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Home My WebLink AboutLaskey, Donald III application Revised 6121123 TOWN OF SOUTHOLD � se ZONING BOARD OF APPEALS Phone (631) 765-1809 (631) 765-9064 IMCENED APPLICATION FOR A SPECIAL EXCEPTION PERMIT FOR AN ACCESSORY APARTMENT IN AN ACCESSORY BUILDING JUL 0 1 2025 OF APPEALS Applicant(s)Name(s) aklk��- -Applicant(s) Address �-�' � 0 rhone: �"` � ` � �- Email: � .C.o1\ [ 1/'wye are the owners of the subject property [ ] I am the agent for the property owner and my Letter of Authorization and Transactional Disclosure Form is attached. Representative(if other than applicant): Address Phone: Email A. Statement of Ownershin and lnterg� is(are)the owner(s)of the property known and referred to as D House No. ..... ..Street Hamlet � Zip de Identified on the Suffolk County Tax Maps as District 1000,Section Blockl w Lot(s) Lot Size Zone District_ as shown on the attached deed and survey The above-described property was acquired by the owner(s)on o W I/we hereby apply to the Zoning Board of Appeals for a Special Exception Permit pursuant to Section §280-13B(13) of the Zoning Ordinance to establish an accessory apartment in an accessory building as shown on the attached survey/site plan and floor plan(s) B. Pro'ect Description: IMCEP ED Application Page 2, Special Exception for Accessory Apartment �JUL 01 2025 C. The applicant alleges that the approval of this special exception would be in harNtlMAfRQF APPEALS and purpose of said zoning ordinance, and that the proposed use conforms to the standards prescribed therein and would not be detrimental to property or ersons�e neighborh rid for tkte followin reasons: _ ..._...,...�........_._ D. The applicant alleges that the following standards prescribed by Section §280- 13(13)(13)(a)-(k)of the zoning ordinance will be met: a. The accessory apartment will be located in the accessory building. b. The owner of the premises shall occupy either the existing single-family dwelling or the accessory apartment in the detached accessory structure as the owners' principal residence. The other dwelling unit shall be occupied by a family member as defined in Section §280-4 of the code or a resident who is currently on Southold Town's Affordable Housing registry and is eligible for placement, evidenced by a written lease,for a term of one or more years. c. The accessory apartment shall contain no less than 220 square feet and does not exceed 750 square feet of livable floor as defined in Section §280-4 of the code d. The accessory apartment will be located on one floor of the accessory building and will contain No more than two bedrooms and No more than one bathroom. e. A minimum of three on-site parking spaces shall be provided as shown on the attached survey. f. Not more than one(1)accessory apartment shall be permitted on this parcel. g. No Bed and Breakfast facilities,as authorized by Section §280-13(B)(14)hereof shall be permitted in or on the premises for which an accessory apartment is authorized or exists. h. The accessory apartment will meet the requirements of a dwelling unit as defined in Section 280-4 of the Zoning Code. il. This conversion shall be subject to a building permit, inspection by the Building Inspector and Renewal of Certificate of Occupancy annually. j. The existing accessory building which is converted to permit this accessory apartment has been in existence and has a valid Certificate of Occupancy for no less than three years, and is attached hereto. k. The existing building,together with this accessory apartment, shall comply with all other requirements of Chapter§280 of the Town Code of the Town of Southold. 1. This conversion for the accessory apartment shall comply with all other rules and regulations of the New York State Construction Code and other applicable codes. E. The pr which is the subject of this application (� ec k all that apply): [ as not changed since the issuance of the attached Certificates of Occupancy [ ] has changed or received additional building permits.Certificates of Occupancy for these changes are attached or will be furnished [ ] has been the subject of a prior ZBA decision(s), copies are attached Owner Signature COUNTY OF SUFFOLK) ss.: STATE OF NEW YORK) Sworn to bWre , day of di['� � 202`I" (Notary Public) 6121!23 RA CH L l NOTARY PUBLIC;,STATE OF NEW YORK R09istrafion No.02DA6'272 C ualified In Suffolk C�'ou Commission ion Fx Iris Nc,9m e 2t3 R QUESTIONNAIRE FOR FILING WITH YOUR ZBA APPLICATION A. Is the subject preinirs listed on the real estate market for sale? 9 NOS Yes o 'JUL 01 2025 B. Are -e any proposals to change or alter land contours? N'o Yes please explain on attached sheet. ZONING BOARD OF APPEALS C. 1.) Are there areas that contain sand or wetland grasses? WO 2.) Are those areas shown on the survey submitted with this application? 3.) Is the property bulk headed between the wetlands area and the upland building area? 4.) If your property contains wetlands or pond areas, have you contacted the Office of the Board of Trustees for its determination of jurisdiction? Please confirm status of your inquiry or application with the Trustees: and if issued, please attach copies of permit with conditions and approved survey. D. Is there a depression or sloping elevation near the area of proposed construction at or below five feet above mean sea level? Q 0 E, Are there any patios, concrete barriers, bulkheads or fences that exist that are not shown on the survey that you are submitting? V _Please show area of the structures on a diagram if any exist or state none on the above line. F. Do you have any construction taking place at this time concerning your premises? G. If yes, please submit a copy of your building permit and survey as approved by the Building Department and please describe: H. Please attach all pre-certificates of occupancy and certificates of occupancy for the subject premises. If any are lacking, please apply to the Building Department to either obtain them or to obtain an Amended Notice of Disapproval. I. Do you or any co-owner also own other land adjoining or close to this parcel? If yes, please label the proximity of your lands on your survey. p ,. �ns conducted at this parcel J. Please list present operations and the proposed use use or o 21 (ex:existing single family,proposed:same with garage,pool or other) loriaed signature Date tf SO(/ Town Hall Annex AL RECEIVED Telephone(631) 765-1802 54375 Main Road P.O.Box 1]79 'JUL 0 1, 2025 .. Southold.NY 1]971-0959 + qu I'O(!I ZONING BOARD OF APPEALS BUILDING DEPARTMENT TOWN OF SOUTHOLD STOP WORK ORDER TO: Donald Laskey A-b 0 S 855 Horton Ave Mattituck NY 11952 YOU ARE HEREBY NOTIFIED TO SUSPEND ALL WORK AT: 855 Horton Ave Mattituck TAX MAP NUMBER: 1000-141.-1-24.1 Pursuant to Section 144-8 of the Town of Southold Code, you are hereby notified to immediately suspend all work until this order has been rescinded. BASIS OF STOP WORK ORDER: Construction without first obtaining a Building Permit CONDITIONS UNDER WHICH WORK MAY BE RESUMED: When a Building Permit has been issued. FAILURE TO REMEDY THE CONDITIONS AFORESAID AND TO COMPLY WITH THE APPLICABLE PROVISIONS OF LAW MAY CONSTITUTE AN OFFENSE PUNISHABLE BY FINE IMPRISONMENT OR BOTH. DATE: November 22, 2024 oLe ter Baylin Ordinance Inspector IT SHALL BE UNLAWFUL TO REMOVE THIS NOTICE WITHOUT WRITTEN CONSENT OF THE ISSUING AGENCY. FORM NiO. 4 TOWN OF SOUTHOLD RECEIVED BUILDING DEPARTMENT S TOWN CLERKS OFFICE SOUTHOLD. N. Y. JUL 01 2025 ZONING BOARD OF APPEALS CERTIFICATE OF OCCUPANCY No. ,. ......Za... 1 .... Date .......... ............&j"%WXy..1$............ 19-61 THIS CERTIFIES that the building located at .. b1rs? .. Y��•..e... treet Map No. ....... ....**.de.... Block No. ......*.* ..........Lot No. .....***. ....................................... ............... conforms substantially to the Application for Building; Permit heretofore filed in this office dated .................AU.9U9Lt...4............ 19-0 pursuant to which Building Permit No. ......,?-708. dated . ......... .....Atlqugtt...4..... ........ 195.9.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issuedis ....... ......................WZ"..M.--r ,V-All�41 .. ............ ,................. ........1.... .... This certificate is issued to ..., „, „. ", . . .ro 6kA— pmp; ..... ........ .• ,..• ... (owner, lessee or tenant) of the aforesaid building. Building Inspector FORM NO. 4 RECEIVED TOWN OF SOUTHOLD JUL 0 1 2025 BUILDING DEPARTMENT Office of the Building Inspector Town Hall ZONING BOARD OF APPEALS Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29836 Date: 11/14/03 THIS CERTIFIES that the building ADDITIONS & ALTERATIONS Location of Property: 855 HORTON AVE MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No_ 473889 Section 141 Block 1 Lot 24 .1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 13 2002 pursuant to which Building Permit No. 28908-Z dated NOVEMBER 13, 2002 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is DORMER ADDITION, COVERED PORCH ADDITION AND ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to STEVE ROSIN of the aforesaid building. (OWNER) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N 511465 01/03/00 PLUMBERS CERTIFICATION DATED 11/12/02 HOWARD E WOLBERT i A orized ignature Rev. 1/81 _ = TOWN OF SOUTHOLD RECEIVE[) A BUILDING DEPARTMENT " TOWN CLERK'S OFFICEUL 0 1 2 025 SOUTHOLD, NY d ma's" BUILDING PERMIT ZONING BOARD OF APPEALS (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET CIF APP1O1/ED PLANS AND SPECIPICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 49918 Date: 10/20/2023 Permission is hereby granted to: Laskey, Donald 855 Horton Ave Msttituck NY 11952 To: alter existing covered porch to living space to existing single-family dwelling as applied for. At premises located at: 855 Horton eve Mattit�ack SCTM #473889 Sec/Block/Lot# 141.-1-24.1 Pursuant to application dated 10/10/2023 and approved by the Building Inspector. To expire on 4/20/2025. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $382.00 CO-ALTERATION TO DWELLING $100.00 Total: $482.00 Building Inspector 0 4W 0 TOWN OF SOUTHOLD, NEW YORE DATE.,Sept..,..,2, 1976 ACTION OF THE ZONING BOARD OF APPEALS Appeal No. 2177 Dated August 5, 1976 ACTION OF THE ZONING BOARD OF APPEALS OF THE TOWN OF SOUTHOLD To William and Mary Barhyte Appellant 735 Horton Avenue Mattituck, NY 11952 at a meeting of the Zoning Board of Appeals on September 2, 1976 the appeal ppeal was considered and the action indicated below was taken on your RECEIVED ( ) Request for variance due to lack of access to property ( ) Request for a special exception under the Zoning Ordinance JUL 0 1 (X) Request for a variance to the Zoning Ordinance 2025 tw$CApF APPEAL 1. SPECIAL Ex CEPT'ION.By resolution of the Board it was determined that a special exception ( ) be granted ( ) be denied pursuant to Article .................... Section .................... Subsection ........... paragraph of the Zoning Ordinance and the decision of the Building Inspector ( ) be reversed ( ) bP confirmed because 8t1 p.M. (E.D. .T.) upon application. of William and. Mary Barhy'te, 735 Horton Avenue, M ttituck, New ''fork for a vari- ance in accordance with the Zoning Ordinance, Article III, Section. 100--30 & Bulk Schedule for permission to set off existing dwelling on 'undersized lot. Location of property: Horton Avenue and Oak Street, Mattituck, New fork, bounded on the north by W. Jahodzinsk.is east by Oak Street, .south by Horton Avenues west by J. RUtkowski. 2. VARIANCE.By resolution of the Board it was determined that (a) Strict application of the Ordinance (would) (would not) produce practical difficulties or unnecessary hardship because SEE REVERSE (b) The hardship created (is) (is not) unique and (would) (would not) be shared by all properties alike In the immediate vicinity of this property and in the same use district because SEE REVERSE (c) The variance (does) (does not) observe the spirit of the Ordinance and (would) (would not) change the character of the district because SEE REVERSE and therefore, It was further determined that the requested variance ( ) be granted ( ) be denied and that the previous decisions of the Building Inspector ( ) be confirmed ( ) be reversed. SEE REVERSE Z IN BOARD OF APPEALS FORM ZB4 air an 60ar a Appeals RECEIVED JUL 01 2025 ZONING BOARD OF APPEALS After investigation and inspection the Board finds that the applicant requests permission to set off existing dwelling on undersized lot, Horton Avenue and Oak Street, Mattituck, New York. The findings of the Board are that the Board is in agreement with the reasoning of the applicant. The Board finds that strict application of the Ordinance would produce practical difficulties or unnecessary hardship; the hardship created is unique and would not be shared by all properties alike in the immediate vicinity of this property and in the same use district; and the variance will not change the character of the neighborhood, and will observe the spirit of the Ordinance. THEREFORE IT WAS RESOLVED, William and Mary Barhyte, 735 Horton Avenue, Mattituck, New York be GRANTED permission to set off existing dwelling on undersized lot, Horton Avenue and Oak Street, Mattituck, New York, subject to the following condition: There shall be no further division of the property. Vote of the Board: Ayes: - Messrs: Gillispie, Bergen, Hulse, Grigonis. =EIVED AND FILED BY THE SOUTHOLD TOWtd CLERK DATES dW-7� HOURr :D0-4/rJ rT,,n, a Town of Southold FORM NO. 4 �o s 65- TOWN OF SOUTHOLD CENED BUILDING DEPARTMENT Office of the Building Inspector JUL 01 2025 Town Hall Southold, N.Y. ZONING BOARD OF APPEALS PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-20848 Date JULY 13, 1992 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 855 HORTON AVENUE. MATTITUCK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 141 Block 1 Lot 24.1 Subdivision Filed Map No. Lot No. conforms substantially to the Requirements for a One Family Dwelling built Prior to: APRIL 9 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z-20848 dated JULY 13, 1992 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DWELLING The certificate is issued to MARY BARHYTE (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. Buil g Inspector Rev. 1/81 . FORM No. 4 RECENED TOWN OF SOUTHOLD BUILDING DEPARTMENT JUL 0.1 2025 Office of the Building Inspector Town Hall Southold, N.Y. ZONING BOARD OF APPEALS CERTIFICATE OF OCCUPANCY No Z-23355 Date NOVEMBER 17, 1994 THIS CERTIFIES that the building ACCESSORY Location of Property 855 HORTON AVENUE MATTITUCK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 141 Block, I Lot-0 °-4� 1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 3, 1993 ursuant to which Building Permit No. 21393-Z dated MAY 6 1993 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ACCESSORY GARAGE WITH NON-HABITABLE 2ND FLOOR AS APPLIED FOR The certificate is issued to STEVE ROSIN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N--312295 - MAY 3, 1994 PLUMBERS CERTIFICATION DATED N/A uirding Inspector Rev. 1/81 BUILDI::0 DEP-',T.--=iT TO',;id OF SOUTHOLD, N. Y. HOU-SI"G CODE IiiS?ECTION REPORT Location 855 HORTON AVENUE KATTITUCE N.Y. knumoer csr szreeL) <i•iun-cipaiiLy) Subdivision iNan Mo. Lot(o)- Name of Owner(s) MARY ATE Occupancy ONE FAMILY DWELLING VACANT l typ e) OW n er-Len'-n c) Ad..iitted by: WM. CLARK ,Accompanied by: SAME Key available Suffolk Co. Tax No. 1000-141-1-24.1 RECEIVED Source of request WILLIAM CLARK, ATTY FOR OWNER Date JUNE 16, 1992 JUL 01 2025 D`:LLLI�?G: APPEALS Type of construction FRAME 1-1/2 ZONING BOARD OF Foundation MASONRY (BLOCK) Stories Cellar g Crawl space� � Total rooms, lst. Fl 4 2nd. Fl• ,, ,d. F1 Bathroom(s) 1 Toilet room(s) Porch, type Deck e Patio, BR1" 8, a Breezeway Garac —Utility ity room Type Heat on alarm Air Hotwater xx Fireplace(s) No. F,cits 2 Airconditioning Domestic hotwater II Type heater OFF FURNACE Other -" ACCESSORY STRUCTURES: Garage, type const. Storage type ype const. SWimming pool Guest, type const. Other _CHAPTER 45--N.Y. STATE UNIFORM FIRE PREVENTION 6 BUILDING CODE I»noat on Descrinti on ggJ Art. j Sec. P N , C Remarks: Inspected b Date of Insp. .NNE 24, 1992 B J FI�DBR, ....,... . Time start ' 10:00,•-_erld 10:25 RECEIVED 9dq®S15 AGRICULTURAL DATA STATEMENT �UL p 1 2025 ZONING BOARD OF APPEALS TOWN OF SOUTHOLD ZONING BOARD OF APPEALS WHEN TO USE THIS FORM: This form must be completed by the applicant for any special use permit,site plan approval, use variance,area variance or subdivision approval on property within an agricultural district OR within 500 feet of a farm operation located in an agricultural district. All applications requiring an agricultural data statement must be referred to the Suffolk County Department of Planning in accordance with Section 239m and 239n of the General Municipal Law. 1. Name of Applicant: MI � � - 2. Address of Applicant: z, _. .:.. 3. Name of Land Owner(if other than Applicant):, 4. Address of Land Owner: _ .._.... 5. Description of Proposed Project: 6. Location of Property: (road and Tax map number) ..'I+ r 7. Is the parcel within 500 feet of a farm operation? { } Yes 8. Is this parcel actively farmed? { } Yes (00 9. Name and addresses of any owner(s)of land within the agricultural district containing active farm operations. Suffolk County Tax Lot numbers will be provided to you by the Zoning Board Staff, it is your responsibility to obtain the current names and mailing addresses from the Town Assessor's Office (765-1937)or from the Real Property Tax Office located in Riverhead. NAME and ADDRESS 2 .. 3 .y .� 4. _. ... _.... _... 5. _. _... ....__ 6. _ ....., ._.......... . (Please use the back of this page if there are additional property owners) 1-9 /"Vw Sig Ju e of Applicant Date a The lot numbers may be obtained in advance when requested from the office of the Zoning Board of Appeals at 631-765-1809. Note: 1. The local Board will solicit comments from the owners of land identified above in order to consider the effect of the proposed action on their farm operation. Solicitations will be made by supplying a copy of this statement. 2. Comments returned to the local Board will be taken into consideration as part as the overall review of this application. 3. Copies of the completed Agricultural Data Statement shall be sent by applicant to the property owners identified above. The cost for mailing shall be paid by the Applicant at the time the application is submitted for review. RECEIVED Sogo S 617.20 Appendix B 'JUL O 1 2025 Short Environmental Assessment Form ZONING BOARD OF APPEALS Instructions for earn l tin Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: Project Location(describe,and attach a location map): Brief Description of Proposed Action: Name of Applicant or Sponsor: Telephone: _ E-Mail: Address: r City/PO: Code: N'TA-ng Ncl= 7" k19 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 may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial ❑Residential(suburban) ❑Forest ❑ Agriculture ❑Aquatic ❑ Other(specify): ❑Parkland Page 1 of 4 RECEIVED & 0 S 5. Is the proposed action, ?JUL 2�25 NO YES N/A a.A permitted use under the zoning regulations? b. Consistent with the adopted comprehensive pla SnAgpQEAPPS 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO S If Yes, identify: 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: f- 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? b.Is the proposed action located in an archeological sensitive area? 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? Vol b. Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 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? 16.Is the project site located in the 100 year flood plain? NO YES `1.1" 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? ❑NO❑YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? . If Yes,briefly describe: ❑NO❑YES y� Page 2 of 4 RECEIVED 18.Does the proposed action include construction or other activities that result in the impoundment of NO Y 2025 water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: O ING OARa OF APPEALS 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Date; �- Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate reasonably available eneEg conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 RECEMD fl JUL U 1 2025 smallr to la gee impact impact Y may ZONING BOARD OF APPEAL 5occur 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 t t(ANSACTIONAL DISCLOSURE FORM ,e Town of Southold's Code of Ethics Drohibits,conflicts of interest on the oart of town officers and ern In ees.The of this form is o orovide information which can alert the:town of ossible conflicts of interest and allow it to take whatever action is necessary t!Lavoid same. YOUR NAME : L a"tq lo 14 (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.) so� TYPE OF APPLICATION: (Check all that apply) RECEIVED Tax grievance Building Permit Variance Trustee Permit JUL 0 1 2025 Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) Planning ZONING BOARD OF APPEALS Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold?"Relationship" includes by blood,marriage,or business interest. "Business interest" means a business,including a partnership, in which the town officer or employee has,even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5% of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee. Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply) A)the owner of greater that 5% of the shares of the corporate stock of the applicant(when the applicant is a corporation) B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation) Q an officer,director, partner,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted thi-r11'gz-- day of 1'7 20 Signature?�� Print Name Juno-9,2025 RECEIVED � 0 S JUL 01 2025 To Whom it May (�oncozrn: ZONING BOARD OF APPEALS My namoz is Kelsozy ftrtolas and I rg-,sidoz at 855 tiorton -6vfz,lMattituck, ley 11952. Thoz apartmoznt that I livoz in is owned by my cousin (through marria8oz) Donald bask". I can providoz my 1¢asoz if noz¢dozd, plozas¢lort moz know. My eozll phonon nurrmbozr is 631-255- 5792. Thank you for your timoz. KizlsQy��rtolas � . a.a� s°a 8' SP. d to 'su'ffbik County Kelsey Bertolas i s n. w i II w,g �4 n Y � ffr S`V3d a,r tj v v v 5zoz 10 inr Vgg'l I MII a i Sri r1, n i a 1� ( II r i i i 'fin^ 1 w r I JUL 01 2025 ` f f ZONING BOARD OF APPEAL'` IM if j; f� r ��of i P l� rMe y's ° 4. di � �� r r r ira ar��„ µ ssruurta� ^ ako�� mi w r i � ry u a ; }' a s 711 r a " s,., '".'f: %✓ r n' +r Jti. �7 I RECEIVED I►,i. 01 2025 RD ZONING BOA OF APPEALS i i i i 6 i re �1 � i u �l d„ r RECEIVED I� "JL 01 2025 IIIIIII mu V IIVp i OARD OF APPEAI r i 1 I r //%'�/ i�� // % ��✓//%// ///i/ �1. i 44Z 014U ry J�� d��r up ��IV I Vie 1�'l irF✓��^/i �� f�, �' e� f� rt I � J II o I ; ,I I / r� 1 y' x (� O d C I O 0 '; (nor ' Ln 3 CD O O O a _ 4 ri O (D N �'�,, t„ ` f"m. ( f �„�,i",f i, ,i 'dr b %J t'� f Z rn m r Cl I ��. e I i r f� , 10 { 14, iju 1 1 u p 202 �. 6 T S or- m f ,a N ..f G r TN Ou CIO In, n (51 w �f� I w A N7 f I q, � LU la � I � � a e P a. e F - - .. , 141.4-24.1 3/08 fill t o t a l 3 i �4 r , 1, h1 Bld r Foundation -- - _ Bath t Floors Basement _ __ Extension . . � _ Ext. Walls Interior Finish Extension E i ma Fire Place 3 Heat Extension i a Attic Porch Porch Rooms 1st Floor Patio' i Rooms 2nd Floor . � Breezeway , �� g �� Garage g _ , t 3 O. B. s ,� ,I t All "AIJ i IJf pAf;l;. 11,CIUMk U; UNAU7 1UR i L Al If HAUI(N to AI1L1111t1P7 .. VY LAirIAf�;"rv1.'i Na .If::CA1?fl U 1l7p,P� tl[!"1latlAl ill+, .A1VY ! A 1Jir1V..l1IIU1 fJl Area— c�� CAI � , K) , rr=r 1�r 1rI, � YrIR r u�.,A,.,. 20 830 sq.ft. A 7A Hp A,��,, r F'U , �L D IO Ur.AI A rt"lMI ^IY Y U rlNl'C A"VATIUI"J" 1 l�I u(iQ iluH un nu::: �riGll "J UI" UVAhIC f' YAK r�AND UNIC,Y {7 ALLYl i�l Ur9C Ur l ,�I+IYJfr qq rrm u 1 ru u , O.YB acres �...w..°'..... .......\... Iru t,i,A,";iR l'F,f,) AI'Uj"U M' �AVP x� CA GONG AC N01 ,"HJWIQ ARL X) h1�AHA I r,.::D (,UARA dl ,, V,DJCAIl U Plf M ON NLY 10 ' It' AC'iw Wr 01v P(,U WHOM 1'U SURVfi::'f 1S, 0'1"+;i�PANk:I), ANU Clio V11"a M I1AI C'` 1"rJ T�J1 B'vr — ba,r vv 7 r..,�. 117,Rai' C,UMPAN', GUVN MlMu"[:lv IAI a(,i'IN CY AI'40 A P::f,i C;711'+(, I,I',,TIl,.IYfUd Lfi7f;;'C1 Hi ix"^":C;1 fJ, A 1;7 7..a01s 10N"'A0+^JU(!:. 10 '1FdC A.S)C k'::!S Oi II k:':: I f V OING' INIAr, 1U'"IO GUARApd'1LLS Ah'F'i: OR)ORP 7RAN",fR RANI^I... RECEIVED 'JUL 0 1 2025 ZONING BOARD OF APPEALS 44 y � k• 1`11 ke <01,0 a rO v 2Z V �a 4 y AAA l ^' i Certified to: ;. [onclr Ir%"'er INr",I,,rlr Lod WA, Jnsurrlri,,e f,uMPLII,"y Advocu�e'`'"" Abst d Survey of Property situate at Mattituck 1"i"wp 5.r...Rvn° tw", Town of Southold Suffolk County, New York I7,1 A ��URI AU `,ArVr:I Tax Map #1000-141-01-24"1 110K{(,„HAr H)L <iJ I-tVr I", 'AN"' "jj"NMHS Scale 1 "— 30' August 8, 2016 GRAPHIC SCALE 120 MCAII h'll N1tll 1Q^ II... 110AA 4 (n�I l.v1 i�`i .__.. ,....... ...... .......... .,.,. __._ ....... ,„.w..... u r110 zi ,A,?' SMITHTOWN BOULEVARD /707 . t� 3 RECEIVED ? `- �UL U 1 2025 ; �,.. 3 � a }, r ZONING BOARD OF APPEA4S i r r L-J i lea 0.—LLC sa z =_ Y _ = � Y I'I-Ck NY 5 5S2 G—ge Ane t A-01