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1000-22.-3-1
OFFICE LOCATION: saga 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: 631 765-1938 00UN11,� ' LOCAL WATERFRONT REVITALIZATION.PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Leslie'Weisman, Chair Members of the Zoning Board of Appeals From: Mark Terry, AICP Assistant Town Planning Director LWRP Coordinator Date August 16, 2023 I Re: LWRP Coastal Consistency Review for ZBA File BERRY P. 2021 QPRT 47818 SCTM No. 1000-22-3-1 BERRY P. 2021 QPRT#7818 - Request for a Variance from Article XXII, Section 280-11-6A(1) and the Building Inspector's April 27, 2023 Notice of Disapproval based on an application for a permit to construct a pergola addition to a single family dwelling; at 1) located less than the code required 100 feet from the top of the bluff, located at 2840 Stars Road, East Marion, NY. SCTM No. 1000-22-3-1. 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 and the records available to me, the proposal is recommended as CONSISTENT with the LWRP. Pursuant to Chapter 268,the Southold Town Zoning Board of Appeals shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Paul DeChance, Town Attorney BOARD MEMBERSOF SOS Southold Town Hall Leslie Kanes Weisman, Chairperson O�� ry�l 53095 Main Road•P.O. Box 1179 Patricia Acampora Q Southold,NY 11971-0959 Eric Dantesc Office Location: Robert Lehnert, Jr. Town Annex/First Floor Nicholas Planamento �Q 54375 Main Road(at Youngs Avenue) coUSouthold,NY 11971 http://southoldtownny.gov ZONING BOARD OF APPEALS TOWN OF SOUTHOLD ������� Tel. (631)765-1809 June 9, 2023 JUN 0 8 '2323 Mark Terry, Assistant Town Planning Director Scut:+oio ov�-n Wrlrg Board LRP Coordinator Plan Planning Board Office Town of Southold- Town Hall Annex Southold, NY 11971 Re: ZBA File Ref. No. #7818 —Berry P 2021 QPRT Dear Mark: We have received an application to construct a pergola addition to an existing single family dwelling. A copy of the Building Inspector's Notice of Disapproval under Chapter 280 (Zoning Code), and survey map, project description form, are attached for your reference. Your written evaluation with recommendations for this proposal, as required under the Code procedures of LWRP Section 268-5D is requested within 30 days of receipt of this letter. Thank you. Very truly yours, Leslie K. Weisman Chairp so By: Encl. Site Plan/Survey: Peconic Surveyors, PC, last dated May 26, 2023 FORM NO. 3 rl TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD,N.Y. NOTICE OF DISAPPROVAL DATE: April 27, 2023 TO: Berry P 2021 QPRT 2840 Stars Rd East Marion,NY 11939 Please take notice that your application dated March 6, 2023: For permit to: construct a pergola addition to an existing single-family dwelling at: Location of property: 2840 Stars Road East Marion,NY County Tax Map No. 1000— Section 22 Block 3 Lot 1 Is returned herewith and disapproved on the following grounds: The proposed construction on this 536,957 sq ft parcel in the Residential R-80, is not permitted pursuant to Article XXII Section 280-116A(1) which states; "All buildings or structures located on lots upon which there exists a bluff landward of the shore or beach shall be set back not fewer than 100 feet from the top of such bluff." The survey shows the construction at 80 feet from top of bluff. Au zed Signature Note to Applicant: Any change or deviation to the above referenced application may require further review by the Southold Town Building Department. CC: file, ZBA Fee:$ Filed By: Assignment No. APPLICATION TO THE SOUTHOLD TOWN BOARD OF APPEALS AREA VARIANCE House No. 90 Street S,�,4,QJ' 804,0 Hamlet 84j r /�11�0 A SCTM 1000 Section-2,;l_Block 9 Lot(s) / Lot Size �( -1Zone__A"Q I(WE)APPEAL THE WRITTEN DETERMINATION OF THE BUILDINGSPTTOR. DATED 7 BASED ON SURVEY/SITE PLAN DATED O Owner(s): , _ �,e5mY ? DZ/ OPR7777 Mailing Address: 28,1'67 172940-S' P OW D , 05AST1MR1 d& it/-Y. Telephone: Fax: Email: 84UA&945R,PY NOTE:In addition to the above,please complete below if application is signed by applicant's attorney,agent,architect, builder,contract vendee,etc.and name of person who agent represents: Name of Representative: 1f/C'V4�� ,1. k,1,,V,4 C. for 0 Owner( )Other: Address: P. RO)d 1/0 q 7^ ,1-0 07-19 qW ,Al. < 12 5p"7/ Telephone.V6`(59.6BG7Fax: Email: ?A FZ0/V. Please check to specify who you wish correspondence to be mailed to,from the above names: ( )Applicant/Owner(s), 00 Authorized Representative, ( )Other Name/Address below: WHEREBY TM BUILDING INSPECTOR REVIEWED SURVEY/SITE PLAN DATED d2 and DENIED AN APPLICATION DATED 6,&FOR: Building Permit ( )Certificate of Occupancy ( )Pre-Certificate of Occupancy ( )Change of Use ( )Permit for As-Built Construction ( )Other: Provision of the Zoning Ordinance Appealed. (Indicate Article,Section,Subsection of Zoning Ordinance by numbers.Do not quote the code.) / 1 Article: )CSC!l Section: 28® Subsection: ZAC� Type of Appeal. An Appeal is made for: (X)A Variance to the Zoning Code or Zoning Map. ( )A Variance due to lack of access required by New York Town Law-Section 280-A. ( )Interpretation of the Town Code,Article Section ( )Reversal or Other A prior appeal k-. has, ( has not been made at any time with respect to this property,UNDER Appeal No(s). Year(s). /9 99 .(Please be sure to research before completing this question or call our office for assistance) Name of Owner: ZBA File# �/A 484 REASONS FOR APPEAL (Please be specific, additional sheets may be used with preparer's signature notarized): 1.An undesirable change will not be produced in the CHARACTER of the neighbor or a detriment to nearby properties if granted,because: 2.The benefit sought by the applicant CANNOT be achieved by some method feasible for the applicant to pursue, other than an area variance,because: y7V,,�5 L Q CA T10A1 /T 7M6 OV'-y �teL� r/Q Cq 77D Al ,9 S 1T 00I ZD Ar �" C40 L7N � iW,eLL//I/C, No P4r7o A /N 4 LOCA 770 Al u�l A cr,ST AAeclIV p 3.The amount of relief requested is not substantial because:�v1-45Z/f7-1A1& P W�5Z"AY6 XN,P PROPOU'� AW600 WI« 94 80 'FZoIL-1 7-0,P aX SPX?,,EPAC 7-/�/& A- ',rd 76Y 11v 7;C'a_5_10A1 /A/TO �H� i0 o �T ✓"'U/�?/.Sd/cTJ oN ,SND f,�7_,P4 Ck A1.5"T_o#N v5 4.The variance will NOT have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district because: �, � ��clly/•vG Du�����vG fS /SaCA 725C) t-10L A 12,`A eew r ,vim 161-100 .f 4440 LO C19r aw J/1Uv,4jeA9 �a via � � 4V 5.Has the alleged difficulty been self-created? {XYes,or { )No Why: Are there any Covenants or Restrictions concerning this land? {X No { ) Yes(please furnish a copy) This is the MINIMUM that is necessary and adequate,and at the same time preserve and protect the character of the neighborhood and the health,safety and welfare of the community. k�o &oeaml Signatuie of Applicant or Authorized Agent ,�� (Agent must submit written Authorization from Owner) Sworn too b of re me this �day of / 20 Notary Public DIANE DISALVO NOTARY PUBLIC-STATE OF NEW YORK No. OID1475593 Qualified In Suffolk County My Commission Expires April 30, 20 UP APPLICANT'S PROJECT DESCRIPTION APPLICANT: &1CM& A AV--&,q C',L/ DATE PREPARED: 1. For Demolition of Existing Building Areas Please describe areas being removed: M& U.New Construction Areas (New Dwelling or New Additions/Extensions): Dimensions of first floor extension: MIX Dimensions of new second floor: Dimensions of floor above second level: Height(from finished ground to top of ridge): Na Is basement or lowest floor area being constructed?If yes please provide height(above ground) measured from natural existing grade to first floor: iA M.Proposed Construction Description(Alterations or Structural Changes) (Attach extra sheet if necessary). Please describe building areas: Number of Floors and General Characteristics BEFORE Alterations: Owl�J Number of Floors and Changes WITH Alterations: IV.Calculations of building areas and lot coverage(from surveyor): Existing square footage of buildings on your property: Proposed increase of building coverage: O Square footage of your lot: Percentage of coverage of your lot by building area: V.Purpose of New Construction: --Pr--R ozA ro Or— YJU,7AZ1 & A.44 /W& f 00,Y-D VI.Please describe the land contours(flat,slope%,heavily wooded,marsh area,etc.) on your land and how it relates to the difficulty in meeting the code requirement(s): Please submit 8 sets of photos,labeled to show different angles of yard areas after staldng corners for new construction, and photos of building area to be altered with yard view. 4/2012 QUESTIONNAIRE FOR FILING WITH YOUR ZBA APPLICATION A. Is the subject premises listed on the real estate market for sale? Yes X No B. Are there any proposals to change or alter land contours? _)(__No Yes please explain on attached sheet. C. 1.)Are there areas that contain sand or wetland grasses? y S 2.)Are those areas shown on the survey submitted with this application? 3.)Is the property bulk headed between the wetlands area and the upland building area? 46/0 4.) If your property contains wetlands or pond areas, have you contacted the Office of the Town trustees for its determination of jurisdiction?f&,D&_&_Please confirm status of your inquiry or application with the Trustees:.1'V Q0,6yr TCJ 2_gA and if issued,please attach copies of permit with conditions and approved survey. D. Is there a depression or sloping elevation near the area of proposed construction at or below five feet above mean sea level? A/0 E. Are there any patios, concrete barriers,bulkheads or fences that exist that are not shown on the survey that you are submitting?_Please show area of the structures on a diagram if any exist or state none on the above line. F. Do you have any construction taking place at this time concerning your premises? AJO f yes,please submit a copy of your building permit and survey as approved by the Building Department and please describe: G. Please attach all pre-certificates of occupancy and certificates of occupancy for the subject premises. If any are lacking,please apply to the Building Department to either obtain them or to obtain an Amended Notice of Disapproval. H. Do you or any co-owner also own other land adjoining or close to this parcel? Al D If yes,please label the proximity of your lands on your survey. I. Please list present use or operations conducted at this parcel A,6 ON-AAR,, GI�/ l�d�.Ol POOL and the proposed use O MMII WW1 &4 A24 CLC, P MW4.4 (ex: existing single family,proposed: same with garage,pool or other) A a L/mag- , Authorized signature and Date FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31648 Date: 07/07/06 THIS CERTIFIES that the building NEW DWELLING Location of Property: 2840 STARS RD EAST MARION (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 22 Block 3 Lot 1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 30, 2005 pursuant to which Building Permit No. 31700-Z dated DECEMBER 30, 2005 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is SINGLE FAMILY DWELLING WITH ATTACHED GARAGE, GREENHOUSE & BALCONY AS APPLIED FOR. The certificate is issued to SHAWN P TULLY (OWNER) of the aforesaid building. SDFPOLK COUNTY DEPARTMENT OF HEALTH APPROVAL, R10-01-0037 06 30/06 ELECTRICAL CERTIFICATE NO. 54304C 05/30/06 PLUMBERS CERTIFICATION DATED 06130L06 BURTS RELIABLE "thrivedl nature Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31649 Date: 07/07/06 THIS CERTIFIES that the building ACCESSORY Location of Property: 2840 STARS RD EAST MARION (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 22 Block 3 Lot 1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 30, 2005 pursuant to which Building Permit No. 31701-Z dated DECEMBER 30, 2005 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to SHAWN P TULLY (OWNER) of the aforesaid building. SUFFOLK. COUNTY DEPARTMENT OF BEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 015761 03/11/02 PLUMBERS CERTIFICATION DATED N/A Vbi.rlSignature-A A Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34142 Date: 12/18/09 THIS CERTIFIES that the building AS-BUILT DORMER Location of Property: 2840 STARS RD EAST MARION (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 22 Block 3 Lot 1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 1, 2009 pursuant to which Building Permit No_ 35188-Z dated DECEMBER 1, 2009 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is "AS BUILT" DORMER ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to SHAWN P TULLY (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUiwfl3$ILS CERTIFICATION DATED N/A A ize Sign ure Rev. 1/81 - =_<. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 48367 Date: 10/4/2022 Permission is hereby granted to: Berry P 2021 QPRT 2840 Stars Rd East Marion, NY 11939 To: Install accessory stand-by generator at existing single family dwelling as applied for. Must maintain a minimum of 105 feet from top of bluff to generator location. At premises located at: 2840 Stars Rd, East Marion SCTM #473889 Sec/Block/Lot#22.-3-1 Pursuant to application dated 9/30/2022 and approved by the Building Inspector. To expire on 414/2024. Fees: ACCESSORY $100.00 ELECTRIC $85.00 CO-RESIDENTIAL $50.00 Total: $235.00 Building Inspector APPEALS BOARD MEMBERS Southold l Gerard P. Goehringer,Chairman COGy� 53 95Main Road James Dinizio,Jr. N P.O. Box 1179 Lydia A.Tortora Southold, New York 11971 Lora S.Collins �y ��� ZBA Fax(516)765-9064 George Horning ��l �a Telephone(516)765-1809 BOARD OF APPEALS TOWN OF SOUTHOLD FINDINGS, DELIBERATIONS AND DETERMINATION MEETING OF MAY 5, 1999 Appl. No. 4684- P. THATCHERS. TULLY PARCEL 1000-22-3-1 STREET &LOCALITY: 2840 Stars Road, East Marion DATE OF PUBLIC HEARING: April 22, 1999 FINDINGS OF FACT PROPERTY FACTS/DESCRIPTION: The subject property consists of 12.3268 acres, with access off the east side of Stars Road (approximately 2850 feet north of its intersection with Main Road). The property has variable dimensions: 1575 ft. in length at the easterly property line, 460+- ft. along the tie line along high water mark and 150+- feet minimum frontage along Stars Road at the southwesterly section of the property. The parcel is improved with a single-family dwelling. The setback of the dwelling is shown to be 101 feet from the top of the bluff of the Long Island Sound at the northeast corner and at 110 feet at the northwest corner, shown on the March 19, 1999 survey prepared by Peconic Surveyors, P.C. BASIS OF APPEAL: Notice of Disapproval dated March 12, 1999 regarding a proposed addition which will be located at less than 100 feet from the top of the Long island Sound bluff, citing Article XXIII, Section 100-239.4A(1), which requires a setback of 100 feet. RELIEF REQUESTED: Applicant, who is contract vendee, is requesting a variance with respect to a proposed addition, extending 20 feet from the north side of the dwelling, leaving an 80+- ft. setback to the top of the bluff. REASONS FOR BOARD ACTION. DESCRIBED BELOW: On the basis of testimony presented and personal inspection, the Board makes the following findings: ' (1) The house which applicant wishes to expand, which has never been occupied, is constructed to face inward onto a courtyard. The only view of Long Island Sound is from windows in a corridor connecting two sections of the house. Short of rebuilding the house, an addition such as that proposed by the applicant appears to be the only feasible way to provide a view of the Sound from living areas. r (2) The proposed 20-foot addition is a relatively modest solution to the architectural problem and leaves a setback of 80 feet from the top of the bluff. (3) Grant of the requested variance will not produce an undesirable change in the character of the neighborhood or detriment to nearby properties because the proposed addition will not change the character of the house and because the house is well screened from neighbors. Page 2— May 5, 1999 Re: 1000-22-3-1 (Tully) Southold Town Board of Appeals (4) Reports from the County Soil and Water Conservation District and from John Raynor, a professional engineer retained by applicant, state that the bluff face is stable and well vegetated. However, both reports note that the path running from the easterly edge of the property down to the beach has been significantly eroded by storm-water runoff. Both reports also state that runoff from the proposed addition should not be permitted to flow toward the bluff. (5) The Board will place conditions on the variance with the intent of preventing adverse effects on physical or environmental conditions. (6) The grant of the requested variance, subject to the conditions set forth below, is the minimum action necessary and adequate to enable applicant to enjoy a view of the Sound from his house while preserving and protecting the character of the neighborhood and the health, safety, and welfare of the community. RESOLUTION/ACTION: On motion by Member Collins, seconded by Member Dinizio, it was RESOLVED, to GRANT the application, as applied for, SUBJECT TO THE FOLLOWING CONDITIONS: 1. All runoff shall be confined to this site, and applicant shall take steps necessary to prevent storm-water runoff from reaching the path to the beach, and shall restore the path in the manner recommended by John Raynor, P.E. (as agreed). 2. The house shall be equipped with gutters and leaders adequate to collect all north-flowing storm runoff and to recharge such runoff into a location well away from the bluff. 3. There shall be no (substantial) disturbance to the natural vegetation at the top of the bluff. 4. No heavy equipment (for example, larger than a backhoe) shall be used in constructing between the addition to the existing house and the lip of the bluff. VOTE OF THE BOARD: AYES: MEMBERS GOEHRINGER, DINIZIO, TORTORA, COLLINS. (Member Horning of Fishers Island was absent-excused.) This Resoluti duly ado ted (4-0). "TID F1 LED BY �-Z GERA P. GOEHRINGER t.1 CIvL�Ii� CHAIRMAN .. . s -k y - _i 3:a o p,,iFor Filing 5/7/99 1000-22-3-11J Tow . Cly rk, AGRICULTURAL DATA STATEMENT ZONING BOARD OF APPEALS TOWN OF SOUTHOLD WHEN TO USE THIS FORM: This form must be completed by the applicant for any special use permit, site plan approval, use variance, area variance or subdivision approval on property within an agricultural district OR within 500 feet of a farm operation located in an agricultural district. All applications requiring an agricultural data statement must be referred to the Suffolk County Department of Planning in accordance with Section 239m and 239n of the General Municipal Law. 1. Name of Applicant: 2. Address of Applicant: 2940 Q'�A �&-r 3. Name of Land Owner(if other than Applicant): 4. Address of Land Owner: 5. Description of Proposed Project: Cg&(7' -,e rr ?�(,/ A CAI Z 9K J'-IAI& ,E'r'as = PA 7-60 6. Location of Property: (road and Tax map number) 2 B 40 J'rhRf R4AP, ,&-AJT-&AR 1eM N-X- /"99 7. Is the parcel within 500 feet of a farm operation? { } Yes k No 8. Is this parcel actively farmed? { } Yes X No 9. Name and addresses of any owner(s) of land within the agricultural district containing active farm operations. Suffolk County Tax Lot numbers will be provided to you by the Zoning Board Staff, it is your responsibility to obtain the current names and mailing addresses from the Town Assessor's Office (765-1937) or from the Real Property Tax Office located in Riverhead. NAME and ADDRESS 1. 2. 3. 4. 5. 6. (Please use the back of this page if there are additional property owners) V /,9 Signature of Applicant Date Note: 1. The local Board will solicit comments from the owners of land identified above in order to consider the effect of the proposed action on their farm operation. Solicitations will be made by supplying a copy of this statement. 2. Comments returned to the local Board will be taken into consideration as part as the overall review of this application. 3. Copies of the completed Agricultural Data Statement shall be sent by applicant to the property owners identified above. The cost for mailing shall be paid by the Applicant at the time the application is submitted for review. 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1-Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information Name of Action or Project: P Z021 Q1?R27-- Project Location(describe,and attach a location map): Brief Description of Proposed Action: COAIJ /ctllCr )�XPOO Z Wl"W AI COXPA16e air 0A1 P41-70 Name of Applicant or Sponsor: Telephone: B 7 CSA / E-M .1 Address: P- 0 OW 1047 City/PO: State: Zip Code: ro y LLQ 71 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 X 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: 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑ Commercial KResidential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? X b.Consistent with the adopted comprehensive plan? X 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? y 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: Y 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES K 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 technolo es: 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: NV A 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? 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? X If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ''Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland ❑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? X 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? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? ❑NO ❑YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO❑YES 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: Y 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: X I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE 2 Applicant/sponsorname: c« Date: ���/ZD2J 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 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or affect 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 reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. ❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. ❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. 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) Page 4 of 4 APPLICANT/OWNER 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: &5a�Y RAL114 (Last name,first name,middle 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.) TYPE OF APPLICATION:(Check all that apply) Tax grievance Building Permit Variance X Trustee Permit Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) Planning 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 K 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 that 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 th' day of J ,20�3 Signature Print Name �/ Board of Zoning Appeals Application AUTHORIZATION (Where the Applicant is not the Owner) RgL Q &6?R residing at 2,c6 1q ro �� leo (Pr-int property owner's name) (Mailing Address) do hereby authorize 7 y RICA&A& 0& .��,� cls (Agent) to apply for variance(s)on my behalf from the Southold Zoning Board of Appeals. (Owner's ' ature) (Print Owner's Name) 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 : 0k 1&4 Ck HI C&A,FL (Last name,first name,middle 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.) TYPE OF APPLICATION: (Check all that apply) Tax grievance Building Permit Variance !C Trustee Permit Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) Planning 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 chfld is(check all that apply) A)the owner of greater that 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 jWA, 20 Signature Wd Print Name /t?IGIZA5A. EWA CLG Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: 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# The Application has been submitted to(check appropriate response): Town Board 0 Planning Dept. 0 Building Dept. ® Board of Trustees 0 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital construction,planning activity, agency regulation,land transaction) (b) Financial assistance(e.g. grant, loan, subsidy) (c) Permit, approval,license, certification: Nature and extent of action: COM 9A/ L 5:5M div OA" 0W,�5!LoNU ON EX!.517—IV& A 77�1 Location of action: 2 ff40 ZrAR5: RCrA P, E,4sr ZJARIOAJ Site acreage: Present land use: 94VZDAENT1,-L CIAZE ,�. HJZ Y Present zoning classification: 'P _80 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: ip"p (b) Mailing address:_ 40 DA- 95 R 64-17-1-14RAIA1,�Y 119-17 (c) Telephone number:Area Code( ) (d) Application number, if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No 9 If yes,which state or federal agency? DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No M Not Applicable po" y / r-v x`1411' App 1 c 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 LF27J Not Applicable PaIicy 2 til,4 r 7W1.CA A ZC477eA1 AZO /1251!_J b eOVAOS 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 0 Yes 0 No Not Applicable PVICY 3 N 7-ZI X20 H 4,0 0-Q W IAI Z? 0 /, C C�,� L . l .I'a Q-WD 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 S through 16 for evaluation criteria 0 Yes No Z'N Not Applicable PdOCY -4 AIA n 2WZs ,4®pLs CA ZZQV 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 0 Yes 11 No �Not Applicable PC OCY jr-.411,4 70 YW/r 4 ?AZZ , 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. 0 Yes [] No X Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ No® Not Applicable p oLlcy Av/A Ta Vd 1f ,q PR Z-e C4 77ekv 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 X Not Applicable a u Cy 6 AIZ4 �a MA AP-41 CA n dV PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ YeO No 5a Not Applicable ,E OLI Cy (P Al " M/T.4&YZ CA M4) Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No ® Not Applicable ROZICY 10 A114 r4 T -7 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 J'2�!!7S] Not Applicable �OZVCY V AZA 767 7`�/S A8/'L/C Z70A2 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® Not Applicable PO11 CY 12 A1�Tl0?W >s A ea,1 r,4 ZZQA1 4/0 ,4 cg "AW au PRt)P,F&ry !ice/zz5?/t! -CnO 'rl 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 �Q i Y 13 7-D 7WIT AMI r4M& Created on 512510511:20 AM TOWN OF SOUTHOLD PROPERTY REI: ------ ----: STREET ����tt{y� VILLAGE V'' r u1S I. SUB. LOT � `_-:• IJP.:�C ACR. )) REMARKS .s t °, t,t a<� TYPE OF BLD. p� 7 •��f Ili<s; t�}' �r�'.1:1� ^"'� � G'�Ii�7�z:� Fa r'1{1 G(,-"✓ �F��� �17��[j. r^!t•f/(''/.c�-t r^ 1 /�f PROP. CLASS IMP. TOTAL lr DATEzAs7 P, - Irx-) newa fpi oca ��'Jcti ? ! ? 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PP l I �� �- \ \� •¢p\ \ \ / 3� qRS TR toy 9 I stems 6.% L s mac , - �\ .\ , \, z• \ '�\ , \ \ � `, \ \ \ , \ \ _` =\� O �/ st e •�7°�C r Si St's \ \ 32 ' \ \ \ \ \x ?) \ \ �" \ \ \ �2 GF° °F �� I \ \ \ F , R I x \ \ \ \ C Nj ava x 30 9 \ \ \� �- \ \ \ \ \ \ \ \ Or TEsT N/ r 33• kS DEC HOLE \\ L O/ s• DATA 3s i \ O OF F '143.1 DIE- R l 4AD °F N/°/ BROWN S2 TY ( Sq RM \34 ccNc 7\ \\ \\ \ \\ \ \ SAND W/TN ' °c OUS LAYERS Of GRAVEL s� 3 C q N/�,,,.,�pR£ �p \\ \ 3. y D ° BROWN VERY FUME / FC C Mq N✓J �_ ���4z TO COARSE SAIMp. 38• 1 f _� a \ \ \ - -\ i lyO VNI r Q C NO \ Ay \ \ \ r I am familiar wllh the STANDARDS FOR APPROVAL 0 Q OF F/OAF AND CONSTRUCTION OF SUBSURFACE SEWAGE O RUM DISPOSAL SYSTEMS FOR SINGLE.FAMILY RESIDENCES C,41 �Q and will abide by the conditions eel forth %herein and on the `� � ®G.� permit to construct. _ S l M O V c \ \ \ \ `\ " \\ \ s , O p O F y �� The locations of wsl/s and cesspools shown hereon are from field /50939. observations and or from date obtained from others. \ �� .TOPOGRAPHICAL INFORMATION FROM. GEOMAPS INTL. INC. CONTOUR LINES AND ELEVATIONS ARE 2s \ \ �• / y REFERENCED TO N_G.V.D. SURVEY OF PROPER TY ''M EDGE OF WOODED AREA q p = EDGE OF 'BRUSH OF S \ '3y �o° �. ,� _�02 AT EAST MARION �o qRS / .ti. o � a C The water supply and sewage disposal - cyst®nes for a rssldsnos will oonform �� M q N `' "� `' `�' to the standard.of Th.Suffolk County TOFU N• OF SOUTH 0 L D - °R " � DoT 26 �� �� CID �,�'�� Department of Health Services. _ SUFFOLK COUNTY N. Y. S`'FF CO. i o ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION MqP 90 co 3 OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW 1000 - 022 - 03 - 01 w N0 3e x/82/' /6 ` EXCEPT AS PER SECTION 7209 SUBDIVISION 2. ALL CERTIFICATIONS sQ o HEREON ARE VALID FOR THIS MAP AND COP/ES THEREOF ONLY IF , SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR _ PIpF SCALE I - 60 35.E Ro N 0 s./00,3. Nom. WHOSE SIGNATURE APPEARS HEREON. GGA l ' �/" X.�S- „ 8 40' •, 2Q 30•�e M o S/3o ADDITIONALLY TO COMPLY WITH SAID LAW THE TERM 'ALTERED BY' OCT. I G , 19 89 _ •r p,R s2 3a,w 2s.,Q, z� /� 3s 00•, MUST BE USED BY ANY AND ALL SURVEYORS UTILIZING A COPY S S s•e3 F• s.38%6'30•E.. OF ANOTHER SURVEYORS MAP. TERMS SUCH AS "INSPECTED'AND NOV. 7, I J 89 ` . BROUGHT-TO-DATE'ARE NOT IN COMPLIANCE WITH THE LAW. FEB, l6, 1990. —��' sT 29 92 • 'MAR. 41- 1992 ! found. J � ,V. OF NEpk , � MAR. l5, )996 (REVISION) �0440 tilx Me lOMAY 28, 1997fREVlSINI "1 Qc'� ?C, 'f- JAN.' 1l, 1998 (coastal erosion hazard line J 4j �• ,A, {�� Mar. 18, 1999 (Re visions & Additions) _ r , MAR. /9, /999 ( revlslon J , S. LIC. NO 496/8 APRIL 23, 2001 ( foundation J , �UAREA = 536, 957 sq. ft. J � Q NE 20, 200/ (cleared area 1 or 12.3268 acres to tie link (6 SEPT. 10 2001 (revision 1 , (s3il�gs 't�5o2�v ( 6311 765 - 1797 DEC.61 2005 67,NAL) P.O. RA '�9M v May 25 200& 1//0 /<eczseh7eof� 1230 TRAy�EC.�'k EET ' SOUTHOLD, N.Y. 11971 OCT. 17 2006 ( beach area 8 easement revishms) MAY 26, 2023 (proposed PERGOLA) REVISE CERTIFICATION 03/27/97 5CD95 Rel' RIO- 97- 0105 89 — 394