HomeMy WebLinkAbout9025 MAIN ROAD LLC - AREA VARIANCE FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
DATE: March 23, 2018
TO: Goggins &Associates (9025 Main Road LLC)
13235 Main Road
Mattituck, NY 11952
Please take notice that your request dated February 20,_2018
For permit to build a 3-story hotel containing 200 guest rooms at
Location of property: 9025 Main Road, Mattituck,NY
County Tax Map No. 1000—Section 122 Block 6 Lot 22.1
Is returned herewith and disapproved on the following grounds:
The proposed construction in the Business_MIdistrict is not permitted pursuant to Article VIII, Section
280-49, which states-;-
`No build' 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_ehapter by reference, with the same force and effect
as if such rewjlations were set forth herein in full."
Bulk schedule limits buildings to 2 stones.
Furthermore,the proposed construction requires special exception approval from the Southold Town
Zoning Board of Appeals and site plan approval from the Southold Board.
Authorized ignature
Cc: File, planning, ZBA
GOGGINS & ASSOCIATES
ATTORNEYS AT LAW
13235 Main Road, P.O. Box 65
Mattituck, New York 11952
November 6, 2018
Phone (631)298-4818 William C.Goggins,Esq.
Fax(631) 298-4214
ogfinslavvidgmail.com Donald Mates,Esq.
Southold Town Zoning Board o Appeals Of Counsel
53095 Main Road Philip J.Branigan,Esq.
Southold, New York 11971 Of Counsel
Attn: Kim E. Fuentes
Re: 9025 Main Road, LLC Area Variances
Premises: 9025 Main Road, Mattituck, New York 11952
SCTM No.: 1000-122.00-06.00-022.001
Dear Ms. Fuentes:
Enclosed please find the following documents:
1. Notice of Disapproval with Original Building Permit application;
2. Current survey of Existing Conditions dated September 25, 2018*;
3. Site Plan dated September 25, 2018*;
4. 500' Radius Map dated September 26, 2018*;
5. Full Environmental Assessment Form;
6. Deed;
7. ZBA questionnaire;
8. Town Property Assessors card;
9. LWRP Form and Agricultural Form;
10. Photo of property;
11. Owner/Agent Authorizations;
12. Area Variance Application and Special Exception Application;
13. Narrative regarding the number of guest units; and
14. A check in the amount of$1,000.00.
Ve truly a rs,
William C. oggins
WCG\dmp
Enclosures
*attached to simultaneous Special Exception application
Fee:S. Filed By- Assignment No.
APPLICATION TO THE SOUTHOLD TOWN BOARD OF APPEALS
AREA VARIANCE
House No. 9025 Street Main Road Hamlet Mattituck
SCTM 1000 Section 122 Block 6 Lot(s) 22. 1 Lot Size 8.03 Zone. B
I(WE)APPEAL THE WRITTEN DETERMINATION OF THE BUILDING INSPECTOR
DATED 3/2 3118 BASED ON SURVEY/SITE PLAN DATED
Owner(s):_ 9025 Main Road, LLC
Mailing Address: c/o William C. Goggins, P.O. Box 65, Ma)rtruck, New York 11952
Telephone: 631-298-4818 Fax: 631-298-4214 Email: gogginslaw@gmail.com
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 person who agent represents:
Name of Representative: William C. Goggins for(X) Owner( )Other:
Address: P.O. Box 65, 13235 Main Road, Mattituck, New York 11952
Telephone: 631-298-4818 Fax: 631-298-4214 Email: gogginslaw@gmail.com
Please check to specify who you wish correspondence to be mailed to,from the above names:
( )Applicant/Owner(s), (X)Authorized Representative, ( ) Other Name/Address below:
WHEREBY THE BUILDING INSPECTOR REVIEWED SURVEY/SITE PLAN
DATED 2/20/18 and DENIED AN APPLICATION DATED 3/23/18 FOR:
( ) Building Permit
( ) Certificate of Occupancy ( ) Pre-Certificate of Occupancy
( ) Change of Use
( )Permit for As-Built Construction
(x) Other: Notice of Disapproval for s_p_e, ital - exception for hotel use and
variance for three story structure with 200 hotel rooms.
Provision of the Zoning Ordinance Appealed. (Indicate Article,Section,Subsection of Zoning Ordinance by
numbers.Do not quote the code.)
Article: VIII Section:280 Subsection:49 and 35(B) 4(B) (1)
Type of Appeal. An Appeal is made for:
(x) A Variance to the Zoning Code or Zoning Map.
( )A Variance due to lack of access required by New York Town Law-Section 280-A.
( )Interpretation of the Town Code,Article Section
( )Reversal or Other
A prior appeal( ) has, ( ) has not been made at any time with respect to this vropLrA,UNDER
Appeal No(s). Year(s). (Please be sure to research before
completing this question or call our office for assistance)
Name of Owner: ZBA File#
REASONS FOR APPEAL (Please be specific, additional sheets may be used with preparer's
signature notarized):
1.An undesirable change will not be produced in the CHARACTER of the neighbor or a detriment to nearby
properties if granted,because: the structure will continue to maintain the substantial set
back from the Main Road.
2.The benefit sought by the applicant CANNOT be achieved by some method feasible for the applicant to pursue,
other than an area variance,because:
The Code permits two (2) story buildings only, and limits one room (unit) per
4,000 sq. ft. of land, which would only allow 81 rooms based upon the calculation:
325,273sq.ft./ 4,000 sq.ft. = 81.318. The vaiance to increase the number of rooms
and increase the height of the structure will make the project economically feasable,
3.The amount of relief requested is not substantial because:
The structure qas built on or about 1972 as a shopping center. Then, converted to
a bank operations and processing center containing a cafeteria, offices, and
over 200 employees working on a daily basis.
4.The variance will NOT have an adverse effect or impact on the physical or environmental conditions in the
neighborhood or district because:
The property is zoned General Business, and it has always been used for commercial
business in accordance with the Town's Master Plan.
5.Has the alleged difficulty been self-created? { } Yes,or{ }No Why:
The Zoning Code prohibits three (3) story buildings and sets an arbitrary limit
on the amount of hotal rooms permitted based on lot area.
Are there any Covenants or Restrictions concerning this land? X)No { ) Yes(please furnish a copy) none known.
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.
Wa
Signature of Applicant or Auth tz Agent
(Agent must submit written Authorizat n from Owner)
Sworn to before me this day
of0G+o-6ef-.r— .�f1
]40; �ahhc
DONNA M.PALMER
NoWY Publlc,State of New York
No.01 PA51D69978,Suffolk County
G¢rinmisslon 1 xnjrey-December 9. �I$
PROPOSED HOTEL NARRATIVE
October 31, 2018
Re: 9025 Main Road, LLC Area Variance and Special Exception
Premises: 9025 Main Road, Mattituck, New York 11952
SCTM No.: 1000-122.00-06.00-022.001
The applicant proposes a Hotel at the site pursuant to Southold Town
Zoning Code Section 280-35 A (4), which requires a minimum parcel of five
(5) acres, 4,000 square feet of land per hotel unit with public water and
sewer, no music or loudspeaker system audible from beyond the property
lines, and guest units less than 600 square feet per unit.
The applicant meets the parcel size requirement of five (5) acres. The
applicant has public water at the site. The applicant will install a sewage
facility under the guidelines of the Suffolk County Health Department.
There will not be audible music and entertainment beyond the property lines,
and the individual hotel units will be less than 600 square feet per unit.
The subject parcel is zoned General Business containing 325,273
square feet of area. Based upon the criteria set forth in Section 280-35 A (4)
the permitted number of rooms is eighty-one (81) hotel rooms. The
calculation is: 325,273 sq. ft./4,000 sq. ft. = 81.318
The applicant seeks an area variance for relief from the limitation of
an eighty-one (81) room hotel applying for a two hundred (200) room hotel.
Full Environmental Assessment Form
Part 1 -Project and Setting
Instructions for Completing Part I
Part 1 is to be completed by the applicant or project sponsor. 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; indicate whether missing information does not exist,
or is not reasonably available to the sponsor;and,when possible,generally describe work or studies which would be necessary to
update or fully 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"Yes",complete the sub-questions that follow. If the
answer to the initial question is"No",proceed to the next question. Section F allows 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 1 is accurate and complete.
A. Project and Sponsor Information.
Name of Action or Project:
9025 Main Road LLC
Project Location(describe,and attach a general location map):
9025 Main Road, Mattituck, New York 11952
Brief Description of Proposed Action(include purpose or need):
Construct a three (3) story building for hotel use containing 200 rooms.
Name of Applicant/Sponsor: FE-Mail:
elephone: 631.298.4818
9025 Main Road, LLC gogginslaw@gmail.com
Address:
cfo William C. Goggins, P.O. Box 65, 13235 Main Road
City/PO: State: Zip Code:
Mattituck New York 11952
Project Contact(if not same as sponsor;give name and title/role): Telephone:
William C. Goggins E-Mail:
Address:
same as above
City/PO: State: Zip Code:
Property Owner (if not same as sponsor): Telephone:
same as above E-Mail:
Address:
City/PO: State: Zip Code:
Page 1 of 13
B. Government Approvals
B. Government Approvals,Funding,or Sponsorship. ("Funding"includes grants, loans,tax relief,and any other forms of financial
assistance.)
Government Entity If Yes: Identify Agency and Approval(s) Application Date
Required (Actual or projected)
a.City Council,Town Board, ❑YeskkNo
or Village Board of Trustees
b.City,Town or Village [i]Yes❑No Planning Board March 1, 2019
Planning Board or Commission
c.City Council,Town or fi]Yes❑No Zoning Board of Appeals March 1, 2019
Village Zoning Board of Appeals
d.Other local agencies ❑YesJDNo
e.County agencies R]Yes❑No Suffolk County Health Dept,' September 1, 2019
f. Regional agencies ❑Yes2tNo
g. State agencies ❑YesJJNo
h.Federal agencies ❑YesKJNo
i. Coastal Resources.
i. Is the project site within a Coastal Area,or the waterfi-ont area of a Designated Inland Waterway? ❑Yes[i]No
ii. Is the project site located in a community with an approved Local Waterfront Revitalization Program? EN Yes❑No
iii. Is the project site within a Coastal Erosion Hazard Area? ❑Yes®No
C.Planning and Zoning
C.I.Planning and zoning actions.
Will administrative or legislative adoption,or amendment of a plan,local law,ordinance,rule or regulation be the [ Yes❑No
only approval(s)which must be granted to enable the proposed action to proceed?
• If Yes,complete sections C,F and G. Variance
• 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 ❑Yes®No
where the proposed action would be located?
If Yes,does the comprehensive plan include specific recommendations for the site where the proposed action ❑Yes❑No
would be located?
b. Is the site of the proposed action within any local or regional special planning district(for example: Greenway ❑YesUNo
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®No
or an adopted municipal farmland protection plan?
If Yes, identify the plan(s):
Page 2 of 13
C.3. Zoning
a. Is the site of the proposed action located in a municipality with an adopted zoning law or ordinance. ®Yes❑No
If Yes,what is the zoning classification(s)including any applicable overlay district?
Ge-i7ex�t- Ri �xin�sxz� --
b. Is the use permitted or allowed by a special or conditional use permit? UYes❑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? Mattituck Cutchogue
b. What police or other public protection forces serve the project site?
Southold Town
c. Which fire protection and emergency medical services serve the project site?
Mattituck Fire Department
d. What parks serve the project site?
-None
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)?
Hotel Use
b. a.Total acreage of the site of the proposed action? _8-3 acres pre—existing commercial
b.Total acreage to be physically disturbed? S.p3-- acres
c.Total acreage(project site and any contiguous properties) owned complex
or controlled by the applicant or project sponsor? 0.00 acres
c. Is the proposed action an expansion of an existing project or use? ❑YesoNo
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®No
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❑No
iii Number of lots proposed?
7.v Minimum and maximum proposed lot sizes? Minimum Maximum
e. Will proposed action be constructed in multiple phases? ❑Yes®No
i. If No,anticipated period of construction: months
ii. If Yes:
• Total number of phases anticipated
• Anticipated commencement date of phase 1 (including demolition) month year
• Anticipated completion date of final phase month _year
• Generally describe connections or relationships among phases, including any contingencies where progress of one phase may
determine timing or duration of future phases-
Page 3 of 13
f.Does the project include new residential uses? Hotel Use ❑Yes®No
If Yes,show numbers of units proposed.
One Family Two Family Three Family Multiple Family four or more
Initial Phase
At completion
of all phases
g.Does the proposed action include new non-residential construction(including expansions)? ❑YesJRNo
If Yes,
i.Total number of structures
ii. Dimensions(in feet)of largest proposed structure: height; width; and length
iii. Approximate extent of building space to be heated or cooled: square feet
h. Does the proposed action include construction or other activities that will result in the impoundment of any ❑YeMNo
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: El Ground water❑Surface water streams ❑Other specify:
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? ❑Yes&No
(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?
ii. Haw much material(including rock,earth,sediments,etc.) is proposed to be removed from the site?
• Volume(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 dewatering or processing of excavated materials? Yes❑No
If yes,describe.
v. What is the total area to be dredged or excavated? acres
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? ❑Yes❑No
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 ❑YesRJNo
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):
Page 4 of 13
ii. Describe how the proposed action would affect that waterbody or wetland,e.g.excavation,fill,placement of structures,or
alteration of channels,banks and shorelines. Indicate extent of activities,alterations and additions in square feet or acres:
iii. Will proposed action cause or result in disturbance to bottom sediments? ❑Yes❑No
If Yes,describe:
iv. Will proposed action cause or result in the destruction or removal of aquatic vegetation? ❑Yes❑No
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:
c.Will the proposed action use,or create a new demand for water? Use consistent with prior use 0YesZ3No
If Yes:
i. Total anticipated water usage/demand per day: gallons/day
ii. Will the proposed action obtain water from an existing public water supply? ❑Yes ONO
If Yes:
• Name of district or service area:
• Does the existing public water supply have capacity to serve the proposal? ❑Yes❑No
• Is the project site in the existing district? ❑Yes❑No
• Is expansion of the district needed? ❑Yes❑No
• Do existing lines serve the project site? ❑Yes❑No
iii Will line extension within an existing district be necessary to supply the project? ❑Yes[]No
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 or 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: gallons/minute
d.Will the proposed action generate liquid wastes? [29 ONO
If Yes:
i. Total anticipated liquid waste generation per day: unknown gallons/day depends on # of rooms allowed
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 Wastewater_._ _PrQaect_will have__tL own
s..±~wage—treatment p :1][Lt_requiring approval S>>ffoIk _Coiinty HeaIth-Me-pa
iii. Will the proposed action use any existing public wastewater treatment facilities? ❑YeSMNo
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? ❑Yes❑No
• Is expansion of the district needed? ❑Yes❑No
Page 5 of 13
• Do existing sewer lines serve the project site? ❑Yes®No
• Will line extension within an existing district be necessary to serve the project? ❑Yes®No
If Yes:
• Describe extensions or capacity expansions proposed to serve this project:
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):
vi. Describe any plans or designs to capture,recycle or reuse 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.
iii. 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, identify receiving water bodies or wetlands:
• 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? ❑Yes❑No
f. Does the proposed action include,or will it use on-site,one or more sources of air emissions, including fuel ❑YesK]No
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)
ii. Stationary sources during construction(e.g.,power generation,structural heating,batch plant,crushers)
iii. Stationary sources during operations(e.g.,process emissions, large boilers, electric generation)
g.Will any air emission sources named in D.2.f(above),require a NY State Air Registration,Air Facility Permit, ❑Yes$]No
or Federal Clean Air Act Title IV or Title V Permit?
If 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:
• Tons/year(short tons)of Carbon Dioxide(CO,)
• Tons/year(short tons)of Nitrous Oxide(N,O)
• Tons/year(short tons)of Perfluorocarbons(PFCs)
• Tons/year(short tons)of Sulfur Hexafluoride(SF6)
• Tons/year(short tons)of Carbon Dioxide equivalent of Hydroflourocarbons(HFCs)
• Tonslyear.(short tons)of Hazardous Air Pollutants(HAPs)
Page 6 of 13
h.Will the proposed action generate or emit methane(including,but not limited to,sewage treatment plants, ]Yes❑No
landfills,composting facilities)? Suffolk County Health Department will require
If Yes: the creation of a Sewage Treatment Plant.
i. Estimate methane generation in tons/year(metric):
ii.Describe any methane capture,control or elimination measures included in project design(e.g.,combustion to generate heat or
electricity,flaring): unknown at this time
i. Will the proposed action result in the release of air pollutants from open-air operations or processes,such as ❑Yes[3No
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 ❑Yesallo
new demand for transportation facilities or services?
If Yes:
i. When is the peak traffic expected(Check all that apply): ❑Morning ❑ 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
h, Does the proposed action include any shared use parking? ❑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 %mile of the proposed site? ❑Yes❑No
vii Will the proposed action include access to public transportation or accommodations for use of hybrid,electric ❑Yes❑No
or other alternative fueled vehicles?
viii. Will the proposed action include plans for pedestrian or bicycle accommodations for connections to existing ❑Yes❑No
pedestrian or bicycle routes?
k.Will the proposed action(for commercial or industrial projects only)generate new or additional demand ❑Yes®No
for energy?
If Yes:
i. Estimate annual electricity demand during operation of the proposed action:
ii. Anticipated sources/suppliers of electricity for the project(e.g.,on-site combustion,on-site renewable,via grid/local utility,or
other):
iii. 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: ii. During Operations:
• Monday -Friday: $ (�nm Monday -Friday: 24 hr
• Saturday: R —&pm Saturday: 94—„-
• Sunday: None Sunday:_ '2
• Holidays: No„o Holidays: 24 brs
Page 7 of 13
m. Will the proposed action produce noise that will exceed existing ambient noise levels during construction, ❑Yesmo
operation,or both?
If yes:
i. Provide details including sources,time of day and duration:
ii. Will proposed action remove existing natural barriers that could act as a noise barrier or screen? ❑Yes❑No
Describe:
n. Will the proposed action have outdoor lighting? same as currently exists ❑Yes❑No
If yes:
i. Describe source(s), location(s),height of fixture(s),direction/aim, and proximity to nearest occupied structures:
ii. Will proposed action remove existing natural barriers that could act as a light barrier or screen? ❑YesK1N0
Describe:
o. Does the proposed action have the potential to produce odors for more than one hour per day? ❑Yesg]No
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) ❑Yes No
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 (e.g., month,year)
iii. Generally describe proposed storage facilities;
q. Will the proposed action(commercial,industrial and recreational projects only)use pesticides(i.e.,herbicides, ❑Yes ®No
insecticides)during construction or operation?
If Yes:
i. Describe proposed treatment(s):
ii. Will the proposed action use Integrated Pest Management Practices? ❑ Yes 91No
r.Will the proposed action(commercial or industrial projects only)involve or require the management or disposal ❑ Yes ®No
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:
• Construction:
• Operation:
iii. Proposed disposal methods/facilities for solid waste generated on-site:
• Construction:
• Operation:
Page 8 of 13
s.Does the proposed action include construction or modification of a solid waste management facility? ❑ Yes® No
If Yes:
i. Type of management or handling of waste proposed for the site(e.g., recycling or transfer station,composting, landfill,or
other disposal activities):
ii. Anticipated rate of disposal/processing:
• Tons/month, if transfer or other non-combustion/thermal treatment,or
• 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 disposal of hazardous ❑Yes[JNo
waste?
If Yes:
i. Name(s)of all hazardous wastes or constituents to be generated,handled or managed at facility:
H. Generally describe processes or activities involving hazardous wastes or constituents:
iii. 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? LJYesLjNo
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.1. 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 ❑ 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
Covertype Acreage Project Completion (Acres+/-)
• Roads, buildings,and other paved or impervious
surfaces 8.03 0
• Forested 0 0
• Meadows,grasslands or brushlands(non-
agricultural,including abandoned agricultural) 0 0 0
• Agricultural
(includes active orchards,field,greenhouse etc.) 0 0 0
• Surface water features
(lakes, ponds,streams,rivers,etc.) 0 0 0
• Wetlands(freshwater or tidal) I 0
• Non-vegetated(bare rock,earth or fill) 0 0 0
• Other
Describe:
Page 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,hospitals,licensed ❑Yesl�No
day care centers,or group homes)within 1500 feet of the project site?
If Yes,
i. Identify Facilities:
e.Does the project site contain an existing dam? ❑Yes®No
If Yes:
i. Dimensions of the dam and impoundment:
• Dam height: feet
• Dam length: feet
• Surface area: acres
• Volume impounded: gallons OR acre-feet
ii. Dam's existing hazard classification:
W. 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, ❑Yes®No
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 wastes been generated,treated and/or disposed of at the site,or does the project site adjoin ❑Yes®No
property which is now or was at one time used to commercially treat,store and/or dispose of hazardous waste?
If Yes:
i. Describe waste(s)handled and waste management activities, including approximate time when activities occurred:
h. Potential contamination history. Has there been a reported spill at the proposed project site,or have any ❑Yes® 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:
W. Is the project within 2000 feet of any site in the NYSDEC Environmental Site Remediation database? ❑Yes❑No
If yes,provide DEC ID number(s):
in if yes to(i),(ii)or(iii)above,describe current status of site(s);
Page 10 of 13
1> Is the project site subject to an institutional control limiting property uses? ❑YesMo
• If yes,DEC site ID number:
• Describe the type of institutional control(e.g.,deed restriction or easement):
• Describe any use limitations:
• Describe any engineering controls:
• Will the project affect the institutional or engineering controls in place? ❑Yes❑No
• Explain:
E.2. Natural Resources On or Near Project Site
a. What is the average depth to bedrock on the project site? feet none known
b.Are there bedrock outcroppings on the project site? ❑YeADNo
If Yes,what proportion of the site is comprised of bedrock outcroppings? %
c.Predominant soil type(s)present on project site:
to
top 80"i
p4
d. What is the average depth to the water table on the project site? Average: 301 feet
e. Drainage status of project site soils:9 Well Drained: 100 %of site
❑ Moderately Well Drained: %of site
❑ Poorly Drained %of site
f.Approximate proportion of proposed action site with slopes: P 0-10%: %of site
❑ 10-15%: %of site
❑ 15%or greater: %of site
g.Are there any unique geologic features on the project site? ❑YesE3No
If Yes, describe:
h. Surface water features.
i Does any portion of the project site contain wetlands or other waterbodies(including streams,rivers, ❑YesE3No
ponds or lakes)?
ii. Do any wetlands or other waterbodies adjoin the project site? ❑YesUNo
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, ❑YesT3N0
state or local agency?
N. For each identified regulated wetland and waterbody on the project site,provide the following information:
• Streams: Name Classification
• Lakes or Ponds: Name Classification
• Wetlands: Name Approximate Size
• Wetland No. (if regulated by DEC)
r. Are any of the above water bodies listed in the most recent compilation ofNYS water quality-impaired ❑Yes4N0
waterbodies?
If yes, name of impaired water body/bodies and basis for listing as impaired:
i. Is the project site in a designated Floodway? ❑Yesallo
j.Is the project site in the 100 year Floodplain? ❑YesTnNo
k.Is the project site in the 500 year Floodplain? ❑YesMNo
I.Is the project site located over,or immediately adjoining,a primary,principal or sole source aquifer? ❑YesUNo
If Yes:
i. Name of aquifer:
Page 11 of 13
m. Identify the predominant wildlife species that occupy or use the project site: None
n.Does the project site contain a designated significant natural community? ❑Yes®No
If Yes:
i. Describe the habitat/community (composition,function,and basis for designation):
ii. Source(s) of description or evaluation:
iii. Extent of community/habitat:
• 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 ❑Yes®No
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 ❑Yes No
special concern?
q. Is the project site or adjoining area currently used for hunting,trapping,fishing or shell fishing? ❑YeaN0
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:
b.Are agricultural lands consisting of highly productive soils present? ❑Yes®No
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 ❑YesUNo
Natural Landmark?
If Yes:
i. Nature of the natural landmark: ❑ Biological 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? ❑YesUNo
If Yes:
i CEA name:
ii. Basis for designation:
W. 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®No
which is listed on,or has been nominated by the NYS Board of Historic Preservation for inclusion on,the
State or National Register of Historic Places?
If Yes:
i.Nature of historic/archaeological resource: El Archaeological Site ❑Historic Building or District
ii. Name:
iii. Brief description of attributes on which listing is based;
f.Is the project site,or any portion of it,located in or adjacent to an area designated as sensitive for ❑Yes[ZNo
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? ❑Yes$3No
If Yes:
i.Describe possible resource(s):
ii. Basis for identification:
h.Is the project site within fives miles of any officially designated and publicly accessible federal,state,or local ❑Yesl3No
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 ❑YesJ3No
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? ❑Yes]E&vo
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.
G. Verification
I certify that the information provided is true to the best of my knowledge.
Applicant/Sponsor Name - • m r_ GO gg3u----_ Date --xCLveMbRr I_. ___2f1.1 R
Signature Title Attorney/Agent
ft
PRINT FORM I Page 13 of 13
QUESTIONNAIRE
FOR FILING WITH YOUR ZBA APPLICATION
A. Is the subject premises listed on the real estate market for sale?
Yes X No
B. Are there any proposals to change or alter land contours?
X No Yes please explain on attached sheet.
C. 1.) Are there areas that contain sand or wetland grasses? NO
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 Town
trustees for its determination of jurisdiction? Please confirm status of your inquiry or
application with the Trustees: and if issued, please attach
copies of permit with conditions and approved survey.
D. Is there a depression or sloping elevation near the area of proposed construction at or
below five feet above mean sea level? NO
E. 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.
F. 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:
G. 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.
H. 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 storage
and the proposed use Hotel
. (ex: existing single family, proposed: same
with garage, pool or other)
WAI, -/ 0 -�
Authorized signature and to
AGRICULTURAL DATA STATEMENT
ZONING BOARD OF APPEALS
TOWN OF SOUTHOLD
WHEN TO USE THIS FORM: This form must be completed by the applicant for any special use permit,
site plan approval,use variance,area variance or subdivision approval on property within an agricultural
district OR within 500 feet of a farm operation located in an agricultural district. All applications
requiring an agricultural data statement must be referred to the Suffolk County Department of Planning
in accordance with Section 239m and 239n of the General Municipal Law.
1. Name of Applicant:___9{]25 Main Ro d, T Lf
2. Address of Applicant: York 1 1952
3. Name of Land Owner(if other than Applicant):
4. Address of Land Owner: same as above
5. Description of Proposed formerly commercial bank
Project: r.,,,uert, to
6. Location of Property: (road and Tax map
number) 1000-122.00-06.00-022.001
7. Is the parcel within 500 feet of a farm operation? { } Yes XX No
8. Is this parcel actively farmed? { } Yes Z) No
9. Name and addresses of any owner(s)of land within the agricultural district containing active farm
operations. Suffolk County Tax Lot numbers will be provided to you by the Zoning Board Staff, it is
your responsibility to obtain the current names and mailing addresses from the Town Assessor's Office
(765-1937)or from the Real Property Tax Office located in Riverhead.
NAME and ADDRESS
I.
2._L
3.
4.
5.
6.
(Please use the back of this page if there are additional property owners)
a
0 q 6 ),D ,�
Signature of Applic t Date
Note:
1.The local Board will solicit comments from the owners of land identified above in order to consider the effect of the
proposed action on their farm operation. Solicitations will be made by supplying a copy of this statement.
2.Comments returned to the local Board will be taken into consideration as part as the overall review of this application.
3.Copies of the completed Agricultural Data Statement shall be sent by applicant to the property owners identified
above. The cost for mailing shall be paid by the Applicant at the time the application is submitted for review.
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for
proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This
assessment is intended to supplement other information used by a Town of Southold agency in
making a determination of consistency. *Except minor exempt actions including Building Permits
and other ministerial permits not located within the Coastal Erosion Hazard Area.
2. Before answering the questions in Section C, the preparer of this form should review the exempt
minor action list, policies and explanations of each policy contained in the Town of Southold Local
Waterfront Revitalization Program. A proposed action will be evaluated as to its significant
beneficial and adverse effects upon the coastal area(which includes all of Southold Town).
3. If any question in Section C on this form is answered "yes", then the proposed action may affect the
achievement of the LWRP policy standards and conditions contained in the consistency review law.
Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a
determination that it is consistent to the maximum extent practicable with the LWRP policy
standards and conditions. If an action cannot be certified as consistent with the LWRP policy
standards and conditions, it shall not be undertaken.
A copy of the LWRP is available in the following places: online at the Town of Southold's
website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all
local libraries and the Town Clerk's office.
B. DESCRIPTION OF SITE AND PROPOSED ACTION
SCTM# 122 - 6 - 22.1
The Application has been submitted to(check appropriate response):
Town Board 0 Planning Dept. D Building Dept. ® 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:
Construction of a three (3) story, two Hundred (200) room Hotel.
Location of action: 9025 Main Road, Mattituck, New York 11952
Site acreage: 8.03 acresw
Present land use: None, formerly commercial bank operations
Present zoning classification: Business
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: 9025 Main Road, LLC
(b) Mailing address:, c/o William C. Goggins, P.O. Box 65
13235 Main Road, Mattituck, New York 11952
(c) Telephone number: Area Code �3� 298-4818
(d) Application number, if any:
Will the action be directly undertaken,require funding, or approval by a state or federal agency?
Yes ❑ No 0 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
Eff cent use of infrastructure
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 ❑ No 0 Not Applicable
Attach additional sheets if necessary
Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See
LWRP Section III—Policies Pages 6 through 7 for evaluation criteria
Yes H No ® Not Applicable
Attach additional sheets if necessary
NATURAL COAST POLICIES
Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP
Section III—Policies Pages 8 through 16 for evaluation criteria
Yes No ® Not Applicable
Attach additional sheets if necessary
Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III
—Policies Pages 16 through 21 for evaluation criteria
Id Yes D No ®Not Applicable
Attach additional sheets if necessary
Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including
Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22
through 32 for evaluation criteria.
Yes R No® Not Applicable
Attach additional sheets if necessary
Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies
Pages 32 through 34 for evaluation criteria.
Yes ❑ No® Not Applicable
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 Ed Not Applicable
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.
❑ YeEl No L'J Not Applicable
Attach additional sheets if necessary
WORKING COAST POLICIES
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria.
Fr Vpc ❑ Nn F� Not Annlicable
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic
Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria.
❑ Yes ❑ No ® Not Applicable
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 ❑ No® Not Applicable
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
Created on 5125105 11:20 AM
Board of Zoning Appeals Application
AUTHORIZATION
(Where the Applicant is not the Owner)
1, 9025 Main Road_ L , residing at 9025 Main Road
(Print property owner's name) (Mailing Address)
Mattituck, New York do hereby authorize William C. Goggins
(Agent)
to apply for variance(s) on my behalf from the
Southold Zoning Board of Appeals.
9021 Main Road, LL
BY:
(O ier's tgtiature)
ALAN A. CARDINALE, Member
(Print Owner's Name)
AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southoid's Code of Ethics prohibits conflicts of interest on the part of town officers anti 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 necessar►•to avoid sHme.
YOUR NAME : WILLIAM C. GOGGINS
(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 XX Trustee Permit
Change of Zone Coastal Erosion
Approval of Plat Mooring
Other(activity) S n 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 30 day of April 2018
Signature 8/7 -
Print Name T
APPLICANT/OWNER
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics prohibits conflicts of interest an the part of town officers and emVIo►'ees.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 : _9(l 5 Ma;n Road, TJX (Alan Cardinale)
(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 XX 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)
Q an officer,director,partner,or employee of the applicant;or
D)the actual applicant
DESCRIPTION OF RELATIONSHIP
Submitted th day of l ,20 18
Signature
Print Name ALAN A. CARDINALE
i
_ ± �
��`� _�ry
��. ..
1 i
I JIB•.
� - _ - - _
)WN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
JILDING DEPARTMENT Do you have or need the following,before applying?
)WN HAIL Board of Health
)UTHOLD,NY 11971 4 sets of Building Plans
,L: (631)765-1802 Planning Board approval
LX: (631)765-9502 Survey —
utholdtownny.gov PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
amined __,20 Single R Separate
Truss Identification Form
Storm-Water Assessment Form
Contact:
provad 20 Mail to: _
;approved a/c
Phone:
piration 20___
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date February 14, 2018 .20
INSTRUCTIONS
a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
is of plans,accurate plot plan to scale.Fee according to schedule.
b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or
gas,and waterways.
c.The work covered by this application may not be commenced before issuance of Building Permit.
d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant.Such a permit
all be kept on the premises nvailable for inspection throughout the work.
e.No building shall he occupied or used in whole or in part fur any purpose what so ever until the Building Inspector
;ues a Certificate of Occupancy.
F. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
nuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the
operty have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an
,dition six months.Thereafter,a new permit shall be required.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
_iilding Zone Ordinance of the Town of Southold,Suffolk County,New York,and other applicable Laws,Ordinances or
egulations,for the construction of buildings,additions,or alterations or for removal or demolition as herein described.The
)plicant agrees to comply with all applicable laws,ordinances. building code,housing code,and regulations,and to admit
ithorized inspectors on pregi iscs and in building for necessary inspections.
(Signature of applicant or name,if a corporation)
(Mailing address of applicant)
late whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Attorney a ent
ame of owner of premises gQ75_+,F^.,,; R,ari.T.T,r
(As on the tax roll or latest deed)
applicant is a corporation,signature of duly authorized officer
(Name and title of corporate officer)
uilders License No.
lumbers License No.
lectricians License No.
tther Trade's License No.
Location of land on which proposed work will be done:
9025 Main Road, Mattituck
Subdivision Filed Map No. Lot
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy T cammerieial bank building
b. Intended use and occupancy three (3) story Hotel
Nature of work(check which applicable):New Building Addition Alteration
Repair Removal Demolition Other Work 2p_prnval g
(Description)
Estimated Cost Fee
(To be paid on filing this application)
If dwelling,number of dwelling units Number of dwelling units on each floor
If garage, number of cars
If business,commercial or mixed occupancy,specify nature and extent of each type of use..
Dimensions of existing structures,if any: Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front_ Rear
Depth Height Number of Stories
Dimensions of entire new construction:Front Rear Depth
Height Number of Stories _
Size of lot:Front Rear Depth 8.03 acres
i.Date of Purchase Name of Former Owner .
Zone or use district in which premises are situated
!.Does proposed construction violate any zoning law,ordinance or regulation?YES X NO
I.Will lot be re-graded?YES_NO x Will excess fill be removed from premises?YE5 NO
1.Names of Owner of premises Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No.
i a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO_X
IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED.
b.Is this property within 300 feet of a tidal wetland?* YES NO X
k IF YES,D.E.C.PERMITS MAY BE REQUIRED.
i.Provide survey,to scale,with accurate foundation plan and distances to property lines.
7.If elevation at any point on property is at 10 feet or below,must provide topographical data on survey.
3.Are there any covenants and restrictions with respect to this property?* YES NO
*IF YES,PROVIDE A COPY.
TATE OF NEW YORK)
SS:
OUNTY OF SUFFOLK)
being duly sworn,deposes and says that(s)he is the applicant
(Name of indivt uai signing contract)above named,
3)He is the Agent Attorney
(Contractor,Agent,Corporate Officer,etc.)
f said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application:
iat all statements contained in this application are true to the best of his knowledge and belief,and that the work will be
erformed in the manner set forth in the application filed therewith.
worn to before me this
d—of �n -
ro,.ne x Yeti,., r
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4
NORTH FORK BANK
1 r
I r •x -
ASBUILT SW%'E'r'
I - -
�! 1
'u-ri
OFFICE ADDRESS: TOWN OF SOUTHOED OFFICE HOURS&PHONE
53095 ROUTE 25-P.O.SOX 1409 CONSOIADATED REAL PROPERTY TAX BILL MON-FRI 8:00 AM TO 4:00 PM
SOUTHOLD,-NY 11971-MO I 17ECEMBER 1,2014-NOVEMBER 30,2015-TAXES BECOME A LIEN DECEM 3ER 1,2014 631-765-1803 FAX:631-765-5189
SUFFOLK COUNTY TAX MAP NUMBER jSCHOOLCODEIF THE WORD"ARREARS"IS PRINTED HERE SEE I ACCOUNT
LON
TY TREASURER'S NOTICE 1
VERSE SIDE.
473889 122.-6-22.1 73�782 14 17791
LOCATIONPROPERTY
9025 Route 25 8.03 INDL.DEVLP 124,995 10,683,333 COrrOWN/SC
TOWN AID BANK ..
269,157,439 1,654,119 �� �
PROPERTYTYPE
463 8 Bank complex
06411 'ASSESSMENT TO
712/2" TALASSESSMENT
23,260 124.995
9025 Main Road LLC OWNER AS OF TAXABLE STATUS DATE ON MARCH 1,2014
10095 Main Rd Unit 4
Mattituck,NY 11952-1658 Suffolk County IDA
rAYMENT INFORMATION • OF ASSESSED VALUE
ASSESSED VALUE RAnC1 100%QF FULL VALUE
First Half: 17784 $7,302.70 2/6/2014
Second Half. 17784 $7,302.70 5/13/2014 124,995 RICH1.170 oFrrs:
IS: 10,683,333
LEVY R I PTI O N LEVY% TAXABLE VALUE I T T ' — - TAX AMOUNT TOTAL TAX AMOUNT
Mattituck School 0.00% 0 878.990 0.500 0.00
Mattituck Library 0.00% 0 57.499 1.80°l 0.00
' FOR SCHOOL .00
Suffolk County Tax 1 0.00% 0 17.962 0.001 0.00
TAX LEVIED FOR COUNTY .00
Southold Town Tax 0.00% 0 1 263.111 -1.100/ 0.00
TAX LEVIED FOR TOWN .00
NYS Rea[Prop TaxLaw 0.00Y 0 22.159 146-70 0.00
MTA Payr0 Tex 0.00% 0 .643 -6 3 0.00
Cut Of Cty SCCC 0.00% 0 .933 28.00° 0.00
M3ttiluckFD 66.97% 124,995 80.15D 1.80AA 10.018.35
Mattituck Park 14.61% 124,995 17.491 1.90 2,186.29
Solid Waste District 17A9% 124,995 20.931 2,810% 2,616.27
_V31e_!01l-:cDistrilt ^93°! -- 12".,995 - ---- - _-2_70% 139.24
TAX LEVIED FOR OTHER DISTRICTS
FIRST HALF TAX 7,480.07 SECOND HALF TAX 7,480.08 TOTAL TAX LEVY 14,960.15
DUE DEC.1,2014 PAYABLE WRHOUT PENALTY TO JAN.10,2015 DUE DEC.1,2014 PAYABLE WITHOUT PENALTY To MAY 31,2015.SEE REVERSE THIS TAX MAYBE PAID IN ONE OR TWO INSTALLMENTS
SEE REVERSE SIDE FOR PENALTY SCHEDULE. SIDE FOR PENALTY SCHEDULE AND COUNTY TREASURER'S NOTICE.
SECOND HALF - SOUTHOLD TAX LEVY• 2014-2015 SUFFOLK COUNTY TAX MAP NUMBER -- `
DETACH STUB AND RETURN WITH SECOND HALF PAYMENT-RETURN BOTH STUBS 473889 122.-6-22.1
FOR PAYMENT OF TOTAL TAX,MAKE CHECK PAYABLE TO GEORGE R.SULLIVAN,
IECEIVER OF TAXES AND WRITE BILL NO.AND TAX MAP NO.ON FACE OF THE CHECK. AMOUNT DUE BILL NO.
7,480.08 17791
PAID BY. ❑ ASSESSED ❑ OTHER
9025 Main Road LLC
The following bank branches located within the Town of Southold accept payments durina reaular business hours-
I IIIIIII IIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII
Illlil IIIII IIIII IIII Illl
SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEED Recorded: 09/12/2014
Number of Pages: 4 At: 04:15:46 PM
Receipt Number : 14-0121094
TRANSFER TAX NUMBER: 14-04152 LIBER: D00012788
PAGE: 530
District: Section: Block: Lot:
1000 122.00 06.00 022.001
EXAMINED AND CHARGED AS FOLLOWS
Deed Amount: $1,088,095.24
Received the Following Fees For. Above Instrument
Exempt Exemp
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 $60.00 NO
Transfer tax $4,354.00 NO Comm.Pres $18,761.90 NO
Fees Paid $23,495.90
TRANSFER TAX NUMBER: 14-04152
THIS PAGE IS A PART OF THE INSTRUMENT
THIS IS NOT A BILL
JUDITH A. PASCALE
County Clerk, Suffolk County
L!JI.2 1
Nunihcr of pages
This document will be public
record. Please remove all
Social Security Numbers
prior to recording.
Deed/Mortgage L1strument Deed/Mortgage Tax Stamp Recol-ding/Filing Stamps
FEES
Page/Filing Fec � Mortgage Amt.
1. Basic Tax
I L•indling 20. 00 2. Additional Tax —
IT 58-1 Sub"Folal
Nnl,il on Spec./Assn.
or
I.A-52 17 (County)-- — Sub Total Spec./Add. —
liA 5217 (Slalcl _ TOT.MTG.TAX
T I ' CsC'Irf Dual Town Dual Count
k4 * u;•t Ifeld for Appointment _
_`�j —.
('nnnn nPL:d _- - 5 00 � .�r�q TransfcrTax �„�'•1� —
nrrida,.;, % • �� Mansion Tax =
The property covered by this mortgage i
Ccilil-ied Ciq)y
or will be improved by a one or lw,
NYS.Suithaigo �. I S_ 00. family dwelling only.
` Sub Total-- YES or NO
— — Grand Tolal If NO,sec appropria(c lax clause on
page ll —of this instrumeul.
'1402482 1 1 L-u l 5 Community Preservation Fund
_ i000 izzoo 0600 ozzooi Y
Kril I'ini,ci T - I IIIIIIIII Iljl IIIIIIIEI Illlllllllll�lllljlllll Consideration Amount jI Lei Lj-7
I,ix Scrvic L ROL A 7 if I
ngcne y QS EF-lk CPF Tax Due
Vciil"icalin. "�
Improved X _
Salisfac(ions/I)i.schargcs/Releases List Properly Owncr;s Mailing Address
6 RECORD &RLsTURN TO: Vacant Land
r
I'D Ic
TD
TD
Mail to: Judith A. Pascale, Suffolk County Clerk 7 Titk, Cnm),an Information
310 Center Drive, Riverhead, NY 11901
www.suffolkcounlyny.gov/clerk Title
` r' FIDELITY NATIONAL TITLE
If r' i Li- 7-i L' - �1 5 .3:`, - •�r F
Suffolk County Recording, & Endorsement Page
fliis page forms part of the aunched i�t l=�_ _ -__ made by-
(SI'EC I17Y TYPE OF INSTRUMENT)
Ac" 1,—_ The premises herein is situated in
SUFFOLK COUNTY,NEW YORK
TO In the TO\VN of_ `7c,;-fl,� 1 --
(� in [lie VILLAGE
nr I[AMLET of --
IMPORTANT NOTICE
II the doeurlrcrll you've lust- recorded is your SATISFACTIONOF MORTGAGE. please lie mvare of
Ilse Inllnwliif;:
if 11 portion of groin- ninriflily morIgabe payment- Included your properly [axes, * oiy i will rlmy 11W-10.
coiclacLy,nlir Inca1 Trnvn 1'�tix l t:r:�lvtr so t)7►lyou nay be billed [tlre-CLIV ror all fulurc Pc_oP- CIA
sta(emenis.
Local properly Fixes are payable Lwice a year: on or hefore January 10"' and on or before May 31".
Failure to make paymcnLs In a timely fashion could result in a penalty.
Please contact your local Town Tax Receiver with any questions regarding property tax:
payment.
r3ahylon Town Receiver of'l'axcs Riverhead Town Receiver of`faxes
200 Lasl Sunrise Ilifhway 200 Howell Avenue
North Lindenhurst, N.Y. 11757 Riverhead, N.Y. 11901
(G31) 957-3004 (631) 727-3200
i1ruokhaven Town Receiver ol"Taxes Sheller island Town 1Zecciver ol,Tascs
011c Independence I-Till SlcelLer Island Town IIall
Farnlingville, N.Y. 11738 Shelt-er Island, N.Y. 1 10GA
(63 1) 45 1-9009 (63 t) 749.3338
Last li,nnpton Town Receiver of Taxes Smilhfowil Town Receiver of Taxes
30CI Parligo Pl;ccc 99 Wcsl Main SlrecL.
Last- Ilampton, N.Y. 11937 Smiili[own, N.Y. 1 1787
(G31) 32.1-2770 (6;3 1) 360-7610
I luntington Town Receiver of faxes Southampton Town Recelver of Taxes
100 Nlain Sheet 116 I-TampLon Road
Iluillinglou, N.Y. 11743 Southampton, N.Y. 119G8
(G31) :351-32.17 (631) 283-6514
Islip Town Receiver of T,lxcs Southold Town Receiver of'faxes
40 Nassau Avenue 53095 Main Sh-cel
Islip, N.Y. 1 1751 Southold, N.Y. 11971
(631) 224-5580 (63 1) '765-1803
Sincerely,
Judith A. Pascale
Suffolk Coc.ulty Clerk
12
DEED
THIS INDENTURE,made this_s_day of .7.:1,; ,, .2014
BETWEEN
CAPITAL ONE,N.A.,having an address at 275 Broadhollow Road, Melville, New York 11747,AS
SUCCESSOR TO NORTH FORK BANK,
party o1'the first part.and
9025 MAIN ROAD LLC,having an address at 10095 Main Road,Unit 4,New York 11952
party of the second part.
WITNESSETI-I, Thal the party of the first part. in consideration of fen Dollars and other valuable
consideration paid by the party ol'the second part, does hereby grant and release unto the party, ol'the
second part.the heirs or successors and assigns ol'the party oflhe second part Forever.
ALI, that certain plot. piece or parcel of land. NNith the buildings and improvements thereon erected,
situate. 1%ing and being in the
lice Schedule A altached hereto and made a part hercol-.
Being and intended to be the some premises described in deed recorded in fiber 12777 page 916 in the
Sullilll.County Clerk's Office _ t
1'OGIa I E'R N%ith all right,title and interest. if any,ol'thc party ohthe first part in and to any streets and
roads abutting the above described premises to the center lines thereof; T0GI-'TFI1:R with the
appurtenances and all the estate and rights of the party oI the Iirst pail ill and to said premises; fO I IAVE
AND fO HOLE)the premises herein granted unto the party ol'thc second pail,the heirs or Successors and
❑ssions of the party ol'the second part lorc\ci-.
AND the party of-the first earl emc mutts that the party of-the first part has not done or suflcred anything
hereby the said premises lime been encumbered in any%\ay l%halcver,except as aforesaid.
AND the party of-the first part. in compliance \Nith Section 13 ol'the Lien Law.covenants that the party
of the first part \%ill receive the consideration for this comcyancc and hold the right to receive such
considuation as a tRIS1 fund to be applied first filr the purpose of paying the cost of the improvement.
IN WITNESS WHEREOF, the party of the first part has duly csecuted this deed the day and year first
above�N ritten.
In presence of:
Capital One,N.A.
By:
Nar Robcrl.I. Maenano
Title: SVP Facilities Management Real Estate
C'OMMONI'v LAIR I1 OP VIRGINIA )
Ss.:
COUNTY Of- 1 AIRFAX )
On the 1 _-day of III,'!:_ t in the year 2014.before nlc,the undersigned. Robert.l.
Magnano. persoll.nll,: ktiowl to my iu proved to me on the basis of satisfactory evidence to be the
individual whose name is subscribed to the within instrument at acknowledge to me that he executed the
same in his capacity, that by his signature on the instrument, the individual or the person on behalf of'
%%hich the individual acted, eXecuted the instrunTcnt, and that said individual did make such appearance
before me in the CommomNealth ot'Virginia.County of Fairfax.
LIOA GUTHRIE MURRAY
NOTARY PUBLIC
REGISTRATION#7516468
COMMONWEALTH OF VIRGINIA NOtarV 'Uhl IC L,n ( 1 1� ,�vi (e,Y
MY COMMISSION EXPIRES -
JUNE 30 2016
Bargain and Sale Deed District: 1000
Section: 122,00
13lock: 06.00
Lots: 022.001
COMM SLlffolk
C'API I-AI.O\I..N- A.
10
9025 MAIN ROAD. I I C
Return b) Mail to:
I
Philip Cardinale. I.sy.
P.O- Box 2021
Jamesport.New York 11947
Kescr�c I his Space I-or t Ise ol"Recording 011ice
SCHEDULE A
Parcel I -'tax Lot 022.001:
At L that certain plot, piece or parcel of' land. situate, lying and being at Mattituck. Town of
Southhold.County of Suffolk and State ol'New York,bounded and described as ('ollows:
BEGINNING on the northerly side of Main Road where the westerly side of lands no),y or
formerly ol'W'ilson intersects same:
RUNNING I HENCE along the northerly side of Main Road the following THRLI;courses and
distances:
1. South 48 degrees 20 minutes 10 seconds West 340.70 feet:
2. South 47 degrees 51 minutes 30 seconds West 171.84 feet:
3. South 52 degrees 02 minutes 10 seconds West 1.74 leet to land now or formerly ol'the
State ol'Ncw York:
I I IENCI,. along the easterly side of'the last mentioned lands and the easterly side of lands now
or formerly ol'Nyche. lands now or Ibrmerly of l3runskill,and lands now or lormcrly of I lobson
the Inllowing I I IRI:I:courses and distances:
1. North 20 degrees 27 minutcs 42 seconds West 181.83 feet;
2. North 18 degrees 34 minutcs 20 seconds West 228.00 feet:
3. North 26 degrees 41 minutes 10 seconds West 277.04 feet to the land of Long Island Rail
Road:
I I11.NCli along the southerly Side of last mentioned lands the Iollowing I-'IVI,' courses and
distances:
1. North 44 degrees 43 minutes 50 seconds I.:ast 46.36 feet:
2. SOUth 33 degrees 1 1 minutes East 9 feet:
3. North 44 decrees 43 minutes 50 seconds Last 138 feet
4. North 21 dcgrccs 56 minutcs 20 seconds West 10.87:
5. North 44 degrees 43 minutes 50 seconds Vast 316.89 feet to land now or formerly of
Wilson:
I I II NC'I: along the westerIN side of the last mentioned land South 24 degrees 04 minutes 20
seconds Fast 711.70 Ceet to the f31:GINNING POINT.
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22413 Date JUNE 22 1993
THIS CERTIFIES that the building ALTERATIONS
Location of Property 8885 & 9025 MAIN ROAD LAUREL, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 122 Block 6 Lot 20 & 22
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 29 1993 ____pursuant to which
Building Permit No. 21306-Z dated_ APRIL 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 INTERIOR ALTERATION TO EXISTING BUILDING AS APPLIED FOR.
The certificate is issued to NORTH FORK BANK CORP.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL INSPECTION NO. 2646 DATED MAY 14, 1993
PLUMBEIM— CERTIFICATION DATED N/A
wilding Inspector
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-26929 Date: 02/14/00
THIS CERTIFIES that the building STORAGE ADDITION
Location of Property: 9025 MAIN RD MATT/LAUREL
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 122 Block 6 Lot 20
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 13, 1999 pursuant to which
Building Permit No. 26011-Z dated OCTOBER 1, 1999
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 C4.2 "STORAGE ADDITION" ACCESSORY TO AN EXISTING Cl COMMERCIAL BUILDING
AS APPLIED FOR.
The certificate is issued to SUFFOLK COUNTY IND.DEV.AGENCY
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 33228 12/16/99
PLUMBERS CERTIFICATION DATED N/A
Au prized Signature
Rev. 1/81
t FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold", N.X.
CERTIFICATE OF OCCUPANCY
No Z-18441 Date OCTOBER 3, 1989
THIS CERTIFIES that the building ALTERATION
Location of Property 9025 ROUTE 25 ,(MAIN ROAD) MATTITUCK, N.X.
House No. Street Hamlet
County Tax Map No. 1000 Section 122 Block 05 Lot 20
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated, OCTOBER 21, 1987 pursuant to which
Building Permit No. 15563-Z dated OCTOBER 23, 1987
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 ALTERATION To EXISTING ROOM FOR OFFICE SPACE AS APPLIED FOR.
The certificate is issued to SUFFOLK COUNTY INDr: DEVELOPMENT AGENCY
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL C10-87-01378116 1989
UNDERWRITERS CERTIFICATE NO. N-015777-JUNE 9, 1988
PLUMBERS CERTIFICATION DATED 7/12 1989,_J_H.RUDGEMECHANICAL CONTRACTORS
Building Inspector
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18440 Date OCTOBER 3, 1989
THIS CERTIFIES that the building ALTERATION
I
Location of Property, 9025 ROUTE 25 (MAIN ROAD) MATTITUCK, N.Y.
` House No. Street Hamlet
County Tags Map No. 1000 Section 122 Block 06 Lot 20
i
Subdivision_ Filed Map No. Lot No.
I
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 21, 1967 pursuant to which
Building Permit Po. 15644-Z dated JANUARY 28 1987
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 ALTERATION TO EXISTING OFFICE COMPLEX AS APPLIED FOR.
The certificate 1s issued to SUFFOLK COUNTY LAND VEVELOPH= AGENCY
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL C10-87-013-8/16/1989
UNDERWRITERS CERTIFICATE NO. PENDING - AUGUST 7, 1987
PLUMBERS CERTIFICATION DATED OCT. 7 1987-MATTITUCK PLUMBING & HEATING
Building Inspector
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. . . . . . . . Date . . . . . . . .4rlL . . . .13. . . . . . .. 19.72.
THIS CERTIFIES that the building located at .31/K M AJa .R . . , _ . . , Street
Map No. -XXK . . . . . . . Block No. . . . . . .Lot No. .XZi NIttltuak I•Y.
conforms substantially to the Application for Building Permit heretofore filed in this office
5-1 M 1�
dated . . . . . . . . .`�. - .
19.71.' . pursuant to which Building Permit No. %3f*
dated . . . . . . . . . 1.4 19.71., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is . .�"43?!;s .gilding . . .rv�ail stoves
The certificate is issued to . .�G.Ultuft ►4 POQ1-400 .Iso 9�nrrs
. . . . . . . . . . . . .
of the aforesaid building. (owner, lessee or tenant)
Suffolk County Department of Health Approval ♦per .39. 19g2. . by.Re. YLIU.
UNDERWRITERS CERTIFICATE No. . . . . . ... ..
HOUSE NUMBER. j. . . . . . .Street. . . .Iftft.to."
Building Inspector
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No."p . . . . . . Date . . . . . . . . . . . .AIM . . . 2 . . . . . .. 19. 72,
THIS CERTIFIES that the building located at . M/g.Min.Road. . . . . . . . . . . Street
Map No. .xx . . . . . . . . Block No._ .XX. . . . . . .Lot No. . . .=. . . . . . .YAtt3tlutk. . N.Y.. . .
conforms substantially to the Application for Building Permit heretofore filed in this office
dated . . . . . . . . NjD7. . . . .16. . ., 19.r. pursuant to which Building Permit N0.56314. . .
dated . . . . . . . . . . .Rpm • . • •1 e ., 19.71., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is . .daQppW6rY. bu11d1U9' (gyp. house .d. water- -oentroll. bldg). . . . . . .
The certificate is issued to . .Mattituck • •AasocLatefs• Inc• . • • . • • •Ow'ner . • . • . . . . . . .
of the aforesaid building. (owner, lessee or tenant)
Suffolk County Department of Health Approval . -N.R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE No. . . 1122101. . . . . . . . . . . . . . . . . . . ... . . . .
FIOUSE NUMBER. . . Street. . . . .
9�5. . . . - Main' Road' • - •Mattitua]c. . . . . . . . . . . . . . . . . . .
Building Inspector
0�
�122'02 7/ arc
LOT OWNERSHIP DATA SUBJECT
/ �22,
PREMISES/
S.C. TAX No. OWNERS NAME & ADDRESS
/ 'j �QO 2�,2 COUNTY OF SUFFOLK
/ 1p0 122�p2' ` 1 1000-12f-05-4.5 330 CENTER DRIVE L �j
RIVERHEAD, NY 11901 0
o
` CAROL SULLIVAN
2 1000-122-02-8.1 10020 SOUND AVENUE
MATTITUCK. NY 11952 KEY MAP
PATRICIA DESLAURIER 0 SCALE 1 "=1 000'
3 1000-122-02-23.12 960 COTTAGE WAY
CS ` MATTITUCK, NY 11952
p0/ ` BOA HOLLY SCHMIDT
/ 1p ,�L .L.06 4 1000-122-02-23.13 900 COTTAGE WAY
I►� p/� ` °0.1� MATTITUCK, NY 11952
O �°
/ rv/ti ry1./ BRIAN AND JAIME McCLEERY
.p 05 5 1000-122-02-23.14 PO BOX 1713
,22�06' MATTITUCK, NY 11952
EMILY HEALY V ®o ' RADIUS
6 1000-122-02-23.15 780 COTTAGE WAY
+ MATTITUCK, NY 11952
MAP OF PROPERTY
7 1000-122-02-23.25 PO F1179 THOLD
OQ. ECMSOU LLLD, 11971 SI T UA TE
�a
� ECM LLC
�• 0 8 1000-122-02-24.4 c/o CAROL SULLIVAN
MOTTO SOUND AVENUE MATTITUCK
MATTITUCK, NY 11952
SUFFOLK COUNTY WATER AUTHORITY
P.O. BOX 38 TOWN OF SOUTHOLD
0\ ! �Q� 9 1000-122-02-25 OAKDALE, NY 11769
o �o TDaDTD SUFFOLK COUNTY, NEW YORK
// y O� Op ` ,QQQ�122 JOSEPH SIDNEY
IC 1000-122-06-04 PO BOX 443
�! aa0 ` MATTITUCK, NY 11952 S.C. TAX N 1000— 12 2—0 6—2 2. 1
1/ y N ` NANCY LEE MOORE SCALE 1 — 10 0
N 11 f000-122-06-05 504 FACTORY AVENUE
ppp ."""""" 0 a ` MATTITUCK, NY 11952 f f_ 1
1 NANCY LEE MOORE SEPTEMBER 28, 2018
01 12 1000-122-06-06 PO BOX 507
Or
O /\rt�) MATTITUCK, NY 11952
C iY 00 ' ` �0°° MARY E. MILLS
/ („Y 0 13 1000-122-06-07 265 FACTORY AVENUE
p 000
\ ` MATTITUCK, NY 11952
/ N
00 KOCH HOLDING CORPORATION
O
14 f000-122-06-09 840 N. OAKWOOD DRIVE
O O \ O
/` 0 ...'.'.'.............. ...:. ....... ::::...... •:.:::..'.'.'... ! i 0 \ ` �N, LAUREL, NY 11948
by �� 01 22�Q,6
\ ANTHONY J. ANTONGEORGI
�0 :......'.'.:........'.'.....'.....'.......:' .'..".'....'..'.".'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.... 0 10o° 15 1000-122-06-11 3175 ROUTE 48
.....::'...........'.'.'.'..............'..'...'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.....'.'.'..'..'.'..'.'.'.'.'.'.'. ` MATTITUCK. NY 11952
' 1 ` P MARINE SALES
16 1000-122-06-12 PO BOX 528
MATTITUCK, NY 11952
'.'.'.'.'..'.'.'.......'....'..'...........'.'.'.'.....'.'.'.'.'.'.'.'.'.'..'.............................'.'.'.'..'..... O
�•:.°
:.:.:.'..:.:.:.'.:..:.'.:....:.:.:..... .........'.'.'.'.'.'.'....'.'.'........:::..... ...............:.. O MICHAEL AND THERESE HUGHES
- - -f000 f22 O6 13
17 PO BOX 1282 pp F ` r•
' 500+ ... ..........:.'.:..:...:.:.:.:.:.:.:.'........ aa\ ` MATTITUCK. NY 11952 i'do1' c�
...... .... ..................... ............... 0
.�• \ MICHAEL AND THERESE HUGHES
/r1, ................... ....... ... .. ..... 18 1000-122-06-14 PO BOX 1282 `.,.�:h�,.7 '.;��'i;.i:��l�ts: p,n,;';,•�i,�
p o ... ...'.1000-122-06-22.1'.'...'.'.'.'.............'.'.'.'..'..'.:.'.:.'. .'. ` Lv
...' .' .'.'.'.'.'.'.'.... .'.'.'.. '...... MATTITUCK, NY 11952 ryti .....'.'.'.'.'.'..... ..
p - - - MICHAEL HUGHES
0 a ` 19 1000 122 06 15 PO BOX 1282
: ::::::::::: o MATTITUCK, NY 11952
s :.'.'..... ` THERESE HUGHES
\
....'.'.'.'.'.'.'...'.'.'.'.'.'... 000 - - - PO BOX 1282
20 1000 122 0s 16
\ \ MATTITUCK, NY 11952
N
? KEIL FARMS LLC
1
O .. .....* '''' O 21 1000-122-06-17 30 EASTGATE DRIVE
O ...... .... .... ..........
0 .. ..... ......... .........'.'.'.'.'.'......'......................... \ 1 HUNTINGTON. NY 11743
.... .. ........ ..............
:.:.'.'.'...:. .' i� MARIUSZ JACHIMOWICZ
22 1000-122-06-18 9395 ROUTE 25
a .....'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'....'.'.'.'............ .. ............:::::: ::::::: 0 MATTITUCK, NY 11952
O
\ COUNTY OF SUFFOLK
> 23 1000-122-06-19.1 330 CENTER DRIVE
W RIVERHEAD, NY 11901
'.'.'.'.'.'.'.'.'..... \O
... ........... .. .. ... .. .'... .'.'.'...'.'.'.'.'.'.'.'.'.'.'................. I
o " .'.'........................ '.'..'..'..:...'....'.'.'...'.'.'.........'.'.'.:.:.:.:.:.:..:.'.:................. .. 9255 MAIN ROAD LLC
24 1000-122-06-19.2 PO BOX 645
.••• MATTITUCK, NY 11952
aim ''.'............. .'. ..'.:.:.:.:.:.:..:..:.....'.:.:.:.:..:.:.:.::.:................ '. '.'.'.'.'.'.':'
\ ............................................................................... (� ' 1000-122-06-21.1 LONG ISLAND RAIL ROAD (M.T.A.)
6+\ ....... .. .:..:. ........ S ' 25 1000-122-06-2f.2
as oo 1
1000-122-06-28 .. .. . .••. •.•••• •..• •• �+ I MARK A. AND DEBORAH A. FARINA
` ...........:::::::::: ...... .'............................ ... 26 1000-122-06-23 355 HOBSON DRIVE
'.'.'.'.'.'.'.'.'.......................'..'.........'.....'.....'.. 355HOBSON
DEBORAH A. FARINA
'.. MATTITUCK. NY 11952
` /
27 f000-f22-06-24 355 HOBSON DRIVE
` .'...'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.. .. / MATTITUCK. NY 11952
.. .
MARK A. AND DEBORAH A. FARINA
` 1000-122-06-26 0� /
28 1000-122-06-25 355 HOBSON DRIVE
MATTITUCK, NY 11952
.. .'...'
..
MOOT-122-07-09 MARK O FARINA
...
29 f000-122-06-26 355 HOBSON DRIVE
MATTITUCK, NY 11952
. 30 1000-122-06-27 STATE OF NEW YORK
9025 MAIN ROAD LLC
31 1000-122-06-28 10095 MAIN ROAD UNIT 4
MATTITUCK, NY 11952
/ WILLIAM M. AND MARY ANN GREMLER
1000-122-06-27 / 32 1000-122-07-6.4 PO BOX 173
MATTITUCK, NY 11952
MARKETSPAN GAS CORPORATION
/ 33 1000-122-07-6.6 175 EAST OLD COUNTRY ROAD
HICKVELLE, NY 11801
/ MATTITUCK PROPERTY MNG LLC
34 1000-122-07-6.7 c/o GEORGE MACDONALD
` 14 INLET VIEW PATH
1000-122-07-6.4 / EAST MORICHES, NY 11940
/ 8400 MAIN ROAD CORPORATION
35 1000-122-07-6.8 PO BOX 1086
/ WESTHAMPTON BEACH, NY 1197E
1000-122-07-8.9
MEGA STYL LLC
36 1000-122-07-8.9 PO BOX MATTITUCK,
NY 11952
/ 9300 MAIN ROAD LLC PREPARED IN ACCORDANCE WITH THE MINIMUM
0 / 37 1000-122-07-09 PO BOX 28037 STANDARDS FOR TITLE SURVEYS AS ESTABLISHED
0
w BY THE L.I.A.L.S. AND APPROVED AND ADOPTED
PORTLAND, OR 97228 FOR SUCH USE BY THE NEW YORK STATE LAND
TITLE ASSOCIATION. - ti
1000-122-07-6.6 MARY AND TONY INCORPORATION OF
38 1000-143-01-Of 1 WEST MAIN STREET ' 'Q
HAMPTON BAYS, NY 11946 �� C
MARGARET NOONE O�
39 f000-143-Of-4.1 210 SIGSBEE ROAD
"
�1000-122-07-6.8 / MATTITUCK, NY 11952 I� x
Q
a f0000' yr}167 >
1000-122-07-6.7 0 /
►. Y.S. Lic. No. 50467
UNAUTHORIZED SECTION SURVEY
I THEAALTERATION
A I YORK TION
Nathan T of t Corwin I l l
TO THIS SURVEY IS A VIOLATION OF
EDUCATION LAW.
COPIES OF THIS SURVEY MAP NOT BEARING Land Surveyor
THE LAND SURVEYOR'S INKED SEAL OR
EMBOSSED SEAL SHALL NOT BE CONSIDERED
TO BE A VALID TRUE COPY.
CERTIFICATIONS INDICATED HEREON SHALL RUN Successor To: Stanley J. Isaksen, Jr. L.S.
ONLY TO THE PERSON FOR WHOM THE SURVEY Joseph A. Ingegno L.S.
IS PREPARED, AND ON HIS BEHALF TO THE
TITLE COMPANY, GOVERNMENTAL AGENCY AND Title Surveys - Subdivisions - Site Plans - Construction Layout
LENDING INSTITUTION LISTED HEREON, AND
TO THE ASSIGNEES OF THE LENDING INSTI- PHONE (631)727-2090 FOX (631)727-1727
TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE.
OFFICES LOCATED AT MAILING ADDRESS
AND/OR EASEMENTS OF RECORD, IF
THE EXISTENCE RIGHT WAYS 1586 Main Road P.O. Box 16
ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947
38-232-1
SURVEY OF PROPERTY FOR
9025 MAIN ROAD , LLC
SI T UA TE
MATTITUCK
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
,r
S.C. TAX No. 1000- 122-06-22. 1
SCALE 1 "=40'
SEPTEMBER 259 2018
AREA = 325,273 sq. ft.
7.467 ac.
OWNER:
9025 MAIN ROAD, LLC
0 10095 MAIN ROAD, UNIT 4
MATTITUCK, NEW YORK 11952
40 0 40 80 120 0'
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PREPARED IN ACCORDANCE WITH THE MINIMUM
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FOR SUCH USE BY TH I`W-TORK-STATE LAND
TITLE ASSOCIATION. or-mc- /
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N.Y.S. Lic. No. 50467
UNAUTHORIZED ALTERATION TI ADDITION Nathan T of t Corwin
TO THIS SURVEY IS A VIOLATION OF
SECTION 7209 OF THE NEW YORK STATE
EDUCATION LAW. Land Surveyor
COPIES OF THIS SURVEY MAP NOT BEARING
THE LAND SURVEYOR'S INKED SEAL OR
EMBOSSED SEAL SHALL NOT BE CONSIDERED
TO BE A VALID TRUE COPY.
CERTIFICATIONS INDICATED HEREON SHALL RUN Successor To: Stanley J. Isaksen, Jr. L.S.
ONLY TO THE PERSON FOR WHOM THE SURVEY Joseph A. Ingegno L.S.
IS PREPARED, AND ON HIS BEHALF TO THE
TITLE COMPANY, GOVERNMENTAL AGENCY AND Title Surveys - Subdivisions - Site Plans - Construction Layout
LENDING INSTITUTION LISTED HEREON, AND
TO THE ASSIGNEES OF THE LENDING INSTI- PHONE (631)727-2090 Fax (631)727-1727
TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE.
NOTE: THE EXISTENCE OF RIGHT OF WAYS OFFICES LOCATED AT MAILING ADDRESS
MAP MADE FROM OFFICE RECORDS AND FIELD OBSERVATION. AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P.O. Box 16
ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947
00
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SUBJECT `�P1
PREMISES �oPo
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KEY MAP
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SCALE 1 "=600'
40 0 40 80 120
Scale 1 " = 40 '
� SITE PLAN FOR
0025 MAIN ROAD , LLC
SI T UA TE
" MATTITUCK
/'/ TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
�1, 0 S.C. TAX No. 1000- 122-06-22. 1
SCALE 1 "=40'� e
a / SEPTEMBER 25, 2018
�'� �,'��• Q` AREA = 325,273 sq. ft.
7.467 cc.
OWNER:
9025 MAIN ROAD, LLC
�\ �G 10095 MAIN ROAD, UNIT 4
MATTITUCK, NEW YORK 11952
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MATTITUCK, NY 11952 0
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FOR SUCH USE BY THE NEW YORK STATE LAND.-
TITLE ASSOCIATION.
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67 N S. Lim. No. 50467
UNAUTHORIZED ALTERATION OR ADDITION a t a Taft ®r 'i✓® i n I l i
TO THIS SURVEY IS A VIOLATION OF
SECTION 7209 OF THE NEW YORK STATE
EDUCATION LAW. Lary Surveyor
COPIES OF THIS SURVEY MAP NOT BEARING �
THE LAND SURVEYOR'S INKED SEAL OR
EMBOSSED SEAL SHALL NOT BE CONSIDERED
TO BE A VALID TRUE COPY.
CERTIFICATIONS INDICATED HEREON SHALL RUN Successor To: Stanley J. Isaksen, Jr. L.S.
ONLY TO THE PERSON FOR WHOM THE SURVEY Joseph A. Ingegno L.S.
IS PREPARED, AND ON HIS BEHALF TO THE
TITLE COMPANY, GOVERNMENTAL AGENCY AND Title Surveys - Subdivisions - Site Plans - Construction Layout
LENDING INSTITUTION LISTED HEREON, AND
TO THE ASSIGNEES OF THE LENDING INSTI- PHONE (631)727-2090 Fax (631)727-1727
TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE.
NOTE: THE EXISTENCE OF RIGHT OF WAYS OFFICES LOCATED AT MAILING ADDRESS
MAP MADE FROM OFFICE RECORDS AND FIELD OBSERVATION. AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P.O. Box 16
ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947