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Home My WebLink About#8077-BKM Properties of Shoreham ZBA Application FORM NO. 3 Received TOWN OF SOUTHOLD OCT 3 0 2025 BUILDING DEPARTMENT SOUTHOLD,N.Y. Zoning Board of Appeals NOTICE OF DISAPPROVAL DATE: May 7, 2025 RENEWAL: October 21, 2025 TO: BKM Prpts of Shoreham Inc 82 Cobblestone Dr Shoreham,NY, 11786 Please take notice that your application dated April 1, 2025: For permit to: to construct additions and alterations to an existing two-fan dwdllin . and le alize an existing accessory shed at: Location of property: 7600 Main,.Road East Marion NY County Tax Map No. 1000—Section 31 Block 6 Lot 11 Is returned herewith and disapproved on the following grounds: The-proposed construction on this non-donforrnin g 17 388 sal. parcel in the R-40 residential district is not ermitted pursuant to Article XXIII Section 280-124 which states lots measuring less than 20.000 square feet in total size re uire a minimum front yard setback of 35 feet. The survey shows a front hard setback of 23.7 feet. Additionally, the existin accessory shed is not permitted pursuant to Article Ill Section 280-15 which states accessoa buildings and structures on lots between 10,000 and 19,999 s .ft. shall maintain minimum rear and side and setbacks of 5 feet. The survey shows the shed to have a rear yard setback of 4.9 feet. Variance re uirements were found a on field ins ections for BP# 51471 horized Signat e Note to Applicant: Any change or deviation to the above referenced application may require further review by the Southold Town Building Department. CC: file, ZBA A Received APPLICATION TO THE SOUTHOLD TOWN BOARD OF APPEALS AREA VARIANCE 0 C T 3 0 2025 House No. Street Hamlet .. SCTM 10 � Zone 00 Section: Block:ILot(s) Lot Size: --fl— R_4� I(WE) W Y EN DETERMINATION OF THE BUILDING IN' PEC DATEDY 5BASED ON SURVEY/SITE PLAN DATED JJ"i Owner(s): V61, P Ae I =� 0--EL tj b Mailing Address: Tele 1: —a � . NOTE: In addition to the above please complete below if application is signed by applicant's attorney,agent, architect,builder,contract vendee,etc.and name of erson who agent represents: Name of Representative. o ner( ) Other: Address:Al Ltihlro it1 Telepl: ltIix• Aj118L Email: ()Y, Ij3 Cot" Please check to specify who youW:� spondence to be marled to,from the above names: ( ) Applicant/Owner(s), orized Representative, ( )Other Name/Address below: WHEREBY` 1-1 II NG INSPECTOR REVIEWED SURVEY/SITE PLAN DATED and DENADON�PPJ.jC�A,TdO Dp�TEp FOR: uilding Permit �� (( Certificate of Occupancy ( ) Pre-Certificate of Occupancy ( ) Change of Use ( ) Permit for As-Built Construction ( ) Other: Provision of the Zoning Ordinance Appealed. (Indicate Article,Section,Subsection of Zoning Ordinance by numbers.Do not quote the code.) Article: Section: Subsection: y Type of Appeal. An Appeal is made for: ( ) A Variance to the Zoning Code or Zoning Map. J Variance due to lack of access required by New York Town Law-Section 80-A►. �' . nterpretation of the Town Code,Article Section � w�-* '4 ( )Request for Reversal or Overturn the Zonn .g� ffxcer's Denial Other A prior appeal ( ) has, has not been made at any time with respect to this property, UNDER Appeal No(s). Year(s). (Please be sure to research before completing this question or call our office,for assistance) t Page 2, Area Variance Application Revised 6/2023 Received REASONS FOR APPEAL OCT 3 0 2025 (Please be specific, additional sheets may be used with preparer's signature notarized): a- d of Appeals I. An undesirable change will not be produced in the CHARACTER of the noT#i W A detriment to nearby properties if granted,because- ' 4 tie 4�Z'N Ir t-r &HAN hvuo is flu (2-0 r%)am A, foA, e ve b S6 ne t 2.The benefit soughLt9y 1h1c4-applTarfteANNO achieve y ne j Fea%s ,Vr)iieapplicant to pursue,other than an area variance, because: I % I e9 U A (X 1 00 Atv- cgs A ru. AfZe-&LJ1-.1 0 F#A PNL N rouj I As Vat/&- 4 111i� j efrcqu , d is n Te 3 The e tl L i n t�o r Yei 7 -e s t7c Z (K s Pan t�ia -r 14,g '-e I"e F- bf A c ce-s,-S,a it S ii e.J fftAS.�Ml op/ he ita I S F.T AC Le, I k)t'A1Q0A I AwS"( -14)XIN altfittioilprac on �p�iyWia on&W i It on ne-0 the neighborhood or district,becawse.- 0 5 A I\J�4T'lla-PA W PR ' Lll C1WQ.LL1#VV5 000 .14 A W A S.Pssu,4 e 5 l 1141 rirficulty been selfcreat d Yes,or, No Why-. • Are there any Covenants or Restrictions concerning this land? C*Wo Yes(please furnish a copy) This is the MINIMUM that is necessary and adequate, and at the same time preserve and protect the character of the neighborhood and the health, safety and welfare of the community. By signing this document, the PROPERTY OWNER understands that pursuant to Chapter 280- 146(B)of the Code of the Town of Southold,any variance granted by the Board of Appeals shall become null and void where a Certificate of Occupancy has not been procured, and/or a subdivision map has not been filed with the Suffolk County Clerk,within three(3)years from the date such variance was granted. The Board may, upon written request prior to the date of expiration,grant an extension not to exceed three(3)consecutive one(1)year terms. IT IS THE PROPERTY OWNER'S RESPONSIBILITY TO ENSURE COMPLIANCE WITH THE CODE REQUIRED TIME FRAME DESCRIBED HEREIN. plicant or Authorized Agent li t or Authorized Vp SignatL e ,t written or (Agent s submit written Authorization from Owner) REMY M BELL Sworn to b fore me this • STATE OF NEW YORK NOTARY PUBLIC.ST,\ of0 Registration No.01 BE4985318 Qualified m Sufi County :Notary Public My Commission,expires:! Zoning Board of Appeals APPLICANT'S PROJECT DESCRIPTION I APPLICANT: P g. KT l � ��No. U CCT 3 1. For Demolition of Existing Building Areas ' ,Zoning Board of Appeals Please describe areas being removed: II. New Construction Areas (New Dwelling or New Additions/Extensions): Dimensions of first floor extension: Dimensions of new second floor: --MIA Dimensions of floor above second level: Height(from existing natural grade): Is basement or lowest floor area being constructed? If yes, please provide height(above ground) measured from natural existing grade to first floor: III.-Proposed Construction Description (Alterations or Structural Changes) (Attach extra sheet if necessary). Please describe building areas: Number of Floors and General Characteristics BEFO E Alterations:�� Number of Floors and Changes WITH Alterations: Calculations of'bu-1 �gkajMain l%��T�,T kD planes(Fro S�r<Ve n ro o t/ �T.Tlfw- IV. Existing square footage of buildings on your property: Proposed increase of building coverage. --=:::W Square footage of your lot: .... 414 Percentage of coverage of your lot by building area(lot coverage)J _ _ Gross Floor AreaJGrA)of single family dwelling including the attached garage and/or habitable detached accessory structure: (Please refer to Chapter 280, Section 280-207 of the Town Code): For Residential lots, is project within the allowable Sky Plane? (Please refer to Chapter 280, Section 280-208 of the Town Code): V.Purpose of New Construction: 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: 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. Re,dsed 6/2023 QUESTIONNAIRE FOR FILING WITH YOUR ZBA APPLICATION A. Is the sub ect premises currently listed on the real estate niarkct for a _ % " Ycs —No OCT 3 o 2025 B. Are there any proposals to char a or alter land contours? �No es,plea g explain on separate sheet. ,, of Appeals C. 1.)Are there areas that contain sand or wetland grasses. 2.)Are those areas shown on the survey submitted with this application. VNdiinig-a—rea? 3.) Is the property bulk headed between the wetlands area and the upland 4.) If your property contains wetlands or pond areas,have.you ��of the BOARD OF TRUSTEES for its determination of jurisdiction? t�ntact t a Ol tce Please confirm status of Y q our in uirY or application with the Board cstees: If issued,please attach copies of your permit Iisting conditions of approval with a copy of the approved survey- D. Is there a depression or sloping elevation near th of proposed construction at or below five feet above mean sea level? E. Are there any patios,concrete barriers,but . w,ds or tence that exist that are not shown on the survey that you are submitting? If any of the aforementioned items exist on your property,please show them on a site plan. F. Are there any construction projects currently in process on your property'? If yes,please submit a copy of your building permit and survey as approved by the Building Department and please describe scope of work:A ' 'v G. Please attach all pre-certificates of occupancy and certificates of occupancy for the subject premises. If none exist,please apply to the Building Department to obtain them or to obtain an Amended Notice of Disapproval. ^ H. Do you or any co-owner also own other land adjoining or close to this parcel? ,u v If yes,please label the proxity,of yout lands on your surrey and identify the Suffolk County Tax Map No. �,, ,or operations ronductedd at your property, dm"or the proposed use I. Please list re�t,nt u,•�, J. (examples:.xisting singly surd progt� ed:same with garage E or other) P P Pz Auth ed signature Date FORM NO. 4 TOWN OF SOUTHOLD Fkecelved �1 BUILDING DEPARTMENT Office of the Building Inspector 2025 Town Hall Southold, N.Y. Zoning Board of ¢peals PRE EXISTING CERTIFICATE OF OCCUPANCY No Z19269 Date AUGUST 6, 1990 THIS CERTIFIES that the building TWO FAMILY DWELLING Location of Property 7600 MAIN ROAD EAST MMION House No. Street Hamlet County Tax Map No. 1000 Section 31 Block 06 Lot Oil Subdivision Filed Map No. Lot No. conforms substantially to the requirements for a private one family dwelling built prior to APRIL 9, 1957 pursuant to which Certificate of Occupancy Z19269 dated AUGUST 6, 1990 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 NON CONFORMING TWO FAMILY DWELLING WITH 3 ACCESSORY BUILDINGS NON HABI'TA 3L ' The certificate is issued to JOHN AND NIKI PORFIRIS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N A PLUMBERS CERTIFICATION DATED N/A ****SEE ATTACHED INSPECTION REPORT Building Inspector Rev. 1/81 4 BUILDI'•:G DEP:'RT:-LE T TO"RIT OF SOUTHOLD, N. Y. d All HOUSING CODE Ii15?ACTION RE " ceiv�' Location 7600 MAIN ROAD EAST MARION knumoer sLreec) s a ) Subdivision Map No. Lot(s) dOHN PORFIRIS 6 WIFE ��'„.on1 flg rackOfApt Name of O��mer(s) Occupancy A2 OWNER (type ' owner-zenanz) Admitted by: NIRI PORFIRIS Accompanied by: SAME Key available Suffolk Co. Tax No. 31-6-11 Source of request KEVIN J. MC LADGHL'IN Date 7119/90 D1,11ELLING Type of construction WOOD FRAME #stories 2 Foundation STONE Cellar 1/3 Crawl space 2/3 Total rooms, lst. F1 6 2nd. F1 2 3rd. Fl Bathroom(s) 3 Toilet rooms) Porch, type FRONT OPEN Deck, type - Patio, type_:: Breezeway Garage Utility room Type Heat OIL warm Air Hotwater xx Fireplace(s)ONE No. Exits I Airconditioning Domestic hotwater Type heater Other STORAGE ROOM AT REAR OF HOUSE ACCESSORY STRUCTURES: Garage, e const. o , type c 1 WOOD FRAME Storage, type const. 2 WOOD FRAME Swimming drool Guest, type const. Other VIOLATIONS: CHAPTER 45—N.Y. STATE UNIFORM FIRE PREVENTION 6 BUILDING CODE Lncztion Descriotion Arta Sec. ALL ITEMS CORRECTED FROM LAST INSPECTION YY Remarks: Inspected by: _Date of Insp. 7/27/9D s B/6/90 GARY ISH Time start 9:45 end 10:30 a.m. .Y y Il r �'�P OF �r.7PEf2TY �bcevved ° - , a QCT 3 � 202 4 J. is on n Board of ApPea `I—JGLD Y. •E.. FAIL FENCE w 9 Y� d' �� ,. Jo^qr!-�•F.. „- .�y... ._ _TITLE IN�UiIP�-:_ :. i ,d _. ..�,.. %we *° BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY ROOOivOC BUILDING PERMIT 202� OCT 3 (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECII= '' ��:I °f Appeals UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 51471 Date: 12/3U2024 Permission is hereby granted to: - BKM Prpts of Shoreham Inc 82 Cobblestone Dr Shoreham, NY 11786 To: Construct alterations to an existing two-family dwelling as applied forto include insulation,roofing, fixtures,electric and window upgrades. Premises Located at: 7600 Route 25, East Marion, NY 11939 SCTM#31:6-11 Pursuant to application dated 10/21/2024 and approved by the Building Inspector. To expire on 12/12/2026. Contractors: Required Inspections: Fees: Single Family Dwelling Alteration $790.00 CO Single Family Dwelling-Addition/Alteration $100.00 Total $890.00 �Kl—ldlng.Inspector SEAL IVANDOW EX.21045 DH WINDOW LpCEMENT DIRECT REPLACEi' ENT '� RR RFPAIREn IXISTING AGRICULTURAL DATA STATEMENT ZONING BOARD OF APPEALS fl�T ZO25 TOWN OF SOUTHOLD oard of Appeals WHEN TO USE THIS FORM: This form must be completed by the appP 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: -0- 2. Address of Applicant:—kj� 3. Name of Land Owner(if other than Applicant): 4. Address of Land Owner: 5. Description of Proposed Project: A � '" 41 6. Location of Property: (Road and Tax map Number) 7. Is the parcel within 500 feet of a farm operation? { } Yes { } No 8. Is this parcel actively farmed? { } Yes )<1140 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 Cc' 2. NOR -��Vol 5. .__..... .... ... I !... 6. (Please use Pea of this page if there are additional property owners) Sign ure nt late 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. 61 Z20 ec Ne� Appendix B 0 Short Environmental Assessment Form OCT 3 0 2025 Instructions for Completing Toning Board of Appeals 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 6 HN.,AA ti Nc Name of Action or Project: Project Location(describe,and attach a location map): p ropme4 Action,- + M '` / Clt rwel`l escrt tirsttof P �� BWv- .L tA)Cl . fV Ro V (Z1' x X r I I 5ecT1�ll� ca Name of Applicant of Sponsor. Telephone: lbo ci�u N W S l -flail r NOOL ��. A ,, _ LSD ti -T, E ' City/PO: Sta zip lode: KI C1 7op 1.Does the proposed action only involve the le2islatixk adoption of a plan,local law,ordinanc 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 I f Yes,list agenc: (s)matte^and,permit or approval: gu 1 R Q�M lT.0 , C Ovo 3.a.Total acreage of the site of the proposed action? / acres b.Total acreage to be physically disturbed? acres W L 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 Pagel of 4 5. Is the proposed action, 1"'�-" NO YES N/A a.A permitted use under the zoning regulations? b.Consistent with the adopted comprehensive plan? pGT 3 d 2025 6. Is the proposed action consistent with the predominant character of the existirw bOobpatgralc '�� NO YES landscape? Zoning 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO 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? 7 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: 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 INO 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 YES wetlands or other waterbodies regulated by a federal,state or local agency? b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? 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 17.Will the proposed action create storm water discharge,either from point or non-point sources? 10YES If Yes, a.Will storm water discharges flow to adjacent properties? ❑NO❑YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO❑YES Page 2 of 4 18.Does the proposed action include construction or other activities that result in O " of NO YES i water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: / 19.Has the site of the proposed action or an adjoining property been the locatiDbpfmg aWN4Vr dos NO YES solid waste management facility? If Yes,describe: - �k 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 TRU&AND ACCURATE T THE JEST OF MY KNOWLEDGE ,., Applicant/sponsor na : 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 r occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 Receive N1 No,or Moderate OCT 3 2a mall to large impact impact may Board of '� ais Y Zoning occur occur 10 Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. * Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) Page 4 of 4 Received' Board of Zoning Appeals Application OCT 3 0 2025 OWNER'S AUTHORIZATION Zoning Board of Appeals, (Where the Applicant is not the Owner) b% I, , (Print property owner's name) (Mailing Ad � 0 P& &o hereby authorize (Agent) 5 3 3 LrO4) .007�� o a pl for variances)on my behalf from the Southold Zoning Board of Appeals. By signing this document,the Property Owner understands that pursuant to Chapter 280- 146(B)of the Code of the Town of Southold an variance granted by the Board of Appeals shall become null and void where a Certificate of Occupancy has not been procured,and/or a subdivision map has not been filed with the Suffolk County Clerk,,orithin three(3)years from the date such variance was granted. The Board of Appeals may,upon WTitten request prior to the date of expiration,grant an extension not to exceed three(3)consecutive one(1)year terms. IT IS THE PROPERTY OWNER'S RESPONSIBILITY TO ENSURE CC MPLIA CE WI"I"'II THE CODE REQUIRED TIME FRAME DESCRIBED HEREIN. (6evt16r's Signature) REMY M BELL NOTARY PUBLIC,STATE OF NEW YORK 114stration No.01 BE4985318 Ll.I Quiflified n1 SLIft1k County t Owner's Name mmission x it-es .. _ oJ,4- (Pnn ) M y Co N eceivecj OCT 3 0 2025 APPLICANT/OWNER Zoning Boaro of Appeal; TRANSACTIONAL DISCLOSURE FORM TflelownotSouthold':s Code to Ethic s is of interest on the part n towil e- anal et to aes.°` e putpose of tills fgrM s ov de Information% l ct a t' ors' oss hle conflicts est d alloy it to take Ehatever a of l n ee sari°to avid sank YOUR rAVIE: L {Last name.fiat name,mh1die foil ial,unless you are applying in the name of someone else or other entity.such as a company.Irso,indicate the other person's or company's name.) TYPE OF APPLICATION:(Check all that apply) Tax grievance Building Permit Variance Trustee Permit Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) 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. r 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 appliamt/ageat/representative)and the town officer or employee. Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): 1)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) Cl an officer,director,partner,or employee of the applicant,or D)the actual applicant DESCRIMON OF RELATIONSHIP r--� ulatni t jay of , Signalu Print Name Rece,i\fed OCT 3 0 2025 cp APPLICANT/OWNER Zoning Board of Appeal',-� TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees,The p_urpose o this form is to provide information which can alert the town of nossible conflicts of m-and allow it to take whatever action is necessary to avoid same. YOUR NAME K (Last name,First name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) TYPE OF APPLICATION: (Check all that apply) Tax grievance Building Permit Variance Trustee Permit Change of Zone Coastal Erosion - ----- Approval of Plat Mooring Other(activity) Planning Do you personally(or through your company,spouse,sibling, parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage,or business interest."Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of(or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO If you answered "YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person _ Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee. Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply) — A)the owner of greater that 5% of the shares of the corporate stock of the applicant(when the applicant is a corporation) B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation) Q an officer,director,partner,or employee of the applicant; or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this REMY M BELL 20 Signature NOTARY PUBLIC,STATE OF NEW YORK Registration No.0 1 BE4985318 Print Name x// Qualified in SO"Ik County ........... My Commission expires: 21 Town of Southold . E)C V LWRP CONSISTENCE ASSESSMENT FOR 0 2025 A. INSTRUCTIONS Zoning Board of Appeals 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#_ - l0 - I L The Application has been subnutted to(check appropriate response): Town Board 0 Planning Dept. WBuilding Dept. 0 Board of Trustees 0 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g.capital construction,planning activity,agency regulation,land transaction) (b) Financial assistance(e.g.grant,loan,subsidy) (c) Permit,approval,license,certification: Nature and extent of action: Re Yv t i6 ri,w, Tw iL-,V bwtr Ll P Received Solt Location of action:_ 9 600 R1 _ , (0)vcdo;V Site acreage: L �,,� p � ^ oQing Boardof Apoeal�•�`""�() Rq�� .4 Present land use: Present zoning classification: R,, YD 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided:KM (a) Name of applicant: l? �" S ;, Q C, (b) Mailing address: t41 _ (c) Telephone number: Area Code( ) (d) Application number, if any: s , Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes 0 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- please explain) illy Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Purl" ies Pages 3 through 6 for evaluation criteria 0 Yes 0 No (NDt Applicable—please explain) Attach additional sheets if necessary ls Policy 3. Enhance visual quality and protect scenic resources thrTydW l�eMVn'9R aSouthold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Yes No � (Not Applicable—please explain) Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III_P"olicies Pa es through 16 for evaluation criteria Yes E .No (Not Applicable—please explain) Attach additional sheets if necessary Policy 5. Protect and .improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 tlarau h 21 for evaluation criteria Yes �I No (Not Applicable— please exp ai'n) Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaW a criteria. l!l Yes [E NoNot Applicable—please explain) tj V" ' „ a Attach additional sheets if necessary Bpafo fj �onin9 Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. See Section III—Policies Pages; 34 through 38 for evaluation criteria. �❑r Yes No (Not Applicable—please explain) Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No�(N,ot Applicable—please explain) mm r PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. EA YeLl NX;ot Applicable—please explain) Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new wt " ie �1ei`t uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. OCT 30 20,,< Yes ❑ NoX (Not Applicable—please explain) . _ r .,(l of '�l'�:�l,iul oh Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. RYes Nox Not Applicable—please explain M Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III— Policies; Pages 62 through 65 for evaluation criteria. Yes ❑ Nw Not Applicable—please explain ksbT &-ek OA ftk��l Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. Yes ❑ No;<Not Applicable—please explain 2 � I !� �l , l r r G/ n, V ry J ! Vh, All r ^J 4 � INY11 / /97/r�1/rI�D j i ;rye �• 1 rV/I �/cur// lr rr�yG 3��y�/✓%l Jr i ��%Jfi�� III !y� �ns �i'�� r !rirnr7lrJr ,rri ' EC r� jjjj Vp O�p // Ilyiluu� Ili I / T JI J � vl p r IF �' �AIIjj �; SEE iijl Jill %1 i I I i"SLUM Ko it �iU� !III ig im is / i / f � I a ///l14 I✓ r �6 Y r �„ Y„ �e lr � ID.Ki„, li�lf-•i� r �r ��p r v� P i r� N� 77, r: .� P M HT 0 202, ,�"�� t �0V'I �5 Sa G" N l �� I iu Ill�y',I� Y14/l°o7onn�l rltifr r °,m�u r r III /"r"rr d��ti rmri` r .. . I � �'" ➢ � 1 J's 1 M Pl rl i, �AArJlrr+rmy Y mrl l mw r r�'sr r r�/f� 9 i i�,I ' I � VI4 luliul i ul„ 'I� 'Ir��,1�. � d's,��'trwz� N ✓ul:�� °I lipl fl Y17ilr n ro^rc r�r°rrrr;m„r m " ��I>Y 1>wN11/1 11 I 1-0��1 r'Y"�J1J� onin,g TOWN OF SOUMOLD PROPERTY RECORD CARD ( ,+r r , _ ayVILLAGE P SUB. LOT FbPMER GWNER N E AOL e 4 TYPE OF BUILDING i SEAS. VL 4 FARM comm. CB. Nike. Winne � LAND IMP. TOTAL DATE REMARKS a. x = _ - M t , At 01 s t E AGE BUILDING CONDITION TOWN F � NEW NCRMAL SELOW ABOVE FA Acre Value Per clue Acre Tillable FRONTAGE ON WATER Woodlond FRONTAGE ON ROAD _ r land i DEPTH n _ House Plot ..� BULKHEAD Totot DOCK e E hat = COLOR I , E 3 e g TRIM - �z a F -v 5 �r L V - u • AA Sid — 9 _ a t Extension Extension e � - — --- - Externs;on �` ® a�n �.'�+� i f'3�,r-c �i r ;Foundation ;Both (pia-�t t _. �-- �� _... e i �_ e Rorci � CD iBcsement Floors Parch �Ext. W43115 Interior Finish s _ LR Breezeway .Fire Floce "Meat DR, Jp Goroge iType Roof ;Rums 3st Floor f � 4 FatiS !Recreation Rocni Rooms 2r,d Floor� F[t 0. B. 'Donner Driveway •� �3 c:lx Total e