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HomeMy WebLinkAbout1000-86.-6-20 OFFICE LOCATION: OF SO(/lyO MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 .IL 4 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) T Southold, NY 11971 Q CA Telephone: 631 765-1938 Fax: 631765-3136 OUNTI, 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: April 25, 2012 Re: Coastal Consistency Review for ZBA File Ref. BARRY ROOT#6559 SCTM#1000-86-6-20 BARRY ROOT#6559 - Request for Variance from Article XXII Code Section 280-116(B) based on an application for building permit and the Building Inspector's February 14, 2012 Notice of Disapproval concerning proposed partial demolition and reconstruction with additions to a single family dwelling, at; 1) less than the code required bulkhead setback of 75 feet, located at: 6315 Indian Neck Lane (adj. to Richmond Creek) Peconic, NY. SCTM#1000-86-6-20 The Board of Trustees issued a permit (#7510) in March 23, 2012 for bulkhead work on the property. A 15' non-turf buffer was required within the permit. A trench drain, gutters, leaders and drywells are shown to control storm water. 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 determination that the proposed action is CONSISTENT with the below listed LWRP polices and therefore CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Jennifer Andaloro, Assistant Town Attorney BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD,NEW YORK PERMIT NO.7510 DATE:MARCH 23.2011 ISSUED TO: BARRY ROOT PROPERTY ADDRESS: 6315 INDIAN NECK LANE,PECONIC SCTM#86-6-20 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on March 23,2011,and in consideration of application fee in the am of$250.00 paid by Barry Root and subject to the Terms and Conditions as stated in the Resolution,the Southold Town Board of Tnftm authorizes and permits the following: Welland Permit to reconstruct various sections of existing 53 linear foot timber-sheathed bulkhead and returns with new vinyl-Atathed bulkhead and returns along the northern section of property;remove various sections of 110 linear foot existing timber-sheathed bulkhead and returns along the northern section of property;install various sections of 113 linear foot new vinyl-sheathed bulkhead and returns along the northern action of property;remove existing 100 square foot concretalstone ramp within the northeastern section of property;establish sa area of beach and native beach plantings(1,350 square feet)backed with a dugle-row of rip-rap(200-5N lb.rock at 50'length) within northeastern section of property;hulas a sisWe-row of rip-rap(200-M lb.rock at 7'length)off southern terminus of bulkhead return within the northwestern section of property;and Install a docking facility oft the northwesters section of property consisting of a 41x 104'fixed elevated catwalk,3'x15' hinged ramp,6'x20'floating dock and two(2)S"diameter tie-off pilings;with the conditions that the dock and float are made into a"T"or"L"shape,and a 15'wide non-turf butter Is Installed and maintained along the landward side of the bulkhead;and as depicted on the site plan prepared by Suffolk Environmental Consulting,Inc.,let dated March 25,1011.and stamped approved on April 4, 2011. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. Aril.2 BOARD MEMBERS �pf SOUTH, Southold Town Ha Leslie Kanes Weisman, Chairperson �p`� OHO 53095 Main Road •P.O. Box 1179 Southold,NY 11971-0959 James Dinizio,Jr. Office Location: Gerard P. Goehringer • i� Town Annex/First Floor,Capital One Bank George HomingOl 54375 Main Road(at Youngs Avenue) Ken Schneider OUt�IY, Southold, NY 11971 http://southoldtown.northfork.net ZONING BOARD OF APPEALS TOWN OF SOUTHOLD Tel. (631)765-1809 •Fax (631) 765-9064 March 13, 2012 Mark Terry, Principal Planner LWRP Coordinator Planning Board Office O l9 lD Town of Southold Town Hall Annex Southold, NY 11971 MM 14 M2 Re: ZBA File Ref. No. #6559 (Root) Dear Mr. Terry: We have received an application for partial demolition and reconstruction with additions in Peconic. 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 268-51) is requested within 30 days of receipt of this letter. Thank you. Very truly yours, Leslie K. Weisman Chairperson By: Encls. FORM NO. 3 NOTICE OF DISAPPROVAL DATE: February 14, 2012 TO: LeeAnn Romanelli for: Barry Root P.O. Box 88 Southold,NY 11971 Please take notice thatour application dated February 10 2012: Y PP Y For ermit for partial demolition and reconstruction with additions at: P Location of property: 6315 Indian Neck Lane Peconic, NY County Tax Map No. 1000 - Section 86 Block 6 Lot 20 Is returned herewith and disapproved on the following grounds: The proposed partial demolition and reconstruction with additions on this conforming 1.73 acre lot in the residential R-40 District, is not allowed pursuant to Article XXII, section 280-116 (B), which states"All building or structures located on lots upon which a bulkhead ...exists... shall be set back not less than 75 feet from the bulkhead." The site plan shows a proposed setback of approximate 62 eet from the bulkhead. Authorized Signature Note to Applicant: Any change or deviation to the above referenced application may require further review by the Southold Town Building Department. CC: file,Z.B.A. TOWN OF SOUTHOLD E C l5 0 U ED BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTME Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD, NY 11971 FEB 13 2012 4 sets of Building Plans TEL: (631) 765-1$02 Planning Board approval FAX: (631) 765-9502 BLDG. DEPT. Survey SoutholdTown.NorthFork.het_ PIQRT4ff1J740V Check Septic Form N.Y.S.D,E.C. Trustees C.O. Application Flood Permit Examined 20_ Single& Separate Storm-Water Assessment Form Contact: ,t Approved �( 20 Mail to:Lea,4rin -ROm4ned/ Disapproved a/c P�i Phone: '7(05J`WO Expiration 20_ Building Inspector APPLICATION FOR BUILDING PERMIT Date .:2//p , 20 /a. INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building I'tispector with 4 sets of plans,accurate plot plan to scale. Fee acooiding 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. Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy G M JA krill ! 1660 I W b. Intended use and occupancy 137M-- U)I M Qd/2l/ h-017 3. Nature of work(check which applicable): New Building Addition '� Alteration ✓ Repair Removal Demolition t/ Other Work (Description) 4. Estimated Cost Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling 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 of existing structures, if any: .From :y t1 , A- sear V. A ep:.a 1ti Height Number of Stories Dimensions of $ame structure with alterations or additions: Front 7V Rear 7 Depth L'3 13 Height Number of Stories / 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front 60' Rear 10 10. Date of Purchase 61rry/10 Name of Former Owner Wo L6 f K 11. Zone or use district in which premises are situated R-40 12. Does proposed construction violate any zoning law, ordinance or regulation? YES X NO 13. Will lot be re-graded? YES_NO Will excess fill be removed from premises? YES_NO X 14. Names of Owner of premises ig/jl /opj— Address /b.1brre%UravMPd.LAe No. Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES X NO * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES NO X * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF� LgeAIAI &Mang/lr being duly sworn., deposes and says that(s)he is the applicant (Name of individual signing contract)above named,t (S)He is the (Contractor, Agent, Corporate Officer, etc.) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swornsto before me this day of 20 VICKI TOTH uMic State of N Notary Public No.ojY06190696 Signature o:Applicant UNalifieQin Suffolk(•peunt��� Fee:$ Filed By: Assignment No. APPLICATION TO THE SOUTHOLD TOWN BOARD OF APPEALS HouseNo.6315 Street Indian Neck Lane Hamlet Peconic SCTM 1000 Section 86 Block 6 Lot(s) 20 Lot Size 75441.56 Zone R40 I(WE)APPEAL THE WRITTEN DETERMINATION OF THE BUILDING INSPECTOR DATED 2/14/12 BASED ON SURVEY/SITE PLAN DATED 12/19/2011 Applicant(s)/Owner(s): Barry Root Mailing Address: 16 Horsehollow Rd Lattington, NY Telephone: Fax: Email: 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: Leeann Romanelli for❑DwnewlOther: Address: P.O. Box 88 Southold, NY 11971 Telephone: 765-5020 Fax: Email: Please check to specify who you sh correspondence to be mailed to,fir 4e above names: Applicant/Owner(s), Authorized Representative, Other Name/Address below: � WHEREBY THE BUILDING INSPECTOR REVIEWED SURVEY/SITE PLAN DATED 12/19/11 and DENIED AN APPLICATION DATED 2/10/12 FOR: Building Permit Certificate of Occupancy O Pre-Certificate of Occupancy Change of Use Permit for As-Built Construction Other: Provision of the Zoning Ordinance Appealed. (indicate Article,Section,Subsection of Zoning Ordinance by numbers.Do not quote the code.) Article: xxn Section: 280 Subsection: 116(e) Type of Appeal. An Appeal is made for: QA Variance to the Zoning Code or Zoning Map. eA 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 Qhas,p✓ has not been made at any time with respect to this property, UNDER Appeal No(s). Year(s). (Please be sure to research before completing this question or call our office for assistance) Name of Owner: ZBA File# REASONS FOR APPEAL(additional sheets rear be used ivith prepurer's siPaature): ,4R&111 VARIANCEREASONS: (1) An undesirable change will not be produced in the CHARACTER of the neighborhood or a detriment to nearby properties if granted, because: Existing dwelling has been in the same location since prior to 1957. The dwellings adjoining on both sides are closer to the water than this dselling. (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: An addition to the existing dwelling is the most feasible and affordable. The location of the dwelling is existing. (3) The amount of relief requested is not substantial because: The amount of variance requested is approximately 13%, which is a relatively small request. The addition is not forward of the existing dwelling, it is adding onto the side. (4) The variance will NOT have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district because: There is a newly installed bulkhead, all runoff will be contained on site. (5) Idas the alleged difficulty been self-created? Yes,orDNo. Are there Covenants and Restrictions concerning this land: r-1No.W�Ycs (please furnish conA. 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 0 IF A USE KtRLINCE IS BEING REQUESTED, XVD PLEASE COMPLETE TIIE ATT4CHED USE VARIANCE SHEET: (Please be su a co It your o ey.) O Signature of Appellant or Authorized Agent (Agent must submit written Authorization frmn Owner) Swornbefore me this do ay of U . Notary Public MCKI TOTH Nary No.OIYO-6190696 York Qualified in Suffolk County— Commission Expires July 28,20 1 APPLICANT'S PROJECT DESCRIPTION (For ZBA Reference) Applicant: Barry Root Date Prepared: 2/10/12 I. For Demolition of Existing Building Areas Please describe areas being removed: attached garage 337.4 sq.ft. IL New Construction Areas(New Dwelling or New Additions/Extensions): Dimensions of first floor extension: 32X36 Dimensions of new second floor: n/a Dimensions of floor above second level: n/a Height(from finished ground to top of ridge): Is basement or lowest floor area being constructed? If yes, please provide height(above ground) measured from natural existing grade to first floor: n/a 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: single family one story dwelling Number of Floors and Changes WITH Alterations: one story addition IV. Calculations of building areas and lot coverage (from surveyor): Existing square footage of buildings on your property: 2565.86 Proposed increase of building coverage: 2058 Square footage of your lot: 75441.56 Percentage of coverage of your lot by building area: 5.68% V. Purpose of New Construction: larger living area and updated 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): dwelling was built prior to 1957,there is a new bulkhead and the existing house location is within 75 feet of the bulkhead and the addition will also be within the 75 foot setback. Please submit seven (7)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 A. Is the subject premises listed on the real estate market for sale? Yes X No B. Are there any proposals to change or alter land contours? .�No Yes please explain on attached sheet. C. 1.)Are there areas that contain sand or wetland grasses? tie 5 2.)Are those areas shown on the survey submitted with this application? )�e.!5 _ 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? NO Please confirm status of your inquiry or application with the Trustees: and if issued, please attach copies of permit with conditions and approved survey. D. Is there a depression or sloping elevation near the area of proposed construction at or below five feet above mean sea level? k/d E. Are there any patios, concrete barriers, bulkheads or fences that exist that are not shown on the survey that you are submitting? A/c� Please show area of the structures on a diagram if any exist or state none on the above line. F. Do you have any construction taking place at this time concerning your premises?NU If yes, please submit a copy of your building permit and survey as approved by the Building Department and please describe: G. Please attach all pre-certificates of occupancy and certificates of occupancy for the subject premises. If any are lacking, please apply to the Building Department to either obtain them or to obtain an Amended Notice of Disapproval. K Do you or any co-owner also own other land adjoining or close to this parcel? /p If yes, please label the proximity of your lands on your survey. I. Please list present use or operations conducted at this parcel S i/qI6 in I w d eyelh"q and the proposed use m4n�11 a�rt/n— . (ex:existing single family,proposed:same with garage,pool or other) Authorized signature and Date Board of Zoning Appeals Application AUTHORIZATION (Where the Applicant is not the Owner) l-a/ ROD+- residing at (Print propchy owner's`nname) (Mailing Address) ZO-r-T ✓?lin kA/, NY do hereby authorize L ep_44 jA) 6 ave (Agent) to apply for variance(s) on my behalf from the Southold Zoning Board of Appeals. (Owner's Si Nature) (Print Owner's Name) I APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM i The I i Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and emolovces The purpose of this form is to provide information which can alert the town of co sable conflicts of interest and allow it to take whatever action is necessary to avoid same. �1,PClCJt-� YOURNAME: i (Last nant,first name,mi me mural,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.) i 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 the 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 If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicantlagent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. I 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 y of o44 Signature Print Name Form TS 1 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 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: a ado'e, JIr 4-.�nC.L✓�n ! (Last name,first time,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 the 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,manage,or business interest.'Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO �( If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicantlagent/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 orher 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 RELATIONSMP Submitted ttyist '.5 day of� '1pA-(J-` 200 lr Signature O�jM�( ,jJ A.,•H!kj o 0 0� Print Name_�0-0 407 7TAVU— 'Pit t I Form TS I AGRICULTURAL DATA STATEMENT ZONING BOARD OF APPEALS TOWN OF SOUTHOLD WHEN TO USE THIS FORM: The form must be completed by the applicant for any special use permit,site plan approval, use variance, or subdivision approval on property within an agricultural district OR within 500 feet of a farm operation located in agricultural district. All applications requiring an agricultural data statement must be referred 4o the Suffolk County Department of Planning in accordance with Sections 239- m and 239-n of the General Municipal Law. 1)Name of Applicant: L e emn Rt2A4,1AI4/1 t 2) Address of Applicant: PO IJ x �.J4TYilcj ky 1l971 3)Name of Land Owner(if other than applicant) 4) Address of Land Owner: 'i 0 Itfz-4*6 1E( %find f onJ 5) Description of Proposed Project: ��_ S �)d 6) Location of Property(road and tax map number): ' i - D 7) Is the parcel within an agricultural district? [4No ElYes If yes, Agricultural District Number 8) Is this parcel actively farmed? WNo ❑Yes 9) Name and address of any owner(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 1 2- 3. 4. 5. 6. (Please use backside of page if more than six property owners are identified.) The lot numbers may be obtained, in advance, when requested from either the Office of the Planning Board at 76 1938 or the Zo ' Board of Appeals at 765-1809. Signature of Applicant Date . Note: -1.The local board.will solicit comments fromthe owners of land identified above in order to consider the effect of the proposed action on their farm operation.Solicitation wiltbe made by supplying.a copy of this statement. - 2.Comments returned 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 be acted upon by the board. - - 1-14-09 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I -PROJECT INFORMATION o be completed by Applicant or Project Sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME Le-eatin v OL-4 3. PROJECT LOCATION: 0315ht*d n �� la /�/ Municipality e, J'i"KGr County 4lv- 4. PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map) &315 S dji2n Neck(a1ge Pf(0/1)c ivy 393` zdlo SmersCa�dr (�ecrQ 5. PROPOSED ACTION IS: New [g Expansion ModificatioNalteration 6. DESCRIBE PROJECT BRIEFLY: Odddlot) and OJ4(fa�on fa pr(s�iric� d tt/ellr�� 7. AMOUNT OF LAND FE ED: Initially s Ultimately acres 8. WILL PROPOSED AC ON COMPLY WITH EXISTING ZONING OR 6THER EXISTING LAND USE RESTRICTIONS? Yes ® No If No,describe briefly °75`hul kh eat' S6+&&k 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? 10 Residential El Industrial Ej Commercial Describe: AgricultureAgricultureParklForosVOpen Space Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,STATE OR LOCAL)? NYes No If Yes,list agency(s)name and permit/approvals: N'1S� S6 TRI�STEES b 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAIJ PERMIT OR APPROVAL? QYes ❑No If Yes,list agency(s)name and permit/approvals: - D�u tread MplawM14- tiVso&C- saarkzb sT3 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? I]Yes No I CERfi TTHE RMATIO P VIDED ABOVE I P�TO THE BEST OF MY KNOWLEDGE /A Applicant/spons r ame: Date: 16 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 OVER 1 � PART II - IMPACT ASSESSMENT To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF. ❑Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. E]Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) C1. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character!Explain briefly: C3. Vegetation or fauna,fish,shellfish or wildlife spades,significant habitats,or threatened or endangered species?Explain briefly: C4. A community's existing plans a goals as officially adopted,or a change in use a intensity of use of land or other natural resources?Explain briefly: C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: C6. Long term,short term,cumulative,or other effects not identified in C1-05? Explain briefly: C7. Other impacts(including changes in use of either quantity or type of energy)? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? 11 Yes R No If Yes,explain briefiy: E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? M Yes F-1 No If Yes,explain briefly: PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant Each effect should be assessed in connection with its(a)setting(i.e. urban or rural);(b)probability of occurring;(c)duration; (d)irreversibility;(e) geographic scope; and(f)magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part 11 was checked yes,the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY oaur. Than proceed directly to the FULL EAF 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 adverse environmental impacts AND provide,on attachments as necessary,the reasons supporting this determination Name of Lead Agency Date Print or Type Name of Responsible Officern Lead Agency Title of Responsible Officer Signature of Responsible Offloarn Lea Agency Signature of Preparer different from responsib officer) I Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# % - (P - QO The Application has been submitted to(check appropriate response): Town Board Planning Dept. E Building Dept. © Board of Trustees 1. Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency(e.g.capital 0 construction, planning activity,agency regulation, land transaction) (b) Financial assistance(e.g.grant, loan, subsidy) (c) Permit, approval, license,certification: Nature and extent of act i9 'n: I d(i.f-ho-h 1 Q tix 46 RC1 'o-/ C1 Kllll.�G{ Location of action: b'h15 &)ftkW Q m(b Site acreage: j ,T7 Present land use: C I Present zoning classification:-1}0 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant:_LPQQmnQ�� (b) Mailing address: (c) Telephone number: Area Code( W 65 � (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? k3LjS EL 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—Policies Pages 3 through 6 for evaluation criteria LN Yes ❑ No 0 (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 Section III—Policies Pages 6 through 7 for evaluation criteria ® Yes 0 NoEd (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�D Nq ('Nfot Applicable— - a explain) KWhrO I,�,�Tof�C ►l?a a��()Q_ _ _ 1I1 C I o MP 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 Ld No E (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 evaluation criteria. Yes No E (Not Applicable—please explain) 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. See Section III—Policies Pages; 34 through 38 for evaluation criteria. Yes ❑ No❑ (Not Applicable— please explain) Attach additional sheets if necessary Policy S. 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— please explain)Vf I I a s t� 1 em l 0 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. ❑ YeLl No 4 (Not Applicable— please explain) 13 �Itfa�P �D�rOnPr�l�- 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 I,WRP Section III—Policies; Pages 47 through 56 for evaluation criteria. 14 Yes ❑ No ❑ (Not Applicable—please explain) u Malw 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. [aYes 1:1 No X Not Applicable—please explain Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No 4 Not Applicable— please explain Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. Yes ❑ No ❑ Not Applicable—please explain TOWN OF SOUTHOLD PROPERTY - RECORD CARD OWNER STREET fy� ." VIL DiSTRtCT SUB. LOT , r . I i)ec is Lc, C d921 e FORMER OWNERE ACREAGE ' ` e / o0 S I TYPEOFBUILDING d do SEAS. VL. FARM COMM. IND. k CB. MISC. Est. Mkt. Value LAND IMP. TOTAL DATE REMARKS 9�v s orJ 7 fS�AGE( BUILDING CONDITION NEW NORMAL BELOW ABOVE FRONTAGE ON WATER / YP XCsr, , Loh! =6 Farm Acre Value Per Acre Value FRONTAGE ON ROAD Tillable 1 BULKHEAD LtJU Tillable 2 DOCK Tillable. 3 Woodland Swampland B rushland "•r' House Piot Total b I i i I I I i i A Bid Foundation I1-P""^�'x Both Bldg. I38�(3ra 3 0 0 �i+a a o. n o ExtensionBasement ��t f e� !Floors Extension I � I ':Ext. Walls 'Interior Finish ------------- Extension !l=ire Place Heat �� y f i Porch I Roof Type �yySC Porch Rooms lst Floor i Breezeway I (Patio ! Rooms 2nd Floor Garage dD.� 4 Driveway Dormer O. B. r i 3 FORM NO. 4 I TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY NO: Z- 34492 Date: 08/03/10 THIS CERTIFIES that the building DWELLING AND ACCESSORIES Location of Property 6315 INDIAN NECK LA PECONIC (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 086 Block 0006 Lot 020 Subdivision Filed Map No. Lot No. T conforms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 34492 dated AUGUST 3, 2010 I i i 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 ONE FAMILY DWELLING WITH ACCESSORY GARAGE AND SHEDS.* (GARAGE AND SHEDS IN DISREPAIR) The certificate is issued to KATHERINE S WOLOSIK (OWNER) of the aforesaid building. y SUFFOLK COUMTPY DEPARTMENT OF HEALTH APPROVAL NIA ELECTRICAL CERTIFICATE NO. N/A I ! PIMMERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. /AVfhoriXed Signature v 1 81 Re / BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 6715 INDIAN HECK LA PECONIC SUBDIVISION• NAP MD.- LOC (S) lQU(E OF OIEIBB (S): KATHERINE S WOLOSIR OCCUPANCY: SINGLE FAMILY DWELLING KATHERINE S WOI/JSIK AOQTTED BY: ACCOMPANIED BY: KEY AVAIIABIE: SOPF. CO. TAY NAP NO.: 86.-6-20 SOURCE OF REQUEST: DAVID W OLSEN, ATTY ALTS: 08/03/1 DWELLING: TYPE OF CONSTRUCTION WOOD FRAME STORIES: 1.0 EMITS: 3 FOUNDATION: CEMENT BLOCK CELLAR: FULL CRANL SPACE: TOTAL RODS: Lal FNA.: 5 2ND FIA.: 0 IND FLA.: 0 BATHROOM(S) 1.0 - TOILSl ROM(s): 0.0 OTIIITY ROOM(S): PORCH TYPE: DECK TYPE: PATIO TYPE: I HREEZEIWY• FIREPLACE: 1 GARAGE: DOIO3PIC ROIIUNTER: YES TYPE NEATER: AIRCODITICHIM: TYPE NEAT: OIL WARN AIR: HOTHATER: X OTHER: ACCESSORY STRUCTURES: GARAGE, TYPE OF CAST.: 2 CAR WOOD FRAME GARAGE STORAGE, TYPE COS`r.: 2 DELAPIDATED SHEDS SNIIS[IIC POOL; GURST. TYPE CONST.- O[ffi: VIOLATIONS: CHAPTER 65 N.Y. STATE UNIFORM FIRE PREVENTION 6 BUILDING CODE LOCATION I DESCRIPTION ART. I SEC. I I ACCESSORY GARAGE ROOF IN NEED OF REPLACEMENT OR I I ' EXTENSIVE REPAIR I I I I I I I I I I I I I I I I I I I I I I I REIWRKS• t INSPRCTRD BY: DATE ON IRSPBCDION: 07/22/10 GARY J F SH TIME START: END: TOWN OF SOUTHOLD PROPERTY RECORD CARD �J•�� OWNER STREET j�.3r VIL DISTRICT SUB. LOT S. D i ANl CIC Lo FORMER OWNERE ACREAGE I uo S / TYPE OF BUILDING SEAS. VL FARM COMM. IND. I CB. MISC. Est. Mkt.Value c_ LAND IMP. TOTAL I DATE REMARKS b wogm wplbvt dadro z s o0 73o0 s 1 16 1,- .7- r.7-90� -rAGE( BUILDING CONDITION NEW NORMAL BELOW ABOVE FRONTAGE ON WATER /•�� x 3a Farm Acre Value Per Acre Value FRONTAGE ON ROAD Tillable I BULKHEAD U y Tillable 2 DOCK ' Tillable 3 Woodland Swampland Brushlond House Plot Tata, . ........_.. r • i i i I 3 i M. Bldg. & O 3.0 0 H a 0• 6o Foundation Bath i Extension IqAlqz 2.60 1b�; 0 Basement � � Floors Extension - Ext. 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