HomeMy WebLinkAbout1000-97.-9-10.4 BOARD MEMBERSSouthold Town Hall
Leslie Kanes Weisman,Chairperson 53095 Main Road• P.O.Box 1179
Southold,NY l 1971-0959
Patricia Acampora Office Location:
Eric Dantes
tt Town Annex/First Floor,
ilk �, ����� ��;f,�
Robert Lehnert,Jr. � r 54375 Main Road at Youngs Avenue
Nicholas Planamento Southold,NY 11971
http://southoldtownny.gov oldtownny.gov w .. .t .
ZONING BOARD OF APPEALS '-
TOWN OF SOUTHOLD i fl
Tel.(631) 765-1809 •Fax (631) 765-9064
2021
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MEMO . .. uanu....4ig.I �._....._..�..�...._
TO: Planning Board
FROM: Leslie K. Weisman, ZBA Chairperson
DATE: October 20, 2021
SUBJECT: Request for Comments ZBA #7598SE 160 Route 25, LLC
The ZBA is reviewing the following application. Enclosed are copies of Building
Department's Notice of Disapproval, ZBA application, current map on file. Your review
and comments are requested at this time.
The file is available for review of additional documentation at your convenience for
reference if needed.
_ w
APPLICN A _ .HtARNG COD_' DATE OF-- PRE
EPA. RER
T ZONE DATE SECTION STAMPED OF
DIST SURVEY/SITE SURVEYISITE
PLAN PLAN
160 Route'' 1000- . . 7598SE.._. .................._ ._ __....... ..
Not Art VIII October 7, L.K. McLean
25, LLC 97-9- calendared Sec 280- 2021 Assoc., P.C.
10.4 at this time 38(8)(3)
Thank you,
Encls.
SH EA, KELLEY, DU BIN & QUARTARARO, LLP
Thomas A.Twomey,Jr Martin D.1"im ey
(1945-2014) Partner
John F.Shea,III
Christopher D.Kelley 631-727-2180,x-265
David M.Dubin '. I
Jay P.Quartararo t
Peter M.Mott
Janice L.Snead
Bryan C.Van Cott +
Kathryn Dalli By, Hand
Martin D.Finnegan 0
Reza Ebrahimi
Jeffrey W.Pagano a
Karen A.Hoeg October 15, 2021
Bernadette E.Tuthill
Craig H.Handier
Bryan J.Drag Ms. Leslie Kanes Weisman, Chairperson
Daniel R.Bernard to Zoning Board of Appeals
SENIOR COUNSEL Town of Southold
Stephen B. Latham P.O. Box 1179
ASSOCIATES
Katerina Grinko Southold, NY 11971-0959
Lorraine Paceleo
Terrence Russell
Christina M. Noon t Re: Special Exception Application of 160 Route 25 LLC
A.Chadwick Briedis
Martha F.Reichert Premises: 160 Route 25, Greenport
MaryKate L.Brigharn SICTM#1000-97-9-10.4
OF COUNSEL
Lisa Clare Kombrink
Kevin M.Fox Dear Chairperson Weisman and Members of the Board:
Patricia J Russell
Jennifer P.Nigro
Craig Gibson With respect to the above-referenced application, enclosed please find a
Joan Morgan McGivern
Scott Handwerker check made payable to the Town of Southold in the amount of$1,200.00
representing the required filing fee and an original and eight (8) copies of the
NY&LA BARS
Ir LL.M IN-1 AXA:noN following documents for your review:
4 NY 4 NJ B,IkAS
,-) NY.NJ&PA BARS
A NY,NJ&DC BARS
A NY.NJ&FL BARS 1) Notice of Disapproval dated August 26, 2021;
Main Office 2) Special Exception Application, including an attachment of explanation;
33 West Second St. 3) Applicant's Questionnaire Form;
P.O. Box 9398
Riverhead, NY 11901 4) Agricultural Data Statement;
631.727.2180 5) Short Environmental Assessment Form;
suffolklaw.com 6) Local Waterfront Revitalization Program (LWRP) Consistency Assessment
Form;
7) Executed Owner's Authorization;
8) Applicant Transactional Disclosure Form signed by Martin D. Finnegan, as
Agent for the property owner;
9) Applicant Transactional Disclosure Form signed by the property owner;
10) Color photographs of the subject premises;
11)Copy of the current deed;
12)Operating Agreement for 160 Route 25 LLC;
13) Topographical surveys of the subject premises;
14)Conceptual site plans for the subject premises;
15)Building floor plans for the subject premises.
Kindly advise if you require any further documentation in order to place this matter on
your next available agenda for a public hearing. Thank you for your consideration.
--wry tru yours,
Madfin, ). Finnegan
MDF/as
Enclosures
cc: Paul Pawlowski
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD,N.Y.
NOTICE OF DISAPPROVAL
DATE: May 17, 2021
RENEWED: August 26,2021
TO: Paul Pawlowski (Jordans Partners)
PO Box 783
Mattituck,NY 11952
Please take notice that your application dated April 8, 2021:
For permit to: construct ffl buildiRgs each containing professional offices on the first
floor and ag4Aments on the second floor at:
Location of property: 160 Route 25 Oreen,port,,NY
County Tax Map No. 1000— Section 34 Block 2 Lot 1
Is returned herewith and disapproved on the following grounds:
Pursuant to Article VIII Section 280-127 the proposed uses re wire site flan approval
from the Southold Town Plarupin Board.
In addition the proposed apartments over the professional offices must obtaig s cial
xcepption a royal from the tonin Board of A eats.
You may now apply to these agencies directly.
Autho 'red 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, Planning Board
ZONING BOARD OF APPEALS
TOWN OF SOUTHOLD,NEW YORK
Phone(631)765-1809 (631)765-9064
APPLICATION FOR SPECIAL EXCEPTION
Application No.
Date Filed:
TO THE ZONING BOARD OF APPEALS, SOUTHOLD,NEW YORK:
Applicant(s), 160 ROUTE 25 LLC
of
Parcel Location: House No. 160 Street ROUTE 25 Hamlet GREENPORT
Contact phone numbers: (631)^315-6070 _ _ _
499
SCTM 1000 Section Block Lot(s)_ Lot Size aces Zone Districty R...
034.00 02.00 001.000 RO/R-40
hereby apply to THE ZONING BOARD OF APPEALS for a SPECIAL EXCEPTION in accordance with
the ZONING ORDINANCE,ARTICLE VIII ,SECTION 280 ,SUBSECTION 38(B)(3)
for the following uses and purposes: CONSTRUCTION OF FORTY (40)APARTMENT UNITS ABOVE
PROFESSIONAL OFFICES IN FOUR (4) BUILDINGS.
as shown on the attached survey/site plan drawn to scale. Site Plan review IV] IS or [ ] IS NOT required.
A. -�at�rq nt Iaft: wner�hip and lnterest:
160 ROUTE 25 LLC is(are)the owner(s)of property known and referred
to as 160 ROUTE 25, GREENPORT
..................._ ,,,....,,. ,.
_ ._________________-________
--------
(House No.,Street,Hamlet) tion o34.aa
, �identified on the Suffolk Count TaxMaps as District 1000, Secoc2w .d.._,,__,Lot
001.000 and shown on the attached deed. APRIL $, 2021
The above-described property was acquired by the owner on
B. The applicant alleges that the approval of this exception would be in harmony with the intent and
purpose of said zoning ordinance and that the proposed use conforms to the standards prescribed therefore in
said ordinance and would not be detrimental to property or persons in the neighborhood for the following
reasons:SEE ATTACHED.
C. The property which is subject of this application is zoned RO and[ ] is consistent
with the use(s)described in the CO(attach copy),or [ j is not consistent with the CO being furnished
herewith for the following reason(s): v
[J�is vacant land.
COUNTY OF SUFFOLK)
ss.: . .
STATE OF NEW YORK) (Signature)BY:DART D I' EGAN„AUTHORIZED AGENT
Sworn to before me this 15th day of OCTOBER ,2021
A
ma
l�c)
-------------
SCHWEITZER ANNALISE
[NOTARY PUBLIC-STATE OF NEW YORKNO.01SC6409457QUALIFIED IN SUFFOLK COUNTY
COMMISSION EXPIRES SEP 28,20
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ZONING BOARD OF APPEALS
TOWN OF SOUTHOLD,NEW YORK
Phone(631)765-1809 (631)765-9064
APPLICATION FOR SPECIAL EXCEPTION
Application No.
Date Filed:10/15/2021
Page 2
General Standards, please answer the following as it pertains to your project:
A. The use will not prevent the orderly and reasonable use of adjacent properties or of
properties in adjacent use districts BECAUSE:
SEE ATTACHED
B. The use will not prevent the orderly and reasonable use of permitted or legally established
uses in the district wherein the requested use is located or of permitted or legally
established uses in adjacent use districts BECAUSE:
SEE ATTACHED
C. The safety, the health, the welfare, the comfort, the convenience or the order of the town
will not be adversely affected by the proposed use and its location BECAUSE:
SEE ATTACHED
D. The use will be in harmony with and promote the general purposes and intent of Chapter
280-142 BECAUSE
SEE ATTACHED
E. The use will be compatible with its surroundings and with the character of the
neighborhood and of the community in general, particularly with regard to visibility, scale
and overall appearance BECAUSE:
SEE ATTACHED
F. All proposed structures, equipment, and material shall be readily accessible for fire and
police protection BECAUSE:
SEE ATTACHED
G. The proposal shall comply with the requirements of Chapter 236, Stormwater Management
BECAUSE:
SEE ATTACHED
RIDER TO APPLICATION OF 160 ROUTE 25 LLC
FOR A SPECIAL EXCEPTION TO CONSTRUCT 40 WORKFORCE APARTMENT
UNITS ABOVE PROPOSED PROFESSIONAL OFFICE SPACE PURSUANT TO
SECTION 280-38(B)(3) OF THE TOWN CODE
Section 280-142 of the Town Code sets forth the criteria for the issuance of a special
exception approval by the ZBA upon their finding and determination that:
A) That the use will not prevent the orderly and reasonable use of adjacent
properties or of properties in adjacent use districts.
The proposed Residential Office Campus, located at the corner of Route 25 and Main
Street in Greenport, will in no way prevent or impact the use of adjacent properties that lie in the
R-40 Zoning District. This property was carved out for RO zoning because it is perfectly suited
for the proposed development. The proposed access will only be from Main Street and Route 25
and the small "tail"portion of the property stretching down to Knapp Place will remain
undisturbed.
B) That the use will not prevent the orderly and reasonable use of permitted or
legally established uses in the district wherein the proposed use is to be located or of
permitted or legally established uses in adjacent use districts.
The proposed mixed use campus style project will consist of four separate buildings with
residential fagades that are intended to blend in with the surrounding residential community. The
professional office space will be predominantly medical offices that will not prevent but in fact
enhance the nearby Hospital use by providing additional health care resources to Town and
Village residents. The residential component will contribute to the Town goal of providing
affordable housing opportunities for health care workers, teachers and first responders who are
the backbone of our community. \
C) That the safety, the health, the welfare, the comfort, the convenience or the
order of the Town will not be adversely affected by the proposed use and its location.
The proposed Residential Office Campus has been thoughtfully designed to be entirely
conforming to the bulk schedule and all applicable regulations. The proposed development will
bolster the health, safety welfare, comfort and convenience of Town Residents by providing
access to medical and professional services and desperately needed work force housing
opportunities. The property-will have minimal enviromnental impacts as it has access to County
water and Greenport Village Sewer.
D) That the use will be in harmony with and promote the general purposes and
intent of this chapter.
The mixed residential office use is consistent with the goals set forth in the Town's
Comprehensive Plan and is entirely compliant the regulations in the Residential Office zoning
district regarding setbacks, lot coverage and parking.
E) That the use will be compatible with its surroundings and with the character
of the neighborhood and of the community in general, particularly with regard to visibility,
scale and overall appearance.
See Response to A, B, C and D above; The residential design of the mixed use buildings
will make them compatible with the surrounding neighborhood and the number of structures
proposed is less than the maximum allowable under the Town Code. Renderings of elevations
submitted with the Application confirm the tasteftil architecture, substantial greenspace and
natural screening that will buffer the property from the adjacent neighborhood.
F) That all proposed structures, equipment and material shall be readily
accessible for fire and police protection.
The property will have ample access for emergency equipment and first responders from
both Route 25 and Main Street,
G) That the proposal complies with the requirements of Chapter 236,
Stormwater Management, or in the alternative, the Zoning Board of Appeals shall
condition such approval on compliance with the requirements of Chapter 236, Stormwater
Management.
All ston-nwater runoff will be contained on site in compliance with Chapter 236 and a full
Grading and Drainage Plan will be part of the Site Plan review and approval process before the
Planning Board.
QUESTIONNAIRE SPECIAL EXCEPTION
FOR FILING WITH YOUR ZBA APPLICATION
1. Has a determination been made regarding Site Plan review? V Yes No
If no,please inquiry with the ZBA office and if site plan is required,you may apply to the
Planning Dept. at the same time so both applications can be reviewed concurrently.
2. Are there any proposals to change or alter land contours?
a. V No Yes please explain on attached sheet.
3. Are there areas that contain sand or wetland grasses?NO
a. 2.)Are those areas shown on the survey submitted with this
application?
b. 3.)Is the property bulk headed between the wetlands area and the upland building
area?
c. 4. If
.................._............._.
your property contains wetlands or pond areas have you contacted the Office
of the Town trustees for its determination of jurisdiction? Please
confirm status of your inquiry or application with the trustees:
and if issued,please attach copies of permit with
conditions and approved survey,
4. Is there a depression or sloping elevation near the area of proposed construction at or
below five feet above mean sea level?NO
5. Are there any patios,concrete barriers, bulkheads or fences that exist that are not shown on
the survey that you are submitting? NO Please show area of the structures on a
diagram if any exist or state none on the above line.
6. Do you have any construction taking place at this time concerning your premises? NO If
yes,please submit a copy of your building permit and survey as approved by the Building
Department and please describe:
7. 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 obtain copies of them. N/A
8. Do you or any co-owner also own other land adjoining or close to this parcel?NO If
yes,please label the proximity of your lands on your survey.
9. Please list present use or operations conducted at this parcel VACANT LAND
and the proposed use RESIDENTIAL OFFICE CAMPUS
WIT RK ORCE HOUSING _ (ex:existing single family,proposed:same with
aha poczl or t , or vacant proposed office with apartments above,etc.)
10/15/2021
Authorised si nature and Date
INTERDEPARTMENTAL AGENDA
October 1, 2021 at 10:00 AM
• Heather Lanza a Kim Fuentes 0 Leslie Weisman
• Mike Verity 0 Mary Eisenstein 0 Mark Terry
• Bill Duffy 0 Brian Cummings 0 Nick Planamento
MµMµMµMM Agenda Item —W �- - FuDiscussion Decision/Action Steps
Section io80�38A (3)(d) • l� PB t ;;11 Lead
Paul Pawlo
ski Jordans Partners offices are �rtrt ,yxl„
wProfess
c
i /0% iv/�, permitted uses al`, fi t tan a ed”I s�"
160 Route,25,� reenport =""� P ,
���,� • Proposing 12 Medical office • PLa sand �ualdmf;, t11� eetlo
To construct four (4) buildings buildings, 40 Residential revte�c pCitbl vaftidce
gpro offices ff and
apartments artments • P
nrnccss n � "and� B'can
cotainin ��� �
• Special Exception Application ;/#K`$ �� �ot ) t �
apartments.
Pending regarding Section • F
280-38B (3) Apartments
SCTM No. 1000-34-2-1 permitted provided that not
4.69 Acres or 204,296 sq. ft. more than one use shall be
allowed for each 40,000 sq. ft.
Zoning Split: RO and R-40 of lot area. total 204,296 sf in
area.
• Section 280-62C -Proposing • Request for comments from
11900 Oregon Road, LLC to Create Two Accessory PB
Cutchogue apartments in a pre-existing Apartments are customarily
Martin Kozmynka single family dwelling. incidental to storage units.
• Application received by Gail Ask reason for two
L.I. Zoning District Wickham to Reverse the apartments.
SCTM No. 1000-83-3-5.3 Zoning Officer's Notice of L.I. Zone does not allow
Disapproval. SFD, keep the SFD as pre-
existing non-conforming.
• currentlymm--........._w ry Request that the UPDATES: Consultant..._ ._ .._.�.....� ._.. w_...._.._� q applicant
conducting preliminary submit a site plan application
The Mattituck Hotel/Cardinale SEQRA Review of submission to Planning:Dept.
9025 Main Road dated September 3, 2021. • Plann:ing.Board will take over
SCTM No. 1000-122-6-22.1 & 122- Total 155,233 sq. ft. in area SEQRA Review and
6-28 is 125 Room Hotel plus 4 coordination as Lead Agency
Special ExceptionNariances kitchenette suites, 275 seat
restaurant, 300 seat catering,
General Business (B) Zoning 1,500 sf. spa and outdoor pool.
District
......_..�.�_,..�.._...._....... ........ .._..�,..�..__,,,, . w..w__.�......_ __ ... _._ .. ..____ �......a ......
UPDATES• Special Exception Hearing Consider optionsto reduce
Opened and scheduled for intensification of site.
The Enclaves Hotel & Restaurant October 14, 2021 • Possible reduction of
Special Exception FEIS accepted on August 26, Conference Center Area.
2021 • Accessory Uses, i.e. catering,
Finding Statement Pending events, do not need their o«n
sq. ft. area calculation.
Also, review of a Pool house (Tuck) with two rooms surrounding covered deck: As per Mike V, the
NOD will be amended to include "pool house (two rooms) does not meet the definition of a pool
house".
APPEALS BOARD MEMBERS
SCOTT L. HARRIS
Gerard P. Goehringer, Chairman Supervisor
Charles Grigonis, Jr. * Town Hall, 53095 Main Road
Serge Doyen, Jr. P.O. Box 1179
Joseph H. Sawicki Southold, New York 11971
James Dinizio, Jr. BOARD OF APPEALS Fax (516) 765-1823
Telephone (516) 765-1809 TOWN OF SOUTHOLD Telephone(516) 765-1800
ACTION OF THE BOARD OF APPEALS
Appeal No. 3915 — Application of JORDAN'S PARTNERS.
Variance to the Zoning Ordinance, Article VII, Section
100-71, as disapproved, for permission to construct retail
stores in conjunction with office building uses; proposed
retail construction is not permitted in this RO Zone
District. Property Location: 1000 Main Street and
160 Main Road, Greenport, NY; County Tax Map District 1000,
Section 34, Block 2, Lot 1.
WHEREAS, public hearings were held in the Matter of the
e Application of JORDAN'S PARTNERS under Appeal No. 3915; and
WHEREAS, at said hearings all those who desired to be heard
were heard and their testimony recorded; and
WHEREAS, the Board has carefully considered all testimony
and documentation submitted concerning this application; and
WHEREAS, Board Members have personally viewed and are
familiar with the premises in question, the physical
characteristics of the land, its present zoning, its previous
zoning classification(s) , and the surrounding areas; and
WHEREAS, the Board made the following findings of fact:
1. This is an appeal of the January 31, 1990 Notice of
Disapproval in which an application dated May 9, 1989 was
considered by the Building Inspector to construct office and
retail stores, which was disapproved on the following grounds:
" . . .Under Article VII, Section 100-71, proposed
construction is not a permitted use in this district.
Action required by the Zoning Board of Appeals. . . . "
2. The premises in question consists of 4.75+- acres with
frontages along three streets: (a) North Road (a/k/a State
Route 25) along the northerly end of the premises, (b) Main
Street (a/k/a State Route 25) along the westerly end of the
premises, and (c) Knapp Place (a town street) along a southerly
79.97 ft. portion which is situated in the Residential Zone
District, Hamlet of Greenport, Town of Southold.
Page 2 - Appeal No. 3915
Matter of JORDAN'S PARTNERS
Decision Rendered October 17, 1990
3. Since January 9, 1989, most of the subject premises
has been situated in the Residential-Office (RO) Zone District,
and only a small section (approximately . 30 of an acre) has
been situated in the R-40 Residential Zone District. The entire
tract is vacant land, except for partially completed foundation
construction which includes footings and concrete wall extending
372.6 feet in an east-west direction.
4. Surrounded on its southerly and easterly boundaries are
residential communities in the R-40 Residential Zone District.
To the north are State Route 25, and to the north thereof a
preexisting restaurant located in the Limited Business (LB) Zone
District and residential communities in the R-40 Residential
Zone District. To the west are Main Street and residences in
residential use districts.
5. The following facts and events are additionally noted
for the record:
(a) On October 3 , 1985, the Southold Town Board adopted a
moratorium concerning all business and industrial zone districts;
(b) on October 10, 1985, an application was pending before
the Southold Town Planning Board (referred to as 11280 North
Road," applicant) and which was under a town-wide moratorium
affecting all business and industrial zone districts in the
pending "Master Plan Revisions";
(c) On October 22, 1985, the Town Board denied the
request of the applicant (by his attorney, John C. Tsunis, Esq. )
for the requested Waiver under the provisions of Local Law
#14-1985 for the reason that the uses ro oed were
inconsistent with the proposed Residential-Office Zone
District rovts ons.
(d) It is apparent that during 1985 and 1986, and up until
January 9, 1989 (the date of adoption of the new zoning regula-
tions) , the subject premises was being considered by the Town
for a change in the zoning use district to Residential-Office
(from B-Light Business) . In the applications before the
Town Board and Planning Board during the period from 1984
through 1985, a site plan dated September 9, 1985 was filed
for an office mall area in excess of 12,000 sq. ft. , together
with retail stores and bank facility. (See copy of site
plan on file with the Southold Town Clerk and Planning Board) .
Page 3 - Appl. No. 3915
Matter of JORDAN'S PARTNERS
Decision Rendered October 17, 1990
5. (e) Again, on January 13, 1986, John Tsunis, attorney for
the property owner, requested a second Waiver under the provisions
of the moratorium, and the record is clear, as is also shown in
the February 4, 1986 Town Board minutes and in its resolution
granting a waiver at the same meeting, that:
". . .the applicant proposes to utilize the premises
to conform with the uses in a Residential-Office
Zone District. . . ." (Emphasis added)
(f) Following the grant of the waiver to utilize the
premises to conform with the uses in a Residential-Office Zone
District, the applicant/property owner proceeded to make
amendments to the Planning Board under the site plan process.
(g) On June 23 , 1986, the Planning Board adopted a resolu-
tion approving a site plan for the building and on-site changes.
It should be noted that although the Planning Board proceeded
under the site plan process, the Town Board waiver was strictly
for those uses which would conform to those in the Residential-
Office (RO) Zone District.
(h) It is noted for the record that the Planning Board is
and has always been without authority to consider a chap e of
use chane of zone or use variances and the proper forum for
those requests are before the Town Board as a legislative agency
and/or Board of Appeals as a quasi-judicial agency.
(i) The applicant has also furnished the board with copies
of canceled checks, invoices, and a list of expenses which the
applicant asserts was expended during the course of this project.
The Board has evaluated the record and notes that the expenses
are not itemized and are without a clear breakdown for -the total
claim, thus the Board questions the validity of some of these
claims, including real estate taxes on vacant land; fees for
consultants as well as attorney fees to review the town files
and represent the applicant in the proceeding before this
Board; certain expenses for real estate commissions
(which are normally paid by the seller rather than the
purchaser if the commissions were for the sale of the
premises) ; closing costs were not itemized; mortgage payments
with interest were claimed without specific time periods or any
breakdown as to how the figures were arrived at; the amount
given for the purchase of the land differs from that shown
in the Suffolk County real estate transfer records; insurance
expense was given without a breakdown as to type or coverage
or time periods covered; purpose of payment of corporate tax and
miscellaneous expenses was not provided; and the purpose of
incurring certain expenditures as a necessity in the process
to the extent charged is not provided.
Page 6 - Appl. No. 3915
Matter of JORDAN'S PARTNERS
Decision Rendered October 17, 1990
16. With reference to the third requirement, it is the
opinion of this Board that the essential character of the
locality will be altered. The locality consists mostly of
single-family residences, and there is one preexisting
restaurant.
17. In considering this application, the Board also finds
and determines:
(a) sufficient proof has not been demonstrated as
required by the statutes to show that: (1) the property cannot
yield a reasonable return with underlying facts in dollars and
cents proof; (2) the burden of proof of unnecessary hardship or
that literal application of the zoning ordinance would result in
unnecessary hardship has not been sufficiently met (Otto v.
Steinh .lber) ; (3) the use to be authorized will not alter
the essential character of the locality;
(b) the uses proposed are not permitted uses in this
zone district and will not be in harmony with the general
purposes and intent of the zoning ordinance;
(c) the current uses of the property and the zone
district regulations are not so restricted that the premises
could not be used for reasonable purposes;
(d) the Board does not dispute that the circumstances
and events which have taken place are unique;
(e) the property in question is centrally located in
center of other Residential Zone Districts, and although the
Residential-Office Zone District does permit office use as well
as residential use;
(f) this Board cannot under the semblance of a
variance exercise legislative powers;
(g),_ the denial of this use variance will not
cause a building to be destroyed or replaced since the
land is vacant with the exception of the foundation
wall/footings as mentioned previously;
(h) this variance may not be granted because the
applicant claims a higher return for retail uses rather than
office use or other uses authorized in this RO use district;
M x y
5
Page 7 - Appl. No. 3915
Matter of JORDAN'S PARTNERS
Decision Rendered October 17, 1990
(i) Good faith reliance on an invalid permit does not
automatically entitle the applicant to a variance {See Raman v..
Welch, 112 AD2d 795, 492 NYS2d 295 (1985, 4th Dept. ) ) ;
(j ) The issue of a use variance is not whether
the use as presently zoned is the most profitable use, but
merely whether that use will yield a reasonable return,
(see Bellanca v. Gates 97 AD2d 971, 468 NYS2d 774 (1983,
4th Dept. ) , affd. 61 NYS 2d 878, 474 NYS2d 480, 462 NE2d 1198. )
(k) An application for a change of zone is not
without merit and has not been exhausted.
NOW, THEREFORE, on motion by Mr. Dinizio, seconded by
Mr. Goehringer, it was
RESOLVED, to DENY the relief requested in the Matter of the
Application of JORDAN'S PARTNERS under Appl. No. 3915, for the
reasons stated above.
Vote of the Board: Ayes: Messrs. Goehringer, Doyen,
Grigonis and Dinizio. (Member Sawicki was absent. ) This
resolution was duly adopted.
lk
GERARD P. GOE G10,7IRMAN
)ECEIVED AND FILED BY
THE SOUTHOLD TOWN CLERK
DATE J6Az/9c)HOURi a l P r'►
Town Clergy, Town of 5go),
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:
160 ROUTE 25 LLC.... ..............______.____._ _�- ...... ..._......._.
2. Address of Applicant OFFICE BOX 783,MATTITUCK,NY 11952
POST ---------------------------------
3.
—....................v_...................... __w................._..... ..,,,,,-
3. Name of Land Owner(if other than Applicant)=m._,,_...w....-.,—....... _._... - _ .......................__.
4. Address of Land Owner:
5. Description of Proposed
Project:
CONS REE(3)UNITS OF PROFESSIONAL
Ur""ItON COF FOUR(�#)C MPUS-STYLE MIXED USE B LD
OFFICE SPACE ON'THE FIRST FLOOR AND TEN 10 WORKFORCE APARTMENT UNITS ON THESE -..a_._.,_
( ) OND FLOOR.
6. Location of Property...(road and
.a _............
. r ax map
160 ROUTE 25,G -SCTM 1000-034.00-02.00-001.000
numb r�.. 11 feet P f a... .. ........ ..w.......
)
7. Is the parcel wit;llin 50 . farm operas m, { } Yes o
8. Is this parcel actively farmed? f ) Yes 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)
- 10 /15 /2021
Sig ure -Pp-Meant 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 Com l tin
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 Act.....�. ..__..-
ion or Project:
RESIDENTIAL OFFICE CAMPUS AT 160 ROUTE 25
Project Location(describe,and attach a location map):
160 ROUTE 25, GREENPORT, NY
Brief Description of Proposed Action:
.. ......................... on:
CONSTRUCTION OF FOUR (4) CAMPUS-STYLE, MIXED USE BUILDINGS ON A VACANT
4.699-ACRE PARCEL IN THE RO ZONING DISTRICT WITH THREE (3) UNITS OF PROFESSIONAL
OFFICE SPACE ON THE FIRST FLOOR AND TEN (10) WORKFORCE APARTMENT UNITS ON THE
SECOND FLOOR.
Name of Applicant or Sponsor: Telephone: 631-315-6070
160 ROUTE 25 LLC E-Mail: MFINNEGAN@SUFFOLKLAW.COM
Address: ,n._.._,_._.w,_....w_...._.,,._,,...�........................._.........
POST OFFICE BOX 783
City/PO: __. . ........................................_._.............__
State , Zip Code:
MATTITUCK NY 11952
1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES
administrative rule,or regulation? X __.......
If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that
may be affected in the municipality and proceed to Part 2. If no,continue to question 2.
2..Does the proposed action require a pe. ...........................................mm_
rmit,approval or funding from any other governmental Agency? NO YES
If Yes,list agency(s)name and permit or approval: X
SOUTHOLD TOWN PLANNING BOARD-SITE PLAN APPROVAL
GREENPORT VILLAGE, SUFFOLK COUNTY DEPARTMENT OF HEALTH (SEWER HOOKUP)
3.a. Total acreage of the site of the on.
proposed action?
. .... .� M4.699----mmq___..w._acres
b.Total acreage to be physically disturbed? +_4.2 ------------ acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? 4.6,99 acres
(non-agriculture) w
4. Check all land
duses that on,adjoining iand Oarthepo....sed .�._ri_.
❑ Mural tComine
rc_ia..l
Residential(suburban)
❑Forest ❑Agriculture ❑Aquatic ❑Other(specify):
❑Parkland
Page 1 of 4
5. Is the proposed action,ctiaon,......wwwwww_.____..._._..._..........................____........__...._ w Ko—i N/A
i ro IT..„ YESm
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? X
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:
8. a. Will the proposed action result in a substantial increase in traffic above present levels? NO YESmm
X
b.Are public transportation service(s)available at or near the site of the proposed action? X
c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? _www- X._
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: X
aw__........ ._....ww..w.........w__
10. Will the proposed action connect to an existing public/private water .....M.M_�.
supply? NO YES
If No,describe method for providing potable water: X
11.Will the proposed action connect to existing wastewater utilities? -....... ...................................
..............._......... ..www . NO YES
If No,describe method for providing wastewater treatment: . ..............____................. X
12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES
Places?
X
b.Is the proposed action located in an archeological sensitive area?
13. a.Does an portion of the site of the proposed action,or lands adjoining_....._..�.........._wwwwwwwwwwwwwwww....wwww._...ww�wwwww�t
Y P P . _...........
p � 'ning the proposed action,contain NO YES
wetlands or other waterbodies regulated by a federal,state or local agency? X
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 ste..w..........._......... ......... ..............i . Check all that apply:
❑ Shoreline ❑Forest 0 gricu'lturaligrasslands ❑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
X
17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES
If Yes, X
a.Will storm water discharges flow to adjacent properties? ❑NO NYES
b.Will storm water discharges be directed to established conveyance systems(runoff and .to drains)?
If Yes,briefly describe: ❑N ' YES
ALL STORMWATER WILL BE COLLECTED ONSITE IN ACCORDANCE WITH AN APPROVED STORMWATER
.M.AN.A.G.....E.M.E.N.T.......PL .N..P.E.R..CH.....2 6WL.�WW�✓� ���_�,- _�-_�,_-� �
_______._. ..
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)? X
If Yes,explain purpose and size:
w_.........w_............................._-_w
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? X
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? X
IfYes,describe: . .........................._......_...____..__..................,,,,mmmmm„m,m,mmm _ ...._..
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE TO THE T MY
IS TRUE AND ACCURATE BEST OF MY
KNOWLEDGE
� ry
Applicant/sponsor narne;., IN D.FINNEG N,AUTHORIZED AGENT Date: 10/15/2021
_.......—____________w.___
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? _ ....___....._a........,.,
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
, y 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.........._...........................M.._..,,,,.w.._...................__.w.w..._.
Print or Type Name of............. - Officer i.... ...................................._, _.�....�....__�_.. .....____- ...._............._.�................
...Responsible...... ........................i .
ypn Lead Agency Title of Responsible Officer
MM~~....FFFFFFFFSi mnature of Res onsible Officer in Lead A ency
........... ............ _....
g p g Signature of Preparer(if different from Responsible Officer)
Page 4 of 4
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# 034.00 _02.00 _001.000
The Application has been submitted to(check appropriate response):
Town Board C'L Planning Dept. R Building Dept. R Board of Trustees L !J VZONII O BOARD
OF APPEALS
1. Category of Town of Southold agency action(check appropriate response):
(a) Action undertaken directly by Town agency(e.g. capital 0
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:
CONSTRUCTION OF FOURA41 CAMPUS-STYLE;MIXED USEBUILDINGSON_A VACANT 4.699-ACRE PARCEL
IN THE RO ZONING DISTRICT WITHTHREE(3)UNITS OF PROFESSIONAL OFFICESPACEON THE FIRST FLOOR
AND TEN (10�WORKFORCE APARTMENT UNITS ON THE SECOND FLOOR. ..
Location of action: 160 ROUTE 25, GREENPORT
Site acreage:4.699 ACRES
Present land use:VACANT LAND
Present zoning classification:
.RO R-4.0......_.............m.._ __................ ............._ _............w .ww.._.........._...................................................—.......m_m
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: 160 ROUTE 25 LLC-C/O MARTIN D. FINNEGAN, ESQ.
(b) Mailing address:
POST OFFICE BOX 1452, MATTITUCK, NY 1...........1952........................................................................_.......................mmmm..mmmmmm,—.._
(c) Telephone number: Area Code{ )631-315-6070
(d) Application number, if any:,_____...
Will the action be directly undertaken,require funding,or approval by a state or federal agency?
Yes ❑ No;Z 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 0 No ❑ Not Applicable
THE PROPOSED DESIGN OF THIS CAMPUS-STYLE PROJECT WILL BE MORE RESIDENTIAL THAN COMMERCIAL IN KEEPING WITH THE CHARACTER OF THE
NEIGHBORING RESIDENTIAL COMMUNITY.wTHE-PROJECT IS COMPLETELY CONSISTENT WITH THE INTENT OF THE RO ZONING DISTRICT AND WILL PROVIDE
DESPERATELY NEEDED WORKFORCE HOUSING TO THE RESIDENTS OF SOUTHOLD TOWN AND GREENPORT VILLAGE.
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 Frl- No ® 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 0 No D Not Applicable
THE PROPERTY WILL HAVE ACCESS TO COUNTY WATER AND VILLAGE SEWERS.
......_.._.._..._..............
Attachadditionalsheets if necessary ....................__.._._— ......_................
Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including
Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22
through 32 for evaluation criteria.
Yes []No® Not Applicable
_ __www..—.__..�.........._................. m_.._.._.............._m___a_ ............_
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 D No V Not Applicable
Attach additional sh ets 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 R No I r] Not Applicable
THE PROPOSED BUILDINGS WILL BE CONNECTED TO THE GREENPORT VILLAGE SEWER SYSTEM,.
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.
--'-.1 YesEl No® Not Applicable
Attach additional sheets if necessary
WORKING COAST POLICIES
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria.
❑ Yes ❑ No ® Not Applicable
.....,ww.....
Attach additional sheets if necessary _w... —....,.—
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic
Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria.
❑ Yes ❑ No ® Not Applicable
Xiiaci additional sheets if necessa
Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages
62 through 65 for evaluation criteria.
Yes No W Not Applicable
___w_..........www_..........__...........w __._......................................._............�..... �. —_........._............. _...............................__......_._.........._._._www..__......._........_
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.
D Yes ❑ No W Not Applicable
Created on 512510511:20 AM
Board ol"Zoning A )eals Application
AUTHORIZATION
(Where the Applicant is not the Owner)
LLC voo4i*g, at
Pri.ntro er owner's name .rt�Nt all dc�r � POST
OM T,OFFICE
A CE)BOX 783
160 ROp Tp property ) (mailing
.............................._....mm.. __
MATTITUCK, NY 11952 D. FINNEGAN
do hereby authorize MARTIN
(Agent)
to apply for variance(s) on my behalf from the
Southold Zoning Board of Appeals,.
160 ROUTE 25 LLC
BY: P LT, LO SKI,MEMBER
a
BY: KENNETH BALLATO, MEMBER
AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers,and enigloyee&The purpos
of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever
acti2n is tiggessary to avoid same.
YOUR NAME : MARTIN D.FINNEGAN,ESQ.
(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 Trustee Permit
Change of Zone.......—------ Coastal Erosion
Approval of Plat— Mooring
Other(activity) SPECIAL EXCEPTION 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
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)
Q an officer,director,partner,or employee of the applicant;or
D)the actual applicant
DESCRIPTION OF RELATIONSHIP
Submittej!�_t�his �5
A_d,uy�of OCTOBER 2021
ayol�l
Signature
.............. .www_
......................
Print Name MARTIN D.FINNEGAN,ESQ.
APPLICANT/OWNER
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics orohibits conflicts of interest on the part of town officers and emg!2yggjjhe ur�c>se
of this form is to Provide informatioo which can alert the town of possible conflicts of interest and allow,it to take whatever
action is necessary to avoid same,,
YOUR NAME : 160 ROUTE 25 LLC
(Last name,-firsi'"n—amc,"m`iddIc—initial,uniessyou are applying in thenameof 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 Trustee Permit
Change of Zone Coastal Erosion
Approval of Plat— Mooring
Other(activity) SPECIAL EXCEPTION 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 V
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)
Q an officer,director,partner,or employee of the applicant;or
D)the actual applicant
DESCRIPTION OF RELATIONSHIP
.............
Submitted this s day OfOCTOBER 2021 Submitted this-1,54k\_ day of OCTOBER,2021
. .........— I
Signature Signature._ //
gnaure,_ 14
Print Name Y:KENNETH BALLATO,MEMBER
Print Nam:eqBPAUL PA
, VWLOWSKI,MEMBER. .. ...B..