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HomeMy WebLinkAbout5848Office Location: Town Annex/First Floor, Capital One Bank 54375 Main Road (at Youngs Avenue) Southold, NY 11971 Mailing Address: 53095 Main Road P.O. Box 1179 Southold, NY 11971-0959 http://southoldtown.northfork.net BOARD OF APPEALS TOWN OF SOUTHOLD Tel. (631) 765-1809 Fax (631) 765-9064 COVER SHEET WITH ZBA FILE STATUS OF FILE [ ] Re~d issued: CABOT activate or reactivate file (Applic~t has withdrawn application). [/x~ ] NO REFUND DUE, based on time spent for Town to process application and heatings. [ X ] Obsolete & expired; CANNOT reactivate this file: NEW APPLICATION NECESSARY: Extensive time has passed; Zoning Code changes are now in effect and this application expired. NOTE: Applicant may apply for a new application with Building Inspector for a new Notice of Disapproval and submit NEW application with all documents and current maps to ZBA, or modify plan to conform to the current code. This Town file based on applicant's previous year requests has expired. [ ] No forms to be scanned; FILE # VOID: APPLICATION RETURNED. forms were r~med to applicant early in process, as requested by applicant.) (All Office Location: Town Annex/Fa-st Floor, Capital one Bank 54375 Main Road (at Youngs Avenue) Southold, NY 11971 Mailine Address: 53095 Main Road P.O. Box 1179 Southold, NY 11971-0959 http://southoldtown.northfork.net BOARD OF APPEALS TOWN OF SOUTHOLD Tel. (631) 765-1809 Fax (631) 765-9064 VIA CERTIFIED April 15, 2010 Patrick and Oreanna Kaelin 24400 County Road 48 Cutchogue, NY 11935 RE: Pending ZBA File#5848 Dear Mr. & Mrs. Kaelin: Your application has been dormant since February 2006. The Zoning Board of Appeals is writing to inform you of their iment to close this application, unless within thirty (30) days of your receipt of this letter, you respond in writing of your intention to move forward. If you have any questions, please contact this office. Thank you for your prompt attention to this matter. Sincerely, Vicki Toth Board Assistant · pflnt your name and address on the mveme hat v~e can tatum the card to Y°u' · or on the front If space Pe~its' 1. Nt~le Addressed to: ). is delivery address dhlemrtt from Item [3 No if ~1~S, enter d~ive~ address bstow: ~ 7009 0820 0001 PS Form 3811, Febn~Y 2004 omw NO. 3 -gV g NOTICE OF DISAPPROVAL DATE: November 22, 2005 TO: Oreanna & Patrick Kaelin 24400 CR 48 Cutchogue, NY 11935 Please take notice that your application dated November 14, 2005 For permit to convert an existing food distribution facility to a recreation facility at Location of property 8305 Cox's Lane, Cutchogue, NY County Tax Map No. 1000 - Section 84 Block3 Lot 1.1 Is returned herewith and disapproved on the following grounds: The proposed use is not permitted pursuant to Article XII, Section 100-131. "Permitted Uses" A recreation facility is not a permitted use. In addition, if approved by Zoning Board of Appeals, site plan approval from the Southold Town CC: file, Z.B.A. Note to Applicant: Any change or deviation to the above referenced application may require additional review from the Southold Town Building Department. SUFFOLK COUNTY, N. Y. 1000 - 84 - 03 ~ 1.'1 Scale 1" = 40 s~o~.'~ GOre' AREA = 2.99acres CERTIFIED TO, AMERIC,4N COMMUNITY BAiVK FIRST NEE-YORK TITLE ,~ ABSTRACT LTD. PR.~VlE PURVE¥ORSt /NC. N/O/F W P. O. BOX 909 I,E30 TF,~4.V£LER ~SOUTI-I_OLD, N.Y. , .:- MIDDLE ROAD (C.R. 48) i,(NORTH ROAm I °1 APPLICATION TO THE SOUTHOLD TOWN BOARD OF APPEALS tffice Notes: Parcel l,ocation: Honse No. ~.~O,~,'eet (~Ox','%)dy~__r~o SCTM 1000 Section~z~Block.5 Lot(s) iJ i Lot Size Zone l)istrict I (WE) APPEAl. THE WRITTEN DETERMINATION OF 'FILE BUILDING INSPECTOR Mailing NOTE: Ifapp~ican~isnotthe~waer~state~fapplicantis~Wner~sa~t~rney~agent,a~cbitect~builder,c~n~ra~tvendee,etc. Authorized Representative: Address: Telephone: Plea~specify who you wish correspondence tO be mailed to, from the above listed names: ~Applicant/Owner(s) [] Authorized Representative [] ()tiler: WtlEREBY THE BUILDING INSPECTOR DENIED AN APPLICATION 1)ATED il I iq IC~ FOR: [] Building Permit 13 Certificate of Occupancy © Pre-Certificate of Occupancy gff'Change of Use [] Permit for As-Built Construction Other: Provision of the Zoning Ordinance Appealed. Indicate Article, Section, Subsection and paragraph of Zoning Ordinance by numbers. Do not quote the code. Article X_'?~'~ Section 100- ~ Subsection Type of Appeal. An Appeal is ~nade for: [] 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. ~Interpretatlon of the Town Code, Article X ~.. Section Iof) I-6l A prior appeal [] has E/~as not been made with respect to this property UNDER Appeal No. Year Page 2 of 3 - Appeal Application Pad A: AREA VARIANCE REASONS (attach extra sheet as needed): (1) An undesirable change will not be produced in the CHARACTER of the neighborhood or a deklmenf to nearby properties, If granted, because: ~3,~u~ ~_Y~C.u'~c ~_ A;~O~ ~Oi \\ ~ (2) The benefit sought by the applicant CANNOT be achieved by some method feasible for the applicant fo pursue, other than an area variance, ~ecause:'T~m6 ~D~,~d mc~ i,5 ~L ~t'J~{¥ (3) The amount of relief requested ~s i~fl'~ul~stantial because: ~ ~- r~ (4) The variance will NOT have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district because: ti~/or~._' (5) Has the variance been self-created? ( ) Yes, or ( ) No. If not, Is the construction existing, as built? ( ,~ Yes, or ( ) No. (6) Additional information about the surroundlng topography and bulldlng areas that relate to the difficulty In meeting the code requirements: (attach extra sheet as needed) This Is the MINIMUM that is necessary and adequate, and at the same time preserves and protects the character of the neighborhood and the health, safety, and welfare of the community. ( ) Check this box and complete PART B, Questions on next page to apply. USE VARIANCE STANDARDS. (Please consult your attorney.) Otherwlser,~ase prdceed to the slanature and notary area below. Signature of Appellant or Authorized Agent Sworn to bpfore me this , (Agent must submit Authorization ~om Owner) ..... (Nota~ Public)~ '~ ~ ~'~'~.~: Y~rk ~A App 9~0/02 Page 3 of 3 - Appeal Application Patf B: REASONS FOR USE VARIANCE (if requested): For Each and Every Perml~ed Use under the Zoning Regulations for the Particular Dlstrlcf Where the Project is Located (please consult your a'dorney before completing): 1. Applicant cannot realize a reasonable return for each and every permitted use under the zoning regulations for the particular district where the property is located, demonstrated by competent financial evidence. The applicant CANNOT realize a REASONABLE RETURN because: (describe on a separate sheet). 2. The alleged hardship relating fo the property is unique because: 3. The alleged hardship does not apply fo a substantial portion of the district or neighborhood because: 4. The request will not alter the essential character of the neighborhood because: 5. The alleged hardship has ~bt been seff-crearea because: ~ 3~ 6. This Is the minimum relief necessary, while at the same time preserving and protecting the character of the neighborhood, and the health, safety and welfare of the communlfy. (Please explain on a separate sheet J! necessary.) 7. The spirit of the ordlnance will be observed, public safety and welfare will be secured, and substantial Justice will be done because: (Please explain on a separate sheet if necessary.) ( ) Check thls box and complete PART A, Questions on previous page to apply. AREA VARIANCE STANDARDS. (Please consult your attorney.) Otherwise, please proceed to the signature and notary area below. Signature o! Appellant or Authorized Agent Sworn to ~efore me this (Agent must submit Authorization from Owner) PROJECT DESCRIPTION (Please include with Z.B.A. Application) I. If building is existing and alterations/additions/renovations are proposed.' A. Please give the dimensions and overall square footage of extensions beyond existing building: Dimensions/size: Square footage: B. Please give the dimensions and square footage of new proposed foundation areas which do not extend beyond the existing building: Dimensions/size: Square footage: Ifa sign is proposed, please: A. Give dimensions of existing sign with photograph or sketch with details. B. Give dimensions of new sign. C. Is the new sign replacing an existing sign? Yes No . If so, please explain: II. If land is vacant: Please give dimensions and overall square footage of new construction: Dimension/size: Square footage: Height:. II1. Purpose and use of new construction requested in this application: IV. Additional information about the surrounding contours or nearby buildings that relate to the difficulty in meeting the cod9 requirement(s): V. Plmse submit seven (7) photos/sets after s~hng comers of ~e proposed new cons~ction. 7/02 PATRICK AND OREANNA KAELIN November 28, 2005 Patrick and I have had a dream of always opening up a family fun Center in our local town, as we all know there is really nothing to do regarding entertainment for our families. It very hard to find a big building to lease you either have to buy land and build one or maybe by luck you would find a building that would be exactly what you are looking for. We could go into Riverhead or up island but we are very community oriented, we volunteer for our local fire department, our children goes to school here and we are very much part of the north for We were lucky to find that building right here on the north fork of long island, the building is located on 8305 Cox's Lane in Cutchogue, it is a 5800 square foot building that would be perfect for the family fun center. We am looking to open a center where anyone from toddler to adults can enjoy. We want to provide an affordable, safe and secure family environment. We are not opening an arcade but a place of jungle gyms, simulatom, if you like roller coaster you can build your own and then ride it and stay in one place or at night iftbe adults want to get out and shoot a game of pool or through some darts we will have a special room for them to enjoy or they can play in the main entertainment floor. We are offering birthday party packages for children and adults of all ages. We will be a non-alcohol business but will serve fountain soda and snacks. I feel that this adventure would be a very good asset for our communities of Southold Township. We were talking to a friend of ours and our community has to drive a minimum of forty five minutes one way to a birthday party that there kids were invited to that the birthday kid is also from the north fork (sport plus, wood kingdom, etc), that is one of many people that tell me the same thing and that they wish that there was something closer. The bowling alley was a good place but that is gone and the movie theater is very expensive to bring you whole family for an hour and half money. We had submitted for a building permit on November 14, 2005 for this recreation center, the building is zoned light industrial our permit we applied for was recreational and that was not part of that zoning so they disapproved us and told us to go to the zoning board of appeals. I tried to find where the use of recreation and I could not find one. We are asking that you take in affect the need we have for this family Fun center in our community to rebuild our community spirit and family values that we seemed of lost over time because of busy life styles and demands of life in general. Please consider our request for a variance regarding this building; our future of recreation will be kept on the north fork instead of going elsewhere. We appreciate you time and consideration in our venture, we will be looking forward to hopefully hear good news from you and maybe meeting you and your families at the fun center. Please feel free to contact us if you have any question or input regarding this fun adventure. Sincerely Yours, Patrick and Oreanna Kaelin TOWN OF SOUTHOLD BUILD.~NG DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ Examined ,20__ Approved ,20 Disapproved a/c Expiration _, 20__ PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey_ Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: c?Z-~ Phone: ~t.~} Building Inspector APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets 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 areas, 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 shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ~ ~/~ (Signature of applicant or name, if a corporation) ' (Mailing address of applicant) ~3 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ~e> _~0v_ ( lc (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Loc~tion of land on w, hich proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section ~3 t~ Block 3 ":" ,.,s~i., Subdihsion Filed Map No. ~:~ me) State existing use and occupancy of pre,lisps and intended use and occupancy of proposed construction: a. Existing useandoccupancy ~Dr}~ d,.a,3rvl ~u b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost 5. If dwelling, number of dwelling units If garage, number of cars Fee Addition Alteration Other Work O,o.SnaoJac_ (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front ~q~ Rear <~ q' Depth Number of Stories Height Dimensions of same structure with alterations or additions: Front ~ Depth ~.'J f Height lur - I h~ T-.t-. Number of Stories 8. Dimensions of entire new construction: Front '~ Rear Height ~. Number of Stories ~t~ Rear Depth 9. Size of lot: Front Rear Depth 10. Date of Purchase Leo.~Ssaa~ Name of Former Owner 11. Zone or use district in which premises are situated Li a.\ 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO v/ 13. Will lot be re-graded? YES NO Will excess fill be removed from premises? YES 14. Names of Owner of premises ~ah ~lrai I~ t3 Address Phone No. Name of Architect Address Phone No Name of Contractor Address Phone No. No 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES * 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 ~ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. NO V 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) /~-Ir)~/~ ~ ~0~[,'~ being duly swom, deposes and says that (s)he is the applicant (Nme of individual si~i~ contract) above nmed, (S)He is the (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this L/ dayo~Vrb "'---~Nxff~ary Public Signature of A~plicant )WNER TOWN OF SOUTHOLD PROPERTY RECORD CARD ST~.~ ~.._~ ...... 1-~~-~",, ~ 1 ~T~ ....... ~u~.---- ACR. -Lb~r BLD. REMARKS LAND IMP. TOTAL DATE FRONTAGE ON WATER FRONTAGE ON ROAD DEPTH BULKHEAD TILLABLE WOODLAND MEADOWLAND HOUSE/LOT TOTAL TOWN OF $OUTHOLD PROPERTY RECORD CARD OWNER FORM£R OWNER / STREET N VI LLAGE /l ~,i SUB. LOT TYPE O~ BUILDING .ES. ~:/? SEAS, VL. FARM LAN D IMP. TOTAL DATE r 370 o 6 oo :A~ A~re V=lue Per V~lge Il=hie ON WATER '~land ~ , ~;, ~ d FRONTAGE ON ROAD eodowland D[PTH ~u~e Plot BULKHEAD ~ta~ ' I DOCK COLOR TRIM tension ~: '/ .J ~ >~ ~'~ , d. - ~'~ ' ~ o --~ ,6 ~' '~ 7 J :~ ~:~ ,~ ~ ~ Foundation Bath Dinette rch j~;/ '~,O,~ ~ jBasement Floors ~ I rch I x [ ~t. Walls Interior Finish J I~~1~'~ ~ ~' ~ ' jT~ Roof Rooms 1st Floor ~r~, ~,..~ (:.x ~z) %, .,~.~.~t _ , f ~ ~ 0 'Recreation Room Rooms 2nd Floor j FIN. B j Dormer Driveway ~ tal ~ ~ J FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall 5outhold, N,Y. Certificate O[ Occupancy No. Z] ................. 2942 Date .... .0.c.~9 ~)~.r..~? ................. 1~.4. · THIS CERTIFIES that the build~ng ...... H.~.~.. U~.ora~;e shed .................... ........ 5. . Location of Property Hou~ No. ' ' ' ~/~ County T~ Map No. 1000 Section ~.~ ........ Block . . .0.~ .......... Lot ...... ) ...0. q ~ ..... Subdi~sion ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Pe~it heretofore fried ~ t~s office dated .... Q.c.~: . j J .......... 19 ~. pursuant to w~ch Build~g Pe~it No. q.2.5~7~ ............... dated . .~ 5 :..~.~ .................. 19~., w~ issued, and conforms to a~ of the requkements of the applicable provisions of the law. ~e occupancy for w~ch t~s certificate is i~ued ~ ......... ...~.t. al. s.t.qc~g.e..b~iAdiog...wh~.c.h .r~.~ac~..~b~..~.n. ~.r.~ ~.q ...... ~e ce~ificate is issued to . ~ .P.q~..~VCY~.ZgC~.,..~Og.. ................................ (owner, ~ ~ X o~ the a~orcsaJd Suffolk County Dep~tmc~t of Health Approval ....... ~/,A ................................ Building Inspector Rw. 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-19704 February 4, 1991 THIS CERTIFIES that the building Location of Property 8305 COX LAiqE House No. County Tax Map No. 1000 Section 84 Subdivision ADDITION CUTCHOGUEr N.Y. Street Hamlet Block 3 Lot 1.1 Filed Map No. Lot No. conforms suJ~stantiall¥ to the Application for Building Permit heretofore filed in this office dated OCTOBER 31, 1989 pursuant to which Building Permit No. 18848-Z dated MARCH 8, 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 ROOF ADDITION OVER CONCRETE LOADING DOCK AS APPLIED FOR. PRIME PURVEYORSr INC. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTM]ZNT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building I~spe~or ~ '-' Rev. 1/81 ]:"OF~/~ NC. 4 TOWN OF SOUTHOLD BUILDING DEPAI~TMENT office of the Building Inspector Town ~all Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19705 February 4~ 1991 THIS CERTIFIES that the building Location of Property 8305 COX LANE House No. County Tax Map No. 1000 Section 84 Subdivision ACCESSORIES Street Block 3 Lot 1.1 Filed Map No. Lot No. CUTCHOGUE, N.Y. Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 24~ 1987 pursuant to which Bui%ding Permit No. 16666-Z dated DECEMBER 4, 1987 was issued, and conforms to all of the requirements of the applicable provisions of %he law. The occupancy for which this certificate is issued is ~;O ACCESSORY STRUCTURES~ cOOLER & FREEZER The certificate is issued to PRIME PURVEYORS~ INC, (owner) of the aforesaid building. SUFFOLK COUN'I~f DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N-023354 - JI3LY 27~ 1988 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-19706 February 4r i991 THIS CERTIFIES that the building ADDITION Location of Property 8305 COX LANE House No. Street County Tax Map No, 1000 Sec%ion 84 Block 3 Subdivision Filed Map No. CUTCHOGUEr N.Y. Hamlet Lot i.1 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 25r 1987 pursuant to which Building Permit No. 16178-Z dated JULY 7t 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 STORAGE ADDITION TO EXISTING BUILDING AS APPLIED FOR. PRIME PURVEYORS, INC. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 FOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20210 Date SEPTEMBER 12~ 1991 THIS CERTIFIES that the building Location of Property 8305 COX LANq5 House No. County Tax Map No. 1000 Section 84 Subdivision ALTERATION CUTCHOGUE~ N.Y- Street Hamlet Block 3 Lot Filed Map No. Lot No. 1.1 conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 1r 1991 ~urs~ant to which Building Permit No. 19650-Z dated FEBRUARY 1~ 1991 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 OFFICE ROOM INSIDE STORAGE BUILDING AS APPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED PRIME PUR%~!yoRS ~ INC. N-192274 - JUNE 18, 1991 N/a Building Inspector Rev. 1/81 APPLICANT TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of Town officers and employees. Thc 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. (Last name, firsi name~ middle initial, unless you are apply'ing in the name of someone else or other entity, such as a company. If so, indicate the other person or company name.) NATURE OF APPLICATION: (Check all that apply.) Tax Grievance Variance Change of Zone Approval of Plat Exemption from Plat or Official Map Other If "Other", name the activity: ~ ('~ h_0 6 ~ O~J~ ~'~,~ ~ 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 thc 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 that relationship between yourself (the applicant) and the Town officcr or employee. Either check the appropriate line A through D (below) and/or describe the relationship in the space provided. The Town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); C) an officer, director, partner, or employee of the applicant; or D) the actual applicant. DESCRiPTION OF RELATIONSHIP Submitted Signature: Print Name: 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I - Project Information (To be complete by Applicant or Project sponsor) 1. Applicant / Sponsor ~ 2. Project Name 3. Project location: Municipality County 4. Precise location (Street address and road intersectiorfc~ prominent landmarks, etc. or provide map) 5. Is proposed action: ( ) NEW ( ) EXPANSION ( v~ MODIFICATION / ALTERATION 6. Descdbe project briefly: I 7, Amount of land affected: Initially: acres-~. ~) ~//1~,~; Ultimately: acres 8. Will proposed action comply with existing or other existing land use restrictions:( ) YES ( ) NO If No, describe bdefly: 9, What is present land use in vicinity of project: (deschbe): ( ) Residential (~} Industrial ( ) Commercial ( ) Agricultural ( ) Park/Forest]Open Space ( ) Other 10. Doee action involve a permit approval or funding, new or ultimately from any other Governmental agency.(Federal. State or Local) ( k,,)'YES ( ) NO If Yes, list agency(e) and permit/approvals: 11. Does any aspect of the action have a currently valid permit or approval? (, ) YES ( ) NO if Yes, list agency(s) and permit]approvals: 12. As a result of proposed action, ~1[ e~sting pe~iUapproval r~uire modifi~fion? J(~ES ( ) NO If Yes, list agency(s) and peri,approvals: I ce~l~ t~at the intonation provided a~ve is ~ue to the best of my k~owledge [Applicant/SponsorName: '"''~' ~ ~ Date: Signature: If the action Is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 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 infom~ation 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. 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). 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# c$i~ 5 [.I The Application has been submitted to (check appropriate response): Town Board [] Planning Board [] Building Dept. [~J Board of Trustees 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) [~y P~it, approval, license; certification! [~ Nature and extent of action: Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria ~'~ Yes [] No ~] 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 ~ Yes ~ No [~Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Signi_ficant Coastal Fish and_~_Wiid~life Habitats and.wetlands..See LW .R~_ Secti~on III - Policies; Pages ~2~ through 32 for evaluation criteria. Yes [-~ 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 ~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. [] Yes ~'~ No ~ 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. ~Ye~ ~ NO ~ N~t Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peeonie 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. V1 Yes VI 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. VI Yes ~ No ~ Not Applicable Created on 5/25/05 11.'20 AM Location of action: ,)Ot.~ (~9~(.% ~ fl~.i , [1~ Site acreage: ~. 35 [)e~k~.b Presentlanduse: * , ¢.J.-:t kf.~.~qOld-&/)~/)J(.iO - ~/O. dCt~d LQccddta~ Present zoning classification: _~d? ~--/~0dO~'. 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: ~) (P~Ct~/.~g,~ ~/ ~C-~/'L,t C )C',d&-CJ,',~ (b) Mailing address: (c) Telephone number: Area Code ( ) tO3 t - 73 - / I,9- (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ~ No [-~ If yes, which state or federal agency?. C. DEVELOPED COASTPOLICY 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 ~-] bio [] Not Applicable Attach additional sheets if necessary Poi~y ~2: Protect and prc~rYe histbri~ and archfieo~i~aI'~'~s6~r~ ol ~e To~fi--0t'Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria ~'] Yes [] No [-~ blot Applicable ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: FROM: DATED: RE: Southold Town Zoning Board of Appeals Elizabeth A. Neville February 3, 2006 Zoning Appeal No. 5848 Transmitted herewith is Zoning Appeals No. 5848 of Oreanna Marie Kaelin- the Application to the Southold Town Board of Appeals. Also enclosed is a Project Description, a Transactional Disclosure Form, a Short Environmental Assessment Form, a Town of Southold Property Record Card, a Notice of Disapproval, a Survey of the property, and a drawing of the proposed recreational facility. ZBA TO TOWN CLERK CHECK TRANSMITTAL SHEET (Filing of Application and Check for Processing)~ DATE: 02/2/06 ZBA'# NAME CHECK # AMOUNT TC DATE STAMP KI:CEIVI:U KAELIN, OREANNA (CFI 1474 $400.00 5848 Worldco Resources Ltd.) FEB 3 ;~006 Southo~ Tow~ TOTAL' ;400.00 Thank you. OsTOWn Of Southold P.O Box 1179 outhold, NY 11971 Date: 02/03/06 * * * RECEIPT * * * Receipt~: 1474 Transaction(s): 1 1 Application Fees Reference Subtotal 5848 $400.00 Check#: 1474 Total Paid: $400.00 Name: Kaeiin, Oreanna M. 24400 Rt 48 Cutchogue, NY 11935 Clerk ID: MICHELLE Internal ID: 5848