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HomeMy WebLinkAboutTR-6794A James F.King,President *OF soUlyo Town Hall Annex Jill M. Doherty,Vice-President ,`O l0 54375 Main Road Peggy A.Dickerson P.O.Box 1179 ' Southold,New York 11971-0959 Dave Bergen Bob.Ghosio;Jr. �Q Telephone(631) 765-1892 CDU Fax.(631) 765-6641. BOARD OF TOWN TRUSTEES ` TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0405C Date: February 20, 2009 THIS CERTIFIES that the raising_the dwellingand and replacing foundation posts/girders, and replacing existingdecking ecking surrounding the dwelling landward of the Coastal Erosion Hazard Line At 120 Rabbit Lane, East Marion,New York, Suffolk County Tax Map# 31=18-5 Conforms to the application for a Trustees Permit heretofore filed in this.office Dated 01/09/08 pursuant to which Trustees Permit#6794A Dated 01/23/08 and 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 raising the dwellinga_nd replacing foundation posWgirders and replacing existing decking surrounding the dwelling landward of the Coastal Erosion Hazard Line The certificate is issued.to ALBERT MOYSE owner of the aforesaid property. C; ' Authorized Signature James F.King,President \\0 so yo Town Hall Annex' Jill M.Doherty,Vice-President 01 0 54375 Main Road P.O. Box 1179 Peggy A. Dickerson Southold,New York 11971-0959 Dave Bergen Bob Ghosio,Jr. 0 �Q Telephone(631) 765-1892 `yCDU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD February 18, 2009 Mr. George Koch 1250 Mt. Beulah Avenue , Southold, NY 11971 RE: ALBERT MOYSE 120 RABBIT LANE, EAST MORION SCTM# 31-18-5 Dear Mr. Koch: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, February 18, 2009: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Administrative Permit#6794A to remove the.condition requiring the installation of gutters and drywells. Any other activity within 100' of the wetland boundary'requires a permit from this office. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, James F. King President, Board of Trustees JFK:eac James F.King,President ti Town Hall,53095 Main Rd. Jill M. Doherty,Vice-President �. P.O. Box 1 179 Peggy A. Dickerson �' Southold,NY 11971 Dave Bergen Telephone(631)765-1892 Bob Ghosio,Jr. �' Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF I ECTION: C Q I C`� Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction / '/z constructed Project complete, compliance inspection. INSPECTED BY: (Y1 1 S COMME TS: � c7 C/Aj_ CERTIFICATE OF COMPLIANCE: rift r' -irk , +�� •t� r�*�.T�* 'k•�� � �4 �i�� � � ._ 1I _:ate.. - - , .� i i �� -- �.ar. ::�. - , � . _. , �' 02/06/2009 15 � 04 A .y. b_ w.� h• t 1 }^ = t L ,P� i "w S , . .. `�021�06 Survey of Property Prepared for: Suzanne Moyse N ® e �OaQ Surveyed: August 2007 , d W SCT# 1000-31-18-5 E JAN - 9 2008 Situate: East Marion s �` Town: Southold Suffolk County, Board of-Trustees NY Town rustees Reference Deed 0 Liber 12136 Page 334 Area = 0.2-7 acres ° ,r I to current HWM 5 1 t1 = 301 e QtO� v o7 O 710 0-NI\ �� I 00 \\ PC l L� u \ o APPROVED 15"117 � ! BOARD of TRU-3 e _, , °\/ \ j% TOW N of SOU T HOLE) °- r \0 ®ATE PA ° t,� I g s "Unauthorized otterotlon or od Itlo o a survey _ /� ; mop beormg q licensed lord curveyyar's seal Is o ___ __ - - _-_..,e;� \ •� , O violation of sectlon 1209•sub-division 2,of the --' "'---" �, ��\ �• .\� New York 5tote Education Low.° M � i 'Only copies From the original of this survey mocked !f j �0��' with on orlglnol of the land surveyor's stomped ROBERT H.FOX seal sholl be considered to be volld true copies" NYS PLS#50197 "GertIFIcotions Indicated hereon signify that this 1 '� _ �j .� survey was preppared In accordance with the ex- P 0 BOX#.366 Isting God.of R'octice for Lond 5urveus adopted I t j n by the New York 5tote Association of fJrofe5slonol - Q � AQUEBOGUE Lond Su \rveyors. sold certifications sholl run only I -�-�- - ,•�, O to the person for whom the survey Is prepared. �` �� �y NY 11931 and on his b m behalf to the title company;cC 63 ernen- �r� tol ogency old lending institution listed hereon,and \ 1-722-3390 to the assignees of the lending Institution. Gertif lc o- 9/26/?001 4:01:53AM J �� Lions are not transferable to additional Institutions ,20 '7 q;01�n AM 7ARO0 i EF TRUSTEES $OWN OF SOUTHOLD L. i) (` 8ro+-4 F-ceLlc.aL sco-60 r-I_A+7JC,'es I U Zk hC q - LiT12mc T�s. I I u I --— -. EXf-CTv-r1-CbTEC..TT&J �1 I A u /' AS (ZCrZusxzi5-- c, I > > S S 5' ' '� x 3' x 3V 8 A NFW CON511?fJC11ON f3p�ACKFT r'` � `°1°` 4r�kk I . i i k � r>t l rt.l_r T41511 , , 41 11 rl ---� S q .Z ± 9 . Z t c 14 P . I di ! Gn2At.: ��.002 SLAB (CwS'fS� 0rit 6 GcrnOe N,�TI ALL �A(C_ lC-An1 SC RC,SS ' ! 1•-1t. ' P�C�OW ---1ftTCN6ti5_.- �'Ii.rJt�. C��hDC . i I ' �Tt�. fZCSlot►Jrr�t � ��IICA,J S�2t',1 -�Zn' rLl.rl4rs W� 13" C64C . G11_L6•o SuWe'ruf5ei Te 5uP6A_r C-.#k6ek% S Toil t ' O It is a vrolahon of NYS Education Law for any person, unless he is acbrig under the direction of a licensed JAIL — 9 2�� ° { - ' rr h ?�. ) uj professional engineer.to after an item in any way.If an 4j item bearing the seal of an engineer is altered.the (o.{S ro h altering engineer shall affix to the stern his seat and the \ \ ` s 1.: notation"altered try"followed try his signature and the Southhold Town ! \ �'.�,, C�;t: b�/C' date of such alteration. and a specific description of the E y - --.--.._... -- - --- -- - -- ---�_ ��,.��_r� r�ti� SCALE: t- o" APPROVED 8Y ORAYVN BY TNf 1(%11� Beard of Trustees --__--_. - —: _--_-- '� " '`• alteration DATE: 1111' -1 ( 6I '7 DRAWING NUMBER 1 i jj I I o , I ; 'Z- i I t i i � • ij , I lea-rtpwsJ— i JA N - 9 ZOO,) scN.E• �no,rEo sr DMVM Bi u — DAM _ _ _ _ Seuthhrld To,;.n Rh15R1----�i4��-...__—�I�FS'r --�-- --^ — I Board of Trustees --F' --- • .1rw�sw�w�wr Mo.�t�tpisa � I James F. King,President �S*0f S��ro Town Hall Jill M. Doherty,Vice-President �� yl0 53095 Route 25 Peggy A. Dickerson l P.O.Box 1179 Southold,New York 11971-0959 Dave Bergen G Q Bob Ghosio, Jr. Telephone(631) 765-1892 COMM, 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 1 st day of construction Y2 constructed ✓/Project complete, compliance inspection. James F. King, President so yo Town Hall Jill M. Doherty,Vice-President ,`O l0 53095 Route 25 Peggy A. Dickerson P.O. Box 1179 Southold,New York 11971-0959 Dave Bergen G Bob Ghosidj Jr. Telephone(631) 765-1892 I'OUN Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6794A Date of Receipt of Application:.January 9, 2008 Applicant: Albert Moyse SCTM#: 31-18-5 Project Location: 120 Rabbit Lane, East Marion Date of Resolution/Issuance: January 23, 2008 Date of Expiration: January 23, 2010 Reviewed by: Trustee Bob Ghosio Project Description: To raise the dwelling and replace foundation posts and lower building back onto new post/girder arrangement. Remove/replace.existing deck surrounding building landward of the Coastal Erosion Hazard line, as necessary, to facilitate work. 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 plans prepared by J.H. Rich Jr. last dated December 16, 2007. Conditions: Gutters and drywells are installed in accordance with Chapter 236- Stormwater Management, of the Town Code.. 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. Jame A. King, Preside 7 Board of Trustees James F. King,President rq SD(/)yO Town Hall Jill M. Doherty,Vice-President ,�O �� 53095 Route 25 Peggy A. Dickerson P.O. Box 1179Southold,New York 11971-0959 Dave Bergen G �r Bob Ghosio,Jr. �Ol� �Q Telephone(631) 765-1892 �4UNTY, Fax(631) 765-6641 � BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Please be advised that your application dated /Olu'' has been reviewed by this Board at the regular meeting of 1 a,3 1D 9 and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1st Day of Construction ($50.00) '/2 Constructed ($50.00) Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ 50, M BY: James F. King, President Board of Trustees l James F.King,President sorry Town Hall Jill M.Doherty,Vice-President ,`O Ol0 53095 Route 25 P.O. Box 1179 Peggy A.Dickerson J [ Southold,New York 11971-0959 Dave Bergen G Q Bob Ghosio,Jr. Telephone(631)765-1892 O Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Southold Town Board of Trustees Field Inspection/Work session Report Date/Time: I(� - Applicant: Hl/�-fi Boys Agent: Location and SCTM#: Description of Activity: Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound ✓Bay Distance of proposed work to edge of above: Part ofTown Code proposed>or'k falls under: ,/ Chapt.275 ✓Chapt. 111 other Type of Application: _Wetland_Coastal Erosion_Amendment administrative _Emergency_Pre-Submission_Violation Info needed: Modifications: AV 0� Conditions: GJo2 IS Present Were: _J.King J.Doherty P.Dickerson_D. Bergen z, Ghosio, Jr H. Cusack D. Dzenkowski_Mark Terry_other Form filled out in the field by: Mailed/Faxed to: Date: Environmental Technician Review: , R H O �Hptth 9 % �? . W 10 xz aI ♦ 4 J1 ,. 1 ��•� Y i�. 1 fj Mk `. V U 120 Rabbit Lane East Marion,NY 1000-31-18-5 i1v0V.e < rE(� SEF$EL MI.OII M1 \ utsf[ssc w. SEE CFL 160Y! � ° \ Oi-i>-Pe WTOI LME ]e'' W1CM LME >x-aWTCM 1130' �— • —��� —2Z-- �_ Ue.y Sm � I13, 1Lx] fal PfY.N]. r L)Sl. -oso JxF .64 � 521° ` °•, 1L1y � it1 E'S]J�PLt �16T � xp )1 xy u 1.WI0 2 ) 5 J MAW u to-n a IaO lOR 1. ,a tsPE � SM4LLx CpmrT .uw ....w y' 1 © •S rx,En YIrcOEfY nE m,. ru os, ss.0 6 yd `lop 4 fm Pa.ln O A }' � S i'e 'n+ ]o�y+a',v •�,, J , .,� MARION LAKE 41 ,e°� zulE x., . MARION LAKE �, 5 �t b a y 4 T n ]awn rc m„n,uo • �,,• ul l.i f` o� 8�61 LlA a ,ib '@j+• 3w )Zn �JS E + � �'¢ LL M1 o TY°.ME=aic < _ NOTICE COUNTY OF SUFFOLK © E °"6 SOUTHOLD SECTION NO E � " T. rs IuxrFwr+E4,EcnIp.54FOn Red Property Tax Service Agency r MEa 031 G _____ —_.—_ — ,—_ m*I�„lox ar ul war�E �7ri` Canty Lontx Revel-11,xY IW A ev N ' •• 'r ___ —_ ,..—..—_ un •.m., -,fix P l000 PROPERTY MAP .r.n.w. n,Wn rcx r[ tiar w..e u.Al.or ssa.i..,,.. ____— ...r...o. --i ,.....�.r,r x....mw....,sc..zn uac.. James F. King,President ��0� so yo Town Hall Jill M.Doherty,Vice-President t0 53095 Route 25 Peggy A. Dickerson P.O.Box 1179Southold,New York 11971-0959 Dave Bergen G John Holza fel �� Telephone(631)765-1892 p � Cou Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application X Administrative Permit Amendment/Transfer/Extension �l iReceived Application: E ((? - Received Fee:$ ® lJ _Completed Application _Incomplete JAN d 9 2008 _SEQRA Classification: Type I Type II Unlisted —Coordination:(date sent) ­.L'WRP Consistency Assessment Form 1111109 of South Town Board of Trustees CAC Referral Sent: Date of Inspection: 1 10& _Receipt of CAC Report. _Lead Agency Determination: _Technical Review: —Public Hearing Held: ► a Resolution: Name of Applicant A��� �T }`>°d,•FS� V - - Address /,el, L 2 Ij i .S 11��,✓ lJ.Laj- �� Phone Number:( Suffolk County Tax Map Number: 1000 Property Location: d Z a'g,; x 1- s 4 (provide LILCO Pole#, distance to cross streets, and to ion) AGENT: (7. /t/. (If applicable) Address: ,1`Ci � csL1-dtt ceA, 16 318'— 9 9y8' c�7 / 7/ Phone: S �t� rd of Trustees Applicatic i I GENERAL DATA II �70 Land Area (in square feet): _ /� !�7'0 Area Zoning: Previous use of property: Intended use of property: S,a w r, Covenants and Restrictions: Yes '� No If"Yes", please provide copy. Prior permits/approvals for site improvements: Agency Date AlmVX ,---'No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a gov rnmental agency? No 3/Yes If yes, provide explanation: , Project Description (use attachments if necessary): �zcs/z ��ic b�r✓�� / M EiJ 0�2 Q,�oce...J.�.�1�'��,c.D�n�C . AS N�c�s s!f-Q,� ..� ff1�i,�i�—�� .�✓Q� rd of Trustees Applicatic WETLAND/TRUSTEE LANDS APPLICATION DATA. Purpose of the proposed operations: Area of wetlands on lot: E:) square feet Percent coverage of lot: O % Closest distance between existing structure and upland edge of wetlands: : feet Closest distance between nearest proposed structure and upland edge of wetlands: A 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? Iq cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: /-./. l� Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason //of such proposed operations (use attachments if appropriate): ----rd of Trustees Applicatic AUTHORIZATION (where the applicant is not the owner) I, 'al- 1`C© s4 residing at /e2 Q�✓/� ST (print owne f property) (mailing address) WI M qd j��AQAL.. 11 o v do hereby authorize ac (Agent) to apply for permit( s) from the Southold Board of Town Trustees on my behalf. All (owner' s`si n ture) 8 PROJECT ID NUMBER 617.20 SEAR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT/SPONS�QOR� 2.PROJECT NAME Gwfli�/� 9�'DCP 3.PROJECT LOCATION: Municipality I County FOL/� 4.PRECISE LOCATION: Street Addess and Roa Q errrssections, Prominent /ndarks etc -or provide map 10 5. IS PROPOSED ACTION: ❑ New ❑Expansion Modification/alteration 6.DESCRIBE PROJECT BRIEFLY: 1JH1.54cz'ie/�c a/,f� %� �EPaG�}Cr� �c'>EL�Jo,L/F}iL�r� �oc2n/�.?i�vs9 �o5,—s. �m��lLct��./,�a��� �Acl1 oaT�o ��kl��%/�i�����r1•�4'•��`?E.,9i l�4 f✓/;0 14A s4 Jq ��C/L SSkQ�oce,9�inl(�'�csl /�c- iaCjJ 195 /'(rlrFasS'�R�� T AMOUNT OF LAND AFFECTED: Initially--4 acres Ultimately acres p 8.WILL ,PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open Space ❑Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGE N Y (Federal, State or Local) ;7 Yes ❑No If yes, list agency name and permit / approval: ajp� p� o,JW�^/'L 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ElYes 2116 If yes, list agency name and permit / approval: 12. AS A I].ESUkT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / S 'onsor Name Date: Signature If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT(To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF. ❑ Yes © No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. ❑ Yes 19 No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten,if legible) C1. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: oAb✓ s TS.__. ._.. _._.._. . C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: 0.......M..7, C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: C4. A community's existing plans or goals as officially adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly: -r er_5... C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: :F- /, ib C6. Long term,short term,cumulative,or other effects not identified in C1-05? Explain briefly: .. _....._ _..__._ C7. Other impacts(including changes in use of either quantity or type of energy? Explain briefly: o_ A_✓r,LfSF�_. ''r=F .0 S__ __ _ _ D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? If es,ex lain briefl : Yes ®No E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes ex lain: Yes No PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its(a)setting(i.e.urban or rural);(b)probability of occurring; (c)duration;(d)irreversibility;(e) geographic scope; and (f) magnitude. If necessary,add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes,the determination of significance must evaluate the potential impactof the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box if you have determined,based on the information and analysis above and any supporting documentation,that the proposed actin WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Name of Lead Agency Date 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) Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town. 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 1600 PROJECT NAME The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees LJ l. 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: ` fi 4p,,4—T/O of /0T 7�ek AC.r i f'e 7— 77— i �� �.J f� �^rG�Ql�,QAT.�7� �©nJ r�/-ri � l�,�F�a✓,�/��Y�.�A��� f�iGi<si i,J�' TV Location of action: �H,a,a,r,L,�,✓,y �12id"J . Site acreage: / A0- Present land use: Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: . d� (c) Telephone number: Area Code( ) J,A (d) Application number,if any: d. A Will the action be directly undertaken,require funding; or approval by a state or federal agency? Yes ❑ No 2� 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 2Not Applicable '' r✓cT tJ o f S% c A 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 ZNot Applicable C FC 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 c-4— OFF — 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 ❑ sP No u Not Applicable n/o O/Ce, o.f 5 r.Z u-0-r4-12A5 R,-7.> nrAn c.R gL. 2/ So ca-A csCS r9* Ni O e a -,J ig . 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 o u Not Applicable _ m t1 H 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. ❑ ❑ LJ Yes No Not Ape,.. able 1.f 4L W 4d4r nro F FC'/Gci o� �v� lo�.b iico s.rsr��Jti/� �,Jc�u-D�n/ jAb, ip� / 47s Lltr�A.JaS' 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 O&J R/jQ 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 ❑ NoI2Nott -Applicable 1Jl — 444-14- WO 05t XC 77 y.J /�A'✓��o�JJh�.i.✓T Tito aS®L f a GA2 aowS _5.,2 RsT-A- QAC-9 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. n/ ❑ Yes[] No D Not Applicable Attach additional sheets if necessary WORKING COAST POLICILu--, 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 r T T 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. El Yes ❑ [ No �J 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 u 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 c40 X*UX o L•Q DS aQ. 'Z.t rro u-Q o-r�S PREPARED BY 0,d'v,0 Gg_- 1,/: TITLE %(:VF07— DATE / oS/oe -Board of Trustees Application County of Suffolk State of New York G-X-0R4,,0_ !,/. o --� r-'�✓% BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE 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. 'Slignature SWORN TO BEFORE ME THIS 0 DAY OF ,9w ,20 a� CONSTANCE SZYMCZAK Notary Public;State of New York No.;Qi SZ632561 6 ouallfled irl.Suffolk,CoU -` GN tary Public Cormr�,sbb Explris-Ap410.-2001 lard of Trustees Appli.cati AUTHORIZATION (where the applicant is not the owner) residing at /_2 L z�i,✓ s; (print ownerQoj property) (mailing address) -� / o do hereby authorize � (Agent) / �7�oQ�� i✓. Al ealq to apply for permit(s) from the Southold Board of Town Trustees on my behalf. ( wner' s i n ture) 8 APPLICANT/AGENT/REPRESENTATIVE ✓ TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: (Last name,first narrikjfiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the.other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee ✓ Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship.with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the Awn officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted thi $� ay o 200 e S ignatur Print Name s o Form TS 1 f Albert J. Krupski, President ��� C'0 Town Hall James King,Vice-President �'L` �y 53095 Route 25 Artie Foster p P.O.Box 1179 Ken Poliwoda Southold,New York 11971-0959 Peggy A.Dickerson � Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD OTHER POSSIBLE AGENCIES YOU MIGHT HAVE TO APPLY TO N.Y.S. Dept. of Environmental Conservation (DEC) SUNY, Bldg. 40 Stony Brook, NY 11790-2356 (631) 444-0355 Mon., Wed., Fri., 8:00 AM-3:00 PM Suffolk County Dept. of Health Services County Center Riverhead,NY 11901 852-2100 U.S. Army Corp. of Engineers New York District 26 Federal Plaza New York,NY 10278 212-264-3912 N.Y.S. Dept. of State Coastal Management 162 Washington Ave. Albany,NY 12231 518-474-6000 t j , §58-1 NOTICE OF PUBLIC HEARING §68-1 Chapter 68 NOTICE OF PUBLIC HEARING §68-1. Providing notice of public hearings. [HISTORY: Adopted by the Town Board of the Town of i Southold 12-27-1996 as L.L. No. 25-1995, Arnenduents noted where applicable.] i §68-1. Providing notice of public hearings. i Whenever the Code calls for a public hearing, this section shall apply. Upon determining that an application is complete, i the board or commission reviewing the same shall fix a time and place for a public hearing thereon.The hoard or commission reviewing an application shall provide for the giving of notice: A. By causing a notice giving the time, date, place and nature of the hearing to be published in the official newspaper within the period prescribed by law. B. By requiring the applicant to erect the sign provided by ; the town, which shall be prominently displayed on the premises facing each public or private street which the ; property involved in the application abuts, giving notice of the application, the nature of the approval sought thereby and the time and place of the public hearing thereon. The sign shall be set back not more.than ten (10) feet from the property line. The sign shall be displayed for a period of not less than seven (7) days immediately pfeceding the date of the public hearing. The applicant or his/her agent shall file an affidavit that s/he has complied with this provision. C. By requiring the applicant to send notice to the owners i .of record of every ptoperty which abuts and every property which is across from any public or private street I §68-1 SOUTHOLD CODE §58-1 from the property included in the application. Such notice shall be made by certified mail, return receipt requested,posted at least seven(7)days prior to the date of the initial public hearing on the application and addressed to the owners at the addresses listed for them on the local assessment roll.The applicant or agent shall file an affidavit that s/he has complied with this provision. TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Po you have or need the following,before applying? TOWN HALL , Board of Health �o SOUTHOLD,NY 11971 4 sets of9tiW4wPlans rS TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey fh S �f> SoutholdTown.NorthFork.net PERMIT NO. heck fc 5 Septic Form do N.Y.S.D.E.C. O Trustees.. Examined . 12 Storm-Water Assessment Form Wo Contact: Approved ,20 Iylail.to: f,��oe.4 Disapproved a/c n �q PP ,(,ly�o 1-�T�Eu.t Aft"/7�✓F_ c�,',rlo `J Phone: Expiration ,20 Building Ins ctor AFPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS — `a.This appllt�dah�Y LIST be c pletely filled in by typewriter or in ink and submitted'io the'Building Inspector with 4 sets of plans, accurate plot plan to sea E Fee according to schedule. b.Plot plan showing.location of lot and-of buildings on premises,relationship to adjoining`pr'emises or public streets or areas, and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of.Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completedwithin 18 months:from such date.If no zoning amendments or other regulations affecting the property-have keen enacted in the interim,the.Building Inspector may authorize, m writu�tg,-the extension of the permit for an addition six months.Thereafter, a new permit shall be required. -APPLICATION IS HEREBY MADE toY;theBuilding Department for the issuance cf:a{Buildi ig Permit pursuant to the Building Zone Ordinance of the Town*of Southold,Suffolk County,New York, and other applicable Laws;Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described:The applicant agrees to comply with all applicable laws, ordinances,building:code,housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. 70 sE �Dui�.�i•fir o rAeicia ram= �A�,¢ 6,�'ic�cE}P/r,di m �r c'�isrr.,/G o�.��ar�o,f �osrs ���r�,✓�K..�.�.,✓� . (Signature of applicant or name,if a corporation a✓T'o �'W 1p2so ��ucA�✓� /����rr9�r �'� (Mailing address of applicant) ' State whether applicant is'owner, lessee, agent architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises GgE,Z i WO r,%g , (As on the tax roll or latest deed) If applicant V ;17 oration, signature of duly authorized officer (Name and title.of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No.a:22,ovI,s 5 1. Location of land on which proposed work will be done: House Number Street - Hamlet . County Tax Map No. 1 Oo0 s Section + Lot . ,� Subdivision _r Lot r A !. 9lollu2 ni beli ty s (Name) ,At livA a9,iax3 noi2a6Mmco 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .�ctAso,JgL oSd�soc� �Esiafl�C�' b. Intended use and occupancy AQ 3: Nature of w k(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work o (Description) 4. Estimated Cos Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units f Number of dwelling units on each floor / If garage, number of cars 2 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. A , 9- 7. Dimensions of existing structures, if any: Front ,3 S' Rear ,33 Depth 7 7 Height Z� I Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth SANE Height 6,4yr Number of Stories S... Dimensions of entire new construction: Front---A/A Rear Depth �• Height ,f A Number of Stories 4L,4. o ,✓ c Q ,3���-�i�� .I�EK,E�✓si�^� 9. Size of lot: Front .•84• 7? Rear SG .oS Depth /h�V,r.Z C�o�✓ �`Sr ��►r�'iJs�oaJ 10. Date of Purchase + 1 Q 8a Name of Former Owner L o.✓��Jo,�Zrd �a,✓e,9,✓ 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO . 13. Will lot.be re-graded? YES NO Will excess fill be removed from premises? YES NO 19 /, 14.Names of Owner of premises �ix3E4T �y'®. s, Address)4„0.40- ,7 orc IV Phone No.,/G-. 7,,//-04-M Name of Architect Address Phone No Name of (�. Qe1i Address D Mr aiWAI A4hone No. 7C&-.3�Gy4 6 aoc7 oi4 A/ 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet.of a tidal wetland? * YES ✓ NO * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation.plan and:distances to property, lines. 17. If elevation any point on property is,at 10 feet or below,must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES No , * IF YES, PROVIDE A COPY. STATE OF NEW YORK} SS: COUNTY OE�� boz� a being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)He is the �E.✓T (C tractor,Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best,.of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swamto before me this , day of W I' D' o ary u. 'c y Signature of Applicant pualiftedin Suffolk COU* ` Commission Expires April 18,200