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1000-117.-5-24
of sour OFFICE LOCATION: y~~" 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 _ic` ~ Fax; 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Leslie Weisman, Chair Members of the Zoning Board of Appeals From: Mark Terry, Principal Planner LWRP Coordinator Date: August 26, 2013 Re: Coasta{ Consistency Review for ZBA File Ref. MICHAEL and CELIA WITHERS #6670 SCTM#1000-117-5-24 MICHAEL and CELIA WITHERS #6670 -Request for Variance from Article XXII Code Section 280- 116(8) based on an application for building permit and the Building Inspector's June 13, 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: 6635 New Suffolk Road (adj. to School House Creek) New Suffolk, NY. SCTM#1000-117-5- 24 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 _ _ QF SO(/j Mailine Address: pffice Location: 9p1~ Town Annex /First Floor, Capital One Bank # ~ 53095 Main Road 54375 Main Road (at Youngs Avenue) ae P.O. Box l 179 Southold, NY 11971 ~ • ~O Southold, NY 11971-0959 ~~'~OOUNi'I http://southoldtow n.northfork.net BOARD OF APPEALS TOWN OF SOUTHOLD Tel. (631) 76~p}~ 20(631)765-9064 Mark Terry, Principal Planner _ _ - LWRP Coordinator Planning Board Office - ` Town of Southold JAL 2 Z~13 Town Hall Annex - ' 1' t Southold, NY 11971 1 ` Re: ZBA File Ref. No. #6670 1000-117-5-24 Dear Mark: We have received an application for additions & alterations to a 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 yours, Leslie eisman Chai n By: Encls. 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NOTICE OF DISAPPROVAL DATE: June 13, 2013 TO: Samuels and Steelman (Withers) 25235 Main Road Cutchogue, NY 11935 Please take notice that your application dated June 4, 2013 For permit to construct an additions and alterations to an existing single family dwelling_at Location of property: 6635 New Suffolk Road, New Suffolk. NY County Tax Map No. 1000 -Section 117 Block 5 Lot 24 Is returned herewith and disapproved on the following grounds: The proroosed construction is not permitted pursuant to Article XXII Section 280-116B, which states; "All buildin s located on lots u n w ' a b ead concrete w ri ra or similaz structure exists and which are ad'acent to tid ater bo es other than sounds shall be set back not less than sevent -five 75 feet from ead." The ro sed construction notes a set k of+/- 35 f et to the existin bulkhead. C Authorized Signature Cc: File, ZBA t a TOWN bF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following, before applying? TOWN HALL Board of Health SOUTHOLD, NY 11971 4 sets of Building Plans TEL: (631) 765-1802 ~ Planning Board approve! FAX: (631) 765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO. Check Septic Form N.Y.S.D.E.C. Tnistees 1 Flood Permit FYI'"'"-~'~ Zp1~ Storm-Water Ass~e~nt Form_ Contact: Approved . 20_ ~ Mail to: Disapproved a/c _ Phone: 7'~ -~[5C~ Expiration 0_ D ~ ~ ~ ~ ~ 2 g ector _ Imo" LS LIGATION FOR BUILDING PERMIT LI l ~Uld - 4 2013 Date ! 1'z Ilh~ 20 INSTRUCTIONS This ap be c~om~1 ly filled in by typewriter or in ink aad submitted to the Building Inspector with 4 sets of p tO"sc~e. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may aot 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 irupection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever urnil 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 noz~nm~g atnendmarts or other regulations affecting the property have bear enacted in the interim, the Building Inspector may authorfie, in writing,~tlie extension of the'pemut for an addition sut months. 'Phereafter, a new permit sh811 be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuam to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances oz Regulations, for the construction of buildings, additions, or alterations or for removal or dcmolitierr as hereia descn'b~. The applicant agrees to comply with all applicable laws, ordinances, building code, ho and regulatioru, and to admit authorized inspectors on premises and in building for necessary inspections. rgnanue apply azname,ifacorporation) (Mailing address of ) ! l 33 State wh/e1th'e-r Iapplilcant islowner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises 1 ' I ~ l~~'~g ~ A i .Ire, (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer , (Name aad title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Locgti~ ~ ~ on which_prppo ; work y~jjj b i done` 1 Ho(ulse Number tteet G~~•~..p '1~1 l~ County Tax Map No. 1000 Section ~ ~ 7 Block : ` ; ~5 Lot Z~ Subdivision )Map i~io. Lot > ~ 2. State existing use and occupancy of premises an mtended use and occupancy f proposed construction: a. Existing use and occupancy Gil y1Q~G }~~..yy~i l(_? ~C~ ~~~i~~~ b. Intended use and occupancy_~I h~~,G~ 1~1Yr~~ ~L11 ~o j~~~~ 3. Nature of work (check which applicable): New Building Addition~Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost ~GQr/'>[y~ 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 tr';e. 7. Dimensions of existin structures; if any: Front to ~ =1('~ Rear j ID ° Depth ISL_~_ He~ Number of Stories I /z Di nsions of same structure with alterations or additions: Front ~d ~ Rear 80 ~ DepthrS7=`a" Height 21 ~ Number of Stories 8. Dimensions of entire new construction: Front Rear Depth. Height Number of Stories 9. Size of lot:Erontg~2.Sl~~bLLRear Depth 10. Date of Purchase ~ 9 70 Name of Former Owner 11. Zone or use district in which premises are situated {/~~-M 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO_ 13. Will lot be re-graded? YES_ NO_~Will excess fill be removed from premises? YES_ NOS 14. Names of Owner of premises M 1° }Cali Address Po. 1~ one No. =5~-G Name of Architect BIZ Address -Phone No -!o 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 3~ES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAYBE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES~_ 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~_ * IF YES, PROVIDE A COPY. STATE OF NEW YOR&) ~~,~y/SS: COUNTY OF~Sltt7tZ- ) ~V~~ "t"~.~.~ ~y~-~y~ being duly sworn, deposes and says that (s)he is the applicant (Name of ~n~signing contract) above named, (S)Hc is the i (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 cornained 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. Sworn to before me this f day of t T JV\Q _ 20~ , P T AICHARDS %y ~ i tea. I'> Yatk Notary Public NiD. Q1 t~i69bt ~,t7 S' a of Applicant Qttalifipd in Suftotft Coa ' ~ ConaPpiasion. Expftea May 30 ?mil ~ r Fee: $ Filed By: Assignment No. APPLICATION TO THE SOUTHOLD TOWN BOARD OF APPEALS House No.6635 street New Suffolk Rd Hamlet New Suffolk SCTM Iooo section 17 Block 05 Lot(s) 24 Lot size 1.36AC zone M I I (WE) APPEAL THE WRITTEN DETERMINATION OF THE BUILDING INSPECTOR DATED sr~~t3 BASED ON SURVEY/SITE PLAN DATED e~<n3 Applicant(s)/owner(s): Michael & Celia Withers Mailing Address: P.O. Box 654 New Suffolk, NY 11956 Telephone: 631-734-5646 Fag: Email• alerion28@gmail.com NOTE: In addition to the above. please complete below if application is signed by applicant's attorney, agent, architec4 builder, contrect vendee, etc. and name of person who agent represents: Name of Representative: Nancy Steelman for~net?Dther: Aaaress: Samuels & Steelman 25235 Main Rd. Cutchogue Telephone: 734-6405 Fag: 734-6407 Email: nancy~ysamuelsandsteelman.com Please check to specify who yo correspondence to be mailed to, jr a above names: ~Applicant/Owner(s), Authorized Representafive,~ Other Name/ Address below: WHEREBY THE BUILDING INSPECTOR REVIEWED SURVEY/SITE PLAN DATED moans and DENIED AN APPLICATION DATED &4n3 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: Section: 280 Subsection: ttaiei 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, has not been made at anv time with respect to this orouerty, UNDER Appeal No(s). Year(s). . (Please be sure to research before completing this question or call our office jor assismnce) 1 + Yame of Owner: ZBA File # REASONS FOR APPEAI. (udditioreul sheets mnv be used with preparer's sirnuture): .9REA ~ARIA:VCEREASONS: (1) An undesirable change will not be produced in the CHARACTER of the neighborhood or a detriment to nearby propertles if granted, because: (See Attached) (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: (See Attached) (3) The amount of relief requested is not substantial because: (See Attached) {4) The variance will NOT have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district because: (See Attached) (5) Has the alleged difficulty been self-created? Yes, or ~No. Are there Covenants and Restrictions concerning this land: ~No. Yes (please furnish convl. 'T'his is the MINIMUM that is necessary and adequate, and at the same time preserve and protect the character of [he n^eighborhood and the health, safety, and welfare of the community. Check this bpY tLy IF A USE VARIANCE IS BEING QUESTED, D PLEASE COMPLETE THE ATTACHED USE VARIANCE SHEET: (P/ease be sur asult your rtlo n y.) S' nature of ani or Authorized Agent (Agent must sub written Authorization from Owner) Sworn to before me [his Notary Public PAirtc~.=: Yiiv+YH~~`~ York Notary PubNc, State of New No. 01816042467 Dualitled In Suffolk County COmmisslon Expires May 30.~i!` " 1 « Withers Residence REASONS FOR APPEAL 1. An undesirable change will not be produced in the CHARACTER of the neighbor or a detriment to nearby properties if granted, because the proposed addition is characteristic of other residential properties in the neighborhood in both scale and design and will not be seen from the street. 2. The benefit sought by the applicant CANNOT be achieved by some method feasible for the applicant to pursue, other than the area variance, because the entire house is located within the 75' setback and a variance would be required for any proposed addition. 3. The amount of relief requested is not substantial because the proposed addition is a one story addition which is located behind the house at the furthest distance from the bulkhead as possible. 4. The variance will NOT have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district because the proposed construction will retain all water on site via new drywells and comply with all best management practices for storm water run off during construction. 5. The alleged difficulty has NOT been self created because it is the result of a pre- existing situation where the existing house was. located within the waterfront setback prior to zoning. I ~ i Prepared by~~~ ~ ~Z~' .tc " Date G 21 /--3 t r APPLICANT'S PROJECT DESCRII'TION APPLICANT: Michael & Celia Withers DATE PREPARED: 6/17/13 1. For Demolition of Existing Building Areas Please describe azeas being removed: None II. New Construction Areas (New Dwelling or New Additions/Extensions): Dimensions of first floor extension: 18 ' 2 "x 2 5 ' - 3 " Dimensions of new second floor: Dimensions of floor above second level: Height (from finished Bound to top of ridge): 17 ' - $ " Is basement or lowest floor azea being constructed? If yes, please provide height (above ground) measured from natural existinggadetofirstfloor: Crawl space 2'-10" IIL Proposed Construction Description (Alterations or Structural Changes) (Attach extra sheet if necessary). Please describe building azeas: Number of Floors and General Chazacteristics BEFORE Alterations: 1 1 /2 Floors Number of Floors and Changes WITH Alterations: Same IV. Calculations of building areas and lot coverage (from surveyor): Existing squaze footage of buildings on your property: 2 7 6 5 S . F . Proposed increase of building coverage: 4 6 5 S . F . Square footage of your lot: 5 9, 3 7 9 S. F. Percentage of coverage of your lot by building area: 5 .4 3 ~ V. Purpose of New Construction: (New art studio) 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): Land is primarily flat and does not. relate to the difficulty in meeting code requirements 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. 4/2012 ! QUESTIONNAIRE FOR FILING WITH YOUR ZBA APPLICATION A. Is the subject premises listed on the real estate mazket for sale? Yes x No B. Are there any proposals to change or alter land contours? x No Yes please explain on attached sheet. C. 1.) Are there azeas that contain sand or wetland gasses? NO 2.) Are those azeas shown on the survey submitted with this application? 3.) Is the property bulk headed between the wetlands azea and the upland building azea? Yes 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: submittal after ZBA determination and if issued, please attach copies of permit with conditions and approved survey. D. Is there a depression or sloping elevation neaz the azea of proposed construction at or below five feet above mean sea level? No E. Are there any patios, concrete barriers, bulkheads or fences that exist that aze not shown on the survey that you are submitting? No Please show azea of the stmctures on a diagam if any exist or state none on the above line. F. Do you have any construction taking place at this time concerning your premises? No 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 aze lacking, please apply to the Building Depamnent 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. I. Please list present use or operations conducted at this pazcel Residence and marina and the proposed use same . (ex: existing single family, proposed: same with garage, pool or other) ~ G Zo a-'- uthorize gnature and Date ~ ~ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25548 Date: 02/23/98 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property: 6635 NEW BUFFOLK RD NEW SUFFOLK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 117 Block 5 Lot 24 Subdivision Filed Map No. Lot No. conf orme eubetant Tally to the Application for Building Permit heretofore filed in this office dated JUNE 16, 1997 pursuant to which Building Permit No. 24258-Z dated JULY 18, 1997 was issued, and conf orme to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued ie ADDITION & ALTERATION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to MICHAEL J WITHERS (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N-444071 01/26/98 PLUMBERS CERTIFICATION DATED 02/10/98 MATTITUCK PLUMB.&HEATING B ild~ apector Aev. 1/81 f M FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-22071 Date DECEMBER 30. 1992 THIS CERTIFIES that the building ONE FAMILY DWELLING 6635 M6U' SDFFDLH ED. b Location of Property 6515 NEW SiTFP'OLK ROAD MEW SUFFOLK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 117 Block 5 Lot 29 Subdivision Filed Map No. Lot No. conforms substantially to the Requirements for a One Family Dwelling built Prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z-22071 dated DECE!ffiHR 30, 1992 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 D~•T•T~ WITH ACCESSORY WOOD FRAME GARAGE ' The certificate is issued~to HICHAEL J. WITHERS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITER3 CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE 3EE ATTACHEDINSPHCTION REPORT. ~ Building Inspector Rev. 1/81 BUILDIF:C DU? "u'T:'=•iiT T0:9;d OF SOO7Fi0LD, N. Y. fiOUSII;G CODi ZI~IS?~CTTOi'1 RG°ORT 6635 B64 SDFFO[.H HOAR tHi51 SIIFFO7.H, N.Y. Location (numocr a ssreesl (i•iunicipah sy) Subdivision Man IJo. Lot(o) Naae of Owner(s) MICFIAHL J. NI'I~HS ' Occupancy ONH FANILY DN61J.I)7G (type orm er-tenant) Admitted by: - Accompanied by: Key available Suffolk Co. Ta:: IJo. IOOD-117-05-24 Source of request MI®AHL J. yITH~ ' Data DHC. 1992 D':f:,'LLI*TG: Type of construction {N)OD FHANH '#'stories t-t/2 Foundation awCH Cellar Crawl space >Q Total rooms, 1st. Fl 3 2nd. F1 2 3rd. F1 Bathroom(s) 1 Toilet room(s) Porch, type Declc, type •~D Patio, type Breezeway Garage Utility room t lyre Heat DIL ~ +/arm Air YE .Hot:~iater Fireplace(s) 1-BHIC6 No. E::its 3 Airconditioning Domestic hotwater Type heater pT ClTRIC Other ACCESSORY STRUCT[JRES: Garage, type const. WooD FsAe~ Storage, type const. S(~~i:ming pool Guest, type const. Other PD!@ HOBSH (N.W. COHNHH)tPIDd• SAD (S.H. OF HODSE) SIS 6 VIOLAT?OILS: ,CIiAPTHH 45-N.Y. STATH [IN&FORH FIRH PNHVENTION E HDILDING CODE - Lncation DP°crintion IArt. Ip{ See. I' I I I I I 1 I I Remar!<s• eP (21149-Z - CO Z-22072 DHC[ ADDITION Inspected by: Date of Insp. DHC. 16, 1992 VICTOR ISSSARD Time start 10:15 end 10:45 1 ~ FORM NO. 4 TOWN OF SOUTHOLD BUILDFNG DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22072 Uate DECEMBER 30, 1992 THIS CERTIFIES that the building ADDITION 6515 AEA SUFFOLK RD. 6 Location of Property 6635 NEW SUFFOLK RD. NEW SUFFOLK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 117 Block 5 Lot 24 Subdivision Filed Map No. Lot No. conforms substantially to the Application £or Building Permit heretofore filed in this office dated DECEMBER S, 1992 pursuant to which Building Permit No. 21149-Z dated DECEMBER 161992 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 DECK. ADDITION TO EXISTING ONE FAMILY DWELLING AS BUILT The certificate is issued ko MICHAEL J. WITHERS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N/A PLUMBERS CERTIFICATIONDATED N/A _ _ _ ~0..~, uilding Inspector Rev. 1/81 ~ 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 dutriM OR within SOOJeet of a farm operation located in an agricultural district Al[ applications requiring an agriculural data statement must be referred to the Suffolk County Department ojPlanning in accordance with Sec[ion 239m and 239n oJthe General Municipal Law. 1. Name of Applicant: Michael and Celia Withers 2. Address of Applicant: P.O. Box 654 New Suffolk, NY 11956 3. Name of Land Owner (if other than Applicant): ' 4. Address of Land Owner: 5. Description of Proposed Project: New addition to an existing residence 6. Location of Property: (road and Tax map number) 6635 New Suffolk Rd., New Suffolk, NY 11956 7. Is the pazcel within 500 feet of a farm operation? { }Yes { ~CNo 8. Is this pazcel actively farmed? { }Yes { ~cNo 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 to you by the Zoning Board Staff, it is your responsibiliTy to obtain the cturent names and mailing addresses from the Town Assessor's Office (765-1937) or from the Real Property Tax Office located in Riverhead. NAME and ADDRESS 1. 2. 3. 4. 5. 6. (Please use the back of this page if there are additional property owners) > ~o i Zy i ZOl3 Si afore of A scant Date Note: I. 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 faun 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 Agricultural 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 the application is submitted for review. r M 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I • PROJECT INFORMATION To be coin leted b A licant or Pro ect S onsor i. APPLICANTlSPONSOR 2. PROJECT NAME Michael and Celia Withers Withers Residence 3. PROJECT LOCATION: Municipality Southold County Suffolk 4. PRECISE LOCATION (Street adtlress and road intereections, prominent landmarks, etc., or provide map) 6635 New Suffolk Rd, New Suffolk, NY (See attached map) 5. PROPOSED ACTION IS: New ~ Expansion ~ ModificatioNalteration 6. DESCRIBE PROJECT BRIEFLY: Construction of new one story addition to an existing residence with new dry well for roof runoff. 7. AMOUNT OF LAN? AFFECTED: Inifialry U6 acres Ultimatery .07 acme 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ~ No If No, descnha briefly Proposed addition encroaches on a waterfront setback 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ~ Industrial ~Commemial ~ Agdwtture ~ ParWForest/Open Space ~ Other Desaibe: Residential & Marinas 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? Ves ~ No If Yes, list agency(s) name and permiVapprovals: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes ~ No If Yes, list agency(s) name antl pertnNapprovals: Non-jurisdication from NYS DEC 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? Yes ~ No I CERTI HAT THE INF R TION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLFAGE / / Applirant/sponsorriame: Date: 3 Signature; """77"~~" If the action is in the Coastal Area, and you are a state aggency, complete the Coastal Assessment Form before proceeding with this assessment OVER ~ ~9~?iy". ~'it r M PART II -IMPACT ASSESSMENT To be com leted b Lead A enc A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 8 NYCRR, PART 8f 7.4? If yes, coordinate the review process and use me FULL EAF. Yes ~ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 677.6? If No, a negative tledaretion may be supersetled by another involved agency. Yes ~ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, 'd legible) Cf. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patiem, solid waste produr.Yion or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agriculturel, ardtaeological, histortc, or other naWrel or elWral resources; or community or neighborhootl chareder7 Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife spetles, significant habitats, or threatened or endangeretl spades? Explain bdefly: C4. A wmmunitys existing plans a goals as offidally adapted, or a change in use or imensiry of use of land or dhar natural resources? Explain briefly: C5. Growfh, subsequent development, cer related adivaies likely io be induced by the proposetl action? Explain briefly: C6. Long term, short tens. emulative, or other effects not identified in C1-C57 Explain briefly: C7. Olhar impacts (inducting changes in use deiMer 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 ARF1+ (CEA)? Yes ~ No It Ves, explain bdefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? Ves ~ No If Yes, explain bdefly: PART 111-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 identfied and adequately addressed. If question D of Part it was checked yes, the determination of significance mustevaluate the potential impact ofthe proposed action on the environmental characteristics of the CFA. Check this box if you have identified one or more potentially large or signiflwm atlverse Impacts wtuch MAY occur. Then proceed directly to the FUL F1kF and/or prepare a poskive dedaretion. Check this box if you have tletermined, basetl onihe infartnation and anatysis aboveand anysupporting doementation, that the proposed adlon wlflL NOT result in any significm adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting this determination Name of Lead Agency to iM or ype Name o Resporrsl a cer in cad Agency d e o Responsible car ignature of esponsible cer in cad Agency ignalure reparer I rent om responsr e o LOCATION MAP o~ 0 WEST CREEK ~ q'Q~0 GEORGE RD C ~.Q ~ ~Pr O LITTLE r It@ PECONIC `p ~ BAY Rp o ~ RCHARD S KOUROS RD. C ? Z ? ~ O ~ r ~ ~Ni ~ Z ? ~ ~ ST NEW SUFFOLK AVE. JACKSON ST. GREAT PECONIC BAY Board of Zoning Aooeals Annlication AUTHORIZATION (Where the Applicant is not the Owner) I, Michael & Celia Withers residing atP.O. Box 654 New Suffolk (Print property owner's name) (Mailing Address) do hereby authorize Nancy Steelman (Agent) of Samuels and Steelman to apply for vat7ance(s) on my behalf from the Southold Zoning Board of Appeals. (Owner's Signature) Michael & Celia Withers (Print Owner's Name) L AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest os the Dart of town officers sod 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 necessary to avoid same. YOUR NAME: Nancy Steelman (Lut aamq first same, middle initial, unless you are applying to the acme of someone else or oNer endty, such as a company. If so, indicate the other person's or company's names) TYPE OF APPLICATION: (Check aB that apply) Tax grievance Building Permit Variance x 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 town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO x If you answered "YES", complete the balance of this form and date and sigh where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself (the appficant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply) A) the owner of greater 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 enfity (when the applicant is not a corporation) C) an officer, dlreetOr, parmeq or employee of the applicant; or D) the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this 'day f y20~ Signatur / J Print Name Nancy Steelman e APPLICANT/OWNER TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the Dart of town officers 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 necessary to avoid same. YOUR NAME: Michael Withers (Last usuu, first name, middle initial, unless you are applying in the Dame of someone else or other entity, such as a company. If s0. indicate the other person's or company's name) TYPE OF APPLICATION: (Check all that apply) Tax grievance Building Permit Variance x 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? "Rebttionship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO x I[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 applfcant/agenUrepresentative) and the towv 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 (wbea the applicant is a rnrporation) B) the legal or beneficial owner of any interest in anon-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 ~ day o 20~ Signature Print Name chael Withers l e APPLICANT/OWNER TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the Dart of town officers and emolovees. The purpose of thL form is to provide informatiop which can alert the town of possible conflicts of interest and allow it to take whatever action is neceasarv to avoid same. YOURNAME• Celia Withers (Last name, first name, middle initial, ualesa you are applying is the name of someone else or other entity, such as s company. It so, indicate the other persods or company's name.) TYPE OF APPLICATION: (Check al? that apply) Tax grievance Building Permit Variance x 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 town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO x If you answered "YES^, complete 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 appticant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply) A) the owner of greater 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 officer, director, partneq or employee of the applicant; or _ D) the actual applicant DESCRIPTION OF RELATIONSIIIP Submitted this day of , 20~ Sigtlature Print Name Celia Withers 1 ! 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 acfion 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 acfion 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 standazds 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 Boazd of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 17 _ 5 _ 24 The Application has been submitted to (check appropriate response): Zoning Board of Appeals Town Board 0 Planning Dept. ~ Building Dept. 0 Board of Trustees 0 1. Category of Town of Southold agency action (check appropriate response): (a) Action undertaken duectly by Town agency (e.g. capital construction, planning activity, agency regulation, land transacfion) (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: Construction of new one story addition to an existing residence. Location of action: 6635 New Suffolk Rd. New Suffolk, NY Site acreage: 1.363 Ac Presentlanduse: Residential/Marina Present zoning classification: Ml 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: Michael & Celia Withers (b) Mailing address: P.0. Box 654 New Suffolk, NY 11956 (c) Telephone number: Area Code O 6 31- 7 3 4- 5 6 4 6 (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ? No x? If yes, which state or federal agency? DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III -Policies; Page 2 for evaluation criteria. Yes ~ No ~ Not Applicable Adding to an existing residence preserves open space around the existing residence and makes efficient use of the existing structure and property Also the addition to h property ;s l4 5~ l 7,an hr 20~ to ov age allnmerl by Winning Attach additional sheen 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 ~ Not Applicable There are no historic or archeological structures on property. ~ Y 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 Q Not Applicable The addition to the existing residence is in keeping in style and scale of neighboring structures. Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III -Policies Pages 8 through 16 for evaluation criteria ® Yes ~ No ~ Not Applicable All rainwater runoff is and will be retained on site with the use of underground drywells. Attach additional sheets if necessary Policy 5. ProteM and improve water quality and supply in the Town of Southold. See LWRP Secfion III -Policies Pages 16 through 21 for evaluation criteria ® Yes, 0 No ©N~t r~plica~le . All rainwater runo f 3 an will be retained with the use of underground drywells. The sanitary system for the residence meets current Suffolk County Dept. of Health Services standards for sanitary waste water. The property is aarvPr3 with nuhli~ water from Ai~ffc~lk (".rn~nr_y- 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 No development will take place in the "protected" or "natural indiginous environment". Y 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 development will not add pollutants into the air. All construction vehicles meet the Federal standards for air pollution discharge. The mechanical systems of the residence meet the federal standards for air pollution discharge 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 evaluafion criteria. © Yes ? No ? Not Applicable The construction and use of the residence will make use of the town's _ disposal and recyclin center. 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. ® Ye~ No ? Not Applicable No public land involved. Littoral access unimpeded. 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 ~ t The existing marina will be maintained and not affected by this proposed expansion to the existing residence. Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III -Policies; Pages 57 through 62 for evaluation criteria. © Yes ? No ? Not Applicable This project will protect and preserve the living marine resources by maintaining all rainwater discharge and sanitary flow from the residence on site by approved SCDHS sanitary system and drvwells for rainwater runoff. 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 There are no agricultural lands on site. 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 The construction will be using equipment approved by the Federal government for energy usage. The residence will meet Federal standards for conserving energy "energy Star Program" and will use "NY State Energy Conservation and CnnaYrnnYi nn ('nr3P" fnr rnnatrnrfi nn of tha rpaidanra PREPARED B~ TITLE f.d}~r~.,lrf~q DATE 3 Created on 5/25/0511:20 AM E Y South i ~ ~ r i - _ ~ i . _ _ _ _ - - - - _ I I a - e,YK J4':~~~Ax,`~~~~~, ~h~"~:tif L7Rt~,ejY Y.k,'. Y, '1y?~s ~ v:/. J ~ arx y ,Kl ~tyW Ill x ,a i~ ~ - _ ~~sa~ z~. , , ~r ,,tt rKf4v~n"i " ;tai' Q -~t W~~,~:rs .-~~:sidence Date: 6/20/13 ~ orth .x x,. .K E # ~ i ~ ti~ ~ ,T.t:Rz. ~ R - ~ ~ _ y _ ~ _ R _ - - ..o _ ~ .t~_~ f - `S, Li ki .b ~ TW A T . py~ ~ 4„-,yam ~ Y,. r ','A ~ - . L d~+~r - i! ~ - _ y. - i~~~ R + ' y ~.<x v. y -~1. 1' ~M~p ~ ~W ti's r ~ ~ . T F,y. k~ s., a: { ~ t III -~s' W ithers RE ' ~ flate 0 00 - s- a ;TOWN OF SOUTHOLD PROPERTY RECORD CARD ~ j ~ OWNER STREET ,V ~ VIL~L/AGE DIST. SUB. LOT ~yi,~ ~ ~ . ~ ; ~ ~e w l oa /V 2 w fv l k /S' FORMER OWNER N E CR. R / C ~ ~ / / h'iZ q i e 'S• V~i 21'S ~ ~ S W TYPE OF BUILDING V mi~~er -(Zv(ces Y ~A %YPwfuf~olK is RES. ~ILlf~ SEAS. VL. FARM C CB. MISC. Mkt. Value ~ LAND IMP. TOTAL DATE REMARKS Iti wr `rid ~ w, l/ ~ T da,-•. E-. dU0 ,~00 sQ~ < IY b~ ~/a ~s/So~o'~~oovbC~tie. No~HE P L Eu.r,cN~G, TMSw,s~rRS.~wF a~ !~"'O dd 2ti 6 / Jet 6D C7 ~ 8C7 ~Jl7 23 'emu ~ 7.~ ~ ~ cm~ ~lroo~eJ S'7©o ,z 7 43 0 ~ /y G~~r'~t.-, Y J''4.'J_ AGE BUILDING CONDITION / / 7Ge~ Cv 7 Cz b'/ % ~//J/M D''aa~. i is'~~.pp6b'iih~E.~' /8/ NEW NORMAL BELOW ABOVE ~l~-~.llD/•~? o~ -~~Y?~ ~~-W Ft~'7her5 N/~ FARM Acre Value Per Value _ ~ Acre ~al~9a-SP#atr~9-eons~,Deek ~1-~D61,'~iph-~C~~,$a0,` Tillable 1 7 ~ - 9"! - BP ~a ~'f ~o~ ~',~~.1 A.~TFtZaZ'~ one Tillable 2 - i t Tillable 3 Woodland Swampland FRONTAGE ON WATER Brushland FRONTAGE ON ROAD House Plot DEPTH 1 ,ems BULKHEAD Total DOCK 1 ~a b _ ~ ~ Pe Foundation G~, Bath ~ Dinette Z 2 tensi ~ ~ lSY- ` _ ~ Basement Floors ~ K. Extg~nsion 1" ~ _ a~ pi`s ~ Ext. Walls 'y3 Ce~lLW ~g1ti 'Interior Finish LR. f _ ~E~e sion 20 x2Z~ ~qb 32s 4$O Fire Plac X43 v Heot `0.3 DR. ~ ~ ~ _ ,fir" Type Roof Rooms 1st Floor BR- Z Porch z~, _ 27Q> ~ ,Z~ 0 Recreation Room Rooms 2nd Floor g,N~`® ,fm.: 2 ~ Porch q X " 9~ l~fo ~Sa ~5n 53 Dormer ~"""iB" kx BreezewaY ' / ~ O1 5'je2) Driveway Garage yY rp .2atio ~y RS