 1230 Ruch Lane, Southold to4ding at — N. Y,.ss..._ Vert•of the coasideration for the issuaaoe of the, Permit does understand and prescribe to the.foV sawing: . t. That the said aoard of Trustees and the Town of Southold are released -from any and ' all damages, or tIaiars for damages, of snits wising:directly or Indirectly as a result of any oper.. ntlon performed pursuaat'1:;:tiur,.,.pe. _ _ ,_ t,..usd•_he.said Vermittx•... at.Us or-her own ezpeasq defend.:.any and all such suiwinitiated:by third parties, and the said Vermdttee assvxnes full with respect_thereto, q-the-�ooroplete exclusion of tho ward of Trust.of the Town of SouiWd. 2. That this P'eiibit Is valid •for z &-riod of :24 •Nos. which is d*6ddbd to be tine . estimated time-required to ooanplete the work involved,but should cirduiistances warrant, request: for an extension ,may be made•to the Poard at a _later date: 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to'maintain the•structure or project involved, to provide evidence to anyone concerned that auth- orization was originally obtained. . 4. That the work involved will.be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application, may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no uattasonable interference with navigation, as a result of the wodc herein authorized. G. That there shall be no interference with the right of :the public to pus and repass along the beach between W& and low water marks. 7. That if future operations of the Town of Southold require the.removal and/or alwndoas in the -location of the wodk terda.=dwrhed, or 14 in the opWM'of the.Board of Trustees, wosk..shall cause unreasonable obstruction to free navigation, the :aid Penduce will be regait+ed, °p°A due notice, to remove or alter this work or project herein stated wiftat Vcpeases to the`Tb� ` Of $opthold. & That the said Board will be notified by the Permittee of the mtWedon,cf the work auth- odwd. 9. Th t:at the 'Petma will obtain all other petmks and t�oaseats ► be required SUP elemental to this permit which may-be subject to revo$e upon falltmo to obtain tame. =' r Albert J.Krupski,President ��OF SoUjyO Town Hall James King,Vice-President O l0 53095 Route 25 Artie Foster P.O.Box 1179 Ken Poliwoda N 41C Southold,New York 11971-0959, Peggy A.Dickerson G p@ Telephone(631) 765-1892 �lif'COU � Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 24, 2005 Mr. Thomas Samuels Samuels & Steelman Architects 25235 Main Rd. Cutchogue, NY 11935 RE: DAVID HOFFMAN 1230 RUCH LANE, SOUTHOLD SCTM#52-2-36 Dear Mr. Samuels: The Board of Town Trustees took the following action during its regular meeting held on Wed., August 24, 2005 regarding the above matter: WHEREAS, Thomas Samuels on behalf of DAVID HOFFMAN applied to the Southold Town Trustees for a permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated August 4, 2005 and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on August 24, 2005, at which time all interested persons were given an opportunity tb be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, a WHEREAS, the structure complies with the standards set forth in Chapter 97 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of DAVID HOFFMAN to rehabilitate the existing boat house and repair in-kind, including stucco at existing masonry walls, new wood doors, slab, and new terrace over existing, with the condition there is minimal disturbance to the surrounding wetland vegetation, and all as depicted on the site plan prepared by Thomas C. Samuels dated October 8, 2004. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, Albert J. Krupski, Jr., President Board of Trustees AJK/Ims Albert J.Krupski,President *0f SUUT o Town Hall James King,Vice-President ,`O l0 53095 Route 25 Artie Foster P.O.Box 1179 Ken Poliwoda N Southold,New York 11971-0959 Peggy A. Dickerson �l �OQ Telephone(631)765-1892 �+�U�, Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: A un(�� Please be advised that your application dated— has been reviewed by this Board at the regular meeting of 9161 W 0Y and the following action was taken: ( ✓) Application Approved (see below) �) Application Denied (see below) �) Application Tabled (see below) If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: SIGNED: PRESIDENT, BOARD OF TRUSTEES r ' I O�OSUFF���AO TI lephone co Town Hall (631)765-1892 _ � �? 53095 Route 25 O P.O.Box 1179 . Southold,New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Wed., August 17, 2005, the following recommendation was made: Moved by Doris McGreevy, seconded by Jacob Smith, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH CONDITIONS of the Wetland Permit application of DAVID HOFFMAN to rehabilitate the existing boat house and repair in-kind, including stucco at existing masonry walls, new wood doors, slab, and new terrace over existing. Located: 1230 Ruch Lane, Southold. SCTM#52-2-36 The CAC recommends Approval of the application with the Condition there is minimal disturbance to the surrounding wetland vegetation and the project is consistent with the LW RP. i i Vote of Council: Ayes: All Motion Carried i i 4 ` 'Ilk 1 -ice * r♦ P•. }. l �� •rlJl� .?. f 1 +• 1 x ' Aug. 17, 2005 • Inspection 1 ' ezl-ve �r '�''• f.16.0 '�B \� .� •A i0R PARCEL N0. 4 J SEESEC.NO. ou-m-vou )oiml CIO M 4 15 • EOJ ' t A ;n•G�PYI£L N0.{ O Yl.l Y_ .)A•e,c O 12111c1 1U PLAY FOR ,1\ • •.: • b ��h'� L1Alc1 LLOERtl90N _ •C•e. z A \sC .. r, 'F 9I2'!,b'9 ., 6 993 99.T4• • I Y 2 �� a \•k0 � " 4 -� IuA I >soA)d � 60.) 602 65AIe1 t +.//a3p(f+ q�•AA ,- II.Ouc, 1]9AIc1 A: \ I..OF SO.,IXat➢ / /%/ O^R d'>/i 59.10 /gym. .5 %, i •> 34.6A 4 f'ei ,ye, Ih TOONnOF�S'ODT li 451 2l.)1 I v, PEO L!D—T + J. ')`(, �� '` FOR PARCEL NO. w'e \ FOR PAPLFL NU. `�\ ` SEE a.NO. 1.P�RCFL N6 \ ��O-NO' 3 ',,�J yEx 096-OS-011.1 L 9EE 096-W-O]I ---osfi-0l-voc "'60a LNE "TCN----z ' SEE 9EC.NO.- Albert J. Krupski, President Town Hall James King,Vice-President VFF�� �QS �C 53095.Route 25 . Artie Foster �� ��j P.D.Box 1179 Ken Poliwoda j � Southold,New York 11971-0959 cz Peggy A. Dickerson c Telephone(631) 765-1892 • `� Fax(631) 765-1366 y'jJpl �ao� 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 1st day of construction '/2 constructed Project complete, compliance inspection. Alberti.Krupski,President*-"- Town Hall dos �C James King,Vice-President ��� ��/y 53095 Route 25 Henry Smith o P.O.Box 1179 = Southold,New York 11971-0959 Artie Foster y Ken Poliwoda • Telephone(631)765-1892 y�jJol �a0� Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Applicatio -�Wetland Permit Application Major Minor Waiver/Amendment/Changes iReceived Application: deceived Fee:$ ,Completed Application Q _Incomplete SEQRA Classification: e II Unlisted Type I Type A Coordination:(date sent) o'CAC Referral Sent:' $ Southold Town o-Date of Inspection: °1 Board of Trustees _Receipt of CAC Report: _Lead Agency Determination: _Technical Review: Public Hearing Held: b _Resolution: 3�Name of Applica 1111L W i�-m /V Y AN /°dolt Z nt CL(/i G� � � ���� � �� Address �[N 0 pa Uit ti-�f�l/(.0 y Phone Number:( ) a 1 2 07 T Suffolk County Tax Map Number: 1000- Property Location: 1a LLDL° (provide LILCO Pole#, distance Ato,cross �streets, and location) AGENT: [,o n, � (If applicable) n Address: Phone: --r Board of -Trustees Application GENERAL DATA Land Area(in square feet): f�j q7� a�T• / �� ��� Area Zoning: Previous use of property: lV e4r d eitI L&J Intended use of property: 2 U Mz `--- Prior permits/approvals for site improvements: Agency Date 7i-,w ee 45`�o o � `� ��a/0� A Lo zM - w b55I s,Z g-/©4 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? vl No Yes If yes, provide explanation: Project Description use attachments if necessarY): l� over expo Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: T® &&ke "a_k-te al' G� Area of wetlands on lot: (fT O square feet Percent coverage of lot: `J % Closest distance between nearest existing structure and upland edge of wetlands: a 1 feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? /—No Yes If yes, how much material will be excavated? "— cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: l&ae Q.d PK C4 Manner in which material will be removed or deposited: v 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): Aox 1.4-1.6•4(2/87)—Text 12 PROJECT I.D.NUMBER 611.21 SEQ Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I—PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT!SPONSOR 2. PROJECT NAME DA 662 3. PROJECT LOCATION: Municipality ' Q�� County d. PRECISE LOCATION(Street address and road intersections, prominent landmarks, etc.,or provide map) /!L77/ 5. IS PROPOSED ACTION: ❑New ❑Expansion Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: TC kED d/g 7. AMOUNT OF LAND AFFECTED: Initially a 8O r acres Ultimately loot acres 8. WIDE =.90POSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Li Yes ❑No If No,describe briefly 9. VJ�gHy,T IS PRESENT LAND USE IN VICINITY OF PROJECT? lUJ Residential Dridustrial r Commercial ❑agriculture L!Park/Forest/Ooen space L Other Describe: W. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE LOCAL)? LYJ Yes ❑No If yes,list agency(s)and permitlapprovais <P&0, off`©NTHOGl5 &D6, t,06PT ------------- 11. DOES ANY ASP T OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes' El No if yes, list agency name and permit/approval 12. AS A RESULT O PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑Yes Nb I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IISSJTRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: ///`/ v y�1� f f/' V V L Date: Fun, Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER ?ART ll—ANVIE'tOPlME:`•11�.' =�c._S SirtE`l.a .ii0 be corcietea by •eye^C'A. _ ... DOES ACT!CN EXCEED ANY -E i THRESHGLO !N o NYCRn, ?.a;,T 5i7.:2? It yes. acrdfnaie :tie review zrocess ana usa the Fi1LL __AF=. 1 Yas No 3. WILL ACTICN AECciv=-OCRDINATcD RE`IIE%N AS PROVIDED=DR UNLISTED ACTiCNS iN d NYC=R. ?.ART 5t i.oi !t`4o, a negative dec:ara ! may be sucersedec Oy ancther;nvolved agency. I LEI Yes !_'No ._.. C. COULD ACTION RESULT iN ANY ADVERSE=F==_GTS ASSCC:ATcD•NITS"! -:;c FOLLOWING:,Answers .^.ray ce nandwritten, it:eglble) C1. Existing air quality, surtaca or'grounowater duality or cuantity, noise ieVels, existing :raific catterns. solid ,vaste procue"on or alscc potential for erosion, drainage or Hooding problems?Explain briefly: C2. Aesthetic, agricultural, archaeological,historic,or other natural or cultural resources:or community or neignbcrnood cnaracter? =xolain cr CO. Vegetation or fauna. `Isn, snallfisn or wildlife species,significant :taoitats,or threatened or endangerea scenes? Exclatn orlafly: C;. A community's existing plans or goals as officmily adopted,or a change in use or intensity of use of land or other natural resources?Explain cr Cs. Grow(h, subseouent•Ievelooment.or related activities likely to be induces by the orcoosea action? Exomin orieily. Cs. Long :arm, snort :arm,cumulative•or other effects not identified in C.-Cs? =xplaln brla y. I Cater;moac:s Onct*ding ::ranges in use of either quantity or type of energy)? Exolaln criefly. i I I • I '�. :3 T:iERE. ^-R iS THERE L:KcL•.' C 3E,CONT:RCVE=SY RELATED TO POTENTIAL ADVERSE =_`ivlRONMENTAL:'AP.ACTS? i Yes NO :f''es. exclain briefly ?ART III-0Ei cRMINA T ION OF SIGNIFICANCE To be comoleted by agency) INSTRUCTIONS: For each adverse effect identified acove,determine whether it is substantial,large, important or otherwise signi tic =ach affect snould be assessed in connection with its (a) setting (i.e. urban or rural); (b).probability of occaing; (c) duration irreversibility:%e) geographic scope;and (I) magnitude. If necessary, add attachments or reference supporting materials. Ensure explanations contain sufficient detail to snow that all re!evant adverse impacts have been identified and adequately addresser.. u Check this box if you have identified one or more potentially large or significant adverse imoac:s which ;1AA': _ occur. Then 6roceed directly to the FULL EAF ano/or prepare a positive-declaration. Check this box if you have determined, based on the information and analysis above and any su000rtinc documentation, :hat the pr000sed action WILL NOT result in-:prty significant adverse environmental imcac:: i AND provide on attachments as necessary, the reasons su000rting this determination: i I i --- .v„u,e of _eau Agency - i i ?rmt of :vae `lame ]I -wicons,ofe Vlpcer,n Leja AguncY dale of <—oons,ole Officer I j,gnatufc 9f •tescom,ole LI:ICE!in t7la•Agency Signature or r:eoater or �,fterent Rom resoons,o,e olfic2rl i Jatc 1 'h Albert J. Krupski,President Q�QSVFFO(�C �G Town Hall James King,Vice-President 53095 Route 25 Artie Foster cm P.O.Box 1179 Ken Poliwoda to Southold,New York 11971-0959 Peggy A.Dickerson lk Telephone(631) 765-1892 1 `1► Fax(631) 765-i366�ofpy) BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of V-Pm ------------------ --- a-�-------------------- COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, �, residing at 76FZ A/&7 c_C/�bk' ,eD- /�i��t/ being duly sworn, depose and say: That on the day of , 20 iI personally posted the property known as by placing the Board of Trustees official poster where it can easily be seen, and at I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to beheld W�. (A, Dated: oi (si Sworn to b fore me phis l� day of j 200 5 Notary Pub 'c BONNIE J.DOROSKI Notary Public,State Of New York No.01D06095328,SuffolC unty Term Expires July 7,20,�,! PROOF OF MAILING OF NOTICE ATTACH-CERTIFIED MAIL RECEIPTS I Address: Name: -�'�ow� � �� r'es��,�, lam- �-ex-BCU►l 1-2 �.-�- , I`-� L1 S-�� STATE OF NEW YORK COUNTY OF SUFFOLK 4 `�{ IC P residing at yy(j �7'►'� - �`�( being duly sworn,deposes and says that on the lA,p day of 202f S deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of Town of Southold; that said Notices were mailed at the United States Post Office at that said Notices were mailed to each of said persons by (certified) (registered) ail. \mot--��^--_ - ,t/C°i-'�'—� - • Sworn to before me this ° Day of .,�= 20 John M.Judge NOTARY PUBLIC State of New York No.01JU605940b 0-7 Qualified In Suffolk County (� Commission Expires may 1 ,�® otary Public r Board of Trustees -Application County of Suffolk State of New York smv& 5 BEING DULY SWORN DEPOSES ES S 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 TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS DAY OF 20D Notary Public PATRICIA RICHARDS Notary Public, State of New York No. 01 R16042467 Qualified in Suffolk County Commission Expires May 30, 2002-0('0 David G. Hoffman Charterhouse Group International, Inc. 535 Madison Avenue New York, NY 10022 August 12, 2004 I hereby authorize Tom Samuels of Samuels & Steelman Architects to act as my agent in obtaining all required permits from the State of New York, Suffolk County and Southold Town for the renovation of my residence at 1230 Ruch Lane in Southold, NY. Davi . Hoffman - APPMCANT TRANSACTIONAL" DISCLOSURE FORH The Town of Southold's Code of Fthics Ofohibibs cbnflicte of interest on the part- of town officers and employees. The -ur ose of this form is to provide information which can alert the town of possible conflicts of nterest and allow it to take whatever action is necessary bo avoid same. YOUR NAHB= . ILasb name, first name, middle in ill# 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. ) NATURE OP APPLICATION: (Check all that apply. ) Tax grievance Variance Change of zone ' App gval of plat h Exefption from plat or official map Other (If "Other," name the activity. ) Do you personally (or through your ebrtpany, apeuee, 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. nouniness interest" means a business, including a partnership, in which Che town officer or employee has even a partial ownership of (or employment by) a corppration in which the town officer or employee owns more than 5% of the Shares. YBS NO if you answered NTES,". complete the baiance'df 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 (bha applicant) and the town officer or employee. Either check the appropriate line h) 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)v A) the owner of greater than 579 of the shares or the corporate stock of the applicanb (when the applicant is a corporation); g) the legal or bbneficial owner of any interest in a noneorporabe'entity (when the applicant is not a corporation)l c) an officer, director► partner, or emplbyee. of the appiicanbt or D) the apbual•applicanb. DESCRIPTION OF RELATIONSHIP Submitted this-" 06 . Sighs bur :�:� :..,:;:. :.. • ,;.� : 'Print homeh � "• r -0 EL S A M U E L S & S T E E L M A N July 15, 2005 Board of Town Trustees P.O. Box 728 Southold New York 11971 RE: HOFFMAN BOAT HOUSE 1230 Ruch Lane, Southold SCTM# 1000-52-2-36 Dear Trustees: Enclosed please find two SITE PLANs and APPLICATION forms for a project on Arshamomaque Pond in Southold. We are planning a minor project here, involving repairs to an existing masonry boathouse located adjacent to tidal wetlands, as noted in our enclosed plans. We are therefore requesting a permit from the Board of Trustees. If you have any questions, please do not hesitate to call us. Sincerely, C E homas C. Samuels AU G - 4 2005 cc: Hoffman Southold Town Board of Trustees ARCHITECTS 25235 MAIN ROAD CUTCHOGUE,NEW YORK 11935 (631)734-6405 FAX(631)734-6407 • Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold(Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes", then the proposed action may affect the achievement of the LWRP policy,standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. 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 n—at e o n 9F_� s website (southoldtown.northfork.net), the Board of Trustees Off.- libraries and the Town Clerk's office. ocal AUG - 4 2005B. DESCRIPTION OF SITE AND PROPOSED ACTION r— SCTM# - -2 _ �y7 Southold Town Board of Trustees The Application has been submitted to (check appropriate response): Town Board ❑. Planning Dept. ❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation,land transaction) ❑ (b). Financial assistance(e.g. grant, loan,subsidy) (c) Permit, approval,license,certification: Nature and extent of action: PAIR EX(JTAWl ,-Ertl Ce 0 1 j)20 �' V16 0-t kyolr MiZA19 c t Location of action: �, °3D &c d , LVE J'O OTh/p�_19 Site acreage: (�, J 7 d " E Ly Present land use: V( FS 60 I'c Present zoning classification: —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: 44 I/O D 67, #Q (b) Mailing address: AURSOAl 4 VE C _ / Q0?2- (c) Telephone number: Area Code( ) 2( �s�il -2,3 (d) Application number, if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes 0 No❑ If yes; which state or federal agency?_ 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 critexia. NYes ❑ 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 ❑ No L"J Not A licable PP Attach additional sheets if necessar 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 F 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 ' 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 El Yes ❑ No 10 Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III —Policies; Pages 22 through 32 for evaluation criteria. ' Yes ❑No ❑ Not Applicable r 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. j 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 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. �j, El Yes❑ No U 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. Q Yes ❑ No ❑ Not Applicable Y 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.' r ❑ 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 Created on.S/2S/0511:20 AM