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1000-115.-12-15
OFFICE LOCATION: ~~OF SOUfyO MAILING ADDRESS: Town Hall Annex ~p P.O. Box 1179 54375 State Route 25 * # Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) ' Southold, NY 11971 ~ ~ Q Telephone: 631 765-1938 0 ~ Faz:631765-3136 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: August 26, 2013 Re: Coastal Consistency Review for ZBA File Ref. FRANK MARSILIO #6674 SCTM#1000-115-12-15 FRANK MARSILIO #6674 -Request for Variance from Article XXII Code Section 280-116(6) based on an application for building permit and the Building Inspector's June 28, 2013 Notice of Disapproval concerning a permit to construct additions and alterations to an existing single family dwelling, at; 1) proposed construction at less than the code required bulkhead setback of 75 feet, located at: 1080 Deep Hole Drive, (adj. to Deep Hole Creek) Mattituck, NY. SCTM#1000-115-12-15 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. 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 Office Location: ti~~~Of SOVTy~IO Mailing Address: Town Annex /First Floor, Capital One Bank # # 53095 Main Road 54375 Main Road (at Youngs Avenue) ~ P.O. Box 1179 Southold, NY 11971 ~ • ~O Southold, NY 11971-0959 o~y00U~,~~ http://southoldtown. northfork. ne[ BOARD OF APPEALS TOWN OF SOUTHOLD 'Pel. (631) 76~~0~ ~~(631) 765-9064 1'~- Mark Terry, Principal Planner LWRP Coordinator JUL 2 32013 Planning Board Office ~ Town of Southold i Town Hall Annex Southold, NY 11971 Re: ZBA File Ref. No. #6674 MARSILIO, FRANK 1000-115-12-15 Dear Mark: We have received an application for additions and alterations to existing single family dwelling, bulkhead setback. 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-SD is requested within 30 days of receipt of this letter. Thank you. Very truly ours, Lesli eisman Chair rs \ ~ By: o E cls. I~w FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL DATE: June 28, 2013 TO: Natalie Niemann (Marsilio) 26 Churchill Lane Smithtown, NY 1 (787 Please take notice that your application dated June 18, 2013 For permit to construct an additions and alterations to an existing single family dwelling_at Location of property: 1080 Deep Hole Drive, Mattituck, NY County Tax Map No. 1000 -Section 1 l5 Block 12 Lot 15 Is returned herewith and disapproved on the following grounds: The proposed wnstruction is not permitted pursuant to Article XXIL Section 280-1 16B, which states; "All buildings located on lots upon which a bulkhead, concrete wall, riprap or similar structure exists and which are adjacent to tidal water bodies other than sounds shall be set back not less than seventy-five (75) feet from the bulkhead." The proposed construction notes a setback ~f+/- 72 feet to the existingbulkhead. Au i re Cc: File, ZBA TOWN of SOYT110Lp OFFICE OF BUILDING INSPECTOR Town Hall Annex Receipt No. 8 3 6 0 9 Southold, New York 11971 Date (o , 2.$ - ~ Received of ~~~~~L1 i ~U'.~iLtR t C - / l OODollars For ~ QrtnJAQ ~ ~ Fee for Fee for Fee for Fee for Fee For CertiFimte Electrical ? Sign ? Flood Development F'mt. ? Building Permit ? of Occupanq ? Inspection ? Cash Check ~ 0 b ~ ~D,~~y Building Department TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need [he following, before applying? TOWN HALL Boazd of Health iOUTHOLD, NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 • Survey SoutholdTown.NorthFork.net PERMIT NO. • Check Septic Form N.Y.S.D.E.C. Tmstees Flood Permit Examined , 20 Stonn-Water Assessment Form Contact: t,' Approved , 20 ~M1ail to: ~~~~,1~~. "Iv~t~~Q".~l(~.t~aylNl~ llisapproveda/c ~ISAPP~R~IIAL '`tle,(/l/lo'lyl,(~pp~-St(/tryti(yTV~tiv Expiration , 20_ / 2` C.~t.~?ril~Lj,~r( L~~ l ~J?w6t wt ~,--K't ~ I Building nspec ~~7g ~J J) ~ - .-___-1 PLICATION FOR BUILDING PERMIT JUN 1 R 2013 I Date ~w1,L, ~ , 20 I~, INSTRUCTIONS a. This ~t~~j{iST be car pletely filled in by typewriter or in ink and submitted to the Building Inspector with 4 :ts sea e. ee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. c. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months From such date. if no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION 1S HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. N'te,~l,t~,vwl .Nlewla~l,ol ~rol-ld;'~. (Signature of applicant or name, if a corporation) `L~ r~lxr,~l ~ f~aLU n N ~ I I ; (Mailing ad eas of applicant) State whether (ap'p-licant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ~r~~ }~A~(^a,~t~,l p (As on the tax roll or latest deed) If a t is a orati nature of duly authorized officer (Name and title-o-tf-corporate officer) Builders License No. 1 • ~•i) Plumbers License No. 'r.)3•t] Electricians License No. [~j. D Other Trade's License No. g. t•7 1. Location of land on which proposed work will be done: t~e~v I~c4c txi~re House Number - Street Hamlet... . ~ County Tax Map No. 1000 SectionM ~ Block ' ' F Lot Subdivision t? FileilIvlap~No:Lot 2. State existing use and occupancy of premises' and inte/~1~dped use arnd occupancy of proposed construction: a. Existing use and occupancy _~11e 4j ?lLl I ~ftv t o'P~-~ b. Intended use and occupancy- ~~,~{lnn ~ K2>! ~d ~-[p_ 3. Nature of work (check which applicable): New Building Addition X Alteration~_ Repair Removal Demolition Other Work (Description) 4. Estimated Cost ~7.'(~. 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 r, l,• $ t!n~l ~6! ~~i ~ , 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Ditiiensions dt`~existiflg structures; if any: Front l9~ I - S n Rear to S Depth ~ t - l t Height_J7 t ~.4~tt [Number of Stories I u ( tt Dimerisfons of same structure with alterations or additions: Front I- s Rear~~ -5 Depth Height j-(I - D" Number of Stories I rw • GS f _ u~ ( 4 8. Dimensions f enttre new construction: Front D Rear l'~ ~ fD~pth,~'Ot -'btu Height ~~Y- I t` Number of Stories 1 ~ ~~E7. t Depth 222. 2 t 2 ( 9. Size of lot: Front OO Rear_ 10. Date of Purchase 2 2of ~ Name of Former Owner l~P~l C G(a4LLbt ?1 O - ,SG ~~~D~~ t_ ti~D 11. Zone or use district in which premises are situated ~'1 C_P~'1 ~¢~j,tV~ l~~ 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO_ 13. Will lot be re-graded? YES NO~WiII excess fill be removed from premises? YES- NO 3S~nwa~dble_ Rd 14. Names of Owner of remises jL. Mx~l ~l~AddressCmrt,n.le~ (j72S Phone No.Gw(- ~7' 2093 Name of Architect~~~~P ~1~i AddressZG(.k2 ~ SYU~~1,.1a.Elwne No G~(•g22 Name of Contractor -1: P>. T7 • Address tl-1$7 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 NO * IF YES, D.E.C. PERMITS MAYBE 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 X NO * IF YES, PROVIDE A COPY. ~G STATE OF NEW YORK) SS: COLJN'fY OFS n,~) ~ICY~~ ~ e 1 `t j'~~l/tq'~~f/l,(~1 being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the ~ptn (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 tme to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this day of ' ~TU nn P , 20~ - RITU PAWA~~ _Nota Public ~ is -State of New Si nature of A licant ry N0.01PA6160535 g pp Oualilled in Suffolk Count My Commission Expire 6 't's. , . S. C.D.H. S. REFERENCE NUMBER R 10-10- 0063 ~ SURVEY OF PROPERTY N°,~. AT MATTITUCK SUBSURFACE SEWER DISPOSAL TOWN OF SO UTHOLD SYSTEM DESIGN BY.' JOSEPH F'SGl-,ETT'• P. E SUFFOLK COUNTY, N. Y. HOBART ROAD NE'R' SUFFOLg A t'ENUE 1000-115-12-15 SOUTHOLD, N. Y. 11971 A B (631) 765-2954 ST 26' 39.5" LP , 3s' ss' SCALE.• 1'=30' LP 2 30 55 OCTOiBER 27, 2010 LP 3 36' 51.5' DECEMBER 7, 210 (NEW SEPTIC SYSTEM) o LP 4 36 63 - JUNE 1, 2011 (RNAL~-ON SEP71C SYSTEM) ~ LP 5 42 59.5 JANUARY 4, 2013 (TOPO & PROPOSED ADD/7/ONS) ~ N y- y N/O/F LORRAINE WENDT ~ a Y WETLANDS `"1 (DWELLING Wi s ~ ~ Y TFI PUBL/C WATER) ~ ~ Y ~ S '19'2 'E FE E7.. 2T EL JA' /MQ'J. a O.JS 218.88' EL. 7.?' ~ / _ _ SPUr RMC ~I / / r~ o o WA ]ER LINE O 7T / is 7ER a a ET. 7, f' AIEIER 2k O ~ ~ ZS 1LI' ~ ~ , ~ ~ ~ ~ ~ ~ DISAPPR~IIAL o ! ~ ~zavE aE ~ zavE x ~ ~ ° ~ ° ~ ~ W ~ W ~ ~ 6J ~ ~ a AoornoN Q ~ CP /r O W ~I ! ~ ~x- J ~ ~ ~ x W 7z' 9 h y 'v sr LP m m ~ ~ I Jlrv/ W e 4 0 105' z iP /ESr NCtiE WEU ~ ~ 2 ~ : I ~ : ~ ~ ~ r/; a~ EL 70' CAeANOOrvew) I ~ k' ~ Q 3 ~ ~ I BO, ~l I ~i / ' ' ' ' Cpyp7E7E p/pg I ~ v Z 159' I / i 26.5' ~ ~ BD.I' m v Ir~ I G~RaI,~ Gi4AYEL ORIYEWAY $ ~ a TEST HOLE DATA EL..16' ` 7T' ; zz.s' O McDONALD GEOSCIENCE SrQVE RET.I /EL SB' PRO~°D.~ED /i IXAVOREI(' gApg ~ wACC / PAYERS n Stec ~ Bs.J' O 10/13/10 N eROxN sLrr saNO sN '1sN TE it EL ~s• I h N8779'20'W ~D ez. ao' zs ROW OF EYERppEENS 222.32' N/O~ BROWN FlNE SAND SP ALL DWELLINGS WITHIN 150' USE PUBLIC WATER CHRISITANO & PATRICIA MELE FLOOD ZONE FROM FIRM MAP NUMBER 3610300482 H (DWELLING WITH PUBLIC WA /ER) ~P,~~GF NF~,~ O'D y:A~ 6.1' SEPTEMBER 25, 2009 ~ oa~y'i. ~+Ep~ Og,~ WARP /N BROWN FINE SAND sP ELEVATIONS REFERENCED TO N. A. V.D. '88. ~ ~ U~"T' !r I am familiar with the STANDARDS FOP APPROVAL AflEF1=21190 SQ, F ~'I AND CONSTRUCT/ON OF SUBSURFACE SEWAGE y t'~'S..r`.L-` asF~osA~ s rs rEnas FoR slNC~ L FAMIL r RL~srocNCES TO 11E LINE u - cE3 d~=, ~ N.Y.S. LTC. NO. 49618 and will abide by fhe ronditicns set forth (herein and on the ANY ALTERATION OR ADDITION TO TH/S SURVEY /S A NOLA770N ONIC YORS, P. C. permit to construct- OF SECTION 72090E THE NEW YORK STATE EDUCATION LAW. ~ 31) 765-5020 FAX (631) 765-1797 EXCEPT AS PER SECTIAN 7209-SUBDIVISION 2. ALL CERT/FlCATIONS ~ P. O. BOX 909 Ih= n n ic_n nF~K I~ r_e=5~ r,.~s sh ~ro ~ hFr~an or HEREON ARE VALID FOR THIS MAP AND COPIES 7HEREbF ONLY lF fr ;m n ,y or e ~ , a ` and - r from ~ c ~ n /~b M n e d h o ~ t h r,r s SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR ~ =TREE 1230 TRAVELER STREET WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N. Y. 11971 10-222 Iq(av2 ~GQ 1. ).109 89fC.M iM ~I W1CH~~iRIwiK3pIwYO le~ tvz 9vll9crriiwvwrq ~,pEENP~~ 2+YM « t9 t 11 3 8 92 t9yq > Ixalq aa'J4 zas i9wwaswwnNlo tvawnasiw~ris aWcl ? 2 i ~ ~ C 131 ( 9 w~l n 10.5 ~ ~ ~ IS 1• n ma~Sr l~~o, K 61 ~ ~p311~ n N n ll~ - 13-rQ 3 lid- . ®~k(~~- IIf - ia- lt~ 9 /~3 - 3 - 02 $ ~7'3W./.1 0~ S~ci7+Foc..~ az.v; a T E 131 IAV4 l 4 w 16 ~ ew M ~ , 11 A w HO o _ j~ la m n Sla a a9314 li b P 19] ~ 5 • 19 N v 10.1 11.1 ? ?M ~0.V4 p 31 It ~ 1 ~ 29 1 p ~ !1 yr 1 ~ P F Nc) 91 s 8 \.t = 1 ~ P i M =1 1 ° i + m 3 • p n u~ a oc 1s t 11 a b " P .Q = f+ :I a ~ /1 = Ry 3 A 26 1: • 3 P 1. A 1 y . r ~ . N n T i 131.(q ~ 6 • p9 M 1 ~ 0.S x.ayq ~ ~ 0. 6 1 20 4 6 p w9 D aYyq YY 1 P m • A : ~ _ ! • P 59 9 n 11 x v o i va lu I w 1 u i 11 11 Iv • ^ n Ix • n, tT 9 n a 9 1D9 I.Ox{at 1] 9 ti • M M H 1 6k 1dMq ~ ~ ? 9 p 16 a P > 1 6 Y M ~aN ~ M M 19 I,pygiq b r a •3 ~~9 H 10 Iw 10. 1t N i@1 ~ 61 ~ b M 13 t= 13 P P 11 R • 1 I ~ t6 A 19 ? 19 ,w O ~ 5s w Iw n t9 13•(4 ~ ~ ?'+r w 9 M M 11 t6 W INRGEIlxi t1 9w M o.+r I , E aK.NO. M1.fEi '9 w w Y91A4.t 13 m FlM CCL NO, i 1 2]Nq 9E>; sEC. No. '0' ~ • • v 1xS61@9 ,p• w9 , s a i w w 1MTLM IINE ~.t\ ~ ~ w LINE I ~fe 19p 11 IS y IS 11 HOLE ror.u. - o..u. ~ewn~+r°A"`"~'~a~ NOTICE COUNTY Of SUFfOIK © E w ~ wwiuwccKluwnax.>wFO9 RealProperly Tax Service Agency v rur... --w-.- awiu.--w~-- me x Owmw~nppr~unpwloxwirE CWOIyCmW PoYMiW.NY1tWt ti~u, r wtl wimucpxrUw wvwnwwlco ~ M wo.u~ o.ru.--ww-- wuxv m~artw9nex ce9w9ww at>rw o A - uv wmwmru.9Ewncc++E9a V ~a S C.D.H. S. REFERENCE NUMBER R 10-10-0063 N SURVEY OF PROPERTY NDTE: AT MATTITUCK SUBSURFACE SEWER D/SPOSAL TOWN OF SOUTHOLD SYSTEM DESIGN BY.' JOSEPH F/SCHETTT, P.E. SOU]HOLDON.Y. 11971 A B NEB SUFFpy~ AVENUE SUFFOLK COUNTY, N. Y. (631) 765-2954 ST 26' 39.5' 1000-115-12-15 LP 1 35 5s SCALE.• 1'=30' cP z OCTOBER 27, 2010 y LP 3 J6 51.5' DECEMBER 7, 210 (NEW SEP17C SYSTEM) g LP 4 - 36 63 JUNE 1, 2011 (FINAL ON SEPTIC SYSTEM) ~e~' ~ LP 5 42 9.5 JANUARY 4, 20/3 (TOPO & PROPOSED ADDl7TONS) ~ ~ ~ N ~ ~ ~ ~ Y ~ ~ N/O/~' ~ORR,q/NE WENDT ~ y ~Dy (DWELL/NG WITH PURL/C WATER) / ~I zr 'EL .zo• i~uav. ~ ass 216.88' 7D, RECENE® I ~ / / / K 3PUT RA/L FENCE 7.9' o - wA ~x i $ I a 1 i ~ ,s II°-74' BOARDOPAPPEALS o / ~ _ Si+ 'V ~ ~g ~ ~ ~ I ~x r zcwE ~ zap x aRavosEO ~ ~ 3 O J S ti ~ ~ I I 72' ' ~ ~ ~ ST m ~ yY~ ~ 59' ~ ~ Lei 7 • t t ~ Z J 4! ~ ~ 6 ~ Z 105' 2 U+ IFST NqE ~`f_ 4 ~ , i 3 4 tl• ~ ~ 80' / / ~ ~ i ~ ~ ~ Ca'.~cRE7E auve I U ? J ~ ~ l ^ j%; ~A'¢ /Aw~'wAY ~ a, a TEST HOLE DATA ~ ¢sraNEREr.t / ` ~wago : , zs' g ~ McDONALD CEOSCIENCE I IxAU / Ei. SB' PA1ERS b ~ ~ ~,r O\ 10/13/10 ~ 1.1N (O/L) r - - - ~ 9RONN S27Y SAND SM '1.4N I EL 7.5' I N8779'20'W "'~D Qo' zs' ROM' OF E S 22232' /y/O~ ~ERtt BROMN FlNE SAND sp ALL DWELLINGS WITHIN 150' USE PUBLIC WATER CHRlST1AN0 ~c PATRICIA MELE CsF i~~ ; (OW£LLINC W17H PUBLIC WA7ER na`' 'tF o.D' 6'I• FLOOD ZONE FROM FIRM MAP NUMBER 3610300482 H ) fa . SEPTEMBER 25, 2009 `a f ~ ~ . ~ WA1ER IN sROMN FIM/E SANG SP ELEVA 770NS REFERENCED TO N. A. V.D. '88. k ~ ~ " !L' ~ t ! Iz' l am familiar with the STANDARDS FOR APPROVAL AREA=~~~ AND CONSTRUCTION OF SUBSURFACE SEWAGE ~ ~3; s • olsPOSa~ srsrEMS FoR siNCCE FAMILY RESroENCES TO TIE LINE ; °``^,.y N. Y. S. UC. NO. 49618 and wil/ abide by the conditions set forthherein and on the ANY AL7ERA710N OR ADDl710N TO 7HlS SURVEY /S A NOLAT70N permit to construct. .A.t~e~ IC YORS, P. C. OF SECTON 72090E 7HE NEW YORK STA7E EDUCA110N LAW. 31) 765-5020 FAX (631) 765-1797 EXCEPT AS PER SECTION 7209-SUBDINSION 2. ALL CER77FICA710NS The location of wells and cesspools shown hereon ore HEREON ARE VALID FOR THIS MAP AND COPIES ]HEREOF ONLY IF P. O. BOX 909 from fie/d observations and or from data obtained from others. SAID MAP OR COPIES BEAR 7HE IMPRESSED SEAL OF 7NE SURVEYOR ~ =TREE 1230 TRAVELER STREET WHOSE SlGNA1URE APPEARS HEREON. SOUTHOLD, N. Y. 11971 10-222 Fee: $ Filed By: Assignment No. APPLICATION TO THE SOUTHOLD TOWN BOARD OF APPEALS ~~,IAREA VARIANCE HouseNo.ID O Street~~ n~le ~hlV2 Hamlet ~DU'+'V1©IC1 __r~ SCTM 1000 Section ~ Q NONG~s1"~'yNt Block Lots ~ S Lot Size 2 ~ 16~ S Zone J I (WE) APP L HE WRITTEN DETERMINATION OF THE BUILDIN IN PECTOR DATED ~ 2 BASEDLON'AS/URVEY/SITE PLAN DATED Applicant(s)/Owne2r(s): Y1 YI' IYvI r~{.~51 ^I I ~ Mailing Address: J~ I~V~N~N~o1~'1~ KBr~A ~W~YYlr7~ ~ Ny ~T Telephone:~~JI-3g~-20~ Fax: EmaiL•Tf l.t/V1'1 OD'~OI'1~t?le• Vlt°+' NOTE: In addition to the above, please complete below it application is signed by applicant's attorney, agent, architect, builder, contract vend*ee,~ etc. and name of person who agent represents: Name of Rnnep//rese~~nt``ative: i V~~~II°~ N 6~`Q,"IMa~V1VL1' for ~ Owner ( )OtheLr: Address:G-to t~V1ufC~l1~~ L~~GT JyV1V'~it~wVl ~~~~0`_ F- ~~7g7 Telephone:6,Zj~- ~22- Fax: Email: V~?-,"~iG ~ V1t ~lMaV1y1 desigh yUI it Please check to specify who you wish correspondence to be moiled to, from the above names: ( )Applicant/Owner(s), Authorized Representative, OOther Name/ Address below: WHEREB TBU~ ILDING INSPECTOR REVIEWED SURVEY/SITE Pt LAIN DATED and DENIED AN APPLICATION DATED 2 13 FOR: Building Permit ( )Certificate of Occupancy OPre-Cert~cate of Occupancy ( )Change of Use ( )Permit for As-Built Construction ( )Other: Provision of the Zoning Ordinance Appealed. (Indicate Article, Section, Subsection of Zoning Ordiuaoce by numbers. Do not quote the code.) Article: Section: Subsection: Type of A 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 ( )has, 9(} 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 ova office for assistance) Name of Owner: ZBA File# REASONS FOR APPEAL, {Please be specific, additional sheets may be used with preparer's signature notarized): 1. An undesirable change will not be produced in the CHARACTER of the neighbor or a detriment to nearby properties if ranted, because: -(G~ ~ ~eG~ ~Gavere~ t s ~P~+; csv?a~ w ~ ~ -Wte ov~ra~l.l ~~3e,. titoLtS~e. w~.,,(d ~tavc a reue~-e In.i ~ ~o~ -~i~tyr ~J({,v?,d5 ? w.-11., ~~Ci ~kiv~ ~ i P ?''o~ . 2. The benefit sought by the applicant CANNOT be achieved by some method feasible For [he applicant [o pursue, other than an area variance, because: ~ ~ ~ x ~ t~>°~ d~ ~~~d i S d~e5 r raga(-G ~ Ok-~d~'' d~w~~ . A i1nrr,~ ~ d~, w~,t Id ~ Wi-wit~l -1~e ~e~ ? b~ ~o~lt~ l{ w~~~-- ~,e uu aF ~'>n.e ~~er,{~ . 3. The amount of relief requested is not substantial because: h a'~P ~°X ~IIM a'}-~ '~/It''~ °~C~D~ ~ ~ `riwl I S V1~~ti1C~S~ W {~i~ a ~ ~ F~~ S~'~~ ~~ic~( i S a r~a~?~e 4. The variance will NOT have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district because: `~V1~ ~rf7P~d d~~ w~Ld, ~ ~D . 5 s~-(~ a~-c ®f 'P,h arts Invv~ , t~ s ~r ~ ~1~~ red 5~t . ~ ~ ~ ~ ~ ~'ea ~ s v~ • ~ i vv~~ }'o ave~r~l~(. ld- si fie. 5. I las t e al eged difficulty been se f created'? Yes, or { } No Why: Are there any Covenants or Restrictions concerning this Iand7 { } No { }Yes (please furnish a copy) This is the MINIMUM that is necessary and adequate, and a[ the same time preserve and protect the character of the neighborhood and the health, safety and welfare of the community. Signature of Applicant or Authorized Agent , { (Agent must submit written Authorization Cmm Owner) Swom.tcb fore me this ~ ~ day of , 20f_~1__. 71 ~ ~ ~f:t ~,t,. c k~- Notary Public SERENITY NOEL JUSINO Notary Public • State of New York N0.01JU6236127 Oualifiad in Suffolk C My Commission Expires SS ' APPLICANT'S PROJECT DESCRIPTION APPLICANT: ~~~It° `~jWl DATE PREPARED: 1. For Demolition of Existing Building Areas Pleas describe areas b ing removed: 4s'~~ r s r i O IL New Construction Areas (New Dwelling or New Additions/Extensions): DI 1 Dimensions of first floor extension: Dimensions of new second floor: Dimensions of floor above second level: Height (from finished ground to top of ridge): ~ ~ ~ ~ 2 ~ Is basement or lowest floor area being constru led? If yes, please provide height (above ground) measured from natural existing grade to first floor: ~t ~ ~ ~~2 ~t i' III. Proposed Construction Description (Alterations or Structural Changes) (Attach extra sheet if necessary). Please describe building areas: umber f FI ors and General haracteristics EF RE Alte lions: ~ ' 1 ~t_ N 2 Number of loors d Changes WIT Alteryations: - S 1 l IV. Calculations of building areas and lot coverage (from surveyo Existing squaze footage of buildings on your nrooert g 2 S . l ~ ~ CS ~I ~aG~~ Proposed increase of building coverage: ~ ~ 1 s•~ ~~DOSG.~ 'a i ~(p,~ vr~ a 5) Square footage of your lot: Percentage of coverage of your lot by building area: ° . . V. Purpose of New C nstruclion: Y5 I V rh s. r c S 6 V~csc~ cL~r1i A~ . VI. Please describe the land contours (flat, slope heavily wooded, marsh area, etc.) on your land and how it relates to the ditTicL`ul,t,y in meeting the code IIrequirem-enlt (s): p4'•P 3 6~ C2Y15'IY• U ~lla/1 I S r?i l r~-~I"~ V'C~ ~ T l ~ ~~iZC_ S' 6 yc ~ ~ r_~Vl~_ Please submit 8 sets of 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. aizot2 QUESTIONNAIRE FOR FILING WITH YOUR ZBA APPLICATION A. Is the subject premises listed on the real estate market for sale? Yes ~No B. Are there any proposals to change or alter land contours? No X Yes please explain on attached sheet. C. l Are there areas that contain sand or wetland grasses? 'e 2.) Are those areas shown on the survey submitted with this application? 3.) Is th~e IQ~roperty bulk headed between the wetlands area and the upland building area? Nfl 4.) If your property contains wetlands or pond aeeas, hav~~yrro,,~~u contacted the Office of the Town trustees for its determination of jurisdiction?Please confirm status of your inquiry or application with the Trustees: and if issued, please attach copies of permit with conditions and approved survey. D. Is there a depression or sloping elevation neaF~e area of proposed construction at or below five feet above mean sea level? E. Are there any patios, concrete bamers, bulkheads or fences that exist that are not shown on the survey that you are submitting? SID -Please show area of the structures on a diagram if any exist or state none on the above line. 11 F. Do you have any construction taking place at this time concerning your premises?~If yes, please submit a copy of your building permit and survey as approved by the Building Department and please describe: G. Please attach all pre-certificates of occupancy and certificates of occupancy for the subject premises. If any are lacking, please apply to the Building Department to either obtain them or to obtain an Amended Notice of Disapproval. H. Do you or any co-owner also own other land adjoining or close to this pazcel? No If yes, please label the proximity of your lands on your survey. L Please list present us~ or operations conducted at this parcel e ~l5'h~1 Si a~P. 1 ~ and the proposed use san/VlP . (ez: ezisling single (amity, proposed: same with garage, pool or other) h0 ~ii~2 7 I tb ~ 13 Authorized signature and Date Board of Zonine Aaaeals Aaalication AUTHORIZATION (Where the Applicant is not the Owner) 1, ~rAn /'''A fS ~ ~ ~ v residing at3s i 1 nn5n cic~a R~ (Print property owner's name) (Mailing Add1re*ss) l~tJ iv,nw•~E t /t/i CI ~2.t do hereby authorize I~~d(~ Iy i Q~~~ (Agent) to apply for variance(s) on my behalf from the Southold Zoning Board of Appeals. (Owner's Signature) ~rw,k M~.rs,"I~~ (Print Owner's Name) APPLICANT/OWNER TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nrahibits conflicts of interest oo the Dart of town officers and emnlovees The ournose of this form is to provide information which can alert the town of oossible conflicts of interest and allow it to take whatever action is necessa to void same. YOUR NAME : blf $ I I t A ~(~,nk (Last name, first name, middle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) TYPE OF APPLICATION: (Check all that apply) Tax grievance Building Permit Variance Trustee Permit Change of Zone Coastal Erosion Approval of Plat Mooring Other (activity) Planning Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the [own 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 [hat person Describe the relationship between yourself ([he applicantlagentlrepresentative) and [he town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply) A) the owner of greater that 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation) B) the legal or beneficial owner of any interest in anon-corporate entity (when [he applicant is not a corporation) C) an officer, director, partneq or employee of [he applicant or D) the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this ~ ~ day of ~V L , 20 ~3 Signature ~~m~a Print Name Frr^'tkMArrt~lt~a AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM "fhe Town of Southold's Code of Ethics prohibits conflicts of interest on the Dart of town ofrcers and emolovees. 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 pecessarv to avoid same. ,y~ fo_y,, p YOUR NAME : N I'e~~l ~~~1 °L ~N!~'l~ 't(.,U (){rP t f G~ (Las[ name, firs[ name, middle inifial, unless you are applying in the name of someone else or other~nty, such as a company. If so, indicate [he other person's or company's name.) TYPE OF APPLICATION: (Check all that apply) Tax grievance Building Permit Variance Trustee Permit Change of Zone Coastal Erosion Approval of Plat Mooring Other (activity) Planning Do you persopally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? °Reaationship" includes by blood, marriage, or business interest "Business interest" means a business, ipcluding 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 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 otrcer or employee or his or her spouse, siblipg, parent, or child is (check all that apply) A) the owner of greater that 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation) B) the legal or beneficial owner of any interest in anon-corporate entity (when the applicant is not a corporation) C) an otticer, direc[oq partner, or employee of the applicant; or D) the actual applicapt DESCRIPTION OF RELATIONSHIP Submitted thi/s /~_~day o I , 20 Signature ~IA rl,Z}---- ^ , 1p~~ PriptName Iy1 -'"I~,~ IVlli~~~ I~IEMANN AARCHITECTURE, P.c. 26 Churchill Laue, Smithtowq NY 11787 (631) 922-4021 email: NiemannAcchitecture@verizon.net PHOTOS OF PROJECT SITE Owner Frank & Carol Marsilio Site Location: 1080 Deep Hole Drive Mattituck, NY 11952 Applicant Name: RECENED Natalie Niemann, R.A., (631) 922-4041 ~~l y 7 ZQ~3 Date photos taken: BQARDOFgpp~~ September 25, 2012 R'FN' .tit rF'F'OI,K .4 6"F,h'( ~ a x' ~.:nrs i 3J W i~- t ~ ! L, 1i n I T ^ ] EF w voo~ D? y T~/1'~ ~ II FATME.N~PfiE ~ '-'itii~F fNAI I~l ~ «t VVV `ll I _ '~i sr, «eu~. 1~ ~ t__ ~ ~ ~ ~ ~ NALL L (12,~ v__~ _ i II ~I M1'OM rf cbfRrR~f~ _ • .I PHOTO KEY MAP >L~' Not to male ? r , M ~ ~ ,~rt1 fir. - _ '1 ` ~ ~ t . - i ,:r l,! ~1 ~ it~xf~ _ - _ f, . '4 _ .r A' r r ~ti~ ~ _ ~ ~ ' Photo ~`''~c `t `~t- - ~ . (M M.. Yiq ~ ~h ( ~ 6F ~ r ~ 1r \ X : ' y _ r+ s; ~ ~ - A } . :;h Y xl n~uq _ ° , Photo ~ - .J ~ ~ ~ ~ ~ E ~ ~ ~„'`W r~~ s`. ~c ~ ' ~ a^v Ma~Y" ~ '1RC,y~,~v~~+~M~ ~ ~.~ir ~F f - r. Yik~ iJ+ ~ l r photo _a ~~M r.. x ~ ~ ~ ; A ~ ~ ? ?`Xd... ~.Y ~ •J y^ n Z ~ e' eii~"J as ~ ~r9 ' -.w+~r? sue. '.r~'E'~. '.it-_~if.?.. +O' - g . acs I . s . .t ~ y F y Y 'T,~ I • r \ kt ri ~ v. _ a MF: ~ '*T'~~ 'l W FF i~rir.~y» ~ I ~L F ' 'RT l I Photo 5 .r , j ` E • y~ r s ~ ~ mot. - ti ai i 4 _ - ~ ~ ~ , r: ~ r ~~~w`~ ~-Y ~ _ ~ ~ ` ~ ~ ~ Photo 11, - f ~ h .x ~ . .fi' "4 ' S 'p` _ ~ , mr rte' fit. ~ . Photo _ ~ M~ ~ ; ~ ~d # t Y~ L T PhOtO ~ ¦ 1i _.r? i ~ a r ~~~u~i+ s.~['~'s t1'~ , - 1 4 x t ! `fit Xt w"~'s . - - - ; - Photo • 3_; . 9 f r Y SM1 r ~ s ~ :ate * ~ j... ~ ~t. t~ ~ i.r 1e 1 ' # i ~ ~f'~'M` t _ • y r; ~ ~ , o 0. = r. 0. ( F ~t ~i w / c • `2~,' f, it t a~ 4 4 is ~ 1 yi ~ ~ .Ytn _ ~ f. / ~ mow.. r ~.4~. ~ ~ ~ e+,.i~i ~ ~"rl ~ }l _ - ~ ~ _ A, _ ~ . ..c • ~ Y,. } i ! ~ ~ ti . ~ _ ,k i r ~ ~ ti H.. a - - _ ,t y r- ~ f, t ~ y~l ~ ~ J ~ y,,., f~.~ . ice. ' ~ ~ ,x(11O i1!(1~1/ South ( y t View l,oul.ittg ,i;ti'~ ~ i~~'{~1Y"'~~r ~ ~7rf` ti. fix. Ems; - ~ , ~ ~ ~ r s f~.. ,ed~"~ ~ '~.K y > . '"i, w Y ~ . ~ i.~ ~~Y~ ~ ~ ~ ,1~ ,~e~~a . ~ , hots map) ~ - ~ l~lurttt {rtu~ n~ i,cy P ~c ~ View Looking IEMANN RCHITECTURE, P.c. 26 Churchill I,anc, Smit4ztow~, NY 11787 (G31) 922-4021 email: NicmannArchitecture@~erizon.net PHOTOS OP PROJECT SITE -STAKING date taken: November 25 2012 Owner: Site Location: Frank & Carol Marsilio 1080 Deep Hole Drive Mattituck, NY 1 1952 A licant Name: Natalie Niemann, R.A., (631) 922-4041 r 1 a. . . ~y , , - _ ~a i :i ~w View looking East from existing bulkhead (future proposed rear ~ ~ ~ ~ porch location). 1~y ~ :x~_ i . S• ~ ,f - y¦! 7 ~ 7~F • , j~N~ View looking West from future proposed rear ~ porch edge. ; _ - _ ~ ~ ~r - - _ , ~ - - ~ ~i . i , ; ~ . _ - ~ Far view looking at ' ~,+s.,~ Northwest stake. ' w a i „y _ ~ r _ _ _ } , .S ` ~ ~F ~ za- Mid view looking 2 ~ / - - at Northwest stake. - ~ , . r . _ _ r a• ~ ;'ate' ~ ~ 4 ''nC mow: i7r. 'z,,\'" n ~ 1~ ~L c. i ~ t~lo5eup looking at ~ Northwest stake. L 7 . _ 1. \y ~ w D 4 i x~ ~ ~ v^t - _ _ l~as view looking at ~ - ~ Southwest marker. G F Mid view looking at ~ ' ~ ~ ~ Y Southwest marker. ~ ` _ - _ 3 i ~w ,y - l~ 1 .yr ~ ~ I 7-y` ~ 4 J - "tom-. - e~~.~a' i ~ u ~ ' ~ ` _ Closeup looking at ` ~ ~ g~g,~'' Southwest marker. -.a a - i ruanc nu. s w TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ..2..355 J 28 59.. Date 19...... THIS CERTIFIES that the building located at...Yf~S,.,Uoephole,DrSye,,,,,,,,,,,,,,,,,,,,,,,,,, Street Map No...~~ Block No...,............Lot No... x$......Mattituoka....N.Y,.,t....................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ~Y...... u............, 1959...., pursuant to which Building Permit No...7.t67g.................. doted '''laY.......ut......., 19..5.8.., was issued, and conforms to all of the requirements of the applicable provisions of the low. The occupancy for which this certificate is issued is Private one family dteellinb........................................................ This certificate is issued to ...d:tNSS..~ivoltel........~axnF:z~ (owner, lessee or tenant) of the aforesaid building. ............................1.. Building Inspector i w FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Ball Southold, N.Y. CBRTIFICATS OF OCCOPANCY No 2-25163 Data JULY 30, 1997 TH15 CERTIFIES that the building ADDITION 6 ALTERATION Location of Property 1080 DHSP HOLE DA. FATTITOCR, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 115 Block 12 Lot 15 Subdivision Filed Map No. Lot No. conforms eubetantially to the Application for Building Permit heretofore filed in thte office dated SEPT. 22, 1970 pursuant to which Building Permit No. 4967-5 dated BHPTSMHffit 22, 1970 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate ie issued is ALTER SEISTIN6 GARAGE INTO HABIRABI.S ROOM, G NSW GAAAGS ADDITION TO BZISTING ONE FAMILY DWBI.LIN(i The certificate ie issued to SLSIE DIGONS (owner) of the aforesaid building. SUPFOLR COUNTY DEPARTMENT OP HEALTH APPROVAL N/A UNDHRWRITHAS CHRTIPICATH NO. N/A PLUMBERS CERTIFICATION DATED N/A~ •THZ3 UPDATES CO 5-4091 ISSOBD ON DEC. 21, 1970. ui ding Inspector Rev. 1/81 v l r ' 3. Nature of work (check which aGPlicobie): New Building Addition Alteration . Repair Removal Demolition.................. Other Wark (Describe) . 4. Fsti~rated Cost ...].I~IIO4 ..........................................Fee .......5..04..........._......................................................._.... (to be paid on fi.'(ng this application) t 5. If dwelling, number of dwelling units ........O,A4 .............Number of dwelling units on each floor If garage, number of cors 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dimensions of existing stnxtures, if ory. Front Rear Depth Height Number of Storfes Dimensions of same structure with olterotims or additions: Front Rear Depth Height ..._.._...................Number of Stories 8. Dimensions of entire new constne:tion: Front ....rZ~..t4...._............ Rear Depth ...9L...22........ Height Number of Stories ....OL/~..............._..................._.................................................................. 9. $iu of lot: From Rear Depot 10. Date of Purchase ..........................._...........................Nome of Former Owner 11. Zone or use district in which premises on situoted ..._...!!1R..b~.iL 12. Does proposed construct7on violc~e. ~r~ law, ordirtonce or regulation? ...............I10........................................ 13. Nome of Owner of premises ~5 ..................Addreu ..Mtt.LliUCk.................... Phone No..................... Nome of Architect ......................................................Address Phone No..................... Noma of Cmtroctor ..._E.0..~~r~ ...........................Address .......1lmi:&itgcY............... F'Ftana No.................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and irdicate all set•botk dimensions from property lima. Give street and block number or description according to deed, and show street names and indicate whether interior or comer tot. t 1'r a'~7 a Y ~ _ lr y'~'?'.! rb, 1 ` q. yr ~ 1 ~?L~ STATE OF NEW YORK 1 CWNlY OF ......SIi,LL•01k........J55. ............................_..BdY..lb1f`,i..........................................t»ing duly sworn, deposes and says that he a tM (Nome of individual dgnirq applfcotbn) applicant above rwmed. Ha is the ....:........OA3LriC#41....................................................,.................._..........».._..................:........ (Contnoetor, agent, corporate officer, ete.l of sold owner or owners, and is duly autftorized to perform or have performed the said work and to n+ake ord file this applicotfon; that all statements contained in this application aro trW t0 the best of his krawkdge and balisi; and ttyar the work will be performed in the manner set forth in the applicMion filed therewith. to before me this .........._....,2$,. or ..Snp ts....~p / ' ~ftt••••••.~ Notary Publi County eJ,~'~ L%~Sigratura of applkant) . tuwctx ua u~ 0 71 tlorulr tuiiuc. sea a tarn rat ra. szatxsus, swa» . Jww L~~Mrw 3e, t ~ . `1~JY/7°_ ~7N .r~t.° tin ~'t?rn ; ly~~~ U - ewes[ na s ~ o eul~NO off "'I/'`~ /i"" ~ ,v~ Taw?fcuRKxol~cR ,,-,d,,,,, ..1.t. ~ L souTfftxo, x: t. ~ f.~.L.>~r{-'- Ercarr,ined .S~»~.."~..~..y.....~.~.2........ 19~ ~ APPlkotlon No....t..L..~.7.......... o ! Approved 19........ Penult No.....q.!!..7..Z- . 0.-,1 j~.o Dbapprowd o/c ~ s-~~~1 (Bulidinp In , 1 0 A?IKICATIOM fOR ~UIf,DiNO ffRMIT ~ O " Dote .....:.............$Opt.......22..-.......... I9...rRp.... b m INSTRUCTIONS ~ o. Thls opplicotlon must to conglehly felted In by typewriter or In ink and submitted In duplicme ro the flultdinp= Inspector. b- Plot pionsfq~r~rerqp laeotion of lot ord of here i~ip~ a~n pnmlta, selotipuhlp ro adJ remMr a pu6Uc attests a ~ oraas, and plvltq a d~MMd description of lityotd dlpropwey must be drown at !fr dlo0rarn whkh b poA of 411Y epp(kotlon. c. TM wwk cowed by thb apptkotlon may not M t:amnrneed before ifetrOrtpe of Buq~nO PmtJt. d. ~p~ apprwol of this applkaRitxy the Bulldirq inspector will Isstte o Bulldirtp Pernik ro fete tspplkartt. Such pennif sholl be kept m tM prwntsw awihbb for Irwpectkn thrapha+t the pro0rm of Mr work e. No buildlrq atoll M Ied or aced M whole or in port for orry purpow vdtatewr until o CMlfitzte of Oreuponcy "?~+„sMll haw been prorated by rtes Fluildin0 Inspelor. APPLICATION IS HEREBY MADE ro tM Bulldkp pepprt~enr for the lawonce of o BulWirq Fernier puntwnt ro tM Buildsnnpp Zw Ordinonce of the Town of SotM1oW. SuNolk County, New York, and oMer appllapble I.aw~,QlNrta~cee os Regulotbns, for the t:onsrn+ction of bulldinppyy floras or alNrations, or for removal tx tkrmolMan, a~~daerib.d. The oppllcaM oprees ro ctxrply with all ttpplkoble lows, ordinances, bulldinp code, howlnp code, and ......Bdv..Lblta..Contea~i~r.~Er~s»......w (SlOnotun of applluront, tx name, I a tprporoNOn) ..............1'(Illxt~.k~tCk............................................................. (Address of tlppllceM) State whethK applicant is owner, loaw, a0ent, architect, erglnwr, Oenerol eomrnetor, dttetrklan, plumber w bultder. ...........................................C.aatraatar............................................................................................................._.... Near of owner of premlrp ...L...A1.(,oal If applicant Is a corporoH, sipnotun of duty twthorized offker. (Nome and tltle~of corporote o(flpr) 1. Lacotian of land on which Proposed work will M done. Map No.:.........~ Lot No.: SZ........-.-...... StrNt IJumber ..............Y/5--..-Drip,..llol~..IID......-..-ttattd:tielr......--.................-.............-.....................~ /~80 MatkipolRy 2. Store exlsfin0 use ord accuponcy of pnunim and Intended use and occuponcy of prapad taristrttctlart: - a. Existlnp use and accuponcy d?f.~~.~lL b. Intended .,s. end occupant ......tfilp8..1[itb...slII..atddlYloa V o~ 'I~ ~ I ~ Q Y ~ 0 2 W Y ~ w ~ , 0 0 t ~ ~ 5.97°/9'20E. 235.00 ~ t` i 1~~ 0 u -//r'-- - o J II ~ ~ ~Io a3 T JZ ~ C f. m ~ 4 Q 'I 1.ct ? 9V y W I W r/ ~ O N. g y o / i ~ 4.. Ni 2 4.(1:.00 (I'.~t ~ i1~~ R orb b icy s I ~ ~ °MA~ OF LOTS ro 1' SU KVEY~O, FL i.:. it AND ELS/E ©/GONS A T MAT T /TUCK SUFFOLK COUNTY N•.Y• Sc cr /c SO ~ / /1 Guoranfced fa fie Sout~iold Sovin9s Bonk qnd to the /n ter-County TitleCiuaran?y and Morlyo9e Con~ar)/ASSUr?ey6d ?unC 3~ /9S9 en = .ma „um 6n t ~1'7`o W Von Tuy/ ~ son o r %!'On P%Pe ~'~.1 L /censcd Land SveyByo~s G~aenport, N . AGRICULTURAL DATA STATEMENT ZONING BOARD OF APPEALS TOWN OF SOUTHOLD WHEN TO USE THIS FORM: This form must be completed by the applicant for any special use permit, site plan approval, use variance, area variance or subdivision approval on property within an agricultural district OR within S00 feet of a farm operation located in an agricultural district. All applications requiring an agricultural data statement must be referred to the SuJj`olk County Department of Planning in accordance with Section 239m and 239n of the General Municipal Law. 1. Name of Applicant: ~I ~ ~ 2. Address of Applicant: f t 3. Name of Land Owner (if other than Applicant): O 4. Address of Land Owner: 5. Descripti n of Propo ed _ / L _ I , ~roject~~~~ ~t/ryf P.{~{''ryV/ ~ttlfi(/yll Iv'~,Ltl ~(7Sf ~ D6Y ~P.uJ-~ s awe' ta~Yr 6. Location o Propertyrty road n Tax map 1 L number)1Q D fXlb ~-~.'(~f I V'~ ~CC/f' ~ ~ s ~0~1-' ~ 5 7. Is the parcel within 500 feet of a farm operation? { }Yes ~ No 8. Is this parcel actively farmed? { }Yes No 9. Name and addresses of any owner(s) of land within the agricultural district containing active farm operations. Suffolk County Tax Lot numbers will be provided [o you by the Zoning Board Staff, it is your responsibility to obtain [he current names and mailing addresses from the Town Assessor's Office (765-1937) or from the Real Property TaxnOfrTice located in Riverhead. NAME and ADDRESS t `r~ 1. Z. 3. 4. 5. 6. (Please use [he back of this page if there are additional property owners) Signature of Applicant Date Note: 1. The local Board will solicit comments from the owners of land identified above in order to consider the effect of the proposed action on their farm operation. Solicitations will be made by supplying a copy of this statement. 2. Comments returned to the local Board will be taken into consideration as part as the overall review of this application. 3. Copies of the completed Agicultural Data Statement shall be sent by applicant to the property owners identified above. The cost for mailing shall be paid by the Applicant at the time [he application is submitted for review. New York State Department of Environmental Conservation _ Division of Environmental Permits, Region One SUNY @ Stony Brook, 50 Circle Road, Stony Brook, NY 11790-3409 Phone: (631) 444-0368 Fax: (631) 444-0360 - Website: www.dec.nv.aov Joe Martens Commissioner June 10, 2013 Mr. Frank Marsilio 35 Annandale Road Commack, NY 11725 Re: Permit No.: 1-4738-01717/00006 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please carefully read all permit conditions and special permit conditions contained in the permit to ensure compliance during the term of the permit. If you are unable to comply with any conditions please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Sincerely, Laura J. Scovazzo / ' Permit Administrator LJS/Is eszai feieD-~ New York State ,Department of Environmental Conservation ~ ~ ~ The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted at this site. For further information regarding the nature and extent of work approved .and any Departmental conditions on it, contact the Regional Permit Administrator listed below. Please .refer to the permit number shown when contacting the DEC. Regional Permit Administrator Permit Number ROGER EVANS Expiration Date V' % %~Ie NOTE: This notice Is NOT a permit I SEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ~ Facility DEC ID 1-4738-01717 PERMIT Under the Environmental Conservation Law ECL Permittee and Facility Information Permit Issued To: Facility: FRANK MARSILIO MARSILIO PROPERTY 35 ANNANDALE RD 1080 DEEP HOLE DRISCTM 1000-115-12-15 COMMACK, NY 11725 MATTITIJCK, NY i 1952 (631)387-2093 Facility Application Contact: i NATALIE NIEMANN '.NIEMANN ARCHITECTURE PC 26 CHURCHILL LN SMITHTOwTI, NY 1 ]787 (631)922-4041 I Facility Location: in SOUTHOLD in SUFFOLK COUNTY Village: Mattituck Facility Principal Reference Point: NYTM-E: 709.278 NYTM-N: 4540.623 Latitude: 40°59'23.8" Longitude: 72°30'43.5" Project Location: 1080 Deep Hole Drive -Watercourse -Deep Hole Creek Authorized Activity: Construct additions to existing dwelling. All authorized activities must be in strict conformance with the attached plans stamped NYSDEC approved on 6110/13. Permit Authorizations Tidal Wetlands -Under Article 25 Permit ID 1-473 8-01 7 1 7/00006 New Permit Effective Date: 6/]0/2013 Expiration Date: 6/9/2018 NYSDEC Approval By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, and all conditions included as part of this permit. Permit Administrator: LAURA J SCOVAZZO, Deputy Regional Permit Administrator Address: NYSDEC REGION 1 HEADQUARTERS SUNY @ STONY BROOK~50 CIRCLE RD STONY BRf.~OK, NY 1170 -34Q4 Authorised Signature: ~ ~ _ Date 1 Page 1 of 5 NEW YORK STATE DEPARTMENT OF ENV[RONMENI'AL CONSERVATION ~ Facility DEC ID 1-0738-01717 Distribution List NATALIE NIEMANN Habitat - TW LAURAJSCOVAZZO Permit Components NATURAL RESOURCE PERMIT CONDITIONS GENERAL CONDITIONS, APPLY TO ALI, AUTHORIZED PERMITS NOTIFICATION OF OTIfER PERMITTEE OBLIGATIONS NATURAL RESOURCE PERMIT CONDITIONS -Apply to the Following Permits: TIDAL WETLANDS I. Conformance With Plans All activities authorized by this perntit must be in strict conformance with the approved plans submitted by the applicant or applicant's agent as part of the permit application. Such approved plans were prepared by Natalie Niemann last revised 3/26/13 stamped NYSDEC approved 6/10/13. 2. State Not Liable for Damage The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. 3. State May Order Removal or Alteration of Work If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove or alter the structural work, obstructions, or hazazds caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed, the owners, shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. Page 2 of 5 r NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ~ Facilirv DEC ID 1-4738-01717 4. State May Require Site Restoration If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may lawfully require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 5. Precautions Against Contamination of Waters All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. 6. Post Permit Sign The permit sign enclosed with this permit shall be posted in a conspicuous location on the worksite and adequately protected from the weather. ~ 7. Notice of Commencement At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and wnditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work. 8. No Construction Debris in Wetland or Adjacent Area Any debris or excess material from construction of this project shall be completely removed from the adjacent area (upland) and removed to an approved upland area for disposal. No debris is permitted in wetlands and/or protected buffer areas. v. Seeding Disturbed Areas All areas of soil disturbance resulting from the approved project shall be stabilized with appropriate vegetation (grasses, etc.) immediately following project completion or prior to permit expiration, whichever comes first. If the project site remains inactive for more than 48 hours or planting is impractical due to the season, then the area shall be stabilized with straw or hay mulch or jute matting until weather conditions favor germination. to. Long-term Plant Survival The 700 square foot buffer shall be planted with native shrubs and the permittee shall ensure a minimum of 85% survival of plantings by the end of five growing seasons. If this goal is not met, the permit holder shall re-evaluate the restoration project in order to determine how to meet the mitigation goal and submit plans to be approved by the office of Regional Habitat - TW H. Area of Disturbance for Structures Disturbance to the natural vegetation or topography greater than 25 feet seaward of the approved structure is prohibited. 12. Straw Bales or Other at Tidal Wetland A row of staked straw bales or approvable erosion control devices shall be placed at the landwazd edge of the buffer area or as per NYSDEC approved plan linear feet from the tidal wetland boundary, or as per the NYSDEC-approved plan, prior to commencement of any regulated activities and remain in place and in good, functional condition until the project is completed and all disturbed areas are stabilized with vegetation. [3. Runoff Directed to Upland Drywells Roof runoff shall be directed to drywells a minimum of 60 linear feet landward of the tidal wetland boundary for immediate on-site recharge. Page 3 of 5 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Faciliq~ DEC ID 1-4738-01717 14. No Changes to Septic System This permit does not authorize any alteration, expansion or replacement of existing septic systems. GENERAL CONDITIONS -Apply to ALL Authorized Permits: 1. Facility Inspection by The Department The pennitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECI-. Such representative may order the work suspended pursuant to ECL 71- 0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the pennit area when requested by the Department. .4 copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. z. Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirements contained in such order or determination. 3. Applications For Permit Renewals, Modifications or Transfers The pennittee must submit a separate written application to the Department for permit renewal, modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. Submission of applications for permit renewal, modification or transfer are to be submitted to: Regional Permit Administrator NYSDEC REGION 1 HEADQUARTERS SUNY C STONY BROOK~50 CIRCLE RD STONY BROOK, NY1 ] 790 -3409 a. Submission of Renewal Application The permittee must submit a renewal application at least 30 days before permit expiration for the following permit authorizations: Tidal Wetlands. 5. Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to exercise all available authority to modify, suspend or revoke this permit. The grounds for modification, suspension or revocation include: a. materially false or inaccurate statements in the permit application or supporting papers; b. failure by the permittee to comply with any terms or conditions of the permit; c. exceeding the scope of the project as described in the permit application; Page 4 of 5 . NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ~ Facility DEC ID 1-4738-01717 d. newly discovered material information or a material change in environmental conditions, relevant technology or applicable law or regulations since the issuance of the existing permit; e. noncompliance with previously issued permit conditions, orders of the commissioner, any provisions of the Environmcntal Conservation Law or regulations of the Department related to the permitted activity. 6. Permit Transfer Permits are transferrable unless specifically prohibited by statute, regulation or another permit condition. Applications for permit transfer should be submitted prior to actual transfer of ownership. NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS I Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification "the permittee, excepting state or federal agencies, expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives, employees, and agents ("DEC") for all claims, suits, actions, and damages, to the extent attributable to the i permittee's acts or omissions in connection with the petmittee's undertaking of activities in connection with, or operation and maintenance of, the facility or facilities authorized by the permit whether in compliance or not in compliance with the terms and conditions of the permit. This indemnification does not extend to any claims, suits, actions, or damages to the extent attributable to DEC's own negligent or intentional acts or omissions, or to any claims, suits, or actions naming the DEC and arising under Article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. Item B: Permittee's Contractors to Comply with Permit The petmittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of- way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. Page 5 of 5 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 wil? 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# 1000 _ 115 _ 12 15 The Application has been submitted to (check appropriate response): Town Board ~ Planning Dept. ~ 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 construction, planning activity, agency regulation, land transaction) (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Existing 1,862 sf home (includes 1-car garage); proposed new 140 sf front entry addition; Nature and extent of action: proposed new masonry front porch (70 sf); proposed new composite decking rear porch (141 sf). The proposed renovation and addition to a one-story single family home is minimal. The style of the proposed wo wou en in wi e c ara er o t e exis mg ome an existing neig onng omes, crea ing street and waterfront conditions in character with neighborhood. The proposed rear porch is approx. 72 feet from bulkhead. Lot size 21,960 sf; existing lot coverage is 12.8%, proposed lot coverage is 17%. Therefore a minimal increase of 4.5% in lot coverage is proposed. Location of action: 1080 Deep Hole Drive, Mattituck, NY 11952 Site acreage: 21,960 square feet (0.5 acres) Present land use: Residential /Single-family Present zoning classification: Non Conforming Lots 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: Natalie Niemann /Niemann Architecture, PC (b) Mailing address: 26 Churchill Lane, Smithtown NY 11787 (c) Telephone number: Area Code ~3~ 922-4041 (d) Application number, ifany: 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? DEVELOPED COAST POLICY Policy I. 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 The proposed work is minimal and not a substantial impact. 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 ? Yes ? No 0 Not Applicable The proposed work is minimal and not a substantial impact. Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III -Policies Pages 6 through 7 for evaluation criteria Yes ~ No ©Not Applicable The proposed work is minimal and not a substantial impact. Attach additional sheets if necessary NATURAI. 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 ThP prooo~Prl work is minimal and not a substantial impact 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 0 Yes ~ No ©Not Applicable The proposed work is minimal and not a substantial impact 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 © Not Applicable The proposed work is minimal and not a substantial impact. Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III -Policies Pages 32 through 34 for evaluation criteria. ? Yes ©No © Not Applicable The proposed work is minimal and not a substantial impact. 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 evaluatiou criteria. ? Yes ? No ®Not Applicable The proposed work is minimal and not a substantial impact. 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. n © Yep--1 No ® Not Applicable Private property. Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III -Policies; Pages 47 through 56 for evaluation criteria. © Yes ? No ®Not Applicable The proposed work is minimal and not a substantial impact. Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Towu waters. See LWRP Section III -Policies; Pages 57 through 62 for evaluation criteria. © Yes ? No ®Not Applicable The aroposed work is minimal and not a substantial impact Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III -Policies; Pages 62 through 65 for evaluation criteria. ? Yes ? No © Not Applicable Existing residential property not for agricultural use. Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resom•ces. See LWRP Section III -Policies; Pages 65 through 68 for evaluation criteria. 0 Yes ? No ® Not Applicable The proposed work is minimal and not a substantial impact. Created on 5/25/05 l1: 20 AM ~ 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I -PROJECT INFORMATION To be com leted b A licant or Pro ect S onsor 1. APPLICANT/SPONSOR 2. PROJECT NAME NATALIE NIEMANN R.A. MARSILIO RESIDENCE 3. PROJECT LOCATION: Municipality MATTITUCK County SUFFOLK 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 1080 DEEP HOLE DRIVE MATTITUCK, NY 11952 1084.28 FEET SOUTH OF NEW SUFFOLK AVENUE 5. PROPOSED ACTION IS: New Expansion ModificalioNatterafion 6. DESCRIBE PROJECT BRIEFLY: EXISTING 1959 1-STORY WOOD FRAMED HOUSE (1,540 SQUARE FOOT) W/ 1-CAR GARAGE. PROPOSED NEW I- STORY 140 SQUARE FOOT ENTRY ADDITION (WITH NEW BASEMENT BELOW), PROPOSED NEW MASONRY FRONT PORCH (70 SQUARE FOOT), PROPOSED NEW COMPOSITE DECKING REAR COVERED PORCH (141 SQUARE FOOT). 7. AMOUNT OF LAND AFFECTED: Inttially 400 SQ. Fr. aces Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes No If No, describe briefly VARIANC@ REQUESTED FOR REAR PORCH 3' ENCROACHMENT TO BULKHEAD 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ~ Industrial ~ Commercial ~ Agriculture ~ Park/FOresUOpen Space ~ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? Yes ~ No If Yes, list agenq(s) name and penniUapprovals: TOWN OF SOUTHOLD BOARD OF TRUSTEES, ZONING BOARD OF APPEALS, BUILDING DEPARTMENT 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes ~ No If Yes, list agency(s) name and permiVapprovals: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? Yes ~ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ApplicanVSponsor rtami~IE NIEMANN, NIEMANN ARCHITECTURE RC. Date: I 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 com leted b Lead A enc A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process antl use the FULL FAF. Yes ~ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative dedaration may be superseded by another involved agency. Yes ~ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) Ci. 6risting air quality, surtace or groundwater quality or quarrtiry, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain brefly: C2. Aesthetic, agricuflural, archaeological, historic, or other natural or cuhural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain bdefly: C4. A community's existing plans or goals as ofidally adoptetl, or a change in use or intensity of use of land or other natural resources? Esylain briefly: C6. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short tens, cumulative, or other effects not identified in C1-Cb? 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)? Yes ~ No If Yes, explain bdefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? Yes ~ No If Yes, explain briefly: PART III -DETERMINATION OF SIGNIFICANCE (To be completed by Agency) fNSTRUCTIONS: 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. Ensun: that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part II was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CFA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL FAF andlor prepare a positive dectaration. Check this boxifyou have determined, based on the intormationand analysis above and any supporting tlocumentation, that the proposed action WlL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting this determination Name of Lead Agency Date Pdnt or Type Name of Responsible cer in Leatl Agency Title of Responsible Officer Signature of Responsible Otficer in Lead Agency Signature of Preparer (If tlifferent from responsible o cer) pp~~~,;_, •~P' . , _ - _ _ , TOWPI OF SOUTHOLD ~~'ROPERTY RECORD CARD r, _ o,,: OWNER STREET r"' VILLAGE DISTRICT SUB. LOT IL ~ I r0 ~z ~s J/,~,./~~.~rc- /-7ESe~'!/3f _ Y ~O FORMER OWNER N E , ~ A REAGE ~ ) D W,? / y ~9 ~a,r~. )~~~>r~ SCC+r UZZi ~ i.V S W TYPE OF BUILDING J - ~ _ 7,'.. ti, ~ Ya L an~o/~ ' 'ti.~. / /1 l ,fio cd~)-d RES. Z/D ~ SEAS. VL. FARM ~ COM/vl. IND. CB. MISC. LAND IMP. TOTAL DATE REMARKS ~~~,Yl~~- -yam / f/ )ems, i f ~ G L' ~ ~ / - ~ 9 Z Q U u l J ,S-~/ nc? 5 Z r/r G~~-r.w`~ `~.r~f63 ~E'~' ,GE ~ `J U LDI G DI ~ 11 S" 'S .:'!L ~Z~79 ~ fit,°;L:; a.~~ L-~,' ~~/3a, NEW NORMAL BEL ` J ABOVE 4 " _ Farm Acre Value Per Acre Value .7 q~- n ~i Zr•~ - _ Tillable 1 ~ ` - /G (J ~ Tillable 2 •-h.f~ ~O Li Tillable. 3 I ~~.1' jGG woodland - _ T say ! I a a "(0 r'4u~ ~n~ ar zzr' - ~ G 8' Swampland ( - I o7 ~ - .X'L~Y`fOZZr ~ GtY"Si j acJ~' 7 a~ Brush;' House Plot Tota I I ' ~1,~. r < ~~rl( ~C ~1 u Bath M. ~ ~ C'' ~'6 - ~ Foundation ~ C fj' 2 Exten on = ~ ~ 3 d d ~ Basement ~~(,Q Floors ~ _ Extension Ext. Walls `U~ ~ Interior Finish Extension Fire Place ~ Herat _ fi--- ~0108 f~ld ~lti~~ ~ 2.S 53 y Porch Attic ~~WE 2 Porch Rooms 1st Floor 38R Park Breezeway Patio ! ~t ~ ~ a Rooms 2nd Floor Garage ~ X ~tl/ - 6 d Driveway O. B. _1F r a ~d ~~a/ o~os ~i8 31