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Home My WebLink About1000-70.-12-34 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cot. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To; Leslie Weisman, Chair Members of the Zoning Board of Appeals From: Mark Terry, Principal Planner LWRP Coordinator Date: June 29, 2011 Re: Coastal Consistency Review for ZBA File Ref. MICHAEL and ELLEN CARBONE #6483 SCTM#1000-70-12-34. Note that the Board of Trustees granted a Wetlands Permit (7569) for the action on June 22, 2011. MICHAEL and ELLEN CARBONE #6483 - Request for Variance from Article III Code Section 280-15 and the Building Inspector's May 20, 2011 Notice of Disapproval based on an application for building permit to construct an accessory garage at 1 ) front yard setback of less than the code required 40 feet, location: 1580 North Bayview Rd. (adj. to Goose Creek) Southold, NY. SCTM#1000-70-12-34. The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the action is CONSISTENT with the LWRP policy standards and therefore CONSISTENT with the LWRP. Cc: Jennifer Andaloro, Assistant Town Attorney BOARD MEMBERS Leslie Kanes Weisman, Chairperson James Dinizio, Jr. Gerard P. Goehringer George Homing Ken Schneider 53095 Main Road · P.O. Box 1179 Southold, NY 11971-0959 Office Location: Town Annex/First Floor, Capital One Bank 54375 Main Road (at Youngs Avenue) Southold, NY 11971 http://southoldtown.north fork.net ZONING BOARD OF APPEALS TOWN OF SOUTHOLD Tel. (631) 765-1809 · Fax (631) 765-9064 June 8, 2011 Mark Terry, Principal Planner LWRP Coordinator Planning Board Office Town of Southold Town Hall Annex Southold, NY 11971 Re: ZBA File Ref. No.//6483 (Carbone) Dear Mr. Terry: We have received an application for construction of an accessory garage in Southold. A copy of the Building Inspector's Notice of Disapproval under Chapter 280 (Zoning Code), and survey map, project description form, are attached for your reference. Your written evaluation with recommendations for this proposal, as required under the Code procedures of LWRP Section 268-5D is requested within 30 days of receipt of this letter. Thank you. Very truly yours, Leslie K. Weisman Chairperson Encls. FORM NO. 3 NOTICE OF DISAPPROVAL DATE: May 20, 2011 TO: Frank Uellendahl for M Carbone P O Box 316 Greenport, NY 11944 Please take notice that your application dated May 20, 2011 For permit for an accessory garage at Location of property 1580 No. Bayview Road, Southold, NY County Tax Map No. 1000 - Section 70 Block 12 Lot 34 Is returned herewith and disapproved on the following grounds: The proposed construction is not permitted pursuant to Art. III Sec. 280-15: In the case of a waterfront parcel, accessory buildings & structures may be located in the front yard, provided that such buildings.., meet the front yard principal setback.., and the side yard setback requirements for accessory buildings in Section B. On a 22,904 sq. ft. lot in the R40 zone the principal required front yard setback is 40'. The proposed accessory garage is at 8'. ~atricia Conklin, Permit Examiner -70-12.-3)3, SOUrHOLD BAY NOTICE COUNTY OF SUFFOLK Reap Property Tax Service A rrwm ~ SOUTHOLD SECTION NO ~' __ 070 m~ m 1000 506 SF NAX. 18~ HIGH SEPTIC SYSTEM AREA SUMMARY LOT AREA= co.22,904 100.00% EXIST'G BLDG. COVERAGE = co. 3,379 SF = 14.75% ADDED BLDG. COVERAGE = co. 506 SF TOTAL BLDG. COVERAGE = co. 3,885 SF = 16.97% MAX. ALLOW. COVERAGE = co. 4,581 SF = 20.00% ]]]]]]PROPOSED 2-CAR GARAGE ~ EXISTING STRUCTURE DATED: MAY 19, 2011 SURVEY BY PECONIC SURVEYORS, P.C. CAMERA LOCATION FOR PHOTO VIEW #2 GARAGE CONVERSION AND PROPOSED NEW GARAGE RESIDENCE SOUTHOLD, NY 1580 N. ~WlEW RD ARCHITECT FRANK UELLENDAHL 125 CENTRAl_ AVENUE P.0,BOX 316 GREENPORI, NY 1t944 'EL: 651-477 8624 OWNERS iICHAEL & ELLEN CARBON( i580 N. BAWIE~ ~AD SOUTHOLD, NY llgT1 ROOF PLAN FLOOR PLAN ~16 OC :8 COLLAR TIES @ 48' O.C CONCRETE FLOOR OVER COMPACTED FILL 8" X 3' DEEP EARTH FORMED TRENCH FOOT)ND SECTION 22'-6" PROPOSED GARAGE ELEVATION PROPOSED SITE PLAN SCTM# = 1000-70-12-34 TOWN OF SOUTHOLD SUFFOLK COgNlt', NEW YORK ,OARACE CONVERSION TO RESIDENTIAL SPACE, NEW 2-CAR GARAGE, il ZBA APPLICATION JUNE 7 , 2011 SCALE: 1"= 50' DATE: 06/01/2011 SCALE: 1' = 50' SITE PLAN D~¢. N~E A-1 D~. NO FLOOD ZONES FROM FIRM 36103C0166H: 9- 28- 09 CBRS I1-16-1990 I am familiar with the S, TANDARDS FOR APPROVAL AND CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and will abide b.y fha conditions set forth therein Grid on the permit to construct, The location of we/Is and cesspools shown hereon ore from field observations and or from data obtained from others. ANY ALTERATION OR ADDIZTON TQ THIS SURVEY IS A VIOLA~70N OF SEC770N 7209 OF THE NEW YORK STATE EDUCATION LAW, EXCEPT AS PER SECTTON 7209-SUBDIVISION 2, ALL CERTIFTCATIONS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE S/GNA TURE APPEARS HEREON. AREA=22,904 SQ. FT. TO TIE LINES ~=PIPE SURVEY OF PROPERTY AT SOUTHOLD TOfC_N OF SOUTHOLD SUFFOLK COUNT~, N. ~. 1000- 70-12-34 $CAL~: 1'--30' AUGUST 11, 2004 MA Y 19, 2011 20.02' NO. 4961~ (651) 765-5020 PA.~'~ (651) 765-1797 P.O. BOX 909 1250 TRAVELER STREET I o ^, ,. , 04-236 Fee: $ APPLICATION TO THE SOUTHOLD TOWN BOARD OF APPEALS HouseNo./'~aOm Street/~/ f~/-~t/V'l~/ t~D Hamlet SCTM 1000 Section ~ Block /~ Lot(s) ~ Lot Size ~,~ ~ne I (~) APPE~ THE ~TTEN DETE~INATION OF THE BU~D~G ~SPECTOR DATED ~[~O[l( BASED ON S~Y/SITE PL~ DATED ~/~/~[/ Applicant(s)/Owner(s): ~l~CJ ~ Mailing Address: ~ //~ ~ ~OL~ i ~ Telephone: ~'~Vq Fax: Email: ~fbOH~ 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: ~ M~Q~ for (~wner ( )Other: Address: ll 4q Xe ephon : 31-4 -gbZqhx: faeaen Please check to spec~y who you wi~ correspondence to be mailed to, from the above names: ( ) Applicant/Owner(s), (~ Authorized Representative, ( ) Other Name/Address below: VOtEREBY THE BUILDING INSPECTOR REVIEWED SURVEY/SITE PLAN DATED O~/~/~-~]l and DENIED AN APPLICATION DATED ~/~?~/[( FOR: ' (t,9~Building Permit ( ) Certificate of Occupancy ( ) Pre-Certificate of Occupancy ( ) Change of Use ( ) Permit for As-Built Construction ( ) Other: Provision of the Zoning Ordinance Appealed. (Indicate Article, Section, Subsection of Zoning Ordinance b.~umbers. Do not quote the code.) Article: -H/_ Section: ~-d~O -/~ Subsection: Type of Ap/peaL An Appeal is made 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. ( ) Interpretation of the Town Code, Article Section ( ) Reversal or Other A prior appeal (qfhas, ( ) has not been made at any time with respect to this property, UNDERAppeaINo(s). ?qq9 Year(s). re~earc/l be~.'e compleltng this question or call our qffice for aasis~a~lce) Name of Owner: ZBA File # REASONS FOR APPEAL (additional sheets may be used with preparer's signature): AREA VARIANCE REASONS: (1) An undesirable change will not be produced in the CHARACTER of the detriment to nearby properties if granted, because: or a (2) The benefit sought by the applicant CANNOT be applicant to pursue, other than an area variance, feasible for the (3) The amount of relief requested (4) effect or impact on the physical or environmental conditions (5) Has difficulty been self-created? ( )Yes, or ( )No. Are there Covenants and Restrictions concerning this land: [] No. [] Yes (please furnish copy). This is the MINIMUM that is necessary and adequate, and at the same time preserve and protect the character of the neighborhood and the health, safety, and welfare of the community. Check this box ( ) IF A USE VARIANCE 1S BEING ~E~UE.~ED, AND PLEASE COMPLETE THE ATTACHED USE VARIANCESHEET: (Pleasebesureto~n~ff~attorney.) Sworn tO befol;g me this N o'tal~e Public LYNDA M.~ NOTARY PU9LiO, State of New York No. 01~O6020932 Qualified in Suffolk Count~ Term Expires Maroh 8, 20 ~ Signat~{ Ap'p~ellant or Authorized Agent (Agent n~ust submit written Authorization from Owner) Frank Wolfgang Uellendahl Architect 123 Central Ave PCB316 GreenpoKc, NY 11944 t: 631.477.8624 e: frank@frankuellendahl.com June 6, 2011 Owners: Request for Variance: Michael and Ellen Carbone 1580 N Bayview Road PCB 1164 Southold, NY 11971 SCTM: 1000-70-12-34 Conversion of existing attached garage into family room; Construction of an accessory garage in the front yard RE: APPLICATION TO THE SOUTHOLD TOWN BOARD OF APPEALS PART A: AREA VARIANCE REASONS (1) An undesirable change will not be produced in the CHARACTER of the neighborhood or a detriment to nearby propedles, if granted, because: The proposed 22.5' x 22.5' accessory garage will not be visible from nearby properties. The structure - though located in the front yard - is hidden behind the densely planted tree border along N Bayview Rd. The adjoining vacant lot north of the proposed garage is also owned by the Carbones. (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 existing dwelling is located on this nearly triangular shaped lot providing no space for an accessory garage other than locating it within the 40' front yard, which requires an area variance. (3) The amount of relief requested is not substantial because: The area vadance is not substantial. (4) The variance will NOT have an adverse effect or Impact on the physical or environmental conditions in the neighborhood or district because: The proposed garage is located landward of the existing dwelling, the distance to the existing bulkhead is circa 50 feet. The area variance, if granted, has no environmental impact. (5) Has the alleged difficulty been sell-created? ( ) Yes, or ( X ) No. Does this variance involve as-buill construction or acttvfly? ( ) Yes, or ( X ) No. APPLICANT'S PROJECT DESCRIPTION (For ZB^ Reference) Applicant: ?q~,,qt~ (-2~Y_-Z._~g,.JF~t'gFtC(.~ ~,~ Date Prepared; I. For Demolition of Existing Building Areas Please describe areas being removed: II. New Construction Areas (New Dwelling or New Additions/Extensions): Dimensions of first floor extension: Dimensions of new second floor: Dimensions of floor above second level: Height (from finished ground to top of ridge): ]~ t Is basement or lowest floor area being constructed? If yes, please provide height (above ground) measured fi.om natural existing grade to first floor: III. Proposed Construction Description (Alterations or Structural Changes) (attach extra sheet if necessary) - Please describe building areas: Number of Floors and General Characteristics BEFORE Alterations: ~"t~, ~_. NumberofFloorsandChangesWlTHAlterations: x::'6t/~z ,~ ¥/,~, /2~-I-4,0gAJ~ ~ l ~t d~)~O~,~- IV. Calculations of building areas and lot coverage (from surveyor): Existing square footage of buildings on your property: Proposed increase o f building coverage: Square footage of your lot: ~: Percentage of coverage of your lot by building area: V. Purpose of New Construction: VI. Please describe the land contours (flat, slope %, heavily wooded, marsh area, etc.) on your land and how it relates to the difficulty in meeting the code requirement(s): Please submit seven (7) photos, labeled to show different angles of yard areas after staking corners for new construction), and photos of building area to be altered with yard view. 7/2002; 2/2005; 1/2007 CARBONE RESIDENCE 1580 N BAYVlEW ROAD SOUTHOLD, NEW YORK ZBA APPLICATION JUNE 7, 2011 AUTHORIZATION Submitted to: The Southold Zoning Board of Appeals We, Michael and Ellen Carbone Owners of the property located at 1580 North Bayview Road in Southold, NY 11971 and residing at the above referenced address Tel: 631.765.2409 Emaih ellcarbone~,aol.com do hereby authorize Frank W. Uellendahl, R.A. POB 316, Greenport, NY 11944 Tel: 631.477.8624 Emaih frank~,frankuellendahl.com to apply for the required variance on our behalf. Michael Carbone Ellen Carbone TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-18112 FAX: (631) 765-9502 SoutholdTown.NorthFork. net PERMIT NO. Examined ,20 Approved .20 Disapproveda/c 'ff/)~[(( t~ Exp,rarion~ . , 2~00 BLDG DE?~. TO~WN OF~SOUTHOLB~ BUILDING PERMIT APPLICATION CHECKLIS Do you have or need the following, before applyin~ Board of Health d sets of Building Plans Planning Board approval Check Septic Form Flood Permit Single & Separate Storm-Water Assessment Form Contact: Building Inspector ?LICAT1ON FOR BUILDING PERMIT INSTRUCTIONS ,20 Il a. This application MUST be completely filled in by typewriter or in ink and submilted 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, slid 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 shah expire if the work authorized has not commenced within ]2 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amenthnents or other regulations affecting the properly have been enacted in the interim, the Building Inspoctor may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEP~EBY 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 demolifion 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 fro' necessary inspections. (Signature of applicant or name, ifa corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises X-~lgF. g. ff~t)E/__ ~__~.:&~Ol~- (As on the tax roll or latest deed) tf applicant is ~ c~rporat!,op;1 signature of duly authorized officer (Name arid title,of corporate officer) Bul ders LiCense i,~0. · Plumbers License No. Electricians License No. Other Trade's License No Location of land on which proposed work will be done: /c./~.e_-774 z3.~¢' v.,~.4/' House Number Street Han~let County Tax Map No 1000 Section Z~t9 Block ,/2 Lot .~ Subdivision Filed Map No. Lot a }.xisting use and occupanc~ b Ir, tended use and occupancy ~--.~ Nature of work (check which applicable): New Building Repmr __--~ Removal Demolition Estimated Cost ~ ,:~dg,~ t2g>t9 Fee Addition x/ Alteration Other Work (Description) (To be paid on filing this application) Number of dwelling units on each floor If dwelling, number of dwelling units If garage, number of cars ~. ~.~' If business, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions ofexisting structures, if an>': Front ~:~/. ¢1 Real' ~:¥t. t~ Height t¢ 37ff Number of Stories 2_ Dimensions of same structure with alterations or additions Front ,.~7,J¢,14~'- Rear Depth_ Height Number of Stories / Dimensions of entire new construction: Pro ~_.~t Rear_ ~ Depth ,~.~ Height .~,¢¢' / Number of Stories / -, ) Size oflot: Front_ /~---~! Rear ,2.//.~ Depth ,.2~'Z~.~2'~- I0 Date of Purchase ff-_Z~d:7/ Name of Former Owner 11. Zone or use district in which premises are situated ,~ 12. Does proposed construction violate any zoning law, ordinance or regulation? YES ~.~NO 13, Will lot be re-graded? YES NO v/QWill excess fill be removed from premises? YES V/ NO 14. Names of Owner of premises~Address/~ '(,/t~C.t)l~fW Phone No. Name of Architect ~-- Address ,~'tg~ g~Phone No ~$/-47~ Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a fl-eshwater wetland? *YES v/' NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PEILMITS/MAY BE REQUIRED. b. Is this properly within 300 feet of a tidal wetland? * YES V/ NO * F YES. D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey', to scale, with accurate foundation plan and distm~ces to property lines. 17 If elevation at any point on property is at I0 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES NO * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ~J4,,~' ~.d'~--~//~2~//tff& / being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, OONNIE O. BUSH (Coho-ac*or, Agent, Corporate Omcer, etc.) O~ performed in the manner set forth in the application filed therewith, Sworn to before me this day of /-4aYfl 20 Nola~ Pubhc /l~f Applicant APPEALS BOARD MEMBERS · O~.~ar~ E Gochringer, Chairman James Dinizio, Jr. Lydia A. Tortora Lora S. Collins George Homing BOARD OF APPEALS TOWN OF SOUTHOLD Southold Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 1t971~0959 ZBA Fax (631) 765-9064 Telephone (631) 765-1809 FINDINGS, DELIBERATIONS AND DETERMINATION MEETING OF OCTOBER 25, 2001 Appl. No. 4997 - Michael Carbone 1000-70-12-34 STREET & LOCATION: 1580 North Bayview Road, Southold DATE OF PUBLIC HEARING: October 18 and October 25, 2001 FINDINGS OF FACT PROPERTY FACTS/DESCRIPTION: The applicant's property is located on the southerly side of North Bayview Road in Southold. The property contains an area of 22,904 sq. It. and is improved with a single-family dwelling, as shown on the October 7, '2000 survey map prepared by Anthony W. Lewandowski, L.S. BASIS OF APPLICATION: Building Inspector's June 26, 2001 Notice of Disapproval for the reason that applicants' prqposed new dwelling will be less than 75 feet from the existing bulkhead as shown on the survey prepared by Stanley J. Isaksen dated March 23, 2001. AREA VARIAhICE RELIEF REQUESTED: Applicant.is proposing to remove the existing dwelling structure in its entirety and build a new dwelling as shown on the survey prepared by Stanley J. Isaksen, Jr. dated Mamh 23, 2001. The setbacks at the closest points to the existing bulkhead are 38 feet at the northwest comer and when using the scale furnished, at approximately 52 feet from the center comer point of the dwelling. ADDITIONAL INFORMATION: At the public hearing held October 25, 2001, the agent for the applicant clarified that the proposed dwelling location will not be*closer to the bulkhead than the existing footprint, and the Board of Appeals h~ay rely on the corrected information, by applicant's agent, that the existing closest setback from the bulkhead is 38 feat, not 40 feet as originally stated in the application. REASONS FOR BOARD ACTION: The Board of Appeals held public headngs on this matter on October 18, 2001 and October 25, 2001, at which time written and oral evidence were presented. Based on all testimony, documentation, personal observations by Members of the Board, and other evidence presented, the Board finds the following to be true and relevant: 1. Grant of the area vadance will not produce an undesirable change in the character of the/' neighborhood or detriment to nearby properties. The proposed location of the new house will be closer to the bulkhead than that which exists, 38 feet, from the existing dwelling's footprint. 2. The benefit sought by the applicant cannot be achieved by some method, I=easible for the applicant to pursue, other than an area variance. The location of the new dwelling will not be a further increase in the true existing setback, and in fact will, in part, be a further distance from the bulkhead than the dwelling to be removed. 3. The area vadance is not substantial. Page 2 - October 25, 2001 ZBA Appl. No. 4997 - M. Carbone Parcel 1000-70-12-34 at Southold 4. The proposed variance will not have an adverse effect or impact on the physical or environmental conditions in the neighborhood because the vadance will pen*nit the new dwelling to be located in the same footprint area (except for portions that are being moved somewhat landward of the footprint). 5. The difficulty has not been self-created and is related to the existing nonconforming footprint and layout of the land. In considering this application, the Board deems this action to be the minimum necessary and adequate for the applicants to enjoy the benefit of a new dwelling, after removal of the existing dwelling with deck, and that the grant of this variance will serve the character of the neighborhood, and the health, safety, welfare of the community BOARD RESOLUTION: Now, therefore, on motion by Member Dinizio, seconded by Member Collins, it was RESOLVED, to GRANT the variance requested, for location of a single-family dwelling, to replace the existing dwelling, in a location shown on the survey map dated Maroh 23, 2001, with the condition that the setback not be closer than 38 feet, at its closest point to the bulkhead. This action does not authorize or condone any current or future use, setback or other feature of the subject property that violates the Zoning Code, other than such uses, setbacks and other features as are expressly addressed in this action. Vote of the Board: Ayes: Members Goehringer (Chairm~3),¥t~*~zio~and Collins. (Member Tortora abstained.) Member Homing wes absent.) Thi~olufion w~' du~~3~an/d, one arard P. Go~hdngar, Chsi~man QUESTIONNAIRE FOR FILING WITH YOUR ZBA APPLICATION Is the subject premiss listed on the real estate market for sale? Yes 'X/No Arefifere any proposals to change or alter land contours? X/ No Yes please explain on attached sheet. 1 .) Are there areas that contain sand or wetland grasses? r(J't:5'&/' ~" 2.) Are those areas shown on the survey submitted with this application? /.,~,/4. 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? td~-~ Please confirm status of your inquiry or application with the Trustees: ~5~tF_- l-t~O~.~l.)~.: ~L/~ ZZ t~.~l! and if issued, please attach copies of permit with conditions and approved survey. ls there a depression or sloping elevation near the area of proposed construction at or below five feet above mean sea level? /~20/~t~ Are there any patios, concrete barriers, bulkheads or fences that exist that are not shown on the survey that you are submitting? X.J~,6z~ Please show area of the structures on a diagram if any exist or state none on the above line. Do you have any construction taking place at this time concerning your premises?/dO yes, please submit a copy of your building permit and survey as approved by the Building Department and please describe: If 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. Do you or any co-owner also own other land adjoining or close to this parcel? If yes, please label the proximity of your lands on your survey. Please list present use or operations conducted at this parcel Z;>/4Jt~__t.X./,CJi, and the proposed use ~d=~g~-'2 · (ex: existing single family, proposed: same with garage, pool or other) signature PROJECT ID NUMBER PART 1- PROJECT INFORMATION 1, APPLICANT / SPONSOR 3.PROJECT LOCATION: MantcJpalily 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for Ut/LISTED ACTIONS Only ( To be completed by Applicon! or Project Sponsor) 2, PROJECT NAME , SEQR 4. PRECISE LOCATION: Street Addess amd Road Intersections. Prominent landmarks otc -or provide map 5. IS PROPOSED ACTION: [~New [] Expansion' odlflca~on I alteration 6. DESCRIBE PROJECT SRIEFLY: 7. AMOUNT OF LAND AFFECTED: teitiatiy acres Ultimately~:~- ~)//~:~ acres WILL PROPOSPOS.~I;~-ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? F"-]Yes ~No I! no. describe briefly: 9. W T IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as epply.) 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY FRO~ ANY OTHER GOVERNMENTAL AGENCY (Federal, Stale or LOCal) 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? E~Yes [~ II yes, list agency name and permit / approval: j!2. AS A RE T OF PROPOSED AC'rlON WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFIDATION? I CRT Y THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Signature If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment 'ART II - IMPACT ASSESSMENT (To be completed by Lead A~lency) A, DOES ACTION EXCEED AN~ TYPE ] THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use Ihe FULL EAF. B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN § NYCRR. PART 617.6? if NO, a negative decJaraQon may be superseded by another Involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwflltan, if legible) C1. Existing air qualk~, surface or groundwater quality or quan61y, noise idveia, existing traf~c paUem, solid waste production or disposal, potanl~al for erodE)n, dm~3nge o~lkx3ding pcobtsms? Expia~ bdetiy: ' c6. LCag term. sho~t tsrm, I E. IS THERE. OR IS THERE UKELY TO BEI COI~ITROVERSY RELATED TO POTENTIAL ADVERSE ENVIRON ~EI, CI'AL IMPACTS? If y~as exprath: PART Itt - DETERMINATION OF SIGNIFICANCE (To be complofed by Agency} INSTRUCTIONS: F~reach~dversee~ectidenti~edab~ve~deta~ninewhetherit~ssubstantta~arge~mp~rtantOr~the~wiassigni~canL Each effect should be assessed in coonection with its (a) setting (i.e. urban or rural); (b) probabilit~ of occurring; (c} duration: (d) irreveraib~ily; {e) geographic scope; and (f) magnitude. If ascessa~, add affachmenta or reference supporting materials. Ensure thai exolanations contain sufficient detail to show that all relevant adverse impacts have been idenfitied and adequately addressed, if question d of ;rart iiwas checked yes. the detarminatto~ of signi6cance must evaluate the polentialimpact of the orocosnd actian on {he environmental characteristics of the CEA. Check this box if yo~ have Jdenttfled one ~ more potentially large or significant adverse impacts which MAY occur. Then proceed directly to ~e FULl FAF and/or prepare a posit~e declaration. Check this box if.you have determined, based on ifle information and analysis above and any suppoff]ng documentation, that the proposed ac~Jm WILL NOT result in any significant adverse em/ironmental impacts AND provide, on attachments as necessa~7, the reasons supposing Ihi~ determination. Name of Lead Agency Date Title of Responsible Officer Print or Type Name of Responsible Off]car in Lead Agency Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible oTl'~cer) APPLICANT/AGENT/REPRESENTATiVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics m'obibits conflicts of interest on the part of tewn officers and emt>lovees. The ourpose of this form is to provide information which can alert the town of ~ossible confliels of interest and allow it to take whatever action (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 NAME OF APPLICATION: (Check alt that apply.) Tax grievance / Variance ~/ Change o£Zone Approval of plat Exemption from plat or official map Other (If"Other", name the activity.) Building Tmstee Coastal Erosion Mooring Planning Do you personally (or through, your company, spouse, sibling, parent, or child) have a relationship with any officer or employee &the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business. including a partnership, in which the town Officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO ~/ If you answered 'YES". co nplete the balance ofth's form and da e and s~gn where mthcated. Name of person employed by the Town of Southold Title or position of thru person Describe the relationship between youmelf (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, o'r 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 Form TS I Submitted this 200 Signature Print Name ~z2~ J[~"/~ ~r._.4_/~).~.q. ~z ~/ APPLICANT TRANSACTIONAL DISCLOSURE FORM (FOR SUBMISSION BY OWNER and OWNER'S AGENT) The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of Town officers and employees. The purpose of this form is to provide information, which can alert the Town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: ~'11~-~ ~_.. ~. ~ ~Ok)~ (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 or company name.) NATURE OF APPLICATION: (Check all that apply.) Tax Grievance ~ Variance Special Exception If"Other", name the activity: Change of Zone [ ] Approval of Plat ~ l Exemption from Plat or Official Map I I 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. Complete the balance of this form and date and sign below 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 officer 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 (cheek all that apply): I [ t [ ] A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); J 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 Signature: '~.-~.~. (w ff.~_----~ Print Name: APPLICANT TRANSACTIONAL DISCLOSURE FORM (FOR SUBMISSION BY OWNER and OWNER'S AGENT) The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of Town officers _and employees. The purpose of this form is to provide information, which can alert the Town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: ~ ~:2:} 1~/2~ O ltO{~ (Last name, first name, middle initial, unless you are applying in the name of someone else or other entity, such as a company, lfso, indicate the other person or company name.) NATURE OF APPLICATION: (Check all that apply.) Tax Grievance ~ Variance Special Exception If "Other", name the activity:_ Change of Zone Approval of Plat [ Exemption fi'om Plat or Official Map O,h 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. No Compile the balance &this form and date and sign below where indica~d. 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 officer 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): [ I 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 this ~tt~ day of Print Name: Town of Sonthold ~¢ ~ ~ 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 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. 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 Waterfi'ont 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 a~fect 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# £0C10- ~ ]~- -- ~ The Application has been submitted to (check appropriate response): TownBoard [] Planning Dept. [] Building Dept. [] BoardofTrustees,~ Category of Town of Soutbold 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: Location of action: Site acreage:_ Present land use: -~-~,~/,E;~LrFg Present zoning classification: 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: .,z::~_~)-~ (b) Mailing address: ;~d~3g3 (c) Telephone number: Area Code ( ) C"~-~/,) -~-'~-t~- - ~,~.4-~ (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [~ No [~ lfyes, which state or federal agency? DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. []Yes ~] No [~(Not Applicable- please explain) Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - PoliCes Pages 3 through 6 for evaluation criteria [] Yes [] No[~rL~ (Not Applicable- please explain) Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP,,~ection III - Policies Pages 6 through 7 for evaluation criteria [~ Yes [] No [] (Not Applicable - please explain) Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for evaluation criteria [] Yes [] No ~(Not Applicable- please explain) Ailach 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 L~ Yes L~ No Iq (Not Applicable- please explain) 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 evaluationfriteria. [] Yes [] No [~Not Applicable - please explain) Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWltP Section III - Policies Pages 32 through 34 for evaluation criteria. See Section III - Policies Pages; 34 through 38 for evaluation criteria. ~(Not [~ Yes [] No Applicable- please explain) Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastesk. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. [rq Yes I I No ~M (Not Applicable-please explain) 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. Wn~// [] Yes(~ No I~1 (Not Applicable - please explain) Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses trod promote siting of new water-dependent uses in suitable locations. See LWRP Section II1 - Policies; Pages 47 through 56 for evaluation criteria. [~ Yes ~ No ~(Not Applicable- please explain) 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 - please explain Attach additional sheets ifnecessaw 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- please explain Attach additional sheets if necessary Policy 13. Promote~-~appr°priate use and development of energy and mineral resources. See LWRP Section III- Policies 65 through 68 for evaluation criteria. [] Yes ~ No~1 ~ Not Applicable- please explain TOWN OF SOUTHOLD PROPERTY RECORD CARD /¥--,/7' 'L) 061 '" /4,,' -/ *, -'.,o .Y" ~ ..... '~) VILLAGE DIST. SUB. LOT "' OWNER STRE~ / O ~ FORMER OWNER.. , N ~ E ~, ~ z' S W ~PE OF BUILDIN~ RE~/6 ~ S~S. VL. FARM COMM. CB. M~CS. Mkt. Value ~N D I M P. TOTAL DATE REMARKS AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE ~ o~, -FARM Acre Value Per Volue ~ , · /a ., TiHoble FRONTAGE ON wATER WoMl~nd FRONTAGE ON ROAD ~e~dowl~nd DEPTH House Plot BULKH~D ¢~j. Tot~ ~ DOCK M: Bldg. Extension Extension Extension P'~E C t(. Porch Breezeway Garage Total Foundation Basement Ext. Walls Fire Place Type Roof Recreation Room Dormer Bath Floors Interior Finish Heat Rcoms ]st Floor Rooms 2nd Floor Drivewoy 70-12-34 2/04 COLOR TRIM 1st 2nd ~B'~/ C~/ ~/,'~-~ ~ /,~'¢~ ~5~5 Foundation ~ Fi~, B, Bath Dinette 5T ,~ FULL COMBO ~xtens~n ~/ ~ /~ ~ ~ Basement s~BCRAWL PART'AL Floors Kit. Extension Ext. Walls Interior Finish LR. Extension Fire Place ~ Heat DR. Patio Woodstove BR. Porch Dormer Baths Deck ~/'~ ~ ~ ~ C7~ ,~ /.% Dock Faro. Rm. A.C. Garage ~,~ ~ =,~ ['~' (~/ O.B