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HomeMy WebLinkAboutTR-10527 Glenn Goldsmith,President Town Hall Annex ®�`�®� ®Urf� 54375 Route 25 A. Nicholas Krupski,Vice President ®'Ile ® P.O. Box 1179 Eric SepenoskiB Southold, New York 11971 Liz Gillooly Telephone (631) 765-1892 Elizabeth Peeples a® Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction % constructed When project complete, call for compliance inspection; dr BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD,NEW YORK PERMIT NO. 10527 DATE: JANUARY .172024 r ISSUED TO: WALTER GLESS i PROPERTY ADDRESS: 800 KOKE DRIVE, SOUTHOLD SCTM# 1000-87-5-7 AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on.1 nu ryj 7_2024,and in consideration of application fee in the sum of I, 0.00 paid by W;jtgr G less and subject to the Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit for the as-built demolition of existing approximately 291x20.6' (611sq.ft.) one- story dwelling with attached as-built 20.6'x10.5' and 26.3'x6.2' deck; as-built replacement of existing footings at the deck and seaward portion of the dwelling and new footings proposed for the upland portion; footings to be provided under the proposed screen porch and a foundation wall with flood vents to be installed under the proposed north and east additions; proposed 20.4'x5' (102sq.ft.) one-story north addition; proposed irregularly shaped 11'x20.6' (213sq.ft.) � ' east addition; proposed 20.4'xll' (225sq.ft.) south screened-in porch; proposed irregularly shaped f6.2'x5' south deck addition/infill; abandon existing septic system and install an I/A OWTS system landward of dwelling; install gutters to leaders to drywells to contain roof �� a " runoff; with the condition to establish and perpetually maintain a 40'wide non-turf buffer along the landward edge of the wetlands; and as depicted on the revised site plan prepared by LaChapelle Architecture PLLC,stamped received on February 12,2024,and stamped approved on February 13,2024. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, " and these presents to be subscribed by a majority of the said Board as of the day and year written above. � . �• - TERMS AND CONDITIONS The Permittee Walter Glass,j sidia r I oke...Dr ve, SodkQld qLv York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 36 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5, That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees,the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. 8, The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90)calendar days of issuance of this permit. 9, That the said Board will be notified by the Permittee of the completion of the work authorized. 10. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit,which may be subject to revoke upon failure to obtain same. 11, No right to trespass or interfere with riparian rights. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights,title, or interest in real or personal property held or vested in a person not a party to the permit. Glenn Goldsmith, President � � Town Hall Annex �"�� 54375 Route 25 A. Nicholas Krupski,Vice President '�� xwr� P.O. Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gilloolya Telephone(631) 765-1892 Elizabeth Peeples m 9 Fax(631) 765-6641 � 10 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 19, 2024 Jake LaChapelle, AIA P.O. Box 1251 Mattituck, NY 11952 RE: WALTER GLESS 800 KOKE DRIVE, SOUTHOLD SCTM# 1000-87-5-7 Dear Mr. LaChapelle: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, January 17, 2024 regarding the above matter: WHEREAS, Jake LaChapelle, AIA on behalf of WALTER GLESS applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated November 16, 2023, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policy 6.3 of the Local Waterfront Revitalization Program to the greatest extent possible through the imposition of the following Best Management Practice requirements: the issuance of a permit for the structures, inclusion of a 40' non-turf buffer; and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said- application on January 17, 2024, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, 2 WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that for the mitigating factors and based upon the Best Management Practice requirement imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, RESOLVED, that the Board of Trustees approve the application of WALTER GLESS for the as-built demolition of existing approximately 29'x20.6' (61 1 sq.ft.) one-story dwelling with attached as-built 20.6'x10.5' and 26.3'x6.2' deck; as-built replacement of existing footings at the deck and seaward portion of the dwelling and new footings proposed for the upland portion; footings to be provided under the proposed screen porch and a foundation wall with flood vents to be installed under the proposed north and east additions; proposed 20.4'x5' (102sq.ft.) one-story north addition; proposed irregularly shaped 11'x20.6' (213sq.ft.) east addition; proposed 20.4'x11' (225sq.ft.) south screened-in porch; proposed irregularly shaped ±6.2'x5' south deck addition/infill; abandon existing septic system and install an I/A OWTS system landward of dwelling; install gutters to leaders to drywells to contain roof runoff; with the condition to establish and perpetually maintain a 40' wide non-turf buffer along the landward edge of the wetlands; and as depicted on the revised site plan prepared by LaChapelle Architecture PLLC, stamped received on February 12, 2024, and stamped approved on February 13, 2024. Permit to construct and complete project will expire three years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: $50.00 V my you , Glenn Goldsmith President, Board of Trustees GG/dd RUNOFF VOLUME-EXISTING HOUSE: �\ RUNOFF VOLUME-ADDITIONS: \\ LIVABLE FLOOR AREA CALCULATION: G LESS 2"x 611 SF EXIST.ROOF AREA=102 CF RUNOFF\ 2"x 540 SF NEW ROOF AREA=90 CF RUNOFF RESIDENCE 102 CF=763 GALLON DRY WELL \\ 90 CF=673 GALLON DRY WELL \ EXISTING HOUSE 537 SF \ 800 KOKE DRIVE OR \OR PROPOSED NORTH ADDITION 96 SF 2 2 \ SOUTHOLD,NY 11971 \ 700 KOKE DRIVE PROPOSED EAST ADDITION 217 SF V=Tr r h 102 CF=Tr x 4'x h 90 CIF=Tr x 4'x h '< TOTAL 850 SF h=8.12'TALL h=7\16'TALL > CONFORMS THEREFORE PROVIDE(2)4'0 x 4'TALL RINGS. THEREFORE PROVIDE(2)NEW 4'0 x,4-TALL RINGS. \ DEC-ADJACENT AREA CALCULATION: D f 0 0 !ap p NORTH GENERAL STORMWATER NOTES: \ \ \ FROM TIDAL WETLAND BOUNDARY 0 -INSTALL DRY WELLS MIN. 10'FROM HOUSE \\ NEW 765 GAL.DRY WELL 35` . 15\ TO 10'CONTOUR 3 969 SF a °o4 D 0 -INCLUDE LEAF AND SEDIMENT SUMP UPSTREAM Y (e.g.(2)4'0 x 4'DEEP 11, '\ U ® ° CONCRETE RINGS) 1 \ 1 \ HOUSE BELOW 10'CONTOUR 370 SF T NORTH C3 OF THE DRY WELLS `• �1 0 1 DECK BELOW 10'CONTOUR 376 SF (25.27•) 0 0 PIER LINE'PER§275-2 FOR \'. \ i \. 1 1 \ \� m 1 18.8%COVERAGE DWELLING STRUCTURES ` �' \ 1 \ \ o 1 TAX MAP N0.3000$7:57 EE 11'r O 50 / \ \ \. , f 1�� \ \ # ISSUE/REVISION DATE \0 0 '� LG�\\ � E G� NEW I/A SEPTIC LG .00 FILING SET 01.23.2024 FEB 12 2024 G Po \9 °� \ ` \�� �X EGA \ \ I� ;, �• \ \\ LG-3 \\ \ APPROVED BY Southold Town I \ 7� 1 0 1 i»sE�\Tlc Board of Trustees 'Z �\ I moll ' \-\ I °35a 1 \oIBOARD OF I f?USTEES I \� ` TOWN OF SOUTHOLD DRAWN BY:J.LACHAPELLE O 'Z O\ „„�,„i ,,, „ 1 lJ 29.0 ..\.W \ \ I \ CHECKED BY:J.LACHAPELLE C\ 5, ,o,,,, \ 1 \\ ®SATE �ebru�r-1 /3 �oay _ 1�`STY FIRM��b-0' �;�,, o ll'\ 1 I \ NOTE:DRAWING MAY BE PRINTED AT REDUCED SCALE =v N DWELLING ..... � � I \ eA-joo\ 1� #800 ,�•�. y, 1 \ '.•\o rn. ...FFL�`EL 10.2....w ;;:::; OO 1 I I \ I EXISTING WOOD .o \ �. \ 1 1� \ I LaChapelle Architecture PLLC DECK TO BE REBUILT 0': j . WELL IN PLACE AND KIND �� ..1: p OOSED" 112 1R 1 \ P P.O.Box 1251 SCREENED: 0 1 TIDAL WETLAND BOUNDARY \ 26.3 ` \\\\\(jORCH;\ \- \\ 1 \ I Mattituck,NY 11952 1 (646)251-5058 jake@lachapellearchitecture.com AS DELINIATED BY 20.4-- \ \ 1 \` .... \ COLE ENVIRONMENTAL SERVICES MARCH 25, 2023 ;` 1 it '•� 1 \ \ ;\ \ N1\1\- \ \ \ 1 ABANDON EXISTING \ \ \ WELL AND CONNECT \ U.P•\ \ \ TO TOWN WATER ED -� \ NEW 675 GAL.DRY WELL C� �� 23 (e.g.(2)4'0 x 4'DEEP P �n o -�5�11 \ \ CONCRETE RINGS) Nv 9' ;©N-TURF\VEGETATED BUFFER(NON-FERTILIZER ��F O. 03343 DEPENDENT)w/4 ACCESS OF NE`N \ •` PATH TO RAMP y{ NOT FOR CONSTRUCTION '\ •, 10'BUFFER PRESCRIBED BY 1 ZONING APPEALS BOARD/ FEMA MAP#36103CO166H EFF. 09/25/2009 LWRP IN 11/2/2023APPROVAL SITE PLAN NAVD88 1 9,969 SQ.FT. or 0.23 ACRES \ BACKGROUND DATA FROM 2023 SURVEY BY TRUE SHEET NO: \ KEN WOYCHUK;ADDITIONAL DRAFTING AND NORTH O SITE PLAN 890 KOKE DRIVE�\ ,, LIVABLE FLOOR AREA CALCULATION BY A5m00 SCALE: 1" = 20� LACHAPELLE ARCHITECTURE PLLC SHEET 5 OF 16 SOUTH�OLD TRUSTEE,S Noe � 0sooZ7 Issued To -lJal �er r /e.�s D..ate � � � . Address 2O.O . kak&�Dr;ve, THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765.1892 ' I Glenn Goldsmith, President Town Trustees A Nicholas Krupski, Vice-President CO z 54375 Route 25 Eric Sepenoski o " P.O. Box 1179 Liz Gillooly '!.1� ao�� Southold, NY 11971 Elizabeth Peeples "Y' Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: WALTER GLESS c/o JAKE LACHAPELLE Please be advised that your application dated November 16, 2023 has been reviewed by this Board at the regular meeting of January 17, 2024 and your application has been approved pending the completion of the following items checked off below. xx Revised Plans for proposed project— SILT BOOM Inspection Fee ($50.00) 1st Day of Construction ($50.00) '/ Constructed ($50.00) x Final Inspection Fee ($50.00) - Dock Fees ($3.00 per sq. ft.) xx The Permittee is required to provide evidence that the non-turf buffer condition of the Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: 1 . 11 0+ TOTAL FEES DUE: $ 50.00 0 l BY: Glenn Goldsmith, President Board of Trustees a Ll Glenn Goldsmith, President �0 COGy�` Town Hall Annex A.Nicholas Krupski,Vice President < 54375 Route 25 Eric Sepenoski y ? P.O.Box 1179 Liz Gillooly y • ol1, Southold,NY 11971 Elizabeth Peeples �Olr �� Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: 11'112.4 Completed in field by: ZY%zAbc;- . Pee-pleb Jake LaChapelle, AIA on behalf of WALTER GLESS requests a Wetland Permit for the as-built demolition of existing approximately 29'x20.6' (611sq.ft.) one-story dwelling with attached as-built 20.6'x10.5' and 26.3'x6.2' deck; as-built replacement of existing footings at the deck and seaward portion of the dwelling and new footings proposed for the upland portion; footings to be provided under the proposed screen porch and a foundation wall with flood vents to be installed under the proposed north and east additions; proposed 20.4'x5' (102sq.ft.) one-story north addition; proposed irregularly shaped 11'x20.6' (213sq.ft.) east addition; proposed 20.4'x11' (225sq.ft.) south screened-in porch; proposed irre larly shaped ±6.2'x5' south deck addition/infill; abandon existing septic system stall an I/A OWTS system landward of dwelling; install gutters to leaders to drywego contain roof runoff; and to install a vegetated 10' wide non-turf buffer along the landward edge of wetlands. Located: 700 Koke Drive, Southold. SCTM# 1000-87-5-7 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: V/Chapt. 275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: \v\crease bu ftd w&A .rea P44c w A\ sa j+ tp l cxxwV y erae,� '&\ Present Were: G. Goldsmith '/N. KPE. pski E. Sepenoski �/ L. Gillooly Peeples RUNOFF VOLUME-EXISTING HOUSE: \\ RUNOFF VOLUME-ADDITIONS: \\ LIVABLE FLOOR AREA CALCULATION: G LESS 2"x 611 SF EXIST.ROOF AREA=102 CF RUNOFF\ 2"x 540 SF NEW ROOF AREA=90 CF�UNOFF RESIDENCE 102 CF=763 GALLON DRY WELL \\ 90 CF=673 GALLON DRY WELL \ EXISTING HOUSE 537 SF OR \ 800 KOKE DRIVE \OR PROPOSED NORTH ADDITION 96 SF V=Tr r 2 h V=TT r 2 h \ SOUTHOLD,NY 11971 \ 102 CF=Tr x 4'x h 90\C�F=Tr x 4'x h x700 KOKE DRIVE PROPOSED EAST ADDITION 217 SF TOTAL 850 SF CONFORMS h=8.12'TALL h=7\16'TALL THEREFORE PROVIDE(2)4'0 x 4'TALL RINGS. THEREF91RE PROVIDE(2)NEW 4'0 x,4-TALL RINGS. �\ ® 0� TRUE Q \ / // \ \ NORTH �O ❑ p GENERAL STORMWATER NOTES: \\ /'NEW 765 GAL.DRY WELL35� U. 15\ 0013 r3 D 0 -INSTALL DRY WELLS MIN. 10'FROM HOUSE / (e.g.(2)4'0 x 4'DEEP 1�1• �\ \ PROJECT ® d -INCLUDE LEAF AND SEDIMENT SUMP UPSTREAM ; CONCRETE RINGS) NOTH � 1 • 25827°) OF THE DRY WELLS \ \ ._lA / \ 1 U-% 0 I TAX MAP NO.1000-87,5-7 \ \ -n C ` .,•1 1�`70, '\/ \ \_ \ \\ \ \P y # ISSUE/REVISION DATE NEW IIA SEPTIC _' Qr ••\,• y yy, \� \ i1� •l\ \ _ EXIST./� \\ \ .00 FILING SET 1116.2023 r7 Q \ `;, '\ \ \ •1' _�\\$EP'TI( S., II \ \CSI a� 1�l \ it Z`' \ •O 5` N\ \O I 1 1 DRAWN BY:J.LACHAPELLE eo If."+ h, ......•29.0 •', w /z//// 1 CHECKED BY:J.LACHAPELLE .� •.N.•:••:�1 WEWNG::,,��y, �/ \ I •\ 5 � NOTE:DRAWING MAY BE PRINTED AT REDUCED SCALE saw wwD DECK REBUT II �� �: !-:'o.o':' :1:' "' �� \•M�Ett I i� i� \\ LaChapelle Architecture PLLC IN PUKE AND IOTA TO BE � .� .:.;:...... 3 ��. . P.O.Box 1251 110N• �� BOUPID+IRY 1 ' � \ 26.3 •�pRCN, �1\ 11 } \. I Mattituck,NY 11952 COLE�� 6 '� 1 \ \ \\'\ i \ \ (646)251-5058 jakeC�?lachapellearchitecture.com BY 2 1� MARCH 25' 2R3 \ �1 11 I` 1 \ \ a2 ��\ ` Nl�l\\ \\ \ \ \\11 ABANDON EXISTING WELL AND CONNECT b. \ II `. 1 \ \ ADDIinPW 10\ \�._ \1 \ U.P. \ \ TO TOWN WATER E° RC 9 DECfOMG. _\ \ \ \ _.�. \ �� LACHgp _ \ \ \ d. _. \ NEW 675 GAL.DRY WELL < <n I I7 \1 1 \ \_ _1\. 111.231 (e.g.(2)4'0 x 4 DEEP c� •.i •t OAT J 7 \ C. _ �.�� ll � \ \ � CONCRETE RINGS) ••�� � II \ X8° IVVO 8 SO N9 F i '(E* 9T�O 03393 Q� DEC 1 9 2023 I I 'PIER LINE'PER§275-2 FOR �j � 1 of NeN � \ DWELLING STRUCTURES .\ l J Southold Town '. 10'NON-TURF NATIVE A1� NOT FOR CONSTRUCTION \ VEGETATED BUFFER Board of Trustees \ �, (NON-FERTILIZER DEPENDENT) CONTEXT PHOTO KEY: a. SITE PLAN FEMA MAP#36103CO166H EFF. 09/25/2009 WI 4'WALK TO RAMP NAVD88 l 1 9,969 SQ.FT. or 0.23 ACRES r/ 1 BACKGROUND DATA FROM 2023 SURVEY BY TRUE SHEET NO: \ KEN WOYCHUK;ADDITIONAL DRAFTING AND NORTH OSITE PLAN 890 KOKE DRIVE !_ LIVABLE FLOOR AREA CALCULATION BY A5mOO SCALE: 1" = 20' \� LACHAPELLE ARCHITECTURE PLLC SHEET 5 OF 16 S.C.T.M. NO. DISTRICT: 1000 SECTION: 87 BLOCK: 5 LOT(S): 7 \ \ U \ 5� 1� � 1113 \\ X114 0 1 N©V 8323 c < g° ,SO EXIST. SEPTI o \ \ \F�f�,+� 1 '� 111 �Q \L.P \5 N T1�O 1 p 11 0 \ D.P. \ Z ` \ �,\ 1 �� 1 I I ` / 1 54\ 1 _ \ \ Na 1 1 I % 3 1 t o p \ Q, 1 \ 1 ,, 4 : ,:: o , O UA \ 1 FOOTPRINT OF •.tt.0' . O SEPTIC 1 1 N -{ F�4G O �► ',///' \ p O DEMOLISHED 1 , I 5' 29.0 :::� :w ' BATHROOM AREA ;..STM FR..7:.r.�': o I tt o o: DWELLING ... •. .&o M.H. 1 1 o I I o . #800 a 2 w ;g C. I 11 1 EXISTING WOOD ELEV. 12.0 DECK TO BE REBUILT t IN PLACE AND KIND I 30 •p POSED `; IN FAV R 0 I 1 1 OL MIXED I 1 T. rn „ . ED\.. DY LOAM ,, SONG" • ,\= PUBLIC WATER 1 1 1 9�' TIDAL WETLAND BOUNDARY 1 \ 6' 26.3' �'- •••• PORCH' BROWN ^ AS DEUNGITED BY CES \ �2 ••••• 0.4• 1 COLE ENVIRONMENTAL SERVICES \ \ \ SM LOAMY SAND 1 N�1 \ -2 MARCH 25, 2023 2 .4\ A\ :1 1 \ Q2 \ \ y \T.HoLE \ \ \ BROWN \'\Qr\ 1 I W \ PRO �Q N \ O \ \ \ SP MEDIUM POSED SAND 4' 1 \ 1 I cr \ ADDITONAL \ C3! \ N U.P. \ PALE R \ I _I 0 DECKING \ \ \ MEDIUM \ sw SAND GRAVEL -1.2' FLpp,T \ 1 ► \ Q `1J WATER EL 0.8 ° WATER IN HIGHEST EXP. 2.0 I I 1 S78 gI PALE MEDIUM SAND I 1)Jj SW Qc GRAVEL f 7' '0 MAY 3, 2022 \ K. WOYCHUKHUK LS THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS FEMA MAP#36103C0166H EFF. 09/25 2009 f�1� AREA: 9,969 SQ.FT. or 0.23 ACRES ELEVA77ON DATU . NAVD88 LOT COVERAGE PTA110" OR�YOEMBOSSED VEY ISBEaysroe� OF VTCTY £°U "ON COPIES OF SMAAPOZED G THE LANSURVEYORS SEE HA"OT TOBEAUD RUE STATE INDICATED HEREON SHAURUUN UPLAND AREA: 9458 S.F. or 0.22 ACRES ONLY TO THE PERSON FOR NHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE 77TLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS77TUT70N LISTED HEREON. AND TO THE AS.9G7NEES OF THE LENDING INS77TUTION, GUARANTEES ARE NOT 7RANSFERABLE. THE OFFSETS OR DIMENSIONS SHOW HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIRC PURPOSE AND USE THEREFORE THEY ARE EXISITNG HOUSE W/REAR DECK: 990 S.F. or 10.59 NOT INTENDED TD MONUMENT THE PROPERTY LINES OR TO otar THE ERECT70N or FENCES, ADD177ONAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS AND/O4 SUBSURFACE STRUCTURES RECORDED OR UNRECORDED AR£NOT CUAR UNLESS PHYSCALLY ENDENT ON THE PREMISES AT THE 77ME OF SURVEY PROP. SCREENED PORCH: 225 S.F. SURVEY OF:DESCRIBED PROPERTY 101 ° E`V CERTIFIED To: WALTER GLESS; PROP. SOUTH ADDITION: 213 S.F. MAF OF: �P�F,SN M IY °•p•F PROP. NORTH ADDITION: 102 S.F. FILED: W= x PROP. DECK ADDITION: 21 S.F. Y SITUATED AT: BAY VIEW o PROPOSED COVERAGE: 1551 S.F. or 16.49 Tom OF:SOUTHOLD F ��" KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK 2rF 050582 e Professional Land Surveying and Design REVISED 06-25-23 P.O. Boz 153 Aquebogue, New York 11931 ADD FLAGGING 03-30-23 FILE #222-66 scALE:1"=20'DATE: MAY 3, 2022 N.Y.S. LISC. NO. 050882 PRONZ (881)288-1588 FAX (881) 298-1588 R G LESS _ RESIDENCE DRAWING LIST 800 KOKE DRIVE 800 KOKE DRIVE SOUTHOLD,NY 11971 A1.00 DRAWING LIST,ABBREVIATIONS, SYMBOLS, &INSPECTIONS Y2.nIZ00NE)Trc S O U T H O L D, NY A3:00 Sr-I'urn rc�o niSrn n�i n rRAM � A".nrvoNAILING&STRAPPING DETAILS A5.00 SITE PLAN TRUE p - — -- ------ SCTM#-1000-87.-5-7 A6.00 FOUNDATION PLAN NORTH �O ❑0 p _. A7.00 GROUND FLOOR PLAN D ^- -- - A8.00 ROOF PLAN ® O A9.00 ntnLEETrn CETI TIP46 PLAN PROJECT NOV ' 2023A10.00 NORTH ELEVATION 52i^I G2O o A11.00 EAST ELEVATION h Al2.00 SOUTH ELEVATION TAX MAP N0.1000-87.-&7 I A13.00 WEST ELEVATION A14.00 SECTION # ISSUE/REVISION DATE A15.00 DETAILS NOTE: DO NOT SCALE .00 FILING SET 11.15.2023 A16.00 DECK DETAILS FROM DRAWINGS SYMBOLS REGULATORY NOTES ABBREVIATIONS 1. THIS APPLICATION IS FILED WITH THE TOWN OF SOUTHOLD A.F.F. ABOVE FINISH FLOOR GWB GYPSUM WALL BOARD LEVEL BUILDING DEPARTMENT, IN CONFORMANCE WITH THE TOWN ALT ALTERNATE DRAWN BY:J.LACHAPELLE O WINDOW THIRD FLOOR CODE CHAPTER 144. APP. APPLIANCE(S) HM HOLLOW METAL CHECKED BY:J.LACHAPELLE A EL. +31'-3" HT HEIGHT ELEVATION ABOVE 0'-0" 2. THE CONTROLLING CODE IS THE 2020 BUILDING CODE OF NEW B.O. BY OTHER HW HOT-WATER NOTE:DRAWING MAY BE PRINTED AT REDUCED SCALE O DOOR YORK STATE AND THE 2020 ENERGY CONSERVATION CODE OF NEW YORK STATE, IN COMBINATION WITH THE TOWN CODE. C/C CENTER TO CENTER MECH. MECHANICAL 1 ELEVATION NUMBER CLG CEILING MTL METAL LaChapelle Architecture PLLC O PARTITION TYPE A6 SHEET NUMBER 3. REFERENCE HEREIN TO 'BC'SHOULD BE CONSTRUED TO MEAN CMU CONCRETE MASONRY UNIT P.O.Box 1251 THE APPLICABLE BUILDING CODES OF NEW YORK STATE. CONC CONCRETE PTD PAINTED Mattituck,NY 11952 CONT. CONTINUOUS (646)251-5058 jake@lachapellearchitecture.com 4. THIS SINGLE-FAMILY HOME OCCUPANCY CLASSIFICATION IS CONT'D CONTINUED RCP REFLECTED CEILING PLAN A3 1 DETAIL NUMBER RESIDENTIAL GROUP R-3 UNDER BC CHAPTER 3. A4 SHEET NUMBER D.H. DOUBLE HUNG O.C. ON CENTER 5. THIS STRUCTURE IS CLASSIFIED AS CONSTRUCTION TYPE V(B) DIM. DIMENSION +REO AR (UNPROTECTED WOOD FRAME) UNDER BC TABLES 601 AND 602. DIA. DIAMETER SIM. SIMILAR DISC. DISCONTINUOUS S.S. STAINLESS STEEL ��5 LACMgA 6. - TO THE BEST OF MY KNOWLEDGE THE WORK PROPOSED DWG DRAWING STL. STEEL 1 it J HEREIN IS COMPLIANT WITH ALL APPLICABLE LAWS, CODES, AND REGULATIONS. ELEC. ELECTRIC TYP. TYPICAL STAIR DIRECTION LABELS ENG. ENGINEER 00 INSPECTIONS EEQUAL V.I.F. VERIFY IN FIELD s,, UP DN EXIXI ST. EXISTING 0339 y0 SPECIAL INSPECTIONS MUST BE PROVIDED IN CONFORMANCE WITH THE FL FLOOR WD. WOOD OF NE`N SC SMOKE+CARBON MONOXIDE DETECTOR REQUIREMENTS OF BCNYS 1704&1705. NOT FOR CONSTRUCTION SMOKE AND CO DETECTORS SHALL COMPLY FOOTING DRAWING LIST, SCOPE O F WORK WITH UL 268,7th ADDITION FOUNDATION ABBREVIATIONS, FRAMING,TIE-DOWN/STRAPPING AND PLUMBING ® MATCH LINE PERIMETER INSULATION THE GENERAL INTENT OF THE WORK IS TO BUILD AN ADDITION ON THE INSPECTIONS,&SYMBOLS ROUGH ELECTRIC — — CENTER LINE HOUSE INCREASING THE GROSS SQUARE FOOTAGE TO OVER 850, INSULATION AND CAULKING PERFORM VARIOUS UPGRADES AND ALTERATIONS TO THE HOUSE,AND SHEET NO: BREAK LINE SOLID FUEL-BURNING APPLIANCE &CHIMNEY BUILD A NEW DECK ON THE EXISTING HOUSE. NO CHANGE OF USE OR ALOO ENERGY CODE COMPLIANCE OCCUPANCY IS PROPOSED. 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W-L--U i i i i 1 1 4-44 LaChapelle Architecture PLLC P.O.Box 1251 J L +++-I Mattituck,NY 11952 444 1 it I w (646)251-5058 jake@lachapellearchitecture.com 11 IT 11 11 IT 11 T 11 1 1 1 1 11 1 IN I E LJ A JAC 0 32 N NOT FOR CONSTRUCTION WEST ELEVATION SHEET NO: WEST ELEVATION SCALE: 1/4" = T-0" Al 3,00 SHEET 13 OF 16 G L ESS RESIDENCE 800 KOKE DRIVE g SOUTHOLD,fVY 11971 } i� d Nov 1 2023 � � a - TRUE NORTH DO a 0 oa ❑C7o p o 1-3/4X11-7/8 NORTHT Q ML RIDGE (25.27°) 0 0 1-3/4X11-7/8 ML RIDGE 2X12 LAYOVER TAX MAP NO.1000-87:5-7 P TE # ISSUE/REVISION DATE DBL 2X8CT@48"OC 2X1 RR 2X12 ALLEY L .00 FILING SET 11.15.2023 @ 16"OC P�� 6 0 7 2X10 RR @16 RR 3 1 A LTO ROOF 2X8 CJ @16"OC 2X8 Cl @16"OC (2)1-3 4 11-7/8 _ 1- 4 - 8 DRAWN BY:J.LACHAPELLE MLGIRDER o ML GIRDER CV CHECKED BY:J.LACHAPELLE r-I NOTE:DRAWING MAY BE PRINTED AT REDUCED SCALE O i RAILING TO CODE 3'h oo LaChapelle Architecture PLLC ® ® ® P.O.Box 1251 Mattituck,NY 11952 (646)251-5058 jake@lachapellearchitecture.com SA DECKING 3/4,,suRFinnR 3/4:L8FLn0R 2X8 ACQ @16"OC 2X10 FJ @16"OC 2X10 FJ @16"OC (3)2X10 ACQ (3)2X10 ACQ (3)2X12 ACQ (4)2X12 ACQ (4)2X12 ACQ (4)2X12 ACQ GIRDER GIRDER GIRDER GIRDER GIRDER GIRDER 2X6ACQ ILL PLATE ItED ARC S ACM 6X6 AC POSTTERMITE SHIELD ♦ ` •4�4 . ` . 8"CMU(TYP) SILL SEAL p toj 12 dia. p AS REQUIRED DAMPPROOF - CONC.PIER Q 1 � � � � � • � � � � 2"CONC.SLAB m . . 24X24X12 FTG 16"X8"CONC.FTG (2)#4 REBAR 9 03393 y0� �F N NOT FOR CONSTRUCTION SECTION SHEET NO: OSECTI SCALE: = T-0" A:l4mOO SHEET 14 OF 16 2x6 STUD FRAMING,TYP. G LESS 2"CLOSED-CELL SPRAY FOAM PROVIDE STRAPPING - - I I'BATT PER RESIDENCE INSULATION(R-14)PLUS 3 2'BATT - CODE;SEE A3 MINERAL WOOL INSULATION(R-15)FOR I 800 KOKE DRIVE ' WHOLE ASSY MIN.R-29 PROVIDE SOUTHOLD,NY 11971 NOVGUTTERS& 223 VINYL SHINGLE SIDING TO MATCH EXISTING LEADERS 1 7 Z"CLOSED-CELL SPRAY FOAM THROUGHOUT D o lam (R-50);ALLOW FOR AIRSPACE TRUE D p -- - 2x10 JOISTS;PROVIDE FURRING IF NORTH NECESSARY FOR FAIR CEILING SURFACE 1'-8" L ® Q a O D ® d° FASTEN P.T.SILL PLATE TO CONCRETE 20 oz.COPPER DRIP PROJECT NORTH Q STEM WALL w/2"S.S.THREADED ROD (25.27°) 0 0 @ 48"O.C., LOCATE ONE ROD WITHIN TAX MAP N0.100087:57 32'OF ENDS OF EACH PLATE;MIN 12" EMBED IN CONCRETE;(R403.1.6) CONT.SEALANT AND BACKER ROD # ISSUE/REVISION DATE SLOPE GARAGE I 'I' —' SILL GASKET ABOVE AND BELOW AT PERIMETER OF WINDOW TO FLOOR 1/8"PER I I a6 .00 FILING SET 11.15.2023 FT FROM BACK :I Ia TERMITE SHIELD STOP AIR INFILTRATION T I I° 4"GARAGE SLAB w/6"GRID WOVEN PTD. EXTENSION AT 0 FRONT f ° JAMB WIRE FABRIC REINFORCING WINDOWS, PROVIDE leUSE APPROVED EXPANSION JOINT TRIM TO MATCH EXIST. - - 1 1 MATERIAL AT PERIMETER OF SLAB I � ANDERSON 400 SERIES WINDOWS; PROVIDE EMIL POLYETHYLENE VAPOR SEE WINDOW SCHEDULE RETARDED UNDER GARAGE SLAB, DAM BLOCKING @ SILL DRAWN BY:J.LACHAPELLE __. __ THOUGH NOT REQUIRED BY R506.2.3 2x6 STUD FRAMING,TYP. CHECKED BY:J.LACHAPELLE e• a BUILD GARAGE SLAB ON UNDISTURBED 2"CLOSED-CELL SPRAY FOAM I' • NON-ORGANIC _ INSULATION(R-14)PLUS 3 2'BATT NOTE:DRAWING MAY BE PRINTED AT REDUCED SCALE MINERAL WOOL INSULATION(R-15) FOR WHOLE ASSY MIN.R-29 LaChap elle Architecture PLLC PROVIDE#5 AR P.O.Box 1251 <I°•� ° REINFORCING @ 3' Mattituck,NY 11952 O.C.IN BOH (646)251-5058 jake@lachapellearchitecture.com DIRECTION(VERT.& HORIZ.)INS EM ' WALL REFERENCE f' DRAWING A6&A7 .°. j°° . ��RED qRC CMgp FOR COORDINATION I Co OF FOOTING LOCATION 03393 . . .° ' I NOT FOR CONSTRUCTION DETAILS a PROVIDE STRAPPING 1 THROUGHOUT PER CODE;SEE A3 SHEET NO: O TCALEAL SECTION N DETAIL @ GRADE O TYPICALA15,00SECTION DETAIL @ EAVE 2 CALE. 121 = T-0"' SHEET 15 OF 16 IF EXISTING LEDGER ° FLASHING IS INTACT BEND IT GLE S 2x8 JOISTS&LEDGER BACK TO ACCEPT NEW (2)2x10 EDGE BEAM RESIDENCE LEDGER AND BEND INTO DETAIL'A' ��� I 800 KOKE DRIVE PLACE;IF FLASHING CAN'T BE SOUTHOLD,NY 11971 s / i r; ( SIMPSON DTT2 NOV 1 6p I`"� r TO JOIST RE-USED THEN SELECTIVE REPLACEMENT OF HOUSE LAYOUT RIM JOIST I SIDING IS NECESSARY TO ' I N ` ACCEPT NEW FLASHING SIMPSON LUS28 JOIST I 0 p HANGER,TYP. --_I-__ W TRUE O NORTH BAND'JOIST' I > a Da �n0 D I OJ rtrt TYPICAL SECTION I PROJECT - I NORTH QO O / 1 JI (25.27°) DECK JOISTS PROVIDE POLYETHYLENE OR :�� E BLOCKING OTHER WEATHER-RESISTANT I TAX MAP N0.100087.57 i ® - RAILING NOTE: ) Ct DETAIL'S' PROVIDE 36'RAILING AT LEDGER SPACERS FOR I a ISSUE/REVISION DATE I ® DTT2 TO I ALL LOCATIONS WHERE DRAINAGE BLOCKING DROP IS OVER 30" ° I° .00 FILING SET 11.15.2023 LAYOUT _ SIMPSON COLUMN °° °. ;.�,° ° V_ ® I I I I BASE W/ STANDOFF ° DRAWN BY:J.LACHAPELLE ` ® / I \ \ / ��` I _• )° a I i ° •° CHECKED BY:J.LACHAPELLE ` 6 - �•.,°'-•J e® a n`r-�; a°° CV NOTE:DRAWING MAY BE PRINTED AT REDUCED SCALE n d ° I. LaChapelle Architecture PLLC P.O.Box 1251 PVC RISER / Mattituck,NY 11952 181 (646)251-5058 jake@lachapellearchitecture.com ' ROUND OR SQUARE • ® POST / POST FLARED FOOTING BOTTOM PLAN VIEW DETAIL C /• � (2)SIMPSON SEE A5&A6 FOR FOOTING / SIMPSON DECKING DTT2 REINFORCING AND DATA �tED ARC DTT2 DECKING / (ONE EACH ` ��5 �,ACHgp y� SIMPSON STANDARD SIDE) RAILING ATTACHMENT / N ° ° ® l N ° ® ® ® ® 1 DETAILS 1 -® ® ° ° I 1 ® ® ° ° 9 F 03393 ADJUST FOR PROJECT CONDITIONS I OF N - _ N - N - NOT FOR CONSTRUCTION 16"MIN. DECK DETAILS JOIST RIM JOIST J ` BLOCKING %"DIA. BOLTS OR /• THREADED ROD w/ / JOIST / SHEET NO: O DETAILA '%,, NUTS AND WASHERS, /' DETAIL B TYPICAL DECK DETAILS � TYP. A16,00 SCALE: 1z° = T-0" _, —, _ _ ,_ _ r SHEET 16 OF 16 GLESS RESIDENCE 800 KOKE DRIVE SOUTHOLD,NY 11971 -j TRUE NORTH 16 2023 E3 NOV D 'U, PROJECT NORTH QO TAX MAP NO.1000-87:5-7 # ISSUE/REVISION DATE .00 FILING SET 11A8.2023 DRAWN BY:J.LACHAPELLE CHECKED BY:J.LACHAPELLE NOTE:DRAWING MAY BE PRINTED AT REDUCED SCALE LaChapelle Architecture PLLC P.O.Box 1251 Mattituck,NY 11952 (646)251-5058 jake@lachapellearchitecture.com L - - - - - - - - - - - - - - - - - - - - - - - - - %p . 0 39 OF IN NOT FOR CONSTRUCTION EXISTING NORTH ELEVATION SHEET NO: OEXISTING NORTH ELEVATION SCALE: 1/4" = T-o" SK-04 SHEET 1 OF 4 GLESS RESIDENCE 800 KOKE DRIVE SOUTHOLD,NY 11971 110V 1 6' 2023 0 0 TRUE NORTH on 0 C3 D 13 PROJECT NORTH QO (25.27') TAX MAP NO.1000-87.-5-7 # ISSUE/REVISION DATE .00 FILING SET 11.19.2023 DRAWN BY:J.LACHAPELLE L.1 11 Ll CHECKED BY:J.LACHAPELLE NOTE:DRAWING MAY BE PRINTED AT REDUCED SCALE LaChapelle Architecture PLLC P.O.Box 1251 Mattituck,NY 11952 (646)251-5058 lake@lachapellearchitecture.com - - - - - - - - - - - - - - - - -i D qRc %p 39 OF IN NOT FOR CONSTRUCTION EXISTING EAST ELEVATION SHEET NO: OEXISTING EAST ELEVATION SCALE: 1/4" = T-0" SK-05 SHEET 2 OF 4 G LESS _ — _-- RESIDENCE '` (�-V �• 800 KOKE DRIVE SOUTHOLD,NY 11971 Nov 6 2023 e � t TRUE o O p �._._,.._. -....._ `'" _F_._•-,- - - NORTH OO o p D o 0 PROJECT ® d NORTH QO (25.27') � TAX MAP NO.1000-87.-5-7 # ISSUE/REVISION DATE .00 FILINGSET 11.18.2023 LU DRAWN BY:J.LACHAPELLE CHECKED BY:J.LACHAPELLE LL LU A NOTE:DRAWING MAY BE PRINTED AT REDUCED SCALE LaChapelle Architecture PLLC y P.O.Box 1251 Mattituck,NY 11952 L 1 (646)251-5058 jake@lachapellearchitecture.com — — — — — — — — �— — — — — — — — — — — —i A3-, L - - J (tE D q Rc ��5 �,ACHgA 'yi > ci sq F03.2 yp��lr OF NEVI NOT FOR CONSTRUCTION EXISTING SOUTH ELEVATION SHEET NO: OEXISTING SOUT SCALE /4" = l HCELEVATION SK-06 SHEET 3 OF 4 GLESS RESIDENCE 800 KOKE DRIVE SOUTHOLD,NY 11971 1 16 2023 ov TRUE NORTH OO a 13 D PROJ NORTHECT (25.27') TAX MAP NO.1000-87.-5-7 ISSUE/REVISION DATE .00 FILING SET 11.18.2023 DRAWN BY:J.LACHAPELLE CHECKED BY.J.LACHAPELLE NOTE:DRAWING MAY BE PRINTED AT REDUCED SCALE LIL LaChapelle Architecture PLLC Ox 1251 Matfituck,NY 11952 (646)251-5058 jake@lachapellearchitecture.com I I I I I I T I I I I I I I I I I I T I %,ACc; -4 s9 F 03 OF N NOT FOR CONSTRUCTION EXISTING WEST ELEVATION SHEET NO: O EXISTING WEST ELEVATION SCALE: 1/4" = 0, SK-07 SHEET 4 OF 4 See / / / of i I i ar • • View from •• • - I of existing house—photo • 511612023 i. Fig. •-Viewfrom southof existing house with proposed••• • • •• r•••beyond—photo taken 511612023 STAKE VISIBLE BEYOND HOUSE Pbotos of Proposed Action owner bf'alter Gless lk WE _ I 4 '\ 1. � •rl� t P �. Fig.c-View from south of existing house with proposed addition staked/taped—photo taken 5/16/2023 PLEASE NOTE:SAFETY FENCING MESH DOES NOT DENOTE PROPOSED ADDITION A e 'Y� C i Fig.d-View from southeast of existing house with proposed addition&screened porch staked/taped—photo taken 5/16/2023 PLEASE NOTE:SAFETY FENCING MESH DOES NOT DENOTE PROPOSED ADDITION � '� ..°�•� �`o j��.� q• + :: yam# -, �„ ~'� � � _. :rte•-�. x 14, 1 e-Viewfrom east/ existing houseproposed addition I •screened porchI I • • photo / 511612023 NOTE:PLEASE DOES NOTDENOTE PROPOSED ADDITION .[nJ J y`, _ 11 I.f-Viewfrom northeast1 existing house with proposed•II • 1 "• taped photo I511612023 PLEASE NOTE:SAFETY FENCING MESH DOES NOTDENOTE PROPOSED ADDITION _ r� � , ''fir ' ,�.�• . + �,.� I / I I I I • I III 'I III • I I 11'. I I 1 I �. .s ,�� • Jam,`#�}3D�`'} h{�Yr�(ri - Hwy. :1.. _ VA 6. _ v - 1 � ' �. .._` FAI - t fir/ 4-4 •� .� tip. I . I .1. -I III . 1 -1 ..•. I- 0 0 0 0 0 0 - Rg�g_s oaos-ss 2 14 Fry - „H<1 7� mx as 011]°9 p),1,t ��B !^♦ >r . • �- _�� k 4`<1�]i9 L Y) Ay v _,., - ,;I• `,s g UNf { lyva - "t,, Dsmso a>,a. ♦ °1a a k. 4 ,3ai i 4.y' ';•',x-.., ^ ff eEc ops "-bx - -. ,•x]. THE�MaDN]ALD 5. - a, .... i 38N<t .) 33111 . R^ -•'+oWy a TQMI OFSW!NOLD •_._� �'+.i••: -A iKl1 b k� T aFF3��t` 6.+ < sa<Mcl rtiI zi, t 08BE�414tp k'• i 4<`,W`- / 3• ,M<1a1,/4 ne3p1 DR3HC, FD 28 LD 49 P i...a ,� 3 i !.! ml ^ is �A_.-.-...� ••�.^+i �'y-,_.,••t .� ci .,, � 4'; _� ,�&i]t ,A i p,M 1 .� o� , � ++•a-i+psi Q x aaS x .r Ix, ..-_,_._ DOU,TY OF 90FiOLl( 2 6 I tICG ACK HAY COUNTY OF SUFFOLK N O „P __• w.orn+r __.__ r,n, _ .. - K t P,.I,p 1Y Ii. ti e.RlD<, h,6WMM 1,E Y)� SECTIOpN rY N �r�__.__ __ __ —O ••• u..... �' t.,r ..-.MLL.1]1 U W "• E Rb»1iD R ,was tg1TNOLD Op� D _ ' _.r.._ "• —_ r.r�. (21) p v •• D V OFFICE LOCATION: 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 ��� u , LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: January 16, 2024 Re: LWRP Coastal Consistency Review for WALTER GLESS SCTM#: 1000-87-5-7 Jake LaChapelle, AIA on behalf of WALTER GLESS requests a Wetland Permit for the as-built demolition of existing approximately 29'x20.6' (611 sq.ft.) one-story dwelling with attached as-built 20.6'x10.5' and 26.3'x6.2' deck; as-built replacement of existing footings at the deck and seaward portion of the dwelling and new footings proposed for the upland portion; footings to be provided under the proposed screen porch and a foundation wall with flood vents to be installed under the proposed north and east additions; proposed 20.4'x5' (102sq.ft.) one-story north addition; proposed irregularly shaped 11'x20.6' (213sq.ft.) east addition; proposed 20.4'x11' (225sq.ft.) south screened-in porch; proposed irregularly shaped ±6.2'x5' south deck addition/infill; abandon existing septic system and install an I/A OWTS system landward of dwelling; install gutters to leaders to drywells to contain roof runoff; and to install a vegetated 10' wide non-turf buffer along the landward edge of wetlands. Located: 700 Koke Drive, Southold. SCTM# 1000-87-5-7 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is INCONSISTENT with LWRP Policy 6.3 and therefore, INCONSISTENT with the LWRP. Policy 6.3. Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction. The as-built work was conducted without Board review or approval. See Southold Town Board of Appeals conditions outlined in Determination 7826. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Honorable Lori Hulse, Attorney +19FF t/( John G. Stein,Chairperson Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O.Box 1179 Southold,NY 11971 " w+ Telephone(631)765-1889 Fax(631)765-1823 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held on Wed., January 10, 2024, the following recommendation was made: Moved by Maggie Merrill, seconded by Shannon Wright, it was RESOLVED to NOT SUPPORT the application of WALTER GLESS to construct an addition to the single-family residence, rebuild and add to deck and construct new screened porch. Install new I/A septic system, gutters, leaders and drywells, and a 10' vegetated non-turf buffer seaward of the wetland boundary. Located: 800 Koke Drive, Southold. SCTM#87-5-7 Inspected by: John Stein, Shannon Wright, Maggie Merrill The CAC does Not Support the application because the proposed project is within the flood zone and out of compliance with Ch. 275. Vote of Council: Ayes: All Motion Carried t c LaChap elle Architecture 6 ' I� � f H DEC 1 5 2023 Description of Proposed Scope Southold Town 800 Roke Drive Boar d of Trustees Southold,NY 11971 Tax lot SCTM#-1000-87.-5-7 In response to Trustees request,the following is a detailed project description at the above address: The proposed scope of work consists of an addition to this seasonal dwelling to bring up to zoning minimum size for single family residence,rebuild deck,and build new screened porch. Existing house irregular;approx. 29'x 20.6' 611 SF Existing deck (20.6'x 10.5) + (26.3'x 6.2) 379 SF Proposed north addition: 20.4'x 5.0' 102 SF Proposed east addition: irregular;approx.. 11.0'x 20.6' 213 SF Proposed screened porch: 20.4'x 11.0' 225 SF Proposed deck infill at south: irregular;approx. 6.2'x 5.0' 21 SF Existing code-compliant footings at the deck and seaward portion of the dwelling will be retained and new footings provided at the upland portion.Footings will be provided under the screen porch.A foundation wall with Appendix G-compliant flood vents will be provided under the north and east additions.All foundation and footing elements will be designed for lateral force,uplift,and frost line requirements. A new I/A septic system will be installed in conformance with Suffolk County design and approval guidelines. Gutter,leaders,and dry wells will be installed to collect runoff in conformance with § 236-7 from the existing and new impervious surfaces (roofs,etc.). In response to LWRP request a vegetated (non-turf)buffer will be included seaward of the wetland line.This buffer will be approximately 10'deep including existing vegetation. P.O.Box '1251 Mattituck,NY 11952 (646) 251-5058 jake@lachapellearchitecniie.com t: 1 BOARD MEMBERSSouthold Town Hall Leslie Kanes Weisman,Chairperson O�C1�F S�Urif r0! 53095 Main Road-P.O. Box 1179 Patricia Acampora O Southold,NY 11971-0959 Eric Dantes #t Office Location: Robert Lehnert,Jr. y Town Annex/First Floor Nicholas Planamento 0 �� 54375 Main Road(at Youngs Avenue) CDuSouthold,NY 11971 http://southoldtownny.gov �. ZONING BOARD OF APPEALS NOV - 6 2023 TOWN OF SOUTHOLD Tel.(631)765-18099South��rk FINDINGS,DELIBERATIONS,AND DETERMINATION MEETING OF NOVEMBER 2,2023 ZBA FILE: #7826 NAME OF APPLICANT: Walter Gless SCTM#1000-87-5-7 SEQRA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type II category of the State's List of Actions, without further steps under SEQRA. SUFFOLK COUNTY ADMINISTRATIVE CODE: This application was referred as required under the Suffolk County Administrative Code Sections A 14-14 thru A14-25,and the Suffolk County Department of Planning issued .its reply dated June 11,2023 stating that this application is considered a matter for local determination as there appears to be no significant county-wide or inter-community.impact. LWRP DETERMINATION: This application was referred for review under Chapter 268, Waterfront Consistency review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards.The LWRP Coordinator issued a recommendation dated September 19,2023. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department,as well as the records available, it is recommended that the proposed action is INCONSISTENT with the LWRP policy standards and therefore is INCONSISTENT with the LWRP. 1. The structure, although in original form,predates Southold Town Zoning Regulations. 2. Any as-built work is not consistent with the Policy 1. 3. A vegetated buffer seaward of wetland line that includes existing vegetation is recommended to further Policy 6 of the LWRP policy standards. 4. Require that the I/A Innovative Advanced sanitary system be shown on the survey. The Board of Appeals has determined that maintaining the existing the rear yard setback at 22.4 ft.as shown on the survey will not increase the degree of existing non-conformity. The applicant has agreed to install anew Innovative Advanced(I/A)Wastewater Septic System as approved by the Suffolk County Department of Health Services. The applicant has a Board of Trustees Permit#751 authorization to construct a bulkhead on Corey Creek. The Board of Appeals has determined that this application poses no adverse impacts and therefore is CONSISTENT with the LWRP. PROPERTY FACTS/DESCRIPTION: The subject property is a nonconforming 9,969 square foot parcel (9,458 square feet buildable land) located in the Residential R 40- Zoning District. The northerly property line measures 11.35 feet,the easterly property line measures 100.00 feet and is adjacent to Koke Drive,the southerly property line measures 111.23 feet and the westerly property line measures 79.93 feet and is adjacent to Corey Creek. The parcel i Page 2,November 2,2023 #7826,Gless SCTM No, 1000-87-5-7 is improved with a one-story from dwelling with attached wood deck at the rear of the dwelling facing Corey Creek as shown on the survey map prepared by Kenneth M.Woychuk,LS,and last revised June 25,2023. BASIS OF APPLICATION: Request for Variances from Article XXIII, Sections 280-124; and the Building Inspector's June 28, 2023 Notice of Disapproval based on an application fora permit to legalize the "as built" demolition of an existing residence(as per Town Code definition)and to reconstruct a single-family dwelling; at 1) les than the code required minimum rear yard setback of 35 feet; located at 800 Koke Drive(adj. to Corey Creek) Southold,NY. SCTM#1000-87-5-7. RELIEF REQUESTED: The applicant requests variances to legalize the "as built". demolition of an existing residence per Town code definition and to reconstruct a single-family dwelling. The proposed construction,on this nonconforming 9,969 square foot lot (9,458 square feet buildable land) located in the Residential R-40 Zoning District, is not permitted pursuant to Article XXIII, Section 280-124, which states lots measuring less than 20,000 square feet in total size require a rear yard setback of 35 feet. The proposed construction will result in the dwelling having a rear yard setback of 22.4 feet as shown on the Site Plan drawings prepared by Jake LaChapelle,Architect and dated May 15,2023. ADDITIONAL INFORMATION: The original dwelling was built over 100 years ago and predates Town Zoning Code. The Site Plan drawings and the survey show all the proposed additions will be landward. The existing dwelling is 990 square feet and the proposed additions and alterations will total 1,551 square feet which include replacement of the rear deck and new screened"porch located on in the front and side of the dwelling. In order for the applicant to comply with Section 280 Attachment 3 (Schedule A) of the Town Code an addition is needed to meet the requirements of 850 square feet of habitable space. This requirement will be met by the additions proposed by the applicant to the front and side of the dwelling. The rear yard setback will remain at 22.4 feet. During the October 5, 2023 public hearing, the applicant was asked to better clarify the rear yard setback on the survey and to depict the Innovation Advanced(UA)septic system on the survey. A survey was received on October 27,2023 clarifying the subject setback, locating the proposed IA system in a conforming front yard,'and indicating the unchanged revision date of June 25,2023. FINDINGS OF FACT/REASONS FOR BOARD ACTION: The Zoning Board of Appeals held a public hearing on this application on October 5,2023 at which time written and oral evidence were presented. Based upon all testimony,documentation,personal inspection of the property and surrounding neighborhood,and other evidence,the Zoning Board finds the following facts to be true and relevant and makes the following findings: 1. Town Law 4267-b(3)(b)(1). Grant of the variances will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. The surrounding neighborhood on Koke Drive is characterized by similar single-family residences and similar nonconforming under-sized lots. Many of these waterfront homes have seen renovations and have been enlarged over the years. 2. Town Law 4267-b(3)(b)(2). The benefit sought by the applicant cannot be achieved by some method,feasible for the applicant to pursue, other than an area variance. The non-conforming rear yard setback already exists. Relocation of the dwelling is not feasible.The addition is modest and allows the applicant to meet the compliance of Section 280 Attachment 3 (Schedule A)that requires 850 square feet of habitable space to be defined as a dwelling. The existing dwelling with the attached rear deck is 950 square feet. The new addition with a front and side screed porch,the addition to the other side of the dwelling and a small addition to the deck will total 1551 square feet. Page 3,November 2,2023 #7826,Gless SCTM No. 1000-87-5-7 3. Town Law 4267-b(3)(b)(3). The variances granted herein is mathematically substantial,representing 36%relief from the code. However, the relief requested is for the rear yard and will not further alter the existing rear yard setback of 22.4 feet. The new additions will remain within code conformity to front and side yards. 4. Town Law 4267-b(3)(b)(4). No evidence has been submitted to suggest that a variance in this residential community will have an adverse impact on the physical or environmental conditions in the neighborhood. All construction must be FEMA compliant as a portion of the dwelling has always been located in a FEMA Flood Zone AE(EL6). The Southold Building Department will inspect the alterations and additions to make sure the applicant is in compliance with all FEMA regulations.and Town Codes. The applicant must comply with Chapter 236 of the Town's Storm Water Management Code. 5.Town Law 4267-b(3)(b)(5). The difficulty has been self-created. The applicant's family have owned this property for over 100 years. The applicant's knowledge of the limitations on the use of the parcel under the Zoning Code in effect prior to renovations. 6. Town Law 4267-b. Grant of the requested relief is the minimum action necessary and adequate to enable the applicant to enjoy the benefit of a renovated dwelling with additions while preserving and protecting the character of the neighborhood and the health,safety and welfare of the community. RESOLUTION OF THE BOARD:In considering all of the above factors and applying the balancing test under New York Town Law 267-B,motion was offered by Member Acampora,seconded by Member Dantes,and duly carried, to GRANT the variance as applied for,and shown on the survey map prepared by Kenneth M.Woychuk,LS,and last revised June 25,2023 and Architectural Drawings prepared by Jake LaChapelle,Architect,and dated May 15,2023, last received by the ZBA on October 27,2023 SUBJECT TO THE FOLLOWING CONDITIONS: 1. 'A vegetated buffer seaward of the wetland line that includes existing vegetation shall be installed. 2. An (I/A) Innovative Alternative Wastewater Treatment septic system approved by the Suffolk County Department of Health shall be installed. 3. The rear deck shall remain open to the sky. 4. The applicant shall receive a Wetland Permit from the Southold Town Board of Trustees for all proposed construction. This approval shall not be deemed effective until the required conditions have been met.At the discretion of the Board of Appeals,failure to comply with the above conditions may render this decision null and void That the above conditions be written into the Building Inspector's Certificate of Occupancy, when issued The Board reserves the right to substitute a similar design that is de minimis in nature for an alteration that does not increase the degree of nonconformity. IMPORTANT LIMITS ON THE APPROVAL(S) GRANTED HEREIN Please Read Carefully Any deviation from the survey,site plan and/or architectural drawings cited in this decision,or work exceeding the scope of the relief granted herein, will result in delays and/or a possible denial by the Building Department Page 4,November 2,2023 #7826,Gless SCTM No. 1000-87-5-7 of a building permit and/or the issuance of a Stop Work Order, and may require a new application and public hearing before the Zoning Board of Appeals. Any deviation from the variance(s)granted herein as shown on the architectural drawings,siteplan and/or survey cited above,such as alterations,extensions, demolitions,or demolitions exceeding the scope of tl:e relief granted herein, are not authorized under this application when involving nonconformides under the zoning code. This action does not authorize or condone any current or future use, setback or other feature of the subject property that may violate the Zoning Code,other titan such uses,setbacks and other features as are expressly addressed in this action. TIME LIMITS ON THIS APPROVAL: Pursuant to Chapter 280-146(B)of the Code of the Town of Southold any variance granted by the Board of Appeals shall become null and void where.a Certificate of Occupancy has not been procured, and/or a subdivision map has not been filed with the Suffolk County Clerk,within three(3)years from the date such variance was granted. The Board of Appeals may,upon written request prior to the date of expiration,grant an extension not to exceed three(3)consecutive one(1)year terms.IT IS THE PROPERTY OWNER'S RESPONSIBILITY TO ENSURE COMPLIANCE WITH THE CODE REQUIRED TIME FRAME DESCRIBED HEREIN.Failure to comply in a timely manner may-result in the denial by the Building Department of a Certificate of Occupancy, nullify the approved variance relief, and require a new variance application with public hearing before the Board of Appeals Vote of the Board: Ayes: Members Planamento, Lehnert, Weisman,'Acampora, and Dantes. This Resolution was duly adopted(5-0): ie Kanes Weisman, Chairperson Approved for filing ��/ /2023 FORM NO. 3 RECEIVED TOWN OF SOUTHOLD JUN, 2 9 20 BUILDING DEPARTMENT 73-�& a,(o SOUTHOLD,N.Y. Zoning Board of Ap ais NOTICE OF DISAPPROVAL DATE: June 28, 2023 TO: Jake LaChapelle(Gless) PO Box 1251 Mattituck,NY 11952 Please take notice that your application dated May 11,2023: For permit: to legalize the"as built"demolition of an existing residence(as per Town Code definition) and to reconstruct a single-family dwelling at: Location ofroPettY� 800 Koke Drive, Southold,NY P County Tax Map No. 1000—Section 87 Block 5 Lot 7 Is returned herewith and disapproved on the following grounds: I The"as built"construction, on this nonconforming 9,969 sq. ft. lot 9,458 sq. ft. buildable land)in the R-40 District,is not permitted pursuant to Article XXIII Section 280-124 which states lots measuring less than 20,000 square feet in total size require a rear yard setback of 35 feet. _ The construction has a rear yard setback of 22.4 feet. Authorized Signa j' Note to Applicant: Any change or deviation to the above referenced application may require further review by the Southold Town Building Department. r CC: file,Z.B.A. ORIGINAL Glenn Goldsmith,President `�oF S��ry Town Hall Annex A.Nicholas Krupski,Vice President ,`Oo�� 54375 Route 25 P.O.Box 1179 Eric Se enoski P Southold,New York 11971 Liz Gillooly Elizabeth Peeples �, ® � Telephone(631) 765-1892 sv Fax(631) 765-6641 �'��4d1NTt,H� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application X Wetland Permit Application NOV 1 6 2023 Administrative Permit _Amendment/Transfer/Extension �( Received Application: 1/•/b-23 Southold Town Board of Trustees Received Fee: $ 126V. _ Completed Application: 1/•27.23 Incomplete: _. SEQRA Classification: Type I__ Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: _ Coordination:(date sent) 1C LWRP Consistency Assessment Form Sent: -1 �� XI CAC Referral Sent: d- � '3 Date of Inspection: TO 2W Receipt of CAC Report:_ —/ Technical Review: –Public Hearing Held: _ Resolution: Owner(s) Legal Name of Property (as shown on Deed): Walter Gless Mailing Address: 428 Oxoboxo Dam Road,Oakdale, CT 06370 Phone Number: (860)460-9718 Suffolk County Tax Map Number: 1000- 87•-5-7 Property Location: 800 Koke Drive, Southold, NY 11971 (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Jake LaChapelle AIA - Mailing Address: P.O. Box 1251, Mattituck, NY 11952 Phone Number: (646) 251-5058 Email: waltergiess@aol.com C-q a3 \�1 LaChapelle Architecture Description of Proposed Scope 800 Koke Drive Southold,NY 11971 Tax lot SCTM#-1000-87.-5-7 In response to Trustees request,the following is a detailed project description at the above address: The proposed scope of work consists of an addition to this seasonal dwelling to bring up to zoning minimum size for single family residence,rebuild deck,and build new screened porch. Existing house irregular;approx.29'x 20.6' 611 SF Existing deck (20.6'x 10.5 + (26.3'x 6.2) 379 SF Proposed north addition: 20.4'x 5.0' 102 SF Proposed east addition: irregular;approx.. 11.0'x 20.6' 213 SF Proposed screened porch: 20.4'x 11.0' 225 SF Proposed deck infill at south: irregular;approx. 6.2'x 5.0' 21 SF A new I/A septic system will be installed in conformance with Suffolk County design and approval guidelines. Gutter,leaders,and dry wells will be installed to collect runoff in conformance with §236-7 from the existing and new impervious surfaces (roofs,etc.). In response to LWRP request a vegetated(non-turf) buffer will be included seaward of the wetland line.This buffer will be approximately 10'deep including existing vegetation. P.O.Box 1251 iblattituck,NY 11952 (646)251-5058 jake@lachapellearchitecture.com p. 1/1 r � Board of Trustees Appl__3tion GENERAL DATA Land Area(in square feet): 9,969 SF (9,548 SF buildable) Area Zoning: R-40 Previous use of property: residential Intended use of property: ,residential Covenants and Restrictions on property? Yes No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? 7 Yes _nNo If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? _Yes =No If"Yes", please provide copy of decision. his project require any demolition as per Town Code or as determined by the Building Dept.? ✓ Yes No Does the structure(s) on property have a valid Certificate of Occupancy? Yes F-1 No Prior permits/approvals for site improvements: Agency Date Town of Southold Zoning Board of Appeals Nov.2,2023 ❑ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? F-1 No ❑✓ Yes If yes, provide explanation: Project Description(use attachments if necessary): Build addition to this single family residence to bring it up to zoning minimum size requirements, rebuild and add to deck, and build new screened porch. T Board of Trustees Appl�_.Ution WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Improvements to property, code compliance. Area of wetlands on lot: 511 square feet Percent coverage of lot: 5.13 _ Closest distance between nearest existing structure and upland edge of wetlands: 1 4 feet Closest distance between nearest proposed structure and upland edge of wetlands: 14 feet Does the project involve excavation or filling? ❑ No � Yes If yes, how much material will be excavated? 6 cubic yards How much material will be filled? 0 cubic yards Depth of which material will be removed or deposited: 3 feet Proposed slope throughout the area of operations: no change(-4.5%) " Manner in which material will be removed or deposited: Excavation for crawl space for addition will be performed with earth moving equipment (e.g. backhoe). Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): The effect on wetlands and tidal waters will be negligible, as operations are limited in size, and impact will be mitigated by silt fence and double-staked straw bales to reduce control runoff. T � 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: 800 Koke Drive Project Location(describe,and attach a location map): 800 Koke Drive, Southold, NY 11971 Brief Description of Proposed Action: Build addition to this single family residence to bring up to zoning minimum size requirements, rebuild and add to deck, build new screened porch. Name of Applicant or Sponsor: Telephone: (860) 460-9718 Walter Gless E-Mail: waltergless@aol.com Address: 428 Oxoboxo Dam Road, Oakdale, CT 06370 City/PO: State: Zip Code: Oakdale CT 06370 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: The proposed action requires approval from Town of Southold Trustees,NYS DEP,Suffolk County Department of X Health,and the Town of Southold Building Department. 3.a.Total acreage of the site of the proposed action? 0.23 acres b.Total acreage to be physically disturbed? 0.013 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.23 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial 00 Residential(suburban) ❑Forest ❑Agriculture M Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 1 � 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? 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: - X 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES 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? 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 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: X 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: new I/A septic will be provide 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? X 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? 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 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 X 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO j YES If Yes, a.Will storm water discharges flow to adjacent properties? ®NO❑YES X b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ®NO❑YES Stormwater runoff from proposed new impervious surfaces will be directed to new s ormwa er detention devices rywe in con ormance with sae regu a ion. Page 2 of 4 1 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: F1 F 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: _ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE / Applicant/sponsor n e. alter GI@SS ... Date: L I Cn_/�_3 Signature:_ r Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all ofthe,.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 El ❑ 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, Elwaterbodies,groundwater,air quality,flora and fauna)? El 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 Board of Trustees Appl 3tion AFFIDAVIT. Waiter Gless BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND.THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Si ature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS _ DAY Notary Public KAYLA GODIIN NOTARYPUBLIC MY COMMISSION EXPIRES APR.30,2024 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southoid's Code of Ethics prohibits conflicts of intierest on.the part of town offiaers and employs Thic nuroose of this1orm is to provide inforination.which can.alert the.townof possible conflicts of inert st and allow it to take whatever action is necessary to avoid same: YOURNAME: Gless, Walter (Last name,firstname,jpiddle initial,unless you are applying in the nam of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you persatally,(orthrougkyow company,spouse,;sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by.blood;:marriag Lor busita;ss,interesi."Business inter ?means a business, including a partnership.,in:which thatownoffiar or emptgyce has even a partial ownership of(or employment try)a corporation in which the town officer or employee owas_more than-5%ofthe shares. YES n NO If you answered"YES",complete the balance ofthis 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): 1,A)the owner of greater.than A of the shares of the corporate stock orthe-applicput � (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-coiponite entity(whewthe :RCapplicant is not a corporations an officer,director,partner,or employee of the applicant;or D))the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this day q _20 23 Signature Pont Name. . UOa' SS Fonn TS I APPLICANT/AGENT/REPRESEN'T'ATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest-on the part of town officers and emplovees.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:-Jake LBChapell2 AIA (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.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you persbnally(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 toren officer or employce 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): _aA)the owner of greater than 5%of the shares of the corporate stock of the applicant � (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-c(irporate 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 15 'd y of Pd"W� 20 23 Signatur Print Name t f, y-er Foran TS I Board of Trustees App] tion AUTHORIZATION (Where the applicant is not the owner) I/We, Walter Gless owners of the property identified as SCTM# 1000-87.-5-7 in the town of Southold ,New York,hereby authorizes_. Jake LaChapelle AIA to act as my agent and handle all necessary work involved with the application process for permits)from the Southold Town Board of Trustees for this property. Pr perry Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS _ _ DAY OF , 20� N4ary Public KAYLA GODIN NOTARYPUBLIC MY COMMISSION EXPIRES APR.30,2024 F Board of Trustees Appii. , ion AFFIDAVIT IT 91"xan� a Calfa i roh eBEING DULY SWORN DEPOSES AND AFFIRMS THA /SHE IS THE APP ICAN OR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED.TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signa e of Property Ownee Signature of Property Owner SWORN TO BEFORE NM THIS DAY OF MARTHA LUCIA FONTANA Notary Public,State of New York NO.01 FO6181216 Qual fted In Suffolk County Not ry Pub1i "^mmission Expires January 28,20� ~-, APPI,ICANUAGENT/REPRESENTATM TRANSAMONAL DISCLOSE FORM The Town of South old's Code of Ethics mnhibits conflicts of interest on the part oftown ofRiie's and emoloYees The pnnwse of. thrs form is to provide mformatron which can alert the town of ngggble conflicts of interest and allow It to take whatever action is necessary to avoid sam YOURNAME. a Ifr29/MA e- , 11 U U17/7 e _ roast name;first name, iddle initial,unless you are applyingin the name of someone else or other entity,such as a company_If so,indicate the other person's or company's name.) NAME OF APPLICATION. (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Other Exemption firm plat or official map Planning (If"Mee,name the activity.) Do you personally(or through your company,spouse,siibling,parent;or child)have a rblationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage6 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 ofthis form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person 1 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;o'r child is(check all that apply); ELA)the owner of greater than 55A of thc shares of the corporate-stock of the applicant = (when the applicant is a eorporationj B)the legal or beneficial owner of any interest in a non-colporate entity(when the applicant is not a cotporationk -R C)an officer,director,partnee,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted,this day of0 0- Signature Print Flame 1"Yl!!1 Form IS 1 Board ,of Trustees Appl. Pion AUTHORIZATION (Where the applicant is not the owner) IIWe, Y,7-ahhe raYgol" ^p17L� owners of the property identified as SCT1M# 1000-87.-5-7 in the town of Southold ,New York,hereby authorizes Jake LaChapelle AIA to act as my agent and.handle all necessary work involved with the application process for permits) from the Southold Town Board of Trustees for this property. 'Prope Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF /_ , 200 MARTHA LUCIA FONTANA Notary Public,State of New York N0.01 F06181216 Qualified in Suffolk County N tart'Publ" -- Commission Expires January 28,20� ; Board' of Trustees. Applia on AFFIDAVIT a ' BEING DULY SWORN DEPb§i9ANb'AF S THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED (S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND kELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH I??THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING TIME TERM OF THE PERMIT. Si tore Property Owner Signature'of Property Owner SWORN TO BEFORE ME THIS DAY OFL . , 20 lic � ' APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics o phibits conflicts of interest on the part oftown officers and eniotoyees The nuraMof this form is to urovide 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: C 0 I (Last name,first name,yiiddle initial,unless yoa.atr applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or companyr's name.) NAME OF APPLICATION. (Check all that apply.) Tax grievance Building Variance Trustee ✓. Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (if`Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent;or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interesr 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 then 5°/.of the shares. YES NO If you answered"YES,complete the balance ofthis 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)andfor describe in the space provided. The town officer or employee or his or her spouse,sibling,pmA or child is(check all!Hat apply): Il,A)the owner of greatcr than 5%of thc shares of the corporate stock of the applimt � (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the Iqapplicant Is not acorporadon); C)an officer,director,pw tnei,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitte�Wa-l day of 1: '%Z,2p, Signature Print Name Form TS I Board of Trustees Appli :ion AUTHORIZATION (Where the applicant is not the owner) I/We, C1 q ol owners of the property identified as SCTM# 1000-87•-5-7 in the town of Southold ,New York,hereby authorizes Jake LaChapelle AIA to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. ZY609�ere,.s Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF .0 SGS o`�N� Still. Colo Zo�� Notary Public �,IQ��°•y � °c `� a �E Board. of Trustees Applic on AFFIDAVIT ),Q0Vtn S+Nnt BEING DULY SWORN DEPOSES AND AFFIRMS THAT SIE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES .AND CLAIMS ARISING TINDER OR.BY VIRTUE OF SAID PERMIT(S),IF GRANTEJCD. IN COMPLETING THIS APPLICATION,I.HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL, TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES.IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO UNSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF ta20 2,3 Commonwealth of Pennsylvania-Notary seal Wary Public ANDREA J VAN VOLKENBURG-Notary Public Cumberland County My Commission Expires February 23,2026 Commission Number 1322550 APPLICANT/AG ENT/REPRESENTAT'I W TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics milibim con llcts of interest on the part of town oflieera and emnlomes The ours m of ft Nm is to Mdde inlbrm3ti which can alert the town of possible amflMcts of intcrest and allow it to take whatever r!dion is necessary to amid same. YOUR NAME: S�YU n UKXI (Last name,fest name,iriddle initial,unless you am applying in the name of someona else or other entity.such as a company_If so,Indicate the other person's or company's name.) NAM OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of pint Mooring Exemption from plot or otlie®1 map Planning Other (If"Other'.name the activity.) Do you persaully(or L'uough your company,spouse.sibling,parent,or child)have a relationship with any officer or employee ofthe Town of Southold? "Relationship"includes by blood rnarriage.or business intertest"Business interest"mans a busiaes., including a partnership.in which the town officer or employee has even a partial ownership of(or employment by)a corporafzon in which the lmvn officer or employee owns more thon 51J.of the shams 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 mladorsship between yourself(the applicaat/agenthepresentative)and the town officer or employee.Ekber check the appropriate line A)through D)and/or desert be in the space provided. The town officer or employee or his or her spouse,sibling,parer%or child is(diad*all that apply): ,jA)the owner of greater thaw 3%of the shores of the corporate stock of the applicant = (when the applicant is a corporation}; B)the legal or beneficial ownerof any interest in a norrcorponcte entity(when the applicant is not a corporationX C1 an officer,director,partrwi or employee of the applicant;or D)the actual applicant DEECRUMON OF RELATIONSHIP Submitted day of 20 cx Signature _ PriniName Form T5 I i Board, of Trustees Applia, "\Ion AUMO ATION (Where the applicant is not the owner) I/We, U Iv LaYI� N ftftun k owners of the property identified as SCT1M# 1000-87.-5-7 in the town of Southold ,New York,hereby authorizes Jake LaChapelle AIA to act as my agent and handle all necessary work,involved with the application process for perinit(s)from the Southold Town Board of Trustees for this property. Property Owner's Signature Property Owner's Signature SWORN TO BEFORE IME THIS 15� DAY OF 20 a 3 It � IY'C I�it'l Public FANDREAJ Pennsylvania-Notary Seal KENBURG-Notary Public rland County pires February 23,2026 Number 1322550 Board of Trustees Appl ' tion AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS.THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Si a e of Property Owner Signature of PropertyOwner SWORN TO BEFORE ME THIS�Tr DAY OF , 20 p� Notary 'ublic MARGARET ANN MANDATO Notary Public,State of New Jersey My Copy i�lsi E ires APPLICANT/AGENT)REPRESENTATAT TRANSACTIONAL DISCLOSURE FORM The Town.of Southold's Code of Ethics rrrohibits conflicts of interest on the trarroftown ofliceis end employees The nuitfose of this form is to oMvvide information which can alert the taws of passible conflictsw r actionis -neces.sam.0avordsa_me. YOURNAME: �I.Q C LAI A-, `Zit tAA) (Last name,'firstname ipiddle initial,unless you are appiyingin the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION:(Check all that apply) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval ofplat Mooring Exemption from plat or official map Planning Other (if"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or.child)have.a Wadonship with any officer or employee ofthe Town of Southold? "Relationship"incltides by.blood,'ihddage,or business interest:"Business interest"means a business, including a partnership,in which the town officer or employce has even a partial ownership of(or employment by)a corporation in which thelown 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 appUcantlagent/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): fIA)the owner of greaterthan S%of tht 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=corparate entity(where the applicant is not a corporation); C)an officer,director,partnei,oremployee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP iso Submitted this day of U£C£-aa,et AL 20�3 Signature . Print *dam Form IS 1 Board of Trustees Applin ion AUTHORIZATION (Where the applicant is not the owner) I/We,.. �rLjAu J%�rC%1. 3aL owners of the property identified as SCTM# 1000-87--5-7 in the town of Southold New York,hereby authorizes Jake LaChapelle AIA to act as my agent and handle all necessary work involved with the application process for permits)from the Southold Town Board of Trustees for this property. Pro e O er's Signature Property Owner's Signature SWORN TO BEFORE ME TIES . � , DAY OF 20 0� otary1"(�,A5ja MARGARET ANN MANDATO Z Notary Public, State of New Jersey z My Conio Ex fires C ---- "�� __ a Board of Trustees Appli ";ion AFFIDAVIT P4VI BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE ANI)BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING'PHIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A.FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PEI RIVHT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. . 0 tel, Signature of Property Owner Signature of Property Owner " SWORN TO BEFORE ME THIS DAY OF.L)Q r-2�Zl , 20 3 nhoo-010 Notary Publi MICHELLE L TOMASZEWSKI NOTARY PUBLIC-STATE OF NEW YORK No..01 T06156671 Qualified in Suffolk County My Commission Expires 11-27-2026 APPLICAN IA.GEN UREPRESENTATM TRANSACTIONAL DISCLOSURE FORM The T wn of South d' C de E 'bits n 'cis of in o the fto Mr.—and a of this form is to provide infarination which can alert the fawn of pa�sibie conflicts ofihterestand allow It ro take whateveraction rs a to avoid same YOUR NAM . (Last name,firstname,itiddle initial,tuilessyoii are applyhtgin the name of someone else or other entity,such as a company.If so,indicate the other person's or compan}Ps Hama) NAME OF APPLICATION: (Check all that apply) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval ofplat Mooring Exemption from plator official map Planning E, Other .. - (1f"Other=°,name the activity.) Do you personally(or through your company,spouse;sibling;parent,or child)have a rclatiouship with any officer or employee ofthe Town of Southold?"Relationship"includes by blood,marriage,or busines0riterest"Business interest"means -bus'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/a of the shares. YES �— NOVI If you answered"YES",complete the balance ofthis 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 appGcant/agent/representetive)and the town officer or employee.Either check the appropriate line A)through D)and/or desegbe in the space provided. The town Officer or employee or his or her spouse.sibling,parent;d1r child is(check au am apply): _,A)the owner of greater than S%ofthc shares of the corporate stock of the applicant F (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 corporationk C)an officer,director,partner,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this day of ., 20 Signature Form TS 1 Print Name APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURT+r FORM The Town of Southoid's Code of Ethics arohibits conflicts of inbetest on thenar+of town olf'i=m and employeesh'henumose of this form is to provide mfotrnation which can alert the town of possible conflicts of interest and allow it to take whatever action Is necessary to avoid same /' ,/� YOUR NAME: - ((�MAN►'1`^ 1 P IS'� (hast name,fustnamei Jpiddle Initial.unless you ate applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or compan y s name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustx ✓ Change of Zone Coastal Erosion Approval of phd Mooring Exemption from plat or official map Planning Other Of"Other",name the activity.) Do you personally(or through your company,spouse,sitiling,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 buusioess, including a pamrershiA 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 90%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicabed. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agentimpresentative)and the town officer or employee.Either check the appropriate line A)through D)andfor describe in the space provided. The town officer or employee or his or her spouse,sibling,parent;or child is(check all that apply): _A)the owner of greater than 5%of the shares of the corporate stock of the appiiceot � (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 corporat6t C)an officer,director,partrier,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this qA y of "`v"'•' a Signature_ lil� Print Name Form TS 1 f av -N'�"r I :d of Trustees Applicatio- AUTHORIZATION (Where the applicant is not the owner) Me, , owners of the property identified as SCTM# 1000-87•-5-7 in the town of Southold ,New York,hereby authorizes Jake LaChapelle AIA to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town, Board of Trustees for this property. Property Owner's Signature Property. Owner's Signature SWORN TO BEFORE ME THIS DAY OF ,20 Notary Public Board of Trustees Apply Uon AUTHORMATION (Where the applicant is not the owner) I/We, OCA 1p.ti 5 owners of the property identified as SCTM# 1000-87•-8-7 in the town of Southold New York,hereby authorizes Jake LaChapelie AIA to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS y�k DAY OF CC 4IZf , 20.23 _ Notary Publi MICHELLE L TOMASZEWSKI NOTARY PUBLIC-STATE OF NEW YORK No. 01T06156671 Qualified in Suffolk County My Commission Expires 11-27-2026 Boa; of Trustees Application AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS THAT ISE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO;HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH.THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF , 20 Notary Public n,oard of TrusteesApplication AFFIDAVIT r � 11 BEING DULY SWORN DEPOS S AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)'AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO'INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. e �G Signa Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS L4+I % DAY OF 20,Q U I Notary Pu is 0 MICHELLE L TOMASZEWSK1 NOTARY PUBLIC-STATE OF NEW YORK No. 01706156671 Qualified in Suffolk County My Commission Expires 11-27-2026 o i APPLICANT/AGENT/REPRESENTATIVE - TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide inforination which can alert the town of Wssible conflicts of interest and allow it to take whatever action is necessary to avoid same. � YOUR NAME: , t ce_C� S (Last name,first name,qiiddle initial, less you are applying id the name of someone else or other entity,such as a company.If so,indicate the.other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance. Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other,name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee by blood,marriage,or business interest."Business interest"means a business, of the Town of Southold? "Relationship"includes including a partner ip,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town fficer 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,11 Title or position of that person e'e —- - '^ = -•� Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP C,. � �n►o r O �iS��� Submitted this L& day of 203 Signature R _ Print Name mmi'r—Li Form TS 1 f MICHELLE L TOMASZEWSKI NOTARY PUBLIC-STATE OF NEW YORK No. 01TO6156671 Qualified in Suffolk County My Commission Expires 11-27-2026 a� 7W e - .of ,"o f dg, �a Board of Trustees Applica )n AUTHORIZATION (Where the applicant is not the owner) I/We �0.`� J1 1 _ owners of the property identified as SCTM# 1000- in the town of TAKE &A- U.E'O � ,New York, hereby authorizes to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. Property Cfn1r'L Signature Property Owner's Signature SWORN TO BEFORE ME THIS L4 DAY OFA c ty. )z4 ,. , 20�2;? Notary Public MICHELLE L TOMASZEWSKI NOTARY PUBLIC-STATE OF NEW YORK No. 01T06156671 Qualified in Suffolk County My Commission Expires 11-27-2026 Board of Trustees Appl, '►tion AFFI]DAV�'I` \�V M BEING DULY_SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED—IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES;THEIR AGENT(S)OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. ' Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS L ! DAY OF �J?C ,2013-- ANDREW KAYE NOTARY PUBLIC•STATE OF NEW YORK No,01KA0o14887 NO b1icQuuilfled In Suffolk County QflF MIdelon Expires October 25,2o27 APPLICANT/AGENT/IWRESENTATM TRANSACTIONAL DOCLOSURF FORM The Town of Sauthotd's Code of Ethics Whil)&-mg1ja afint on the hart oftown ofI'Kxrs anal emda ,,The nuMose of No form is ba tsroyide information winch can alert the w m of p9j4bk conflicts of i Mag and allow it to take whateyundoo 15 ne�ssar1►to midsame. YOUR NAME: (Last naahe,fast name ipiddle initial unless you ate applying in the name of someone else or othoc entity,such as a may.If so,indicate the other person's or cotmpagy's nine.) NAME OFAPFI,ICATION: (Check all the spply) Tax gnevance Building Variance TMACC ✓ Change of Zone Coastal Erosion Approval ofplst Mooling Exemption from plat or offciel map Planing Other Of"Other,nwft the activity.) Do you petsimally(or Rough your company,spoor,sj,&&parent;or child)lhave a r 1adonsldp with any officer or employee of the Town of Southold? "ReMonsW inchrdes by blood,marriage,or bmbxw iti%=L"Bcsiness intertest='means a hiWaaM irutudntg a partnership,in which the town officer or employee has even a pallial ownehship of(or employment by)a corpom ion in which the town officer or employee owns mine than 5%of the shares YES — 1:1 NO , Iq _ if you answered"YES",wmpietathe Wdauce ofthis foam and date and sign where ind'hca A Name ofpetson employed by the Town of Southold Tittle lir position of that person Describe the relationship between yourself(the and the town officer or employe.Either chock the appropriate line A)through D)and/or descrt'be in the space provided. The town officer or employee or his or her spouse,sibling pates or child is(check all tis!apply): IIA)the owner of greaser than 5%of the shares of the corporate stock of the applicant � (when the appticatht is a O"paration); B)the Iegal or beneficial owner of any interest in a mon-earpon#e entity(when the applicant is not a corpondt nk an officer.dim pmtw,oremptoyce of the appliean4 or D)the setae/applicant: DESCRIPTION OF RELATIONSHIP Submitted b" ofd.h � Z 20'a3SignatureI�4�_ Form IS l Printwilme Boards of Trustees Appli, :ion AU'THORIZATION (Where the applicant is not the owner) I/We, � GmA"&y s owns of the property identified as SCTW 1000-$7.-5-7 in the town of Southold .New York,hereby authorizes --- Jake LaChapelle AIA to act as my agent and handle all necessary work involved with the application process for pmmit(s)from the Southold Town Board of Trustees for this property. Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF��C ,20 ANDREW KAYE Notary NOTARY PUBLIC-STATE OF NEW YORK No.01KA0014887 Qualified in Suffolk County Commission Expires October 25.2027 Board of Trustees Appl:_ ,tion AFMAVff � BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERNIIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND`BELIEF,AND THAT ALL WORK WI L BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE _ BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERNUT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE.PREMISES IN CONJUNCTION WITH THIS-APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERNIIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. ' Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS I 1� _DAY OF 20 Notary Public DREW D. CASS NOTARY PUBLIC,STATE OFNEWYQRg Registration No.OICA6298761 Qualified in Suffolk County Commission Expires 17 March 2026 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FARM The Town of Southotd's Code of Ethics Prohibits eanflicts of interest on the Md of town off cies and cmflIQM The nnroose of this forth to to tuavrde information which can alert the town ofssibte conflicts of interest and allow it to take whatever action is necessary to avoid same/.' YOURNAME: (Last name,fust name,ipiddle Initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company s name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance .Building Variance Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other Of"Othce%name the activity.) Do you personally(or through your company,spouse,sibling,,parent,or child)havea,relationship with any officer or'employee of the Town of Southold? "Relationship"inchrdes by blood,'maMag,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 empioymnent by)a corporation in which the town officer or employee owns more than 50%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(chedc all that apply): _aA)the owner of greater than 5°/D of the shares of the cotporatc stock of the applicoat I (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 corpo do'nk � C)an officer,director,panne',or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this / day of 20 O� Signature Form TS 1 Print Name^� 6 ( ✓�/2PnS: Bd of Trustees Applicatio: AUTHORIZATION (Where the applicant is not the owner) I/We, owners of the property identified as SCTM# 1000-87•-5-7 in the town of Southold ,New York,hereby authorizes Jake LaChapelle AIA to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF ,20 Notary Public Board of Trustees APP1 , =on AUMORWATION (Where the applicant is not the owner) owns of the properly identified as SCTM# 1000-87.-5-7 in the town of Southold .New York,hereby authorizes _. Jake LaChapelle AIA to act as my agent and handle all ney work involved with the application process for penait(s)from the Southold Town Board of Trustees for this properly. //9 z z' Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS I 1 DAY OP - 20 3 Notary Public DREW D.CASS NOTARY PUBLIC,STATE OFNEWYORK Registration No.01CA6298761 ,Qualified in Commission Expires 1 arch County026 )ard of Trustees Applicat__ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS APPLICATION NAME & SCTM#: NAME: S-? -S-- STATE OF NEW YORK COUNTY OF SUFFOLK residing at being duly sworn, deposes and says that on the day of , 20 , deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite their respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office located at , that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Signature Sworn to before me this Day of , 20 Notary Public Board of Trustees 'Application PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS APPLICATION NAME& SCTM#: GleSS SCTM #1000-87.-5-7 NAME: ADDRESS: 1000-87.-5-6: Angela Salerno & Paul Salerno - 879 Maloon Ave, Franklin Square, NY 11010 1000-87.-5-8: Shaw Hana Rev Living Trust - 11520 Lockhart PI, Silver Springs, MD 20902-3165 1000-87.-5-12.2: Anthony R. Daniele - P.O. Box 150, Southold, NY 11971 1000-87.-5-12.3: Suffolk County - Peter Belyea, Dept of Economic Development & Planning, 100 Veterans Memorial Hwy, Floor 2, Hauppauge, NY 11788 1000-87.-5-15: Matthew Zand & Maria Manfre-Zand - 1136 Lorraine Dr, Franklin Square, NY 11010 1000-87.-5-16.1: Regina Calcaterra &Todd Ciaravino - 250 Oak Rd, New Suffolk, NY 11956 STATE OF NEW YORK COUNTY OF SUFFOLK Jake LaChapelle AIA ,residing at 1870 Ole Jule Lane Ma�ttituck, NY 11952 , being duly sworn, deposes and says that on the Z(�" day of k1kj& i' , 20 Zq, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite their respective names;that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold;that said Notices were mailed at the United States Post Office located at TUB-- ,that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. qj� Signa Sworn to before me this Day of rA 4 ,20 6.1 A�w DIANE DISALVO Notary Public NOTARY PUBLIC-STATE OF NEW YORK No. O1 D1475593 Qualified in Suffolk County My Commission Expires April 30, 20z�. 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F` ° VF -- n p -------- ------- - o. -� No ------------------------------------- - ivy lq f A)o o - .- I a ' 1 " � _ •: - - icy '��E��„- )z�2,6 2023 . a-.a-•- W: \ 111 f .111 w ' NOTICE OF HEARING NOT E IS HEREBY GIVEN Mat a Public Hearin'Weil be held by Me Southold Town Board of Trustees at the Tawn Hall,S3M Main Road,S-Mold,New York,C-11ning thls property. OWNE,XD9FRECORO WAITER G1ESS SUBIFROF PUBLIC HEARING Fora Wetland Permingit for the as-bulh demoBtwn p/eai,nn, - � '�;' approa t ty 29'a20.6'(611sq N.)ono story dwell wM a[taMed>s bulN 20 6'el0 S'and �� 26 3'a6 i d k as-bu N replacement o/daistM!footings at the dick and seawartl pdrtbn of the -sir Y N.s,_tir'•+� dwelfln[and new f.o 0 proposed for the upland pO.On;footings t0 be provided under the 'M proposed teen porch and a f...nation Well Wlth flood vent,tp be Installed under the ( .' prapoud north and east addltlons,proposed 10 a'a5'(IOisp N.)One u,,_north addition; 1 sue, Pfppptee Rte[ula'IV shaped 1V1 6'(213s4N)east addition,0ropota020.4'al1'(225t4 —7 1-1—ed-1n porch;propoud IrnBWarly MrlW t6.3'aS'tourh deck addIvOn/inhll. t� abandon eekting xpHc,ytMm arts M,tallanl/4OWt5 system landward of dWell:n6lmtall e [utters to lead.,,to drywalls to ron[ain roof runoff;and to Inftall a ve8etated 10'wide non.d e buffer along the landward edge of weliand,.Iontad)001(oke 0r1ve,SouMeld.X W 10 6)S) TIT�.1E 8 OATE Oi PUBLIC Hl ARItiG:Wedn•ay,January 17,2024-at ar about 5:300.M.tt sou beta an me.a�a t t mW.ct you an mden se wew arse)o.r,hH(d wn:cn are - avMbMe onllrw rt wvw.southoltlrvWn,w.eea aM/d In the trustee pan wnll to Ma tlaY of Me nearh,a OeY�nBtm3lml^.ck pk4 Nxw. bnirlNiM rE) os so •(utl t,sspt ) �� i��• --�.-..� 1t � Lea �.-aYtt/ �;� � pia. _,.: _ti._ ��•R�:�±=-�..r� Glenn Goldsmith,President S�E 014, Town Hall Annex A.Nicholas Krupski,Vice President „�� Gym 54375 Route 25 Eric Sepenoski H " P.O.Box 1179 Liz Gillooly p 'i Southold,NY 11971 Elizabeth Peeples 'y?1�1 �ao�cr Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of WALTER GLESS COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING yD.0rJV :" fiE 'HI ` ®R1Vl� TIL _ ,aSII�ASRMN � I1L1�CCE+ ®=R�1T LEAS� VEI `DAY'd� TOTHEPUBMA' HEAR,,,, C'O P TE=PHIS DY LIB HTH_DA,Y ORAL 4T R I, KILKE ,residing at/dba �0 0l.� d v(,r being duly sworn, depose and say: That on the Zb day of -VE "13,M20 2 3, I personally posted the property known as 000 Ko((� P12-I yul , so o NO up , A)V / l q' I l by placing the Board of Trustees official noticing poster where it can easily be seen from the street, and that I have checked to be sure the noticing poster has remained in place for a full seven days immediately preceding the date of the public hearing. Date of hearing noted thereon to be held Wednesday,January 17,2024. Dated: R 20 Zy (si ature) Sworn to before me this day of Ttq.20 2*: DIANE DISALVO NOTARY PUBLIC-STATE OF NEW V4RK No. O1 D1475593 Quo i d In Suffolk County Notary Public My Commission Expires April 3U. z,;moo. NOTILEL. OF Ht:Am1 %,11NG NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: WALTER GLESS SUBJECT OF PUBLIC HEARING: For a Wetland Permit for the as-built demolition of existing approximately 29'x20.6' (611sq.ft.) one-story dwelling with attached as-built 20.6'x10.5' and 26.3'x6.2' deck; as-built replacement of existing footings at the deck and seaward portion of the dwelling and new footings proposed for the upland portion; footings to be provided under the proposed screen porch and a foundation wall with flood vents to be installed under the , proposed north and east additions; proposed 20.4'x5' (102sq.ft.) one-story north addition; proposed irregularly shaped 11'x20.6' (213sq.ft.) east addition; proposed 20.4'x11' (225sq.ft.) south screened-in porch; proposed irregularly shaped ±6.2'x5' south deck addition/infill; abandon existing septic system and install an I/A OWTS system landward of dwelling; install gutters to leaders to drywells to contain roof runoff; and to install a vegetated 10' wide non-turf buffer along the landward edge of wetlands. Located: 70.0 Koke Drive, Southold. SCTM# 1000- 87-5-7 TIME & DATE OF PUBLIC HEARING: Wednesday, January 17, 2024 — at or about 5:30P.M. If you have an interest in this project, you are invited to view the Town file(s) which are available online at www.southoldtownny.gov and/or in the Trustee Office until to the day of the hearing during normal business days between the hours of 8 a.m. and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 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# 87. - 5 - 7 The Application has been submitted to(check appropriate response): Town Board ® Planning Dept. F Building Dept. ® Board of Trustees 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: Build addition to this single family residence to bring up to zoning minimum size requirements, rebuild and add to deck, build new screened porch. Location of action: 800 Koke Drive, Southold, NY 11971 Site acreage: 0.23 acres Present land use: seasonal dwelling / single-family residential Present zoning classification: R-40 "Low-Density Residential District" 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: Jake LaChapelle AIA (b) Mailing address: P.O. Box 1251 Mattituck, NY 11952 (c) Telephone number:Area Code( ) (646) 251-5058 (d) Application number, if any: not available Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No® If yes,which state or federal agency? 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. X]Yes ❑ No ❑ Not Applicable Koke Drive is an established suburban neighborhood in Southold hamlet in the Town of Southold. The proposed action of this application reinforces the character of this neighborhood in support of the hamlet center. It does not impact rural or agricultural lands, and maintains a clear sense of separation between hamlet and countryside. It proposes to enhance a stable residential area and doesn't develop agricultural land, open space, or sensitive coastal areas. The proposed action reinforces the traditional land use pattern of the hamlet, and the Town of Southold. 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 ❑ Not Applicable The proposed action does not impact identified archaeological resources of the Town of Southold. Potential adverse impacts on any nearby historic resources are not expected due to the modest scale of alterations to this existing non- historic structure. The improvements support the character of this maritime area, though the project site in not within the notable historic maritime areas of the Town of Southold. 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 0 Not Applicable The proposed action will minimize discordant design components and will remove the degraded existing structural elements and replace them. Alterations to the home and siting of the addition away from the water will continue to be compatible with the area, in support of the goal of improving the visual quality associated with the hamlet areas and the Town of Southold. Full-cutoff lighting will be provided. Existing vegetation will not be impacted. Minimal plantings can be provided at the front to enhance visual quality at the street. 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 E No 0 Not Applicable The project site of the proposed action is within the 100-year flood plain (not within a FEMA Zone AE) and work will comply with town Code Chapter 1448 and NY State Building Code Appendix G for flood resistant construction. The siting of the new components ensures that construction does not impact existing natural vegetation, and does not impact existing drainage contours. The proposed drywell will reduce surface runoff and presumably reduce future erosion on site. The resultant reduction of runoff to surrounding upland sites-however small -enhances the capacity of surrounding natural protective features to accept surface runoff from other unrelated sources, benefiting the public. 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 ® YesEl No E]Not Applicable The proposed action does not increase bed count, yet includes an I/A septic system to reduce nitrogen discharge to the water supply and Corey Creek. As detailed above surface runoff will be reduced by the addition of a drywell to accept rain water from the additional roof/impervious surface. Overall the approach reduces the current impact on water quality and coastal waters from the minimal runoff from the existing roof. Additionally the owner will encourage the use of dust collection during construction -especially when cutting PVC products (e.g.Azek)to minimize the runoff of microplastics. Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. © Yes E No 0 Not Applicable While the beneficial impact of the proposed action is not large, the introduction of the I/A septic system and the capture of runoff from the structure is expected to have a beneficial impact on water quality. The scale of the action is minimized on site and restricted generally to areas already developed. 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 The proposed action does not introduce new sources of air contaminants, and is expected to have no impact on NOX emissions from automobiles. 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 ❑ Not Applicable The proposed action will seek to reduce the production of solid waste typical to the construction process by looking to re- use construction materials where feasible (e.g. 2x4 studs, rafters, etc.). The renovated home is not expected to generate additional solid waste once in use. 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. ® Yes:] No❑ Not Applicable The proposed action neither enhances nor degrades public access (physical or visual) to coastal waters, public lands, and public resources of the Town of Southold. 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 The proposed action supports continued appropriate use of the Town of Southold's water-dependent uses- including Marine I and Marine II districts-by continuing the siting of uses that are not water dependent elsewhere in this R-40 district. 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 ❑ Not Applicable The proposed action will neither enhance nor degrade sustainable use of the living marine resources in local waterways. 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 F-1No❑ Not Applicable The proposed action neither develops nor encroaches on agricultural lands of the Town of Southold. 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 0 Not Applicable The proposed action supports the Town of Southold's goals of promoting energy efficient design by meeting and exceeding the Energy Conservation Code of the State of New York. Created on 5125105 II:2O AM