HomeMy WebLinkAbout#8035SE-615 Pike St LLC ZBA application st
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FORM NO. 3 JUN 13 2025
TOWN OF SOUTHOLD
BUILDING DEPARTMENT Zoning Board of Appeals
SOUTHOLD,N.Y.
NOTICE OF DISAPPROVAL
DATE: May 7, 2025
TO: 615 Pike St LLC
350 Brook Ln
Southold,NY, 11971
Please take notice that your application dated March 20, 2025:
For permit to: construct a one-story commercial building with 4 retail/takeout units and
basement storaize at:
Location of property: 615 Pike Street, MattitLick,
County Tax Map No. 1000- Section 140 Block 2 Lot 21
Is returned herewith and disapproved on the following grounds:
The proposed construction in the zoning district HB is not permitted pursuant to Article
X. Section 280-45 (B-9), which requires a special exception from the zoning board.
In addition. the proposed construction requires site plan approval from the Southold
Town Planning Board.
You may now apply to these agencies directly.
af-W X- �)Wwkj
AViorized Signat r)
Note to Applicant: Any change or deviation to the above referenced application,
may require further review by the Southold Town Building Department.
CC: file, Planning Board
CC: file, ZBA
A M P Architecture Address:10200 Main Road,Unit 3A,Mattituck NY 11952
Phone:(631)603-9092
Design + Build
Received a �
JUN 1, 3 8
Zoning Board of APP0 5
Southold Town Zoning Board of Appeals
54375 Route 25
Southold, N.Y.11971
Re:615 Pike Street LLC
615 Pike Street
Mattituck, N.Y.11952
SCTM#1000-140-02-21
Dear Board Members,
AMP Architecture represents the owner of the above mentioned property.
Our application is for a Special Exception permit to apply for a new commercial building within
the Hamlet Business District of Mattituck.
Two of the proposed units within the building are proposed to be retail take-out which is a
permitted use,with the grant of a special exception permit, under Southold Town code
280-45 (B)(9).
Thank you,
Anthony Portillo
Principal, RA
AMP Architecture
(631) 603-9092
ZONING BOARD OF APPEALS
TOWN OF SOUTHOLD, NEW YORK � �.f�l.'
Phone 631 765-1809
APPLICATION FOR GENERAL SPECIAL EXCEPT irtg 13aardt Appear
Applicant(s)/Owner(s): 615 Pike St. LLC
Parcel Location: House No. 615 Street Pike St Hamlet Mattituck
Contact phone numbers: 631-603-9092 Email: dscharadin@amparchitect.com
SCTM No. 1000 Section 140 Block 02 Lot(s) 21 Lot Size.5 Acres Zone District Hamlet Buisneess(HB)
hereby apply to THE ZONING BOARD OF APPEALS for a SPECIAL EXCEPTION in accordance with
the ZONING ORDINANCE, ARTICLE X , SECTION 280-45 , SUBSECTION (B-9)
Please indicate Special Exception criteria/requirements are met,if any: Proposing (2) retail take-out
units in new commercial building
for the following uses and purposes: retail take-out
As shown on the attached survey/site plan drawn to scale. Site Plan review [X] IS or I ] IS NOT required.
Name of Agent/Representative: Anthony Portillo, AMP Architecture for(x) Owner( )Other:
Address: Po Box 152, Mattituck, N.Y. 11952
Telephone: 631 603 9092 Email: dscharadin@amparchitect.com
A. Statement of Ownership and Interest:
615 Pike Street LLC (Stephan Mazzella) is(are)the owner(s)of property known and referred
to as 615 Pike Street, Mattituck, NY 11952
(House No., Street, Hamlet)
identified on the Suffolk County Tax Maps as District 1000, Section 140 Block 02 Lot 21
and shown on the attached deed. The above-described property was acquired by the owner on April 2024
B. The applicant alleges that the approval of this exception would be in harmony with the intent and purpose of said zoning
ordinance and that the proposed use conforms to the standards prescribed therefore in said ordinance and would not be detrimental
to property or persons in the neighborhood for the following reasons:
The proposed commercial building is allowed by code at this property
C. The property which is subject of this application is zoned Hamlet Business and[ ] is consistent with the use(s)described
in the Certificate of Occupancy(attach copy),or [ ] is not consistent with the Certificate of Occupancy being furnished herewith
for the following reason(s):
Please indicate(check)whether premises is vacant land: [X]
Zoning Board of Appeals YU
APPLICANT'S PROJECT DESCRIPTION
oniny r3oarci of APP0010.
Please complete sections below that apply
APPLICANT: AMP Architecture (Anthony Portillo) SCTM No. 1000-140-02-21
1. For Demolition of Existing Building Areas
Please describe areas being removed: N/A
II. New Construction Areas(New Dwelling or New Additions/Extensions):
Dimensions of first floor extension: 84'-0" x 61'-0"
Dimensions of new second floor: N/A
Dimensions of floor above second level: N/A
Height(from existing natural grade): 26'-7"
Is basement or lowest floor area being constructed? If yes, please provide height(above ground) measured from
natural existing grade to first floor: 4"
III.Proposed Construction Description (Alterations or Structural Changes)
(Attach extra sheet if necessary). Please describe building areas:
Number of Floors and General Characteristics BEFORE Alterations: Vacant Lot
Number of Floors and Changes WITH Alterations: Proposed 1 story commercial building with basement storage
and proposed septic system
IV. Calculations of building areas and lot coverage,GFA,sky plane(From Surveyor,Design Professional):
Existing square footage of buildings on your property: Vacant Lot
Proposed increase of building coverage: 4,742.0 S.F.
Square footage of your lot: 22,811.0 S.F.
Percentage of coverage of your lot by building area(lot coverage) 20.8%
Gross Floor Area (GFA)of a residential dwelling on a residential lot, including the attached garage and/or habitable
detached accessory structure: (Please refer to Chapter 280, Section 280-207 of the Town Code):
N/A
For Residential dwellings on Residential lots, is project within the allowable Sky Plane?(Please refer to Chapter
280, Section 280-208 of the Town Code):
N/A
V. Purpose of New Construction: Proposed 1 story commercial building with basement storage and
partial attic
VI.Please describe the land contours (flat,slope %, heavily wooded, marsh area,etc.) on your land and how it
relates to the difficulty in meeting the code requirement(s): Describe on separate page if needed:
Property is flat
Please submit 8 sets of photos,labeled to show different angles of yard areas after staking corners for new
construction,and photos of building area to be altered with yard view.
Zoning Board of Appeals-Page 2-Application—Special Exception-General
General Standards please answer the following as it pertains to your project:
JUN '1 202
A. The use will not prevent the orderly and reasonable use of adjacent properties or of properties in adjacent use districts
BECAUSE:
honing Board of Appeals,
Majority of neighboring properties are existing commercial buildings, some being 2 stories.
B. The use will not prevent the orderly and reasonable use of permitted or legally established uses in the district wherein
the requested use is located or of permitted or legally established uses in adjacent use districts BECAUSE:
Neighboring commercial buildings have retail units and retail take-out units.All required parking for this proposed building
will be kept within the properties boundaries.
C. The safety, the health, the welfare, the comfort, the convenience or the order of the town will not be adversely affected
by the proposed use and its location BECAUSE:
Pike Street is perpendicular with Love Lane which is part of the same Hamlet Business district.
D. The use will be in harmony with and promote the general purposes and intent of Chapter 280-142 BECAUSE
The proposed uses within the commercial building are allowed by code and in harmony with other established businesses
within this business area
E. The use will be compatible with its surroundings and with the character of the neighborhood and of the community in
general,particularly with regard to visibility, scale and overall appearance BECAUSE:
The proposed 1 story commercial building is designed to compliment both commercial and residential buildings within the
neighborhood. The design utilizes exterior building materials that are copastethic to neighboring buildings
F. All proposed structures, equipment, and material shall be readily accessible for fire and police protection BECAUSE:
The proposed building is designed to meet all currrent Commercial Building Codes as established by NY State and the
local municipality.
G. The proposal shall comply with the requirements of Chapter 236, Storm-water Management BECAUSE:
By signing this document,the PROPERTY OWNER understands that pursuant to Section 280-141D [including
280-1411)(1),D(2),D(3)] of the Code of the Town of Southold,a violation of any limitation or condition of a
special exception approval or of any provision of this chapter applicable to a special exception use shall constitute
a violation of this chapter.The Zoning Board of Appeals shall retain jurisdiction and shall have the right, after a
public hearing,to modify,suspend or revolve such approval or any term or condition thereof or to impose
thereon one or more new conditions,all on the grounds listed in Chapter 280-141D [including 280-1411)(1),D(2),
D(3)] of the Code of the Town of Southold. FURTHERMORE,IT IS THE PROPERTY OWNER'S
RESPONSIBILITY TO ENSURE COMPLIANCE WITH THE TOWN CODE REQUIRED TIME FRAME.
SEE CH PTER
'l di:)T,�( Y PifEil_IC,$TAPE Car NEW YORK
o Z�c,istr tion l`,lo. 01A1)0019644
ni alified in Si ffolk County of Applicant or Authorized Agent
must submit written Authorization from Owner
_ss<)n ' xpires January 9, 2028 (Agent )
Aow 0 V, —A �?_o
COUNTY OF SUFFOLK) PRINT NAME
ss.:
STATE OF NEW YORK)
Sworn to before me this 9Z day
of ,jcgr� 20 � a D[yaCc Cam.
(Notary Pk
Revised:03/2024 c iv di, _ (6
QUESTIONNAIRE SPECIAL EXCEPTION JUN 1. 3 2025
FOR FILING WITH YOUR ZBA APPLICATION
Zoning Board of Appeals
a) Has a determination been made regarding Site Plan review? X Yes No
If no, please inquiry with the ZBA office. If site plan is required,you may apply to the Planning Dept. at the
same time so both applications can be reviewed concurrently.
b) Are there any proposals to change or alter land contours?
a. X No Yes, please explain on attached sheet.
c) Are there areas that contain sand or wetland grasses? No
d) Are those areas shown on the survey submitted with this application? N/A
e) Is the property bulk headed between the wetlands area and the upland building area?
N/A
f) If your property contains wetlands or pond areas, have you contacted the Office of the Town Board of Trustees
for its determination of jurisdiction? N/A
Please confirm status of your inquiry or application with the Trustees: N/A and if
issued, please attach copies of permit with conditions and approved survey.
g) Is there a depression or sloping elevation near the area of proposed construction at or below five feet above
mean sea level? No
h) Are there any patios,concrete barriers, bulkheads or fences that exist that are not shown on the survey that you
are submitting? No Please show area of the structures on a diagram if any exist or state none on the
above line.
i) Do you have any construction taking place at this time concerning your premises? No If yes, please submit a
copy of your building permit and survey as approved by the Building Department and please describe:
j) Please attach all pre-certificates of occupancy and certificates of occupancy for the subject premises. If any are
lacking, please apply to the Building Department to obtain copies of them.
k) Do you or any co-owner also own other land adjoining or close to this parcel? Yes . If yes, please label the
proximity of your lands on your survey.
1) Please list present use or operations conducted at this parcel Vacant Lot
and the proposed use 1 story commercial building with basement storage and
partial attic . (ex: existing single family, proposed: same with garage,
pool or other or vacant proposed office with apartments above, etc.)
Aut signature and Date
Prini Name and Title(Owner,Representative)
r
Yrra" za TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE Received
o � SOUTHOLD, NY
y�io �ss .1lJN 202
BUILDING PERMIT Zonirig Hoard of Appeals
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 44678 Date: 2/11/2020
Permission is hereby granted to:
Olde Colonial Place LLC
45 Broidy Ln
Southhampton, NY 11968
To: Demolish an existing building as applied for.
At premises located at:
615 Pike St, Mattituck
SCTM #473889
Sec/Block/Lot# 140.-2-21
'Pursuant to application dated 1/27/2020 and approved by the Building Inspector.
To expire on 8/12/2021. `
Fees:
DEMOLT $683.50
Total: 683.50
Building Ins ector
pc so
BOARD MEMBERS ®�� South
Leslie Kanes Weisman,Chairperson ® 53095 Main 6x 179
Southold,NY ll971-059.
Patricia Acampora Office L" 202`3
Eric Dantes ® aQ Town Annex/First Floor,
Robert Lehnert,Jr. ®�� 54375 MaiE p a(3Ym* liv.E�41"a1
Nicholas PIanamento COUI ,� Southold,NY 11971
http://southoldtownny.gov RECEIVED
ZONING BOARD OF APPEALS -�;t.6 � 3;3N-?m
TOWN OF SOUTHOLD APR - 3 2019
Tel.(631)765-1809•Fax(631)765-9064 10 � aMa
Sou old Town Clerk
FINDINGS, DELIBERATIONS AND DETERMINATION
MEETING OF MARCH 28,2019
ZBA FILE: #7248
NAME OF APPLICANT: Olde Colonial Place,LLC
PROPERTY LOCATION: 50 Pike Street, Mattituck,NY SCTM#1000-140-2-21
PROPERTY FACTS/DESCRIPTION: Olde Colonial Place, LLC, owns the property located at 50 Pike Street,
Mattituck, NY. SCTM#1000-140-2-21. The current property is a 23,809 square foot lot with a large older home
(to be demolished) that has multiple occupants and is located in the FIB District in Mattituck. Pike Street has
several established businesses, single family residences, a municipal parking area to the south and the Mattituck
Fire Department next to the parking area in the direct vicinity of this property. Love Lane is the main road that
runs south and north from Route 25 (Main Road)to County Road 48 (Middle Road)and Pike Street intersects Love
Lane to the west and east. To the west on Pike Street are retail businesses on the south side of the road and the
Long Island Railroad station on the north side. The applicant's 23,809 square foot parcel has 130 feet frontage on
Pike Street on the southerly line, the westerly line measures 159.02 feet, the northerly line measures 130.93 feet
with the Long Island Railroad tracks directly to the north, and the easterly line measures 198.30 feet. This is a very
busy area as the Love Lane area and its shops attract both local residents and visitors to the area especially during
the summer season and holiday season.
SEORA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this
application and determines that this review falls under the Type II category of the State's List of Actions, without
further steps under SEQRA.
LWRP DETERMINATION: The relief, permit, or interpretation requested in this application is listed under the
Minor Actions exempt list and is not subject to review under Chapter 268.
TOWN OF SOUTHOLD PLANNING BOARD: This application was referred to the Planning Board for review
and comments. In a memorandum dated March 13, 2019, the Planning Board indicated their support of an
interpretation that the bulk schedule applies to each building as opposed each use within one building in the Hamlet
Business"HB"Zoning District,
The Planning Board, as part of their review, took into consideration this Board's previous decision in Appeal
#5383 (hereinafter"the Malon decision"). The Planning Board noted that in Malon the ZBA determined that based
on the wording in what was previously § 100-102 and is now section 280-49, the bulk schedule of a minimum lot
size requirement applies to each building, rather than to every use or occupancy within a building. The Planning
Board went on to note that that same exact wording that is contained in § 280-49 for the B Zoning District, is
present in § 280-46 for the HB Zoning District.
Page 2, March 28, 2019 Received
#7248, Old Colonial Place
SCTM No. 1000-140-2-21 JUN
a
Zoning Board of4Appeal
The Planning board also stated that this interpretation would be consistent with the goals and purpose of the HB
Zoning District.
BASIS OF APPLICATION: This is a request under Section 280-146D for an Interpretation of the Town Code,
Article X, Section 280-46"Permitted Uses", appealing the Building Inspector's October 5,2018 Notice of
Disapproval that the proposed construction of four retail stores in a single building at the property located at 50
Pike Street,Mattituck,NY. SCTM#1000-140-2-21 construction is not permitted pursuant to Article X,280-46
which states,
"No building or premises shall be used and no building or part thereof shall be erected or altered in the HB
District unless the same conforms to the Bulk Schedule and Parking and Loading Schedules incorporated
into this chapter by reference with the same force and effect as if such regulations were set forth herein in
full."
According to Bulk Schedule 20,000 square feet of property is required for each principal use. There are four
principal uses for retail space being proposed on this 22,809 square foot lot. �
RELIEF REQUESTED: The applicant requests a determination that the bulk schedule for the HB Zoning District
should be interpreted as applying to each building rather than each use or occupancy within a building and that the
proposed construction meets the bulk schedule for minimum lot size under section 28046 of the Town Code. The
applicant cites to the Board's decision in Malon as precedent because the language considered by the Board in that
decision, although addressing a different zoning district, is identical to language contained in section 280-46undr
consideration here.
ADDITIONAL/BACKGROUND INFORMATION: In 2015, the Planning Board asked this Board for an
interpretation (Appeal # 6885) as to the effect of the Malon Decision. That is, whether or not the Malon decision
was intended to apply to all zoning districts or just the Business B"' Zoning district. At that time the board
rendered a decision that since the only matter before the Board at the time of the Malon decision was the issue of
the application of bulk district in the B zoning district, that the determination in the Malon decision was only
applicable to the B Zoning District.
FINDINGS OF FACT/REASONS FOR BOARD ACTION:
The Zoning Board of Appeals held a public hearing on this application on March 14,2019 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:
In the 2004 Malon decision, this Board was asked to interpret what was at the time, section 100-102 of the Town
Code based on a Notice of Disapproval from the building department which found that the proposed construction
of a building, containing up to 8 different uses, on a 53, 821 square foot lot in the Business`B"Zoning District was
not permitted because, in part, because the bulk schedule required a minimum lot size of 30,000 square feet per
use. Since the Malon decision, section 100-102 has been renumbered to Section 280-49, but still reads the same:
§280-49 Bulk, area and parking requirements.
No building or premises shall be used and no building or part thereof shall
be erected or altered in the B District unless the same conforms to the Bulk
Schedule and Parking and Loading Schedules incorporated into this
Received ,
Page 2, March 28, 2019 JUN 13 202
#7248, Old Colonial Place
SCTM No. 1000-140-2-21 Zoning Board of Appeals
chapter by reference, with the same force and effect as if such regulations
were set forth herein in full.
Here,the applicant applied to construct a building containing four principal uses for retail space on 22,809 square
foot lot in the Hamlet Business"HB"Zoning District,which requires a minimum lot size of 20,000 square feet.
Similar to the circumstances in Malon, the building department has issued a Notice of Disapproval stating that the
proposed construction does not comply with the bulk schedule, in that,the bulk schedule requires 20,000 square
feet per use pursuant to section 280-46. Section 280-46 states as follows:
§280-46 Bulk, area and parking regulations.
No building or premises shall be used and no building or part thereof
shall be erected or altered in the HB District unless the same conforms to
the Bulk Schedule and Parking and Loading Schedules incorporated into
this chapter by reference, with the same force and effect as if such
regulations were set forth herein in full.
As stated above, the wording with regard to the application of the bulk schedules in both the B and the HB Zoning
Districts is identical. There is nothing in the legislative history to suggest that§§ 280-46 and 280-49 should be
interpreted differently regarding the application of the bulk schedule's requirements—even though the wording is
identical.
As stated in the Planning Board's memorandum, the purposes and goals of the HB Zoning District also support an
interpretation that the application of the bulk schedule requirement in § 280-46 should be interpreted as § 290-49
was interpreted by the Board in Malon.
The Board finds that pursuant to 280-46 the bulk schedule requirement of 20,000 square feet is to apply to each
building rather than to each use or occupancy within building areas. Moreover, even though the facts in this matter
involve four of the same uses, this interpretation shall be read to apply regardless as to whether all of the proposed
uses within a building are the same or whether several different uses are proposed within one building
RESOLUTION OF THE BOARD: In considering all of the above factors motion was offered by Member
Acampora, seconded by Chairperson Weisman and duly carried, to GRANT the Appeal and OVERTURN the
determination in the Notice of Disapproval dated October 18, 2018 that the proposed construction did not meet the
bulk schedule pursuant to Section 280-46 of the Town Code.
Vote of the Board: Ayes: Members Weisman(Chairperson), Dantes, Planamento, Acampora and
Lehnert.
Leslie Kanes Weisman, Chairperson
Approved for filing �/ / /
Rece
ivec,
AGRICULTURAL DATA STATEMENT
ZONING BOARD OF APPEALS JUN 13 2025
TOWN OF SOUTHOLD
.honing Board of A
WHEN TO USE THIS FORM: This form must be completed by the applicant for any special use permit,site plan approfall&
variance, area variance or subdivision approval on property within an agricultural district OR within 500 feet of a farm
operation located in an agricultural district. All applications requiring an agricultural data statement must be referred to the
Suffolk County Department of Planning in accordance with Section 239m and 239n of the General Municipal Law.
l. Name of Applicant: AMP Architecture
2. Address of Applicant: PO Box 152 Mattituck N.Y. 11952
3. Name of Land Owner(if other than Applicant): 615 Pike St. LLC
4. Address of Land Owner: 615 Pike St. Mattituck N.Y. 11952
5. Description of Proposed Project: Proposed 1 story commercial building with basement storage and partial attic
6. Location of Property: (Road and Tax map number): 615 Pike St, Mattituck, N.Y. 11952 SCTM: 1000-140-02-21
7. Is the parcel within 500 feet of a farm operation? { } Yes {x} No
8. Is this parcel actively farmed? { } Yes {x} No
9. Name and addresses of any owner(s)of land within the agricultural district containing active farm operations. Suffolk County
Tax Lot numbers will be provided to you by the Zoning Board Staff. It is the Applicant's responsibility to obtain the current
names and mailing addresses from the Town Assessor's Office(765-1937)
NAME and ADDRESS
1.
2.
3.
4.
5.
6.
(Please use the back of this page if there are additional property owners)
of Applicant Date
Note:
1. The local Board will solicit comments from the owners of land identified above in order to consider the effect of the
proposed action on their farm operation. Solicitations will be made by supplying a copy of this statement.
2. Comments returned to the local Board will be taken into consideration as part as the overall review of this
application.
3. Copies of the completed Agricultural Data Statement shall be sent by applicant to the property owners identified
above. The cost for mailing shall be paid by the Applicant.
Full Environmental Assessment Form
Part I -Project and SettingKID
Instructions for° Completing Part I civil
Part I is to be completed by the applicant or project sponsor. Responses become part of the applicatioQ] tl p,ir' 2a2 ending,
are subject to public review,and may be subject to further verification.
ZO
Complete Part I based on information currently available. If additional research or investigation woe to
any item,please answer as thoroughly as possible based on current information; indicate whether missing information does not exist,
or is not reasonably available to the sponsor;and,when possible,generally describe work or studies which wou d be necessary to
update or filly develop that information.
Applicants/sponsors must complete all items in Sections A&B. In Sections C, D&E,most items contain an initial question that
must be answered either"Yes"or"No". If the answer to the initial question is"Ycs",complete the sub-questions that rollow. If the
answer to the initial question is"No",proceed to the next question. Section F a!k;ws the project sponsor to identify and attach any
additional information. Section G requires the name and signature of the project sponsor to verify that the information contained in
Part tis accurate and complete.
A. Project and Sponsor Information.
Name of Action or Project:
615 Pike Street Commercial Building _
Project Location (describe, and attach a general location map): _
615 Pike Street, Mattituck, NY 11952_
Brief Description of Proposed Action(include purpose or need):
Proposed 1 story commercial building with (4) retail units
i
1
1
i�
1
Name of,applicant/Sponsor. Telep one: 631-603-9092 ------
-Niail: dscharadin am a
AMP Architecture (Anthony Portillo) rchitect.com p
Address: !
PO Box 152
_ ------ _-.__ zip
Mattituck
State: Code:
City,PO: NY ( 11952
City,!PO:
_
Project Contact(if not same as sponsor;give name and title/role): Telephone: _
E-lai1:
-Address:
--
�tate: Zip Code:
City/PO:
i
Property Owner (if not same as sponsor): Telephone: 631-848-8734 __
Stephan Mazzella 615 Pike St. LLC) cheffmazz
Address:
300 Brook Lane
L
_ _ state: Zip ode:
City/PO: Southold NY
L_ _ — ----
Page l of 13
B.Government Approvals
B. Government Approvals,Funding,or Sponsorship. ("Funding" includes grants,loans,tax relief,and an ancial
assistance.)
Government Entity If Yes: Identify Agency and Approval(s) Applica i y[ tff d�025
Required (Actual or projecte
a.City Council,Town Board, ❑Yes(MNO Zoning Board o11"�1 < I',
or Village Board of Trustees
b.City,Town or Village [4Ycs0No Southold Town Planning 06/10/25
Planning Board or Commission Board Site Plan Approval
C.City Council,Town or [ Yes❑No Southold Town Zoning Board 06/10/25
Village Zoning Board of Appeals Special Exception
d.Other local agencies ❑Yes[XNo
e.County agencies NYes❑No Suffolk County Health Department 05/14/25
f.Regional agencies ❑Yes(RNo
g.State agencies ❑Yes[ Ni o
h.Federal agencies ❑Yeswo
i-. Coastal Resources.
i. Is the project site within a Coastal Area,or the waterfront area of a Designated Inland Waterway'? ❑YesMNo
ii. Is the project site located in a community with an approved Local Waterfront Revitalization Program? ❑Yes[XNO
iii. Is the project site within a Coastal Erosion Hazard Area? ElYes[XNo
C. Planning and Zoning
C.I. Planning and zoning actions.
ll administrative or legislative adoption,or amendment of a plan, local law,ordinance, rule or regulation be the Yes❑No
Wi
only approval(s)which must be granted to enable the proposed action to proceed?
® If Yes,complete sections C,F and G.
• If No,proceed to question C.2 and complete all remaining sections and questions in Part 1
C.2.Adopted land use plans.
a. Do any municipally-adopted (city,town,village or county)comprehensive land use plan(s)include the site DQYes❑No
where the proposed action would be located?
If Yes,does the comprehensive plan include specific recommendations for the site where the proposed action ❑YesMNo
would be located'?
b. Is the site of the proposed action within any local or regional special planning district(for example: Greenway ❑Yesl�No
Brownfield Opportunity Area(BOA): designated State or Federal heritage area;watershed management plan;
or other?)
If Yes, identify the plan(s):
c. Is the proposed action located wholly or partially within an area listed in an adopted municipal open space plan, ❑Yes'(_XNo
or an adopted municipal farmland protection plan?
If Yes, identify the plan(s):
Page 2 of 13
C.3. ZoningCp
a. Is the site of the proposed action located in a municipality with an adopted zoning law or ordinance. XYes❑No °
If Yes,what is the zoning classification(s) including any applicable overlay district? JUN i 202 "
_-_Hamlet Business
b. Is the use permitted or allowed by a special or conditional use permit? JKYes❑No
c.Is a zoning change requested as part of the proposed action? ❑Yes( No
If Yes,
i. What is the proposed new zoning for the site? ------_-_._._._._
CA.Existing community services.
a.In what school district is the project site located? MattltucK7CIItShogUe-lhlion.F_ree _ ._----,--.-.-.--- -- -----
b.What police or other public protection forces serve the project site?
Southold Town Police - - - --
c.Which fire protection and emergency medical services serve the project site?
Mattituck Volunteer Fire Depar ----
d. What parks serve the project site?
Mattituck-Laurel Parks Dis rir ._ -- -- -- --- - — ---- - -�
D.Project Details
D.I. Proposed and Potential Development
a. What is the general nature of the proposed action(e.g., residential, industrial,commercial,recreational; if mixed,include all
components)? Proposed 1 story commercial building with (4) retail units
acres
b.a.Total acreage of the site of the proposed action'? _52 ,
--
b.Total acreage to be physically disturbed? .L_.______ acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? 52 acres
a Is the proposed action an expansion of an existing project or use? CI Yes(�No
i. If Yes,what is the approximate percentage of the proposed expansion and identify the units(e.g., acres,miles,housing units,
square feet)? % _ ___ Units:
d.Is the proposed action a subdivision,or does it include a subdivision? ❑Yes RNo
If Yes,
i. Purpose or type of subdivision?(e.g.,residential, industrial,commercial; if mixed,specify,types)
ii. Is a cluster/conservation layout proposed? Yes o
iii. Number of lots proposed.'
iv. Minimum and maximum proposed lot sizes? Minimum Maximum
e. Will proposed action be constructed in multiple phases'.' — ❑YesL�No
i. If No,anticipated period of construction: __ _ months
ii_ If Yes:
• Total number of phases anticipated
• Anticipated commencement date of phase I (including demolition) — month year
• Anticipated completion date of final phase _— month year
• Generally describe connections or relationships among phases, including any contingencies Gvhere progress of one phase may
determine timing or duration of future phases: --
Page 3 of 13
[f,Does the project include new residential uses? Nof Yes,show numbers of units proposed.One Family Two Famil Three Family tilultiP-le Family four—morel °nitial Phase
1UN 1 t completion
of all phases __-._._____—..._._-____.-__Zoning Board of Appeals
g.Does the proposed action include new non-residential construction(including expansions)`? Wes[]No
If Yes,
i. Total number of structures _
ii. Dimensions (in feet)of largest proposed structure: 26'-7" height; 53'-0" width; and 84'-O" length
iii. Approximate extent of building space to be heated or cooled: 4 429 S.F_ square feet
h.Does the proposed action include construction or other activities that will result in the impoundment of any [I Yes Xo
liquids,such as creation of a water supply,reservoir,pond, lake,waste lagoon or other storage?
If Yes.
i. Purpose of the impoundment: _ __._
ii. If a water impoundment,the principal source of the water: Iround water[]Surface water streams _]Other speci{y:
iii If other than water, identify the type of impounded/contained liquids and their source.
iv. Approximate size of the proposed impoundment. Volume _ .,million gallons;surface area _ acres
v, Dimensions of the proposed dam or impounding structure: _ _ height; length
vi. Construction method/materials for the proposed dam or impounding structure(e.g.,earth fill,rock,wood,concrete):
D.2. Project Operations
a. Does the proposed action include any excavation, mining,or dredging,during construction,operations,or both? ❑YesgNo
(Not including general site preparation,grading or installation of utilities or'foundations where all excavated
materials will remain onsite)
If Yes:
i.What is the purpose of the excavation or dredging?
it. HOW much material(including rock,earth,sediments,etc.) is proposed to be removed from the site?
e Vohlme (specify tons or cubic yards):
• Over what duration of time? --.-
iii. Describe nature and characteristics of materials to be excavated or dredged, and plans to use,manage or dispose of them.
iv_ Will there be onsite dewaterrng or processing of excavated materials? Yes No
Ifyes,describe. __ . _-- .-- _
v. What is..the total area to be dredged or excavated?
vi. What is the maximum area to be worked at any one time? - ____ acres
vii. What would be the maximum depth of excavation or dredging'? feet
viii. Will the excavation require blasting? L]Ycs[gNo
ix. Summarize site reclamation goals and plan:
b. Would the proposed action cause or result in alteration of, increase or decrease in size of,or encroachment ❑YesRNo
into any existing wetland, waterbody,shoreline,beach or adjacent area?
If Yes:
i. Identify the wetland or waterbody which would be affected(by name,water index number,wetland map number or geographic
description).
fare 4 of 13
ii. Describe how the proposed action would affect that waterbody or wetland,e.g.excavation,fill,pi rnent oFstructu-es,or
alteration of channels,banks and shorelines. Indicate extent of activities alterations and additions iv ores;
- -- - -� --.__�- 1U � __ _.
_--------------
iii. Will proposed action cause or result in disturbance to bottom sediments? Zoning Board C#"Orw&
If Yes,describe: --
iv. Wilt proposed action cause or result in the destruction or removal of aquatic vegetation? ❑Yes�4No
If Yes:
• acres of aquatic vegetation proposed to be removed: -
• expected acreage of aquatic vegetation remaining after project completion:____ __......
_
• purpose of proposed removal (e.g. beach clearing, invasive species control,boat access) __..
• proposed method of plant removal: ----,
• if chemical/herbicide treatment will be used,specify product(s):
v. Describe any proposed reclamation/mitigation following disturbance:
m
c.Will the proposed action use,or create anew demand for water? _ ZYes❑No
If Yes:
i. Total anticipated water usage/demand per day: 2J00 _ gallons/day
ii. Wit] the proposed action obtain water from an existing public water supply? [R`es❑No
If Yes:
• Name of district or service area: Suffolk County Water Authority
• Does the existing public water supply have capacity to serve the proposal? M Y'es❑No
• Is the project site in the existing district? MYes❑No
• Is expansion of the district needed? ❑YesC4 No
• Do existing lines serve the project site? MYes❑No
iii. Will line extension within an existing district be necessary to supply the project., ❑Yes[XNo
If Yes:
• Describe extensions or capacity expansions proposed to serve this project:
• Source(s)of supply for the district: ----- _______ ---------—---- ---- --
iv. Is a new water supply district of service area proposed to be formed to serve the project site? ❑ Yes®No
If,Yes:
• Applicant/sponsor for new district:
• Date application submitted or anticipated
• Proposed source(s)of supply for new district ------ _.__......
-- — --
v. If a public water supply will not be used,describe plans to provide water supply for the project:
vi.If water supply will be from wells(public or private),maximum pumping capacity: gal lonshninLite.
d. Will the proposed action generate liquid wastes? Yes❑No
If Yes:
i, Total anticipated liquid waste generation per day: 413.9 gallons/day
ii. Nature of liquid wastes to be generated(e.g„sanitary wastewater, industrial; if combination,describe all components and
approximate volumes or proportions of each): Sanitary & Kitchen/Gray
iii. Will the proposed action use any existing public wastewater treatment facilities? ❑Yes No
If Yes:
• Name of wastewater treatment plant to be used:
• Name of district _ _ _ _.-_._---
• Does the existing wastewater treatment plant have capacity to serve the project? ❑Yes No
• Is the project site in the existing district? El Yes
• Is expansion of the district needed? ❑Yes❑No
Page 5 of 13
MNo
• Do existing sewer lines serve the project site? ceiv Ies..
• Will line extension within an existing district be necessary to serve the project? YesNo a
If Yes: JUN 13 202
® Describe extensions or capacity expansions proposed to serve this project:
_-_
eRing--Bear ear-d-of-A e�—
iv. Will a new wastewater(sewage)treatment district be formed to serve the project site? ❑Yes No
If Yes:
• Applicant/sponsor for new district:
• Date application submitted or anticipated
• What is the receiving water for the wastewater discharge? —.-------._._
v. If public facilities will not be used,describe plans to provide wastewater treatment for the project,including specifying proposed
receiving water(name and classification if surface discharge,or describe subsurface disposal plans):
Proposed private I/A OWTS___,_._
vr. Describe any plans or designs to capture,recycle or rein.,liquid waste: - ._.._ _ ...__... _ _
e. Will the proposed action disturb more than one acre and create stormwater runoff,,either from new point ❑Yes®No
sources(i.e.ditches, pipes,swales,curbs,gutters or other concentrated flows of stormwater)or non-point
source(i.e.sheet flow)during construction or post construction?
If Yes:
i. How much impervious surface will the project create in relation to total size of project parcel?
Square feet or _acres(impervious surface)
Square feet or acres(parcel size)
ii. Describe types of new point sources.
i. Where will the stormwater runoff be directed(i.e.on-site stormwater management facility/structures,adjacent properties,
groundwater,on-site surface water or off--site surface waters)?
• If to surface waters, identity receiving water bodies or wc,tlands:
• Will stormwater runoff flow to adjacent properties? — ❑Yes❑No
iv. Does proposed plan minimize impervious surfaces, use pervious materials or collect and re-use stormwater? ❑YesX No
f. Does the proposed action include,or will it use on-site,one or more sources of air emissions, including fuel OYesXNo
combustion,waste incineration,or other processes or operations?
If Yes, identify:
i. Mobile sources during project operations(e.g.,heavy equipment, fleet or delivery vehicles)
---------_. — — ---- _ _-- _- _
i. Stationary sources during construction(e «,power generation,structural heating,batch plant,crushers)
iii. Stationary sources duina operations(e g., process emissions, large boilers,electric generation)
Will any air emission sources named in D 2.f(abuve), require a NY State,Air Registration,Air Facility Permit, ❑YesRNo
or Federal Clean Air Act Title IV or Title V Permit?
I IT Yes:
i. Is the project site located in an Air quality non-attainment area? (:Area routinely or periodically fails to meet
❑Yes❑No
ambient air quality standards for all or some parts of the year)
ii_ In addition to emissions as calculated in the application,the project will generate:
Tanslycar(short tons)of Carbon Dioxide(CO,)
Tons/year(short tons)of Nitrous Oxide(NCO)
_ ___To ns/year(short tons)of Perfluorocarbons(PFCs)
__ _Tonsiyear(short tons)of Sulfur Hexafluoride(SF(,)
-------------
Tons/year(short tons)of Carbon Dioxide equivalent of Ilydroflourocarbons(HFCs)
Tonsiyear(short tons)of Hazardous Air Pollutants(HAPs)
Pa,e 6 of 13
h.Will the proposed action generate or emit methane(including,but not limited to,sewage treatment plants, ❑YeskNo
landfills,composting facilities)? P�
If Yes:
i-i- Estimate methane generation in tons/year(metric): -
ii.Describe any methane capture,control or elimination measures included in project design(e.g., combrl fir}t ny¢tybhea r
electricity, flaring): —_____.._ ULL�
i.Will the proposed action result in the release of air pollutants from open-air operations of-pros k1,�4
quarry or landfill operations?
If Yes: Describe operations and nature of emissions(e.g.,diesel exhaust, rock particulates/dust):
j.Will the proposed action result in a substantial increase in traffic above present levels or generate substantial ❑YesMNo
new demand for transportation facilities or services?
If Yes:
i. When is the peak traffic expected(Check all that apply): ❑Morning U Evening []Weekend
❑Randomly between hours of__ to _.
ii. For commercial activities only,projected number of semi-trailer truck trips/day:
iii. Parking spaces: Existing Proposed --------- Net increase/decrease
iv. Does the proposed action include any shared use parking? E]Yes[]No
v. If the proposed action includes any modification of existing roads,creation of new roads or change in existing access,describe:
vi. Are public/private transportation service(s)or facilities available within !/z mile of the proposed site? xYes[:]No
vii Will the proposed action include access to public transportation or accommodations for use of hybrid,electric ❑Yes(RNo
or other alternative fueled vehicles?
viii. Will the proposed action include plans for pedestrian or bicycle accommodations for connections to existing ❑YesmNo
pedestrian or bicycle routes?
k. Will the proposed action(for commercial or industrial projects only)generate new or additional demand ❑YesUNo
for energy?
If Yes:
i. Estimate annual electricity demand during operation of the proposed action:
u, the .,project e on-site combustion,on-,,it,renewable,—
. . .
r.-��,,, for , r � via god/local utility,or
dS Anticipated SOUrCeS/sLpphei'i Oi i,il,�.trlCity pr �� �•, -'
other):
I
nit. Will the proposed action require a new,or an upgrade to,an existing substation? []Yes No
1.Hours of operation. Answer all items which apply.
i. During Construction u. During Operations:
® Monday- Friday 7_30am -4:30pm,_. Monday-Friday: 10am-- 09m _- _.
® Saturday: _8.a._m -2 pm ---
w Saturday: 10am 10pm _ _
® Suuday:. N/A 9 Sunday:_10am--10pm _.
_.. -- — _.
® Holidays: N/A_ O Holidays:
Page 7 of 13
m. Will the proposed action produce noise that will exceed existing ambient noise levels during construction, ❑Yes RNo
operation,or both?
r�
If yes:
P _
i. Provide details including sources,time of day and duration; Receive
ii. Will proposed action remove existing natural barriers that could act as a noise barrier or screen`: TyYesXNo
Describe: --
_-_
n.. Will the proposed action have outdoor lighting? XYes❑No
If yes:
i. Describe source(s), location(s),height of fixture(s),direction/aim,and proximity to nearest occupied structures:
Sconces on sides-of_building-ballusters aarkig,areas ____ _ -.--- --- --------- - -
ii. Will proposed action remove existing natural barriers that could act as a light barrier or screen? ❑Yes No
Describe: —. ._._,... ---... ... --- --_--.-.
o. Does the proposed action have the potential to produce odors for more than one hour per day? ❑Yes XNio
If Yes,describe possible sources,potential frequency and duration of odor emissions,and proximity to nearest
occupied structures: -
p. Will the proposed action include any bulk storage of'petroleum(combined capacity of over 1,100 gallons) ❑YesXNo
or chemical products 185 gallons in above ground storage or any amount in underground storage?
If Yes:
i. Product(s)to be stored ___ _ ----- -
ii. Volume(s) per unit time_ a (e.g., month,year)
iii. Generally describe proposed storage facilities -.-.-.- ---
q. Will the proposed action(coinrnercial, industrial and recreational projects only)use pesticides(i.e., herbicides, ❑Yes NNO
insecticides)during construction or operation?
I f Ycs:
i. Describe proposed treatrnent(s):
-- — ---- --- - -—
ii. Will the Eroposed action use Integrated Pest Management Practices? ❑ Yes RNo
r. Will the proposed action(commercial or industrial projects only)involve or require the mariagement or disposal ❑ Yes RNo
of solid waste(excluding hazardous materials)?
If Yes:
i. Describe any solid waste(s)to be generated during construction or operation of the facility:
• Construction: tons per (unit of time)
• Operation : _ _ tons per (unit of time)
ii. Describe any proposals for on site minimization,recycling or reuse of materials to avoid disposal as solid waste: j
• Construction: -
_ _ _ - -- _ _— -- -. ... __._ __.
• Operation _
iii. Proposed disposal methods/facilities for solid waste generated on-site:
• COnStrUCtlOn: ._....
• Operation. - ...-.._
Page 8 of 13
s. Does the proposed action include construction or modification of a solid waste management facility'? ❑Yes X No
If Yes:
i. Type of management or handling of waste proposed for the site(e.g., recycling or transfer station,compostinUr landfill,or
other disposal activities). —
ii. Anticipated rate of disposal/processing.
Tons/month, if transfer or other non-combustion/thermal treatment,or JUN 13 2025
o �Tons/hour, if combustion or thermal treatment.
iii. If landfill, anticipated site life: _ .._. --._.._-. years
t. Will proposed action at the site involve the commercial generation,treatment,storage,or do t p,f j oR es No
waste?
If Yes:
i. Name(s)of all hazardous wastes or constituents to be generated,handled or managed at facility: ____-,__�_._____,___-
ii. Generally describe processes or activities involving hazardous wastes or constituents;
iti.Specify amount to be handled or generated tons/month
iv. Describe any proposals for on-site minimization, recycling or reuse of hazardous constituents;
v. Will any hazardous wastes be disposed at an existing offsite hazardous waste facility? ❑Yes No
If Yes:provide name and location of facility:
......_.__
If No: describe _.._.__.-.. .___....___
proposed management of any hazardous wastes which will not be sent to a hazardous waste facility:
E.Site and Setting of Proposed Action
E.I. Land uses on and surrounding the project site
a.Existing land uses.—
i. Check all uses that occur on, adjoining and near the project site.
(Urban X Industrial ® Commercial Residential (suburban) ❑ Rural (non-farm)
❑ Forest ❑ Agriculture ❑ Aquatic ❑ Other(specify): --
ii. If mix of uses,generally describe:
b.Land uses and covertypes on the project site.
Land use or � Current ��—Acreage After Change
Covertvpe -- Acreage — Project Completion - (Acres Tl )
• Roads, buildings, and other paved or impervious 0 17,134 s.f. +.4 acres
surfaces
m Forested 0 0 0
• Meadows,grasslands or brushlands(non- 0 — 0 0
_ agricultural, including abandoned agricultural)
® Agricultural p 0
(includes active orchards,field, greenhouse etc.) �0 _ m �—
• Surface water features 0 0 0
(lakes,ponds,streams,rivers,etc.) _ -__—
• Wetlands (freshwater or tidal) 0 0 0
• Non-vegetated(bare rock,earth or fill) 0 0 0
Other
Describe.
Pa(Tz 9 of 13
c-Is the project site presently used by members of the community for public recreation? ��� �� �—❑Yes®No
i. If Yes: explain: _ _ ... _ _.--_ _ _ -- —_._ ---
d.Are there any facilities serving children,the elderly,people with disabilities(e.g.,schools,hospi s, Ireens d Yes�No
day care centers,or group homes)within 1500 feet of the project site? C IV 11
If Yes,
i. Identifv Facilities:
e. Does the project site contain an existing dam? Zoning Boarr 0 � No
If Yes:
i. Dimensions of the dam and impoundment:
• Dam height: feet
• Dam length: feet
• Surface area: acres
• Volume impounded: , w _ _ ^_gallons OR acre-feet
ii. Darn's existing hazard classification: _ _ _.__._._...— __--------
iii. Provide date and summarize results of last inspection:
_ --_--
f.Has the project site ever been used as a municipal,commercial or industrial solid waste management facility, ❑YesCKNo
or does the project site adjoin property-which is now,or was at one time,used as a solid waste management facility?
If Yes:
i. Has the facility been formally closed`? ❑Yes❑ No
• If yes,cite sources/documentation. ------
ii. Describe the location of the project site relative to the boundaries of the solid waste management facility:
iii. Describe any development constraints due to the prior solid waste activities:
g.Have hazardous--pastes been generated,treated and/or disposed of at the site,or does the project site adjoin ElYes(XNo
property which is now or was at one time used to commercially treat,store and/or dispose of haza
If Yes:
i. Describe waste(s)handled and waste management activities, including approximate time when activities occurTed:
h Potential contamination history. Has there been a reported spill at the proposed project site,or have ally FYesZ No
remedial actions been conducted at or adjacent to the proposed site?
If Yes:
i. Is any portion of the site listed on the NYSDEC Spills Incidents database or Environmental Site ❑Yes®No
Remediation database? Check all that apply:
❑ Yes—Spills Incidents database Provide DEC ID number(s):
❑ Yes—Environmental Site Remediation database Provide DEC.ID number s
❑ Neither database
ii. If site has been subject of RCRA corrective activities,describe control measures: -_ .__
iii Is the project within 2000 feet of any site in the NYSDEC Environmental Site Remediation database? ❑YesXNo
If yes,provide DEC ID rnumber(s)
iv. If yes to(i),(ii)or(iii)above,describe current status of site(s):
__ _...
Page 10 of 13
v Is the project site subject to an institutional control limit' prop rty uses? ❑Yes No
• If ves, DEC site ID number:
• Describe the type of institutional control (e.g.,deed restriction or easement}
• Describe any use limitations: _.._.OR �_ �
• Describe any engineering controls: --_-- _ — --------- -----
_ -_--
• Will the project affect the institutional or engineering controls in place? ❑�e�I
• Explain;
E.2. Natural Resources On or Near Project Site
a.What is the average depth to bedrock on the project site? N/A feet
ID lre there bedrock outcroppings on the project site? _ ❑YesUNo
If Yes,what proportion of the site is comprised of bedrock outcroppings? %
c.Predominant soil type(s)present on project site: Dark Brown Loam
Brown Silt
Pale Brown Fine Coarse San_
_ to d %
d. What is the average depth to the water table on the project site? Average: 13.5 feet
e.Drainage status of project site soils: Well Drained: 80 %of site —
❑ Moderately Well Drained: _ %of site
❑ Poorly Drained ____%of site
F. ,Approximate proportion of proposed action site with slopes: kQ 0-10%: 100- %of site
❑ 10-15%: %of site
❑ 15%or greater: 4%of site
g.Are there any unique geologic features on the project site? ❑Yes[�No
If Yes,describe:
h.Surface water features. —
i. Does any portion of the project site contain wetlands or other waterbodies (including streams,rivers, ❑Yes[RNo
ponds or lakes)?
ii. Do any wetlands or other waterbodies adjoin the project site? ❑YesRNo
If Yes to either i or ii, continue. If No,skip to E.2.i.
iii. Are any of the wetlands or waterbodies within or adjoining the project site regulated by any federal, ❑YesZNo
1 state or local agency?
iv. For each identified regulated wetland and waterbody on the project site, provide the following information:
a Strearns: Name Classification _____...._-..
Lakes or Ponds: Name Classification _
m Wetlands: Name Approximate Size
Wetland No. (if regulated by DEC) . —_
v. Are any of the above water bodies listed in the Most recent compilation of NYS water quality-impaired
❑�'es�Io
waterbodies?
If yes,name of impaired water body/bodies and basis for listing as impaired:
i. Is the project site in a designated Floodway? ❑Yes®No
j. is the project site in the 100 year Floodplain? ❑YesNNo
k is the project site in the 500 year Floodplain? ❑YesRNoNo
—i
1. is the project site located over,or immediately adjoining,a primary. principal or sole source aqu ❑
ifer? _ Yes[X
If Yes:
i Name of aquifer:
Page I I of 13
m. Identify the predominant wildlife species that occupy or use the project site: _ _.......
None vacant lot inbetween 2 developed lots
n.Does the project site contain a designated significant natural community; Yes
tu o
If Yes:
i. Describe the habitat/community(composition,function,and basis for designation): . _ ,_
ii Source(s)of description or evaluation
iii. Extern of community/habitat: Zoning
t3oaCC.1_0'��t'�e�7�78 _
• Currently: acres
• Following completion of project as proposed: acres
• Gain or loss(indicate+or ): acres
o.Does project site contain any species of plant or animal that is listed by the federal government or NYS as ❑YesMNo
endangered or threatened,or does it contain any areas identified as habitat for an endangered or threatened species?
p. Does the project site contain any species of plant or animal that is listed by NYS as rare,or as a species of Mes[RNo
special concern?
q.Is the project site or adjoining area currently used for hunting,trapping,fishing or shell fishing? ❑Yes®No
If yes,give a brief description of how the proposed action may affect that use:
E.3. Designated Public Resources On or Near Project Site
a.Is the project site,or any portion of it, located in a designated agricultural district certified pursuant to ❑Yes�No
Agriculture and Markets Law,Article 25-AA, Section 303 and 304?
If Yes, provide county plus district name/number:
i b.Are agricultural lands consisting of highly productive soils present? � _ — ❑YesRNo
i. If Yes: acreage(s)on project site? —
ii. Source(s)of soil rating(s): --
c. Does the project site contain all or part of,or is it substantially contiguous to,a registered National � ❑YesUi o
Natural Landmark?
If Yes:
i. Nature of the natural landmark: ❑Biolo-ical Community ❑ Geological Feature
ii. Provide brief description of landmark, including values behind designation and approximate size/extent: _
d. Is the project site located in or does it adjoin a state listed Critical Environmental Area? ❑YesXNo
if Yes:
i. CEA name:
ii. Basis for designation:
iii. Designating agency and date
Page 12 of 13
e. Does the project site contain,or is it substantially contiguous to,a building,archaeological site,or district ❑Yes[ONo
which is listed on,or has been nominated by the NYS Board of Historic Preservation for i i r8 t d
State or National Register of Historic Places? �; 66 `
If Yes:
i. Nature of historic/archaeological resource: ❑Archaeological Site ❑Historic Building gt�jsY�ic �2 a
ii.Name: _.. — ---..-. A _JJ_ _�+
iii. Brief description of attributes on which listing is based:
Loninssorci of AYE
-
---- ---
f.Is the project site,or any portion of it, located in or adjacent to an area designated as sensitive for ❑YesgNo
archaeological sites on the NY State Historic Preservation Office(SHPO)archaeological site inventory?
g. Have additional archaeological or historic site(s)or resources been identified on the project site? ❑YesRNo
If Yes:
i.Describe possible resource(s):
ii. Basis for identification: _ —.....
h.Is the project site within rives miles of any officially designated and publicly accessible federal,state,or local �ElYesMNo
scenic or aesthetic resource?
If Yes:
i. Identify resource:
ii.Nature of,or basis for,designation(e.g.,established highway overlook,state or local park,state historic trail or scenic byway,
etc)
iii. Distance between project and resource: ___ miles.
i Is the project site located within a designated river corridor under the Wild,Scenic and Recreational Rivers ❑Yes�No
Program 6 NYCRR 666?
If Yes:
i. Identify the name of the river and its designation: .._—__.. _._ � __--
ii. Is the activity consistent with development restrictions contained in 6NYCRR Part 666? ❑YesZNo
F.Additional Information
Attach any additional information which may be needed to clarify your project.
If you have identified any adverse impacts which could be associated with your proposal,please describe those impacts plus any
measures which you propose to avoid or minimize them.
C. Verification
I certify that the information provided is true to the best of my knowledge.
r z �_-Z
Applicant/Sponsor Name Date.._._-_'11(jl_ —.. - .�.- `a-''�j)
--.... .._ _.. ____ Title L1t_ -4 _.-- �---
-
PRINT FORM Pace 13 of 13
Fleceived '6)'
Board of Zoning AL)I eats X 1 location JUN 13 2025
Zoning Board of App(,P!�-'
AUTHORIZATION
(Where the Applic"Int is not the OW"e")
Stephan Mazzella (615 Pike St. LLC) resldin-() at 350 Brook Lane
(Print property, owner's name) (\Jailim, Address)
Southold do hcrchv autlj()t-j/c AMP Architecture
—---------- ----—------
(A(,cnt)
to apply for variance(s) on my behall'k-om the
Southold Zoning Board ol'Appeals.
......------------
,Cmne
(Print 'Name)
ARTICLES OF ORGANIZATION Rewpived ;hoc
OF JUN . 2-025
615 PIKE STREET LLC Zoning Board of Aopeais.
Under Section 203 of the Limited Liability Company Law
THE UNDERSIGNED, being a natural person of at least eighteen (18) years of age, and acting as the organizer
of the limited liability company hereby being formed under Section 203 of the Limited Liability Company Law of
the State of New York certifies that:
FIRST: The name of the limited liability company is:
615 PIKE STREET LLC
SECOND: To engage in any lawful act or activity within the purposes for which limited liability companies
may be organized pursuant to Limited Liability Company Law provided that the limited liability
company is not formed to engage in any act or activity requiring the consent or approval of any
state official, department, board, agency, or other body without such consent or approval first
being obtained.
THIRD: The county,within this state, in which the office of the limited liability company is to be located is
SUFFOLK
FOURTH: The Secretary of State is designated as agent of the limited liability company upon whom process
against the limited liability company may be served. The post office address to which the
Secretary of State shall mail a copy of any process against the limited liability company served
upon the Secretary of State by personal delivery is:
STEPHAN MAZZELLA
350 BROOK LANE
SOUTHOLD,NY 11971
FIFTH: The limited liability company is to be managed by:
One or more members
SIXTH: The existence of the limited liability company shall begin upon filing of these Articles of
Organization with the Department of State.
SEVENTH: The limited liability company shall have a perpetual existence.
Page 1 of 2
EIGHTH: The limited liability company shall defend, indemnify and hold harmless alr"gers,~
and former members and managers of the limited liability company agains expenses (including
attorney's fees, judgments, fines, and amounts paid in settlement) incurred in cc rUU 1gtT,3 jg2,�ny
claims, causes of action, demands, damages, liabilities of the limited liability company, and any
pending or threatened action, suit, or proceeding. Such indemnification sh4lonNcJn 4VJ *
extent permitted by the laws of the State of New York, provided that such acts or omissions
which gives rise to the cause of action or proceedings occurred while the Member or Manager
was in performance of his or her duties for the limited liability company and was not as a result of
his or her fraud, gross negligence, willful misconduct or a wrongful taking. The indemnification
provided herein shall inure to the benefit of successors, assigns, heirs, executors, and the
administrators of any such person.
I certify that I have read the above statements, I am authorized to sign this Articles of Organization, that the above
statements are true and correct to the best of my knowledge and belief and that my signature typed below
constitutes my signature.
STEPHAN MAZZELLA ORGANIZER(Signature)
STEPHAN MAZZELLA,ORGANIZER
350 BROOK LANE
SOUTHOLD,NY 11971
Filed by: HOWARD S COHEN CPA PC
159 ROUTE 25A BLDG 2 STE G
MILLER PLACE,NY 11764
Page 2 of 2
APPLICANT/OWNER
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold s Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this
form is to provide information which can alert the town of ossible conflicts of interest and allow of to take whatever action is ,�t
necessary to avoid same. KeCe
���rt
YOUR NAME • Stephan Mazzella (615 Pike St. LLC) 202�
(Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such
company.If so,indicate the other person's or company's name.)
TYPE OF APPLICATION: (Check all that apply)
Building Permit Zoning Board ()T !•��)�.3.`r;Ra1�'y
Tax grievance
Variance Trustee Permit
Change of Zone Coastal Erosion
Approval of Plat Mooring
Other(activity) Special Exception Planning
Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or
employee of the Town of Southold?"Relationship"includes by blood,marriage,or business interest."Business interest"
means a business,including a partnership,in which the town officer or employee has even a partial ownership of(or
employment by)a corporation in which the town officer or employee owns more than 5%of the shares.
YES NO X
If you answered"YES",complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either
check the appropriate line A)through D)and/or describe in the space provided.
The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply)
A)the owner of greater that 5%of the shares of the corporate stock of the applicant(when the applicant is a
corporation)
B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation)
C)an officer,director,partner,or employee of the applicant; or
D)the actual applicant
DESCRIPTION OF RELATIONSHIP
Submitted this ay of, ,2U
Signature c /A✓ /�
Print Name S 1�I�f f� m � �` l
�.,,ec-.eived
JUN 13 2025
:honing Boa,l of Appe,as
III�I�llll�llllll111(Illlllllllllllll�fllllllllilllllll
IIIII IIIII IIIII IIII I�iE
SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEED Recorded: 04/02/2024
Number of Pages : 4 At: 03:27 :03 PM
Receipt Number : 24-0042176
TRANSFER TAX NUMBER: 23-25113 LIBER: D00013242
PAGE: 519
District: Section: Block: Lot;
1000 140.00 02 . 00 021.000
EXAMINED AND CHARGED AS FOLLOWS
Deed Amount: $600 ,000.00
Received the Following Fees For Above Instrument
Exempt Exempt
Page/Filing $20 .00 NO Handling $20 . 00 NO
COE $5 . 00 NO NYS SRCHG $15 . 00 NO
EA-CTY $5 .00 NO EA-STATE $250. 00 NO
TP-584 $5 . 00 NO Notation $0.00 NO
Cert.Copies $0 . 00 NO RPT $200 .00 NO
Transfer tax $0 . 00 NO Comm.Pres $0 .00 NO
Fees Paid $520.00
TRANSFER TAX NUMBER: 23-25113
THIS PAGE IS A PART OF THE INSTRUMENT
THIS IS NOT A BILL
VINCENT PULED
County Clerk, Suffolk County
REC`1F,C:Ef� � �
Numberofpages 2024 for 0') 03:27:0-3 Prl
VINCEtIT FULEO Received
CLERK OF
This document will be public SUFFOLK COUNT,'
record. Pleaseremove all L 00101013242 'JUN 13 2025
Social Security Numbers T F 515
D,# 2s-251113
prior to recording.
:Zoning hoard of appeals
Deed I Mortgage Instrument Deed/Mortgage Tax Stamp Recording I Filing Stamps
3 FEES
Page I Filing Fee A Mortgage Amt.
J 1.Basic Tax
Handling 20. 00 2. Additional Tax
TP-584 5 — Sub Total
Notation Spec./Assit.
or
EA-52 17(County) 5 Sub Total 50 Spec./Add.
EA-5217(State) `Jd - TOT.MTG.TAX
Dual Town Dual County
R.P.T.S.A. Held for Appoint _
Comm.of Ed. 5. DO Transfer Tax
Affidavit • �. Mansion Tax
The property covered by this mortgage is
Certified Copy or will be improved by a one or two
NYS Surcharge 15. 00 J l�� _ family dwelling only.
Sub Total ` YES or NO
Other
Grand Total �a,�f If NO,see appropriate tax clause on
page# of this instrument.
3 [-L aA
4 Dist.1 D 24011591 1000 14000 0200 021000 5 Community Preservation Fund
Real Property
a I IIIIII IIIII ll�l�lll llll 111 _ Consideration
Amount$Apo,Daa
Tax Service
Agency PF ax Due --
_
Verification
Improved
6 Satisfactions/Discharges/Releases List Property Owners ailing Ad ress
RECORD&RETURN TO: Vacant Land
Harvey A.Arnoff,Esq. TO
206 Roanoke Avenue TO
Riverhead, NY 11901
TO
Mail to: Vincent Puleo, Suffolk County Clerk 7 Title Company Information
310 Center Drive, Riverhead, NY 11901 Co.Name Eminent Abstract,Inc.
www.suffolkcountyny.gov/clerk Title#
EA3504-S
8 Suffolk County Recording & Endorsement Page
This page forms part of the attached Deed made
by: (SPECIFYTYPEOF INSTRUMENT)
Olde Colonial Place,LLC The premises herein is situated in
SUFFOLK COUNTY, NEW YORK.
TO In the TOWN of Southold
615 Pike Street LLC IntheVILLAGE
or HAMLET of
BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
over
NY 005-Bargain and Sale Deed with Covenant against Grantors Acts Individual or Corporation(Single sheet)(NYBTU 8002)
CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMFNT-TnIS INSTRUMENTsuouLD BE USED BY LAWYERS ONLY
THIS INDENTURE,made the day of March in the year 2024 ® g
BETWEEN ��
Olde Colonial Place,LLC, aNew York Limited Liability Company,with offices located at 45 Rece
Broidy Lane,Southampton,New York 11968 ,C
zoning Bel,lft) () eta:�,
party of the first part,and
615 Pike Street LLC,a New York Limited Liability Company, with offices at 350 Brook Lane,
Southold,NY 11971
party of the second part,
WITNESSETH,that the party of the first part,in consideration of Ten Dollars and other valuable consideration paid by the
party of the second part,does hereby grant and release unto the party of the second part,the heirs or successors and assigns of
the party of the second part forever,
ALL that certain plot,piece or parcel of land,with the buildings and improvements thereon erected,situate,lying and being in the
SEE ANNEXED DESCRIPTION
Said premises being known as vacant land on Sound Avenue,Riverhead,New York 11901
District 1000;Section 140.00;Block 02.00;Lot 021.000
The disposition of the property described herein was made in the usual or regular course of
business of the grantor cerjwA-9*m.L.GC
Being the same premises conveyed to the party of the first part by deed dated 12/29/2009 and
recorded 01/06/2010 in Liber 12611 at page 935
TOGETHER with all right,title and interest,if any,of the party of the first part of,in and to any strccts and roads abutting the
above-described premises to the center lines thereof;TOGETHER with the appurtenances and all the estate and rights ol'the
party of the first part in and to said premises;TO HAVE AND TO HOLD the premises herein granted unto the petty of the
second part,the heirs or successors and assigns of the party of the second part forever.
AND the party of the first part covenants that the party of(he first part has not done or suffered anything whereby the said
premises have been incumbered in any way whatever,except as aforesaid.
AND the party of the first pan,in compliance with Section 13 of the Lien Law,covenants that the parry of the first part will
receive the consideration ror this conveyance and will hold the right to receive such consideration as a oust fund to be applied
first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the
improvement before using any part of the total of the same for any other purpose.
The word"party"shall be construed as if it read"panics"whenever the sense of this indenture so requires.
IN WITNESS WHEREOF,the patty of the first part has duly executed this deed the day and year first above written.
IN PRESFYCE OF: n
PATRICIA BROIDY,SOLI MEMBF,R
i,
EMINENT ABSTRACT, INC.
Received
SCHEDULE A DESCRIPTION jUN 13 2025
Title Number: EA3504-S
Zoning Beard
Revised 2/27/2024
ALL that certain plot, piece or parcel of land,situate, lying and being at Mattituck, in the Town of
Southold,County of Suffolk and State of New York, bounded and described as follows:
BEGINNING at a point on the northerly side of Pike Street (Railroad Avenue) distant 172.61 feet easterly
from the corner formed by the intersection of the northerly side of Pike Street(Railroad Avenue)with the
easterly side of Love Lane, said point of beginning also being where the division line between the
premises described herein and land now or formerly of Thucvy Pham intersects the northerly side of Pike
Street(Railroad Avenue);
RUNNING THENCE from said point of beginning along land now or formerly of Thucvy Pham, North 26
degrees 06 minutes 00 seconds West,159.02 feet to the southerly line of the Long Island Railroad (M.T.A.);
THENCE along the southerly line of the Long Island Railroad (M.T.A.), North 46 degrees 19 minutes 40
seconds East, 130.93 feet to a point;
THENCE along land now or formerly of Stephan Mazzella and Joanna Cemmler, South 27 degrees 35
minutes 40 seconds East, 198.30 feet to a point on the northerly line of Pike Street(Railroad Avenue);
THENCE along the northerly line of Pike Street(Railroad Avenue)South 63 degrees 45 minutes 40
seconds West,130.00 feet to the point or place of BEGINNING.
USEACKNOn7XWAfFNT FOIM BELOW 11'17'itINNF.'WYORKSrITIi ONI.)i U$fiACKNDWIEIXibltiATFORS/RF.7.05Y w7TlH,x'N1i 11'YORK$T;1TEO,VI,Y; +
Stale of New York,County of Suffolk Iss.: State ofNeiv York,Con ntyof Iss.: �
On the 119 day of March in the year 2024 On the day of in the year j
before me,the undersi red, crsona11 appeared before ine,the undersigned,personally appeared � , d a
PA'1'RICIA BR�IDY
personally known to inc or proved to me on the basis of satisfactory personally known to me or proved to me on the basis of satisfactory
evidence to be the individual(s)whose name(s)is(are)subscribed to the evidence to be the individual(s)whose name(s)is(are)subscribed to the � U
within instrument and acknowledged to me that hc/shdthcy executed within instrument:md acknowledged to me that he/shchhey executed
25
the same in his/her/their capacity(ics), and that by his/her/their the same in his/hedthch capacily(ies), and that by his/her/their
signatmc(s)on the instrument,the individual(s),or the person upon signalure(s)on the instrument.the individual(s),or the person upon
hehair of which the indivi Ial(s)acted,executed the instrument. behalf of which the individual(s)acted,executed the instrument.
zoning B()afri t:)x
STEPHEN SPANBURGH
NOTARY PUSUC, ATE OF NEW YORK
Reglatra0on No.01SP49D6864
Quetilied In Suffolk County
COMITILulon RP res OctoW 5,2025
ACtiVOH'IlllGWEN FORMFOR S VIIT1DNIVEIVYORKSTATF.ONLY; ACKVOVVIEDGdIEM'FORAth'ORUS1,'OUTSIDENE'l'YORKSTATE'ONL):'
(NeN•Yark ubst•ribing 1ViMexa Acknmvlydymrru CerrifraneJ /Ouf nf,Slmr ar Rvrign Genera!ArknmvlydRmrat CrnifirnmJ
State of New York,County of }ss.: ... . ............................................I ss.:
(Cangrleir Venur a-irh Smre.Cnunrrv,Penvinrc nr Mmriripaliry•)
On the day of in the yew-
before me,the undersigned,personally appeared On the day of in the year
before me,the undcRigned,personally appcarcd
the subscribing witness to the foregoing instrument,with whom 1 an; •
personally acquainted,who,being by me duly sworn.did depose and personally known to me or proved to me on the ha;is of.satisfactory
say that he/shchhey residc(s)in evidence to be the individual(s)whose name(s)is(are)subscribed to the
within instrument and acknowledged to me that he/shchlmy executed
(iflhe place Tfresidenceisinacily,include the.vreetandstreetnumber, the same inhis/her/thcircapacity(ics),that byhi.s/her/thcirsignmure(s)
if am,rhereofi;that helshe/they know(s) on the instnnnenl,the individual(s),or the person upon behalf of which
the individual(s)acted,executed the instrument,and that such individual
to be the individual described in and who executed the foregoing made such appearance before the undersigned in the
instrument;that said subscribing witness was present and saw said
execute the saddle;and that said witness at the same time subscribed (Insert rile rin,or other political subdivision and due stale orcolnrtry or
his/her/their name(s)as a witness thereto. other place the uclaunaledgnrent was taken).
BARGALN&SAi.F DFEII
wmi COYEWAM3 AGAINST OR AN RMS ACTS
TrrLENo,EA3504-S DISTRICT 1000
$T:CTTON 140.00
Olde Colonial Place,LLC Stock 02.00
LOT 021.001)
COUNTY OR TOWN SUFFOLK
TO
615 Pike Street LLC RECORDEDATRE'QUESI'OI'
Fidelity National Title Insurance Company
RETURN RI•MAIL TO
FIDELITY NATIONAi,TITI.F. Harvey Arnoff,Esq.
G INSURANCIE COMPANY 206 Roanoke Avenue
11101 a—En 1QZ8 Riverhead,NY 11901
r�a�nd,Fidelity fJirna, v
Memhr�Nm t'ark.Snne I—d Tillr.trnu w,wi
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INSTRUCTIONS(RP-52I7-PDF.INS);www.orps.slala.ny.us
FOF2 COUNT1f'USE ONLY , f v1 Now York Stag Department of
C1.SWISCode �,3,� I Taxation and Finance '74
C2.Dale Dead Recorded i / �_f I Officis of Real Property Tax ServioeS
' °� ... RP-5217-PDF
C3 Book t 1,�,��,2- GI.Page `y t� peal Property Transfer Report(8110) e
v
PROIsER'rY INFORMATI rl ION ,,
1-� 615 Pike Street �� �"�
•e1ML7 NareER •KIWI.!'"L
Southold Mattiluck 11952
•aryoRlove, _ wunrta -' — omit 1-c-afo CT Appeals
zsuyer 615 Y_ke Street: LLC
NAM .UNT NWF.r:[/Yvwr -INlr WEN
I Aar NAY[.cOAPAth I MT nAW
3.Tex Indicate where future Tax Ellis we to 0o sent
awing t other then buyer Wdrase(at bottom o1 lam) tAv-NAwrAx vAlll' - ... nw Neer.
Address
sTmrMaaZRANn Nme U:YORTOWN e1Ai P. apcom
A.Indicate the number of AaasaampM 1 a of Parted DA ❑Part of o Poral (OIy Il Pad of a ParW)Ch k aeihsy opply: ❑
Ault parcels traraNrred on the dead 4A.Planning Boom Wsh Subdivision Authonly Exists
e.Dead S OR 0.S C ❑
40,Subdivhon Approval wee RegWrod far Trermlar
Property -FnoNrFrrr •oLvnt •Arays
Slxe t—
aC.Parcel Approved for Subdivieia,with Map Provided 1__I
I
O_cie Colonial Place i.LC
d Saber -tABt N-MVI11'AW fawT NAG¢
Name
`7.Select the doacdption which moat accurately describes tto Check to pax"below as they appy:
UN of the property at the time of sole: 6.Ownership Type is Candorrirwm ❑
C.Itesidt-ritf.11 Vacant Land 0.New Construction an vacant Land ❑
i0k,rkoportytocalod within anAgrxtrdhnai Diebict ❑
108.Uuyar iccoived a disclosure nolice ndiarng that the Wopetty is In an
Agricultural Could ❑
SN.E INFOnMATiON 15.Check pbe or more of these condlume as eppwcabre to tranafor:
A.Sale DetwaYt Rolsom or Former Roiatwas
11.Sole Contract Dots 01/31/2 0 2 4 '-!D.Salo between Related Companies of Partners in tk,ai,gb. t
C.One of the Buyers Is also a Seller
A 12.Date of Selalransfer 0 3/12/2 0 2 4 0.Guyer mm or Solar to Oeve ud Agency or Lending IlyMution
E.Dead type not Wananty or Bargee and Salo(Spociiy Below)
F.Sale of Fractional of Less than i•ee Interest(Specify Below) '
�I&FUN sale Pries ,00,000.00 0.Significant Chango in.1 Eaayeaa Taxable Status and Said Oaiae
H.Solo of Business is Included it Sale Pace
(Full Sale Price is"total amount paid W ate property neiorgng p"nonnt property, 1.Other Unusual Fack rs Affecting Sala Pita(Specify Wow)
This payment may be in the torn of cash.othat property or goods,or the sasumpton of J.None
mortgages or other obWk)nr.)Pk+aer,round to tra nearnal wlrolo dollar arrmni.
Comment(s)on Condition:
IA.utdicats the value of paroara d
property included In the sate .I
ASSESSMENT INFORMATION-Data should reflect the latest Final Assessment Rog and Tax Bur(
16.Yoar of Aesestemod BON from which mtomutlon taken(YY) 23 •17.TaII Aamessad Ydus 1,300
eta.prop"Chas 311 _ .fa.School District Name .yaL•L i tUck
.a.Tax Map Idsntlnr(e)1Ron tdarlifior(s)in men than Motor.attach sheet with additional Identnor(s))
1000-'40.00-02.CO-021.000
CERT I N
I Corny that all of to items at Information entered on fill form re we acid conect(to the best of my knowledge and bellsO and I understand that do making of any wmew
Mine statement of malarial feet herein subject me to t etprovtshenteal the pKW law relative to the,making and filing of tale Instruments.
CFII LSIGNAUFU BUYER-CONTACiALE08MAT(ON
IG:n htan111im ktihe ante.tral¢N outer a LLG,aaoofY.ewodasm,cuporaam lent[tit#mroony osste w
+}, soul'Me:to not an hot AKA aemr or kluavy.:-a none rn mina M'V-Wm of en urdravaGTnphoratlo
Q./ .Bi1-�• J 1 panywuo on wu w 0Aauax IoWd rep er nnear slat to smith.r".w P"Clary.)
sP1lParreMATalI* fM`/a. �/, WIt
Q ,r1 AE Ma:: ells Stephan
'- `� /�OV •ArIFA[OM 'ILLL$N WWWq Ore lc►s91
tl.. Ya1MWYL DAT
350 LtZUUit: L7RP.
-51MTxuam •atrcrr NeVl
f Southold NY 11971
I —•crn•OR laws _ .�— -sTA1e •hP cxx;
M YE82AUORNEY
I
Arr.oEf Harvey
Uer RAW HIE,NeAr
(4311 '12'1-3940
na.AfllaF —•..- 1r12P1.)AEI.AarNelwaereq -
I Itl 1
APPLICANT/AGENT
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to
provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same.
YOUR NAME: AnthonyPortillo AMP Architecture) n
(Last name,first name,middle initial,unless you are applying in the name of someone else or other entit e
If so,indicate the other person's or company's name.) �� 77
TYPE OF APPLICATION: (Check all that apply) JUN 13 20
Tax grievance Building Permit
Variance Trustee Permit
Change of Zone Coastal Erosion
t�r" 't' �`, a > �a
Approval of Plat Mooring
Other(activity) Special Exception Planning
Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of
the Town of Southold?"Relationship"includes by blood,marriage,or business interest."Business interest"means a business,
including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation
in which the town officer or employee owns more than 5%of the shares.
YES NO
If you answered"YES",complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee. Either check the
appropriate line A)through D)and/or describe in the space provided.
The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply)
A)the owner of greater that 5%of the shares of the corporate stock of the applicant(when the applicant is a
corporation)
B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation)
C)an officer,director,partner,or employee of the applicant;or
D)the actual applicant
DESCRIPTION OF RELATIONSHIP
IIVN
Submitted this day of 3 e Q-, ,20°
Signature
Print Name O C)
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM JUN 13 2025
A. INSTRUCTIONS Zoning Board of Apr.)-Pi:,
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# 140 - 02 - 21
The Application has been submitted to(check appropriate response):
Town Board D Planning Dept. D Building Dept. ® Board of Trustees El
1. Category of Town of Southold agency action(check appropriate response):
(a) Action undertaken directly by Town agency (e.g. capital
construction,planning activity, agency regulation, land transaction)
(b) Financial assistance (e.g. grant, loan, subsidy)
(c) Permit, approval, license, certification:
Nature and extent of action:
Proposed 1 story commercial building with basement storage
Location of action: 615 Pike Street, Mattituck, N.Y. 11952
Site acreage: 0.5 Acres 2025
Present land use: N/A
Zoning B0arci
Present zoning classification: Hamlet Buisness
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: AMP Architecture
(b) Mailing address: PO Box 152, Mattituck, N.Y. 11952
(c) Telephone number: Area Code( ) 631 6039092
(d) Application number, if any:
Will the action be directly undertaken, require funding, or approval by a state or federal agency?
Yes IN 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.
®Yes No ❑ Not Applicable
The prQpQsed commercial building will have similar characteristics as the near by properties
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
0 Yes 1:1 No ® Not Applicable
Address:615 Pike St.Mattituck,N.Y.11952
A M P Architecture Phone: AJN - 0 ,6
Design -+-- Build
Zi;arii.;g i3Oard of Appeals
.j
M�
k }T.
Existing South Elevation (Front) Existing Southeast Elevation ( Right Corner)
Existing East Elevation ( Right side) Existing Northeast Elevation (Rear corner)
615 Pike St.
Owner:615 Pike St. LLC.
Applicant:AMP Architecture
All photos taken on August 08, 2024
AMP Architecture Address:615 Pike St.Mattituck,N.Y.11952
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Existing North Elevation ( Rear side) Existing Northwest Elevation ( Rear corner)
Existing West Elevation (Left side) Existing Southwest Elevation( Left corner)
615 Pike St.
Owner: 615 Pike St. LLC..
Applicant:AMP Architecture
All photos taken on August 08,2024
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