HomeMy WebLinkAboutTR-9635A Glenn Goldsmith,President so(/ry Town Hall Annex
A. Nicholas Krupski,Vice President ,`O ��� 54375 Route 25
P.O. Box 1179
John M. Bredemeyer III [ Southold,New York 11971
Michael J.Domino G Q Telephone(631) 765-1892
Greg Williams �� �� Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
#-1795C Date: February 10, 2021
THIS CERTIFIES that the as-built 16'x8 2'pool storaize shed with no interior water or.gas to
be installed,replacing an existing 12'x8.2' shed in-place; as-built generator on a 56"x34"04"
high.pad; and for the as-built extension of existing driveway an additional 37' seaward for a total
ed
of approximat2 394sq ft of driveway'
At 3905 Wells Avenue, Peconic
Suffolk County Tax Map#1000-86-2-14
Conforms to the application for a Trustees Permit heretofore filed in this
office Dated June 7, 2019 pursuant to which Trustees Administrative Permit#9635A
Dated February 12, 2020,was issued and conforms to all
the requirements and conditions of the applicable provisions of law. The project
for which this certificate is being issued is
for the asbuilt 16'x8.2' pool storage shed with no interior water or gas to be installed,
replacing an existing 12'x8 2' shed in-place; as-built generator on a 56"x34"04"high pad; and
for the asbuilt extension of existing_driveway an additional 37' seaward for a total of
amiroximately 2 394sq.ft. of driveway.
The certificate is issued to John Arcara&Michael Scopellite owners of the aforesaid
proUerty.
Authorized Signature
Glenn Goldsmith,President �QF sorry 1 Town Hall Annex
Michael J.Domino,Vice-President ,`QOl0 54375 Route 25
P.O.Box 1179
John M.Bredemeyer III Southold,New York 11971
A.Nicholas Krupski G Q Telephone (631) 765-1892
Greg Williams �� �� Fax(631) 765-6641
enuo,�
BOARD OF TOWN TRUSTEES
a TOWN OF SOUTHOLD
1
DATE OF INSPECTION.:
INSPECTED BY: (� �—✓ ``�—S
Ch. 275 Ch. 111
INSPECTION SCHEDULE
Pre-construction; haybale line/silt boom/silt curtain
1 st day of construction
% constructed
Project complete, compliance inspection
COMMENTS•
IJ1 - .G di c✓-S 7b bC� J��(G� �Cyiloo
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CERTIFICATE OF COMPLIANCE: OK
Glenn Goldsmith, President QF S10(/TTown Hall Annex
Q 54375 Route 25
Michael J.Domino,Vice-President P.O.Box 1179
John M.Bredemeyer III l�[ Southold, New York 11971
A.Nicholas Krupski G Q Telephone(631) 765-1892
Greg Williams �� �� Fax(631) 765-6641
coUNT`I
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
SOUTHOLD TOWN BOARD OF TRUSTEES
YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES
72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF
BELOW
INSPECTION SCHEDULE
Pre-construcft n,"hfi bale linelsilfboo&/sift curtain
1St day of construction
y % constructed
/� When project complete, call for compliance inspection;
Glenn Goldsmith,President �Q� SOUrTown Hall Annex
�0� Ol0 54375 Route 25
Michael J.Domino,Vice-President P.O.Box 1179
John M.Bredemeyer III [ Southold,New York 11971
A.Nicholas Krupski G Telephone(631) 765-1892
Greg Williams �� Fax(631) 765-6641
�ycoyNTy
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 9635A
Date of Receipt of Application: June 7, 2019
Applicant: John Arcara & Michael Scopellite
SCTM#: 1000-86-2-14
Project Location: 3905 Wells Road, Peconic
Date of Resolution/Issuance: February 12, 2020
Date of Expiration: February 12, 2022
Reviewed by: Greg Williams, Trustee
Project Description: For the as-built 16'x8.2' pool storage shed with no interior water
or gas to be installed, replacing an existing 12'x8.2' shed in-place; as-built generator on
a 56"x34"x34" high pad; and for the as-built extension of existing driveway an additional
37' seaward for a total of approximately 2,394sq.ft.-of driveway.
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 project'plan prepared
by John Arcara, received on June 7, 201-9 and stamped approved on February 12, 2020.
Special Conditions: None.
Inspections: Final Inspection. -
If the proposed activities do not meet the requirements for issuance of an Administrative
Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be
required. -
This is not a determination from any other agency.
Glenn Goldsmith, President
Board of Trustees
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Michael J. Domino, Pre �s�FFO(,��, Town Hall Annex
John M. Bredeme er II1,Viceftre�i t �� - ` 54375 Route 25
Glenn Goldsmith y P.O.Bo'x 1179
A.Nicholas Krupski _ ? Southold,NY 11971
Greg Williams 4' p� ; Telephone(631)765-1892
Fax(631)765=6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Date/Time: 7L91( Completed in field by:
JOHN R. ARCARA & MICHAEL SCOPELLITE request an Administrative Permit for an as-built
56"x34" generator pad; as-built 8'2"x16' pool•storage shed with no water or electric; and for a 37'
extension to existing gravel driveway. Located:- 3905 Wells Road, Peconic. SCTM#: 1000-86-2-14
CH. 275-3 - SETBACKS
WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required
1. Residence: 100 feet
2. Driveway: 50 feet
3. Sanitary Leaching Pool (cesspool): 100 feet
4. Septic Tank: 75 feet
5. Swimming Pool and related structures: 50 feet
6. Landscaping or.gardening: 60 feet
7. Placement of C&D material: 100 feet
TOP OF BLUFF:
1. Residence: 100 feet
2. Driveway: 100 feet
3. Sanitary leaching pool (cesspool) 100 feet:
4. Swimming pool and related structures: 100 feet
Public Notice of Hearing Card Posted: Y / N
Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action
Type of Application: Pre-Submission Administrative Amendment Wetland
Coastal Erosion . Emergency Violation Non-Jurisdiction
Survey <_ 5 years: Y/N Wetland Line by: C.E,.H.A. Line
Additional information/suggested-mo'dification, s/conditions/need for outside
review/consultant/application completeness/comments/standards:
&0/1- jL0'j !ge-ev.- s CAP' �0'9 P_ Ilea In G�-,) 11
�V l e Ile P_J�' ` � (j
have read & acknowledged'the foregoing Trustees comments:
Agent/Owner:
Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski
G. Williams Other
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SURVEY OF.DESCRIBED PROPERTY CERTIFIED To: JOHN R. ARCARA;
MAP OF. MICHAEL SCOPILLITE,
-N, RLED., WELLS FARGO BANK, N.A.:
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- SOUTHOLD ( #S348994)
EMMEM M WOYC= LAND SURVEYING, PLLC
SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design
P.O. Box 153 Aquebague, New York 11931
PHONE(631)208-15W FAX(631)M-1586
FILE016-76 ScAm-I"e,30'DATE:MAY 18, 2016 MYS LISC. Na 050882 I mdntohftg t1w raazd. f Rabat J.Hannam a ZimnlamefM IL
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4
BOARD MEMBERS ��,®F S0t'/jy® Southold Town Hall
Leslie Kanes Weisman,Chairperson ,`4 l0 53095 Main Road•P.O.Box 1179
Southold,NY 11971-0959
Patricia Acampora � � Office Location:
Eric DaneTown Annex/First Floor,
Robert Lehnrtrt,Jr. O� ,��`� 54375 Main Road(at Youngs Avenue)
Nicholas Planamento 'YCl7UfiJT`(,� Southold,NY 11971
http://southoldtownny.gov RECEIVED
ZONING BOARD OF APPEALS "lam�`C9 10.20 AIM
TOWN OF SOUTHOLD JAN 2 7 2020
Tel.(631)765-1809•Fax(631)765-9064 P a44
Sou old Town Clerk
FINDINGS,DELIBERATIONS AND DETERMINATION
MEETING OF JANUARY 23, 2020
ZBA FILE: 7357
NAME OF APPLICANT: John Areara and Michael Scopellite
PROPERTY LOCATION: 3905 Wells Road(Adj.Richmond Creek),Peconic NY SCTM: 1000-86-2-14
SEORA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this
application and determines that this review falls under the Type II category of the State's List of Actions,without
further steps under SEQRA.
SUFFOLK COUNTY ADMINISTRATIVE CODE: This application was referred as required under the Suffolk
County Administrative Code Sections A 14-14 to 23, and the Suffolk County Department of Planning issued its
reply dated October 8, 2019 stating that this application is considered a matter for local determination as there
appears to be no significant county-wide or inter-community impact.
LWRP DETERMINATION: This application was referred for review under Chapter 268,Waterfront Consistency
review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy
Standards. The LVW Coordinator issued a recommendation dated December 16, 2019. Based upon the
information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the
records available it is recommended that the proposed action is INCONSISTENT with LWRP policy standards
and therefore is INCONSISTENT with the LWRP.
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.
The as-built pool house was constructed without obtaining required review or permits. As-built
development does not minimize adverse effects of development, sets precedent and reinforces a
traditional land use pattern of the Town of Southold that is not supported. The action does not
meet this policy.
Policy 4. Minimize the loss of life, structures, and natural resources fromflooding and erosion.
The as-built pool house is located within the FEMA flood zone with a 0.2 percent chance of
annual flooding. The entire parcel is located in this designation and therefor the structure cannot
be relocated out of the zone.
Page 2,January 23,2020
#7357,Arcara
SCTM No. 1000-86-2-14
However, with the conditions imposed herein the Zoning Board of Appeals finds the proposed action to be
CONSISTENT with the LWRP
PROPERTY FACTS/DESCRIPTION; The subject, irregular-shaped, conforming 41,061.09 square feet, 0.94 acre
waterfront lot(upland lot area 36,750 square feet buildable) located in the R-40 zone measures 229.00 feet along a
curve in Wells Road, then runs 170 feet due south, along a residentially developed lot to the east, to Richmond
Creek, then runs 314.87 feet along Richmond Creels and returns 160 feet north, along a second residentially
developed lot to the west, to Wells Road. The site is developed with a two-story wood frame dwelling with
attached garage, an attached wood deck with an outdoor shower and partially covered with a canvas awning, an
attached wood deck surrounding an in-ground swimming pool, an attached shed (subject of this application), brick
walkway, brick entry stoop, stockade and chain-link fencing around pool area, a generator, a stone driveway with
Belgian-block apron and edging, wood rail fencing at the eastern lot line and stockade fencing on the western lot
line, along with a wood catwalk, ramp and floating dock at Richmond Creek, as shown on the survey prepared by
Kenneth M. Woychuk,Land Surveying,PLLC and dated May 18,2016.
BASIS OF APPLICATION: Request for a Variance from Article 111, Section 280-15; and the Building Inspector's
September 19, 2019,Notice of Disapproval based on an application for a permit to legalize an "as built"accessory
pool house; at, 1) located in other than the code permitted rear yard; located at 3905 Wells Road, (Adj. to
Richmond Creek)Peconic,NY. SCTM No. 1000-86-2-14.
RELIEF REQUESTED: The applicant requests a variance for an as-built, accessory shed measuring 16 feet by 8.3
feet with a height of 9 feet at the highest point, attached to the deck surrounding the pool which is also attached to
the residence and located in a side yard where the code permits such structures to be built in the required rear-yard
or in the case of a waterfront residence in the front yard provided principal setback requirements are met.
ADDITIONAL INFORMATION: A Stop Work Order was issued by the Town of Southold Building Department
dated May 3, 2019. This Board does not define the subject construction, subject of the Stop Work Order, to be a
pool house, but rather an accessory shed. The subject property is covered by the following Certificates of
Occupancy:
#Z-4899 Issued November 8, 1972 Private One-Family Dwelling
#Z-7805 Issued August 3, 1977 Deck Addition
#Z-22498 Issued August 6, 1993 "As Built"Finished Second Floor to Dwelling
#Z-25852 Issued July 27, 1998 Addition to Existing Dwelling
#Z-25854 Issued July 27, 1998 Deck Addition Surrounding Swimming Pool with Fencing
#Z-25853 Issued July 27, 1998 Accessory Storage Shed Attached to Existing Wood Deck
The applicant states the `As Built' structure is actually a repair and expansion to the shed which was covered by
Certificate of Occupancy Z-25853, originally built in 1998 that measured 12 feet by 8 feet. Additionally, the
applicant indicates only limited plumbing to accommodate a hose bib and limited electric to accommodate basic
outdoor lighting is proposed and that the structure will not be heated, cooled or conditioned in anyway and that
there is no proposed bathroom or food preparation facilities and the structure will only be used for storage. The
applicant stated an outdoor shower exists elsewhere on the property. The subject waterfront parcel is primarily
located in FEMA Flood Zone X with a small portion of land, located along the creek, in Flood Zone AE Elevation
6. No member of the public or any immediate neighbor spoke in favor of or against this application.
FINDINGS OF FACT/REASONS FOR BOARD ACTION:
The Zoning Board of Appeals held a public hearing on this application on January 2,2020 at which time written
and oral evidence were presented. Based upon all testimony, documentation, personal inspection of the property
Page 3,January 23,2020
#7357,Arcara
SCTM No. 1000-86-2-14
and surrounding neighborhood, and other evidence,the Zoning Board finds the following facts to be true and
relevant and makes the following findings:
1. Town Law 5267-b(3)(b)(1). Grant of the variance will not produce an undesirable change in the character of
the neighborhood or a detriment to nearby properties. The subject residence is located towards the road-end of a
Town maintained street that terminates at Richmond Creek and services an enclave of approximately 30 residences
developed between an agricultural area south of Main Road and the creek front. Most homes were built in the
1960's to 1980's and are sited in a woodland environment, many of which have been recently renovated or
expanded upon. Neighboring homes have accessory sheds and one has a pool-house located in a side yard. The
subject accessory shed replaces a structure that was previously permitted and was originally built over twenty years
ago. While slightly expanded upon, the structure is shielded by a stockade fence and plantings and native
vegetation and is mostly hidden from sight.
2. Town Law 4267-b(3)(b)(2). The benefit sought by the applicant cannot be achieved by some method, feasible
for the applicant to pursue, other than an area variance. Asa result of the initial placement of the residence on the
narrow, waterfront lot a variance will be required for the placement of any accessory structure. There is no
possible location to place a shed in a conforming rear or front yard location and placement in the side yard,
accessible to the pool and deck area is most logical.
3. Town Law 5267-b(3)(b)(3). The variance granted herein is mathematically substantial, representing 100%
relief from the code. However, a prior structure stood in the "as built" location and was covered by Certificate of
Occupancy#Z-25853. Furthermore, while the ridge height of the new shed is 9 feet in height, it is below the code
permitted maximum height and is partially screened by a stockade fence,plantings and native woodland trees.
4. Town Law 5267-b(3)(b)(4). No evidence has been submitted to suggest that a variance in this residential
community will have an adverse impact on the physical or environmental conditions in the neighborhood. The
applicant must comply with Chapter 236 of the Town's Storm Water Management Code.
5. Town Law §267-b(3)(b)(5). The difficulty has been self-created. The applicant purchased the parcel after the
Zoning Code was in effect and it is presumed that the applicant had actual or constructive knowledge of the
limitations on the use of the parcel under the Zoning Code in effect prior to or at the time of purchase.
6. Town Law 5267-b. Grant of the requested relief is the minimum action necessary and adequate to enable the
applicant to enjoy the benefit of an accessory shed while preserving and protecting the character of the
neighborhood and the health,safety and welfare of the community.
RESOLUTION OF THE BOARD: In considering all of the above factors and applying the balancing test under
New York Town Law 267-B, motion was offered by Member Planamento, seconded by Member Acampora, and
duly carried,to
GRANT the variance as applied for, as shown on the survey prepared by Kenneth M. Woychuk, Land Surveying,
PLLC, and dated May 18, 2016; and the architectural drawings labeled page 1/2 and 2/2 prepared by Robert James
Higgins,Architect, and dated August 12,2019.
SUBJECT TO THE FOLLOWING CONDITIONS:
1. The applicant must apply to the Building Department.for a building permit for the"as built" improvement
within 30 days of the date of this decision and submit same to the Office of the Zoning Board of Appeals,
or submit a written request for an extension to the Board of Appeals setting forth the reason(s)why the
applicant was unable to obtain a building permit in the time allotted.
Page 4,January 23,20.20
#7357,Arcara
SCTM No. 1000-86-2-14
2. The applicant must obtain a Certificate of Occupancy from the Building Department for the"as built"
improvement and submit same to the Office of the Zoning Board of Appeals within 4 months of this.
decision or submit a written request for an extension to the Board of Appeals setting forth the reason(s)
why the applicant was unable to obtain a Certificate of occupancy in the time allotted.
3. The"as built" improvement may not be used,until a Certificate of Occupancy has been obtained
4. No bathroom or cooking facilities may be installed in the shed and only limited plumbing for a hose bib
and limited electrical for basic lighting is permitted.
5.1 The shed may not be used for any purpose other than storage.
6. The applicant is to apply for and receive a Certificate of Occupancy for the `as-built' installation of a
generator,also noted on the Stop Work Order.
7. At the discretion of the Board of Appeals, failure to comply with the above conditions may render this
decision null and void
Any deviation from the survey, site plan and/or architectural drawings cited in this decision will result in delays
and/or a possible denial by the Building Department of a building permit, and may require a new application and
public hearing before the Zoning Board of Appeals.
Any deviation from the variances)granted herein as shown on the architectural drawings, site plan and/or survey
cited above, such as alterations, extensions, or demolitions, are not authorized under this application when
involving nonconformities under the zoning code. This action does not authorize or condone any current or future
use, setback or other feature of'the subject property that may violate the Zoning Code, other than such uses,
setbacks and other features as are expressly addressed in this action. In the event that an approval is granted subject
to conditions, the approval shall not be deemed effective until the required conditions have been met; and failure to
comply therewith will render this approval null and void.
The Board reserves the right to substitute a similar design that is de minimis in nature for an alteration that does
not increase the degree of nonconformity.
Pursuant to Chapter 250-146(B) of the Code of the Town of Southold any variance granted by the
Board of Appeals shall become null and void where a Certificate of Occupancy has not been
procured, and/or a subdivision map has not been filed with the Suffolk County Clerk,within three
(3)years from the date such variance was granted. The Board of Appeals may, upon written
request priof to the,date of expiration, grant an extension not to exceed three (3) consecutive one
(1)year terms.
Vote of the Board: Ayes: Members Dantes,Acampora, and Planamento(3-0)(Members Weisman(Chairperson)
and Member Dantes absent)
Nichs .P anamento, Vice Chai
Appr v d for filing / /2020
SUFFt1(,t- "
Michael J. Domino, President �o�� eoGy Town-Hall Annex
John M. Bredemeyer, III, Vice-Presidento 54375 Route 25
Glenn Goldsmith N P.O. Box 1179
A Nicholas Krupski y Southold, NY 11971
l �a� Telephone (631) 765-1892
Greg Williams _
Fax (631) 765-6641
SOUTHOLD TOWN BOARD OF TRUSTE
TO: SOUTHOLD TOWN BUILDING DEPARTMENT
JUN 1 0 2019
RE: VERIFICATION OF BUILDING DEPARTMENT PERMIT REQUIREMENTS-
-SCTM#:
Property Owner Name:
Date Sent to Bldg. Dept:
The Office of the Board of Trustees is forwarding the above referenced application for
verification of the Building Department's permitting requirements stated below:
YES NO
Will the proposed project require a Building Permit?
Will the proposed project require a variance determination
from the Zoning Board"of Appeals?
Will any part of this application be considered a Demolition
as described under Town Code?
COMMENTS:
LZt4ureef R v wer Date
OFFICE LOCATION: `�®f 6S°®1 MAILING ADDRESS:
Town Hall Annex ® P.O.Box 1179
54375 State Route 25 Southold, NY 11971
(cor.Main Rd. &Youngs Ave.)
Southold, NY 11971 Telephone: 631765-1938
a
LOCAL WATERFRONT REVITALIZATION PROGRAM
TOWN OF SOUTHOLD
MEMORANDUM
To: Michael Domino, President
Town of Southold Board of Trustees
From: Mark Terry, AICP
LWRP Coordinator
Date: July 3, 2019
Re: LWRP Coastal Consistency Review for 3905 Wells Road —John Arcara/Michael Scopellitz
SCTM# 1000-86-2-14
The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the
Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy
Standards. Based upon the information provided on the LWRP Consistency Assessment Form
submitted to this department, as well as the records available to me, it is my recommendation that
the proposed action is INCONSISTENT with LWRP Policy 6, specifically 6.3 (below) and therefore,
INCONSISTENT with the LWRP.
6.3 Protect and restore tidal and freshwater wetlands.
A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws
and regulations for all Andros Patent and other lands under their jurisdiction
9. Comply with Trustee regulations and recommendations as set forth in Trustee permit
conditions.
Town records indicate that the structures were constructed without Southold
Town Board of Trustees review or permit.
In the event the action is approved, it is recommended that a vegetated, non-turf buffer is
required landward of the deck to further Policy 6.
Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its
written determination regarding the consistency of the proposed action.
V soy
Michael J.Domino,President � TyOlO Town Hall Annex
John M.Bredemeyer III,Vice-President 54375 Route 25
P.O.Box 1179
Glenn GoldsmithCA Southold,New York 11971
A.Nicholas,Krupski �p� Telephone (631) 765-1892
Greg Williams 19/1 'N Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
This Section For Office Use Only Fu)
Coastal Erosion Permit A lication _ - Fu)a11 L f , t-
Wetland Permit Application; 1
Administrative Permit � �
Amendment/Transfer/Extension JUN 7 2019
Received Application: &,1./
Received Fee: $200.00 ��Ottr ScutliGId;oy^;n
Completed Application: •/0•/ �o3rcf o T*�t�t�A ;
Incomplete:
SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec.
Lead Agency Determination Date:
V/ Coordination:(date sent):
—LWRP Consistency Assessment Form Sent:
CAC Referral Sent:
Date of Inspection:
Receipt of CAC Report:
Technical Review:
, Public Hearing Held: 7/711
Resolution:
Owner(s) Legal Name of Property (as shown on Deed): . olk,,, 1-(-a.rct, I,'-f-P
Mailing Address: 0 5' GJ e((s [�,za-p
Phone Number: l'D =ff 9 S-7-2 e�
Suffolk County Tax Map Number: 1000 -
Property Location: 3 5 Q t 6J e-11
(If necessary, provide LILCO Pole#, distance to cross streets,-and location)
AGENT(If applicable):
Mailing Address:
Phone Number:
Board of Trustees Appli4 ion
GENERAL DATA
Land Area(in square feet): YJ 4C� / HT1
Area Zoning: q�+�,, u
Previous use of property:
Intended use of property: ;'e s i 8 a�4, h-A
Covenants and Restrictions on property? - Yes No
If"Yes",please provide a copy.
Will this project require a Building Permit as per Town Code? �C Yes No
If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review
and Elevation Plans will be required.
Does this project require a variance from the Zoning Board of Appeals? Yes No
If"Yes",please provide copy of decision.
Will this project require any demolition as per Town Code or as determined by the Building Dept.?
Yes No
Does the structure (s) on property have a valid Certificate of Occupancy? Yes No
Prior permits/approvals for site improvements:
Agency Date
w-3 o = sGv4o `� l 1 '?-1
l C4-✓J o SOJ-F ,o x> �l r / iQ'
No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a governmental agency? a No Yes
If yes, provide explanation:
Project Description (use attachments if necessary): ✓r P -SPD Ly - Sro,^ X . 1Dv 1, l
ccrb a t'L ��� t�E e.� , Gs !� AD C-Jc,�'Y o�/�J' F_
(P oZ x Re is C'n S �;o'C,,q r► P;01 y
T 0
°
Board of Trustees Appli :ion
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: Pf?f`u
An 4-b �x �.-.at m i -s e-1 �. r 14—L1—
i
Area of wetlands on lot: square feet
Percent coverage of lot: C a %
Closest distance between nearest existing structure and upland edge of wetlands: -6-5 feet
Closest distance between nearest proposed structure and upland edge of wetlands: :5- S' 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: D-) feet
Proposed slope throughout the area of operations: 0
Manner in which material will be removed or deposited: �1
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):
617.20
Appendix B
Short Environmental Assessment Form
Instructions for Completing
Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses
become part of the application for approval or funding,are subject to public review,and may be subject to further verification.
Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully
respond to any item,please answer as thoroughly as possible based on current information.
Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful
to the lead agency;attach additional pages as necessary to supplement any item.
Part I -Project and Sponsor Information
Name of Action or Project:
Project Location(describe,and attach a location map):
Brief Description of Proposed Action:
A �(o k3 /
Name of Applicant or Sponsor: LE
phone:
��? ✓� .Z c r9� S'Co4'-,— ail:^ !'c e /
Address:
3'3 0 -5-
City/PO: State: Zip Code:
1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES
administrative rule,or regulation?
If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that 54-'
may be affected in the municipality and proceed to Part 2. If no,continue to question 2.
2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES
If Yes,list agency(s)name and permit or approval: ® ❑
P ,
3.a.Total acreage of the site of the proposed action? ,e acres
b.Total acreage to be physically disturbed? �j '' acres
c.Total acreage(project site and any contiguous properties)owned
or-controllbd by the applicant or project sponsor? ® acres
4. Check all land uses that occur on,adjoining and near the proposed action.
E]Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial residential(suburban)
❑Forest ❑Agriculture El Aquatic ❑Other(specify):
❑Parkland
Page I of 4
5. Is the proposed action, NO YES N/A
a.A permitted use under the zoning regulations? ❑ ❑
b.Consistent with the adopted comprehensive plan? ❑
6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES
landscape? ❑ IN
7. Is the site of thero osed action located in,or d es it adjoin,a state listed Critical Environmental Area? NO YES
If Yes,identify: ✓7 enndf WIV- 1111 r, ' S '
8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES
b.Are public transportation service(s)available at or near the site of the proposed action?
c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed-action?/,, ❑ �-
9.Does the proposed action meet or exceed the state energy code requirements? NO YES
If the proposed action will exceed requirements,describe design features and technologies:
® Q
10. Will the proposed action connect to an existing public/private water supply? NO YES
If No,describe method for providing potable water: 1� ❑
11.Will the proposed action connect to existing wastewater utilities? NO YES
If No,describe method for providing wastewater treatment: n ❑
12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES
Places? ❑
b.Is the proposed action located in an archeological sensitive area? ❑
191
13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain N6 YES
wetlands or other waterbodies regulated by a federal,state or local agency? F-1 EM
b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ❑
If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres:
l
14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply:
❑Shoreline El Forest ❑Agricultural/grasslands El Early mid-successional
etland ❑Urban ❑Suburban
15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES
by the State or Federal government as threatened or endangered? ❑
16.Is the project site located in the 100 year flood plain? NO YES
17.Will the proposed action create storm water discharge,either from point or non-point sources? I NO Y S
1f Yes,
a.Will storm water discharges flow to adjacent properties? NO [—]YES ❑
i
b.Will storm water discharges be directed to established conveyance systems(r off and storm drains)?
If Yes,briefly describe: ANO AYES
Page 2 of 4
18. Does the proposed action include construction or other activities that result in the impoundment of NO YES
water or other liquids(e.g.retention pond,waste lagoon,dam)?
If Yes,explain purpose and size. F91 1-1
19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES
solid waste management facility?
If Yes,describe: ❑
20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES
completed)for hazardous waste?
If Yes,describe:
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE
Applicant/sponsor name: ,-r ,,,,, hZ. S ( Date: 0- 9
Signature:
Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following
questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or
otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my
responses been reasonable considering the scale and context of the proposed action?"
No,or Moderate
small to large
impact impact
may may
occur occur
I. Will the proposed action create a material conflict with an adopted land use plan or zoning El ❑
_ regulations?
2. Will the proposed action result in a change in the use or intensity of use of land? F]
3. Will the proposed action impair the character or quality of the existing community?
4. Will the proposed action have an impact on the environmental characteristics that caused the El 1:1establishment of a Critical Environmental Area(CEA)?
S. Will the proposed action result in an adverse change in the existing level of traffic or El 1:1affect existing infrastructure for mass transit,biking or walkway?
6. Will the proposed action cause an increase in the use of energy and it fails to incorporate 1:1 El
available energy conservation or renewable energy opportunities?
7. Will the proposed action impact existing: El El
a.public/private water supplies?
b.public/private wastewater treatment utilities? E
8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ n
architectural or aesthetic resources? L_J
9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ ❑
waterbodies,groundwater,air quality,flora and fauna)?
Page 3 of 4
No,or Moderate.
small to large
impact impact
may may
occur occur
10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage EI EIproblems?
11. Will the proposed action create a hazard to environmental resources or human health? El 0
Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every
question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular
element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3.
Part 3 should,insufficient detail,identify the impact,including any measures or design elements that have been included by
the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact
may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring,
duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and
cumulative impacts.
EICheck this box if you have determined,based on the information and analysis above,and any supporting documentation,
that the proposed action may result in one or more potentially large or significant adverse impacts and an
environmental impact statement is required.
ElCheck this box if you have determined,based on the information and analysis above,and any supporting documentation,
that the proposed action will mot result in any significant adverse environmental impacts.
Town of Southold-Board of Trustees
'Name of Lead Agency Date
President
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer
Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer)
PRINT Page 4 of 4
Board of Trustees Appli, tion
AFFIDAVIT
j
S�.19Q 11, J�: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
BOARD OF 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, INCLUDING THE -
CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO
INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION,
INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF
TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE
COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL
EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM
OF THE PERMIT.
gnature of PropertyOwner Signature of Property Owner
SWORN TO BEFORE ME THIS DAY_OF
1.
r
Not y Public
CS%;�Mass;ue2L: U� ��Pc—�S
KIMBILEY FELDER
Commissioner of DeedS
City of New York No.44658
Commission Frpires
Board of Trustees Appli,- ':ion
AUTHORIZATION
(Where the applicant is not the owner)
I/We, ,
owners of the propert identified as SCTM# 1000- in the town of
New York, hereby authorizes
to act as my agent and handle all
necessary work involved with the applicatio process for permit(s) from the Southold Town
Board of Trustees for this property.
Property Owner's Signature Property O er's Signature -
SWORN TO BEFORE ME THIS DAY OF ' 20
Notary Public
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 pumose 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: &tic Ar 'R i`e to
(Last name,first name,-pidd a 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 y
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 X
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 day of
Signature
y Print NamVr P1 e 1 o
Form TS I
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for
proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This
assessment is intended to supplement other information used,by a Town of Southold agency in
making a determination of consistency. *Except minor exempt actions including Building Permits
and other ministerial permits not located within the Coastal Erosion Hazard Area.
2. Before answering the questions in Section C, the preparer of this form should review the exempt
minor action list, policies and explanations of each policy contained in the Town of Southold Local
Waterfront Revitalization Program. A proposed action will be evaluated as to its si miant
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#
--- - PROJECT NAME-- 3, -. . 7n - ro .l v�Cod��
The Application has been submitted to (check appropriate response):
Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees
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:
La
4 R �' �.< � �, 4 Q ��a�,p�. �� to . Y 3Y t o X 3Y f n
n G �
Sr-_L�sa� r�." �
x �
Location of action:
Site acreage: q y,
Present land use:
Present zoning classification: q2 e s , C�Q.., 4, `
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: - GA n I-C 14� , /� c A--"-/ S"--�P21=1
(b) Mailing address: ,l(:k ( 5' �- �' �-, �-�-� 2 9 ;e rz �--
(c) Telephone number: Area Code 7 4- 57 '� a
(d) Application number,.if any: ' ! A
Will the action be directly undertaken,require funding, or approval by a state or federal agency?
Yes ❑ No If yes, which state or federal agency?
C. Evaluate the project to the following policies by analyzing how the project will further support or
not support the policies. Provide all proposed Best Management Practices that will further each policy.
Incomplete answers will,require that the form be returned for completion.
DEVELOPED COAST POLICY- -
Policy 1. Foster a pattern of development in the Town of Southold that enhances community character,
preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and
minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation
criteria.
❑Yes ❑ No of 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 1:1Noi Not Applicable
Attach additional sheets if necessary
Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See
LWRP Section III—Policies Pages 6 through 7 for evaluation criteria
❑ Yes ❑ No Not Applicable
Attach additional sheets if necessary
NATURAL COAST POLICIES
Policy 4.' Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP
Section III—Policies Pages 8 through 16 for evaluation criteria
❑ Yes ❑ No ' Not Applicable
Attach additional sheets if necessary
Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III
—Policies Pages 16 through 21 for evaluation criteria
❑ Yes ❑ Nox,�, 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 Nlf"_1pplicable
Attach additional sheets if necessary
Policy 7. Protect and improve air quality in the Town of Southold.- See LWRP Section III = Policies
Pages 32 through 34 for evaluation criteria.
❑ Yes ❑ No Not Applicable
Attach additional sheets if necessary
Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous
substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria.
❑ Yes ❑ No yA� 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. '
❑
YeP4 4 No❑ Not Applicable
Attach additional sheets if necessary
WORKING COAST POI [ES
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 *'d No ❑ Not Applicable
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic
Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria.
❑ Yes ❑ No N 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 ❑ NoX Not Applicable
- - --- - -- - - - - - - -
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Section III—Policies; Pages 65 through 68 for evaluation criteria.
❑ Yes ❑ No Not Applicable
PREPARED BY TITLE Our- DATE � 7