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Home My WebLink About1000-77.-2-7 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. 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: From: Date Re: Leslie Weisman, Chair Members of the Zoning Board of Appeals Mark Terry, Principal Planner LWRP Coordinator May 25, 2011 Coastal Consistency Review for ZBA File Re GEORGE and MARY VAIL #6475. SCTM#1000-77-2-7 GEORGE and MARY VAIL #6475 - Request for Variances from Code Article XXIII Section 280-124 and the Building Inspector's April 6, 2011 Notice of Disapproval based on an application for building permit to construct additions to an existing dwelling at: 1) less than the code required front yard setback of 35 feet, 2) less than the code required rear yard setback of 35 feet, 3) lot coverage of more than the code required 20%, 4) accessory structure in a location other than the code required rear yard; location of property: 50 Oak Avenue (Pine Avenue and Unnamed Street) Southold, NY SCTM#1000-77-2-7 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 proposed action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP provided that the following best management practices are considered. To further Policy 5: Protect and Improve Water Quality in the Town of Southold. 5.2 Minimize non-point pollution of coastal waters and manage activities causing non-point pollution the following is recommended if the application is approved: 1. Establish a Landscaped (non-turf) Buffer landward of the concrete wall. LANDSCAPED BUFFER -- A land area of a certain length and width which is planted with indigenous, drought-tolerant vegetation similar to that found within the immediate proximity of the parcel. Vegetation shall be installed in sufficient densities to achieve 95% ground cover within two years of installation. Survival of planted vegetation shall be 90% for a period of three years. Maintenance activities within the buffer are limited to removing vegetation which is hazardous to life and property, trimming tree limbs up to a height of 15 feet to maintain viewsheds, replanting of vegetation and establishing a four-foot-wide access path constructed of pervious material for access to the water body. [Added 12-15-2009 by L.L. No. 15-2009] 2. Require a Storm Water Pollution Prevention Plan pursuant to Chapter 236 to address storm water control pre and post construction. Pursuant to Chapter 268, the Southold Town Zoning Board of Appeals shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Jennifer Andaloro, Assistant Town Attorney BOARD MEMBERS Leslie Kanes Weisman, Chairperson James Dinizio, Jn Gerard P. Goehringer George Homing Ken Schneider Southold Town Hall ~ -tj~ 53095 Main Road · P.O. Box 117~/' Southold, NY 11971-0959 Office Location: Town Annex/First Floor, Capital One Bank 54375 Main Road (at Youngs Avenue) Southold, NY 11971 http://southoldtown.northlBrk.net ZONING BOARD OF APPEALS TOWN OF SOUTItOLD Tel. (631) 765-1809 · ]Fax (631) 765-9064 April 22,2011 Mark Terry, Principal Planner LWRP Coordinator Planning Board Office Town of Southold Town Hall Annex Southold, NY 11971 Re: ZBA File Ref. No. #6475 (Vail) Dear Mr. Terry: We have received an application for additions and alterations 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. To; Garrett Strang for G & M Vail P O Box 141~ Southold, NY 11971 FORM NO. 3 NOTICE OF DISAPPROVAL ~ ~ DATE: April 6, 201 t ~ Please take notice that your application dated March 22, 2011 For construction of additions to an existing dwellin~ at Location of property 50 Oak Avenue, Southold, NY County Tax Map No. 1000 - Section 77 Block 2 Lot 7 Is returned herewith and disapproved on the following grounds: The additions on this non-conforming 10,792 SCl.fi. lot, with three front yards, is not permitted pursuant to Article XXIII Section 280-124 which states; "This section is intended to provide minimum standards for granting ofa buildin~v permit for the principal buildings of lots which are reco~jfized by the town unde, 280-9, are nonconforming & have not merged pursuant to 280-10." On lots less than 20,000 sq. fi., the required front yard setback and rear yard setback 35'. The site plan indicates a front yard setback f ' o 13 & the rear yard setback of 4.5 In addition, the required lot coverage is 20%. The lot coverage upon completion ~:, 22.5%. Also, the proposed shed is not permitted pursuant to 280-15 which requires accessory structures to be located in the rear yard The site plan indicates the proposed shed in the front yard. : Authorize_~jgnat ure TOWN OF SOUTHOLD ~UiLDING DEPARTMENT TOWN CLERK'S OFFICE SOUT~OLD, N. Y. CEF~TIFICATE OF OCCUP,~NC¥ No ......Z..840 ...... Date ................. Oct;ot~ar...19. .......... , l~l~.0.... THIS CERTIFIES that the building located al COl:,.. l~lne. AVe..8[...Oalc..Aveo.,....l~ol~l:~al~.d. ~ap .~.°..~..e,..~(..~k No.*.~.~ ............. Lo~ ~'o ....... ~:~,.8.::~.~ ..................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................. &p~'.t,.1...~l, 4 ........ , 19.60. pursuant to which Building Permit No...~..;L0;I:7 ....... qated ................. Ap~:[J,..&4 .........., 2[9..60., 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 ...................................................................... PIt.~ktA~I... Olq~l.. IgJ~IILY...l~hI~ Y,,NG .............................. This certifma~e is issued to .l$~&nlql..G.,...klul~lte~....~wtl~.l* ............................................................ (owner, lessee or tenant) of the aforesaid building. Building Inspe~or FORM NO. 4 TOWN OF SOUTEOLD BUILDING DEPARTMENT Offic~ of th~ Building Inspector Town Hail Southold, N.Y. CERTIFICATE OF OCCUPANCY No: z-26889 Date: O1/19/00 THIS CERTIFIES that the building ADDITION Location of Property: 50 OAK AVE (HOUSE NO.) {STREET) County Tax Map No. 473889 Section 77 Block 2 Filed Map No. Lot No. Subdivision SOUTEOLD Lot 7 (HAMLET) conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 6~ 1989 pursuant to which Building Permit No. 18491-Z dated SEPTEMBER 15~ 1989 was issued, and conforms to all of the requirement~ of the applicable provisions of the law. The occupancy for which this certificate is issued is DECK ~DITION TO AN EXISTING ONE F~24ILY DWELLING AS APPLIED FOR. The certificate is issued to ROBERT R. WIECZOREK & RITA REIS (OWNE~) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRIC~L CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A E 066738 01/04/00 ' uthorized $~ature TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SouthoidTown.NorthFork,net Examined ,20 Approved ~ 20 Disapproveda/cl?~'¢/ff Expiration MAR ~ 2011 BlDG OEPl. PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying?. Board of Heslth : 4 s~s of Building Plans Planning Board approval ; ~ :: ' , Sapfic Form N.Y.S,D,.F~C. Trustees Contact:. Ma//to: Phone: Building Inspector PPLICATION FOR BUILDING PERMIT INSTRUCTIONS . ,2o { )letely 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 conunencod before issnune~ of Buitding 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 an~, 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 a~er the date of issuance or has not been completed within 18 months fi'om such date. ffno zoning amendments or other regulations affecting the property have been enacted in the intorim, the Building Inspector may authorize, in writing~ the extension of the permit for an addition six months. Tberee~r, a new permit shall be requlv~xl. . APPLICATION IS HEREBy MADE to the~Bullding Department for the is~uapco 0fa Building Permit pursuant to the Building Zone Ordinance of the Town of Sonthold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of bulMin~, additions, 0~7 alterations o~ for removal Or damolifion as. herein dascfi~d, The applicant agrees to comply with all applicable laws, ordinances, building code, housin~ code, and regulations,candt0 admit. ~($ig!~J~ ~f ~pli~at or n~me, if a ~orpomfioo) (Malilng ~dd~zs of appli~nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nam¢ofownerofpremises ~ ~7/r~t~o~S° on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer State existing use and occupancy ofpiemises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work (chock which applicable): New Building~ Repair Removal Demolition 4. Estimated Cost__ ~/~- ~ F~ 5. Addition t/ Alteration .Other Work Sr'a~a~ r (Description) (To be paid on filing this application) If dwelling, number of dwelling units~Number ofdwellhag units on each floor if garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions ofexisting structures, ifany:Front 4F,,.~ ~: gqLd, Rear ~2...~ Depth Height ~ ~'dr' Number of Stories. I Dimensions of same structure with alterations or additions: Front z]~ c,F 73, ] Rear Depth ,7 $, I Height ~- ~ ' Number of Stories ! 8. Dimensions of entire new construction: Front Height Number of Stories 9. Size oflot: Front ~'~,f/ /'~-~ Rear q'~ I0. Date ofPumhase.,. ~,/~?/,~0 Name of Former Owner Depth 11. Zone or use district in which promises are situated ~' - 12' D°es pr°p°sed conmcti°n ~°l~e ~y z°n~ng law, °rd~ or re~la~onT ~S ~0 13. Will lot be r~aded? ~ NO ~ill exc~ fill be remov~ ~m p~mi~s? ~S 14. N~es offer ofp~es I/~ [ ~ Ad~..~o~zfa~ ~0~ N~ - N~e of ~hit~t ~ ~g~- Ad~ Name of ~nm~or : Ad~ .Phone No. 15 a. Is ~is prop~ ~M 100 f~ of a fi~ ~d or a ~h~ter wetl~d? *~S ~O * IF ~, SO.HOLD TO~ ~US~ & D.E.C. PE~S ~Y BE ~Q~D. b. Is ~s prope~ wi~n 3~ f~ ~ a fi~l wefl~ * ~S..~ NO * IF ~S, D.E.C. PE~TS ~Y BE ~Q~D. ' 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on properly is at 10 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) COUNTY O~-~: ¢.~ '~.~ ~....,,?~. ,~'- .'~'"~ ~ y.~, . berg d~y swo~ d~ ~d ~s ~ (s)he is ~ ~plic~t ~e o~ m~vloum sing con~a~) a~ve n~, LETTER OF AUTHORIZATION RE: Premises, 50 Oak Avenue, Southold, NY SCTM # 1000-77-02-7 I, GEORGE VAIL, HEREBY AUTHORIZE GARRETT A. STRANG, ARCHITECT TO ACT ON MY BEHALF WHEN MAKING APPLICATION TO THE UNITED STATES OF AMERICA, STATE OF NEW YORK, COUNTY OF SUFFOLK, TOWN OF SOUTHOLD OR ANY OTHER GOVERNMENTAL AGENCY IN CONNECTION WITH THE ABOVE REFERENCED PROJECT. ~-~5-ORGE VAIL Sworn to before me this Day of/-rs t ~ ,~ Notary Public State of New York ,2011 No{ary Pub#c, New yo~k No 4730095 Qualitie~t i~ S~;flolk CounbJ Comm. Expires July 31 Fee: $ Filed By: Assignment No. I APPLICATION TO THE SOUTHOLD TOWN BOARD OF APPEALS House No. 50 Street Oak Avenue Hamlet Southold SCTM 1000 Section 77 Block 2 Lot(s). 7 Lot st~ .248A Zone R-40 I ONE) APPEAL THE WRITTEN DETERMINATION OF THE BUILDING INSPECTOR DATED ~l 6, 2o~ ~ BASED ON SURVEY/SITE PLAN DATED ~amh 18. 20~ ~ Applicant(s)/Owner(s): George and Mary Vail Mailing Address: POB 159, Cutchogue, NY 11935 973-716-5267 Telephone: Fax: Email: gvail@optonline.net NOTE: In addition to the above, please complete below if applicatlon is signed by applicant's attorney, agent, architect, builder, contract vendee, etc. and name of per, on who agent repr~,entt: Garrett A. Strang, ArchitectJAgent .for ~)wne~Other: Name of Representative: POB 1412, Southold, NY 11971 Address: Telephone: 765-5455 Fax: 765-5490 Email: architect@quixnet.net t----qPlease check to specify who yot~ correspondence to be mailed to, froze above names: ~ ~ --I IApplicant/Owner(s), ~/L~JAnthorized Representative,[__] Other Name/Address below: W]tEREBY THE BUILDING INSPECTOR REVIEWED SURVEY/SITE PLAN DATED ~amh ~8, 2m ~ and DENIED AN APPLICATION DATED March 22, 20~ ~ Bnilding Permit Certificate of Occupancy ( ) Pre-Certificate of Occupancy Change of Use Permit for As-Boilt Constrnetion Other: FOR: Provision of the Zoning Ordinance Appealed. (Indicate Article, Section, Subsection of Zoning Ordinance by number~. Do not quote the code.) Article: ~ Section: 2a0 Subsection: 124,125 Type of A~peal. An Appeal is made for: L~.JA Variance to the Zoning Cede or Zoning Map. A Variance due to lack of access requ!red by New York Town Law- Section 280-A. Interpretation of the Town Code, Article Section Reversal or Other A prior appcal['--]has, [] has not been made at any time with respect to this property, UNDER Appeal No(s~ Year(s). . (Please be sure to research before completing this question or call our oj~we for assistance) Name of Owner: ZBA File # REASONS FOR APPEAL (additianal sheets maF he used ~vith preparer's signature): AREA I/ARIANCE RE/ISONS: (1) An undesirable change will not be produced in the CHARACTER of the neighborhood or a detriment to nearby properties if granted, because: many homes in the neighborhood have been altered and/or expanded or built new, which are considerably larger than that which is proposed in this application (2) The benefit sought by the applicant CANNOT be achieved by some method feasible for tile applicanl to pursue, other than an area variance, because: the property has three (3) front yards and a minimal rearyard as it presently exists (3) The amount of relief requested is not substantial because: the rearyard (west) setback is not being reduced by this proposal; the frontyard (east) setback is being reduced by only 4' at the southeast comer of the dwelling (4) The variance will NOT have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district because: many homes in the neighborhood have been altered and/or expanded or built new, which are considerably larger than that which is proposed in this application (5) Has the alleged difficulty been self-crealed? [~-']Yes, or E~No. Are there Covenants and Restrictions concerning this land: ~]No. ~]Yes (please [ttrnlsh eopF). This is the MINIMUM that is necessary and adequate, and at the same time preserve and protect the character of the neighbm'hood and the health, safety, and welfare of the community. Check this box ~ IF A USE V~4RI/INCE IS BEING REQUESTED, AND PLEASE COMPLETE THE ~tTTACHED USE I/ARI.4NCE SHEET: (Please be sure to cottsu~.~}~nr attorttey.) g gnature of Appellant or Authorized Agent Sworn *~hefore me this ~ day of /~/tL , 20# ~N~ota ry Public Barbara A. Strang No~ry Public, New York NO 4730095 Comm. Expires July 3 , . APPLICANT'S PROJECT DESCRIPTION (For ZBA Re fcrencc) Appiieaut:George and Mary Vail Date Prepared: April 20, 2011 I. For Demolition of Existing Building Areas Please describe areas being removed: not applicable II. New Construction Areas (New Dwelling or New Additions/Extensions): Dimensions of fn'st floor extension: 4 x 13.8, 4 x 19.1, 8.5 x 27, 3 x 20 10 x 10 (shed) Dimensions of new second floor, not applicable Dimensions of floor above second level: not applicable Height (from finished ground to top of ridge):10.5 +- Is basement or lowest floor area being constructed? If yes, please provide height (above ground) measured from natural existing grade to first floor: 2' IlL Proposed Construction Description (Alterations or Structural Changes) (almchextra sheet ifneccss~y) - Please describe building areas: Number of Floors and General Characteristics BEFORE Alterations: O~e and one half story single family residence with attached one car garage. Number of Floors and Changes WiTH Alterations: One and one heft sto~ single family residence with garage converted to living space, additions to other living areas and new 1 O0 sf shed. IV. Calculations of building areas and lot coverage (from surveyor): Existing square footage of buildings on your property: 1944 sf Proposed increase of building coverage: 488sf Square footage of your lot: 10,792 sf Percentage of coverage of your lot by building area: 18% existing/22.5% proposed V. Purpose of New Construction: create a new master bedroom, enlarge existing kitchen, convert existing bedrooms to family area, install new 100 sf. shed VI. Please describe the land contours (fiat, slope %, heavily wooded, marsh area, etc.) on your land and how it relates to the difficulty in meeting the code requirement(s): not applicable 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 QUESTIONNAIRE FOR FILING WITH YOUR ZBA APPLICATION Is the subject premi~?s4isted on the real estate market for sale? Yes '/ No ~Nre any proposals to change or alter land contours? o Yes please explain on attached sheet. 1.) Are there areas that contain sand or wetland grasses? j~/O 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? ~t~, 4.) If your property contains wetlands or pond areas, have you contacted the Office of the Town trustees for its determination ofjurisdiction? 7~ ~ Please confirm status of your inquiry or application with the Trustees: and if issued, please attach copies of pormit with conditions and approved survey. Is there a depression or sloping elevation near the area of proposed construction at or below five feet above mean sea level? Are there any patios, concrete barriers, bulkheads or fences that exist that are not shown on the survey that you are submitting?_ ~'o 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? ,,ao _If yes, please submit a copy of your building permit and survey as approved by the Building Department and please describe: 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. G. Do you or any co-owner also own other land adjoining or close to this parcel? ~.~o If yes, please label the proximity of your lands on your survey. H. PI.ease l~,present use or operations conducted at this parcel ff/~ff~: · ~+~ & ~'~w~ ~bD/~'~a~ '~ ~-'~ ~:.~ . (ex: existing single family, proposed: same ~ith garage, pool or o~her) /~&orized signature and Date #3 VAiL RE~SIDEN£ E 50 OAK AVENI[ E SOUTHOLD SCTM #1000-77~2-7 1/I1/11 2:00 PM PHOTO TAKEN LOOKING WEST #4 VAIL RESIDENCE 50 OAK AVENUE SOUTHOLD SCTM #1000-77-2-7 1/11/11 2:00 PM PHOTO TAKEN LOOKING SOUTH #1 VAIL RESIDEN£E 50 OAK AVENUE SOUTHOLD SCTM 6/1000-77-2-7 t/11/11 2:00 PM PHOTO TAKEN LOOKING NORTH #2 VAIL RESIDENCE 50 OAK AVENUE SOUTHOLD SCTM #1000-77-2-7 1/11/11 2:00 PM PHOTO TAKEN LOOKING NORTHWEST APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town offinem and employees. The purpose of this form is to orovide information which can alert the town of nossible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: ~ ]/~ I ~ (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.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other", name tim activity.) 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 t'~ lfyou answered "YES", complete the balance of this form and date and sign where indicated. Name of pepaon 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 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 ~-~t'~.~3~ c~ _ 20~ ~_ Print Name ~tt:zt~_~ //~ / gL. APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM 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 orovide information which c4m alert the town of tmssible conflicts of interest and allow it to take whatever action is necessary to avoid same. CLast name, f'LrSt name, middle initial, unless you are applying in the name of someone else or other entity, such as a company. If se, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievanee BuiMing Vatianee Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (1 f"Other', name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any omar 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 mom than 5% of t~shares. YES NO *'~ I you answered YES , complete the balance of this form and dale and sign where ~nd~cated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/represent ative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space lyrovided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): A) the owner of greator 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/ff dayof /'[dRcl~ _20~/_ Signature Print Name "~ AGRICULTURAL DATA STATEMENT ZONING BOARD OF APPEALS TOWN OF SOUTHOLD WHEN TO USE THIS FORM: The form trmst be completed by the applicant for any special use permit, site plan approva~ use variance, or subdivision approval on property within an agricultural district OR within 500feet of a farm operation located in agricultural distri~ All applications requiring an agricultural data statement must be referred to the Suffolk County Department of Planning in accordance with Sections 239- tn and 239-n of the General Municipal Law. 1 ) Name of Applicant: 2) Ad.ss of A~li~t: 3) N~e of L~d Owner 4) Add.ss ofL~d ~n~: 5) Descfi~on of Pm~sed ~je~: 6) Location of Property (rom and tax map number): ~'o 7) Is the parcel within an agricultural district? ~No I-lyes If yes, Agricultural District Number 8) Is this parcel actively farmed? ~]No [-[Yes 9) Name and address of any owne~(s) of land within the agricultural district containing active farm operation(s) located 500 feet of the boundary of the proposed project. (Information may be available through the Town Assessors Office, Town Hall location (765-1937) or from any public computer at the Town Hall locations by viewing the parcel numbers on the Town of Southold Real Property Tax System. Name and Address (Please use back side of page if more than six property ownem are identified.) The lot numbers may be obtained, in advance, when requested from either the Office of the Planning Board at 765-1938 orthe Zoning Board of Appeals at 765-1809. ~ ................... 4 i~o1~.~/! j Signature of Applicant Date Note: 1. The local board will solicit commits from the owners of land icLmtified above in order to conside~ the effect of the proposed action on their farm operation~ Solicitation will be made by supplying a copy of this statement. 2. Comments ratumed to the local board will be taken into consideration as part of the overall review of this application. 3. Copies of the completed Agricultural Data Statement shall be sent by applicant and/or the clerk of the board 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. Failure to pay at such time means the application is not complete and cannot he acted upon by the board. 1-14-09 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 information used by a Town of Southold agency in making a determination of consistency. *Except nlinor 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 alt 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 necessm3', 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.norttffork.net), the Board of Trustees Office, the Planning Department, all local l~raries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION The Application has been submitted to (check appropriate response): TownBoard [] PianningDept. [] Building Dept. [] Board of Trust.ees 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: 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 ~NO~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 Ill - Policies Pages 8 through 16 for evaluation criteria [] Yes ~-~ No ~-~Not Applicable Attach additional sheets if necessm3, 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 r-~ No~Nn~Not Applicable - Attach additional sheets if necessary Policy 6. Protect and restore the qnalit-y 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. V~ Yes [~ No [~Not Applicable Attach additional sheets if neeessaqy Policy 7. Pages 32 th rough 34 for evaluation criteria. [~ Yes [] No ~Not applicable Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies 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. : yd2 No Rot app,ieab,e Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent u~es and promote siting of new water-dependent uses in su/table locations. See LWRP Section IH - Policies: Pages 47 through 56 for evaluation criteria. [-~ Yes [--] No ~' Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town wateFs. See LWRP Section IH - Policies; Pages 57 through 62 for evaluation criteria. [] Yes ~-] No F~Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southuld. See LWRP Section HI - Policies; Pages 62 through 65 for evaluation criteria. [] yes F~ No IF~N0t Applicable Attach additional sheets if necessary. Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP S~,III - Policies; Pages 65 through 68 for evaluation criteria. s [--] No ~ Not Applicable ,~-t r'~-~.'~., ?- .~<2~'~//5L. ~ 7~/-/-r. ~.a~. ~: r-~ /:~- Created on 5125105 11.'20 AM 14-1~4 i~/95)--Text 12 PROJECT LD. NUMBER 617.20 Appendix C Stata Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only .PART I--PROJECT INFORMATION (To be completed by Applicant or Project sponsor) ' ' 1. APPLICANT/SPONSOR 2. PROJECT NAME I~N. ~ Exi~;t~on ~Jdodl flcatlon/ait e~at Ion ~/. ~ 10. ~ STA~ / I If the action is in the Coastal Area, and you are a state agency, complete the [ Coastal Assessment Form before proceeding with this assessment I OVER SEQR PART II--ENVIRONMENTAL ASSESSMENT (To be completeci ay Agency) WILL THF PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT C~U~ED THE EsTAeMSHMENT OF A CEA? []w, [].o IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE EHVIRONMENTAt. iMPACTS?. [.~ Yes [] NO If Yes. expia~rl ~,,istly PART Ill--DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each a~erse effect t~ttifled strove, ~etermine ~d~ether H.ts 5ubstantiai, large, important or otha~vise significant. Each effect s~ould ha assessed in connection with its (at setting (i.e. urban o~ rurat); (bt Dr~babitity of occurring; (ct duration; (d) irrever$ibility; (et geographic scope; and (t) msgnitads. If neceesa~, adcl attact~ments or reference supporting materials. Ensure that axolanations contain sufficient detail to stto~v that el! relevant adverse impacts have been identified an~ aclequately addreasml. If' question D of Part II was checked yes, the determination and significance must evaluate the potenUat impact st the proposed action [] Check this bOx if you have identified one or mom potentially large or significant edveme impacts whicll MAY occur. Then proceed directly to the FULL FAF and/or prepare a positive declaration. [] Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant as'verse environmental impacts AND provide on attachments as necessary, the masons supporting this determination: Date 2 PK'OPERTY TOWN OF SOUTHOLD RECORD CARD OWNER .-.~Fo~v~ER OWNER ~ ,-, LAND IMP. VL. TOTAL STREET FARM DATE VILLAGE · ,-~...:~-~.<..,~ ~kL _z~-L.~ E W DISTRICT SUB. COMM. IND, CB, MISC. RE/vb~RKS ,/z, oo AGE NEW Farm Tillable 1 Tillable 2 Tillable. 3 Woodland Swampland .,~, Brushland House Plot Total NORMAL Acre BUILDING CONDITION BELOW Value Per Acre ABOVE Value FRONTAGE ON WATER FRONTAGE ON ROAD BULKHEAD Bldg. [xtenslon !xtenslon ixtension ~reezeway ~orage FoundatiOn Basement Ext.' Walls Bath Floors Interior Finish Patio Driveway 4/% Fire Place, Heat Roof Type Rooms ]st Floor Rooms 2nd Floor Dormer '¢?-~ NOTICE COUN Reol P 1230 T~veler St~, P.O,Box 1412 ~i~q ~ ,, ZONINe FLOOD ZONE WATER BUIIP~Y 2 ii4OLg p~ILY D~AILIJ~ IINOLE FAIiILY DWEI,UNO CUT(~4OOIJI, NY ll~l~i LI GOOSE 86'08'30" W. i ] .'.*.. 60.00',; "' AVENUE · *' NOTES: SURVEY OF LOTS 168 THRU 171 INCL. MAP OF GOOSE BAY ESTATES FILE No, 1176 FILED NOVEMBER 18, 1954 SITUATE SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-77-02-07 SCALE 1"=20' OCTOBER 26, 2010 AREA = 10,792 sq. ff. 0.248 oc. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM EXISTING ELEVATIONS ARE SHOWN THUS:~ 2. FLOOD ZONE INFORMATION TAKEN FLOOD INSURANCE RATE MAP No. ZONE AR: ZONE X: FROM; 56105C0166H RASE FLOOD ELEVATIONS DETERMINED AREAS OF 0.2~. ANNUAL CHANCE FLOOD; AREAS OF 1% ANNUAL CHANCE FLOOD WITH AVERAGE DEPTHS OF LESS THAN 1 FOOT OR WITH DRAINAGE AREAS LESS THAN 1 SQUARE MILE; AND ~EAS PROTECTED BY LEVEES FROM 1% ANNUAL CHANCE FLOOD. THE EXI~NCE OF RIGHT~ OF WAY N.Y.$. Uc. No. 50467 Nathan Taft Corwin III Land Surveyor PHONE (631)727-2~J0 OFFICES LOCATED AT Fax (631}727-1727