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HomeMy WebLinkAboutTR-7008A Jill M. Doherty,President -so Town Hall Annex Bob Ghosio,Jr.,Vice-President 54375 Main Road P.O.Box 1179 James F.King Southold,New York 11971-0959 Dave Bergen G t John Bredemeyer 0 �Q Telephone(631) 765-1892 ly`,outi Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 24, 2011 Mr. Peter Schembri 76 Overlook Dr. Wading River, NY 11792 RE: 1425 SOUNDVIEW RD., ORIENT SCTM#15-3-16 Dear Mr. Schembri: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., August 24, 2011: RESOLVED, that the Southold Town Board of Trustees APPROVES the Amendment to Administrative Permit#7008A to construct a 10'X 25'10" second-story deck above the existing deck and for the existing flagpole, as depicted on the plan prepared by Robert Higgins Architect dated June 24, 2011 and stamped approved on August 24, 2011. This is not a determination from any other agency. Sincerely, JilleDoherty, reside BoaTrustees JMD:lms SURVEY OF P/O LOTS 18 & 19 MAP OF ORIENT BY THE SEA SECTION No. I FILE No. 2777 FILED NOVEMBER 21 , 1957 SITUATE ORIENT POINT O JV6� TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000 15 03 16 3 so2s, S� SCALE 1 "=20' 6,64,5'' � AUGUST 25, 2008 I S I 8 1 007'35°-' E trp TIE NE ALONG 64.79�ON AUG APP C'"I — — 220 08 ENT HIGH WATER MARK AREA = 24,053 sq. ft. I — (TO TIE LINE) 0.552 ac. cd I 00 I � CERTIFIED TO: PETER SCHEMBRI I N GAIL SCHEMBRI I sorroM or BLUFF FIRST AMERICAN TITLE INSURANCE COMPANY OF NEW YORK � I APPROVED BY pA n[�Dg'"p 0T (I rOP OF BLUFF T; I TOWN OF SOU i 11--�irD!I s Soutilhold 1oI,'n I ' RnIrd of Tmstees FOUND PIPE O O O o I I a Q) I � � —CONC. CONC. 0 I j 12.3' STEP STEP x� 37 2 I \ENCLOSED BRICK PORCH 18.5' N 26.5' L 1& 1-1/2 STORY AIR CONDITIONER 0 ':' UNIT 3 _ FRAME HOUSE 29.5' m CHIMNEY :�• N LLJ CONC. APRON n 2nd STORY BRICK OVER CONC. cW Ui do CONC. STEPS a 34.3' 22.8'_ ri N e WOOD STOOP �� IL Fill do STEP PIPE CAP �G I 0 °• Q BRICK W 0 ° '. EXISTING '3 o a l WELL �,i ca 42' s N O � g2 0 a •s C� � 41 ' WI E m ° m PIPE o0U SD I W UTILITY PO UL#I2 G — ' N 80� —O RHEAD a 6 h • 0 f00.99 WIRE` �i • ° n ° ° �5.00, W — UTILITY s. s e a n POLE s a _ N 85*5714099 W n `• ° e S 0 25.00' a � P EDGE OF PAVEMENT PREPARED IN ACCORDANCE WITH THE MINIMUM ��� °°• ° b a p e. STANDARDS FOR TITLE SURVEYS AS ESTABLISHED � '°► � ° a BY THE L.I.A.L.S. AND APPROVED AND ADOPTED n' e FOR SUCH USE BY THE NEW-'YORK-STATE LAND ---LLL TITLE ASSOCIATION. ' a OAD Y.;5. U, No. 50467 EXISTING EXISTING WELL WELL UNAUTHORIZED ALTERATION OR ADDMON Lathan Taft Corwin 'II TO THIS SURVEY A VIOLATION OF SECTION 7209 OFF THE NEW YORK STATE EDUCATION LAW. Land Surveyor COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY Title Surveys — Subdivisions — Site Plans — Construction Layout IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND PHONE (631)727-2090 Fax (631)727-1727 TO THE ASSIGNEES OF THE LENDING INSTI— TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. OFFICES LOCATED AT MAILING ADDRESS 322 ROANOKE AVENUE P.O. Box 1931 THE EXISTENCE OF RIGHTS OF WAY RIVERHEAD, New York 11901 Riverhead, New York 11901-0965 AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. F "@t B. Fastener Schedule for wood plywood panels TABLE 1609.1.4 Fastener Panel Span Panel Span Panel Span i Type Less than feet f less than less than or equal to 4 feet equal to fi feet equal to B' U l w Wood Inches 12 center inches Screor on a INTERIOR�'N� Ne 6w or 10d on center on center an center h `V 1/2"CDX plywood wNOM UNIT 2-1@°tYe Wood 181nchea 16lnches 12 inches Panel,Attached to Screws on comer an center an center SUU��1 ((USA Frame In aacordanee 0i with Note a20 and This table is based on a maximum wind speed(3secand gust) g0atd Table 160S.1.4 In of a 130 miles per hourand a 33 foot mean roof height. General Notes. WMDOW UNIT Fastenersshell be Installed at opposing ends of the wood structural panels. nrrateioR CASING Where screws are attached to masonry or stucco,they shall be attached utilaing vibration resistant andhors having s minimum ultimate withdrew rapacity of 400 pounds. (5)3068 Fixed door panels temp.(SIMS PLYWOOD STORM PANEL 1. All construction shall conform to the 2007 Residential Code of New York State- effective January 1,2006,all Local Building and Zoning Codes and the 2007 Q New York State Energy Consevallon Construction Code.ALL CODES SHUTTER DETAIL Shall supercede the'drawings and shell be Incorporated into the 3-1/2"x I1-1/8"LVL drawings WHETHER they are Indicated an the Plans or NOT. 8 2. The reference Standard that was utilized in the Design of the CONVERT EXISTING PORCH -0-6 the structure Is the AMERICAN FORESTS PAPER ASSOCIATION -6 u Wood Frame Construction Manual for one and two family dwellings INTO NEW KITCHEN X m 2001 Edition.(BOn-090-7732)THIS MANUAL shall �q be incorporated Into the drawings WHETHER they are Indicated .� on the plans or NOT, (2)Fixed door panels (2)Fixed door panels 3. Written Dimensions take precedence over scaled dimensions 6068 French door 6068 f rare-h door 4. The contractor prior to the start of construction shall verifyall 3-V2"x II-1/8"LVL Flush 1W/2"x Il-T/8"LVL 3-1/2"x 11-'V8'LVL dimensions,exstingor now and be responsible for Cold TW2846-2 TW2042 TW2046 TU13046 TW2046 °�—r —4_- 7—+°•'0 --- �+-r—C-0- 5. All Electrical,Mechanical and Plumbing shall conform to the 2007 NY State, Local and County Codes and shag be Inspected and approved by the governing ir1 agencies.The General Contractor shall be repmhsible for all Installation, r REMOVE EXISTIN6 .tea. materials,design and code compliance. � BEARING WALL AND 11-11° 13'-4° O INSTALL NEW LVL HEADER 3 S. The Plumbing system shall be installed in accordance with the 2007 11�-1 KITCHEN N F Residential Code of New york. • r t 11,�u 0 BREAKFAST 7. The Electrical equipment and wiring shall be installed in accordance 2h�n with the 2007 Residential Code of New York State. ROOM B. The mechanical system shag be installed In accordance with the F'� FLAT CEILING 2007 Residential Cade of new York State. NO �q 11. Base design value for visually graded dimensional lumber.Joists,studs rAll DOWN BATH Rafters1.6,Fle=875psi,F lumber shall b1300 psi-Fir 2or attar, rr1 LIVING repetlbve member shall be:2xB=1208 psi,2x10=1107pe1 i�h ALL EXTERIOR LUMBER Shell be ACQ requiring the following: Qt ev ROOM � a.)All Fasteners shall be HOT DIPPED GALVANIZED ASTM A 163 class D h3- N OR STAINLESS STEEL. Bedroom2 Bedroom M1 FLAT CEILING b.)Use Copper flashing only against ACQ Lumbar Sill Plates a)Ail Structural connectors I.e.Simpson strong-Tie or USP,etc smoke alarm shall be Hot-Dipped Galvanized or Stainless Steel. O smoke alarm 0 d.)ACQ Above Ground(.25),ACQ Ground Contact(AO) 13,41 12.Basements with habitable space and every sleeping room shall have at least one operable emergency escape as follows: O - V height of not more than 44 Inches above the floor. A Minimum net dear opening of 5.7 squure feet UP Except grade floor openings shall have a minimum net dear S opening of 5 square feet DINING FOYER O B.Minimum net clear opening height shall be24Inches. ROOM C.Minimemergency net char opening width shall be hall O.emergency escape and rescue openings shall be operational F from the Inside of the room without use of keys or tools. FLAT CEILING `4 • X 17. ALL habitable rooms shall be provided with aggregate glazing area Ill of not less B percent of the floor area of that room,and the minimum Ll openable area to the outdoors shell be 4 percent of the floor area being TW3446 T1113446 ventilated.Refer to Code section R303. 18. Ail window and door headers to be 2-2x10 unless noted otherwise. EXISTING I'. Smoke Alarms:Shall be provided In each sleeping Room,outside of REPLACE ALL EXISTING WINDOWS WITH, P EXISTING: NEW ANDERSEN DOUBLE HUNG TILT WASH UNITS. REPLACE ALL DUSTING WINDOWS WITH. each separate sleeping area in the Immediate vicinity of the bedroom IN EXISTING OPENINGS AS REQUIRED. 1S, FLOOR PLAN NEW ANDERSEN DOUBLE HUN6 TILT WASH UNITS. and on each story of the dwelling,including basement and cellars.Alarms 2ND FLOOR PLAN IN EXISTING OPENINGS AS REQUIRED. shallbeinterconnectedendhardwiredtoncammesm detoa II I,_Oil I WHENEVER an alteration,addition,or converelon Is made to an Existing tt h REPLACE EXISTING WOOD CEDAR SHINGLE SIDING WITH NEW .SCALE: 1/9 = 1_Q Residence,the smoke detection system of the ENTIRE residence must be SCALE: i/S 1_Q NEW DOOR PANELS,SLIDING AND FRENCH TYPE DOORS brought up to code,hard-wired and Interconnected.Code section R313 CEDAR PERFECTION SHINGLES ON ISLE,FELT. ARE AS MANUFACTURED BY JELD-WEN. 20. Carbon Monoxide Alarms:All to the lighting circuit with no Intervening we a are not allowed. REPLACE EXISTING WOOD CEDAR SHINGLE SIDING WITH NEW Co alarms are required o re located. Provide one Detector In CEDAR PERFECTION SHINGLES ON ISLB FELT. g� ' Windows In buildings located in Wood-Boma debris regions(areas within- hurricane prone regions within 1 into of the coastal high water line were the basic wind speed Is 110 miles per hour or greater • or 120 miles per hour as per figure R301.2(4)of tie New York Slate . Residential Building Code shall meet the requirements of tha large Mlsslc test ASTM E 19116 and ilia ASTM E 1886 .b_A - a• referenced therein. (values are nominal design 3-second gust wind speed In miles per hour) v wilvv NOVEMBER 13,2008 WINDOW REPLACE AND SHINGLE SIDING REPLACEMENT FOR: J ROBERT HIGGINS ARCHITECT 511HiddenAcresPath REVISED PETER SCHEMBRI 1 O F Wadding River, 11792 1425 SOUND ROAD, ORIENT, NEW YORK r., Kl . CDE LU U DATE 8)aYl f( W � Z TWO Oho: amz LLJ TYPICAL i>EGK FOOTING Y w Q 12" round concrete poured pfer Q 0 Footings to virgin soil 6 cca- � � O H I-3/4" LVL on each side of 6" Post post, post anchor-See details � W W for strapping and O w O thru-bolted to each past w/ 2- 314" plc` g Haw � hot dipped gale bolts -- - uplift connections. Min 36" o j U- ---- -- Below Final Grade o Q Z � 5 ----- - w ¢ 0.0 U) 0cnf— 0 n=a=slew=q — L ==aaasa=ad I (2) fixed 'aoor panels (2) fixed door panels 6068 french door 6068 french door QC " 3-1/2" x 11-1%6" LVL 'l 3-112 x 11-�/8 I�VL U LU KITCHEN NO Cq F z Q) FLAT CEILING ` AUG 12 2 4 011 f o T cN Southhold Town Board of Trustees 2 RAILING-� MAHOGANY DI=GKING ON MAHOGANY SLErPERs RIPPED FOR A LF_Vr=I_ DECK SURFACE INSTALL EPDM STRIPPING ON #BOTTOM OF EACH 5,1'I^EPER AS PER MANUF. INSTRUCTIONS ANb DETAILS. w U FULLY ADHERED EF'DM ROOF MEMfBRANIwuJ PROTECTION 50 AS f?EQ'D fBY MANUF. � z 3/4" CDX PLYIUD SHEATHING . O UJ a dmw FASCIA TYP. INTERIOIR FLR < 2 W w BLOCKING-- w O -' d � OQ = 21N CONT. VENT----�- 2x1.0 LAG BOLT TO HDR H . D STRIP IN SOFFIT AT 1.6" ON CENTER O w LU O SIMPSON H-2 � °" w AT EACH AND TECO EACH JOIST b z > O JOIST 2X10 JOISTS 12" ON CENTER O Q Z TAPPER CUT TO 7.5" AT END W � 04 6 WOOD POST WRAP IN AZEK BEADED WOOD SOFFIT BOARD TRIM BOARb ON FURRING STRIPS DECKING EXISTING WOOD DECK TYPICAL FLOOR SYSTEtM ' 2X DECK JOISTS-see plan } 2 x ACQ Treated Nailer Board pC (one size larger than joist) Lag Bolted to framing with ##-- 1/2" diameter HOT DIPPEDlu U galvanized bolts at 24" o.c. Simpson ASU66 staggered. Nail each Joist �+ Galvanized to Nailerwith HOT DIPPED v-� post;to Concrete 12 �dia, concrete Ater p� � connectorw/ 1/2" 3ro below grace min. GALV. Joists Hangers at each joist. anchor bolt. � � � � � � � � U z 0) Ud > — EXTERIOR WATER-I�ROOFEDPI AUG 1 2 20111 �� . CQ ID ROOF-DECK DETAIL BSoard of Board Trustees i SCALE: 1/4" = 1 '-0" OeUFFO(1- Jill M.Doherty,President Off' C4 P.O.Box 1179 Bob Ghosio,Jr.,Vice-President �� Gy Southold,NY 11971 James F.King y Telephone(631 765-1892 Dave Bergen �. Fax(631)765-6641 John Bredemeyer y '- Southold Town Board of Trustees Field Ins pection/Worksession Report Date/Time: ��Z 1 )D3O PETER SCHEMBRI requests an Amendment to Administrative Permit #7008A to construct a 10'X 25'10" second-story deck above the existing deck. Located: 1425 Soundview Rd., Orient. SCTM#15-3-16 Ty of area to be impacted: Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: _Chapt.275 Chapt. 111 other Type of Application: Wetland _Coastal Erosion _Amendment —Administrative—Emergency Pre-Submission Violation Info needed: Modifications: II r Conditions: O`�- b /� ,v1� �/ 1:11&rZ Present Were: J. Doherty B. Ghosio J. King D. Bergen, mod'Bredemeyer D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: Jill M.Doherty,President H Town Hall,53095 Main Rd. James F.King,Vice-President , P.O.Box 1179 Dave Bergen d� Southold,NY 11971 Bob Ghosio,Jr. �JQl ��' Telephone(631)765-1892 John Bredemeyer Fax(631)765-WI BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: G ✓� 6 v Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction % constructed /Project complete, compliance inspection. INSPECTED BY: `� h 1��� P"f COMMENTS: a ZN ✓n 1 o— b� �-v Ll rff v-e CERTIFICATE OF COMPLIANCE: i r , James F. King,President *Qf SU!/T Town Hall Jill M.Doherty,Vice-President ,`O� Ol0 53095 Route 25 Peggy A.Dickerson P.O.Box 1179 Southold,New York 11971-0959 Dave Bergen G Bob Ghosio,Jr. �Ol� �O Telephone(631)765-1892 Fax(631)765-6641 CUM BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated /cbt, 6er o?o, Pxa- has been reviewed by this Board at the regular meeting of 6 ei-/0, orb Ff 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: $5y BY: James F. King, President Board of Trustees James F. King,President ��OF S�Uro Town Hall Jill M.Doherty,Vice-President ,`O yl0 53095 Route 25 P.O.Box 1179 Peggy A. Dickerson Southold,New York 11971-0959 Dave Bergen ,e Bob Ghosio, Jr. ` �Q Telephone(631)765-1892 pel nil 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 1st day of construction Y2 constructed V Project complete, compliance inspection. James F.King,President OF S0(/lyo Town Hall Annex Jill M. Doherty,Vice-President ,`O lO 54375 Main Road Peggy A. Dickerson P.O.Box 1179 Southold,New York 11971-0959 Dave Bergen G Bob Ghosio,Jr. Telephone(631) 765-1892 COUNT`l,Nct� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7008A Date of Receipt of Application: November 21, 2008 Applicant: Pete & Gail Schembri SCTM#: 15-3-16 Project Location: 1425 Sound View Road, Orient Date of Resolution/Issuance: December 10, 2008 Date of Expiration: December 10, 2010 Reviewed by: Bob Ghosio, Jr., Trustee Project Description: To replace windows, add French doors, replace siding, and construct a new 25'x45' wood deck. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by Robert Higgins, last dated November 13, 2008 and on the survey prepared by Nathan Taft Corwin III, last dated August 25, 2008. 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. James F. King, President Board of Trustees JFK:eac , � � g '" •;: �,. �-.;.^.*�e�.vn.;�°*" _ � as. F<r� ;� �zcx Vic.. R. t k. *a" ! 6:owa 1 isuwo 1 pp 11 N— ee-11-°: ' ✓ ! 1L1 u a UIN� 1p scN,D.z P, + • + ,, m D.zs � io-osee �-✓ 5 •1� � ;.nd mss site..a3 m 8 ® Lr L.0.90 M.D.60 P.D.66 _ L+A •e� p .�.. H �•W.•'65 1 d 6 .,• O.. z0 m �.0�• Yi�m u LmwTl Ec sifiY. °" 1S• aq.�u1 a a✓ ✓ �. �� 3. e � t,•m a,,,,1, +uw ..last m 11s � S J, 4� ss.i !,:*@ • zu 21. ' n¢ ✓ m • ,ale .n 1 Py 5 z1., "�'S'n" w„ 16n` ••Lli . �1NL111M ^ ✓+ h �` m) NZ m' N.9 31A1 � 5,'a.i m,] a IJA ,1A m J c —_ llle `115 y 1AA n.11A y H �f ♦y a ✓ ✓ T 19e 16 m. ajt " �e i e�+]� 6 n.f a • 2111 .a N.1] a. N r .5n+ 11111J a w � WA 'YY�pI Y ,� ¢ M1)✓ 21.�x nry i110 • �yµJ i 1 J a ISY ' Y.* O 4✓ ® xla241. � •� 211, , e a•"• 1V,. SR 25 J ��a 3 "Z 3)A Y 2110' r+ r\t 1 LlY j1AlJ �S� a l -• ] _ U.ie ]� .n e ] , RD• `� y �`I.lµ+l y p� �•QO• ,S;�J � ..,1!^-�t!"' ya\)t', E � ✓ a♦�,`q.,zuiry .� •moo b° `° je�m Zw ..o! \ ✓1e )y � l]µU � \ 1410 F011 fA.60. NI GCL IA � 2• !+ (,� n a � 1 e — --d— --•— NOTICE 6 COUNTY OF SUFFOLK Q E �66 SOUTHOLD SECTION NO Red Property Tax Service Agency Y mil,�}� �Gerhead,R Y IDo, M, 015 ND.... 1) 121 Ym mtLu's` ---- -- -- ...,.m«¢. —..-- .:¢ g4tx°iusW °fim4,�. 4 ro+; IE NfEFi: A ' 66racrm P 1000 •;._.:.- ........ .. ,ma..... lza Yn +.u. —___— ....>.:..... —_s—_ :µ•ono w PROPERTY NPP J EC WE L! L AUG 12 2011 Southhold Town Trustees Soathhold Town Board of Trustees Re: 1425 Soundview Road,Orient Point, New York Ladies and Gentlemen: I, Peter Schembri, would like to amend permit#7008 to reflect the addition of a second story deck above the existing deck. `D x'';� 5—,10 Thank you for your consideration. Sincere , Peter Schembri James F.King,President ��OF soUlyo Town Hall Jill M.Doherty,Vice-President 53095 Route 25 Peggy A. Dickerson P.O. Box 1179Southold,New York 11971-0959 Dave Bergen G Bob unusi.u,. Jr. Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application Administrative Permit _AmendmendTransfer xtension eceived Application: I I a v7AReceived Fee:$ ©� TAs- 1 ° V Completed Application I I I XQ _Incomplete NQV !� _SEQRA Classification: z 0 2008 Type I Type II Unlisted Coordination:(date sent) Southhold Town _/LWRP Consistency Assessment Form O Board of Trustees -.,t-CAC Referral Sent: t, ate of Inspection: _Receipt of CAC Report.- ­Lead Agency Determination: _Technical Review: —Public Hearing Held: Resolution: Name of Applicant —t- c Address 76 04L "4��4 7t)- Phone Number:( ) (0 3 9°- Suffolk County Tax Map Number: 1000 - Property Location: VA'e;'j (provide LILCO Pole#, distance to cross streets, and location) //1Q AGENT: (If applicable) Address: Phone: =,,rd of Trustees Applicaticr GENERAL DATA Land Area(in square feet): �'�'` (17 Area Zoning: © _ Previous use of property: Intended use of property: Covenants and Restrictions: Yes No If"Yes",please provide copy. Prior permits/approvals for site improvements: Agency Date No pnor permits/approvals for site improvements. Has:any permit/approval ever been revoked or suspended byyaa governmental agency? C�I�o Yes If yes,provide explanation: Project Description (use attachments if necessary): ,51 Lr/ yIAJ Board of. Trustees Applicati^r - WETLAND/TRUSTEE LANDS APPLICATION DATA. Purpose of the proposed operations: r Area of wetlands on lot: square feet Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: 5;;-e feet Does the �project /involve excavation or filling? �No Yes If yes,how much material will be excavated? 0 cubic yards How much material will be filled? o cubic yards 'Depth of which material will be removed or deposited: 0 feet Proposed slope throughout the area of operations: 0 Manner in which material will be removed or deposited: 0 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): PROJECT ID NUMBER 617.20 SEQR 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/SPONSOR 2.PR CCT NAME 3.PROJECT LOCATION: Municipality ' County 5_41&A 4.PRE I$E LOCAT15M Street ddess and Road Intersections, P in t andmar etc -or provide map 5.IS PROPOSED ACTION: ❑ New ❑Expansion F_U�Ification/alteration 6.DESCRIBE PROJECT BRIEFLY: �IJ ��• /J�� � /t /� �� � .�6 �� 7.AMOUNT OF LAND AFFECTED: J Initially acres Ultimately acres V 8.WILL P SED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? es ❑ No If no,describe briefly: 9.WHA PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) esidential ❑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 AGENCY Federal, State or Local) es ❑No If yes, list agency name and permit / approval: VALID PERMIT OR APPROVAL? ElYes If yes, list agency name and permit / approval: 12. AS A RESULT ROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? C Dyes Job I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Spon ame Date: Signature If the action is a Costal Area, and you are a state agency, U complete the Coastal Assessment Form before proceeding with this assessment PART 11 - 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 0 No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be han6ritten,if legible) C.I. 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: C2. Aesthetic,agricultural;archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: 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: C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly. C6. Longterm,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: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? If Yes,ex lain briefly: Yes No E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es 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 f �.+a. Ge resut eyaalHate-ttle-pe 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. -- -----------_6a---------- --._.-.... _.__...._..__....._......_... --- ._..._.. .._._. .. ---- -- ---- ----- Ctieck 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) 3oard of Trustees Applica`-,_'.,in County of Suffolk State of New York 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 REV W OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS o -P-\ DAY OF N)O 720 V � CONNIE D.BUNCH Notary Public Notary Nob0106alt85050wYork Qualified in Suffolk County Commission Expires April 14, 0�� ' hoard of Trustees Applicat- AUTHORIZATION (where the applicant is not the owner) I. residing .at (print owner of property) (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner' s signature) 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 sa YOUR NAME: !/ Last name,first name,.piddle 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 town 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 this d y f 200e Signature Print Name Form TS 1 gUFFO��► ' Albert J.Krupski,President ��� C� Town Hall James King,Vice-President � 53095 Route 25 Artie Foster p P.O.Box 1179 Ken Poliwoda W Southold,New York 11971-0959 Peggy A.Dickerson D,y • 4 aO� .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 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 si nificant 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 t 4 -(aS t website (southoldtown.northfork.net), the Board of Trustees Office 1 rdfLie1E I 1 , a local libraries and the Town Clerk's office. NOV 0 2008 B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# A)00 - l S� - 0-7 - /C eSOMhold TOW, ,�n Oard of Trustees PROJECT NAME �` - J� 1 �- . The Application has been submitted to (check appropriate response): Town Board ElPlanning Board ElBuilding Dept. P---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: _ I , I✓� ���� a vi-64 . Location of action: Site acreage: Present land use: �1 , Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: (c) Telephone number: Area Code ( ) �p3 — �d2�' O s-97r (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ❑ No �Ifyes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No Not Applicable ' Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No IJ Not Applicable 00,4 0 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 t 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 4 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 thrroough�21 for evaluation criteria ❑ Yes ❑ No E;got Applicable A --a- 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 cri ria. Yes No of Apj'� 'ble 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 of Applicable /� r 61C— tA 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 ❑ a 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. ❑ Yel No Not Applicable Attach additional sheets if necessary WORKING COAST POLICII, 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 ��otApplicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town water ee LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ W No N-ot Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Page 5 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable PREPARED BY TITLE �� DATE O